WEBVTT 00:00:01.218 --> 00:00:15.042 - I'm gonna call to order our meeting for the Monroe County Board of Health on today, May 21st. So first, 00:00:15.042 --> 00:00:28.601 - do we need to add any amendments to the agenda items? Does anyone want to add any agenda items to our 00:00:28.601 --> 00:00:30.462 - agenda today? 00:00:31.106 --> 00:00:46.448 - I look good to me. In your package you have the meeting minutes from last meeting that is April 30th. 00:00:46.448 --> 00:01:00.286 - And I will need a motion to approve the meeting. So moved. Second. All in favor. Aye. Okay. 00:01:00.738 --> 00:01:12.048 - So moved, so we approve the meeting. So regarding general public comment, the Monroe County Board of 00:01:12.048 --> 00:01:23.247 - Health encourages and welcomes public input. Written comments may be submitted anytime via email at 00:01:23.247 --> 00:01:26.718 - boardofhealth.co.monroe.in.us. 00:01:27.938 --> 00:01:34.055 - During meetings, comments related to specific agenda items will be heard after the board's discussion 00:01:34.055 --> 00:01:40.053 - of that item and prior to taking a vote. At this time, we would like to invite those who would like 00:01:40.053 --> 00:01:46.290 - to comment on any non-agenda items to speak. For those attending in person, please sign in at the front 00:01:46.290 --> 00:01:52.408 - of the room and those joining us online, please use the raise hand feature to indicate that you would 00:01:52.408 --> 00:01:56.126 - like to provide comment. Each speaker will have three minutes 00:01:56.450 --> 00:02:07.975 - and we ask that you please begin by stating your name for the record. We don't have anyone in person. 00:02:07.975 --> 00:02:20.064 - Did we have anyone with their hands up online? Okay. Moving forward, so we will ask for department updates 00:02:20.064 --> 00:02:23.454 - from Lori. We just got a few. 00:02:24.418 --> 00:02:33.264 - So just starting with vital records and administrative support. The director and assistant director 00:02:33.264 --> 00:02:42.110 - of vital records attended a job fair yesterday. This was in Bloomington. It was put on by work one. 00:02:42.242 --> 00:02:49.149 - They were there to provide information and applications for our public health nurse and health director 00:02:49.149 --> 00:02:55.858 - positions. So just continuing to try to engage in job fair opportunities with Indiana University and 00:02:55.858 --> 00:03:02.499 - Ivy Tech for their school of nursing, trying to look for candidates to fill that position for those 00:03:02.499 --> 00:03:03.230 - positions. 00:03:03.586 --> 00:03:11.129 - They also attended the Spring Conference for Indiana Vital Records today. So, this brings people who 00:03:11.129 --> 00:03:19.046 - work in vital records across the state of Indiana, local health departments together, just an opportunity 00:03:19.046 --> 00:03:27.262 - to kind of talk about challenges, and such. We are beginning to work on preparing the county budget for 2027. 00:03:27.426 --> 00:03:34.588 - At this time, my understanding is that they will not be including a cost of living pay increase for 00:03:34.588 --> 00:03:42.181 - employee salaries. So at this time, we'll just be keeping our salaries the same amount through the budget 00:03:42.181 --> 00:03:49.415 - process, unless we hear differently. Regarding grant budgets and deliverables, the financial manager 00:03:49.415 --> 00:03:52.638 - recently met with our grant funded employees 00:03:52.770 --> 00:03:59.998 - to discuss remaining funds that need to be used prior to the end of the grant cycle, and we'll continue 00:03:59.998 --> 00:04:07.017 - doing that with all of our grant funds. For disease intervention, we did receive an amendment to our 00:04:07.017 --> 00:04:14.245 - current grant that currently funds three full-time disease intervention specialists, additional funding 00:04:14.245 --> 00:04:20.222 - approximately in the amount of around $48,000. This was approved by the commissioners 00:04:20.418 --> 00:04:27.150 - Once we've received the signed copy back from the Indiana Department of Health, it will then need to 00:04:27.150 --> 00:04:33.816 - be taken to the County Council for approval. This is a lower amount than what we were expecting, so 00:04:33.816 --> 00:04:40.948 - when I contacted the state, essentially what they are doing is this is like a stop gap, so they're waiting 00:04:40.948 --> 00:04:47.614 - for federal funding to then be able to provide additional funding for the whole course of the year. 00:04:48.962 --> 00:04:56.412 - Disease intervention and harm reduction are going to begin walk-in testing services on Thursday, 00:04:56.412 --> 00:05:04.170 - June 25th. This will be from 3 to 6 p.m. in the lower level of the health department. So the plan is 00:05:04.170 --> 00:05:10.238 - to continue offering this free walk-in testing every Thursday from 3 to 6 p.m. 00:05:10.658 --> 00:05:19.315 - and treatment for chlamydia, gonorrhea, and syphilis. They'll also be offering rapid HIV and hepatitis 00:05:19.315 --> 00:05:24.862 - C testing and be able to provide Narcan and Fentanyl test strips. 00:05:27.778 --> 00:05:33.237 - So essentially one of the reasons is they're kind of looking at our disease intervention specialists 00:05:33.237 --> 00:05:38.696 - carry a caseload around 20 to 30 for their case investigations. So offering walk-in testing services 00:05:38.696 --> 00:05:43.614 - might help to balance their workload with appointments that they would otherwise schedule. 00:05:45.890 --> 00:05:53.239 - We are waiting for our next grant award for funding that supports our harm reduction specialist. We 00:05:53.239 --> 00:06:01.324 - currently have funds remaining to support this position until approximately November of this year. Population 00:06:01.324 --> 00:06:08.820 - Health and Outreach is working with community members on planning a recovery summit for September 2nd 00:06:08.820 --> 00:06:12.862 - this year. This will be held at the Convention Center. 00:06:14.498 --> 00:06:21.745 - One of the sessions being looked at is bridging the gap program. This is focused on intervening at the 00:06:21.745 --> 00:06:28.922 - earliest stage of recovery, integrating prevention in all stages of recovery. They're also looking at 00:06:28.922 --> 00:06:33.566 - hosting a panel discussion with legal representatives this event. 00:06:35.490 --> 00:06:41.771 - With our maternal and child health, the Milk Bank Express has started off really well. We've distributed 00:06:41.771 --> 00:06:47.872 - 24 bottles so far since towards the end of April, so we had a little bit of a hiccup at the beginning 00:06:47.872 --> 00:06:54.153 - with our first distribution. Our coordinator was out of the office when the individual came in, so we've 00:06:54.153 --> 00:07:00.434 - worked with the Milk Bank on updating our information online with a number to make sure that individuals 00:07:00.434 --> 00:07:04.382 - call to schedule their pick up to make sure that someone is here. 00:07:04.482 --> 00:07:12.872 - We're also, we've created a standard operating procedure and looking at other employees who can be trained 00:07:12.872 --> 00:07:21.105 - to be able to provide this milk for the pickup. She's started providing catch my breath vaping education 00:07:21.105 --> 00:07:26.750 - in the Monroe County schools. So that started in May and will continue. 00:07:27.458 --> 00:07:34.959 - She's also collaborating with Purdue Extension on the nutrition education with families with young children. 00:07:34.959 --> 00:07:42.185 - And will begin working with Indiana University a little bit later in the summer on an eight week program 00:07:42.185 --> 00:07:49.617 - called Goal. So that's get on board active living. This will provide eight weeks for families with children 00:07:49.617 --> 00:07:52.094 - on physical activity and nutrition. 00:07:54.786 --> 00:08:02.229 - For environmental health, our director completed training this week on conducting case investigations 00:08:02.229 --> 00:08:09.891 - for tick-borne illnesses. So really excited about that and was able to submit two cases for review after 00:08:09.891 --> 00:08:17.553 - getting access to the system. So that's going well. Pool inspections are underway and going well. Septic 00:08:17.553 --> 00:08:21.566 - installations have slowed just due to all the rain and 00:08:21.858 --> 00:08:29.250 - weather, but hoping that that'll dry up soon. They do still have eight remaining ARPA systems that they're 00:08:29.250 --> 00:08:36.711 - working to get installed prior to the end of July. Our Director of Public Health Preparedness has completed 00:08:36.711 --> 00:08:43.619 - instructor training through the Red Cross for CPR, First Aid, and ADD, and we're looking at ways to 00:08:43.619 --> 00:08:46.590 - begin offering this service to the public. 00:08:47.554 --> 00:08:55.523 - and our emergency preparedness coordinator completed basic disaster life support training and this training 00:08:55.523 --> 00:09:02.903 - was actually financially supported by the emergency preparedness planning council. We have received 00:09:02.903 --> 00:09:09.470 - $25,000 in grant funding for public health emergency preparedness. This term is July 1st 00:09:09.602 --> 00:09:19.485 - 2026 through June 30th of 27. So this helps to support mileage, training, supplies, and is a big help 00:09:19.485 --> 00:09:29.561 - to that division. That's the end of the question. Yes. Has facilities addressed the paint chips falling 00:09:29.561 --> 00:09:37.118 - down on employees in the loading area? Not to my knowledge, it still has not. 00:09:40.482 --> 00:09:48.384 - I'm wondering whether internal infant care specialist also is addressing drowning issues with parents. 00:09:48.384 --> 00:09:56.210 - So we did that last year with the summer, the educational programs and distributed water safety kits, 00:09:56.210 --> 00:10:03.882 - and we still have some of those left over. So we'll be looking at doing that. We have some outreach 00:10:03.882 --> 00:10:09.790 - activities coming up later this summer so we could still offer that. Thanks. 00:10:13.698 --> 00:10:25.077 - Have you wanted to give us any indicates? Sure. Everything has been going smoothly. I haven't heard 00:10:25.077 --> 00:10:36.570 - of any issues this last week so far. Are you able to make a long site visit? Yes, I stop by at least 00:10:36.570 --> 00:10:42.942 - once a week and then leave the same three times a week. 00:10:43.394 --> 00:11:09.483 - So the next item on our agenda is the prenatal vitamins. And so in your packet, you have the theronatal 00:11:09.483 --> 00:11:13.246 - core vitamins. 00:11:13.410 --> 00:11:20.615 - Um, and I don't know, this is what our folks could get for us. Can you tell us more about that? Yes. 00:11:20.615 --> 00:11:28.034 - Um, so been working through research, trying to find other opportunities for, um, to be able to provide 00:11:28.034 --> 00:11:35.240 - these prenatal vitamins. So this company says that they have some that are available. The expiration 00:11:35.240 --> 00:11:42.302 - date is in September of this year, but they are willing to provide us, um, with the stock of food. 00:11:42.530 --> 00:11:50.675 - are interested in having these to distribute. And is that free to us? And how many do we do it on a 00:11:50.675 --> 00:11:59.065 - case by case basis or they give us like a box of 10 or something to start? So I don't know of an exact 00:11:59.065 --> 00:12:07.373 - number, but since I don't think that we would be asking for that many since they expire in September. 00:12:07.373 --> 00:12:10.142 - So before coming up with an exact 00:12:10.242 --> 00:12:20.095 - amount to try to ask for. I thought we'd see if this means the criteria. So the number one, our number 00:12:20.095 --> 00:12:29.756 - one concern last time was that there was no enough folic acid in the vitamin angels offering. And so 00:12:29.756 --> 00:12:38.174 - this has 400 micrograms of folic acid. Say yes, Kate. But why does it say, hold her in? 00:12:38.786 --> 00:12:50.270 - percentage of daily value, why does it say on it, if I can find it here, that it's 278%. Is it 278%? 00:12:50.270 --> 00:13:02.096 - Well, one, it's methyl tetrahydrofolate, which is slightly different because it's more readily absorbed 00:13:02.096 --> 00:13:08.350 - than folate itself. There are people who cannot handle 00:13:08.834 --> 00:13:20.956 - and have methylation issues. So we've got two different numbers there. You've got the 1665 means what 00:13:20.956 --> 00:13:32.840 - it says, which is why you're seeing 278%. And what they're saying is if just pure folate, when it's 00:13:32.840 --> 00:13:37.950 - not the L5 methylated, then it's 400 mics. 00:13:38.178 --> 00:13:48.561 - It's straight forward. Does that hold it all? I'm not sure what these percent daily values mean. Maybe 00:13:48.561 --> 00:13:58.743 - compared to the RDA for women who aren't pregnant, I'm really not sure how to interpret that. I just 00:13:58.743 --> 00:14:07.614 - want to make sure it's in line with what NICOG recommends. NICOG recommends 400 to 800. 00:14:08.034 --> 00:14:14.226 - This would be within that. At least it's the minimum required, which the other one did not, which is 00:14:14.226 --> 00:14:20.601 - super concerning. The only question I would have on this bottle is I noticed that there are 90 tablets, 00:14:20.601 --> 00:14:26.731 - so this is a three month supply, which means if we get them next month, we would want to get enough 00:14:26.731 --> 00:14:33.291 - for three months, but then that gets us to a third of the pregnancy. So what do we do beyond three months? 00:14:33.291 --> 00:14:37.214 - I'm not saying I say no to this, but this settles as many women 00:14:37.314 --> 00:14:45.954 - as they will give us bottles for three months, and that is all. We'll be looking at this issue again 00:14:45.954 --> 00:14:54.594 - in three months. Correct. Only less than three months. Yeah, probably next month. It will seem to be 00:14:54.594 --> 00:15:03.747 - a continuing agenda item. But I mean, I started looking at prices of prenatal vitamins that aren't readily 00:15:03.747 --> 00:15:06.142 - available, and it's minimum 00:15:07.170 --> 00:15:19.557 - $35 a pop for 90 days. Did we ever decide approximately how many women need these? Well, she under 150 00:15:19.557 --> 00:15:31.704 - within a year. And then the question is, I was asking Lori earlier, who exactly are they distributed 00:15:31.704 --> 00:15:34.590 - to? And apparently this 00:15:35.138 --> 00:15:45.154 - our supplies been going to tandem and we have no actual contract with tandem, which is kind of interesting 00:15:45.154 --> 00:15:54.983 - that the health department has been giving this over to tandem, but without any kind of actual agreement 00:15:54.983 --> 00:16:02.846 - in place of our providing this to them. So does this, I guess I would ask the board 00:16:03.138 --> 00:16:13.443 - Do you want it to go to our maternal infant care folks and the people who are under our umbrella, or 00:16:13.443 --> 00:16:24.156 - are we handing them off to other organizations? If they're expired, you hand them off. No, just kidding. 00:16:24.156 --> 00:16:25.278 - Let's see. 00:16:26.466 --> 00:16:34.630 - Can I ask a clarifying question? 150 women, is that 150 women for their whole pregnancy or 150 bottles 00:16:34.630 --> 00:16:42.952 - we're talking about? Under 150 bottles. Okay, so that's less than 150 women. So that's a lot less women. 00:16:42.952 --> 00:16:50.958 - Yes, that's 50-ish, roughly. Yeah. Okay, and that's how many we were distributing. Yeah, that's what 00:16:50.958 --> 00:16:54.366 - we got from the vitamin angels that, yeah. 00:16:54.722 --> 00:17:06.267 - That doesn't include the amount that we were giving to candidates. That is what you gave to them. Do 00:17:06.267 --> 00:17:18.269 - we have anywhere in our budget that we could buy 50 bottles or whatever we need for these pregnant women 00:17:18.269 --> 00:17:24.670 - with what they need? It would be 150 bottles times $30. 00:17:25.122 --> 00:17:33.816 - of five thousand dollars basically it's 4500 so then i think the question is can we find that money 00:17:33.816 --> 00:17:42.858 - now and can we find that money in the future and i think we'll have a better idea of next year you know 00:17:42.858 --> 00:17:51.726 - next month about where it is but is the thirty dollars based on what retail value of the vitamins are 00:17:51.726 --> 00:17:54.334 - what i mean i or is that what 00:17:54.530 --> 00:18:05.844 - let's say TheraLogix is willing to give us the vitamins they're going to expire, if to continue, what 00:18:05.844 --> 00:18:16.936 - would they be willing to send? I looked on Amazon, our usual retailers, and it was somewhere in the 00:18:16.936 --> 00:18:24.478 - range of $32 a bottle for these. That's what they would retail for. 00:18:24.994 --> 00:18:32.538 - whether we could get a wholesale price from one item. Amazon takes a cut and then the people that sell 00:18:32.538 --> 00:18:39.935 - it make it profit. Actually, I'm just wondering if we went straight to this company, what they would 00:18:39.935 --> 00:18:47.333 - be willing to give us, to sell us the bottles. We could certainly. I certainly think that we should, 00:18:47.333 --> 00:18:52.606 - I would say we take this. Yeah. It solves the problem for three months. 00:18:53.378 --> 00:19:00.892 - Yes, I think we continue to try to look for. This could be continuing business. I mean it is. Well, 00:19:00.892 --> 00:19:08.631 - certainly, but ongoing and continuing business. But I would like to what I would like to see the board 00:19:08.631 --> 00:19:16.370 - do is this make a decision today as to whether or not we're going to accept these. And I think so. The 00:19:16.370 --> 00:19:23.358 - question is, can we help? Maybe 75 patients, yes, over the course of the next few months and 00:19:24.738 --> 00:19:32.796 - they will be, these patients will be taking vitamins, whereas they wouldn't have before, given that 00:19:32.796 --> 00:19:41.176 - it has the 400 micrograms of folate acid. What was the other place that? Oh, like one a day, there were 00:19:41.176 --> 00:19:49.234 - a number of different vitamins. No, no, I mean the other group in town that we were giving them to. 00:19:49.234 --> 00:19:53.182 - Tandem, okay. In my opinion, I think it doesn't, 00:19:54.018 --> 00:20:01.930 - I think we can either distribute them from our facility or tandem. If those patients are used to coming 00:20:01.930 --> 00:20:09.690 - there or using that resource, then I think I don't have a problem with them utilizing the vitamins as 00:20:09.690 --> 00:20:17.297 - well. But I don't know what other opinions folks have. I mean, it sounds like if we have... Is that 00:20:17.297 --> 00:20:22.014 - acceptable? It sounds like if we have a total of 50-ish women 00:20:22.306 --> 00:20:30.087 - including ones from Tandem, I would agree with you. It seems like if they give us 50 bottles worth, 00:20:30.087 --> 00:20:37.867 - I'd rather give them to women who need them regardless of where they're accessing it versus letting 00:20:37.867 --> 00:20:46.114 - them sit on the shelves and aspire. So I would make a motion that we accept the therianatal core vitamin. 00:20:46.114 --> 00:20:50.238 - We need to ask for public comment before we do that. 00:20:51.618 --> 00:21:03.841 - Do we have anyone who would like to comment on this item about the prenatal violence? No, okay. Now 00:21:03.841 --> 00:21:16.064 - you may make an option, please. Pursuant to my previous comments, I'd like to make a motion that we 00:21:16.064 --> 00:21:19.486 - accept the therianatal core 00:21:20.290 --> 00:21:29.659 - vitamins, prenatal vitamins being offered to us. We don't know how many bottles that we're gonna get, 00:21:29.659 --> 00:21:38.845 - right? Well, whatever, how much they're offered. And distribute them ourselves or through tandem so 00:21:38.845 --> 00:21:48.030 - that we make sure all five bunches are distributed. So, sorry. I'll second. All in favor? Aye. Aye. 00:21:49.122 --> 00:22:04.029 - Okay, motion passes. Our next item is about our 2027 Health First Indiana budget items. So that, you 00:22:04.029 --> 00:22:13.918 - reference your packet. I would like to point out that having that. 00:22:14.402 --> 00:22:21.946 - having comment right before you make a motion or after, well, actually before you make a motion is new. 00:22:21.946 --> 00:22:29.200 - So I apologize to her for getting ahead of myself. Technically, the motion can be made and seconded 00:22:29.200 --> 00:22:36.599 - and the same way that there's comment and discussion that also can be when the discussion happens, as 00:22:36.599 --> 00:22:41.822 - long as it occurs before the vote. That's true. It's supposed to happen 00:22:42.402 --> 00:22:54.947 - after the motion's made, then the inspection. Yep, my mistake. Sure. Okay, so in your packet, you have 00:22:54.947 --> 00:23:07.492 - a couple of items showing the fees, and then you have the one that's showing all of the positions that 00:23:07.492 --> 00:23:11.390 - are related, I believe, to HFI. 00:23:12.482 --> 00:23:25.210 - And I'll let Laurie speak to this. Sure. So our 2027 funding for Health First Indiana is the same amount 00:23:25.210 --> 00:23:38.302 - as it is this year. So that's $826,000 roughly. So this is basically showing you what positions that we can 00:23:38.466 --> 00:23:46.261 - go ahead and plug into this budget for 2027. The positions that are highlighted in yellow are the positions 00:23:46.261 --> 00:23:53.695 - that we will be looking for to be covered by different buckets of money, essentially different funding 00:23:53.695 --> 00:24:01.202 - sources. So all of these positions do align with the core public health service. So no issues with that 00:24:01.202 --> 00:24:06.110 - and meeting the compliance for that. We have included FICA and PERF 00:24:06.242 --> 00:24:13.049 - in this. What we have been doing is what was recommended by the Indiana Department of Health is that 00:24:13.049 --> 00:24:19.789 - we include all of the self-insurance into the county health fund. So that's how it will be budgeted 00:24:19.789 --> 00:24:26.866 - because the county pulls all of the funds even for vacant positions. So the problem that we were running 00:24:26.866 --> 00:24:27.742 - into is that 00:24:27.874 --> 00:24:35.294 - funding was being pulled from the Health First Indiana dollars for positions that were vacant that were 00:24:35.294 --> 00:24:42.714 - not actually delivering core services. So to ensure that every dollar is tied to the delivery of a core 00:24:42.714 --> 00:24:49.278 - public health service, we will be budgeting the self-insurance into our county health fund. 00:24:49.474 --> 00:24:57.862 - looking at probably going to be around $450,000 for 2027 so that will take a really large portion of 00:24:57.862 --> 00:25:06.498 - our county health fund. Just additional some expenses budgeted in here for 2027. Other supplies so help 00:25:06.498 --> 00:25:15.550 - to cover costs for cleaning supplies, vehicle repairs, maintenance supplies and in the service category have 00:25:15.714 --> 00:25:23.180 - Funding set aside for travel, mileage, training, and development for all employees across the department. 00:25:23.180 --> 00:25:30.435 - And the services and charges will be covering our workers comp, vehicle insurance, building insurance, 00:25:30.435 --> 00:25:37.549 - our subscription fees, and fees that we pay to the Indiana Department of Health for the lab. So some 00:25:37.549 --> 00:25:44.734 - things to consider. We have been funding Health Net for that homeless, for their homeless initiative. 00:25:44.866 --> 00:25:53.100 - And that has been at $135,000 the year. So one thing I think the board will need to consider is whether 00:25:53.100 --> 00:26:01.018 - we want to look at a way to continue funding that in 2027. And we might want to look at a part time 00:26:01.018 --> 00:26:08.935 - line and do still have the hiring freeze that is going on, but having money and approval to be able 00:26:08.935 --> 00:26:14.398 - to hire part time might be a good idea to offer us some flexibility. 00:26:16.706 --> 00:26:26.350 - Is that, are they going to let us do that? That I don't know. They've been really inflexible to this. 00:26:26.350 --> 00:26:35.899 - As a matter of fact, this is sort of related to this, and this may not be something you have off the 00:26:35.899 --> 00:26:41.950 - top of your head. Do you have a dollar amount that we've had to 00:26:42.690 --> 00:26:50.158 - forgo, give back to the state in terms of grant funding or whatever for this, because we haven't been 00:26:50.158 --> 00:26:57.553 - able to hire people, can we assign a dollar value to that? If you don't have it now, then we'll talk 00:26:57.553 --> 00:27:04.947 - later. Yeah, well, I think that the disease intervention, I can't remember what that, if that was an 00:27:04.947 --> 00:27:11.390 - additional 65,000, but we're really running into the challenge of not being awarded new 00:27:11.554 --> 00:27:19.884 - grants that would require positions so we have applied for some new grants that would support additional 00:27:19.884 --> 00:27:28.530 - positions you know a few hundred thousand dollars but with the hiring freeze does that make that challenging 00:27:28.530 --> 00:27:36.860 - but i could find out that is receiving those grants uh are they contingent upon having someone available 00:27:36.860 --> 00:27:38.526 - to fill that spot so 00:27:40.450 --> 00:27:49.532 - services we can't even but even when we have the money yes exactly we can't get someone even when the 00:27:49.532 --> 00:27:58.793 - money is is there we i think we need to keep i think we need to as a board make a master plan and we're 00:27:58.793 --> 00:28:08.766 - going to talk more about that and keep asking and going publicly and saying hey you know we need cooperation of 00:28:09.186 --> 00:28:17.183 - arms of government to be able to provide services for our people in Monroe County. I mean, I just feel 00:28:17.183 --> 00:28:24.948 - like, again, this is different than County Highway and this is just different and we're at risk. So 00:28:24.948 --> 00:28:32.712 - the thing is right now we're in this key spot where if we do not continue to be able to provide the 00:28:32.712 --> 00:28:34.110 - services for HFI, 00:28:34.850 --> 00:28:42.104 - and prove to the state that we can do that, then we will essentially just lose our funding. So I don't, 00:28:42.104 --> 00:28:49.358 - I really don't understand why there's a lack of cooperation. I agree with Dr. Robinson. We need to keep 00:28:49.358 --> 00:28:56.473 - on doing what we're supposed to be doing. So I think we, we should, we should continue, we need to as 00:28:56.473 --> 00:29:00.030 - a board, I think continue to push the issue and be 00:29:00.290 --> 00:29:07.290 - proactive and say hey, this is what we need and continue to go. Asked to go before the board and I think 00:29:07.290 --> 00:29:13.957 - you know as we progress that you know Lori will go and give health Department updates and will keep 00:29:13.957 --> 00:29:20.624 - saying either she or she and I together saying hey, you know. This is critical because if you don't 00:29:20.624 --> 00:29:27.358 - make some decisions now. In a different direction, we're essentially going to lose funding. I don't. 00:29:27.358 --> 00:29:28.958 - I don't understand the. 00:29:29.570 --> 00:29:38.101 - Which comes back to why I would like to have a dollar amounts assigned to monies that we are not going 00:29:38.101 --> 00:29:46.467 - to get because we can't hire people. And as you recall, I mean, I was beat up in the council for not 00:29:46.467 --> 00:29:54.915 - allowing, you know, for giving up our clinic downstairs and returning those federal dollars, which of 00:29:54.915 --> 00:29:58.974 - course came back once the clinic continued under 00:29:59.074 --> 00:30:07.055 - different management, but they keep harping on that, and I'd like to harp on them for a change. I think 00:30:07.055 --> 00:30:14.345 - it's important to underscore maybe both, because I think if you aren't familiar with medicine, 00:30:14.345 --> 00:30:22.096 - when you say, we're going to lose such and such a thing, they go, I don't know what that means. What 00:30:22.096 --> 00:30:28.926 - does disease monitoring mean? I don't know what that is. But if we say, this is why this 00:30:29.314 --> 00:30:35.483 - this is what this position is, this is what they are doing for your community, and this is why it's 00:30:35.483 --> 00:30:41.774 - important, without this, we are going to lose our ability to do that for our community, and that will 00:30:41.774 --> 00:30:48.251 - be on you. And that's exactly what I heard in reverse. Yeah. And the close of the family planning clinic 00:30:48.251 --> 00:30:54.420 - downstairs was, this money is coming into the county and we're giving you, we're gonna have to give 00:30:54.420 --> 00:30:57.566 - this money back because you're closing the clinic. 00:30:59.522 --> 00:31:07.119 - There were many reasons, but you know that, and I, my point was, well, it opened up two to three months 00:31:07.119 --> 00:31:14.424 - later under different management and that money is still flowing and those services were available. 00:31:14.424 --> 00:31:22.022 - However, the services that we're by, we're gonna forego because we can't hire the people are not coming 00:31:22.022 --> 00:31:28.158 - into our training. No one else is doing this. And no one else is gonna be doing it. 00:31:28.322 --> 00:31:37.487 - I mean, IU was doing it before and, you know, they're, well, anything. It's not just the dollar amount 00:31:37.487 --> 00:31:46.384 - that we're losing because we're not getting it, but it's also the money that we already have and we 00:31:46.384 --> 00:31:56.350 - can't spend it because we can't hire someone because we don't get the blessing of the council for the position. 00:31:57.538 --> 00:32:06.893 - We have the money, it's there. We just need the okay to hire a person. Will we lose that money if we 00:32:06.893 --> 00:32:16.526 - don't hire someone? At least at the leadership symposium last week, there was a lot of talk about this, 00:32:16.526 --> 00:32:24.862 - about how the legislators want instant ratification. They want to see instant results and 00:32:25.122 --> 00:32:33.902 - They don't understand that chronic disease is something long-term that we invest in over time. They 00:32:33.902 --> 00:32:43.032 - want to see the answers yesterday. And indeed, the issue for across the state is if we aren't providing 00:32:43.032 --> 00:32:51.900 - these services, the state indeed will not be giving us the same HFI funding because they're going to 00:32:51.900 --> 00:32:54.270 - say, you haven't spent it. 00:32:55.394 --> 00:33:03.859 - The issue for us, of course, is that we can't spend it because council won't allow us to spend our HFI 00:33:03.859 --> 00:33:12.160 - funding to take care of these positions. So it's kind of a catch-22. Yes, it's fairly clear that the 00:33:12.160 --> 00:33:20.378 - state will not be granting the same amount of HFI funding if it hasn't been spent. They're going to 00:33:20.378 --> 00:33:24.734 - say, oh, you're just wasting our time and our money. 00:33:25.154 --> 00:33:33.713 - I don't have the answer, but I know that there are people across the state, across all of the health 00:33:33.713 --> 00:33:42.442 - departments in the state that are equally concerned, you know, from either a council or a commissioner 00:33:42.442 --> 00:33:51.171 - point of view, or just the inability to find personnel to fill positions. And that's a big issue right 00:33:51.171 --> 00:33:53.374 - now. So thank you, Sarah. 00:33:54.882 --> 00:34:02.732 - So my question is, in this budget, are we, so when we do a proposed budget, can we, I guess, add items 00:34:02.732 --> 00:34:10.352 - that we would like to see approved, and then they can just say no? Do you know what I'm, do you see 00:34:10.352 --> 00:34:18.126 - what I'm saying? Like, we need these positions, we would ask for it in the budget, and then they vote 00:34:18.126 --> 00:34:22.622 - on it, or that's not how this works, because I'm concerned 00:34:23.106 --> 00:34:30.713 - We have, I think we have a set of funds that's around. I don't know, is it around? The 400,000 that 00:34:30.713 --> 00:34:38.472 - got cut last year. Can we go back and ask and put that in our budget and say this is our proposal and 00:34:38.472 --> 00:34:46.079 - then they can just say no? Or is that not how that works? So for the state funds we can only submit 00:34:46.079 --> 00:34:49.502 - a budget for this dollar amount for exhibit. 00:34:49.602 --> 00:34:58.924 - When it comes to the local county funds, you could ask for what you would like to ask for and then ultimately 00:34:58.924 --> 00:35:00.958 - they make the decision. 00:35:01.122 --> 00:35:08.399 - We do still have remaining, because of some of the challenges that you all have just discussed, we do 00:35:08.399 --> 00:35:15.534 - still have some remaining funds from 2024 from HFI which will help fund some of these positions. We 00:35:15.534 --> 00:35:22.739 - also still have some older state funds before the HFI which will help cover some of these positions. 00:35:22.739 --> 00:35:25.950 - So then I think we'll be looking at how much 00:35:26.210 --> 00:35:35.281 - Does the board want to request Monroe County Council invest in the health department for 2020 simple? 00:35:35.281 --> 00:35:44.441 - So where on this we have the approximately $450,000 for the contract for IU. So where is that absorbed 00:35:44.441 --> 00:35:54.046 - in the 2027 budget so we can provide services that they were providing? How do we do that with this budget? 00:35:54.626 --> 00:36:03.605 - So we had moved the IU Health contract out of Health First Indiana into the local health fund when the 00:36:03.605 --> 00:36:12.410 - change came about the Indiana residency. So those dollars are currently sitting in the county health 00:36:12.410 --> 00:36:22.174 - fund. And so those remaining dollars, part of those dollars are funding the communicable disease nurse position 00:36:22.722 --> 00:36:31.789 - And there are still some remaining funds that we would like to be able to use to fund the clinical assistant 00:36:31.789 --> 00:36:40.191 - position and help continue supporting costs for our nursing services that we are now taking on. That 00:36:40.191 --> 00:36:46.430 - was the position you're going to ask Council for? It did not make it. Yes. 00:36:51.554 --> 00:37:01.443 - So before we vote on this budget as further discussion, I can talk about this. So in your packets, we 00:37:01.443 --> 00:37:11.235 - have the current org chart for Monroe County. We discussed this last time then comparing that to the 00:37:11.235 --> 00:37:13.950 - org chart for Allen County. 00:37:14.242 --> 00:37:23.723 - I don't think we had visuals, so yeah. OK, so so I'm going to repeat some things maybe from last time. 00:37:23.723 --> 00:37:32.929 - So if you look at the population of Allen County, approximately 400,000 in 2024, I believe, and you 00:37:32.929 --> 00:37:41.950 - can look at Monroe County's. Population then we're like 32% of Allen County's population. And so. 00:37:42.178 --> 00:37:51.419 - If you look on their org chart, they have 23 full-time employees who answer to their medical director 00:37:51.419 --> 00:38:01.294 - to do infectious disease, immunization clinics, case management, HIV prevention, and it's a little different 00:38:01.294 --> 00:38:09.086 - org chart, but the point is, so there's 23 full-time employees, 30% approximately is, 00:38:09.250 --> 00:38:17.823 - would equal eight full-time employees for Monroe County to do these positions. If you look at, then 00:38:17.823 --> 00:38:26.825 - they have a statistical and information support division, and they have a total in that section of eight 00:38:26.825 --> 00:38:34.970 - full-time employees. And so Monroe County would need about two full-time employees. Currently, 00:38:34.970 --> 00:38:38.142 - we have four. I'm going back to the, 00:38:38.338 --> 00:38:51.626 - part, the medical part. So we have four full-time employees that provide infectious disease, case management, 00:38:51.626 --> 00:39:03.827 - and some of our prevention. And so I think that we need four additional positions to make up for the 00:39:03.827 --> 00:39:07.934 - employees that we've lost when we 00:39:08.610 --> 00:39:20.947 - lost the IU health contract. So in my mind, we need those additional positions and we need probably 00:39:20.947 --> 00:39:33.531 - two positions that allow us to obtain data, work through data, do the statistical analysis and all of 00:39:33.531 --> 00:39:35.998 - those services. And 00:39:37.058 --> 00:39:46.039 - So if we, if we don't look at, you know, Hey, we have this budget cuts, et cetera. I mean, that's, that's 00:39:46.039 --> 00:39:54.511 - really the bottom line is yes, our org chart is a little different than Allen County, but these are 00:39:54.511 --> 00:40:04.254 - the things that we need to provide services for Monroe County citizens in a proper fashion. So the details of the, 00:40:04.418 --> 00:40:12.978 - Step-by-step in the county government asking for this is, you know, we meet with resistance at each 00:40:12.978 --> 00:40:21.537 - turn because you have to get with approval, which is defining the position, what it should pay. And 00:40:21.537 --> 00:40:30.782 - then it has to go through the council and it has to go through PACS also and then through council next. So, 00:40:34.562 --> 00:40:42.882 - I don't know how much of that process we can sort of, well, we can't bypass the process, understood, 00:40:42.882 --> 00:40:51.202 - but is this the point where we ask for what we need in the budget and then go figure out the details 00:40:51.202 --> 00:40:59.687 - at a later time and keep asking for what we need? So that's my question to the board. And I don't know 00:40:59.687 --> 00:41:03.806 - if, you know, the ins and outs of all of that is, 00:41:04.066 --> 00:41:11.233 - county government, but we can work through that. I think if we don't ask for it, we will never, if we 00:41:11.233 --> 00:41:18.401 - never get it, if we sort of keep saying, well, you know, they're not going to approve it or whatever, 00:41:18.401 --> 00:41:25.568 - then if we never ask for it, and the public doesn't see that we asked for it, then we will never have 00:41:25.568 --> 00:41:32.736 - the possibility of getting it. So this is just my opinion. But we do not have enough, you know, boots 00:41:32.736 --> 00:41:33.790 - on the ground, 00:41:34.114 --> 00:41:43.058 - scenario is we do not have enough people to provide the services that we're both required to provide 00:41:43.058 --> 00:41:52.268 - and that Monroe County citizens deserve as their taxpayers and and we're trying to provide the services 00:41:52.268 --> 00:41:57.758 - that they need. So how many people do we currently need here? 00:41:58.466 --> 00:42:07.068 - I'm not even sure I could follow all the reasoning that you had, and I've been here for a long time, 00:42:07.068 --> 00:42:16.010 - so I'm not sure you guys followed it, but maybe you could. And I'm not saying it was, you didn't explain 00:42:16.010 --> 00:42:24.867 - it well, but yeah. But how many people do you currently need to hire to cover the services that we need 00:42:24.867 --> 00:42:27.422 - to provide? I would say five. 00:42:28.290 --> 00:42:38.392 - Do I have additional? And the most important of those would be somebody really, and that would be like 00:42:38.392 --> 00:42:48.886 - the clinical assistant position that we're currently trying to get. The clinical positions, yeah. Nursing, 00:42:48.886 --> 00:42:53.790 - director, someone to oversee the vaccine program, 00:42:53.890 --> 00:43:01.677 - is really important. But we need communicable disease nursing staff. We need nursing staff for the vaccines 00:43:01.677 --> 00:43:09.176 - and clinical support staff. And we need more maternal child health staff because she's only one person. 00:43:09.176 --> 00:43:13.790 - And as we saw when she's out of the office, then those services 00:43:13.890 --> 00:43:21.914 - aren't provided if I'm here then they come to me and I can try to help fill in to some extent but I'm 00:43:21.914 --> 00:43:29.781 - already being a backup for four positions and now with the maternal child health so that's five and 00:43:29.781 --> 00:43:38.357 - we need we need backup upon backup upon backup so to be able to function so basically we need five positions 00:43:38.357 --> 00:43:40.638 - I mean that would that would 00:43:40.834 --> 00:43:48.640 - at least allow us to be operating at capacity. I mean, our full. If I heard you right, you said six. 00:43:48.640 --> 00:43:56.446 - I said six. Yeah, you're right. Actually, you're right, six, because I wasn't looking at this. So if 00:43:56.446 --> 00:44:04.407 - you look at the proposed one, and we've made some other changes, but really to structure this out, how 00:44:04.407 --> 00:44:06.494 - some of our most efficient 00:44:06.626 --> 00:44:12.633 - divisions are like environmental health services and vital records, we need that additional extension 00:44:12.633 --> 00:44:18.876 - because this is our coverage. So we don't have additional built-in coverage with these nursing positions. 00:44:18.876 --> 00:44:25.060 - So when you're already short on staffing for that, there's no other resources to pull from. And maternal 00:44:25.060 --> 00:44:31.186 - child health, there's only one person there. So we need a second person there. We do have the capacity. 00:44:31.186 --> 00:44:34.366 - We could be providing a lot more with those services. 00:44:34.690 --> 00:44:45.752 - but definitely with our nursing services as well. Okay. So six, how much additional money do we need? 00:44:45.752 --> 00:44:57.139 - The money that we already haven't got. So I would ask them, um, full time benefited under 300,000. Okay. 00:44:57.139 --> 00:44:59.742 - So the three positions. 00:45:00.738 --> 00:45:08.212 - So you said six. OK, that's so these three that are kind of dotted lines proposed. Those are ones that 00:45:08.212 --> 00:45:16.048 - are not already approved, right? Those are correct, like they don't exist. The other ones we have received. 00:45:16.048 --> 00:45:23.377 - We have funding for, but have not received approval to hire. We have funding and positions available 00:45:23.377 --> 00:45:30.270 - for these. OK, so really we're just asking. Six total that we don't have that we need to hire. 00:45:30.434 --> 00:45:38.219 - three approved, three we need to get approval for. Thank you. Is that in order to fulfill the requirements 00:45:38.219 --> 00:45:45.714 - that the state has for us, states and groups do these things and just to fulfill those things? So, Dr. 00:45:45.714 --> 00:45:53.063 - Robinson, I would agree. I think that we need to ask for what we need, not what we think we're going 00:45:53.063 --> 00:45:59.902 - to get told yes. I think we need to be very loud and clear to the citizens of the county that 00:46:00.130 --> 00:46:09.017 - here's what we need and the board has the opportunity to, I'm sorry, the council has the opportunity 00:46:09.017 --> 00:46:17.991 - to give that to us if they choose to, but if they don't want to, that is their call. So I would agree 00:46:17.991 --> 00:46:26.878 - with you. Okay, so Lori, we have in this budget, you have the funding listed for public health nurse 00:46:26.878 --> 00:46:28.286 - school liaison. 00:46:28.546 --> 00:46:36.783 - Is that true? I'm just trying to that is not true. So that's currently funded. That is currently funded 00:46:36.783 --> 00:46:44.941 - through the school grant. And the public health nurse communicable disease is county funded, so that's 00:46:44.941 --> 00:46:53.099 - covered from the funds that did not go to IU health. OK, the public health nurse position is currently 00:46:53.099 --> 00:46:57.534 - in 2026 HFI. The idea is to move that to an alternative 00:46:57.698 --> 00:47:06.058 - funding source, such as the school grant or county. So to provide flexibility, you know, with, yeah, 00:47:06.058 --> 00:47:14.666 - with the residency. Okay. So you're saying for the purpose of this budget, there's three positions that 00:47:14.666 --> 00:47:18.142 - are not on this proposed budget. Correct. 00:47:21.986 --> 00:47:28.609 - Okay. And that's the maternal and child health assistant, the senior public health nurse and the health 00:47:28.609 --> 00:47:35.169 - services assistant. Is that right? Those are new positions that would have to be approved. These three 00:47:35.169 --> 00:47:41.665 - positions are not in. Got it. Wait, say it again. This, the maternal child health assistant is not on 00:47:41.665 --> 00:47:48.670 - the budget. Correct. Senior public health nurse, not on budget. Correct. Health services assistant. No. Okay. 00:47:53.794 --> 00:48:06.945 - So we ask if it doesn't get put on the agenda, our hands are tied. Correct. But we just keep asking. 00:48:06.945 --> 00:48:19.965 - We keep asking and we keep going to give updates and we keep going to give public comment. So can I 00:48:19.965 --> 00:48:21.918 - have a motion? 00:48:24.418 --> 00:48:36.507 - Well, one moment. So these positions, Lori, would just, would you have an idea of them being, do we 00:48:36.507 --> 00:48:48.595 - have to vote on a proposed amount? Of course, I would say. So can you give us an idea of what these 00:48:48.595 --> 00:48:51.134 - folks should be paid 00:48:54.018 --> 00:49:02.839 - I mean, I would say, according to the salary ordinance, is that what you mean? No, what do we think 00:49:02.839 --> 00:49:11.659 - these people need to be paid in order to be able to hire the person we need with the credentials we 00:49:11.659 --> 00:49:16.158 - need? So, well, so it's hard for a good example is 00:49:16.898 --> 00:49:29.044 - People in Bloomington are traveling to Morgan County for positions because Morgan County is paying their 00:49:29.044 --> 00:49:40.843 - nurses 36 an hour and our nurses are 28. Okay, so if we ask, so if it's 36 an hour, what is full-time 00:49:40.843 --> 00:49:45.470 - hours? Is it 36, 35? So that's 65, 520. 00:49:46.530 --> 00:49:55.448 - for a year, 65,520. So are each of these positions, well, are each of these positions nurse positions 00:49:55.448 --> 00:50:04.627 - or no? No, so this one is, and this one is a supervisor, so it should ideally be more than these nurses. 00:50:04.627 --> 00:50:13.982 - This is that clinical assistant, so that's what came back as a comment, which is basically a clerical page 00:50:14.562 --> 00:50:21.668 - type position, so I think around $21 an hour is what the county ordinance is. And the maternal child 00:50:21.668 --> 00:50:28.986 - health is not required. It would not necessarily be required to be a nurse, but it would be really nice 00:50:28.986 --> 00:50:36.584 - to be able to have a nurse for that, to work with our community health worker on just some of the perinatal 00:50:36.584 --> 00:50:43.550 - services and be able to provide a little bit more. So I would say these two, you would want nurses 00:50:44.546 --> 00:50:58.571 - that we wanted at least medical assistant. Okay. So the nurses were 65 and the medical assistants. 65, 00:50:58.571 --> 00:51:12.868 - 520 for the nurses and the medical assistant. And benefits? Yes. So the medical assistant position would 00:51:12.868 --> 00:51:14.366 - be 43,680. 00:51:16.162 --> 00:51:30.849 - to add benefits to all of those. What's the cost of the benefit package? Well, so self-insurance right 00:51:30.849 --> 00:51:45.822 - now for 27 is $18,000, purpose 14.2% of the salary and FICA is 7.65% of the salary. So probably... Okay. 00:51:47.234 --> 00:51:57.340 - Just one thing. So are we thinking the 65 for these and then? Like. Are these are these positions in 00:51:57.340 --> 00:52:07.946 - the budget? Are the public health nurse public health nurse? So we put there in the budget at the current 00:52:07.946 --> 00:52:15.550 - county salary. What is that? So it's not. Yeah, it's $28 now. So you would. 00:52:15.746 --> 00:52:22.905 - So what we're describing, what we're discussing should be considered a higher pay rate for those three. 00:52:22.905 --> 00:52:29.789 - Is that what you're... Right, so they wouldn't let... So I couldn't just submit a budget to council 00:52:29.789 --> 00:52:36.811 - for and say we want you to pay these people this amount. They'll say this is what it's classified as. 00:52:36.811 --> 00:52:39.358 - So that would be a separate process. 00:52:47.490 --> 00:52:55.381 - I can tell you that, again, at the symposium, I went to every table of health administrators, 00:52:55.381 --> 00:53:03.943 - health officers, and asked, how do we find public health nurses? And I was told, good luck. You know, 00:53:03.943 --> 00:53:12.673 - that one person at least suggested to me that within five years, all public health nurse positions will 00:53:12.673 --> 00:53:17.374 - probably be medical assistants because we can't compete 00:53:17.698 --> 00:53:27.541 - with the $30,000 sign-on bonuses and the salaries that hospitals are willing to pay because they can't 00:53:27.541 --> 00:53:37.193 - find nurses either. So there's a sense across the state that indeed we're going to, you know, we may 00:53:37.193 --> 00:53:46.654 - get lucky and find nurses who are deeply committed to serving the public and are willing to endure 00:53:47.778 --> 00:53:58.878 - whatever the county is willing to pay, but it's going to be challenging at best. I needed to share that 00:53:58.878 --> 00:54:09.658 - with you guys because we're really up against a wall here between what council is allowing us to pay 00:54:09.658 --> 00:54:16.702 - people and the in availability basically of nursing personnel who 00:54:17.698 --> 00:54:29.621 - really before they come on board, don't really have knowledge of public health nursing and what it entails 00:54:29.621 --> 00:54:40.875 - and have that particular state of mind. They've all been trained essentially as hospital nurses. And 00:54:40.875 --> 00:54:46.558 - when I looked online today, looking at what health 00:54:47.234 --> 00:54:57.483 - Companies who are doing home health care are willing to pay nurses. We are really in a hole because 00:54:57.483 --> 00:55:07.732 - across this state, home health agencies are willing to pay as much, but usually much more than what 00:55:07.732 --> 00:55:11.422 - we can afford according to council. 00:55:12.322 --> 00:55:25.796 - I would say it's not just for the nurse and either just positions in general from Monroe County. Compared 00:55:25.796 --> 00:55:38.507 - to other. So I think the question is, do we ask for? These do we ask for these three positions? And 00:55:38.507 --> 00:55:40.414 - do we ask for? 00:55:40.898 --> 00:55:49.073 - the 65,000, knowing that would include the benefits, or we do, we ask for 80,000, which is the going 00:55:49.073 --> 00:55:57.167 - rate to be competitive and includes benefits. And I will say, you know, that other departments have 00:55:57.167 --> 00:56:05.342 - gone to the council, asked for SO positions, those are special positions for people who are required 00:56:05.342 --> 00:56:08.094 - to be, for instance, an engineer, 00:56:08.482 --> 00:56:18.291 - the county highway and that person was making I don't know I think it was 120 or 130 and that was approved 00:56:18.291 --> 00:56:27.641 - even though there's a hiring freeze so it's not impossible and you know those SO the you know I'm not 00:56:27.641 --> 00:56:36.350 - sure how it will work but these may be a couple of them may be SO positions that we ask for so 00:56:37.602 --> 00:56:48.069 - They are skilled. Yeah, there's definitely, I mean, there's only around their license, their skills. 00:56:48.069 --> 00:56:58.847 - Right. That's what we need. That's what we need. We ask for what we think we need. Yep. Okay, so I will 00:56:58.847 --> 00:57:05.790 - need a motion. How do you want to proceed with that? We need to do 00:57:05.954 --> 00:57:13.343 - three separate motions for all three positions or a motion to include all three? Probably three separate 00:57:13.343 --> 00:57:20.592 - motions. So do we want public comment before we make the motions in second or do we want to motion and 00:57:20.592 --> 00:57:27.630 - second each one and then have public comment? If we do public comment for all three of them before, 00:57:27.630 --> 00:57:35.230 - can you do that? Let's do that. So do we have anyone online or in the room who wants to make public comment 00:57:35.362 --> 00:57:50.394 - about the 2027 proposed HFI budget. Okay, seeing none, we shall proceed with our motions. For which 00:57:50.394 --> 00:58:02.270 - year is this? 2025-26 or 26-27? This budget that will be working on is for 27. 00:58:04.034 --> 00:58:14.699 - Isn't it the 1611 local budget rather than the HFI budget? One moment. HFI budget was on my agenda. 00:58:14.699 --> 00:58:25.898 - Is that not correct? It says 237 HFI. So this is the 2027 HFI budget. And the reason that you're getting 00:58:25.898 --> 00:58:33.790 - this tonight is because I have to submit it to the state before June 1st. 00:58:34.786 --> 00:58:42.296 - So these these proposed new positions are not budgeted for this and would not be budgeted in this if 00:58:42.296 --> 00:58:49.137 - we would my understanding as you would be saying to ask for that in the county health fund. 00:58:49.137 --> 00:58:56.796 - Is that correct? Yes. So if we ask for these one last question, we asked for these. Do we have the job 00:58:56.796 --> 00:59:04.158 - descriptions and stuff already written up to create them? So we're going to ask for them and then. 00:59:07.170 --> 00:59:20.578 - I motion to add to the 2027 proposed budget a position entitled on this org chart, which is the proposed 00:59:20.578 --> 00:59:33.474 - 2026 chart. The senior public health nurse position, which would be, we believe paid roughly $65,000 00:59:33.474 --> 00:59:35.262 - with benefits 00:59:35.522 --> 00:59:45.516 - it's up to $80,000 and we would do the appropriate math to get them that exact number for that. So I 00:59:45.516 --> 00:59:55.510 - propose we add that to the 20-27 budget. Second. All in favor? Aye. Okay, motion passes. Does anyone 00:59:55.510 --> 01:00:02.238 - have another motion regarding maternal and child health assistance? 01:00:05.858 --> 01:00:17.152 - Make a proposal that we ask for in our budget based upon the 26 Monroe County organizational chart that 01:00:17.152 --> 01:00:28.229 - we add, or ask for funding for maternal child health assistant with approximate salary of, what do we 01:00:28.229 --> 01:00:35.614 - have? 65,520. 65,520 plus benefits up to? 80. 80,000. All in favor? 01:00:35.970 --> 01:00:48.811 - Before we have a motion on the. Third position, the health services assistant, so that would be for 01:00:48.811 --> 01:01:01.909 - a medical assistant. So with the going rate, the. Hourly wage for the annual salary would be $43,680. 01:01:01.909 --> 01:01:04.734 - So. With benefits we. 01:01:05.186 --> 01:01:14.378 - probably need to discuss what that number, we think that number approximately should be. And keeping 01:01:14.378 --> 01:01:23.661 - in mind, so the tricky part about that one, I believe is that the three positions that we have in the 01:01:23.661 --> 01:01:33.854 - budget, including public health nurses, we can sort of price that position higher than the public health nurse. 01:01:36.386 --> 01:01:47.382 - What is that? Yeah, what is that pay? That is the 48. And someone says an hour. OK, so. And what is 01:01:47.382 --> 01:01:58.817 - that number? Is that here on the budget somewhere? Sorry, no, those are not included in 2027. It wasn't 01:01:58.817 --> 01:02:05.854 - 26. It's budget is 60,807. Is that right? Oh, for the director. 01:02:08.642 --> 01:02:19.319 - No, it says the public health nurse. That seems wrong. Okay. For some reason, but. So we just need to 01:02:19.319 --> 01:02:30.102 - estimate some benefits for the health services assistant position. And again, the total annual for the 01:02:30.102 --> 01:02:37.534 - annuals or rather for the hourly pay equated to annual pay is $43,680. 01:02:39.106 --> 01:02:45.669 - It would be less because the way we calculated the benefits for the other two were percentage based, 01:02:45.669 --> 01:02:52.231 - right? For the most part, so it would be less than the. Well, we had originally calculated the other 01:02:52.231 --> 01:02:58.924 - two. Do you want me to grab a copy of the salary over that's that happened on my desk? Yes, that would 01:02:58.924 --> 01:03:05.421 - be good. Okay, that would be helpful. Can I ask a question going back for a moment? I don't know if 01:03:05.421 --> 01:03:08.670 - I'm allowed to, but did I hear that the maternal. 01:03:09.026 --> 01:03:19.947 - Child health assistant. It's going to be paid up to $80,000. Right, because she's thinking they need 01:03:19.947 --> 01:03:31.085 - to be a nurse so that that person provides backup. In the staffing. So there's nurse backup. Yeah, no, 01:03:31.085 --> 01:03:38.654 - I mean, our maternal. It looks by your org chart. That individual is. 01:03:38.946 --> 01:03:48.605 - subordinate to the coordinator who certainly is not paid at that rate. So it seems a bit odd that you 01:03:48.605 --> 01:03:58.076 - would want to pay that person $80,000 up to $80,000 in a subordinate position to the maternal child 01:03:58.076 --> 01:04:04.894 - health coordinator. Yeah, she has a good point. So the the assistant is 01:04:05.058 --> 01:04:12.377 - The maternal child health assistant is subordinate to the coordinator. It seems kind of crazy that that 01:04:12.377 --> 01:04:19.695 - person would make a fortune. Same as a nurse. Yeah, I'm confused. Okay, so yeah, so we need to. So this 01:04:19.695 --> 01:04:27.014 - is not correct. That's what we just did. Well, I think it depends on what what the board is then saying 01:04:27.014 --> 01:04:30.462 - the people above should be paid at because it's. 01:04:30.626 --> 01:04:39.623 - The similar situation with the health services director that salary is currently 59,187,000 so. These 01:04:39.623 --> 01:04:49.149 - would all have to be increased to. That's not that's not good work, but we we pay more for medical licensed 01:04:49.149 --> 01:04:58.058 - professionals. I know there are people that are above me in my organization and they don't make that 01:04:58.058 --> 01:04:59.646 - big. For example, 01:05:00.930 --> 01:05:07.452 - have a medical license and I think we pay more for that. Is that the thinking behind that? We're looking 01:05:07.452 --> 01:05:14.099 - for nurses. Nurses are competing with other entities that will pay nurses more based upon their licensure. 01:05:14.099 --> 01:05:20.311 - I think the whole situation is a large challenge because then I think we run into a situation where 01:05:20.311 --> 01:05:23.230 - you have other health department employees who 01:05:23.330 --> 01:05:29.396 - who then, you know, well, I have a master's degree or I have this specialized certification, but so 01:05:29.396 --> 01:05:35.523 - where do you kind of find the balance between what are you going to pay your clinical staff compared 01:05:35.523 --> 01:05:41.831 - to the rest of the department employees that still have to have a degree or specialized education? Just 01:05:41.831 --> 01:05:48.079 - because, for example, an LPN, that's a one year certificate and it is specialized, it's in high demand 01:05:48.079 --> 01:05:53.296 - because it's a service, but then if you have someone, well, I have a master's degree, 01:05:53.296 --> 01:05:59.938 - but I'm making $20,000 less a year, where do you kind of find the balance, I guess? In my understanding, 01:05:59.938 --> 01:06:06.517 - or at least the way I look at it, and I may be wrong, but we're competing against a medical system that 01:06:06.517 --> 01:06:12.843 - pays more for people with a medical license specifically to practice, as opposed to a master's or a 01:06:12.843 --> 01:06:19.232 - PhD. Yes. And so if we're trying to draw people to do the positions, and they can go somewhere else, 01:06:19.232 --> 01:06:22.142 - and with their license make a lot more money, 01:06:22.242 --> 01:06:30.700 - we're gonna have a hard time drawing those people. Correct, and because we're not offering hiring bonuses 01:06:30.700 --> 01:06:38.838 - and such. That's my logic. Well, I guess my question still is, does the assistant to the maternal and 01:06:38.838 --> 01:06:46.897 - child health coordinator need to be a nurse? And what kind of nursing role would that person play in 01:06:46.897 --> 01:06:48.094 - that position? 01:06:49.410 --> 01:06:55.932 - I don't think that I would have to, but I think it would offer us a lot more flexibility with the type 01:06:55.932 --> 01:07:02.327 - of maternal child health services that you're paired with a community health worker and someone that 01:07:02.327 --> 01:07:08.976 - has those nursing skills and the types of services like perinatal navigation, for example, that we could 01:07:08.976 --> 01:07:15.308 - offer and provide. So. Yeah, yeah, I think it's about changing the title. Yeah, because I think the 01:07:15.308 --> 01:07:16.574 - title doesn't work. 01:07:16.802 --> 01:07:25.043 - for what you're saying. And I guess it will be in the definition of that person and the job description. 01:07:25.043 --> 01:07:32.970 - But the way it's written now, it's like, I can't imagine it. So thanks for the clarification. That's 01:07:32.970 --> 01:07:41.054 - really what I needed. So should we change the language to make it more palatable, to make it make more 01:07:41.054 --> 01:07:45.214 - sense and remove our motion and change the language? 01:07:45.474 --> 01:07:52.142 - And maybe change the organizational charts so they're not reporting to the coordinator. So what are 01:07:52.142 --> 01:07:59.144 - the? What are the job descriptions should, listing the qualifications and so forth. The assistant could, 01:07:59.144 --> 01:08:02.878 - for instance, be at the end. What are the requirements? 01:09:14.786 --> 01:09:33.343 - My last question was, do we know, and she may be the one who needs to answer this, but the requirements 01:09:33.343 --> 01:09:43.870 - of the maternal and child health coordinator, like is that 01:09:45.154 --> 01:09:54.729 - I presume it's a non-clinical physician. I think she wants it to be an LPN so that that person can provide 01:09:54.729 --> 01:10:04.035 - coverage when other people are gone or and be have some flexibility. And that's a coordinator or that's 01:10:04.035 --> 01:10:13.342 - the? The coordinator doesn't have that. So the coordinator is a like non-clinical? Yes. Okay. She has a 01:10:13.602 --> 01:10:23.362 - BA or BS, but no specialized training. Okay. So maybe a solution would be to change the name of the 01:10:23.362 --> 01:10:33.318 - maternal and child health assistant to maternal and child health nurse. Yes. Yeah. Okay. Right. Well, 01:10:33.318 --> 01:10:38.686 - should we wait for Lori here? We should wait for Lori. 01:10:44.706 --> 01:10:54.828 - It's already back in the room. I will motion that on the 2026 Monroe County Health Department organizational 01:10:54.828 --> 01:11:04.764 - chart proposed 19 May, 2026 page that the maternal and child health assistant position be renamed maternal 01:11:04.764 --> 01:11:12.286 - and child health nurse. I second. Do you want me to include the financing? Okay. 01:11:12.450 --> 01:11:27.235 - and that we also attend the 2027 proposed budget with a nurse salary, which is 60, 65, 520 with benefits 01:11:27.235 --> 01:11:42.302 - approaching roughly $80,000. And we add that to the 2027 proposed budget. Second. All in favor? Aye. Okay. 01:11:42.850 --> 01:11:54.896 - So yes, you were gonna tell us about, so the maternal child health coordinator is an associate's degree. 01:11:54.896 --> 01:12:06.369 - So we're back to, do you have some sort of comparable position for this MA position that would give 01:12:06.369 --> 01:12:11.646 - us an idea about how much to add for benefits 01:12:11.874 --> 01:12:25.893 - And FICA, if the baseline is $43,680? So the clinic manager position that was in the futures clinic 01:12:25.893 --> 01:12:39.070 - was a Comet C, which the base salary is $44,245,000. And how much were the benefits for that? 01:12:39.778 --> 01:12:54.809 - Uh, if it's full time, 35 hours, I've been full benefits, 18,000 for self insurance, 14.2% for perf 01:12:54.809 --> 01:13:03.678 - instead of the 65.5. Okay. Times 21%. That's 18,000. Yeah. 01:13:17.058 --> 01:13:30.452 - So for the medical assistant, 21,000 times 21% is 4,400. That's another 18,000 to be. I would say let's, 01:13:30.452 --> 01:13:42.442 - I would propose that we consider increasing that salary to maybe 60. The base salary, 43,680, 01:13:42.442 --> 01:13:45.886 - and I mean, we can do the, 01:13:46.050 --> 01:13:57.236 - Details, I'm not sure. Are we able to submit a motion for a vague amounts to be calculated later? Can 01:13:57.236 --> 01:14:04.254 - we do that and then like, sign on to it via email or something? 01:14:04.450 --> 01:14:10.936 - because we really need to have the specific number of surety, right? Like, I think it would be, this 01:14:10.936 --> 01:14:17.615 - is what we want the annual salary to be, or this is what we want the hourly rate, and then plus we want 01:14:17.615 --> 01:14:24.359 - it to be full-time benefited. Okay. So if we say that, then it covers us and we can make the calculation 01:14:24.359 --> 01:14:31.102 - later. Okay. So do we need to make addendums to the other two motions? Yes. Since I placed both motions, 01:14:31.234 --> 01:14:42.251 - Can I attend both motions simultaneously? So I would attend the motion that I initially put forth about 01:14:42.251 --> 01:14:52.949 - the senior health public senior public health nurse to turn on to allow for the financing to suggest 01:14:52.949 --> 01:15:00.894 - twenty eight dollars an hour. Is that correct? That's correct. OK, we did. 01:15:01.378 --> 01:15:10.718 - 36. 36 is what Morgan counted. $36 an hour plus full-time benefits and remaining the ranger of the motion 01:15:10.718 --> 01:15:19.530 - stands. Okay. Second. All in favor. Aye. Okay. Next. The second one would be the maternal and child 01:15:19.530 --> 01:15:28.606 - health nurse that we've already motioned to rename. I would addend my motion to also pay that position 01:15:28.898 --> 01:15:39.062 - $36 an hour and make it full-time benefits. Second. All in favor? Aye. Okay. And since you're on a roll 01:15:39.062 --> 01:15:49.128 - for the Health Services Assistant. I make a motion to, on the 2026 Monroe County Health Department org 01:15:49.128 --> 01:15:55.774 - chart proposed 19 May, 2026, the Health Services Assistant position 01:15:56.258 --> 01:16:08.205 - be added to the 2027 proposed budget for the county health fund at a pay rate of, what do we say, 22? 01:16:08.205 --> 01:16:20.151 - 21,000. What do we do, 21? Well, so what aligns with what the futures was $24.21. $24.31 an hour plus 01:16:20.151 --> 01:16:22.494 - full-time benefits. 01:16:26.978 --> 01:16:43.118 - Second, second, all favor. Okay. Okay. Okay. All right. Yes. Did you address this position? Yes. Oh, 01:16:43.118 --> 01:16:56.222 - yes. So, can you tell me what that is? Thirty six. Thirty six dollars. Okay. Yes. 01:16:58.562 --> 01:17:14.407 - So in the health services director, there's one. So this one, just providing information, this position 01:17:14.407 --> 01:17:27.358 - makes 3252. And that does require a nursing degree. These require a nursing license. 01:17:29.986 --> 01:17:38.955 - So this person requires an RN? Yes, the same? Yes. So I think. We should probably put that on to the 01:17:38.955 --> 01:17:47.924 - ones who are interested. You could do that. Make a motion to change the salary of the health service 01:17:47.924 --> 01:17:56.981 - director taken from the 20-25 Memorial County Health Department additional chart proposed 19 May 2026 01:17:56.981 --> 01:17:58.846 - for the 2027 budget. 01:17:59.042 --> 01:18:15.931 - to change their hourly rates to $36 an hour with full-time benefits. All in favor? Aye. Probably we 01:18:15.931 --> 01:18:28.766 - just need a vote on this proposed 2027 Health First Indiana. Oh, okay. Yes. 01:18:30.498 --> 01:18:39.728 - Okay. We need to propose a motion with the additions we've already made. I was going to say the adjustments. 01:18:39.728 --> 01:18:48.619 - Well, so I would say because these other changes were related to the county health fund, that that would 01:18:48.619 --> 01:18:57.341 - be separate. This is just approving this to be submitted before June 1st. This is a CFI. Correct. Take 01:18:57.341 --> 01:18:58.526 - the motion to 01:18:59.490 --> 01:19:11.003 - approve the proposed 2027 HFI budget as shown in the chart that was given to us. Do I have a second? 01:19:11.003 --> 01:19:22.744 - I second that. All in favor? Aye. Public. Oh, I'm sorry. Yes. Do we have anyone needing to make public 01:19:22.744 --> 01:19:27.646 - comment? Anyone with their hands up? Okay. 01:19:28.866 --> 01:19:45.874 - All in favor? Aye. Okay, motion passes. So moving on to new business. Does anyone have any business 01:19:45.874 --> 01:19:54.718 - to discuss? I'm not sure why the plate is for food. 01:19:54.850 --> 01:20:02.073 - or so much out of whack from what they've been in the past. Why they increased it? Well, that was because 01:20:02.073 --> 01:20:09.160 - the increase because it was like they've been running like 5,000 and late fees and then all of a sudden 01:20:09.160 --> 01:20:16.110 - now it's almost 30,000. For the fees collected? Yeah. Uh-huh. So that was based upon the changes that 01:20:16.110 --> 01:20:20.062 - were made increasing the amount of the late fees charges. 01:20:20.450 --> 01:20:27.534 - And so they surveyed different health departments across the state of Indiana, the foods division did, 01:20:27.534 --> 01:20:34.687 - and kind of looked at what other people were doing to try to get organizations into compliance and came 01:20:34.687 --> 01:20:41.702 - up with that. Okay. So looking at this fee schedule for the birth certificate fees, death certificate 01:20:41.702 --> 01:20:46.654 - fees, and the total vital records fees, we're significantly below that. 01:20:47.394 --> 01:20:54.628 - More than this time in the years, that's something that just hasn't been adjusted. We expected that 01:20:54.628 --> 01:21:01.862 - it will get to that level by the end of the year. For the birth or for the death? Either. Oh, well, 01:21:01.862 --> 01:21:09.169 - we would think that it'll get close to that amount, but we have seen deaths go down over time, which 01:21:09.169 --> 01:21:17.054 - so we have been having less revenue just because of that. And. It's right. It's going to start down as well. 01:21:17.154 --> 01:21:26.138 - And we did. I mean, as I recall, we actually increased fees, not substantially, but a little bit. A 01:21:26.138 --> 01:21:35.570 - little bit. And the state, all health departments now, if you go in from another county, you're supposed 01:21:35.570 --> 01:21:42.398 - to issue different county adjustments. But not all counties do that. Right. 01:21:50.082 --> 01:22:01.961 - Any further board member or health officer comments? Sure. So one, I want to extend deep gratitude to 01:22:01.961 --> 01:22:13.841 - Lori and to Kathy and to Linnea for stepping up during our recent episode of meningococcal meningitis 01:22:13.841 --> 01:22:19.198 - in the community. They've done Yeoman's work. 01:22:19.458 --> 01:22:28.746 - deeply grateful to all three of you for everything that you did in helping us contain and control it. 01:22:28.746 --> 01:22:37.851 - Reminding the public that meningococcal meningitis is something that we have a vaccine for and that 01:22:37.851 --> 01:22:47.139 - vaccinations matter. They save lives. This is a disease that is potentially deadly. Fortunately, this 01:22:47.139 --> 01:22:48.414 - individual is 01:22:49.314 --> 01:22:59.601 - still in the intensive care unit and apparently is beginning to show some recovery, which is good news 01:22:59.601 --> 01:23:09.788 - after more than a week. And I guess I also just want to remind the public that this is how the health 01:23:09.788 --> 01:23:18.078 - department serves our community by containing outbreaks, by watching over not only 01:23:18.786 --> 01:23:29.627 - our food sources when we are out in community, but also our health on an ongoing basis. And that's really 01:23:29.627 --> 01:23:40.059 - why it is important for us to be able to pay the employees that we have and to bring in the people we 01:23:40.059 --> 01:23:47.934 - need to help us manage public health in Monroe County. That's it. Thank you. 01:23:48.514 --> 01:24:06.259 - All right, any other comments. Okay, seeing none, we shall adjourn. Thank you. I motion to adjourn. 01:24:06.259 --> 01:24:09.630 - Everyone in favor.