North Carolina Public Health Law

Consolidated human services board members, consolidated human services agency (“CHSA”) directors, county commissioners, county managers, and citizens who have questions about consolidated human services boards can contact SOG faculty member Kristi Nickodem (nickodem@sog.unc.edu).

• A CHSA can be governed by an appointed CHS board or directly by the board of county commissioners (BOCC).
• If the CHSA includes public health and the BOCC assumes the powers and duties of the governing board, the BOCC must appoint an advisory committee for public health. The advisory committee membership must, at a minimum, meet the requirements for a county board of health found in G.S. 130A-35. If the CHSA will include a department of social services, this advisory committee could have a broader scope and include people with social services expertise or interests. The BOCC also has the option of appointing a separate advisory committee for social services, but that is not required by law.
• If the BOCC becomes the governing body for a CHSA that includes public health, the BOCC should also keep in mind that it will assume almost all of the responsibilities of the local board of health, including acting as the adjudicatory body for public health, imposing certain fees for public health services, public health rulemaking, and taking on activities necessary for accreditation of the health department. Likewise, if the BOCC becomes the governing body for social services, the BOCC assumes almost all of the responsibilities of a county board of social services.

If the BOCC plans to serve as the governing board for the county’s CHSA, it must hold a public hearing.  The law requires “30 days’ notice of said public hearing given in a newspaper having general circulation in said county” (G.S. 153A-77).   The hearing requirement is triggered by the BOCC assuming the powers and duties of any other board, which could be a local board of health, a county board of social services, or a CHS board. 

• If a BOCC does not want to serve as the governing board of the CHSA, it will need to appoint a new CHS board. G.S. 153A-77(c) includes many details about CHS board composition, term limits, powers, and duties. It also includes a specific process for appointing the initial board. The BOCC must first create a nominating committee that includes members of the current (pre-consolidation) board of health and board of social services, as well as the board responsible for managing mental health, developmental disabilities, and substance abuse services in the county. The nominating committee then recommends members for the new CHS board and the BOCC makes appointments based upon those recommendations. After the initial board is in place, the BOCC will fill vacancies based upon nominees presented by the members of the CHS board.
• The initial CHS board could, in theory, consist (at least in part) of the existing board of health and social services board members, provided that they otherwise meet the membership qualifications of G.S. 153A-77(c). That could help to provide some continuity in board operations between the pre-consolidation boards and the post-consolidation board. However, in some situations, retaining the existing, pre-consolidation board members may not serve the county’s goals in creating the CHSA and the CHS board.

Consolidated human services board members are all appointed by the board of county commissioners. 

• The CHS board must be composed of no more than 25 members. All members of the CHS board must be residents of the county. The composition of the CHS board must “reasonably reflect the population makeup of the county” and must include:
  • Four persons who are consumers of human services.
  • Eight persons who are professionals, each with qualifications in one of these categories: one psychologist, one pharmacist, one engineer, one dentist, one optometrist, one veterinarian, one social worker, and one registered nurse.
  • Two physicians licensed to practice medicine in North Carolina, one of whom must be a psychiatrist.
  • One member of the BOCC.
  • Other persons, including “members of the general public representing various occupations.”

The BOCC may elect to appoint a member of the CHS board to concurrently fill more than one category of membership (the categories described above) if the member has the qualifications or attributes of more than one category of membership. For example, a board member might be a registered nurse and a consumer of human services, and could concurrently satisfy both categories of membership.

The members of an appointed CHS board must serve four-year terms. However, for purposes of establishing a uniform staggered term structure for the board, a member may be appointed for less than a four-year term when the CHS board is initially formed. No member may serve more than two consecutive four-year terms. The county commissioner member must serve only as long as the member is a county commissioner.

• If the CHSA includes public health, the CHS board acquires all powers and duties ofthe local board of health except (i) appointing the director, and (ii) transmitting or presenting the budget for local health programs. This includes adopting local health regulations, protecting public health, participating in enforcement appeals of local regulations, and performing regulatory health functions required by State law.
• If the CHSA includes social services, the CHS board acquires all powers and duties of the county board of social services except (i) appointing the director, and (ii) transmitting or presenting the budget for social services programs.
• The CHS board also:
  • Sets fees for CHSA services, based on recommendations of the CHSA director and subject to constraints in the law.
  • Assures compliance with laws for state and federal programs and can conduct audits and reviews of human services programs.
  • Recommends the creation of local human services programs.
  • Advises local officials via the county manager.
  • Performs public relations and advocacy functions.
  • Acts as coordinator or agent of the State to the extent required by State or federal law.
  • Plans and recommends a consolidated human services budget.
  • Develops dispute resolution procedures for human services contractors and clients and public advocates, subject to applicable State and federal dispute resolution procedures for human services programs, when applicable.

Here are a few key differences:

1. The CHS director is appointed by the county manager, not by the CHS board. The CHS board must, however, provide advice on the appointment and consent to the appointment.
2. The CHS board plans and recommends the budget for the CHSA but does not transmit or present the budget to the county commissioners. 
3. The CHS director:

• May only serve as the executive officer of the CHS board to the extent and in the manner authorized by the county manager; and
• May only appoint CHSA staff upon the approval of the county manager.

Information regarding consolidated human services agencies and governing boards is available in this 2014 Social Services chapter of County and Municipal Government in North Carolina by Aimee Wall. Other School of Government training resources for consolidated human services boards are available here.

Yes. State law does not disqualify a person from being appointed to the CHS board because a member of the person’s family is an employee of the CHSA. However, the board member cannot use his or her position on the board to influence the county manager or CHSA director to hire, promote, or provide preferential treatment to the board member’s spouse or any other relative.

Yes. An appointed CHS board member (other than a county commissioner who has already taken an oath of office as a county commissioner and is serving ex officio on the CHS board) must take an oath of office. The appointee must swear or affirm to faithfully discharge his or her duties as a social services board member and to support and maintain the constitutions and laws of the United States and North Carolina. The oath may be taken at any time between the board member's appointment and his or her assumption of office. The oath may be administered anywhere in the State by a judge, magistrate, clerk of superior court, state legislator, city or county clerk, mayor, chair of the board of county commissioners, notary public, or other specified public official. A written copy of the oath signed by the board member must be filed with the clerk of the board of county commissioners. If a CHS board member is reappointed for a second term, the member is required take a second oath of office. More information about the content of the oath of office is available in this Coates’ Canons blog post. 

All CHS boards are required to have at least one member who is a county commissioner. A county commissioner serves ex officio on the CHS board if the commissioner is appointed to the CHS board by virtue of this individual’s office as a county commissioner. A county commissioner who serves ex officio on the CHS board has the right and obligation to participate fully in all of the board's deliberations and to vote with respect to all of the board's decisions. However, a county commissioner who serves ex officio on the county social services board is not subject to the same term limits and multiple office holding restrictions as other CHS board members. The county commissioner member may serve on the CHS board only as long as the member is a county commissioner.

Yes. A county commissioner who serves ex officio on the CHS board may serve on the CHS board only as long as the individual is a county commissioner (G.S. 153A-77(c)). This is different than a county commissioner who serves ex officio on a traditional 3-member or 5-member social services board, whose term on the board is not affected by the termination of their term as a commissioner.

• An appointed CHS board member may only be removed from office by the county board of commissioners. However, if CHS board members become aware of conduct that they believe necessitates removal of a fellow board member, they could advise the board of county commissioners about this conduct through the county manager. The county commissioners remain responsible for the final decision regarding whether or not to remove a CHS board member.
• The county board of commissioners can remove a board member due to (i) commission of a felony or other crime involving moral turpitude; (ii) violation of a State law governing conflict of interest; (iii) violation of a written policy adopted by the county board of commissioners; (iv) habitual failure to attend meetings; (v) conduct that tends to bring the office into disrepute; or (vi) failure to maintain qualifications for appointment required under G.S. 153A-77(c). A CHS board member may be removed only after the member has been given written notice of the basis for removal and has had the opportunity to respond.

G.S. 153A-77(c) states that the BOCC may remove a CHS board member for failure to maintain qualifications for appointment required under G.S. 153A-77(c). The qualifications listed under G.S. 153A-77(c) include being a resident of the county. Accordingly, some people may argue that a CHS board member who ceases to be a bona fide county resident is disqualified from continuing to serve on the CHS board. An alternative argument is that the county residency requirement applies at the time a person is appointed to the board but doesn't apply with respect to the member’s continued service on the board. Given that the statute refers to removal of a member on the basis of failure to “maintain” qualifications for appointment, the stronger argument is that a CHS board member is required to remain a county resident during the duration of the member’s term on the board.

• The CHS board must include one psychologist, one pharmacist, one engineer, one dentist, one optometrist, one veterinarian, one social worker, one registered nurse, and two physicians licensed to practice medicine in North Carolina, one of whom must be a psychiatrist. With the exception of the registered nurse, the physician, and the psychiatrist, G.S. 153A-77(c) does not clarify whether the remainder of the “professional” members of the board must maintain their licensure or ability to practice in their field. One could argue that these requirements only apply at the time when the member is initially appointed by the board. However, given that the statute requires these members to be “professionals” who have “qualifications” in a particular category—and the fact that the BOCC can remove a member for failure to “maintain” qualifications for appointment—the stronger argument is likely that these members must maintain some sort of active credentials or qualifications to practice in their given profession throughout their service on the board. Maintaining active credentials or licensure also ensures that the “professional” members of the board are able to provide current, relevant, evidence-based advice from their respective fields of practice to the CHS director and the CHS board.
• Depending on the composition of the CHS board in question, if a “professional” member of the board had lapsed credentials or an expired license, the board could possibly transition that individual into another category listed in G.S. § 153A-77(c)—for example, the member might meet one of the requirements to be a “consumer of human services” on the CHS board. This will depend on how many people are on the CHS board at the time and which board seats described in G.S. § 153A-77(c) are already filled by other board members.

A majority of the CHS board members must be present to constitute a quorum (G.S. 153A-77(c)).

No. The CHS board would only have this authority if the county’s personnel ordinance and procedures gave this responsibility to the CHS board. The CHS board does not have any legal authority regarding the hiring, supervising, promoting, demoting, disciplining, or firing of CHSA employees.

The CHS board is responsible for planning and recommending the budget for the CHSA, in coordination with the CHSA director. However, an appointed CHS board does not transmit or present the budget to the county commissioners, nor does it have the power to ultimately approve or disapprove the budget. The board of county commissioners has the ultimate authority to approve the county budget for human services.

No, unless the BOCC is serving directly as the CHS board. However, an appointed CHS board can recommend a salary increase to the county commissioner through the county manager (see G.S. 153A-77(e)(6)). The increase in the director's salary must be approved by the board of county commissioners and must be within the pay schedule for county employees adopted by the board of county commissioners.

Unlike G.S. 130A-35 (regarding boards of health), G.S. 153A-77(c) does not have language allowing members of the general public to be appointed to the CHS board in place of a licensed professional if a licensed professional in a particular category is not available. If no county resident is available to serve in one of those licensed professional positions, then that seat on the CHS board likely must remain vacant. The BOCC and the CHS board should, however, continue to make diligent efforts to recruit CHS board members who will fulfill all of the professional qualifications required by G.S. 153A-77(c). 

Yes. G.S. 153A-77(c) allows the board of county commissioners to remove a board member due to habitual failure to attend meetings. A board member may be removed only after the member has been given written notice of the basis for removal and has had the opportunity to respond.

No. The CHS board is subject to the state’s Open Meetings Law and must give public notice of all of the board's official meetings, even if all of the board's business at a meeting will be conducted in a closed session.