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.