- So my old brain is working. I think what she wanted to do was add paramedic to the... And AMTs. And paramedics and AMTs to be allowable. Yeah, would you like me to explain any of that too? I would love it if you would. Okay. So as you may or may not be aware, we put out the new criteria and of course our problem is that council
- limited the amount for the starting salary for the position and essentially we've had no takers for the position because the pay is low. So we began to ask ourselves what we could do in terms of attracting someone with managerial skills who is also licensed to administer a
- an injection and we realized that EMTs could inject and paramedics can inject. And so the idea with the change in the description is that we have included those criteria rather than asking simply for a nurse, be it an LPN or an RN. We've expanded that to basically anybody who can inject so that we have
- better chance of getting a decent applicant pool to choose from for this position. So this is an expansion of the standards of practice for those jobs? Well, yes. Have a lowering, almost. It does. It lowers it, but it does expand it. It expands it into a different pool of people. Yeah. And if we get a good person, who cares? Yeah, because we just want to be able to administer
- that medication on site when you get someone. So that's the reason that this is coming back to you once again, because we still would love to have a person in the position of basically managing the basement so that we're not asking our administrator to administer all departments and that one as well.
- Any discussion or questions before we ask for a motion? Kay's still reading. I want to give her time. I just wonder if this is really going to solve anything. It may not, but because we have no other options, council has told us they're not approving any money changes to this.
- This is our last ditch effort. It doesn't cost us anything. If it gets us a person, great. If it doesn't, we will be able to go back and say we tried everything and we were unsuccessful. We've already been advertising in multiple places. It's the real problems, money issue. Exactly. It has nothing to do with
- No, it's about the money. It's about what is the salary. The salary might be attractive to someone who's an EMT or an employee. So it might work. So now I would ask for a motion. I would vote that these additions be made to the standards of practice. With a job description. With a job description, yes. Is there a second? I second.
- All in favor? Aye. All opposed? Aye. You're opposed? I think I am. Okay. Motion carries, three to one. Paramedic, I was okay with, but I don't know about EMT. We're certainly lower our standards, but we have to. Yeah. Discussion of public comment policy graph. Okay. Hey, how's your foot?
- It's not good. It's healing, but it's not healed. I'm sorry. This item reminded me, we missed you at the meeting Monday, and then I thought, oh, I wonder how her foot is different. I'm sorry. So we had one person join virtually to make a comment about our public comment policy, and he had already written to us. Yeah.
- In my thinking about this, there is some minor editing like wordsmithing that needs to be done. For example, if you guys could weigh in on, are we calling it president and vice president or chair and vice chair? I can get those changes made. That's easy. Does anybody have a preference? Because I've seen it both ways throughout the years. I think your role is
- I'm sent to be president of the board. Now for any given meeting, you are also the chair. So if I'm sick, somebody else would be the chair. That would be true. Okay. So really, I think we should move to say chair because you are chair as the chair is the policy is talking about. Right.
- whoever is chairing the meeting, correct? That makes perfect sense. I will do that. And then the other two substantive comments I would like to have you guys' thoughts on. And if we can all vote since the four of us are a quorum on the changes, then what I'd like to do is revise it, send it around again. We'll have the actual vote on the policy in August when Steve and Lisa are back.
- So here are the two issues that I feel are substantive. I just forgot one of them. I am doing way too much. Maybe it'll come back to me. Okay, so one is, it was recommended to us that we allow open comment, open public comment on any topic, which I think we're doing, but also that we allow
- comments as we're voting on items like the city council does and some other bodies might. I personally feel that's beneficial because people can see like they could see tonight's agenda and if they're really interested in something that we're voting on they might only want to speak on that and if if we hear their comments before we take a vote it feels to me like
- that's an efficient way to do it. So this would be before the agenda item is heard? This would be as we're doing it. So we just did the health services director job, right? So the way it would be done is we'd present health services, we'd talk about it. Before we voted, I'd say, is there any comment on this topic? And people could weigh in, and then we'd close comments, and then we'd vote. So after the discussion, but before the vote,
- Yes. Yes. OK. Makes sense. Like I say, if we were going to vote, I'd say, I think that would be workable. And then we still keep the general public comment portion in there for somebody that wants to talk about something that's not on the agenda. Does anyone? I have a question for you all. Yes. And that would be, so if you are
- indeed having like talking about a particular item. And before you open it to public comment, are you going to take a motion or are you going to hold accepting a motion until after public comment? Generally public comment would be on whatever the motion is on the table.
- rather than the general topic, but it doesn't have to be. But I think that you need to, if you're really gonna look at this, you're gonna need to try and delineate how you want to do that because there are different ways of doing that. I think we should follow Robert's rules of order. There's a stepwise procedure. Does it address this? Yes. Okay.
- Does anybody know? But there are multiple versions of Robert's rules. So the one that she's referenced, though, is very specific. It's the 17th edition. The 17th edition is the latest. That's right. It deals with this, I think. OK. So I'll find whatever that is. Should we take a vote on that? Should we discuss it? No? Are we all? I think we should table it until the document is ready for motion.
- You're asking us for guidance? Yeah, I'm asking you for guidance to revise the document. I don't want to wait another month and then revise the document and then not be able to vote. I mean, I think you ought to, I think basically what we're hearing is that we should, we're inviting you to, or your board is inviting you to refer to Robert's rules in whether you take a motion before or after public comment. Okay.
- But you all would be OK if we did public comment. Specific. Specific. OK. Thank you. Thank you. Thank you. Thank you. After all, we invite general comments at the website by email. Exactly. And we could invite those people who send in such email general comments to attend meetings. Exactly.
- an agenda item directed to their concerns. Okay. Okay. And I think, you know, now that I'm thinking about it, I think I just had that one thing I wanted to ask the guys about. So I think I'm good. Any other, you know, based on the draft and the comments that I've sent to you that people have written in, which aren't many, but you've gotten them all, are there any
- things, any revisions to the policy that you would like made before we vote on it in August? I would simply point out that in the very good comments from this particular commenter, there are many open-ended questions
- But I don't really know how to address many of these. Well, many of them, which is why I didn't raise them, many of them I don't feel need to be addressed in a policy. I feel like they are more procedural and we can handle those. OK. But the biggest one he raised that I felt we did need to address was the one that we just discussed. OK. If that's OK. Unless, George, you've got it. Do you see something jumping out at you that you're like, no, we really need to
- I don't see anything that isn't basically procedural that we couldn't address. Okay. Meeting by meeting. Okay. Because I want us to have some flexibility if we need it. Okay. Can I just ask a question again? And that is, if you intend, and that's what I'm hearing, to take comment on items on the agenda that will require action, are you going to
- when you invite public comment from the public, are you going to ask them to confine their public comments to items not being voted on at this meeting? Yes, until it's arrived. And I don't know whether that's procedural or something you actually want to put into your campus. Thank you. Let me think about it.
- document mostly. Thank you. Sure. Any other thoughts about that? Okay, so I will not read this minute though, but before the August meeting, I will give you guys a revision to look at so that you can see it before the meeting and then we can go at least and Steve will be back. This next one board priorities update might have been answered by
- By Amy's update, I don't know if it was. This is from Lisa and the research we did. Right. It has to do with blood pressure, screening, and vaccinations. No. It has to do with chronic disease management in the county, having some sort of program directed at that. So if you'll let me just go ahead and get a few pieces of paper from Lisa and I. One of them is just a status report on where we are as far as the prevalence of those chronic diseases.
- and how we've attacked them in the past. A lot of this has changed because we lost about 73% of our HFI funding, and some of that was dedicated to chronic disease management. So Lisa and I met several times online and in person and talked about this. We came up with a summary, basically, so you're not going to be able to read this while you're here.
- And I tried to get these sent put in your packet, but I wasn't able to do that. So I would recommend that you you all we all read these two documents and then come prepared to to vote on whether we want to proceed with this kind of a program for our county. So I would say if there's any questions, you probably don't have questions yet, but
- You know, our funding has always been a problem in this county, and it's never been focused on chronic disease management. We focus on the things we're required to do, which is septic tanks and, you know, inspections and those things. In 2024, we had a zero levy in this county for public health. We were asked to spin down our savings accounts, and we used the HFI funding. In 2025, our funding is at .02, which I'm not a statistician, but that's about a tenth of the normal
- a levy for counties in Indiana. It puts us at about, I think it's $8 per capita per year, the levy covers. Whereas in Bartholomew County, it's 18 and Morgan, it's 11 and Brown County is $40 per person per year per capita. And in Marion County, it's 83. So if you look at the graph of where our funding is compared to other counties, we're down here at the bottom.
- We're not at the bottom, but we're close to the bottom. And we had a year where we had zero levy recently. So it really put us in a bad position. So knowing all that, Lisa and I, you may disagree, but Lisa and I recommend that we present a budget to the board, number to the county council that includes an amount for chronic disease management instead of stroke, which we can't control admissions for stroke,
- as a committee, the surrogate would be blood pressure control. That's why I brought that up with the lady from the clinic. The other two are diabetes and obesity, right? And HFI does require that we have a program in place that requires a community alliance be formed in every county in order to receive money from HFI. We haven't done that yet. And so I think our administrators already working on
- creating that, but it's going to cost money. And so part of the proposal from Lisa and I is that we need to ask the county council to fund us adequately somewhere near the median for all Indiana counties, which is going to be probably more like 18 to $20 per person rather than eight. And if we do that and they have a budget from Lori about what it would cost to add on chronic disease, then we should be able to afford it. But again, we may get a negative
- from the County Council as we have on other topics. I happen to be in the Indiana or the County Tree Commission and we spend $7 per capita on the urban forests. Yeah, so in perspective, yeah, we're spending about the same. So we have three things Lisa wanted me to bring up. One was a motion to table a vote on these documents until you've had a chance to read them. And perhaps we can discuss them.
- vote on them at the next meeting. Second motion would be to request Lori, this council or this committee request Lori come up with a cost for this plan so we can put it in the budget and then ask for the appropriate amount of money. Lisa and I's third motion is to alert the county council that we are requesting adequate levies to cover budget and to place us at the median of all Indiana counties going forward. I don't think we need motions
- I think we do. Because we can simply take this item, number three, leave it on under old or continuing business for the next board agenda. So it will be there. That takes care of the first one. We're going to revisit this after folks have had a chance. Your third motion, suggested motion, I don't think we're anywhere near there. The second one asking Lori,
- I feel like this needs to be more fleshed out. Well, I talked to Lori about it just in general before this meeting. She decided that she did not include these imperials in your packet because I hadn't discussed it, but she said that the committee asked her to do a cost analysis to see what it would cost to implement those three areas that she would be happy to provide it to us. Okay, I am not finished actually making my point.
- This is a wonderful problem statement. And you do have some items in here to correct the problem. But this is not a program that the health department can take and go implement. That's what's missing. I say it is. I say it's what we're supposed to be doing. Well, it's not. And Laurie needs to create the program around it, which could include this committee that you referred to, the committee.
- So I think what we could do is based on this, ask Lori to think both about a budget and about a program plan if you guys would want to do that and come back to us in August. She might have budgetary things to, I'm not sure she can get this together by August, but we could ask her to shoot for August.
- and give us a report on what she came up with. Sarah, did you have a comment? Yeah. I'm actually in alignment with you. I don't see a program here. And I certainly recognize the issues that have been raised in this document. But as you said, you wanted Laurie to come up with a budget. It was like, what a budget.
- exactly for what? You need to read those two documents. Most of these programs are already in place. She already has a program for these diseases, but she's losing her funding. Will you please let me finish? Sure. Thank you. So I don't see actual program. If indeed you're asking what would it cost us to maintain the HFI funding for the current
- programming. That's a completely different thing than saying, Laurie, come up with a budget for this. There's nothing here. So if the request is tell us what HFI funding was to cover these areas and let us know, that's a completely separate
- And I think that's an easier way to go about it because if she already had programs to address these issues and they are now lost due to the HFI funding, she should have a really clear handle on it. Exactly. This is what was lost. This is what it costs to put it back. However, those programs were clawed back by our county. Well, they were clawed back by the state when we lost huge amounts of HFI funding. The county could have still had a levy in 2024 and chose not to.
- but that's irrelevant. The point is, if we're gonna ask her to create a budget, it has to be based on something. And there's nothing specific in here that she could do that on. The other issue that I see is that if we're including, and it's another issue that probably we will need to talk about somewhere sometime. If we're going to look at involving the public health clinic
- in also trying to implement this program as you see it, then we have another issue that at least has been looming for me, and that is that we know that vaccines, the 80% that we've talked about at this table in the grant funding that went to IU Health
- for our public health nurses is lost. We know the grant is gone. And so ultimately we're gonna be looking at how do we fund our public health nurses and the clinic if we've lost this huge amount of money that went with vaccine grants. So all the way around, we've got all kinds of budgetary concerns that indeed include
- what did we lose through HFI funding? And the 75% decrease that we got in the promised funding from the state and then the amount that we have lost because the council has not seen fit to necessarily give us the funding that we were promised as well. And I will grant
- that both legislative bodies are struggling with money. Everybody is struggling with money and we know that IU Health apparently is also struggling with what their funding is going to be because they've lost lots of grants as well. So all the way around we know funding is minimal and we can ask Laurie to look at this but we're also going to have to look at
- way bigger issues. And I'm sorry, I've said too much. No, that was helpful. I'm trying to think of how best to craft a motion to ask Lori to do something. We don't have to craft a motion to ask Lori to do something. We can simply ask her to please tell us how much HFI funding we've lost in terms of these chronic areas. Well, I would like to know in terms of all areas.
- Because I think we lost something in MCH. We know we have tobacco. Well, we have none of that. And if I were going to ask the council to start funding something, it would certainly go back to tobacco is a major issue. And our state has withdrawn all of the funding we have for tobacco cessation. So how are we going to keep
- our lung cancer and our COPD rates at something looking like human. So can we ask her to give us a report on the loss of HFI funds and the associated programs that were paid for by those funds so that we have a better handle on what we can't do anymore?
- Is that acceptable? Yeah, yeah. I think you don't need a motion to ask her for the ramifications of all the clawbacks in funding. Okay. Let's remember, let's remember to do that. Thank you. You're such a good doctor. Would county loss of county funding or lack of enthusiasm of county funding be included in that? Sure.
- I guess loss of any funding, but she could identify it by source for us. That would be helpful. Yeah, I think that would be most helpful. And from that end, you also want to see what the clawback in terms of what the loss of our grants, particularly for me, it's looking at what's going to be the ramifications of the loss of our vaccine. That's really scary. The tax care was huge.
- And how we're going to keep our children in this county vaccinated is anybody's guess at this point. Okay. Is it okay to move on? Okay. I want to acknowledge and thank Breanne Carley for attending tonight. They are guests from the auditor's office. And remember at our last meeting, we had a whole lot of discussion and question about
- the audit and all of that, and they are here. I'm not sure we're, we don't have anything on the agenda, so we're not really prepared to ask them questions, but they said they will happily come back next month if we want to follow up from last month's meeting about any questions about the audit. But I just wanted to say thank you for coming. It's very nice. Appreciate it.
- Okay, new business. I have one item that just got added at the beginning of this meeting. As I think you know, the rules for board member attendance are that if you miss three consecutive meetings or four nonconsecutive meetings, you are no longer entitled to serve.
- And I've spoken with the commissioners, they're aware. We do unfortunately have that situation with Ms. Neal, who this is her fourth non-consecutive meeting missed. So I would ask for a motion. I would move that we inform the commissioners of the situation regarding Ms. Neal's attendance record in order that appropriate
- action can be taken. I believe what they told me is that we need to vote to recommend removal to the commissioners and then the commissioners discuss it and act. If you wouldn't mind reframing it. I move that we recommend to the commissioners that we remove
- on the basis of our attendance records. Do we have a second? We do not. Okay, so the motion will fail. You of course can second it. I will second it. Let's vote. All in favor? Aye. All opposed? Nay. What do we do with the tie? We have a tie.
- What is Robert's rural student status? I do not know. Are you like the vice president or something? Or can you get to it? I have no say whatsoever. She's not voting. I know. I think we'll have to be tabled until we have another member who can break the tab. I think that's probably appropriate. What you didn't do was have any discussion around it. And I don't know if that makes a difference. I did notice that.
- Trying not to, we can discuss, remember we're all on camera. Yeah, but what you can discuss is about what does it mean when an appointed board member apparently chooses not to attend meetings and has not been an active member of this
- August party. You have to keep it to attendance. Well, exactly. But that's what I'm saying, that if someone has not attended. Well, it's basically a factual issue. It is a factual issue. But apparently, there is some disagreement about whether, at least I guess I would really enjoy hearing, based on that fact,
- What it is that would cause one to say that this person should retain a seat when they're not occupying the seat? That's what I don't understand. And you know again, I'm not member of your board. How about this? Yes. If you are comfortable, if you would care to share, we would like to hear. The reason I voted no is because
- I've been on the board since 2011. We've never had this happen. We've had people who missed more than the required attendance. I believe that attendance policy set by the state, if I remember those rules properly. And we don't appoint the person. Somebody else appoints. And I feel like that's their role to decide what to do with that since the
- the state requirement is not being met. They're the ones who decide. You're absolutely correct. And this is why I shared that I had a conversation with the commissioners. They need a vote from the board requesting them. They've never done that before. Is that something the state requires is that this, this committee vote person off their own? No, no, no.
- I mean, somebody would have to go read it. I'm not sure. I don't think we have Dave. The county council's responsibility to follow this. County commissioners. County commissioners job. Second thing is, I don't think we've given, I mean, you know, most people, if they don't show up for something, I'm worried about them. I call them and talk to them and ask them if they're disabled, if they're having trouble coming to meetings because there's something we can do to make it easier. We haven't done that. And someone who cannot attend in person has the option of
- Attending virtually If I mean Kay when she's been away attends virtually as much as she can so That you know that again plays into it But we have not seen participation from this member Virtually when she's not been her person and that's that's why I'm just saying that you know if
- And I think the commissioners are trying, and I don't know, I can't really speak for them, but I would guess that what they're trying to do is make sure that the boards are filled with people who will be actively involved and represent the public. So they can, they can replace her at their, at their leisure. And my sense was they asked us to make the recommendation to them to show that they weren't stepping on our toes because
- To me, that would be overreach if they simply decided to pull somebody off the board. And that's happened before. It's happened before. Yes, it has. And there's been a lot of backlash. I appreciate your history. So does this sound like a plan between now and August? I can contact the commissioners and say,
- We're a little confused. In the past, it seemed like you took this action on your own, and now you're asking us to give you a recommendation. What's going on? Sure. What if a board voted absolutely against removing a person, and yet the state law says they have to be removed? Why are we impeding the state? That could happen. We all voted in the majority not to. To me, it's clear cut because
- It's not the state laws not being followed, period. So your objection is procedural and that you say it is the commissioner's duty. Yes, and also I do feel the person should, you know, somebody should communicate with the person.
- Well, typically someone would call in and say, hey, I can't make the meeting today. I usually send you a message. It also gives the person a chance to resign rather than being fired. There's a lot of reasons why you should have communication with people. I will do that. I will talk to the commissioners.
- So yeah, because from what, from Kay's position, I'm so glad I asked for a conversation around this. And what I'm hearing is that Kay, tell me if I'm right, wrong Kay, it sounds like you're suggesting that both you and Lee are suggesting that the commissioners are abdicating their responsibility by asking the board to act, to invite them to do their job.
- Relatively correct. I'm saying this has never ever been done and other people have been just removed if they didn't follow the state guidelines. And we don't have a role in removing that person or we didn't. And there have been past incidents in which we were not consulted and people were removed.
- Okay. Thank you for the history. It was different this time. No, thank you for the history. That's very, very important. Different commissioners, maybe? I don't know. Okay, moving on. I'd like to open it for any public comment. We don't have anyone in the room who wants to make public comment. Is there anyone virtually? We'll try to get you in the order that your hand goes up. We can't.
- Technology being what it is. I'm not seeing any hands. Any board member or health officer comments? Other than what we already talked about. All right. If anyone wants to make a motion to adjourn.
- more business, apparently, I move that we adjourn. I second that. All in favor? Aye. All opposed? Wouldn't that be funny if somebody said, no, I don't want to adjourn. I want to stay here the whole day.