- I would like to call the August 21st 2025 meeting of the Monroe County border fell to order. And the I would like to before we do the approval of meeting minutes. I'm wondering if I can request an agenda change which is moving something from old business.
- which is number two, the public comment policy final draft. I'd like to move that to just after the approval of the meeting minutes and here's why. Because we've all looked at that as you know, it's been, I think we're all fine with it. If we're able to approve that in this meeting, it could be put into place for this meeting. So that's what I'm thinking. Is everybody okay with moving that agenda item? All right.
- Thank you. We're also going to move Simeon after we did the department updates to new business for open business. Where is Simeon?
- I don't know why Simeon doesn't just want to hang around the whole meeting. So where are we moving that before department? In a sympathetic gesture, I thought we would not make it. So will it be now C1? Is that where Simeon will be? Sounds good. Or C1? Could be. Yeah, it could be. OK, OK. Whatever you want it actually. Thanks.
- Thanks, thanks, thanks. Okay, well, that sounds fine. Thank you. On to approval of previous meeting minutes. Any discussion? Did anybody find anything we need to revise on those? We move that we approve that. I'll second. All in favor. There she is. Yay. Sorry. That's okay. I was late too. Aye. Aye. Aye. Aye. Any opposed?
- Okay, thank you. That passes. So I am moving the old business number two public comment policy final draft. You all have seen it. We've held public comment on it, et cetera. I would love to just be able to have a vote and put it into place because as I say, then we can use it at this meeting.
- but does anybody have any last minute? Did you find any typos? Did you, you know, did you think of something we forgot? Anything at all? I'm hoping we've all seen this so much that. I'd like to thank the public for their input. And we did use some of the suggestions that were made by the public.
- So thank you. That's important to point out. We had at our public hearing that we held on this. We didn't have anyone come in person. We had virtual comments and we had several comments received from the public through our email, which was great and really helpful. And thank you very much to everyone who made this comment. I move that we adopt a new
- public comment policy as revised on August 11th. I have a second. All in favor? Aye. Any opposed? All right, we have our very first policy. Hopefully we'll never have a policy for anything ever again, because that was horrible, but I'm really happy.
- Well, there's a provision to revisit it in case. Oh, absolutely. Oh, absolutely. OK, moving on. I'm just curious, now that you have created a public policy for public comment, I noticed that your public comment appears at the end of the meeting. Is that intentional, or do you want it at the beginning? We can probably. I didn't want to hold up Stinian,
- I wanted to move it up. Yes. So I just wanted to know if you were planning it. Because that is not also in your agenda. I was planning on it. OK. I thought I would ask. OK. OK. Are you good to just sit here and watch? He's good. He's good. Hope you brought a book. OK. There is an idea to then move public comments on the agenda.
- unrelated to action items, which is now F, so it's at the end, to move it to essentially right now. I don't know if we need to vote, I'm fine with that. Does anybody have strong feelings? Believe it where it is. Okay, so given our new- I thought we were voting to move it. We should vote. We should vote? Yeah. Okay, do we want, how about a motion?
- I make a motion that we move public comment to this funding meeting, which would be just after the approval of the meeting minutes. I second. All in favor? Aye. Any opposed? Okay. And will it be in that position in the future? I think yes. Yes. Yes. Thank you.
- So, now it is up to me to remember what we wrote in the policy, because I have to make a... Steve? One point related to that. However, since this agenda was set out 48 hours ago, what if somebody comes towards the end of the meeting and wants to make a comment, because it was only... We'll do it again for this meeting. We'll do it again for this meeting, OK? Thank you. Good point.
- So I am required at every meeting now where we have public comment to tell folks what the policy is very briefly. It has been posted online. So if you are in the room and you are going to make a comment, you will need to put your legal name on the paper that's in the back of the room to indicate that you would like to be heard. There still is a three minute time limit.
- for comments. Public comment to items not on the agenda because as our new policy states, we are now going to hear public comment before we vote on an item. So if there's an agenda item you're particularly interested in, you will have an opportunity to say something after we have discussed it, but before we vote on it.
- Public comment must be relevant to the topic. It must be on a topic that is in the responsibility of the Monroe County Board of Health, and abusive, disrespectful comments will be deemed out of order, as well as if the commenter is not addressing themselves
- to the chair of the board. So we don't want any comments about individual staff members or individual board members. We really love comment on issues. If you want to comment online, you may raise your hand during this public comment period for anything that does not appear on the agenda. And we will alternate online public commenters with those in the room.
- I think I covered it all. Okay, first time I've done it. I think I've covered it all. Do we have anyone in the room wishing to make a public comment on an item not on the agenda? You may stand up or you may stand right there. Terry Anfler, I have signed in. Thank you.
- I'm three things briefly. I'm thinking about it. Don't relate anything pending on the agenda for the meeting today. First of all, I along with I teach part time at Indiana University School of the public environment. I shall say. Your Lisa's husband, your Lisa's husband. I am most importantly, probably actually. I understand and will be teaching myself and Professor Alberto Vega.
- will be co-leading a graduate capstone whose topic will be really relating to Monroe County Health Equity Council, which I'm not going to go into when we talk. It's an entity that came out of the Robert Wood Johnson funded Community Voices for Health Monroe County. It's a cross-sector body, so you can tell me more, so on and so forth. Our administrator assumption. Yes, also.
- And so that the capstone will be in support of the CAC. There will be the client and it'll be intended to help with something students sign up. Of course, there's no capstone, there's no voluntary opportunities to do that. Take one, but that'd be anyone. They could be with us too. But if there is, we'll be, I think, coming back and talking to, among many others, who'd like to speak to the board, to see how the CAC can be useful. I think that will be, the CAC wants to know how it can be useful.
- in its work, its interests, its activities. So that's the main, the S to ends up, this is for spring 2026 semester. The only other thing I'd say, one thing that is underway with NCEC in partnership with United Way is something that's being referred to as porch parties. It's an informal community opportunities for people to express what's happening to them with health these days, given changes in the universe.
- I was like, what does it mean? And then part of that will be, hopefully that information will be provided to. So it may be served to the board about for just information sharing, one way or another, just so you know what's going on. And then the only other thing, let's see, I went to look, cause I realized you have a public, there's a public engagement voice item on, as I've been watching the one in the city a little more, the city council.
- But I couldn't find the document looking online for it. When I went online for the Board of Health, I could find the agenda, but I didn't see anything relating to the actual document. Now, I'm just saying it's not a big deal one way or another, but I just did so you know. But if you intended to be available, at least I briefly looking on my phone this afternoon.
- Didn't find it, so that's all. Thank you. Thank you very much for coming and thank you for letting us know that I believe. Do we have someone online who wants to make a comment? Do we have a hand up? I thought it's not OK. OK, I will then close public comment. And we will. Move to.
- chapter new business chapter 360 proposed changes simian baker and i wonder if you should come up here so that they all can see him i think it's a chair okay yeah could you sit over there yes it's time for your close-up sorry simian i'm simian baker senior environmental health specialist at the health department
- been here for over 30 years and I think it's time to look at our Solid Waste Chapter 360 ordinance and discuss the removal of vehicle collar permits. There's a whole list of items of what we're doing and I really didn't plan on going through this. I was hoping that
- Everybody would have potential questions for this, but the big key is it doesn't serve any core service values to us. Now, years past, we had anybody and everybody dumping along the wayside. That doesn't happen anymore. We have mostly packer trucks, which are sealed, and so they contain most of the solid waste.
- The state doesn't require any permitting, item doesn't require any local permitting for this. And if trash is falling off vehicles in the actual ordinance, our department, the Waste Management District has the right as long as they can prove whose trash it was to pursue that further. I think there's like 17, 18 different items
- things that we really feel that it just doesn't serve the community any benefits having this part of the program. Just a quick comment. It used to be true when we had a county landfill and when the PCB issue led to concerns about dumping materials being moved around in the community, possibly on the roadsides, then maybe this made some sense from a health point of view.
- It's basically a littering issue and it's really up to the folks who regulate that kind of thing in the transportation side of the point. So it's really off our menu and really it has been since the county landfill and the PCB issues disappeared. Spot on with that one. Part of it is there's a lot of areas that
- disposal facility, incinerator, landfill that's in the verbiage of the chapter that no longer exists. And if indeed somebody, for whatever reason, decides we're going to have a landfill again, it won't be during my lifetime, that's for sure, that can always be added again. It's not like something like this would just
- All of a sudden, if somebody wants an incinerator to burn PCBs, which is what the main purpose was at the time, that doesn't happen overnight. It would take quite a while to go through federal and state processes before it would even get on the local level. So that could always be added if it ever was needed. Senator, I have a side question. Who is in charge of the litter that is on the highway? I mean, I travel 37 daily.
- And it's just overwhelming sometimes. And I follow trucks where it's blowing out. Beep. State police can stop people. Waste district, if they can determine a source, they could. Highways Department also. And sometimes that's, depending on what kind of road, if you're talking about state route 27, that would be kind of,
- state rather than the local highway department. And when they mow the grass, it's just overwhelming how much it's laying on them. Well, with INDOT, INDOT offers an opportunity for you to send a report. It's called INDOT for you, and you can go there and report anything you want about any state road.
- and you will get a response. Solid waste falling from a garbage truck is enforceable without permitting, because of City of Bloomington Code 6.06.100, including vehicles falling garbage. Yes, and then outside the city, it could be our health department and the waste district.
- mainly the waste district. They have the means, and that's part of their core business right there. We have recycling centers now, and it's just, we've, of course, just dramatically improved everything within the solid waste programs. So where is our solid waste going now? We don't have a landfill for years to go. It's usually Terre Haute, potentially maybe Indianapolis area, but yeah. We're not in place for the last,
- Five, 10, at least 10 minutes. Any other questions or discussion before I open up the public comment? Okay, I would just as before, per our new public comment policy, I would like to open it up for anyone who would like to make a comment on this agenda item only. If you're online, you can raise your hand.
- If you're in the room, you can also raise your hand. Let's see. Okay. Does someone want to make a motion? Yes, I would move that the vehicle permitting be removed from Chapter 360 of the Code. Second? I'll second. All in favor? Aye. Any opposed?
- Motion passes, thank you. Thanks. Thank you very much. Thank you. Lisa, could you, I'd like to ask the school liaison Lisa Greathouse to take a hot seat so that so that everybody following online can see her dinner table and hear her report. Thank you. Hi.
- Good evening. I wanted to condense my report compared to what I've done in the past just to keep it a little bit more timely and relevant to the past several months. So on the bottom portion, you should see just kind of the month by month activities I'm doing to support the schools and health education, professional development, as well as just school support, providing that technical assistance. But on the very top of the front of the page, I wanted to just bring your attention to
- the KPI specific to the School Health Liaison and the progress of where we are in meeting those goals for this year. So within trauma and injury prevention, our goal was to host 10 CPR classes for staff personnel. In the education setting, some of the roles are required to maintain certification, while others just have to be
- certified in order to renew their teaching license. So making sure they have ample opportunities to get those when needed. The next one is regarding maternal and child health. So we are able with the funds to the health department to offer the middle school safe sitter course at no charge to students. So students going into or in sixth, seventh and eighth grade, we teach them about CPR or not CPR.
- choking safety, first aid, safety at home for themselves, but also when they're in care of another child, as well as the business side of maybe earning a few dollars here and there while watching somebody else's kids. And that course was specifically created because an adult caregiver did not know what to do when they were watching another kid and the kid choked and unfortunately passed away. So we've been doing that class for quite some time,
- really, really excited that we're able to provide that at no cost to the middle schoolers in our county as well. And then the last one is regarding tobacco and vaping prevention and cessation opportunities. We can never talk enough around the harms, the dangers, the marketing, the manipulation strategies, right, to the kids, so they feel empowered to make those healthy choices for themselves now and in the future.
- So we are able to partner with some schools to offer that opportunity. And for the most part, we stick to the third grade and the fifth grade, as well as supporting the health educators to make sure it's happening in fifth, eighth and as well. So doing well so far, just need to host one more safe sitter course in order to meet those initial goals. But I'm already in the progress of setting those dates with some schools. Meeting goals is great. Thank you. Yeah.
- Any questions or discussion? How is the safe center class option offered to the middle schoolers?
- So I reach out to the middle school administrators or health educator. They're really, really vital and help recruiting kids either because they know they're going home after school unsupervised or watching their younger peers or they market it through their counseling department. And that information is also set home to parents. So it would be a newsletter or email to the parents. So everyone has an equal opportunity to sign up. And then we host it.
- In the summertime or if the school's on break, like their election days, we'll offer it one day, just a big chunk. If it's during the school week, we'll come Tuesday, Wednesday, Thursday after school hours and do it for two hours each day in order to complete the course. And then they go home with a booklet that has all of the information they learned, most specifically a first aid guidance, ABC order that was pediatrician created. So that way if they're ever in the event with a kid,
- don't know how to handle a nosebleed, a splinter, or whatever it may be, they can refer to this booklet and do it properly. Good, thank you. Yeah. Any other questions? All right, thank you for your time. Thank you very much, Lisa. Moving on. Number one, administration.
- Laurie Kelly, we are ready for our big. Let's see, so county budget season starts next week. We are looking at trying to really cut back on unnecessary supplies and services, being really mindful of training and travel expenses, just really trying to stay focused on having stable funding for our positions to continue carrying out
- our normal programs and required services. Some grant updates. We have received grant funding for emergency preparedness. So this was $20,000. This is a standard grant. There was concern about that amount getting lowered this year or whether we would be receiving it. So we did receive it a little bit late, but we have that now.
- We have received harm reduction grant funding. So in the amount of 71,000. So this supports the saline expenses for the harm reduction specialist. This will last us through about October of 2026. And we have received the additional grant funding for the fourth disease intervention specialist. So that was right around $58,000. So those have all been,
- seen by the commissioners at this point. Let's see, we have received approval to be a milk distribution site. There's no cost to the county for us to have this service. We're essentially volunteering our time and making sure that we're picking up with maintenance of the equipment and providing the service. Recently met with the auditor's office regarding the ongoing research and
- of the old grant funds. We have another meeting scheduled I think in around a week or two to continue working on just getting those taken care of. We are working with the county fleet manager on a mobile unit that I think we'll talk about a little bit more in the old continuing business.
- still collecting applications for the health services director and administrative assistant positions, so starting some free screening interviews and starting to schedule some in-person interviews for those positions. Kathy Hertz has been playing a really large role in being able to help and assisting with reviewing applications, submitting free screening questions, and
- helping to coordinate interview times. So that's been a really big help for me and for the department. For disease intervention, the third new DIS employee began on August 11th. So training will just busy with training right now. This will continue over the next few months.
- We are navigating changes to the courier system for the state lab testing. So this is due to some funding cuts. It's reduced to just once a week. So we have been having some issues with pickups or people having to stay late to make sure that we can still get those samples out.
- So, might have to look at looking at doing a combination of the courier system and shipping through UPS or the disease intervention. Maternal child health has been really, really busy. We've distributed 120 water safety kits throughout the community.
- So each of the kits contained a life jacket, goggles, safety whistle, little first aid kits, sunscreen, some educational materials and activity sheets. These were all funded through Health First Indiana, received well by the community.
- with the Maternal Child Health KPI. So the KPI submitted was decreasing the three-term birth rate in Monroe County from 10 percent, which was in 2022 to 9.7. Recently reviewing those polls, we've identified Monroe County as of 2023 is 9.3 percent. So we're going to be working on updating and submitting new information for that KPI to the state.
- A maternal child health coordinator is collaborating with a social worker from IU Health to set up a community baby shower. So they're looking at scheduling later this fall to be able to help provide supplies that many parents in the area are struggling to be able to afford due to financial hardships. She's also attended the Head Starts Back to School Bash on August 20th and
- doing a lot of outreach in the community with the safe sleep program, our seat checks. We are gonna be collaborating with the city of Bloomington to host a free car seat safety check event on September 26th. This will be from three to five p.m. at 320 West Eighth Street. So it's over by the new Bloomington Mobile Integrated Health Office location in their parking lot.
- We have the all department meeting on August 4th at Cascades Park. All of the employees participated in a training activity on our emergency response plan for continuity of operations. An after action report is being generated by Verizon. We'll be getting that later just to be able to highlight strengths and weaknesses that we can work on.
- Emergency Preparedness and Environmental will be attending a training event on responding to chemical events on August 28th. Essentially, they'll be reviewing how our environmental section would respond in the event of a finable release forest bill.
- Oh, let's see. It's farm reduction. So some upcoming events for them. Sex, drugs, and rock and roll. So our disease intervention specialist and the farm reduction specialists are going to be tabling at that event. They're going to be providing education and helping to do Narcan training and distribution. Let's see.
- and legislative impacts for harm reduction. So for now, any harm reduction supplies specific to the syringe service program, such as tourniquets, cookers, cottons, are being held but not distributed. We can no longer purchase those supplies with our state funding. Okay. Yes. I just had a question about the reduction in the courier service.
- Yes. So are some of our samples that we're sending sit time, time dependent, they have to be refrigerated frozen. So that's going to mean patients can only come in and be tested on a certain day of the week so that we can match it up with the once a week barrier? Yes, they are doing that. But then they're using that they're shipping those out if they need to. So we can still ship by UPS. Laurie, you mentioned the Health First Indiana Fund.
- And I noticed when I read about the behavioral health and wellness that they did a motion class and two people were turned away because they didn't meet the criteria. And I'm wondering if we can somehow get that word out on what that is and that people know ahead of time. Yes, so I've been
- working on how we're going to communicate that information and I've reached out to the legal department to basically get more information about how we're going to communicate these changes. We do have information on the website that essentially puts the clause on there that due to legislative updates during the 2025 session, our Health First Indiana programs that are funded may be
- just the eligibility requirements are different. So I think, Laura, it'd be helpful if you actually shared with the board what legal has said about how we document eligibility, because I certainly was surprised to learn what
- our attorneys that we originally were told basically that we would just make our best efforts. And here our attorneys have become much more specific about what they expect partially due to the fact that we tend to be a very blue community and therefore more likely to be looked at with a very
- fine magnifying glass as to how well we are following the eligibility requirements required by this legislation. So we've been put under much stricter requirements by our attorneys than many of the surrounding counties. In fact, most of the counties in the state
- And I don't know if that helps you at all, Kay, but we are definitely being asked to do a great deal of documentation. And we were talking before the meeting, Lori and I were talking about how we might expedite some of that because most people are not carrying around their birth certificate and whether there are ways that we can
- help people get the proper documentation that they need in order to participate in community events. Is that helpful at all? Well, I just would hate to see anybody turned away from a program we're trying to. And they're interested in taking it. They will because of the state. And we have no choice.
- We have absolutely no choice. My concern is much more with vaccinations and people that need to get vaccinated to protect the entire community and now who cannot because of this law. What are the requirements? What are we being required to do besides a birth certificate? What other documents are we required to produce? There's a form that essentially gives a list of what documents
- qualify for to show Indiana residency and then what documents qualify for the lawful status to be able to clarify those two points. So that's just information. That's kind of how it's broken up. So do those need to be on some on a website? So it's on our website.
- I was surprised when I read it that one, the one person that was angry said that, you know, the documentation she had for TSA was OK. Why wouldn't it be OK for NDF? Because our attorneys have said no. I hear you. Yeah. Any other questions for Lori on the department of data? Well, actually I do.
- So Lori, you've said that we do have the funding for that fourth DIS position. When will we be hiring that fourth DIS position that we were told months ago, once we had the paperwork and had the grant funding in hand, we would hire? I'm not sure. It's supposed to be on the September 16th meeting for the request.
- My understanding is it will be on the council agenda for September 16th. I miss remembering the last council meeting when this was discussed and tabled. I thought that they said, and I think we have a council member on here, so maybe we could speak to that. I thought they said that they had put into place some expedited way for us to get this through the minute the funding came. And so I wonder if,
- I wonder if that means what, is there anyone from the council that can help us understand? Yeah, Peter, I think you were the one who did that. I'm wondering if you can speak to this because indeed, you know, if indeed this finally passes in September, that means we can finally post the position, but that doesn't tell us when we would be able to actually have someone in place. Can you help us with that?
- That's right. I would need to go back and look at the correspondence around that time. I'm not quite, I don't know that I can answer your question at this moment, but let me, I've got my email up here and I can look. So let me do some due diligence here and I'll get back to you. Yeah, you said it during the actual council meeting.
- Yeah, I'm not sure there's an email. It was stated during the council. Let me go back and refresh my memory. And I don't want to speak out of turn or, you know, doing that. I just want to make sure that I'm being honest with you. Because I believe Peter, you were the one who actually moved to
- table indefinitely, I think that was what you said. I think that's what they called it. Yeah, because you said that would help us move this thing forward as soon as we have the money in hand. Yes. Okay, let me, I want to make sure that I'm addressing this as honestly as possible. So let me double check and I'll get back to you as soon as I can. Thank you. Thank you. You're welcome. If I might bring up a topic that you all had an email about,
- recently because I think we should discuss it as a board and probably vote to authorize Laurie to do, to take certain actions. So a couple of weeks ago, we were, well, let me back up. Honey, back way up. Some context, some background. Nearly all local health departments in the country
- And all in Indiana, except Monroe County, have provided direct services in the form of vaccinations and case investigation for communicable diseases. It's like the bread and butter of what local health departments do in this country.
- And NACCHO actually does surveys every couple of years of local health departments to ask them one question is, what do you do? What are you guys doing? And nationally, 92% of local health departments conduct communicable disease case investigations and contact tracing when needed. 88% provide directly routine pediatric immunizations. 87% provide routine adult immunizations.
- And the next two that are the highest in terms of volume, 82% provide screening and treatment for tuberculosis, 63% provide screening and treatment for STDs. And Monroe County, for decades, for longer than any of us on this board. 60 years is what I learned today. 60 years. Thank you, Sarah. We were looking for this for the last 60 years.
- We have not performed those services directly through health department staff. Rather, we have had a very collaborative partnership with Community Health, starting out with what used to be Bloomington Hospital, and what now is IU Health, and their Community Health program, and the public health clinic is on Miller Drive. I'm sure everyone is familiar
- with that, and it's been a great partnership. Well, IU Health has decided they want to expand their community health efforts, make them more regionally based, and they didn't feel that maintaining the contract to do these services, the communicable disease case investigation, the TB follow-up, the vaccinations on our behalf was consistent
- with their new initiative. So they informed us two weeks ago that as of January 1st they will not be they will not be doing that work for us on a contractual basis. Which puts us in the same position as every other county health department in the state by providing
- requiring us to provide those services directly as opposed to contracting without you know. Yeah, so it's it's good. I'm trying to be, you know, positive about it. I think we can. I think we can do this. It's going to take a whole lot of logistics because we've not done this in 60 years. We haven't done this in 60 years.
- I pulled some information that's in your packet because one of the first questions I had was how many communicable disease case investigations are we talking about? So you all have a spreadsheet with some, oh, those are performance indicators. You have something else that was in your packet, I think, or I sent it with the email, about how many communicable disease case investigations there are. The DIS, of course, do the ones for chlamydia, gonorrhea, monkeypox, if there is any, and syphilis.
- So we don't need to do those, but we would need to do all of the others. The Indiana code specifies which notifiable diseases and conditions are the purview of each local health department to follow up.
- And that actually is the responsibility of the health officer. So Sarah herself is responsible for conducting all of these cases. She's going to be very busy. So that means for us that instead of renewing our ongoing contact with IU Health, we will retain those funds to perform this work. A couple of us met to try to
- provide this board with our best advice. Like how do we do this? What are our next steps? And that's I think a little bit of what we would like to present to you. And I'm gonna start and then I would ask Steve or Lisa or Lori or Sarah to jump in if I misspeak or if I've forgotten something. So IU Health has,
- let us know that at the Public Health Clinic on Miller Drive, they plan to continue to provide immunizations. They're going to, they are a vaccine for children provider. So we were trying to get a handle on how many vaccines, how much of that work would come to us. And we're thinking,
- that's an unknown, but we're thinking that since so many people in the community are used to going there for their vaccinations, and they're going to continue to be a provider, we believe that most people will continue to go there. But we do, we must have some ability to do that ourselves here, because we will be getting people that aren't eligible for their services for whatever reason.
- And we need to make sure that, I mean, it's our duty. We need to make sure we can pick up that slack. So we're gonna be doing the application to get registered with the state as a vaccine for children provider. That's the vaccine part. The communicable disease case investigation will require that somebody and probably several somebodies
- become trained in the state's public health surveillance database, which is called MBS, become authorized users, know how to pull down the case reports when something gets reported to the state, know how to enter a case. Someone probably not yet hired is going to need to understand how to conduct case investigations as public health nurses have been doing for so many years at IU Health under contract.
- And then we're going to have to do that. And then the third piece had to do with, this is much less concerning, had to do with the school health liaison. What we were thinking was to, am I okay to say just about the positions? We were thinking we have two existing positions in the health department.
- that we would like to slightly edit their job descriptions. And then we would like to request a new position using local funds who would have total responsibility for the communicable disease case investigation and follow-up. That is a state mandated activity that needs to be funded with local dollars.
- However, we would want all three positions to be cross-trained. So the two positions we currently have that we're going to edit, we're going to add vaccination and communicable disease investigation duties, probably some school health liaison duties, so that all three of those positions can cover for each other. They can provide surge support if we get an outbreak
- of something. What am I leaning out? What am I forgetting? Is it a classic question? Once a hold on to it is have I presented everything that these guys need to know before we get to the questions and discussion? Well, I just want to make sure that. That it's understood that. We are probably going to have to add some positions and.
- That has not been something that has been easily done, so. It has to be done. January 1st. We need this to be there. Maybe a clerical or administrative position. It would have been nice if we had known this a year ago or at the beginning of the year at least. But evidently this is a fairly.
- they've probably been contemplating this for some time, but especially considering that we were the only county in the state that had this arrangement. But, you know, there's just, IU Health has some different priorities, the way they want to be organized right now. So I understand. We've enjoyed a very good relationship with IU Health all these years, and so,
- The staff has been cooperative and but there is a sense of urgency and then that can't be overstated as Lisa has stated. So these new positions need to, they can't be. They can't go through this arduous process and expect us to be ready to go at the beginning of the year.
- when this is, we have to start providing the service. Well, that's why I wondered if Dave was gonna be here with us tonight because we will be out of compliance with state law if we are not able to conduct global disease case investigations on January 1st. These people have to be hired and trained. Hired and trained, yes. Yeah, yeah. And you know, it's going to be different bringing public health nursing into the department. I imagine that it,
- will be a benefit to the entire department to not be in separate houses for us to all be together, to be able to work in a more cooperative and easy fashion. There's certainly models around us everywhere we look. And so that's great. Unfortunately, what we know is that we've had difficulty
- getting positions approved and despite our having money for those positions, being able to get those through our fellow agencies that will approve our paying for those individuals. So it's going to be challenging. I mean, at the moment, you know, we are tracing
- and dealing with pertussis in the community. We have five active cases. We have, and there may be multiple other individuals involved in this that we're only beginning to recognize. So it's not only urgent, and I've been delighted to work with the IU Health
- nurses. They've been incredible partners and they are very supportive in what we are going to try and do and are giving us as much support as they possibly can to make this transition, but they can't do it without cooperation from our local government. I want to give Lee a chance to ask his question because he's been waiting.
- Guys, a couple things. One is, have we notified the state that we're going to be satisfying our requirement to provide the service in a different way rather than through IU Health? The state is aware. They're aware. And then number two, I think it's a great opportunity for us to actually make it a better clinic. And I think that, you know, they're on paper there, I think, aren't they still? What's that? The clinic isn't on paper. They don't have EMR. Yes. So it's an opportunity to do that.
- because we just signed a contract, I think, with the data. Hi. Yeah, hi, hi. This would be a great way to maybe get them to help us analyze our own data and get it back so we can use that data to see if we're doing a good job or not. I think it's a great opportunity. I think it's a great opportunity. I think it's gonna be a heck of a lot of work, but I'm excited about it. Kay, did you have a comment or? Well, I'm just thinking we need more than just people, new people.
- We're gonna need money for supplies. We're gonna need space. We're gonna need space. All of that refrigerated equipment for storing the vaccines. The refrigerator is like the size of this room. It takes up the wall. It literally takes up the wall. Well, we're just, these are the things we're going to have to discuss and decide and put into place as soon as humanly possible. I know. I'm just laughing because in this meeting, it was like,
- And I said, well, we have four months to do this. Now we have less time, man. Because we're not even having, there's not even a council meeting till September 16th, right? Couldn't we conceivably get any help from agencies such as Health Net in matters like this? Could they help us with personnel or any other matters? We thought about that. But they're not really equipped to do these things. I mean, it's really our
- responsibility and they're not really equipped to do it. Maybe chronic disease management down the road, but it's not. The disinfecting is both health net and Centerstone Health Services. Now forget there are two FQHCs here. I think there's some concerns on their part that they would not want their clients to have to prove their citizenship. That is, yes, thank you. That is truly, yeah, that is exactly true.
- They don't need to be paid through the county though for those nursing services anyways. So I guess I don't know if it's appropriate or not. I would really like to know from our council member if he's still here. Peter, do you have an idea about how we are going to expeditiously move forward so that we are
- in compliance with state law? Absolutely, and compliance with state law is something that the council looks forward to working with the health board on. I think this is something that I think Lori and I can work together on to make sure that the council office has all of the relevant details that we can review this and make sure that
- we can see how we can move forward on this. I haven't seen the paperwork on this yet, so I can't be more helpful at this point. But what I can pledge is that just as Lori and I met today to go over the budget, and just as I'm here as a helpful partner in this meeting, that we will work as hard as we can to make sure that we are all in compliance with state law. Thank you. We're gonna need it. Thanks. Yeah.
- And I know you don't necessarily have a great answer for us at this moment, but is there a way to expedite the process that seems to be very time consuming to get positions approved and for all of this to move through council so that we can stay in compliance? Nothing would make me happier than giving you an affirmative answer.
- but until I see the paperwork, there's just no way for me to tell and I don't wanna mislead you. I'm not sure. Can you explain what paperwork, I'm not sure what paperwork you're saying that you need. Oh sure. Yeah, so whether or not this is a new position in the health department, I think that's the first question that I wanted to make sure that I heard correctly. There is one we would be proposing, possibly two. Okay, so that means that we,
- would be working closely with you to generate job descriptions, as well as working to create a new position. There's a questionnaire that we go through. I think, Laura, you've gone through it a couple of times. The biggest hurdle here is going to be that the state has cut our property taxes by about $9 million over the next three years.
- And as such, we have put a pause on new positions. However, I would need to talk with my council colleagues about if a position needs to be put in place for us to stay in compliance with state law, that changes the equation or potentially changes the equation. So there's not only the details of what is this person going to be doing, what educational requirements do they have,
- what all these things, what pay scale they're going to be on potentially, things like that. We also need to make sure that my council colleagues are on board with looking into lifting the prohibition on new positions. So there's some hurdles to cross here. To say the least. Yes, we understand, thank you.
- I will be in communication with you, so we'll be with you. Thank you. Other discussion or questions? Because what I'm thinking I'd like us to do is just authorize Lori to start doing this as we discussed. The only area that
- I didn't think that we had created as a nursing position was indeed the communicable disease tracking position. I thought that we felt that for that kind of epidemiological position, we did not necessarily have to have a nurse. I think that was our discussion. We need to have
- a medical professional at a level who is licensed to give vaccinations. Ideally for all three positions for coverage was what we were thinking. The director has a nurse. The medical director would also have a nursing position so that we would still have three
- potential nurse. Okay, if we have three potential nurses, then you're right that new position would be the field that would not necessarily have to have that medical credential. Yeah, because we'll have sufficient nursing coverage. Okay, before we vote, I'd like to open it for any public comment. If anyone has any ideas or comments on this issue they would like to share.
- So we're talking about two positions that we have that will require some redefinition and one totally new position. One or two, if we need a receptionist. Okay. So, I was just going to say, so the funds that we get that we've been providing
- with a contract for IU Health. Obviously, we won't be spending those funds with IU Health, so. Okay, that was my next question. Where exactly are these coming from? So we have local funds. We have local funds available that had been the contract to IU Health, so apparently the funds
- for these new positions are not. I think that was important to mention. I think it is important to mention. Thank you for bringing that up, Steve. Can you tell us, Lori, off the top of your head? Probably easily. How much have we been spending on this contract with IU Health? Are you able to? This year, it's $2.28 is the contract amount. The grant funds have fluctuated from year to year. So I think the last grant cycle that we had
- I want to say maybe 178, and that was really pretty significantly high compared to previous years. But back in the few years ago, I think it ranged around 60,000, then COVID hit, it got up in the 100,000, and then it went a little bit higher.
- for some of those grant funds. But the contract amount, we won't have any problem covering personnel costs with that. I think that we'll probably be saving around $70,000 if we stick with the plan that the board has discussed. Thank you. I think that was also important. Does anybody in the room want to make public comment?
- Briefly, I'm speaking now about something I know almost nothing about, so I don't want to tell you that, but this is interesting to me. From an organizing and design thing, the work that you talk about, given the changes and some opportunity things, there's a concept of organizational theory in such called parallel architecture. I'm not suggesting, it just means work outside the box a little bit, really. And I'm not suggesting where any positions go and that's where everything, you know where it goes. But you're talking about a change
- And you talk about something that requires education, support from different sectors across. And so how do you think about even who talks about this from this point forward? Is it a way to strategize on how to have success later? I will now shut up. But I'm saying there is an opportunity for everything like this, for how you strategize organizationally to build the capacities you wish to build.
- And that's all I know. I can't help myself. Do you want to hang out with them? Yeah, you really should. Does anybody online want to make a comment on this topic before we vote? You did before, that's fine. Okay. Do we have a motion? It would be authorizing Laurie to continue this plan as we discussed. I would move to do that. Do I have a second?
- I would second that she be authorized to do that. To do that, okay. All in favor? Aye. Aye. Any opposed? Okay, motion passes. Thank you very much, guys. Old business, mobile clinic. Can you give a little background about why we can only spend it this way? Oh, sure. Yes, so let me read the question from my memory again.
- We do have
- COVID vaccine reimbursement funds that essentially my understanding is the state was kind of helping to get these processed and then distributing the funding to local health departments. So the funding has just been kind of sitting in the health department funds. The intention is for one-time use, so one-time expense, at least not to supplant local appropriations or personnel. So-
- infrastructure right um well basically yeah capacity but then trying to address again centered around like vaccinations ensuring that children and communities have access to normal health services um uh i think we i don't i think it was brought up maybe a over a year ago
- Yeah, how are we going to best utilize some of this funding? And so we started the discussion of using it to purchase a mobile clinic. So there are at least three different quotes. We were required by the county to provide a minimum of three different quotes just to go through the process to actually purchase a unit. But the idea is that
- we would really be able to use this unit in different divisions of the health department so they could schedule on different days, whether they are going out and providing those vaccination services, whether the DIS are going out independently and harm reduction. So there's really a lot of ways that we could actually utilize the van and be able to go out and provide these services in the community and to those rural spaces that have limited access and transportation.
- So I think I brought it up again recently, just kind of a nudge about, you know, what's kind of the direction that we want to go with the unit and purchasing it. I have recently found out that we will need to find our own parking space for the unit. So I started trying to reach out to some local community partners just to get a feel for where we might be able to park
- this global unit. We couldn't get one. We couldn't get one because we couldn't find a place to park. So thank you, Lori. So we have discussed this for a year or more and then we kept kind of other things raised their heads. But I really think now is a good time, especially with this change with IU Health.
- I would like to see us think about how we can integrate a mobile health unit into the work that we're going to be picking up. And I think it's really exciting. We can go to far reaches of the county with this and do vaccinations in places where people, and we can do other things. I mean, we can do all kinds of stuff with a beautiful mobile unit that we weren't able
- To do before and I think it's also important to say that we had been up until now partnering with the State Health Department and their mobile unit. They have stopped doing that, so this is a more pressing need perhaps than it was a year ago because we had the states mobile unit that we had been had been using. So I'm.
- I'm super excited about it. And I'm passing around, you'll see there are three quotes there. And you can take a look. All of these brand new units. And we have, you did have like a brief discussion with Commissioner Thomas, correct? About this, something you've already? Oh, I think,
- Yeah, I think that was a year ago I mentioned, yeah. And they were supportive. Oh yeah, I think I did. As far as vehicle insurance and other things. Yeah.
- Yeah, because we have to have insurance. We need to budget some maintenance money, too. Well, I think we have the money, which is a good thing. I think we have the money to purchase it, pay for a parking lot. And I think when we had this before, that was actually an issue. We felt like we needed. And this fund, it's very appropriate and a very appropriate use of the money that's in this fund.
- Which is, you know, not often does the money you have line up with something you want to do. So I was very happy to see that. And I'm curious about, is there a time when this fund disappears? Is that also a piece of why we would want to move in?
- Yeah, I mean, not to my knowledge is there a specific date, but I think we need to spend the money. We need to spend the money. We've been looking at it for a long time. It's not good to have money and not spend it. So it's possible they could pull it back? You don't? Not to my knowledge, but I can't say with certainty. There's a big difference in the cost of the three. I'm really excited because I think that with the changes we're looking at,
- going forward in terms of public health nursing in-house, that indeed being able to reach rural Monroe County is sorely needed. There are elderly, there are all sorts of folks out there that aren't being served necessarily. I can see us going to township offices,
- and parking on a regular rotating basis. The township trustee wants us there badly. I think it's a great opportunity first for us to be able to interface with parts of the community we generally don't see. But it's also such an opportunity for us not only to be gathering data that you and Lee would really like.
- But it also, it helps the community to know their public health department because I would say that the vast majority of people in this county really don't know the public health department and what we do. And this gives us such a great chance to meet with them, especially because as we've known in the past, when our IU health nurses
- went out they were identified as IE health and that's wonderful and I understand that that was something that was necessary for them but it's time for our public to know the Monroe County Public Health Department and what their tax money
- support. The other thing I want to point out is every time in the last several years that we've conducted a community health assessment, the number one need the community tells us is access to health care, and this will be expanding that access. And while it might not be the total expansion that anyone in our community might want, it's a step in the right direction and
- I would hope that part of what our public health nursing staff will do is to help people connect to those resources in our community. I would also like to see us, when we get this, to partner with maybe some community agencies doing behavioral health, for example, so that we can expand that too.
- I'm just really excited about it. Any other questions or discussion before I open it for public comment, we take a vote. Have we picked one of the vehicles, the other three? So I'm not quite sure about the county process. From my understanding, there's some, I think there's some type of a bidding process or something with the quotes. I'm not, I haven't received clarification on that. Probably our role is to specify our need
- You know, we wanted to have two exam rooms. We wanted to have X number of bathrooms, for example. And I don't know that we've done that. And we would need people like Lori and Sarah and possibly if the public health nurse at IU Health can give an opinion. You know, we need to. Also, maybe a conversation with some other counties that have have units to say,
- What's worked? What's worked well? What hasn't? What have you needed that you didn't have on your on your? That would be that would be great. We're going to roll that into the motion when we vote on this to ask Laurie to do well to do. You know you're both going to boot camp, but in two weeks we can have to reach something soon so we will be able to talk to people from around the state. Good, good, good. OK, I'd like to open this up from public comment.
- If anybody in the room has a comment. Does anybody online want to make a comment on this issue with the mobile clinic before we vote? I don't see a hand. Okay. I have a motion. I would move that we explore further the use of these funds for
- containing a mobile van to be specified upon discussions between Sarah and Lori and nursing staff in terms of the size and nature of the van, funds available and the like. I second. All in favor? Aye. Any opposed? All right.
- We're going to have a mobile clinic. Woo hoo. No, we are. We are. Stop it. The next thing under old business, this is the ongoing item for Lisa and Lee about chronic disease prevention. And I don't know how our discussions of tonight and the changes pertain to this, but it's your time.
- Well, I think that this is a positive where we're going and so now we'll kind of have full control over things like checking blood pressures or weights or if we choose to have an A1C machine and check patients blood sugars and figure out if they're diabetic and then we can just set it up from the get-go like he was talking about that we can know what we want and then we can start right away collecting all the data
- and put it into some system that works for us. So I think this goes right along with our priorities. So I think we just make that work as we go along. And I think the mobile unit plays right into that. That would be great. I agree. It's very exciting. Yeah. I just had a question about that. So we have to be careful, obviously, that we use a certain percent of HFI funds for chronic disease and a certain percent for
- regulatory things. I know you watch those numbers. So do we have any estimate about how much money we need to spend? That you need to spend this year? That's by the HFI. It's all budgeted, but we don't know that.
- I can't imagine that we're going to fully utilize all the fund this budget of this year. We did not last year. We came close last year. We spent all of it except for 388,000. And while I was, the first year, I think there was a little bit of concern about going over that regulatory cap because of the way that we've had to shift positions around because of the legislative changes. We really don't have that concern right now. I would say that there's plenty of money in HFI to invest in chronic disease prevention
- just we have to follow those new legislative guidance. I don't see you. Okay, we are just for tonight, because it was on the agenda, we're going to open it up again for public comment unrelated to action items. If anyone in the room or anyone online wants to say anything about something that was not on the agenda,
- you have an additional, you have a two-for-one tonight, and then it's going away forever. Yes. Oh, sure, that's a free gift. It's a free gift, okay. This means a random question as a person who's halfway to 150. So the question is about COVID vaccines, because I'm getting, I'm hearing different information. This doesn't mean I know anything about what's available now,
- say at CBS, somebody says it's a brand new, it's a vaccine to meet the new changes. Another person that says, no, it's not. I've had two different, completely different descriptions of what the vaccine is from the pharmacist. So I just say this is one place they should mention that. Anyway, that's all. And we are, per our comment policy, we are not supposed to be talking back to you, but the idea was,
- was raised. My understanding is that the manufacturers of the COVID vaccines will not have the update available until mid-September. Until mid-September. Somebody, did somebody online have their hand up or did I just say what they were going to say? No, they just, someone had their hand up. Oh, okay. Thank you. Okay.
- Board member and health officer comments. Does anybody have anything to say that does not? That's not what we've already talked about. I do have a comment. I'm afraid I don't. My information is incomplete while I know it is. But there seems to be some concern about water fluoridation over the last few years, and that being
- that the fluoride equipment has been malfunctioning for some number of years. And I asked Lori to send me the annual water reports to show what's basically going in, the most important things are going in through our water. And what I found were some real inconsistencies
- And I also found that I think it was 22 and 23, years 22 and 23, even though it was reported prior to 22 and after 23 and 24 and 25, the fluoride level was completely left out of the report for those two years. And I believe it was 22 and 23, if memory serves, which in itself is a little bit suspicious because
- I think rumor has it that the previous city administration was asked about this, and they said it wasn't included in the report because it hadn't been asked for. Well, if it's always been there before and now it's there afterward, why would somebody specifically ask for this information if you would assume that it would be there? And that sort of, I mean, it may mean nothing, but it certainly is suspicious.
- In the following years, in 24 and 25, if you look at the footnotes, it'll show that the table shows that the fluoride levels in the water were either optimal, but that was the highest it ever got. But if you look at the footnote, it was running about, typically about half of the ideal amount.
- Is this a big deal? Well, it is, because it affects thousands of children in Monroe County, people served by the Bloomington Water Supply. Very few, or if any, in the dental community are aware of this, because that's what I do or did. And I still am connected to the community, and I've asked around. And none of the dentists knew this.
- Why wasn't the health department notified? We didn't know anything about this until just in the last couple of months, isn't that right, Gloria? And I mean, I just find this unconscionable that it was going on, it has been going on, and no one made a public statement or advised the health department of this public health issue.
- The comment one dentist made was, well, you know, I feel I feel like this is anecdotal. I feel like I've been seeing more decay in kids, but I chalked it up to the fact that, you know, kids are drinking a lot of juices and flavored drinks and things like that. And, you know, sugars rambling all over their diets in most cases. So he said, I didn't realize that the that we weren't meeting the
- the criteria for fluoride levels. Well, I saw some article, I think, in a recent publication. It might have been B-squared Bulletin. B-squared Bulletin, yes. Where the administration said there, or not the administration, I'm sorry, that the person in charge of... USB. USB, yeah.
- was committed to transparency. Well, you're committed to transparency once this became public knowledge. But prior to that, it certainly wasn't transparent. So I'd like to know what's happening. Is the equipment fixed? Why weren't we notified of this? Why wasn't the health department notified of this? And who's responsible?
- and what corrective measures have been taken. And I have no answers to that. Is it the city of CBUs, city of Wilmington Utilities? Yes. And so we don't know, is it an equipment problem, or is it a? Rumor has it, it was an equipment problem. The equipment had been repaired at one time,
- it began malfunctioning again. And again, like I said, I'm sort of working in a vacuum of knowledge here. I really don't know. So I don't know how to investigate this. I would suggest two things. One, we could invite the head of CBU to come. We could ask whoever is sitting as the chair of the board for CBU. And because the utility board, if they weren't notified, that's just as bad.
- So can we invite one of them? Recently I heard that the board took some. Minor corrective action, but it sounded like a from what I heard. And again, it's my information is. I don't know how accurate it is, but it sounded like a fairly anemic response by the board. I mean, as the health board, it seems reasonable for us to invite the head of CBU.
- to come and discuss this with us because indeed children's health, the community's health and wellbeing is the purview of the public health department and this board. So that seems like a perfectly reasonable request. I agree. Is that what you guys would like to do? And I also think, you know, you have to remember that, you know, the people, it was always,
- stated that about 40 percent of the American population didn't see a dentist on a regular basis. So, I assume that applies to children as well. And that's old information. But, again, it's the lower income and people who need help who often are hit the hardest
- because their kids, and it means needless suffering for those children if they have decayed teeth that are hurting and they may not receive infections. I mean, this is not a little thing. I mean, that's teeth, but it's bigger than it may sound. And I think this has served worse since this particular economy has entertained
- this population and so I think things are worse than ever and so it seems more important than ever that the City of Bloomington provide the necessary fluoride in the water supply. Thank you for raising this issue. This is really important. Yes. So I'll make a motion that we invite
- Whoever is responsible for quality control for City of Wilmington utilities to give us kind of an update on information and give us information about where they are, what happened, what's the path moving forward. Great. I know we've taken that motion. All in favor? Aye. Any opposed? Motion passes. I just have a question. Is there a policy that we're supposed to be fluoridating our water?
- I mean, is it a city policy, county policy? I'm not sure. But almost all municipalities that do fluoridate the water, it's been voted on. Because to get it removed, it has to be voted out, which is also happening places, unfortunately.
- I guess the only other thing that I would raise, which I mentioned earlier, was that the wastewater surveillance that you've been using to track viruses, the state has not updated there since June. And that leaves us, while we may have local tracking that's provided from that state,
- But yes, outside Indiana State, it's really useful for us, particularly since we've just gotten an influx of people into our community. And for those of us tracking disease, it's useful information to know where we are in terms of COVID flu, measles,
- Pertussis, unfortunately, doesn't fit into that category. But all these other things, RSV, without that accurate or semi-accurate wastewater information, we're kind of at a loss to know, other than ER, and not everybody goes to the ER, where we are in terms of disease. So I just thought I would at least
- raise that spectrum for you. Any other board comments? I have a question for Laurie. Laurie, have the veterans ever gotten back to you about the fresh card connect? No. So Christina is going to circle back around with them to see kind of where they are. So hopefully we can get that going. So I think it'll be really good. She called in vets also. No, we haven't tried that.
- check within there if they keep themselves separated from the other veterans. And so they get left out sometimes. If Lindsey Joy Winning is still on, I think it's her birthday. So I just wanted to say happy birthday. I saw it on LinkedIn. Any other board comments? Anybody want to make a motion to adjourn? Don't move.
- Second. All in favor? Aye. Any opposed to adjourning? Okay.