- meeting to order for the County Board of Health. I have two sets of minutes. Actually, the first set
- is for September 18th, 2025, our regular board meeting. I hope everyone has that chance to review those.
- Does anyone have any corrections?
- I'm sorry, but I don't think we approve. I'll second. OK, all in favor. Aye. Aye. OK, minutes for September
- 18th meeting 2025. We also have minutes from October 7th, 2025. That was a special session to talk about
- job descriptions. Does anyone have any
- The only one I wanted to bring up for discussion was under number two, and it talked about that first
- paragraph, the last sentence. It says, discussion included modifying the PHN descriptions to remove
- the requirement of nursing degree and clarify the requirement for an active Indiana nursing license.
- We did that, but that removing it was
- Were anywhere we wanted to hire an LPN or an LPN because they don't have degrees. But if it was where
- you wanted to hire a four-year nurse, it's okay to leave the degree in. You removed the degree,
- didn't you, and just put? Yes, an active nursing license.
- I think that would cover both categories, so I don't think they have a specific one. As long as it doesn't
- hamper her ability to decide one or the other, it's very inclusive. You certainly wouldn't have wanted
- to hire an LPN for that one. You know that's... Okay. Okay, so... Then I'll move we accept it.
- That's written. Second. That's written. Okay. Everyone in favor? Aye. Aye.
- Say me. In favor. I'm sorry. Okay. Approval. Yes. Yes. Okay. Next we have on the agenda general public
- comment. And so I want to remind everyone that is for items that are not going to be voted on on the
- agenda. I need to make a clarification.
- Under E, number one, the Health Services Director, that's actually a voting item. So if anyone has any
- items they want to make public comment on that are not on the agenda, please raise your hand online.
- You see anyone who's, okay.
- Seeing none and Dave, you are not making public comment. Okay. Okay. Next on our agenda is department
- updates and we'll hear from Lori. So.
- I don't have a whole lot to share today. I think we have a lot of other items we'll be discussing, but
- a few significant updates. So we have an individual who will be starting on Monday to fill the full-time
- administrative assistant position. So we've kept this position vacant for a while, actually, just trying
- to save some funding and try to redistribute some of those duties.
- just to be able to have that position and have some assistance is going to be really great because we
- all kind of have a lot on our plates right now. Our current medical student completes her rotation tomorrow
- and then our next one will be starting on
- Tuesday next week. So again, these are students through the Indiana University School of Medicine in
- Indianapolis. They're here for a full month with us and are able to spend time throughout the entire
- department working one-on-one with employees, seeing the work that's being done before they start their,
- finish their training, their residencies. Applications are being received for the fourth
- grant-funded disease intervention specialist position. County Council has issued a hiring freeze for
- all full and part-time positions. I have copies of that here if anyone would like one to see that. So
- that position, the health services director and the administrative assistant were able to move forward
- with filling those positions if it's before November 1st, from my understanding.
- If it's after November 1st, my understanding is a request will have to be submitted to then be able
- to fill any vacant positions full or part time. We are going to run out of funding for the methamphetamine
- program, so those
- We were going through doing testing and remediation to try to clear that list. But it looks like we're
- going to have two houses that we're not going to be able to have enough funding to do the testing and
- possible decontamination. But otherwise, the program has been really pretty successful and have been
- able to clear a lot of the homes or provide the funding to have them decontaminate. Do you have a number
- for the number of homes who have cleared?
- I'd have to check with Mike just to give you an accurate. Those two that are left, what happens then?
- I mean, do they just condemn them or? They just stay on the list, so they would have to be tested to
- see what the levels are. If the levels are safe, then they gets removed from the list. But if it's not,
- then the homeowner needs to do the decontamination. Just one of those things that we do that is
- regulated, required that we do? No, we have to monitor the list. It's not a state required. For like
- the core services. So the homeowner can do the decontamination or hire it done and then we certify that
- it's done? Yeah, we keep track of the list and then we take it. We have our own internal list of all
- the properties.
- so that we have that for our internal records here. That's all I had. Is Michael online? Is he voting
- tonight or he's just listening? He's online. Yep, I'm on.
- OK, got it. He can't vote. He can't vote without video. And I think the email he sent said he can't
- be on video. Is that driving? He's driving. Yeah, I'm in the car. I'm sorry. Got you. OK. No, yeah,
- we don't. We want you to be safe. Can you guys hear me? Yes. Yeah. OK, very good. Yeah, I'm in the car.
- So just listening. OK. OK, so we have old and continuing business.
- So we have the, actually we have the health services director position filled as Lori alluded to. And
- the issue is that the gentleman may not or will not have his license. He has his degree, but not his
- license until possibly December. So I'll, so we'll need to
- vote on that. We'll let you give them details and then we'll discuss them. Sure. So an offer for the
- position of Health Services Director for the candidate was accepted on September 16th of 2025. So in
- discussions with the candidate is planning on taking the exam for licensing either the end of November
- or December. So we were looking at
- a late December start date for him to complete that. I recently spoke with Dave Schilling about bringing
- the candidate on sooner before he completes his exam for licensing to allow just additional time to
- be able to settle into the position, start some of the training because this position will be assisting and
- potentially with nursing services and communicable disease, this individual could go ahead and start
- that training process. And the request is going to be, does the board approve of us moving forward with
- bringing the candidate on prior to completing his exam or wait? Then the second issue is how is the
- hiring freeze
- May. Impact it because the candidate will not be starting by November 1st, so I think that it would
- be really important for Molly to speak to that. If she's here. So there's not my son with the yellow.
- I'm terrified and the left. Can you hear me now?
- Yes. Okay, sorry. I was waiting to become a presenter. I think the safest thing to do is probably update
- the county council because they did provide an exemption for the health services director, but the exemption
- was set to expire November 1st. So I think they could possibly consider extending the extension depending
- on when you thought this candidate would start. So I would just
- I would recommend that Lori send council office an email, explain the situation, and then I can discuss
- it with county council to see if we can get you an extension or we can extend the exemption past November
- 1st. And so should the board still formally vote on that, whether or not to approve bringing the candidate
- on sooner than our original higher date that we had planned?
- I mean, yes, I think if the original plan is going to change, I would recommend that the board go ahead
- and vote on it contingent on the county council extending the deadline, because I'm sure the council
- is going to ask. Has the board discussed this? OK, ask a question. So if he takes his exam in November,
- December, whatever it is, when does he get results? Do we know if he's licensed to pass? Oh, sure.
- We ought to make sure that we extend it out if we're going to ask far enough to include getting the
- results. And you might have to ask him when he's supposed to get the results. I can follow up with them
- again for that, because I didn't think about that. Of course, the position that's remaining in it would
- be he'd have to meet the qualification at some point. But I don't know. It used to be that your results
- would come
- based on how backed up the Health Professions Bureau was. But technically, the machine that you take
- it on can tell you at that moment whether you pass or fail, but they don't. It has to go through the
- Bureau because Indiana's licensing you. And so it kind of depends on how backed up they are. So how
- long have you got? Is it approximately long so that we ask for enough time?
- My question would be, has he registered for it yet? No, because he said he was looking at two different
- dates. He was looking at Terre Haute and a location in Indianapolis. Hopefully he can get in when he
- thinks he wants to do it. I would move that we bring the candidate for health services director, physician,
- who has already agreed to join us on board as early as possible.
- particularly during a training phase, up till unless he gets his license. But I think he should be limited
- in what he does, that he should do the training part, but not actual hands-on patient care. Oh, yes,
- definitely. Oh, sorry, mom.
- Sorry, if I can jump in, I think I would also recommend talking to Dave because I'm not so sure we shouldn't
- have some type of written agreement so that it's clear to the candidate what the expectation is and
- that what he's doing prior to passing the exam and what will happen if he doesn't pass the exam. So
- I would talk to Dave about getting something in writing.
- Yeah, well, I think we've done that before like a memo and then that goes with their new hire packet
- and it's signed and everything. So I'll follow up with Dave on that. So your motion should it it said
- you said to hire the person as soon as possible. Do we need to make it higher him by November 1st? The
- candidate will not because the candidate needs to would like to provide at least a month.
- to finish out with his permit. OK, so what should we? And he's unlicensed. So you really can't let him
- do any kind of professional duties. So we need to have the contract first before we make our. So when
- I spoke with him we were looking at the second half of November for a start date. I left the motion
- vague because I
- Assume that there were going to be problems with paperwork and the licensing and so on. So. If that
- needs to be sharpened up somehow, I would be happy to entertain a friendly motion friendly amendment.
- I would. I would agree with onboarding activities, but not professional activities until we have the
- license in hand just to protect ourselves and the public.
- Okay, so that would mean and the initial period of his involvement with the department would entail
- principally training until the license of the appropriate kind was obtained. I would second that motion.
- All in favor? Aye. Fantastic, thank you. George.
- Okay, so the next item of business is the 2026 budget discussion. And so I have some updates prepared.
- So I think maybe we, I would like to present these updates and then Molly, definitely we would like
- you to stay with us until, because we may have some questions for you in trying to
- Move forward. So the first item is that we have been asked well. We have been asked by Council specifically
- Dave Henry, our liaison to have a business plan for the mobile unit. However, the
- Proposed budget at this time is that the monies for the mobile unit will actually be unavailable as
- they are being moved. The funds have been moved. Is that correct from the budget? They've been
- de-appropriated? De-appropriated. So that's item number one. Should we discuss each thing or just let's
- kind of roll together?
- Well, it's up to you. I've come about this section. You know, having a business plan is definitely
- appropriate for a business that has an ROI and has to have income and taxes and all that stuff.
- This is not, this is the department of our facility and we don't have to make a profit on it.
- We don't have, what we're doing is public good. And the money that we're being allocated for this is
- for improving the public goods. And you can't really measure that as a business plan.
- So I think it's inappropriate to have a business plan for a mobile unit. So the other comment I would
- like to, well, the other item I want on this, regarding the mobile unit, because this is in regards
- to the COVID funds. And so I want to just read,
- a document, this is a memorandum dated January 4th, 2022 from Dr. Christina Box. And this is in regards
- to the COVID-19 funds. This is a quote, these funds are one time in nature and are therefore should
- be used for one time costs and investment. There she said several things that
- Public health nationwide is experiencing unprecedented funding challenges. Therefore, local governments
- should not use these funds to supplant local budgets. So, I'm not sure what to, I don't know, Molly,
- can you comment on that in terms of what's been suggested with the council's budget?
- I think the only comment that I can provide really is I don't know what they really want when they say
- a business plan. So I wish I could have more insight for you, but I don't know if that means they they're
- concerned about profit, which I don't think they are. I think they're concerned about who's going to
- be using it. Where is it going to be parked? What does all that look like? Where are we buying it from?
- What are we buying? And so I don't really know what details myself they want, and so I can.
- follow up with counsel to see if I can get you guys more detail, but I don't know what, when Mr. Henry
- says business plan, I know what I think of as a business plan. I don't know if it's the same thing that
- he's expecting. Okay, so how can we really facilitate communication because the vote is,
- October 28th. We're supposed to have this information to him by October 28th. So how do we facilitate
- this communication? I can send council an email and I will include board chairs and Lori and I can do
- it either tomorrow or first thing Monday or even maybe tonight and ask you
- You know, you've asked the health department for this business plan. If they provide the following details,
- is that what you're expecting? And see if I can get some guidance from him as early as tomorrow, but
- I can't promise anything. Okay. I think that that directive comes from the. This is from the state.
- From the top. Right. And Dr. Box, and she's saying this is a one-time investment. You need to buy a.
- something with that. We did that. We submitted a request for the band or for the mobile unit. That is
- exactly what the state's asking us to do. I think we should follow the guidance of the state. And the
- health department should decide how we use that equipment. And I don't think it's a matter for the county
- council to decide. I agree. Just like they don't tell the fire department how to put out a fire. I don't
- think they need to tell us how to use a mobile unit.
- But that's my opinion. I agree. OK, so the next item that actually we were then asked to provide a business
- plan for the health department. So does the budget not work well?
- So these are taxpayer dollars that we are trying to run a taxpayer funded department. We are not about
- making a profit. I mean, certainly if you look at the numbers, I mean, our income annually from the
- health department is about $500,000. If you look at the budget with our new, well, with the proposed
- changes with the added
- positions, that's around $2.4 million. And at the last meeting, council suggested that they are going
- to cut our budget or intend to cut our budget by $1.8 million. So we are not a business. We are here
- to provide health and wellness services, vaccines, safety for the public.
- I was looking at this this budget. There's a line item here for financial manager. Is that something
- that we have had in the past? So it started. Yes, it's a position, so it's not sure how long that position
- had been filled prior to Penny retiring, but it was. Do we have still have a financial manager on board?
- Yes, so is that who?
- Council is referring to that. We need to have our financial manager present. A business plan for our
- department and do other departments like fire department have to provide the same thing to the Council?
- So. I wonder why we have to provide that. I think it's a fair question. So only how would how would
- you advise us in terms of?
- this request for this business plan for the health department? Again, I'm not sure what the council
- means when they say a business plan. I don't know if it's something like the parks master plan. Um,
- cause I mean, parks has a master plan. Um, I can't think of any other departments that do this. We don't,
- although the council approves the fire department budget, it's not a county department. So it's kind
- of a weird thing. So I guess I would ask, I can again ask them what they are anticipating the health
- department providing, because it's one thing for them to say, we want a business plan. But I mean, again,
- that's kind of a vague request in the sense that,
- what you think of a business plan is probably not going to be what they think of as a business plan.
- So I would, I would encourage the council to provide you more detail on exactly what they want. Okay.
- Do we have a strategic plan like for that response to the things we list on the CHA? It does need to
- be updated our strategic plan. So we do have that and we can certainly offer that to the county council
- and just so they can see where we're going in the future.
- That won't be a business plan, but it will be a spending plan. We have an annual report which details
- all the activities of the department. I find it hard to understand how that could be interpreted as
- a business plan, but it is our business. And the State Board of Accounts audits our council every year.
- which is another layer of safety because they're looking for things that don't make sense or don't fit.
- So that will be another thing that we already do. And I will say, I think the business plan request
- comes in light of the conversation regarding public health nursing and the ending of the IU contract
- and whether it's another contract or in-house employees. And so I think some inclusion of how that would look like
- or be administered from the health department rather than a contract is also kind of what the council
- was looking for. Okay. Let me speak to that with the request for the positions, the new positions we
- have asked for so that we can meet the needs of the public, the needs that were being met by the contract with IU.
- But that's brought with landmines trying to do that in a very quick fashion so that we can provide services
- so that we can provide our thoughts about what our plan going forward should be. The next item we should discuss
- Is that there is a code actually for the HFI funds and we have to be in compliance with that code and
- with the moving of the funds. In during the last budget meeting. It's really unclear. If we're going
- to be able to meet the criteria that's set out by the state, it's not a straight. It's not straightforward
- because each position is
- different meets different criteria for the code, it's complex. So I'm not sure also how we're supposed
- to maneuver that, Molly, I think, because we have to be in compliance with the state in order to maintain
- our funding. So if council, you know,
- I'm not sure they are aware of all the nuances of what we're trying to accomplish to maintain the funding.
- And I know that seems completely unclear, but. I think I would include the HFI code in our communication
- with the council so that they know that we are between breaking a law, state law, and not getting any
- funds, you know, and put the whole county in. That's provided.
- The information so they have seen the codes. They know that we have. They've seen good. I think that's
- I think that. Sorry, I think it might be helpful. Is there a particular budget move that you think the
- Council made that makes it likely that you're not going to be able to comply with HFI? I would say yes,
- the self insurance is what I'm most concerned with right now.
- Okay. So, um, I don't know that I can speak on the self-insurance cause I think that was a whole conversation
- with the auditor's office and they were following up with the state on it. So I'm not sure what guidance
- has been requested, received, um, or shared with council regarding self-insurance and HFI, but I will
- follow up with the auditor's office and council.
- OK, so the state said their position remains the same, that if it cannot be basically explicitly demonstrated
- that every dollar is going towards a poor service or an employee, that those funds, the self insurance
- should not be in the HFI. There is an email and I can send that to you as well.
- What about the issue too, where the health first Indiana funds say that you have to be a citizen of
- Indiana or a resident of Indiana. But if we have someone, say a homeless person who has tuberculosis,
- we can't do anything with that person. What do we do? Because it comes from those health first Indiana funds.
- between a rock and a hard place there. So we'll definitely have services that we will not be able to
- provide or people that we will have to deny services. So one of the programs just as an easy example
- that we've kind of been dealing with are the septic, the real estate inspections. A lot of those are
- out of state buyers. So that's just one example. We will not be able to provide those services for those
- individuals.
- The hope is that we can use local county dollars for those communicable disease services. Some of the
- positions have been moved to grant funding. If that's an option, that's really what we wanna look at,
- but it's gonna be challenging. So Lori, are there any of these specific, the ones in green on the budget?
- Are any of these positions that were moved from 1161 to 1159, are any of these specifically in violation
- of code? Or is that, you may have to, it may take a while to investigate that. So what,
- with the services you mean being provided for in 2026? Yes, for these positions, yes. So they left two
- food positions in 1159. So our foods division will have flexibility. Essentially every single person
- who walks into the health department will have to provide documentation and then we'll have to determine
- whether or not we can provide the services. They did
- move one assistant registrar. So again, we use an online platform. A lot of those individuals coming
- through vital records don't meet that criteria. So we have one individual who will be able to receive
- all of the online requests and address anyone who is not an Indiana resident or does not have documentation.
- Our other environmental positions, I mean, that's concerning because we don't have any other backup options
- for the rest of our environmental services that are being provided in the community. Except for those
- two food inspectors, everyone, all of the other environmental positions have been moved back to health
- first. So that is delineated the senior environmental health,
- Is that what you're referring to? Yes. So all the wastewater sanitarians and our general environmental.
- So our pool inspections, mosquito trapping, all of the subject wastewater work. So those have all been
- moved back to Health First. So what I would like to see then is just a memo that you create a memo saying
- these positions
- Because we don't have backup positions that don't have the limitations that those moving those we would
- advise against that because of the.
- that we have to meet? Yes, so I have requested and I've asked even if we could flip flop or switch some
- of them, even if it was can you flip flop one of the foods and move a different environmental or even
- the manager who is trained in all of the the area. So if a situation arises, the manager can address
- and take care of those situations. Unfortunately, that request was denied and I was told that that's
- just not an option.
- So I think we need some sort of a legal statement from our attorney about what do we do when we're between
- the law breaking the law and not getting funded. And, and, and especially your point, what do we do
- when we have a person running around coughing up germs and TB germs and Kroger who doesn't meet the
- criteria and therefore we can't treat them. Will the state take care of these people?
- You know, Indiana is one of the states that has a law against untreated TB patients. You can actually
- incarcerate them temporarily to begin treatment. Certainly don't want to do that, but we have to protect
- our community. And I think our lawyer needs to tell us what liability are we at for these unfunded
- requirements by the state code and for patients who have infectious diseases that we're not allowed to treat.
- I think we need some sort of state reading of the statutes. Is there a way to? Bring this to light.
- Before the vote so that Council understands or Council with County legal understands. The position we're
- going to be in and is there an easy easier way to?
- Or can we request to not cut the budget in X line item because we need that position in order to? Have
- public safety. Yeah, I would say those are non negotiable line items. If they're required by law, they're
- not negotiable. And I don't think our county council has authority to overrule the state of Indiana,
- so I think they need to respect those codes and helps us to not break the law. OK, so.
- Which positions, again in the green, would we, and what I'd like to do is make a motion that we request
- council to consider leaving those funds in the, let's see, in the health fund, correct?
- That's what we're at. 1159. Yeah, 1159. Is that correct? 1159, yes, is where they're at currently. I'm
- going to ask him to testify before the council to show his concern, our concerns, and advise us what
- our liabilities are if we break the law. And I guess maybe if I can
- I provided them with a spreadsheet also, you know, taking into consideration that we know that the funding,
- you know, there's these serious funding constraints. So really what I tried to do was even propose,
- you know, just a backup. You don't have to move everyone, but you have to have at least one person in
- all of these areas that can fulfill the needs. That was declined.
- Yes. They declined. So our lawyer needs to ask, what are our options since we've already requested that
- and have been declined? Molly has her hand up. I'm so sorry, Molly. Please. It's OK. I just didn't want
- to interject. So I think county legal is in the same bind that the health department is, is considering
- there's no guidance on this legislation. But I'm going to read an email that was sent to Lori
- from County Legal. And I think this may help with environmental, septic, food safety, things of that
- nature. So it says that we're not gonna comment on the legislation, but it's clear that the intent behind
- HFI was to use state funds for the benefit of Indiana residents. Without making comment on the legislation,
- We think using HFI funds for environmental services complies with the reasoning behind the law. Leaking
- septics or hazardous restaurants are a direct threat to not only the individual who owns them, but to
- Indiana residents. As much as we'd like to make it more clear, the problem is IDOH hasn't given us guidance
- and no one has. So I think to some degree, our thought process was if someone is reporting
- A food poisoning case, the health department investigating it is not just for the benefit of the person
- who may or may not have food poisoning. It's for all Monroe County residents making sure restaurants
- are in compliance with health code is for everyone, not just, you know, one person. So I think that
- was some of our logic behind. I can't speak to council logic, but that was the legal thoughts on those
- environmental septic.
- Wastewater all those positions. Molly and so it's, I mean, it sounded like the last time that I met
- and spoke with Mike, Mike's the director of environmental that there's.
- the guidance he was provided from legal again. So similarly to what you mentioned, if it's impacting
- or risking the entire safety of the public, then we should still move forward. But if it's more of those
- individualized services, such as that align with the core services, like the radon testing that we do
- verify. And if someone can't verify, then we wouldn't go do those extra services because that's just like an
- add on individual type service. Is that correct thinking? I think that was the conversation that was
- had with Mike. I think the problem is, and it's not a problem, it's some of the hesitation legal has
- in making or providing advice is
- I don't really know what everyone in the health department does, right? So I have an idea of what septic
- does. I have an idea of what food services does, but it's hard to just say as a whole, I think this
- is okay without having a real idea of what services they're providing. So I think if it would be helpful
- for legal, and I'm saying legal and roping in Justin Roddy in this, he doesn't know it. It'll be a fun
- surprise for him.
- Um, but if we, you know, you could say when we're talking about environmental or septic, this is what
- we're talking about. We could look at it and try to figure out better whether it needs to be an HFI
- or if there's another way that we could go about it. Okay. Thank you. Any other comments?
- On this, I would just again, I would say anytime that the County Council is picking and choosing which
- parts of our of our plan it will fund. It's in effect becoming the County Health Department because
- it's making health care decisions that should be made by health care people like us. And so I just think
- in general, I understand that they had a financial responsibility to the counties to make sure that
- we're spending the money wisely,
- I don't think that they should be micromanaging healthcare decisions that should be made by the people
- at this table. The next item I wanted to bring up is that we have been asked by, and this is in relation
- to losing the IU health contract by the end of the year. So we've been asked by,
- October 28th, provide quotes for vendors for services. So those services would include TB surveillance,
- for instance, those patients who have tuberculosis and they have to be monitored, all the vaccine programs,
- and all the services that were in the IU Health contract. So
- I just want to say my my opinion is that this is a this is a request that is just bound to ensure that
- we fail at this at this juncture. I don't think those vendors are there's no vendor. I mean that's our
- that's our job. There's no vendor who can really do this in our community, so I'm not sure who that's
- supposed to be.
- had suggested in a memo that maybe we ask other health departments to provide those services temporarily.
- And I, I just, I think that gives me great pause. I, so it was to take it in-house, right? Our plan
- was to just bring everything in-house, but to do that, we have to have a staff number. The number one
- thing we do in health and wellness and what we are doing is staff. I mean, we have to have staff.
- And so our hands are kind of tied. So healthcare, or rather not healthcare, but public health services
- is not county highways, not fire department, is not any other department. We're just really unique.
- So. Yeah, I think we're not going to, you know, again, hiring vendors to do this work involves a middle
- man and it costs more money. It costs more money to pay the middle man.
- I'm in favor of us taking it in-house and then being allowed by the county council to hire enough people
- to staff it, because we just lost the staffing we had through the IU Health Hospital. Dr. T, I see you
- had to be in depth, yes? Yes, thank you. I had a comment and a clarification. I think it's important
- to note that every other
- you know, County Board of Health provides these services. You know, it's, you know, we've had that contract
- with IU Health in Monroe County for a long time, but at this point, you know, we're just trying, we're
- being asked to basically do what every other county in the state is doing. So I think that's important
- to remember and maybe very important to remind the County Commission that
- This is standard of practice for county boards of health throughout the entire state. Secondly, my point
- of clarification was, if I recall correctly, the proposed positions that we agreed on, I believe, last
- Tuesday, if I recall correctly, that was less expensive than the contract with IU Health. Wasn't that
- correct? Yeah, that's correct.
- Again, very important to underscore for the county commission that not only did we, by we I
- mean collectively, work our butts off to come up with a good solution to this problem, we actually saved
- money in a situation where that is obviously very important for the county. I think we gotta underscore
- those things. I agree.
- The other thing, just to put it in perspective, the median amount of money spent by local county health
- departments in the United States is $41 per person per year. The 25th percentile is $23 per person per
- year. Monroe County is at $8 per person per year. So in one of the lower states, as far as funding, we are
- low ourselves within just this county. We should be spending about three times as much as we're spending
- just to be at the median. And so I think that the perspective of the council is a little skewed by not
- knowing where we sit. And, you know, we're at the bottom of the bottom as far as healthcare spending
- and public health. And it needs to be changed. It's ironic that HFI was supposed to bring us up to that
- median level. Right.
- banished like the spring freezes. And I think it was it was alluded to earlier but you know and I don't
- mean to disdain any other councils but you know health providing public health to the community is not
- something that can be done
- free. Like you have to have funding and you know if we're expected to care for folks that have tuberculosis
- and provide all these vaccinations. Those things don't just happen, you have to have the people to do them.
- So I think Dr. McKinley mentioned earlier, like we're not running a business. It ultimately will always
- be a net negative when you just look at the financials. But the positive is the community investment
- that's being made by the Board of Health for just general health care for the citizens living there.
- I have two more items I would like to discuss regarding the budget.
- meetings and updates. So we worked on positions as Dr. Teague alluded to and so we had had the positions
- and the people in place to provide services by January 1st and so now we have been told those positions
- have to go through WIS and I'm not sure how slow that process is and so
- we are in a time crunch to try to get people or lists to approve those and then get people hired and
- get them trained and be ready to go by January 1st. So that's just one of our challenges. And finally,
- I wanna say that, so regarding these highlighted positions in the packets,
- Oh, I'm so sorry. I've missed. Yes, Molly, please. I wanted to let you guys know I did call this and
- explain to them the time crunch before Tuesday's meeting with the council. And this had advised me that
- they will have a two week turnaround from the date that they get them. So hopefully that turnaround
- will make it will get back to us. You can start the hiring process.
- Okay, now they said that in anticipation that they were going to get them Tuesday. I don't, I don't
- know if we get them later in the holidays, like what that does for that. But as of Tuesday, they said
- two weeks. So they have everything they need to review. No, because council Taylor. Yeah, council didn't
- send it to with, um, so once council approves it to go to WIS, WIS is saying two weeks.
- so it's on the council. So the vote is for that, or is it on the agenda? It goes back on the 28th.
- The 28th, it's on the agenda for the 28th. Okay. So we would implore, yes. Yes, one moment. We would
- implore then the council to please address that so that we can move forward and do what we need to do
- for the citizens of New York County.
- Yes, Dr. Ryderbrand. So what we have to remember is that when we go back on the 28th, and we send it
- to WIS, and if they indeed do send it back in two weeks, we still have to go back to council. And the
- way things have been going with council, it could take, it might happen immediately at the next council meeting,
- or that once again, they may table us. We could be well into December before they hash out whether or
- not we can pay individuals, then we can post. But until they approve the pay and approve the positions,
- we're still in nowhere land. I will add that
- I'm at this immunization conference and I have been speaking with people once again from IDOH who are
- doing what they can to try and support us and are going to be brainstorming how they can help us through
- this particular stumbling block that we have to getting public health nurses on board and
- will be reporting back to me, they promised, at the leadership symposium that I made sure that all of
- you know about at the end of October. So I just wanted you to know that. Thank you. And I think Dr.
- Teague has his hand up again. Yeah, so I have a quick question to consider. Yes. I wonder if it is
- even if this goes exactly perfectly, the odds of being able to hire these folks, like find the right
- candidates, get them hired, get them onboarded for a start date of January 1 to me seems very unlikely,
- even if everything were perfect. I was wondering if it would be possible to approach, you know, whether
- it be IU Health, whether it be, um,
- Morgan County or someone like that to say, could we get six months? I don't know if that would be a
- possibility of getting it one time with IU Health. Hey, could we get a six month extension because we
- just do not have enough physical time to do this? Has anything like that been explored or could we?
- Well, not as yet. I think we were hoping to bring it in-house and
- Part of the challenges with these requests for business plans has been that we really don't have, or
- quote unquote, a business plan. We don't have really data from IU, from the contract even. We had asked
- over and over again for data for what patients were being charged, what money was being brought in,
- how much was being spent exactly on
- vaccines and then how many patients were seen, how many patients' blood pressures were checked.
- And so, you know, as vice chair, I would be very hesitant to engage in that if we can't get, you know,
- we don't want to just return to that situation on the one hand. On the other hand, you know, even though
- this is painful, it would be great if we could actually
- be successful and bring it in house and have have support of council in terms of um and and at this
- point it's a budgetary issue at this point I if I guess uh so um that would be my comment but we have
- not explored that as yet uh if I can yes please I think my my biggest concern with even finding
- Um, like a short term, someone short term, but now I could see if, if council says, uh, use a temporary
- hiring agent, maybe for a contract nurse, but everything that.
- all of the work that has to be set up and established under the health department and trying to do that
- with another entity just for a short period of time. So much time and effort is addressed in all of
- those small pieces, the policies, the procedures, the agreements, the health officer, the license.
- I mean, it would be a lot of. Do we ask how you help the delay their departure?
- three or four more months so that we don't have to change to another person and they just stay and keep
- doing what they're doing for another few months until we can fix this. We could. That would be the easiest.
- We wouldn't have to find somebody else. I think we should ask them if they would delay departure from
- our site until we can get this fixed.
- So you would rather do that. And to go to Morgan County or someplace and start from scratch with them.
- They might have different processes than we do here. And they may be short-staffed also, which I think
- most of them won't. I know they've stopped answering our ambulance drivers' calls for help because they've
- been so inundated with calls from Monroe County that they basically have said, we're not going to do
- that anymore.
- So we have leaned on them quite a bit in the last few years. Morgan County. So does someone want to
- make a motion? I would make a motion that until we solve this issue with our County Council that we
- request that IU Health consider continuing their contract with us on a month to month basis until we
- can rearrange our plan.
- Okay. Does someone second that? It seems like almost the only option at this point. Yes, I'll second
- it. I agree with it, but I also see that that might take away some of the hesitancy that the council
- knows we have to move on.
- But we couldn't leave our patients. No, we can't leave patients. I can't let that happen. Okay, so we'll
- take a vote. Yes, I'm sorry. Public comment before we vote. Okay.
- No hands up for public comment, so we'll take a vote. Lee? Aye. Oh, aye. Can I abstain from voting?
- Okay, so the final item I wanted to discuss. So in the highlighted positions in the packet, council
- or rather our liaison is suggesting, I believe the liaison is suggesting that we approach the state
- as to how we would fund these positions and try to get
- funding from the state. Did I misunderstand that, Lauren? Maybe I misunderstood that. I feel my opinion,
- I feel as though there are council members or one of the liaisons that feels as though the state really
- does need to fund the health department and all of the positions. We can't
- requests directly for them to to increase or pay for those because the state just gives us that set
- amount that they give us that which next year will be roughly eight hundred and fourteen thousand um
- didn't they already give us money that was taken away right 2024 we got zero yeah zero yeah we had to
- use our own accounts i mean
- to ask them now to give us more, how do they know it won't be taken away again? I mean, we're in the
- bottom 10 counties in the state of Indiana as far as how much we value public health, financially speaking.
- And I think there's room to go up on the portion of the tax levy that we are entitled to. $8 per person
- is a very, very low number. There are very few other counties that are lower than us.
- I think that the most recent, I guess, I think that we have council members who really feel that we
- should just be using our revenue, what we receive in revenue for the health fund. So that's roughly
- around $500,000. I don't have revenue, you have to have services. We just lost our services.
- So it's kind of a circular thinking. Yeah. And I think the public need to probably weigh in on this
- issue. It's not just for us to decide, but the public, if the public says that indeed we should be in
- the bottom 10 counties as far as how we support public health, then that's what we should do. But we
- haven't really heard from the public. And I think that's the next step is to find out how other people
- feel about this rather than just us.
- I would encourage people to the public to be aware of what's going on and that's part of why we have
- our meeting publicly so they know and to. Present on the 28th and. Render an opinion about. The state
- of things for for health or no can.
- I would just, and I don't know if we need to make a motion about this, but I would like to encourage
- council to consider that we are spending $8 per person, and the national average of Sedley is? 41. 41.
- It's the median. Yes. 23. So that tells you where we're at. Yes. Fighting with Mississippi for the bottom line.
- Yeah, so so the 28th was really important day. So other other discussion. One update. So given these
- changes and where the Council has shifted some of these funds back into the health first Indiana funding,
- I think one of the largest challenges for us is that they've
- placed costs in the Health First Indiana fund that exceed what I'm actually allowed to even submit to
- the state for approval to use. So currently, we're really trying to figure out how we're going to make
- things work. We are going to have funding left over from this year, but I can't
- use that until halfway. I can't submit a budget request to the state to use any of that until we get
- to the midway point of 2026. I have a question. Are some of the funds that we have in our account already
- dedicated towards something that we received from a grant and so we have to fulfill the grant? So we
- really don't have use of those funds. They have to be used for what they were sent here for.
- And so it's not like a general fund. We can just spend anything. So I think that's important. We can't
- break promises if we've got grant money from somebody we have to honor the grant was for. And that takes
- away from how much money we have left to spend for general things. So I think. If we need to. Look at
- the amount of money that we actually have in the general fund that's not already promised and because
- that's going to be a smaller number.
- than what we actually have. And the health fund? Yeah. If it's promised to for some specific thing,
- then we can't really use it for anything we want to. We have to use it for what it was intended for.
- So if there are funds in there that are designated funds, then we should not put those, we should not
- count those toward what we have access to. I think that
- what I'll end up having to do is submit partial salaries to get us at least through a portion of the
- year. But that'll have to be balanced with some of our other costs that we have to have to sustain our
- services. I mean, we can't just simply submit a budget to pay for employees for four months and then
- there's no services or supplies or funding for that.
- it'll end up having to be just a portion of salaries and then kind of balance that out with whatever
- funds need to at least get us to that midway point and then reevaluate and try to submit a second budget.
- I did receive from you a line item budget from IU Health for 2023-2024 for the clinic that we're talking
- about. Okay. So we could use some of that information to get it kind of estimate what's going to cost us.
- to do it in-house. You're sending those to, yeah, you're sending those to 2324. So we can use that as
- a kind of a guideline. It won't be perfect, but we could use that as a get to guess how much we're gonna
- have to spend for vaccines. That would be helpful. And that's kind of, I was trying to, I did provide
- some of those figures to the council just to kind of, what we do know, the,
- the supplies and the services. I mean, it wasn't as high as some other counties only, so. Any further
- discussion about the budget? We'll proceed to new business. Regarding the injury prevention
- grants application approval, I'll turn that over to you.
- So you should have received in your packet so that just kind of outlines them. You can submit apply
- for this grant funding. It's not a whole lot of money, but our maternal and child health coordinator
- did do a small program this year just focused on drowning prevention. The water safety kits if you remember
- that and some education. So I met and spoke with her and she would be interested and
- Applying to see if we could receive a portion of funds to expand some of that programming, or at least
- to be able to provide funding so that she could do that again. Perhaps partner with an agency or provide
- funding for swing lessons in addition to some of the water safety kits and some education. So with the
- board. This would be for a board vote that you would either approve that we submitted application to
- see if we could receive grant funding or not.
- I would so move. I'll say I'm submitting an application. Oh, one moment. I think we have to have. Do
- we have to have public comment? Oh, we have a comment before we vote. OK. All right, seeing none. OK,
- yes, please George. We submit an application for the injury prevention grant. Second. All in favor.
- And I did miss. The item. To vote on regarding moving that health services director to fund 8111. Yes,
- so as we've been discussing here tonight with the challenges around the new legislation in Indiana residency
- and lawful presence.
- If we are able to move forward with getting this candidate onboarded and hired, I think that it could
- be in our best interest to try to move that individual out of Health First Indiana funding
- to this alternative funding source.
- This is what is currently funding our two emergency preparedness positions. It's funded the school health
- liaison. This would allow flexibility for that position to be able to provide services to all people
- in need, which will be really critical, particularly for the clinical aspect. It's the co-ad school
- health co-ad grant.
- Okay, so we're moving it from, do you know which, oh sorry, from the grant. From Health First. So it
- would be to move the position out of Health First Indiana to this grant funding source to give that
- flexibility. Does that position meet the requirements of the grant? Okay.
- and the state has given us written approval because the that grant term has essentially ended. We met
- all of the terms, so we have flexibility with using down the remaining balance. OK, I would move that
- we move the account to what's the line we're moving into the school health coag grant. I'll second that
- motion. All in favor.
- Aye. Okay, motion passes. Next item, if there's any further board member comments or comments from our
- health officer, Dr. Ryder-Varian. I think sure, I just. Yes, we did.
- and thank Molly for helping us tonight. Yes, Molly, thank you. Molly, could you, before we, could you
- just clarify with the health services director, are we going to run into any issues with not having
- the person started before November 1st? You said to just keep council updated, correct? I would go ahead
- and send Kim or council office an email and say that,
- You're aware that this position was included in the exemption until November 1st. This is where you
- are in the hiring process. This is the issue at hand and it would help if you had an anticipated start
- date. And then that way they can look at it and decide if they want to extend the extension or extend
- the deadline for the exemption. Okay. Thank you.
- Alright, do I have a motion to adjourn? Oh yes, Dave. I know this is out of order, but. I think it might
- be useful to ask the question the vote that was taken. I understood your. You're going to be an abstention,
- right? And so my question procedurally and this might be something that Molly Turner King can answer.
- Does that consider to pass? You need a majority of.
- those president voting or you need a majority of the membership of the board? Because. Yeah, my question.
- I do not know the answer to that. Molly well, I'm thinking. So what was what was the result of the vote? 3.
- Yes, votes and one abstention. If I come on camera, am I able to vote? Because I'm in a parking lot
- now, so I can as soon as I pull into this parking lot, I can vote. I could vote, yay. It'll take me
- one minute. Well, I think the board would have to reconsider the vote. I do think it's a majority of
- the board.
- Okay, so what we'll need to do is revisit this item. And before we make a motion, we probably need to
- ask for public comment. May have motion first. Motion and then comment. And then public comment, okay.
- Lee, do you want to make the motion? So I would move that we request IU Health to consider extending
- their their contract with us on a month to month basis for a reasonable period of time until we can
- get funding from our County Council to proceed with bringing those services in-house. Do I have a second?
- I'll second. Then we'll take a vote. Michael, Dr. T.
- I see you. Bye. Bye. Bye. Bye, Stane. Thank you. Oh, shoot. We were supposed to have public comment
- before we voted. Is there anyone who has their hand up? So motion passes. But it would be good to research
- the question. Yes.
- Okay, do I have a motion for adjourn? Also second. Motion for adjournment.