- Thursday, September 18th, 2025. Do I have, I hope everyone's had a chance to evaluate the previous meeting
- minutes. Do I have a motion to approve those minutes? I move we accept the minutes. All right,
- we'll second. Okay, all in favor? Aye. Aye. Aye. Any opposed?
- As per our new protocol, we are taking public comment that is general public comments at this time.
- We want to say the following, the Monroe County Board of Health encourages and welcomes public input.
- Written comments may be submitted at any time via email at boardofhealth.co.munroe.in.us.
- During meetings, comments related to specific agenda items will be heard after the next discussion of
- that item and prior to taking a vote. At this time, we would like to invite those who would like to
- comment on any non-agenda items to speak. For those attending in person, please sign in at the front
- of the room. And for those joining us online, please use the raised hand feature to indicate you would
- like to provide comment.
- Each speaker will have three minutes and we ask you, we ask that you please begin by stating your name
- for the record. So do we have in-person folks? Can you read the statement? I did. She grabbed it.
- All right. Good job. So do we have in-person giving public comment? No. And do we have anyone online? Okay.
- I'll hand it over to you. Thank you, Lisa. I apologize for being a little late. So you called us to
- order? We're all legal. Do you have a comment? We've done that. You approved the minutes? Yes. Did you
- introduce Dr. T? Oh, I'm sorry. No, I'm not. This is Dr. Michael T. So our last meeting, we had a new
- board member.
- appointed, but we were unaware. The message kind of missed us. So I would like to formally introduce
- and welcome Dr. Michael Teague as a new board of health member. And yay, hooray. We're really glad to
- have you, really glad you're here. If you wouldn't mind telling us a bit about yourself and why you're
- interested in this. And then I'd like everyone to just go around and briefly introduce yourself. Sure.
- Absolutely. So I'm my tea guy.
- I'm a primary care physician in Bloomington and have been with IU Health for roughly 13 years. I'm also
- the physician leader for primary care. So one of the things I've been doing is a lot of the hiring of
- the physicians and the nurse practitioners and trying to address a variety of the access needs that
- we have that are across the country, but also, of course, very complicated here as well.
- So I do that a lot. I did my residency at Franciscan up in Indianapolis and I did my medical school
- and undergraduate here in Bloomington. And so now I've lived in Bloomington longer than I lived
- in Indianapolis where I was born. So this is kind of my home. I really like it here. I'm interested
- in this. Just as I have been responsible for a lot of the primary care needs within IU Health throughout
- the region, this felt like a nice,
- step toward being more available to help the community. Because I view that job and take that very seriously
- of the hiring of providers and trying to sort out a lot of the complicated scheduling issues to get
- patients seen and folks taken care of from taking care of the chronic disease management, keeping them
- away from the hospital, all of that. This was a logical next step for, hey, I want to know what the
- county is doing.
- But also I think it's important for the county to know what we're doing as like the largest primary
- care group in the region. So I think I bring something to the table to try to help kind of come alongside
- together to work together to take care of the local community. So that's me. Thank you. Welcome Dr.
- Ryderband. So I'm Sarah Ryderband and I am the county health officer since January of this year.
- Lee McKinley, I'm a retired internist and I teach for IU School of Medicine. I'm Salinda K. Leach. I'm
- an old registered nurse and I also have a background or a master's in public health. George Hageman,
- I'm a retiree from IU, professor of microbiology and biochemistry. Steve Pritchard, retired dentist.
- We're glad you're under 65.
- Arora Diario, retired CDC. Laurie Kelly, Health Administrator. Dr. Lisa Robinson, I have my own private
- practice here in Pillington.
- Are you ready to meet all of you? Thank you. Just a comment on the retirement. It does help to have
- a lot of time. Some meetings are considered retiring early. That's right. I've got about 25 years left
- so. Okay. We do have a guest speaker tonight and I am going to
- ask her if she wouldn't mind to take the hot seat there so that the owl can turn around and we can get
- her face on camera while she's speaking. This is Katherine Kat Zager, the Director of the City Bloomington
- Utilities, who was invited to speak to us about fluoride in the water after our August meeting when
- we all discussed, when Steve brought it up, you know, that we had a problem we weren't aware of. And
- so she has come to
- fill us in a little bit more about that and allow us to ask some questions. So thank you very much for
- coming. We appreciate it. Yeah. So, uh, Catherine Zager, utilities director. Um, I just want to come
- and give a update on the current status of fluoride and the history, uh, in the last five years of fluoride
- in our drinking water. Um, and then where we're going from here. So, yeah. And then I'm, we'll take
- questions. So, um,
- Also, I'm a script person, so. So due to some leaks in our chemical feed system that supplies our fluoride,
- CBU has been unable to deliver the recommended 0.7 milligrams per liter of fluoride since the end of
- 2019. Our bulk tank, which is our larger, we have two tanks. We have a bulk tank and a day tank. Our
- bulk tank,
- was relined in 2022 from a leak, but it continued to leak after that relining. Temporary delivery systems
- were tried, but they pose significant safety risks to staff. With the hydrofluorosilic acid, that is
- one of the most dangerous chemicals we have at our plant. And so some of these temporary solutions were
- not fully safe for staff to operate.
- We're currently testing all of the components of our system to determine if additional relining of our
- 20 year old tank will be effective. We're also exploring additional options if relining the tank is
- ruled out. Our goal is to have a safe temporary cost effective solution finished by the beginning of
- 2026 so that we can safely continue the use of fluoride.
- Additionally, we have a capital improvement project that's slated for 2027 for a more comprehensive
- overhaul and assessment of the system, along with other chemical building improvements in our pending
- rate case, which was approved by the Utility Service Board and is now moving through City Council before
- it's seen by the IURC. In 2024 and 2025,
- We have reported on the minimum maximum and average fluoride levels in our drinking water as a component
- of the annual consumer confidence report. This report can be found on our website and our customers
- are notified of this report annually in their bills. Going forward, CBU is committed to improve our
- customer understanding of this document by presenting it annually at a regular meeting of the utility
- service board.
- In this meeting, we'll break down the report and help to explain each substance identified
- and its significance to public health. We welcome and encourage members of this board and the public
- to attend those meetings. And with that, I'm happy to take questions. I'm wondering, because we have
- a dentist and in my ignorance,
- I would say, why don't you just squirt some fluoride into that water, call it a day, right?
- I don't know. Right? So I wonder if you want to start. My question is kind of like yours. OK. How have
- other communities with similar issues addressed the problem other than to just put it into the annual
- report? Has anyone?
- found a way in the outflow created a way of fluoridating that water rather than just having it in the
- tank. So I think it will help to further explain our chemical system. So all of our bulk chemicals are
- in what we call our chemical building. Those lines do run to the end of our treatment process. So the
- fluoride is actually being added when
- the system is working, it's being added at the end. But the storage of it is in that bulk tank and then
- in the day tank. And that bulk tank having a leak is what caused the problem.
- I don't know how familiar folks are with hydrofluorosilic acid. It's extremely corrosive. And we believe
- what was happening is it was corroding the tank. And since we've had multiple leaks with this bulk tank,
- it's corroded the concrete underneath the tank as well, which is why we are evaluating whether or not
- relining it will actually be effective. And are there ways that other communities have addressed this
- issue? Oh, boy.
- So as far as the ways other communities have addressed this issue, when you say this issue, do you mean
- the issue of fluoride? And making sure that it's not eroding the tank that's holding the chemicals.
- I mean, there must be a way that other communities fluoridate their water. Oh, yeah, absolutely. So
- regular maintenance and updating of tanks. So the I don't know the actual average lifespan of your typical
- fluoride tank, but I know that ours is reaching that.
- And so it's just a costly matter of replacing tanks, replacing lines, replacing pumps. And that is how
- I assume utilities who continue to fluoridate their water manage it. So it's not a metering problem,
- it's the storage of the concentrated form of fluoride that gets pumped into the water to give the effective
- concentration. But yet it has been going
- and down, and when you take a tank out of service, you think it just goes.
- So we do. That's a couple of things that were happening. So one is that we have background fluoride
- in our water. That's just naturally occurring fluoride. And that is around 0.1. So it doesn't quite
- get up to that 0.7. That is the recommended level, which is why we add more. So there's that fluctuates
- around 0.1. And the other spikes that you would see, I think there was a graph that was published that
- we provided actually to Dave Askins.
- That graph showed like spikes, but it never quite got up to 0.7. That's when we were trying our temporary
- solutions. And so that temporary solution looks like a tote. And that tote is hooked up to a pump.
- It's like, I don't know if you've ever, I used to, I used to bartend and you would change a keg and
- you would put that and sometimes it'd spray out. That's kind of how you would attach these totes
- It wouldn't always spray out, but that was a possibility. And so that was a safety concern because we
- were having spills associated with changing out those totes all the time, and we weren't able to keep
- up with those smaller totes. My concern is the dentist. Did they know that there wasn't an adequate
- amount of fluoride in the water when they treat their teeth?
- I mean, I don't know what dentists know. Which gets to my main question is, if this problem's been going
- on for five years, is there some reason why it was never reported as a public health issue to the health
- department or to the dental community? Because this is a serious public health issue. I mean,
- And, you know, again, low income people are disproportionately affected because they may not take their
- kids on a regular basis to the dentist. It's only 40% of the people to go to the dentist anyway.
- And no, this results in significant cost. The dentists aren't aware of it, so they're not trying to,
- you know, compensate for it by
- topical fluorides or suggesting drops or something at home. So I guess that's the thing that really
- bothers me the most. I mean, this is five years, so that's a whole set of kids' primary teeth on one
- child that maybe had no fluoride. And the second thing is that the fluoride levels reported in the water
- are misleading.
- Because it shows, if you read across the top, it says it's the highest reading, which means, well, sometimes
- it was 0.7, but if you look at the fine print at the bottom, it was 0.3, really. So why wouldn't you
- want to reflect an average reading for that year? That seems to be, to me, to be a more accurate reporting.
- So there is a mandated way in which we have to report.
- So that well, then why wasn't it reported for two years in our annual report? So. Let's talk about reporting.
- So. It was not an. Actually, I should have had it in front of me, but in 2024 and 2025 it was reported
- as part of our consumer confidence report. And like you said, it showed the Max and then in the blind
- print had the average in the minimum, right?
- Before that it was not reported and to be perfectly honest I was not the director at the time. It was
- another administration and we thought that at least restoring it back to our consumer confidence report
- because and this is an assumption on our part that we assumed people were reading this. And you know
- I really want to encourage people to read this consumer confidence report especially you know boards
- of health.
- dentists, people concerned about what's in their water. And so if people have a concern about what's
- in their water, they should read the consumer confidence report. And it wasn't reported in that for,
- I believe, two or three years before I became director. And that was- I think it was two years.
- Two years, yeah. Two years. It had no- It was not reported at all for two years before I became director.
- We put it back in our report because we thought it was the right thing to do.
- We should have probably done more push in education. It was a tough position to come into an existing
- problem and you say, okay. Sounds like some knowing nods over here. We understand your position.
- She, our administrator, understands. Is there a hierarchy, like for instance, if there was
- droves contamination, you'd have a boil order or something crazy, and then if there was full coal farms,
- there was certain ones you might, is there anywhere on that continuum where it is? Is it somewhere on
- that list? So could it be added to that list, a thing that we are notified by at the time when it happens?
- That would be a local change. There's no state level notification system because
- the presence or absence of fluoride while still a public health issue does not have impact on the potability
- of our water and the safety of our water. And so those types of notifications we've reserved for safety
- issues of our water as far as like, is your water safe to drink right now? And even though it is not
- as awesome without fluoride, it is still safe to drink.
- And so we you have to be cautious as a water utility to. Not alert. Like to to not alarm the public.
- When like they don't necessarily may not fully understand. How many other things are added to our water
- that don't have to do with safety of water? See.
- I would say fluoride is the only real additive to the water. We do have chemical processes that are
- added during the treatment of our water that are used to treat things like taste and odor. For example,
- we add carbon during the summer to address taste and odor that's removed through the treatment process.
- I would say as far as additives, fluoride is seen. It being the only one,
- I think that it wouldn't be an onerous position to report when that is chronically low. I mean, agreed,
- it doesn't have anything to do with safety in the water. It certainly has to do with general health
- for children. And I'm not trying to blow this out of proportion, but when the whole dental community
- doesn't know, and plus they're busy with their practices, they have lives, they have a lot of professional
- journals to read,
- The fact that they weren't reading the consumer reports on this paper is forgivable. Yeah, of course.
- I know what that's like. So I would suggest when it's going to be this particular item, since it's the
- only one, if this were to continue to happen, I would like to see some sort of notification process.
- I don't think that's too much to ask.
- So, yeah, that's a good point and it's very valid. How would you suggest, and I'm- Did you simply report
- it to the health department? Yeah. And then we'll worry about dissemination of the information. That
- would be amazing. That would be really, really helpful because we now know that we are not currently
- feeding fluoride. When that changes, we plan on making an announcement and letting folks know it's back.
- And we're also trying to improve our outreach and communication around our drinking water and around
- the utility generally. I'll say that you know when we talk to our utility service board you know I think
- the the members of the service board were also like you know hey I don't you know some of us didn't
- read the report and
- they're on the Utility Service Board. So I don't expect your average person to have really scoured it,
- to read the fine print, and to also understand what it means. Which is why we did have a resolution
- recently to push our outreach when it comes to that annual report, because it's really important that
- people understand it. And then people understand not just the fluoride levels,
- but also the levels of other identified contaminants in their water what that means and you know what
- if anything they should be doing to protect themselves. And I would absolutely welcome and will invite
- any members all members of this board to come to those meetings because they'll be extremely informative.
- And I'm just curious would it entail our footing before the utility service board
- some kind of resolution that this happened, that indeed the health board is notified and the health
- department is notified when fluoride in particular is absent or comes back online in our water. Does
- that entail a resolution or is that something that as the director
- you can simply implement. Oh, we can simply implement it. If we want a resolution, a resolution is really
- just to have, you know, when there are many directors into the future and we're not all sitting around
- this table, that they have something to reference. It's, you know, communicating a future plan. So I
- think that to me is the point of the resolutions. You know, just like the resolution with our board,
- I could have said, you know, hey, we'll just do this.
- And then I leave the, you know. Right. Yeah. So is it your suggestion that not only do we attend a utility
- service board meeting, but that we bring forth a resolution of that nature? I think that would be wonderful.
- I think that would be wonderful. I don't think it's necessary to build
- better communication bridges between the utility and Board of Health. I think that's really important.
- I am happy to implement internal processes to make sure that happens. But I do think it would be nice
- to have a resolution and I think that would be great to bring this board and our board together. And
- I think they would appreciate that. Yeah. Perfect. Thank you. Yes such a terrible question. Oh no she
- answered it. Okay.
- And sure enough, I imagine this would take some time and a whole lot of money to fix. What is your sense
- of when you can finally be done with this and you can say fluoride is consistently up to the recommend?
- So 2027, the updates to our chemical building will be when I can not have nightmares about
- But 2026 is when I hope to have a safe and effective temporary solution that we will have to monitor.
- So I'm hoping to say we have fluoride back in the water 2026, but it is a situation we have to closely
- monitor because there are safety risks to set temporary solutions.
- I know that at a recent emergency planning meeting, they actually talked about a scenario. I don't know
- if anyone here is involved in those. But they recently talked about a scenario where if hydrofluorosilic
- acid were to spill and the worst case scenario health outcomes happened, we as a community would not
- be prepared to deal with that. And so I want to make sure that I'm keeping the safety of our employees
- our number one priority because. Do we need such a plan? Yes. So who would be responsible for generating
- that? You guys. Emergency management. We have represented our our COSMAC coordinator is on the ATTENZOS
- meetings. Yes. Thank you. Any other questions or comments. No thanks for coming in.
- Thank you. We really appreciate it. And I hope you're not feeling too beat up about things that happened
- before you were even on the job because. How long I haven't been here. So I will have been officially
- a year this month or the end of last month. Yeah. So this is I'm just finishing my first year.
- Thank you. Thank you very much. Nice meeting you. Yeah. So it was nice meeting you. You too.
- And we will stay in touch. Thank you. And if you think of any way we can help you, please, beyond publicizing
- it somehow, please let us know. We're happy to help. Thank you. Thank you. Before we leave this quickly
- for the doctors in the room, 100 years ago, when my big kids were little, I lived in the state that
- didn't fluoridate the water. And they took fluoride pills. Is that still a thing? And the health department
- used to give them out.
- Is that something that we can or should consider? Or is that not something that's basically I think
- are a prescription item at this point, other than the things that are over the counter, which would
- be toothpaste, rinses, those types of things. But if you want a little higher concentration to substitute
- for lack of, then you have to have a prescription for that and that could come from your desk. So what
- I would suggest is
- There are a couple specials here in Bloomington that have the emails for all the dentists. So I will
- compose a little paragraph or two and one or five, both of you to make sure it's okay. And I will notify
- them and ask them to disseminate that information to them. That would be great, thank you. So I'm wondering,
- since you are,
- taking care of primary care at IU Health. And I assume the primary care also includes Riley. Yes. Whether
- there is an understanding across the board that there is no fluoride basically in the water. And I would
- assume other than dentists that our primary care physicians could also be. Yeah, I have written down, you know,
- We should do the same thing with pediatricians and frankly any primary care provider who takes care
- of children. But then we would cover everybody. So if you want to write it up then I can always disseminate
- it. And then there are some community physicians as well that we would have to get names of Monroe,
- Medical Bribe, etc.
- Thank you to the B Square. You know they don't, which is why we really need to think about it.
- To your point, only 40% of kids will go to the dentist, so getting with the pediatrician office is going
- to be really helpful too. OK, thank you to the B Square for bringing this to our attention. Thank you
- Steve for bringing it to our attention last month, because I think this was really productive.
- People don't mind. We have someone from the health department under new business that I'm sure would
- appreciate being able to go home and have dinner. I'd like to move an agenda item for new business to
- right now before we do the department updates. Hit the hot seat. Yeah, hit the hot seat there so the
- owl can capture you. Thank you. And you want the guy from food.
- to have a meal. I don't believe this. Mike what's your introduction to all of this. Mike is the Environmental
- Health Director at the Health Department. Nice to meet everyone. Earlier this year the Indiana State
- Administrative Food Code was updated. We've been working with legal to reflect those changes in our
- county Chapter Code 341. Some of the biggest changes are the way we note violations. So we're moving
- away from critical and not critical to core priority foundation and priority.
- So we wanted to bring it to your attention those amendments before we bring it to the commissioners.
- So if you have any questions or comments. Yeah who worries anything that's doing general sanitation
- and then priority foundation is supporting those controls. So for example our priority foundation is
- like a food manager that doesn't have a valid food manager certificate. A control is like both foods
- without a cover.
- And then a priority is like chemicals stored above like ready-to-eat foods, food contact surfaces are
- stored with bulk foods. That's spoilage. Spoilage? Yeah, spoilage. And spoilage is so it goes past the
- date. It's going to be a priority foundation because after 24 hours it needs to be date marked for seven
- days to discard. It's going to be filled past that. Because I just need to know whether I should eat
- there or not. Well,
- You know, we used to get those reports. It was actually going to bring that up after we did this, because
- I think it's important. But on this document that we have, the things that are highlighted are those
- things that you're adding, and we should pay attention. Those are the changes and some of the definition
- changes. The big ones are like the definitions for the violations, like core, priority, foundation.
- OK, thank you. Does anybody have any questions looking at the document and seeing the highlighted
- areas that might be necessary for us. And also we added in there, before him we were doing physical
- reports and passing this out, but we moved towards digital, so that reflects those changes as well.
- So they get motion to solve the changes. Yeah, if everybody's finished reading, they can have a motion
- to approve the changes. We had this stuff. Can I read this? Yeah. This is not different than what I
- read. Yeah, yeah. I make a motion to adopt the amendments for the Monroe County Chapter Code
- sections 34, 341-2, 341-5, and 341-8. Baz, give it to us. All in favor? Any opposed? Okay, motion passes.
- Now before you leave the hot seat, several of us really used to appreciate those
- monthly or every other couple of weeks, lists that would come out in the paper version of the HT when
- there was such a thing, listing the code violations because it helped us understand we're not to eat.
- And those haven't been published for a really long time. And we would love it if they could be put on
- the website or sent to the newspaper or something. What's a board? Or sent to B Square. The biggest
- change is with the way we're noting those violations, it was critical and non-critical for now how we're
- entering them in.
- for priority foundation and priority. So the way that information goes to GIS and it's populated on
- the website, it's kind of under construction right now. So we're working on making those updates and
- hopefully it'll be updated soon, how we're transporting our access information to the new server. Will
- it be published in such a way that a normal person can read it without, because I actually tried to
- look something up because I got in an argument with the food server once about how
- dirty his place was here. And I tried to look up when it had last been inspected and it was said, oh,
- well, we have a report from 2004. Well, that doesn't help. I'm sure you have done an inspection more
- recently. But like, and I had to use this GIS thing, which is always horrible. So I guess
- As an older person, I'm asking, can you just like publish the list? I think it would be easy for them
- to read. I'm saying the more we use the GIS, the more user friendly it becomes. But I can speak with
- the food sleeve and see what we can iron out. Thank you. So in doing the GPS, is there a way of like
- making the bad guys read and the good guys reading?
- And the yellow being the cautionary, you know, do it at your own risk so that then we could go to one
- of them and say, oh, that's great. I can go there to eat. Is that possible? Like on the website or on
- the facilities themselves? On the website.
- color code maybe we can potentially work on that. But I know if you dive into the report, like the chunk
- of the important information is there, so. Yeah, it just, you know, it's like, make it simple for us
- old folks to, you know, identify where we can eat and where we can't. This is just my side, but I would
- love to see the system they have in California, A, B, C letters right in the front door. Oh, great.
- Like a grade?
- Yeah. If you go to a dining place in Illinois, they do like a red browny face. If it's not good, like
- a yellow mute face. If it's OK, then like a green smiley face. So should we bring that before the book?
- Well, it's for the general public, too. Yes, right. Right.
- And I have had questions when I tell people I'm on the board. That's one of the first questions they'll
- ask me as well. Where are those reports? I used to read about the restaurant inspections. Do you remember
- there used to be one restaurant that consistently held some of their some of their products were held
- at temperatures below 40? I believe, but now what did 141 hot foods are held out for some?
- holding 141 or above. Yeah, well, right. Unless there were some that it's just like every time or they
- repeated violations for that and. You know that you knew not to go to that. That's a problem. But if
- anybody from the Board of Health wants to finish visit the food protection vision, I listen. I will
- definitely like to show you how to navigate the GIS system exactly when it's working. Not in construction,
- but we have to help the entire public know what is.
- and it's not safe for them to wear. So it's not just about us understanding. Do you guys ever have to
- close a restaurant? Have you ever had to close? Yeah, sure. Are those available to us? Restaurants that
- are closed? Well, they're closed. They're closed. Well, because if you look, you close, but then they
- do, they do it in your mobile phone. You can come to the back door and pick it up.
- Well, that's a whole different issue, though. They're bad actors and everything. Well, thank you very
- much. No, thanks for having me. Before I turn it over to Laurie, I want to thank Mrs. Sarah and Laurie
- for all of their work this past week, because it has been a week and it has felt like every single day
- of a week. It's felt like a year. Working on the budget stuff. And I also wanna recognize that one of
- our council liaisons, Peter Everson, is attending virtually. It does not look to me like our other liaison,
- David Henry, is attending.
- And thank you. I appreciate you being here, Peter. I also just want to acknowledge, having watched most
- of the budget meeting on Tuesday, not all the budget meetings that have been put in place for a month,
- but I just, I can't imagine how hard the job of the council is to cut all of this money while at the
- same time trying to preserve jobs and not cut services. So,
- Just by way of preparing all of you when Laurie goes over our budget. There may be some screaming. There
- may be some hair pulling for those of us who still have hair left. It's it's pretty it's. Pretty amazing,
- it's pretty. It's going to be hard. So. There you go. That said, with that said.
- I was going to also highlight at the county council meeting this week we did have three grants that
- were approved so for public health emergency preparedness so that's $20,000 for this grant cycle.
- harm reduction funding so that was right around 70 or 71,000 for a one-year term. And we finally received
- the additional disease intervention funds. That was right around 58,000. So that grant is now roughly
- over $300,000 supporting four positions. And that will go until that will finish in February.
- So the fourth DIS position disease intervention specialist position has been posted on the county website.
- So that's 35 hours. That is a PAT-AID position.
- In addition to the harm reduction grant term that term was extended until 2029. However that $71,000
- will really only last us probably until around November of next year and it's unclear whether we will
- receive additional grant funding to continue supporting that program or that position. Then moving into
- some of the other budget items and some of the
- previous shifting around that we've done with funds. So earlier this summer, County Council approved
- to move the IU Health Nursing Contract along with nearly every Health First Indiana funded position
- to the County Health Fund. So this was due to legislative changes that state that funds may only be
- used for Indiana residents lawfully present in the United States. And as we learned at the meeting this
- week, all of the positions except
- for two environmental food inspector positions and the administrative assistant physician have been
- moved back to Health First Indiana funding.
- So this is we've been slowly implementing these changes with the positions that have remained in Health
- First this year along with the services and supplies and some of our contracts obtaining and verifying
- Indiana residency and lawful presence. But we will be doing that.
- department wide. So essentially every single person who is receiving services through the health department
- will have to provide proof of being an Indiana resident and proof that they are lawfully here in the
- United States in order for us to provide them with services.
- The originally proposed 2026 budget amount that was being requested after removing the roughly $783,000
- that was vaccine reimbursement funds was right around $1.5 million. After the county council action
- on Tuesday, the new health fund budget for 2026 is $653,913.
- So that's really all I had. I also just want to put in an aside. We talked about this at other meetings
- that the information Lori referred to that the state is requiring about citizenship and residency has
- been posted on our website for quite a while. So it is public facing. Can I ask a question about that?
- So if we have a person living in the county who has active tuberculosis,
- and they're uninsured. And if they're not citizens, what would we do with an active TB case for a non-citizen
- who's walking around for over? That is the dilemma posed by this legislation, because as you know, all
- local health departments have a legal mandate to control communicable diseases. So if we perform one
- of our legal duties, we will be in violation of another law.
- And just this week, some of you received what I sent to our county attorney requesting, suggesting some
- ideas. I also wrote to both of my representatives describing the dilemma. We shouldn't be put in the
- position of one or the other because we can't do both at the same time.
- So the sentiment from the council was. From our liaisons outside of the council meeting was that we
- would just have to talk to County legal to get advice as issues come up on a case by case basis and
- their. Thought was well, maybe this might occur maybe once a week if that or a couple of times a month.
- and they wanted some kind of numbers. I mean, we don't currently have those numbers. We haven't been
- tracking that. So what's the difference how many times that happens? Well, it happens once a year. You
- can't have a person walking around with a TV. Right, so at this point we are instructed to
- talk to county legal. Each time. Which is, I imagine, what we would do. And we would probably make a
- case for the situation being a public health threat. We would probably make the case for our needs to
- protect the public. But who knows? We haven't, that hasn't come up. We just, we can't answer. Well,
- I mean, I can certainly talk, I can say that one of the significant
- ongoing TV cases, active TV cases that we've had this year came from another county, actually came from
- out of state, came to another county in Indiana, then came to us, went back to another county, was supposed
- to go back to another state. I mean, and I know what our public health nurse was doing to track this
- individual to make sure
- that he was taking all three of his meds every day. And when she would lose him, you know, we found
- ways to locate him again, to get him back on track. We have another individual who again is, has, I
- don't know what her legal status is, but another active case, which again, you know,
- A lot of folks come into this community and we know that there are a lot of latent TB cases that we
- would like to follow that are at IU. And unless they agree to being treated and checked, we cannot do
- that. So we have problems all the way around, particularly in terms of TB. That's all I can really tell
- you from health officer standpoint.
- So I believe were these are these printed copies but they weren't in the packet because they came out
- so late. Yes so if you haven't seen this is after the council meeting if anybody wants to see those
- what happened with our budget the other probably the big okay one of the big
- Items was last time we discussed money that we had in the COVID supplies line and our plan to purchase
- a mobile van and how we were going to use that well. We had a nice couple weeks of thinking that was
- going to happen because. I think that money was earmarked for certain. Well, I mean, I thought it was
- clearly stated when we got the money that it was
- things. As a surprise in the council meeting on Tuesday, Councillor Henry brought up that fund and requested
- that what I'm calling a forensic audit be done to determine since it was COVID money if any of that
- needs to be paid back to the Kenilty. So
- We are waiting, presumably, for the results of such an audit going back to 2020, probably 2021. In the
- meantime, they took it. They took it. They didn't take it. And if Peter wants to say anything, it seems
- to me it's in limbo. It's sitting there. We can't use it. We can't use it. So they did take it from the...
- in the sense of we can't use it we can't buy the van at least not now. And then presumably someone is
- going to look at what expenses were paid for using local dollars and. My understanding is that a forensic
- audit will take over a year to complete. So we won't be seeing that money for a very long time if we
- ever see it again.
- externally you know. I assume. No I don't know. But maybe. Peter do you want to do you know anything
- in answer to this question or do you want to say anything about this that would help us understand.
- I think the best thing I could say right now is that we set that line to one dollar. No budgets are
- final right now. So that can be changed at our meeting on the 23rd. That can be changed at the public
- hearing on September 30th.
- and that can be changed anytime before our budget adoption on October the 14th. All of those meetings
- are on the county calendar. You know, what Council Member Henry has in mind for an audit, I can't speculate,
- but if it's going to take longer, like a year or so, I think then we need to revisit this. I know that
- those funds,
- we had talked about using for a vehicle, if I'm correct in my memory. I had a long meeting the other
- night, so I need to be double-checked on everything. You really did, yeah. So I think at this point,
- from my standpoint and from where I sit, it would be really nice to know if that vehicle is allowable
- given the purpose of those funds. And if that is something that can fit into that line, we're really
- up against the timeline here. And so, like I said, budget adoption is October the 14th. And that's kind
- of the deadline, I think, where we need to figure this out.
- Thank you. Thank you. That's helpful. Do we know where the source of those funds came from? It was most
- likely that all of the federal dollars that went to states for COVID. And so it then became state money
- and their vaccine and reimbursement. So like typical vaccine reimbursements. So my understanding, and
- I came in late to the game to all this. So I received an email with a spreadsheet of all this money.
- And I'm like,
- is this. And so started, you know, trying to dig around. So when my understanding is the state was helping
- to do billing for the COVID vaccines, there were there was originally one organization. So Viper,
- I think, is what it was called, and then a Thotex. So two different ones. So they were covering the
- insurance reimbursements. And then this was coming back into the health departments.
- So it's supposed to be treated similarly. It does stay in the County Health Fund into $1,159, like our
- typical, like our VAX care reimbursements that we get. So it's similar to that. Thank you. Thank you.
- I was wrong, then. It wasn't the federal money. May I ask Peter another question? Peter, oops. You'll
- come back. There he is. Peter, can you tell me if, indeed, council orders
- A forensic audit. Of this funding. Does Council pay for that forensic audit? That is a very good question.
- I've been on the Council for. Let's see, I'll I'll be on it for six years now. We have never done something
- like a forensic audit. This is very new to me. My presumption. Is that?
- we would have to see what exactly is entailed here. My assumption was that we were looking just for
- these funds for this budget. And again, adoption is the 14th of October. So if it's gonna take longer
- than half of a month, a month, then that doesn't seem very useful to me. And we do know that our department
- has been meeting with the auditor's office and basically doing forensic auditing
- of all of our grant funding. So I'm wondering whether in your understanding of what Councilman Henry
- was proposing, whether this would fall under that or whether we are genuinely asking for an outside
- forensic auditor to come in, which is, I understand is not only laborious to go through all of our auditing,
- all of our books from
- whenever, and very expensive, because it's at least a year's worth of work. That's my concern. We're
- spending money on an audit that could be spent on health care. Also, forensic audits are basically saying,
- we believe some law has been broken. Now, that was my turn. That was absolutely my turn. And it only
- meant it to do a look back, which was what it sounded like he was saying, going back to 2020,
- Did the county use, for example, rainy day funds for COVID that they should be reimbursing themselves
- with? So I don't want to put words in anybody's mouth. That was my word. So it may well be that what
- we have already been undertaking with the auditor's office going back to all of our grant funds back
- to 2014 and who knows beyond that suffices for what
- Councilman Henry needs to speak. That would be different. I mean, the amount of, if you look at the
- DLGF, the amount of funds that came through the county health department for the budget that was dispersed
- was 4.6 million in 2020. So that audit process would be totally different than what we've been doing.
- And now I don't want to put words into Council Member Henry's mouth, but let me just repeat, we are
- talking here about a vehicle to help you fill your statutory requirements. And I think in the short
- term, we need to figure out if that is an allowable expenditure and move forward with the budget in
- that way. And then Council Member Henry can come and talk about what type of audit he thinks is necessary
- for those funds.
- Thank you. That makes sense. Thank you P.S. We appreciate your being here. It's my pleasure. Any other
- questions having to do with. Oh do we want to talk about the 23rd and the plans we had. If not at all.
- So remember also at our last meeting we talked about what we felt we needed for positions to perform
- community cases case investigations take up some slack with
- vaccinations and do the school health liaison work that's required by Health First Indiana. And we just,
- again, thanks to the help of these guys, we just submitted the request to council this afternoon. It
- will be on Tuesday's agenda, Tuesday the 23rd. So if anybody wants to attend, please do. We are asking
- for one new position that will be called a public health nurse that will have
- primary responsibility for communicable disease case investigations, scheduling vaccine clinics, doing
- the outreach on the van if we're lucky enough to get it for clinics, and taking the lead on the school
- health liaison work that we need. And we also have a request to revise two positions to be backup to
- that effort so that if we have
- a surge of disease and they need more help. We'll have people already trained and it's in their job
- description. Or if that lead person gets sick or goes on vacation, we'll have people that can step in.
- So it's pretty much what we talked about a month ago. Are there any questions about that? I just had
- a question. I know that Kay was concerned because we lowered the salivary range. It was so low that
- we couldn't attract others. Is that still the case that we hired an EMS? It is a PAPD.
- Our request is a path D, which is the same level as the Director of Health Services, which is what went
- through with and that is that a nurse level as well. So this will be minimum LPN. Having taught and
- they'll be in her head. I was over an LPN program and an RN program for many years. That's not in the LPN.
- They're not in that area. They're not. We're going to have to train that person. We're going to have
- to train any person we get. We're going to have to train them in basic epidemiology. They don't have
- that training. That would be.
- putting them through a nursing school outside their scope. They wouldn't be covered by malpractice.
- That's what public health nurses do all around the country. That's what they do all around the country.
- They are not taught public health. Exactly. And that's why they have to be specially trained once we
- get them. Just like our DIS. Our DIS come to us with all different backgrounds. Some of them
- No medical background, you know, degrees in psychology, degrees in business. I mean, and we spend the
- time training them in epidemiology. We train them how to do venipuncture. Legally, they practice and
- they practice under something called the Nurse Practice Act for the state to get their license. It does
- not recognize those kinds of things. They're not licensed in the venipractition. Right, right.
- They're not going to be into it. They're going to be practicing under orders. Yeah, of the health of
- what they do now. My order stands on. And yes, we already have an LPM. So. She is under. The same orders
- that this individual or individuals will be under. That's just.
- It's how it works across the state, unfortunately. And yeah, it'd be delightful if we could attract
- someone with a background and interest in public health nursing who has been doing this. We don't know
- that that's gonna happen, especially at the level we can afford to pay. George. The hearing is on Tuesday
- the 23rd, when and where?
- Probably in the NatU Hill Room 430 or 5? Five. Got five fingers. Thank you. Five o'clock, NatU Hill,
- thank you. And a couple of people who cannot be there. They said that I do not do that. Oh, yeah. Are
- you going to be gone? Are you on vacation? Well, I was supposed to be. I can come back. Oh, my goodness.
- We'll talk about that offline. We'll talk about that offline.
- Yeah, the country. Oh, this is just wonderful to me. Every time I had a patient. Yeah. OK. Oh, I'm sorry.
- Peter, did you have a question? I simply wanted to mention, as of right now, the draft agenda was released
- yesterday. This is item 9G on our agenda. So if you're more than welcome to come at 5 o'clock, or you
- can come a little bit later.
- It's in the middle of the meeting, so. All right. That's good. Good to know. It sounds like it might
- only be me and George. I mean, I don't know, because everybody else is going to be gone. Can I maybe
- talk about one more thing? Peter, since you're here, so some of the changes with the 2026 budget with
- some of the positions. So I think my biggest question is,
- Can we make modifications with what positions can remain in 1159 compared to what is there currently?
- Because for example, right now, we don't have any positions from vital records. So we do get out of
- state individuals who are born here. It would be ideal if we could still at least have one person in
- vital records who could then do
- the services for those individuals rather than we will have to refer them to Marion County. Same thing
- like with our wastewater. So we have backup coverage in each of these areas. This legislation is causing
- so many headaches. Oh my goodness.
- The quick answer is we can look into it. I mean, right now, I think we need to talk about it and which
- positions you're talking about. I'm not looking at the cumulative budget, but let's talk about it.
- I mean, because again, you all are the experts. So I'm just the fiscal guy. Yeah, I mean, I really think that for
- our department and our community having at least one person in each of those areas in environmental
- and at least one in vital records, if not two, still in the county health fund is really necessary.
- If we have someone come in, for example, for a septic permit and say they just refuse or they say, no,
- I'm not, then we're in the same type of situation to where we cannot provide them with that.
- And so having an option of having a person to assist those cases is really, I think, necessary. Yeah.
- Ms. Kelly, if you could send that request to me, your liaisons and Kim Schell, and indicate which specific
- lines you'd want to address, that would be really helpful. Yes. I sent that to Kim earlier this week
- on Monday. So you all should have that.
- All right, great. Thank you. Thank you. I think we're ready to move on to old business. We have an agreement
- to approve, which was in your packet. Does anybody want to speak about this? So I would just encourage
- us to vote it down, even though this is a fund that Steve and I have been working on. The reason is
- because it
- We will add, if you look at the laws that surround pass-through agreements like this, it adds the, and
- then from the city, the county may be required to do this, it adds the auditor's office and it adds
- the county council as being approval bodies for any, it adds it as a line item to our budget, essentially,
- that they have to account for, she has to account for.
- Whereas the intention, at least of me, for this fund was to reward our employees quickly with tokens
- of our appreciation for their service, to help them get further education, to travel through a meeting
- that they couldn't afford to go to otherwise, that would give her some latitude to do that. But it sounds
- like it's going to be more complicated than that. And so I would recommend we vote it down. And I haven't
- talked to Steve about this
- except for now briefly but that may be a different mechanism so for instance we could do it in a different
- way that would involve all the layers of of layers of government like we could get a list from her once
- a year about people who have made requests and we could reward them individually outside the department
- and send them a check from this fund to fund whatever education they need or or to fund their
- recognition or whatever, whatever the administrator feels that would not involve a pass through because
- it wouldn't be held money held by the county. Just just as a little background, if just to make sure
- everybody knows we sent this. The and I set this fund up through the Community Foundation. It's a tax
- deductible fund. It's called the odd money or phone, which means for better things. Thanks to his wife
- name shooting.
- It was really originally set up to reimburse people in the department for things that weren't. Reimbursed
- through normal channels through the through the Council through. Grant things that we were normally
- have as course of matter they would be reimbursed for. For instance, we had recently had a board retreat
- or if you want to call it that.
- And that was in August and it included lunch the day at Cascades Park. There was an agenda. Departments
- were reviewed. There was a program and this fund paid for the food, the shelter house and anything else
- that had to do with this.
- Please. And the employees enjoyed getting out of the department. You know, it's nice to not see the
- same four walls all the time. Trust me, I know what 43 years looking at the same building as a dentist.
- So we set this up and it was an intent to that we would that people could donate to this fund.
- that would be for the betterment of employees. And this was a private donation. So we don't want county
- involvement in a private fund. And I'm not sure if, and I thought we cleared this with county legal.
- I know we saw the document prior to this, but now, you know, here we come back around and now, and my
- concern is this.
- and our concern is that if we pay for something, will the powers that be simply deduct that from what
- they would normally be giving us? And I don't want to sound like we're just, we just trust people, but
- you know, it seems that, you know, our money's being taken away. And I know that part of it, the money's
- been taken away now is the council, I think is,
- is agonizing over much of this. A lot of it's mandated by the tax levies and things like that, that
- they are what they are. But we prefer to have this taking place as private citizens, private donators
- to the department, and they can be reimbursed directly for legitimate expenses, which of course they
- would show receipts and
- Provide an explanation of what it was used for. There there is a list of things that this. Could go
- for that was had to accompany when the foundation paperwork that we had to turn when we turned this
- in. So now at least you have some background about how what what's happening so. I go so to be clear are.
- both know is to allow you to continue to have control of the funds. And use it, you know, the way it
- was intended, which is
- You know, it's very difficult. I mean, it's a long list, but you have to have something on that list
- to justify the money. It's not something you can buy booze with or do anything crazy with. So, you know,
- it's not something that needs an additional sets of eyes looking at all the way up and down the food
- chain in the county. So plus the county, the Community Foundation has a board that reviews each grant.
- That's what that's what it's called. And it kind of reimbursement is called a grant and they review each
- one of those things and the paperwork to accompany it. And they have, they actually have the right not
- to approve it. You know, they don't think it fits the parameters of them, of the document, the original
- documents, so. Anybody want to make a motion? I move that we not sign this agreement. And I'll second
- that. All in favor? Aye. Any opposed? I would think.
- Lee and Steve for their hard work, frustrating efforts and urge that whatever the successor turns out
- to be that we can bring to it to aid our foreign players. Yeah, we certainly accept, since we're all
- retired IRA, you can email right off. We have
- We have one more item which is board member and health officer comments. Anyone besides me? Should I
- just go and we can get out of this? Okay. I do want to say and kind of referencing what the director
- was saying is that you know some of the council meeting felt felt attacking towards Lori and Lori inherited
- department post COVID and a lot of things that she was unaware of or and so she inherited that to guide
- and try to go back and fix things. So I just want to say that she's done an excellent job and you know
- her job currently is a lot of things that she inherited that she has tried to fix and her intent has
- been good.
- And so I just wanted to put that out there. Thank you. I'll second that and say that what I discovered
- is that indeed one of the ways that Lori felt hurt and offended by a council member's comment about
- the fact that she did not take the financial manager with her to budget meetings is that
- Financial managers did not exist when you came on board. They never existed at the council. And so to
- expect you to know that now they would like for you to bring a financial manager, which was not a position
- that existed with you, was just unfortunate, an unfortunate statement. And I hope that you will take
- it with the grain of salt that should have been tossed away
- over the shoulder. So I really, Laurie's been once again has been a rock star through this extraordinarily
- difficult time when we've gone from one horrendous experience to the next, to the next, to the next.
- And we are working incredibly hard to make all of this still work and for us to be able
- to serve the public in the way that all of us intend for this department to serve. Thanks. I just wanted
- to say one quick comment. Since I've done a lot of talking. I just wanted to clear up or provide a reference
- for as everyone here probably knows,
- our arrangement with the public health clinic is changing this year. We'll no longer be partners with
- IU Health in a formal way. We've had a contract in this county for as far back as anybody can remember.
- 60 years. Yeah, okay. And they informed us in August of this year that, well, actually it was Denzel
- Ross, who is the vice president
- for IU Health for the South Central Legion informed us at that meeting that IU Health would no longer
- be treating us differently than every other county in Indiana. And so we will no longer have an official
- contract that we pay for, for them to provide our vaccine services and. Communicable. Yeah.
- If there is any misunderstanding that this somehow there is more to this story or or we did something
- to bring this about, you may contact Denzil Ross. I don't have his phone number, but you can get that.
- I'm sure very easily online. He's the vice president of value health for this area and he has the information
- and can explain the rationale which he explained to us,
- I've kind of shut down when I first heard this because I think my mouth dropped open because we were
- not expecting this and they allowed it and that left us only. Four months till the end of the year to
- try to do something that you know has been there for 60 years and it's just like. I don't know how we're
- going to do it. We're just pushing through. We're just pushing through. We're just going to get there
- and they were providing and they're providing a mandated
- service and disease tracking, and we don't have someone on staff that can do that. Hopefully we will
- soon. And we know Peter's going to help us get that done. We're trying to remain optimistic. Yes. Right,
- Peter? So anyway. I am a politician and I make no promises. Thank you. Smart man.
- Lastly, you all will have seen in your packet, you have a provider fact sheet on Chagas disease, which
- comes from me because I get emerging infectious diseases. I know, I know, I know. But here's why this
- is important. It's not important today, but I wanted to get it on your radar for future because the
- big news to infectious disease nerds is that
- This has been made an endemic disease in the United States, which I read it and I went, what? Because
- it has always been endemic in Central America, South America. This particular bug needs very, very warm
- conditions. Well, thank you, climate change. So we are seeing more cases now in the Southern US. And
- because we're in Southern Indiana, we are going to see this
- before Elkhart, which may not way too cold up there. We may start to see this before anyone does. There
- have been cases, not human cases, as I understand it, reported in Missouri and Tennessee. So it is creeping up the
- The turnpike, it's creeping up the road to us. We may have to deal with this soon. I wanted you all
- to just have some information about it. And if you want me to send you the article from the Emerging
- Infectious Disease Journal, I am happy to do that. It's been on Facebook for some time. Has it? Yeah.
- They don't call it Chagas disease. They talk about the kissing bug. Kissing bug. Don't touch it. Yes, yes.
- Yeah, well it's a real thing and it has some serious health consequences for people and it is treatable
- but we're going to have a lot of clinicians because they've never seen it before because it's never
- been here who are going to be misdiagnosed and so people won't be able to get that early treatment.
- We had a leprosy case in Evansville last year. I'm going to be diagnosed. Oh wow.
- You don't expect to see Hansen's disease either, right? So, you know, who would know about that? This
- disease appears to be hard to diagnose. Yes, sure. Some try panazole and you see the little guy swimming
- in the bloodstream. Cool, George knows. Okay, any other? We have a motion to adjourn. Second?
- Thank you very much everybody good night.