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.