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48 Mr. Parkinson replied that this was correct. Commissioner Gustaveson asked if one county could contract with another county with an inter-local agreement to provide program ser- vices? Mr. Parkinson replied, "Xes, this is being done with some scattered incidents in North Carolina." Mr. Gustaveson inquired of potential problems that the County might encounter. He stated that he had listed inadequate budget propagation, the transition problem of administration and recruiting. "What other pitfalls are there?" - Mr. Parkinson stated that one problem would be the redistribution of the existing staff and the administrated problems such as retire- ment system and social security: These matters xequire resolutions by the Board of Commissioners in the district. xowever, he added thak the biggest problem is the financial area. He added that each program will be looked at separately by the funding source as to which County the program will remain in. Chairman whitted stated that Orange County should schedule a meeting with representatives from the Regional Office to talk about these specific programs and determine the district arrangement of the specific program and haw they relate to other counties. The question was asked that if Orange County withdrew and this left two counties to the North and two counties to the South of Orange County, could these four counties continue as a district. Mr. Parkinson replied "yes" they could continue to operate as a four county district. Discussion ensued as to why Orange County was considering options for providing health services other than the district arrangement. Chairman Whitted stated that for a number of years this Board has been concerned with making appropriations to the district agency and had felt we were not getting the type of information to judge as to whether or not the district health arrangement was cost effective or not. He spoke of the formation of the Orange County Community Health Task Force which had experienced problems in gathering information from the District Health Department to provide to the Commissioners. He stated that one concern of the Board was the representation on the District Health Board. That this representation was not broad enough to speak to all the needs in Orange County. Dr. Fuller had advised the Board that Advisory Boards would be set up for the district to provide broader repre- sentation (this was told to us in October of 1975). The Board has express- ed the need for a Health Administrator and no movement has been made on the Advisory Boards nor the Health Administrator. Mr. Whitted added that Orange County has been concerned about the district board involving itself in the policy and decision making of the District Health Board. Further, he stated that the County Task Force appeared before the District Health Board to present an interim report and came away with less than a favor- able impression because of the reception they received. Commissionez Gustaveson stated that he felt` the leadership role of the Director is tao much for one man who also does the clinical work. Dr. Fuller admitted this at past meetings and has said that a top priority is to hire a Health Administrator. This has been said many times, however, no movement has been made to carry out these top priorities. He added that over the years, the District Board has not been responsive to the particular needs of Orange County and the leader- ship of the Department has not been responsive .to this Board of Commis- sioners. He added that the people we represent in Orange County are deeply concerned. He said it was his feelings, and the feelings of other members of this Board that the County should consider the question of moving on some important questions of health care in Orange County. He reiterated that the Board had not come to this question hastily, but had given it much consideration and wants to look at all the implications and consequences involved, not only to Orange County, but to the other