call the meeting to order for today. Is that acceptable, Ann? I want to add the vote on whether or not
we can add a couple of agenda items. The first one is actually a little different than the item we have
on the agenda. It says clinical office assistance.
What I actually want to address is a and and job a job description for the clinical assistant position
so that we can send that in a timely fashion to the Council, hopefully for approval. So that we can
have staffing. OK, so if I could get someone and more, do you have?
copies of that. We had that updated one. Yeah, so this one. Oh, OK, perfect. OK, great. It's in the
left side of your folder that. So there are four of them, but I just put them in here. So. Did I have
a motion for that? So move.
And anyone second? Second. OK, so we'll add that to the agenda. Aye. Aye. I'm voting number two. Aye.
OK. And then the second item to add is for an update from Kathy Hewitt
regarding the state changes, the state law changes for the needle exchange program. So if I could have
a motion, a verbal motion for that. I'm so sorry. Where would you put that? Number five, we'll put that
as number five. This job description specifically is number four. Well,
or just replace number three on the job? Well, no. It's a separate thing, actually. So anyway, number
four will be the job description that we just approved. And number five would be an update from Kathy
Hewitt. So I need a motion for that. So moved. I'll second that. All in favor? Aye.
Okay. So I do want to welcome Dr. Kevin Moore. He was approved by the commissioners. He is an ER physician.
So welcome. Next on the agenda, we have approval of the previous minutes. Those were from December,
2025. December, he goes 18th.
December 18th, 2025. Does anyone have any changes to the minutes? I move that we accept the minutes
as written. I will second. All in favor? Aye. All right. So regarding general public comments that I'm
going to read,
The Monroe County Board of Health encourages and welcomes public input. Written comments may be submitted
at any time via email at boardofhealth.co.munroe.in.us. During meetings, comments related to specific
agenda items will be heard after the board's discussion of that item and prior to taking a vote.
At this time, we would like to invite those who would like to comment on any non-agenda item
to speak. For those attending in person, please sign in at the front of the room and those joining us
online. Please use the raise hand feature to indicate you would like to provide comment. Each speaker
will have three minutes and we ask that you please begin by stating your name for the record. Do we
have any hands? Okay, seeing no hands and no one in the room for public comment will continue.
Oh, excellent. We get department updates from Lori Kelly. We have quite a few, I think. So we'll just
start off with vital records. So vital records has actually been tracking data related to the legislative changes
that we saw with Health First Indiana and how those funds can only be used for Indiana residents lawfully
present in the United States. So an example of that in February, 80% of the customers going to vital
records did have a real ID or they could otherwise provide identification to confirm their residency
and lawful presence. 20% were out of state.
individuals or otherwise had to rely upon our non-HFI funded employee to be able to provide and complete
those services. So we'll continue just kind of tracking some of this information department-wide to
see how it's impacting us because we don't have a non-HFI employees in every area of the department.
which is putting us into a situation where we then have to turn those individuals away. We have two
employees in Vital Records who need to complete their online training in order to keep their Indiana
notary license. So they'll be doing that. The cost is pretty inexpensive. It's just $50. So they're
working on that.
with harm reduction. Our harm reduction specialist is working with the city on outreach for naloxone
training and distribution, trying to really focus on businesses and training staff for some of our local
businesses here. She's also completing certified peer support professional training and will be certified
once she completes the exam.
So in Indiana, these professionals use that experience with this formal training. It's essentially to
help connect, inspire change, and support individuals for people who are going through their recovery
process. Planning is underway for the biannual Monroe County Substance Use Disorder Awareness Summit.
It's a large work.
This event is going to take place September 1st and 2nd at the Convention Center. So they're looking
at selecting speakers for two different tracks. So one track would be an all-day national speaker who
comes in and actually surveys the community prior to the event, does some evaluation.
and then he shares what he has learned about drug trends in the area and nationally. The second track
will have multiple speakers who are focused on providing information on recovery and resilience, drug
trends and changes, how drugs are made and how that's impacting communities and individuals.
I have submitted the letter of intent to apply for grant funding that does support the salary expensive
of our harm reduction specialist. The award period, it's going to be 12 months and would run from June
1st of this year to through May 31st of 2027.
That grant application, again, will be focused on this individual providing HIV testing, harm reduction,
and support services for the Syringe Service Program. Harm reduction and disease intervention are still
working on providing the drop-in testing services to the public and for free. So looking at starting
that in April. So free testing will be offered one day a week.
during some of the evening hours for HIV, HCV and STIs. Public health emergency preparedness. There
were 37 individuals in the public trained and stops the bleed during February. They are looking at hosting
monthly preparedness trainings for the public. Some of the topics would include
preparing for power outages, emergency communications, vehicle preparedness, and building emergency
kits. Transitioning more into our health services, disease intervention specialists, that next grant
application has been submitted.
So we are hoping to receive just under $300,000, which would continue to support our three full-time
disease intervention specialist positions and related expenses such as mileage, technology, supplies.
When will we know when we get it? If we get it or not.
Hopefully within the next month. So there was a little bit of a delay. So because we lost that grant
funding, because we could not get approval for the additional position with the grant funding, our renewal
was delayed. So they actually had to amend that grant to extend that so then they could reduce the money and
Now, so we're kind of behind, so we hope to know within the next month. Laura, can you help us understand,
originally the grant was for the two positions and then we added more because of the state's requirements
and requests to us. So we've gone back to three and it seems to be working very nicely here. Will we
have to go back to council
not only once we've got the letter, but once we actually have the funding in order to support those
positions. Well, the county commissioners will have to approve the new grant and then it will go to
council and council will have to approve the funds and the appropriation for all of those lines or the
personnel. So do we expect the same kind of prolonged delay that we had
between the letter and the actual funding after July 1st, which means then we have to go to council
and hope that they will indeed approve those positions. And in the interim, do those positions continue
to work? I mean, how does that work out for us?
The idea is that we hope there's not any issues with those positions because there is still some leftover
funding from the grant that actually ended at the end of February. So that was when it was originally
going to end. So even with the reduction of the $58,000 roughly, we still had some extra funds, again,
just because of those long delays where we couldn't hire and fill.
So they've amended that to extend that we can continue using those funds until 2027. And in this time
period also we'll be getting a new contract for the grant cycle that we should have started March 1st.
So basically we're covered and even if council delays approval of utilization of that funding for the
positions,
we should still be okay and that DIS can continue their work. That's how we are currently operating.
Okay, great. Thank you. Can I ask a question about the Stop the Bleed program that we have? We train
individuals from the community for that. How does that go about? How does it happen? Do you want to
talk about that? Sure. Okay, yeah. So I'm the director of public health preparedness.
So Bryce is our emergency preparedness coordinator, and he offers the certified staff of leading training
to either individuals who request it, we do phones to classes here, or the library, for example, if
anybody would like to sign up, it's free of charge. We also work with organizations to train their staff,
channels for their coaches or personal trainers, as well as going into the schools.
The Girl Scouts. Yeah, Girl Scouts and Boy Scouts. And we do offer blade control kits to the people
who participate in this training. Some of them are something to start with. And where do those kits
come from? Those kits come from the Stop the Bleed organization. So it is what they recommend. Penistatives,
an alternative, things like that. Do we pay for them? Yes, they are covered by our preparedness grant.
OK, but is there a reason I'm asking this? Because I'm on the track, Chambu Jack Project Vivian.
there's a lot of money for that sort of thing. Well, we had money. Actually, we had our meeting just
two days ago, and we have money, and we specifically discussed the Stop the Bleeding of the Kids. So
I'll get you more information. Let's see, we should move on.
I'm currently working with the City of Bloomington Mobile Integrated Health to schedule a back to school
health fair later this summer. So where we can provide vaccinations, hygiene kits, you know, some back
to school supplies, sunscreen, and offer health screenings for adults at no cost during that event.
Also looking at
working with them on chronic disease initiatives where we can focus on the high blood pressure and diabetes,
continue providing access to that equipment that we have in stock now. So those blood pressure monitors
and glucose tests for individuals who have that chronic condition and don't have a way to monitor their
condition at home.
We currently have two nurses that are completing their training, going through all of their onboarding,
orientation, state trainings. We are looking at scheduling appointments for vaccines and health screening
starting in April. One of the areas that I'm trying to navigate right now, which we'll talk about,
later in the meeting is, you know, lack of a dedicated front desk support position that would be able
to help us get these services up and started. So to start out, we'll have a main phone line. All of
the nurses have their individual phone line, but we'll have to alternate between the incoming calls,
going, ringing to all the nurse lines,
And someone that's available can answer it, address questions, schedule appointments in times where
it has to go directly to voicemail because they're just not going to have the capacity. They may not
be in the office. They might be out in the community and then those calls would be returned at a later
time. So really hoping to be able to avoid that. We have had complaints over the past years about, you know,
call our clinic and get directly to a person to provide assistance and to schedule appointments and
that delay of care. We are also going to start scheduling the lactation counseling appointments on Monday
afternoons in April. Aubrey, our maternal child health coordinator, will be providing those services.
So Amira, one of our new nurses, she's going to be working with Indiana University on the goal program.
So that's Get On Board Active Living. It's an eight week session this summer. So she'll be spending
some time with Indiana University prior to that program starting just to
develop the program materials, training, advertising. And then during that eight week session, it's
about 10 hours of work time dedicated each week specifically for that program. She's also working with
Purdue Extension for matter of balance classes for the public. So that's around our fall prevention,
our trauma and injury prevention core service. We haven't
get determined, the dates and times, but hope to know that before the end of the month. Let's see. So
working on the transition of our communicable disease case management with the neuro, oh, sorry.
It's OK. I'm just curious. I'm wondering if the goal and the Purdue balance classes
that Amira may take up. Will those again fall under our HFI requirements? Yes, and it's really crucial
that we get those going because that's what we've been, you know, needing to focus on over the past
year. I'm just wondering in terms of the participants having to prove their eligibility under HFI funding, will
Amira's work fall under those guidelines? And if so, how do we envision making that work or is somehow
it's exempt from that? Yes, so that position
is being funded through grant funding, which will not limit those services. Thank you. That's what I
needed to know. Yes. So as long as we're not incorporating or purchasing those HFI supplies, then we're
fine. Yay. OK, yes. So just we'll be transitioning the communicable disease and reportable conditions from our
staff who are currently covering that. So Kathy Hewitt and Linnea to the nurses over the next few weeks
to begin, you know, taking that on. Can we just thank the two of them? They've been doing so much for
us in this time. Thank you. As of this morning when I looked, we have 98 open investigations. Not all
of them are being worked on and 24
to get started, so definitely do a lot of work in that area. Oh, let's see. So there was an issue recently
discovered with lead blood testing, so missing records associated with lead results coming from Riley
locations in the state.
So the Indiana Department of Health has been working with the Indiana Health Information Exchange for
that IHI. And IU Health on the issue recently received a data dump from IU Health of over 8,000 records
from April of 2025 to December of 2025. So they're looking on
the long-term solutions and the issues with the technology and that information not crossing over. That's
just something with our lead program. That information just did not get back to the clinicians? I don't
know all of it, but from my understanding, it wasn't transferring to our state systems.
It went, the pediatricians were testing children for lead. It was going to the lab, but the lab was
not reporting back to the state, the environmental system. Is that right? That's my understanding. Yeah,
so it wasn't being then dumped into our system where we go and check. And so I can remember in 2025,
towards the end, the Indiana Department of Health reaching out and saying, you know, there seems like
the numbers are off and kind of starting to look at it. So I think that they realized something was
going on. And so I'm not sure what's been going on the back end. But apparently there was an issue with
that transmission of data just not happening.
So the results were being reported back to physicians when they weren't being recorded with the state,
is that correct? Or not all of them? Not all of them. And so then we weren't seeing those results. So
they're going to get a, say, backlog list? Yeah, so that's what they're now dumping in. It's just confusing
because we certainly had the one family, the public health nurses were following
that had extremely high levels. And so I know we were getting, at least our public health nurses were
getting those results. And I assume they were getting through the system and not directly as the clinician
of note time. Well, we can still see some of the, some of it now. So I don't think that, I mean, I don't.
Just some of it didn't, so either,
whoever was doing it or something happened, just everything went a bit skew. Okay, got it. Thank you.
Let's see. So if you can remember the Fresh Connect program, and I'm talking about that last year. So
I'm scheduled to meet with the Veterans Office Director again next Friday. So we're going to kind of
circle back around and revisit
whether that's a program that we could work with the Monroe County veterans to get going this year.
Fresh Connect is that program that provides access to fruits and vegetables. Participants essentially
are identified as having a chronic condition, so high blood pressure, diabetes, heart disease, cancer,
for example.
they would agree to participate in providing biometric data and questionnaires where we can evaluate
and understand barriers to eating healthy, engaging in physical activity, accessing healthy foods, maybe
how their health status is impacting their mental or emotional wellbeing so that we could collect this
data over time and also evaluate program outcomes.
I have all of the questions. I'm just wondering if vets in particular were focused on because they are
used to providing data and they don't necessarily have the same amount of skepticism that many of the
other folks within the community who may need that kind of
help may have of providing their personal data. Is that the idea? The idea was trying to find those
with a need that would also fit in with our HSI restrictions. So what are some of those populations
that have needs that we feel pretty comfortable are going to be Indiana residents that could with lawful
status. But that's the thing about the country.
Great. Thank you. Um, let's see. Also working on now promoting our service with the milk bank. So we
are a milk express site. We have the freezer now. Aubrey and I have gone through the training so we
can begin distributing that donor human milk to families. Essentially,
We are basically the access point. Families can go online and order that. It's shipped to us and we're
ensuring that the families can pick that up from our location. I had a PowerPoint. Just, is that okay?
Yes, perfect. Sorry. I felt like we haven't
met, I guess, for three months. Oh, yeah. Yeah, sure. Not a whole lot. So just kind of focused on some
of the highlights from the core service data that we submitted to the state in 2025. Let's see. So this
just kind of gives you some information
for 2025, so we had 19 active TB patients, 350 being treated for LTBI and provided 390 tests. So Linnea
created and sent out this community survey in 2025. So this was conducted during October and November
to just be able to try to
collect some public input on services. So we did, just within those two months, receive input from 315
individuals. 310 of those live, work, or attend school in Monroe County. So this just kind of gives
us an idea about some of the community input and what services we can provide. How did that survey go
out? Who were the people that
No, it's in your packet. Could you just add a little bit on that? Sure. Yeah. So it was made available
online. We also had hard copies that we distributed to groups and to individuals. We also had sandwich
boards with a QR code on it so that people could utilize all the devices to respond to the survey. You
certainly got a lot of information. We didn't better conduct it.
So this was during that time period too when we were going with the council about the mobile unit and
how we can better serve the community and what is the community really looking at from us as far as
services and how we can help assist them. So that's just one little snippet of the information and the
rest is in your packet.
So this was a good highlight for 2025. So our vaccinations so over 1300 for children and 1600 for adults.
Oh, so let me talk about the vaccines. I guess again the Indiana Department of Health. They have come
out and conducted their site visit for our vaccine program, so everything has been done.
Submitted for our vaccine for children. The backs here account has now been transitioned over fully
to the Monroe County Health Department. We are waiting for.
just a few more pieces of equipment from Vax care. So essentially the electronic hub that we use for
inventory counts and the devices that we use to scan the doses before they are administered. We expect
to receive those next week and then we can move forward with placing our first orders for vaccines.
So communicable diseases. This just kind of gives you a snippet of the work being
done there. So 269 completed case investigations. Those don't include the work that our disease intervention
and harm reduction is doing with the HIV STIs and HCV. So chronic disease provided 573 blood pressure
checks, 262 A1C tests, and then 98 cholesterol tests.
So really hoping to, we'll be incorporating these tests for free once we start scheduling patients in
office. And then over time, once we can expand and be going out in the community and offering these
services as well. Is that data from in-house and the outside events? I'd have to look, I pulled these
directly from what the state gave me for their core service.
because they kind of track it differently. And referral services, so, you know, 646 referrals for hepatitis
care. So that really kind of stood out to me. Just the amount of work that employees are doing just
to be available to help connect individuals to referrals and care.
So here's our KPO priority that we really need to focus on this year. So if we can remember back at
the start of Health First Indiana, we had to submit what they were referred to as key performance indicators
at that time. Now they're calling them key performance outcomes. So this was one based around fall prevention
and that rate of non-fatal hospitalizations.
2025, isn't that fair?
So we're not headed in the right direction with this as of right now. So it'll be really good once we
can get a mirror up and going and doing that matter of balance. Also trying to work with the hospitals
to see if we could collaborate on a referral system. So are there frequent fallers? Are there individuals
that they can provide
our information and then we can connect with them to offer them our programming and education. And then
that's just additional data that kind of shows where we're at. I'm curious here. So is there anything
in our looking even at that data and collecting that data that correlates with
substance abuse disorder. Well, so we get this information from the state, and so that's not something
that I've seen, and I'd have to see how they're maybe capturing that. Yeah, because I think it would
be interesting in capturing that data to look at substance abuse and or substance use and how those
falls correlate. OK, let's see what I can find out about that.
And that's just another, just kind of gives you a breakdown of where some of those falls are coming
from. So our other, so we submitted one to focus on decreasing the smoking rate during pregnancy.
So we are slowly increasing our quit for two participants. So if we can remember, we had to temporarily
suspend that program when the changes were made to remove tobacco cessation and prevention from core
public health service in Health First Indiana. So we had a little bit of gap in being able to provide
these services.
Looking back at the February monthly reports, we now have seven active participants and just hope to
continue to grow from there. So our disease intervention specialists wanted to focus on increasing the
proportion of Monroe County syphilis cases being treated. So
Nationally, the Indiana Department of Health has reported congenital syphilis cases have increased.
They increased 82% between 2020 and 2024. So really just, this was really an important area for GIS
employees to focus on. Is the congenital syphilis increase almost double in that short period of time?
What's, do you know the end? Is it in five or is it 50 or 50? Just that percentage, the 82% from 2020
to 2024. So, I mean, in what they're, what I'm hearing is, you know, that limited access to prenatal
care, medication shortages, particularly for pregnant. One of the other things that we're seeing across
the state is that there are emergency rooms where
patients are visiting and are not being checked for any of the communicable diseases, especially when
it's recognized that this is a pregnant woman who may not be getting prenatal care. So while we may
be doing well here, and we've seen the numbers here,
being lower than obviously across the state and the area up in the Northwest part of the state being
some of the highest we're seeing. Across the state, the number has dropped in the last year,
which is great. It's a sign that things are coming down as the amount of awareness is increasing, but
they are finding that there are emergency rooms
that are not checking pregnant women for syphilis and galorea. When would they check? During a routine
visit. That's something that wouldn't happen. Well, there's a big move through IDOH for that to happen.
If women are not getting prenatal care, and that's the only place they're being seen is in the emergency
room, that that happened there, that indeed this is
It's a high risk to infants and the long-term effects and costs to the state are enormous. Well, I find
it interesting. As medical director of the emergency department for the past four and a half years,
I've never heard of that. I've never heard that. I communicate with the OB doctors all the time. So
if IDOH is doing it, they need to increase their penetrance so that we can address it. The other thing
is that they tried that with hepatitis. They tried to test everyone with hepatitis and they found that
a lot of resources
no change in outcomes. So nothing, that's saying that we shouldn't be doing it. And I'm saying that
there needs to be, we need numbers and we need some penetrance. So I've never heard of that. One and
a half years. That they know, you know, it's not penetrating. It's clearly not. Okay. I'll let him know. Thanks.
Let's see, so General Environmental wanted to focus on being able to get these properties. So actually
as of 2025, there's only one property left that needs to be tested to determine whether it's safe to
come off the list or whether decontamination needs to occur. So we really pretty much knocked all of
those out in 2025 and hoping to be able to get this
last one taken care of as well. So 13 went to one. Nice. Yeah, so we contracted with an individual who
went in and did the testing and then he was qualified enough that he could also do decontamination on
the properties that needed that to get them into safe levels. So for the people living in them. And
then this is just our last
KPO, so focused on decreasing the rate of drug-related poisoning fatalities. So still just continuing
to focus on distributing Narcan, providing education and training, being able, working with our suicide
overdose fatality review teams and community partners. There's a huge amount of that. Is that, so the
number says, is that on the right decrease the rate of two
That's a goal. It looks like we're so far ahead of the goal. Is that correct? Yes. So we're doing good
on all of them except for our fall prevention. Yeah. I definitely noticed in the past few years, decrease
in the number of people that are sent to the emergency department who are near fatal events or fatal
events. So that's good. I will stop now. Well, thank you. Is it possible? So the checklist one really
cares about that.
And some of those, you know, when we talk about these numbers and trying to get the percentage increase
and decrease, it changes the math if we know the numbers. And these numbers come to you from the state,
is that correct? Yes. Do they ever give you the numbers or do they just say the percentage? I think
we can ask for it in different ways. But yes, we do get it all from them. So that's something that we could
If there's different formats or something specifically you'd be interested in, we can definitely reach
out to them about that. I think that generally when you look at these things changing so greatly, the
numbers matter. Is it five? Is it three? Is it 50? It matters in terms of how you approach these problems,
I think. We certainly found it in dealing with hypertension and diabetes and severe phobic complications,
those relative risks.
And that matters more than necessarily the percentage change. And in presentations, we do get numbers.
So they have that, and they do give it to us. OK. Laurie, I have a question. When we met in December,
we talked about employees were requesting
assistance monetarily with certifications and the board asked, could we get a list and the number of
certification licenses required because you didn't know how to, we were going to be able to respond
to that with the limited funds that we had. Where are we on that? So Marissa, the administrative assistant
has been creating and, um,
gathering all of that information. So I think it's probably at a point to where we can provide that
to the board at the next meeting. So one of the challenges that we at that time were dealing with was
because of the changes that were made when County Council amended our budget and essentially
we had zero dollars that we could use towards that. So we've been working over the past few months to
submit our financial reports and new budgets for additional funding to be able to now start providing
some of those. But I think the question would be for the board developing a policy. So,
Is our people required to have the certifications prior to hiring and maintain those over time as part
of their employment? Or is it the expectation that the county will cover those costs that are required?
Well, it would really depend on the positions, I would think. For instance, if you're looking for a
nurse, certainly they should have certification before they're hired.
And so then do they maintain paying for their license, you know, like other organizations, I guess,
require, or does in that transition to the county covering those costs? And the cost of continuing education
for those individuals. And I think, Lori, what you shared with me was that Lori's coming up with a schedule of
who has which certifications, how many people in a particular department need to be certified and can
it be done on some kind of rotating basis so that each year so many certifications are handled so that
we're not like every year taking on all the certifications within the whole department and be able to
better manage the financial effects of that kind of
process? Well, I think it's from my opinion only. In my opinion, I think it can be challenging in some
ways to think about a strict standardized system because our funding fluctuates so much. So when we
were going into Health First,
Indiana and we were going to have to start providing all these new core services and these new activities.
And we had additional funding to then where people could start getting those trainings and doing all
of the, you know, develop development. And well, when funding kind of falls back, then how do you, what
are your choices with maintaining those over time?
So currently they cover their? No, they can't. They can cover, as in from our budget. I will say that
anything related to trauma, and I'll get Kimberly, anything related to trauma, even if it's, it can't
be tangential, but if it's related to trauma or it affects the care of Hoosiers in trauma, the TRAC
has funds to help.
So I think when you have that conversation with Kimberly, you can talk to her about other things that
might be useful for getting nurses with certain certifications and education and so on because there's
different money available. And then, you know, is there, are there performance measures that are put
into place or standards and expectations that if the funding is
you know, being provided for employees to obtain these additional trainings and certifications that
they are actually then carrying out those, those programs, um, you know, over time, or what do you do
when you invest $5,000 in someone and then they need to go take a better paying job? Um, and so, I mean,
I think those are just all things that anybody has to. It'll be very helpful.
to get an idea of what kind of certifications we're talking about, how many employees we're talking
about, et cetera. I personally have never worked at a place where it was expected. You just always did
your own. It was never provided. That's how it was always been for me. If it's been provided, I mean,
once you've
been able to provide it, and then you have to take it away for some reason. That creates a lot of discord
with the employees. Yeah, so I think that's one of the big challenges with this makeshift in the health
first. You have this huge influx and all these opportunities, and then it's taken away, and how do you
readjust? I think having all that information in one document would be a good start. I agree.
And is this something that you could imagine the commissioners might want to help address because it
sounds like policy and that they may have, you know, across the county have some kind of ideas. Well,
I wish that the county did have a policy on it because I think it would be
easier if there was a standard policy across the county, but there's not. So maybe that is something
the commissioners really need to address. That would be the council, right? No, commissioners need policy.
Council runs money. So it would have to go to commissioners to really develop a policy that they might
want to talk to council about, but it would be their policy that they would direct
counsel would be paying for, I guess. Yeah. To me, it sounds like your point about people leaving after
you've paid for their certification. Well, having certification to work here should be one
of the requirements. They should expect that. So what I would suggest is that maybe we have some sort
of cost sharing.
so that everyone has some skin in the game, that the employee gets some assistance paying for certifications,
but the county paying for all of it, I think, is like, hey, I've never worked anywhere where somebody
paid for my continuing education to get my, renew my license. Did you? I mean, you did, yeah. So maybe
having some kind of stipend
Oh, I say stipend or some set amount for, and then they pay the rest of it. Yeah. I mean, my, my license
was a trivial amount because the state, you know, has states cheap and you know, that they make it cheap
for everybody. But, but the getting the, you know, paying for the, for the continuing ed was not necessarily
inexpensive. So,
Are you helping the providers? And I believe the nurse is also gonna, so I've been like, my license,
certain amount of CME per year provided by organization. So I think it depends on the umbrella that
you're working under. So it's a perk. So it's a cost sharing thing or? No, no, they, for license renewal,
DEA renewal. So they pay for all. Do you think that's required to work
they pay for and then they also provide a certain amount of money per year for CME that I can use however
I see fit as long as it's requirement. Yeah, it's an iceberg. So that's all in an Excel spreadsheet
so we can submit that with the next board package. Okay, thank you very much. Very good job. I'm a little
bit tired.
That's what I was doing all day. Were you going to address the HIP? Oh, sure. Great Medicine is well
in here? Yeah, we can. So I think this is, I think you saw this at the December meeting. Let me find
it, I guess. It looks like this. Oh. This is the Great Medicine theme.
This was the pilot program that we started with Health Net. So when this came about because we were
looking at ways to reduce the emergency visits and emergency response calls that were going to the Wheeler
mission and then to the emergency department. So we took a portion of the Health First Indiana funds to
help cover personnel expenses for Health Net staff to begin really focusing on trying to intervene to
provide services. And so this is just some of the outcomes that we've seen since that program started
and how it's reduced the emergency department visits. And can you remind us how much we contribute
this program? So 135,000 I believe last year and this year. Okay. So we as a health department, we've
contributed that amount to this program. Yes. Do we have any idea how much IU Health has contributed
to Health Net for this program? That I do not know. Would you be able to find that out?
For us, that would be really interesting information. Since we're improving things for your emergency
room. So the numbers, sorry, the numbers, so if you take $135,000 and divide by 92, so that's $14.60.
On the other side, there's a three. Yes, but that's $1400, $14.67 per person.
So yes, it would be that, you know, we're contributing. So it would be interesting to see, you know,
what IU contributed as well. Yeah. So we'll continue to get some of these updates and information of
these services. So I think there's a little bit of a slow start, again, just because people at the Wheeler
Mission weren't
they weren't aware and it was a new system, but as word got out, they began to start seeing more individuals.
So really great program and I think it's great that we've been able to continue supporting them. Okay,
so the next item is older continuing business. I just want to say that behind the scenes,
the amount of machinations that Lori has had to do to get us transitioned to doing the vaccines on site
as opposed to those occurring at the clinic at IU, or rather at Miller Drive. It's been a lot, and she's
done an awesome job. So we kind of meet.
barriers more along the way than, than I would like to see. Um, and I don't know how to improve our
relationship with council and with our, um, liaisons. I don't know if, uh, you know, we go even publicly
individually to the meetings and you know, say, Hey, we,
We kind of need some help and some collaboration. Peter Iverson, we actually have not met with him once
since January 1st. And that would be helpful. And we're going to also talk about that. I guess I'm skipping
ahead a little bit. But on item three, we were on the agenda for a council. And then to work on this position,
that we desperately need to provide services for Monroe County and we were taken off the agenda with
no notification and found out at a later time. So I. So anyway, we're we're we're moving ahead planning
on giving the vaccines and everything is. Mostly in place and we just need people. I mean, you can't
provide health care or health services that part of things without
without people who are trained. And so, and that's, you know, physically we've been challenged to try
to get that rolling. I don't know if Dr. Moore knows this, but you know, the county has a hiring freeze.
I've heard of that. Yeah. Yeah. So, and they're rabidly sticking to that, even though we,
IU decided not to continue our contract at the clinic, which put the onus on us to hire employees to
run that clinic. Well, they're not letting us do it. So I don't know how they expect us to continue
as we were, but with no extra people. I mean, that's basically
the road we're running into. And we have money to pay these people. So it's not like we're asking for
extra. And I guess I'll just add that Laurie's been incredible in making sure that we have two individuals
who have been helping us immensely track core services, which we're very grateful for. But she's also
had to deal with the
The tech people who were very slow in giving us phones and internet to this new section. The physical
plant people who painted things but then didn't get stuff moved and we've been slowing. We got a generator
contract but then it turned out that no, they needed to do something else because it doesn't work.
So there have been so many elements. Unfortunately, it's not only counsel. It's been one headache after
another. And Lori has been just a godsend because we would not be where we are now without her diligence.
So kudos to you.
We won't fail. Can I ask, where are the two nurses located now? I know we had a space. So right over
in the area. And that's also where our maternal infant care person will be dealing with moms. Yeah.
So it's a little chilly because there's still some holes like in the roof. The roof is kind of OK, but
the ceiling, they're just, but they're, I mean,
reverse, right? You know, we're all here because we're dedicated to serving my county. And I think we're
that's what I try to focus on every day is how fortunate we are to have people who come into this office
every day, despite all the barriers that we face. And so is that
Do we go to the commissioners over? We have the holes in our roof where we're trying to be patient.
I think it's on the list. The roofing people have been here forever. The physical plant people know
what's going on. It's just, they're dealing with the whole county. It's. All right, well, moving on
to new business.
So we have the 2025 annual report for all of our core services and all of our divisions. I won't go
through all of them. We have the vital records, food protection, chronic disease management, immunizations,
trauma, et cetera. And so does anyone have any questions about the report or comments
So at the end, we have goals for 2026 are to work on securing additional funds since we've met with
those challenges and to continue to meet criteria for the health first funds. I think our goals have
had to change because physically things are just difficult
just to try to get more funding. So I think that we need to ask for public, or well, I need actually
a motion to, let me back up. Any questions about the report or discussion? I always enjoy reading it.
I think it's the together well.
Everybody worked on. Yes, that's a lot of information. It's impressive. We have a lot of people come
through our door that we serve, which is awesome. Thank you. So do I have a motion to approve the annual
report? So moved. I second.
Okay, so prior to the vote, we take public comment regarding the annual report. Any hands? Okay, so
we'll vote on the approval of the 2012-2025 annual report. Okay.
So then we have the vitamin angels grant renewal. So this is 50 clients to be served those who needed
vitamins. I'll let Laurie speak a little bit about that.
don't have a whole lot. I mean, we, we essentially started this program shortly after we developed and
hired the maternal child health coordinator. So this, um, just allows us the opportunity to get these
vitamins in for free that then we can distribute to the community. Um, so through partners or through
individuals and just hoping to be able to continue providing access. Um, I have a question back.
maybe September or October, we talked about the prenatal vitamins that we were giving out. And Dr. McKinley
at that time actually looked at the vitamins and found out that they weren't recommending the allowances
on the vitamins that were being given out weren't necessarily recommended by the FDA or whoever does
that recommendation. Are these vitamins the same ones?
I'd have to look and see whether it's the same formula. We talked about it and we all agreed that in
fact they were going to check with the company to see if, I can't remember which vitamin it was. Do
you remember, Steve? No. I remember Dr. McMaster saying he reached out to someone
to discuss it, to see if they would change their allowances to fit what should be on it. And I don't
know what happened with that. Yeah, I'd have to ask. I think I remember, and that's what, gosh, this
goes back more than a year, I think, Kay. It seems like an eternity, because I know I was on the board
then. Time goes fast. What I'm remembering is that we got an answer back
and that he was satisfied with the response that we got in terms of the vitamins that were being distributed.
I don't remember that. That's the part I remember, and I may be wrong. Can we check through our minutes
or something? All right, and I can call and do it. Oh, OK. We really want to make sure the vitamins
we're giving out meet all the recommended requirements. Absolutely. And I can't admit that. It seems
funny that they wouldn't have
A cog recommended levels. Anything is possible, so I think then we should table this until next meeting.
OK. Then Steve real. I call him and ask him. The next item is regarding.
clinical office assistance, and we're gonna have two agenda items here. So first, I'm gonna have Lori
address item number three. Is this regarding the letter? Well, so I mean, essentially, I think we've
gotten a little bit further along than when I originally created the agenda. So ultimately, I think
the goal is that the board would be approving
this job description so that we could then hopefully move forward. But essentially, well, you know,
we've been working since late 2025 to try to get, you know, staffing and positions in place. So I can't
remember the exact date, but earlier this year, I had submitted a request to the County Council to discuss
being able to develop a position.
Well, that was actually after I got the notification that they removed the request. So this goes back
to like January. Did we get an explanation as to why they removed your foot resource? The email that
I received was from one of the county attorneys that says, Lori, hello. I wanted to make you aware that
the health department agenda request was removed. Yeah. So that's not an explanation.
So I just kind of sat on it for a while because I knew that we were going to be running into some resistance.
And then wanted to circle back around just because, again, we're trying to get services in place to
start scheduling and providing services. So let's see. We've had communications with Kim Schell. Dr.
Robinson is
both in the theater about, you know, how can we get this request back in front of the full council for
discussion about how we can develop and receive approval for this position. So that's kind of a guess
for that. And my perception was, so I spoke to both Kim, Michelle, and then Peter, and Peter just,
Kim said, you know, they wanted,
Well, it was very confusing because they sort of wanted job descriptions that were related
to job descriptions that were for Futures Clinic just because they would have some kind of template
for things that had been approved before. But I said, well, we don't have Futures Clinic and so that's
kind of obsolete and we need very specific things for the clinical assistant. So she said, talk to Peter.
So I spoke to Peter and he said, well,
you know, you work with Kim to work on getting us the language. So I took from that, well, I think they
just want something in front of them. And then I guess it's unfortunately gonna have to go before I
can miss no matter what, because it's a new position and a new job description. So we're back to, it's
just a lot of,
And PAC is currently paused, so they're not taking requests. So the council would first have to unanimous,
well, I don't know, maybe they've changed some of theirs, so I don't wanna speak, but all I know is
the council would first have to approve that something could go to PAC for PAC to consider to send it
to WIS and then WIS to the full council. And then I think the hiring, part of me would assume that then
the hiring freeze would
be in addition to that. Okay. So I assumed when I saw it was removed that it was because they weren't
going to approve a new position anyway. And so they just took it off their agenda. So they would have
one less item. That was my assumption. So I didn't necessarily take it personally. So, you know,
so it was, uh, but I could see how they want,
to have a full job description if they're going to consider it. So that's, Lori worked on this and we
did a few revisions. She did a few revisions. We worked on it and feel that this is appropriate language.
So we would like to present this. And at some point we have to have them understand that we are not, you know,
county roads and we're not the county. We're not any. We're different than any of their department and
say, you know, these are vital services. You can't really provide services without. The staff members,
so I'm not sure how else to get that across to Council. And I did. Reach out to.
Again, to try to try to get additional information from other local health departments to help explain
that we're not asking for anything that's out of the norm. So I was able to capture information from
other health departments so that that's available as well. Let's see. Let me ask for this job job because
we finished last
We finished last year, and we had a grant for those employees that now we no longer have. Does that
grant money extend into this year, and how far into this year does that grant money go? So I guess I'm
trying to think about which grant. Well, the grant that would cover
this employee. Okay, so I think that there's a couple different ways that it could be funded. We have
not fully used the amount that originally was intended for the IU Health contract. So that is one option.
I would say that they would not prefer that option because it's local. They would come from local county
dollars, but that is an option. We could pull from
the school liaison grant that were remaining to use down those balances, or we could submit to use one
of our other state funds for this position. But we were paying to support a front office position as
part of our contract obligation with IU Health, so essentially we would be just
be taking another portion of those funds that were originally set aside for the contract and moving
it to cover these expenses. And it would not fall into HFI so then we wouldn't be getting kind of in
the weeds with that hole. So now we have somebody at the front desk who has to make sure that checking
the residency and such. It would seem like the school liaison would be great because this person might also be
working to schedule our outreach to schools for vaccinations, to the community with the trustees in
the different townships for outreach and visits across the community into the more rural parts of our
county to provide screening and vaccinations. So it would seem that
would really work well for us, at least in this moment. And I mean, ultimately, would it take, in answer
to Lisa's question, would it take our showing up again at council to show our solidarity with our health
administrator that, indeed, we need a front office person
to be the voice, at least as far as the clinic goes, for the county to show our commitment to our county
residents that indeed we want you to come in, we want you to be vaccinated, we want to provide the care
that you want and need in this county rather than getting a machine that says, oh, we'll call you back
someday, maybe.
And it may take our showing up. And the sarcastic part of me wants to say, well, would each one of you
come in on a daily basis and fulfill that role for us if we can't hire someone? But that's my sarcastic
side. When is the next opportunity to give a department update to the council?
Is that a 24 and that does that have to be on their agenda or if, you know, okay. So maybe we should.
So you, so you're looking tonight for a, for a, a motion to that says, go ahead and, and submit this
for approval or is this, or are you the revised version?
Or do you need to take this to Kim first to have her look at it and, well, you know, smith it and,
you know, I think that the process changes. So I'm not sure. Uh-huh. So Kim shell being the secretary
for the, for the council who you meet with her and she does
She changes things and she's a, she's a wizard at that. I spoke with her and I spoke with her and she
sent me these and said, well, you know, cross out edit, you know, what is not applicable because it
relates to futures and then add in what you need. So, um, was she happy with the order? Because again,
Molly and Kim,
It had issues with you. You know, I can't even go there, honestly. Yeah, OK. Got it. They have the unrevised
version, and so that was submitted to the council office. The revised version just adds some additional
language around job requirements and makes sure there's a little bit more specific. I understand your
hesitation.
Yeah. So, so, well, I mean, so what, what do we, are we, are we going to submit the revised version
or, okay. I mean, I think in my opinion, again, I think that all I would like, I feel as though all
we can do is try to proactively take all of the steps we can to say, we approve this job description.
We approve it going to the council for review to go to pack and, um,
I'm trying to take some action. But I think this is one of the challenges because of how long the process
takes. It could be, you know, we're going to have several months. But we want to get it in before budget
time. So then I would move that
that we submit the revised version to the appropriate county officials, whether that be PAC or the council
for their approval to submit to PAC. And then to WIS. Steve, you might want to include an approval by
the board of this.
Yeah, I think we should maybe. Maybe the first one be. That we approve the revised version as a bowl
as the board and maybe the second one that we request. I don't know. Can we ask that request as a board
to be added to discuss the position at the next Council meeting? Is that out of line? Is that? Allowed or
I can just say no. Oh, they can just say no. So that would be my... Do we have to have a resolution
to discuss it or can't we just get on, try to get on their agenda to discuss it? Hopefully it is on
the agenda. It was submitted for the 24th. I see. Oh, okay. So maybe we just do one motion. It should
certainly include the approval. Yeah, well, the approval of the clinical assistant position. Revised version.
So that's the motion that we approve the revised version of it. Say it again. Is that the motion that
we approve the revised version? Yes. For submission? That is the motion. Well, that would be either
one of our motions or not. I would second that. I would second his. Okay. We're in this together. Yeah,
here we go. I'm so sorry. I just wanted to be very clear on what the motion is.
to approve the revised version and submit it to the appropriate company official for next steps? No,
I disagree with that. I think we should approve it. And? And then do a second one. We haven't approved
this clinical health
clinical assistant position. You approved it back when we were making the changes with the health services
director, but this is now revised. Okay, so we approved those. We just voted on them and approved them.
I think that's what we do with this one. Yeah, I think we just so let's change the notion to
Well, I can't do whatever you want. OK, well, the motion will be to approve as the board the clinical
assistant position. Job description job description that is revised. We have in front of us and we can
get a copy of that to linear. So do I? That's the motion. OK. I said that's I.
Will you second it? I submit that as my motion then. OK. I retract my first motion and I submit that
one. Now second that. All in favor. Aye. OK. Now, do we have to submit this revised version or? The
county council. Yes. I say we make a second motion.
to put the revised version before council for approval. So moved. Sorry. All in favor. Wait, we need
public comment on it. Oh, I'm so sorry. Yes, we need public comment. Seeing no public comment.
All in favor. Aye. Okay, great. Okay.
And so the item under new business, and I want to apologize, Kathy, because I should have put you higher
up on the schedule so you didn't have to wait. I've been entertained by this. Just for a background,
there was a law change this session. And the details are that for the
Needle exchange. It has to be one to one and the second. Well, I saw really three changes. The second
is that you have to have a valid ID ID and the third is you have to be. Essentially, and it says it's
the language is vague, but at least in the county and maybe surrounding counties that language is vague.
once you have this proof of residence. So please Kathy give us your update. So the key updates are the
long was extended until July 1st, 2031. So that's a five year extension before it was always two years
at a time. So that's a benefit.
It did go to the one-for-one model, which means people will need to bring in syringes in order to get
the same number of syringes when they go. Before we did as needed basis or how many they needed to use
a clean syringe each time they came back. Definitely before they came back up to a certain level, but
now it's got to be a one-for-one.
So staff has really been doing a lot of education in the last couple of weeks, giving out a lot of sharps
containers and informing people on a work on a top basis. It's going on on social media as well to let
everybody know. They're for citizens. So they have some things now too. So you were talking about they
have to be and it is vague. They must be from
Um, a resident of a county within the Indiana housing and community health development authorities balance
a state continuum of care region. So, um, so basically those are like the housing regions of which all
the counties are in sections. We are actually in region 10. I brought this to bathroom so you can see
where we're at. Um, in our region is Martin, Bowen, Green, Lauren, and Morgan.
along with Monroe. So it's a six county region. So participants are supposed to be from one of those
counties and they have to show a valid ID when they come in. So the law did say we do not have to collect
information. So I do not want to collect information, but what I'm requiring people to do is staff have
to check an ID.
You have to see where the person is a resident of one of those counties, document the counties, document
the checked ID, and then sign their initials. So we have a log that they're supposed to track on every
other person or every person. And for the one for one, they do an air table. So it's tracking counters
that everybody who comes in and the service that they receive is anonymous.
But they have to check certain design instructions out and I'd like to get the back end access to the
back end of the air table program. But if I can't, I can also always get a report from them on a minimum
of once a week basis so I can see what's going on in that.
Another big change is that Indiana Department of Health will now be responsible for determining if the
program is in compliance. So we are expecting an update and guidelines from Indiana State Department
of Health. We thought they would be out last Friday, but we were told that they've delayed. So I think
their leadership is looking at it on what, you know, carefully thinking about what guidance they want
to give us. So we're waiting for that.
And once we get that guidance, we can update what we have now, share it with the board, and share it
with the legal. And as long as that's approved, well, it's to get those procedures too. Kathy, I'm just
curious. Will our unhoused folks be able to show some kind of documentation from, for instance, Wheeler
or Beacon that they are getting services from those folks to
show that they live within this region rather than because obviously even if they actually own an ID,
it may not be from this local area. I checked with the DMV and there are procedures where somebody who
isn't housed, if they are going to get services at Beacon or Wheeler,
Beacon or Wheeler can sign up, write a letter on letter hat saying that this person is getting services
from us and they can get their mail there. So that address will become their legal address. So that's
one they can do. And also get letters from other official government sites or other to say that they
got a letter from them and that can suffice as presidency. Thank you. So Kathy, are you doing onsite?
It will also be doing on-site checks. Nico is there three days a week too, so I hear from that. Plus,
I'll do on-site checks as well, drop-ins too. Excellent. Okay. Great. Thank you so much. There's a few
more changes. Oh, yes, please. Okay.
syringes service programs who operate a fixed site that can't be within a 1,000 feet of a school, a
licensed daycare, or a building that's primarily used as a church without written permission from that
establishment. But that doesn't pertain to distribution of loxome, providing referrals, education, or
accepted syringes for safe disposal. So the other thing they want tracked is efficacy of treatment.
We give referrals out for
many services, especially for drug treatment services, but they want efficacy of that treatment tract.
So we're talking about getting word of mouth and asking people, like people always volunteer when they
go to treatment. So just checking in with them and seeing how they're doing and giving support and then
tracking what they say that they're doing. So the other thing or
they said was that we can't distribute chemical reagents or precursors. Nobody does that now that I
know about. So we were kind of discussing like how that came to be. We're meeting at SEP or syringe
exchange programs, administrators. And that was definitely a conversation that we had in our group.
So they're talking about that they can't distribute like suboxone. Is that what they're saying?
What are they? No, they were talking about epinephrine. So, you know,
Yeah. I wonder if they're talking about the tests, the point of care tests that people can use to determine
if what they're about to ingest slash inject has contained fentanyl. If those tests exist, there's opposition
to those being distributed with public funds. That's my guess. The things like the zine test or the
fentanyl test, is that what you mean? Yeah, that's my guess. They made them legal last year. I begin
to think they took it back out this year.
not to check for that. Are you all anticipating a drop off in what we've seen in terms of the decreasing
HIV and hep C numbers? I mean, we've seen a lot of people come through and things were improving.
with the amount of needle exchange we have, are we expecting those numbers to go back up now that these
restrictions are in place? I'm really hoping not. I'm hoping with a lot of education and after they
see how it's still being supported, even with these new changes, that they don't need to worry. It's
still something that we're there to serve them and to help them and to help them get the things that
they need. Now, you're also hoping that we won't get as many
requests to come pick up needles. Actually, those have greatly gone down. I track them every month for
like one of our reports, and we do not get, you know, as much of that the ones we used to get. That's
seriously gone down the last few years. Oh, thank you. So we don't get ready-made requests to go pick
up needles?
That is many, not like we did, especially like in the beginning. The article was talking about the Southside
businesses, make it sound like they're inundated with abandoned syringes on their property. And I have
no doubt that they find some down there and in their mind that maybe that means a lot.
where people say, oh, you have to come. There's like a million syringes, and you get there, and there's
one. I think they expand sometimes. We're happy to go if people need it, but they really have gone down.
That's something that I think. Interesting to know that. And I think our hepatitis C numbers have gone
down, but I think there's a rise in HIV cases that we were concerned about.
At some point we need to address that. Okay, are there any other comments from board members or from
help officer? Yes, I'll be your help officer tonight. I'm curious, what's happened with our mobile unit?
I'm sorry, I don't mean to open a can of worms, I'm just curious.
has the individual who was looking at it and telling us what was available, have they come forth? And
what's going on with that now that we may have some nurses? Well, so we need to go back to the council
to have that re-appropriated because it's changed budget years. So that has been submitted.
for their review and approval this month. So hopefully that continues and it has still been. Still on
the list of that is being the units are being looked at or purchase for the fleet person is still looking
for us. It's still on the list of things that need to be done, but we really if we can get
The approval again for the appropriation, we need it to be done so we don't have to do this again. Is
that also something that's going to be going up before council in like maybe this next week? So hopefully
next week. So indeed it might be helpful to have board members present to support you in the request.
Hopefully it's smooth sailing. Just thought I'd ask. Yeah, there's a lot of excitement in the department
for being able to have that unit and start providing services. So hope we can get that done soon. I
guess I'll only share that since it doesn't appear on here, the idea we created this rural
outreach funding. But we are not all happy because we have this large urban floor. So some of our surrounding
counties may or may not receive funding, but it may sort of float west eventually, possibly. It's still a child.
Peter just expired. We won't let them get you. You have to wait. They're there right now. They're waiting.
Any other comments? Okay, well I make the motion to adjourn. Second.