- I'm gonna call to order our meeting for the Monroe County Board of Health on today, May 21st. So first,
- do we need to add any amendments to the agenda items? Does anyone want to add any agenda items to our
- agenda today?
- I look good to me. In your package you have the meeting minutes from last meeting that is April 30th.
- And I will need a motion to approve the meeting. So moved. Second. All in favor. Aye. Okay.
- So moved, so we approve the meeting. So regarding general public comment, the Monroe County Board of
- Health encourages and welcomes public input. Written comments may be submitted anytime via email at
- boardofhealth.co.monroe.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 items 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 that 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. We don't have anyone in person.
- Did we have anyone with their hands up online? Okay. Moving forward, so we will ask for department updates
- from Lori. We just got a few.
- So just starting with vital records and administrative support. The director and assistant director
- of vital records attended a job fair yesterday. This was in Bloomington. It was put on by work one.
- They were there to provide information and applications for our public health nurse and health director
- positions. So just continuing to try to engage in job fair opportunities with Indiana University and
- Ivy Tech for their school of nursing, trying to look for candidates to fill that position for those
- positions.
- They also attended the Spring Conference for Indiana Vital Records today. So, this brings people who
- work in vital records across the state of Indiana, local health departments together, just an opportunity
- to kind of talk about challenges, and such. We are beginning to work on preparing the county budget for 2027.
- At this time, my understanding is that they will not be including a cost of living pay increase for
- employee salaries. So at this time, we'll just be keeping our salaries the same amount through the budget
- process, unless we hear differently. Regarding grant budgets and deliverables, the financial manager
- recently met with our grant funded employees
- to discuss remaining funds that need to be used prior to the end of the grant cycle, and we'll continue
- doing that with all of our grant funds. For disease intervention, we did receive an amendment to our
- current grant that currently funds three full-time disease intervention specialists, additional funding
- approximately in the amount of around $48,000. This was approved by the commissioners
- Once we've received the signed copy back from the Indiana Department of Health, it will then need to
- be taken to the County Council for approval. This is a lower amount than what we were expecting, so
- when I contacted the state, essentially what they are doing is this is like a stop gap, so they're waiting
- for federal funding to then be able to provide additional funding for the whole course of the year.
- Disease intervention and harm reduction are going to begin walk-in testing services on Thursday,
- June 25th. This will be from 3 to 6 p.m. in the lower level of the health department. So the plan is
- to continue offering this free walk-in testing every Thursday from 3 to 6 p.m.
- and treatment for chlamydia, gonorrhea, and syphilis. They'll also be offering rapid HIV and hepatitis
- C testing and be able to provide Narcan and Fentanyl test strips.
- So essentially one of the reasons is they're kind of looking at our disease intervention specialists
- carry a caseload around 20 to 30 for their case investigations. So offering walk-in testing services
- might help to balance their workload with appointments that they would otherwise schedule.
- We are waiting for our next grant award for funding that supports our harm reduction specialist. We
- currently have funds remaining to support this position until approximately November of this year. Population
- Health and Outreach is working with community members on planning a recovery summit for September 2nd
- this year. This will be held at the Convention Center.
- One of the sessions being looked at is bridging the gap program. This is focused on intervening at the
- earliest stage of recovery, integrating prevention in all stages of recovery. They're also looking at
- hosting a panel discussion with legal representatives this event.
- With our maternal and child health, the Milk Bank Express has started off really well. We've distributed
- 24 bottles so far since towards the end of April, so we had a little bit of a hiccup at the beginning
- with our first distribution. Our coordinator was out of the office when the individual came in, so we've
- worked with the Milk Bank on updating our information online with a number to make sure that individuals
- call to schedule their pick up to make sure that someone is here.
- We're also, we've created a standard operating procedure and looking at other employees who can be trained
- to be able to provide this milk for the pickup. She's started providing catch my breath vaping education
- in the Monroe County schools. So that started in May and will continue.
- She's also collaborating with Purdue Extension on the nutrition education with families with young children.
- And will begin working with Indiana University a little bit later in the summer on an eight week program
- called Goal. So that's get on board active living. This will provide eight weeks for families with children
- on physical activity and nutrition.
- For environmental health, our director completed training this week on conducting case investigations
- for tick-borne illnesses. So really excited about that and was able to submit two cases for review after
- getting access to the system. So that's going well. Pool inspections are underway and going well. Septic
- installations have slowed just due to all the rain and
- weather, but hoping that that'll dry up soon. They do still have eight remaining ARPA systems that they're
- working to get installed prior to the end of July. Our Director of Public Health Preparedness has completed
- instructor training through the Red Cross for CPR, First Aid, and ADD, and we're looking at ways to
- begin offering this service to the public.
- and our emergency preparedness coordinator completed basic disaster life support training and this training
- was actually financially supported by the emergency preparedness planning council. We have received
- $25,000 in grant funding for public health emergency preparedness. This term is July 1st
- 2026 through June 30th of 27. So this helps to support mileage, training, supplies, and is a big help
- to that division. That's the end of the question. Yes. Has facilities addressed the paint chips falling
- down on employees in the loading area? Not to my knowledge, it still has not.
- I'm wondering whether internal infant care specialist also is addressing drowning issues with parents.
- So we did that last year with the summer, the educational programs and distributed water safety kits,
- and we still have some of those left over. So we'll be looking at doing that. We have some outreach
- activities coming up later this summer so we could still offer that. Thanks.
- Have you wanted to give us any indicates? Sure. Everything has been going smoothly. I haven't heard
- of any issues this last week so far. Are you able to make a long site visit? Yes, I stop by at least
- once a week and then leave the same three times a week.
- So the next item on our agenda is the prenatal vitamins. And so in your packet, you have the theronatal
- core vitamins.
- Um, and I don't know, this is what our folks could get for us. Can you tell us more about that? Yes.
- Um, so been working through research, trying to find other opportunities for, um, to be able to provide
- these prenatal vitamins. So this company says that they have some that are available. The expiration
- date is in September of this year, but they are willing to provide us, um, with the stock of food.
- are interested in having these to distribute. And is that free to us? And how many do we do it on a
- 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
- number, but since I don't think that we would be asking for that many since they expire in September.
- So before coming up with an exact
- amount to try to ask for. I thought we'd see if this means the criteria. So the number one, our number
- one concern last time was that there was no enough folic acid in the vitamin angels offering. And so
- this has 400 micrograms of folic acid. Say yes, Kate. But why does it say, hold her in?
- percentage of daily value, why does it say on it, if I can find it here, that it's 278%. Is it 278%?
- Well, one, it's methyl tetrahydrofolate, which is slightly different because it's more readily absorbed
- than folate itself. There are people who cannot handle
- and have methylation issues. So we've got two different numbers there. You've got the 1665 means what
- it says, which is why you're seeing 278%. And what they're saying is if just pure folate, when it's
- not the L5 methylated, then it's 400 mics.
- It's straight forward. Does that hold it all? I'm not sure what these percent daily values mean. Maybe
- compared to the RDA for women who aren't pregnant, I'm really not sure how to interpret that. I just
- want to make sure it's in line with what NICOG recommends. NICOG recommends 400 to 800.
- This would be within that. At least it's the minimum required, which the other one did not, which is
- super concerning. The only question I would have on this bottle is I noticed that there are 90 tablets,
- so this is a three month supply, which means if we get them next month, we would want to get enough
- for three months, but then that gets us to a third of the pregnancy. So what do we do beyond three months?
- I'm not saying I say no to this, but this settles as many women
- as they will give us bottles for three months, and that is all. We'll be looking at this issue again
- in three months. Correct. Only less than three months. Yeah, probably next month. It will seem to be
- a continuing agenda item. But I mean, I started looking at prices of prenatal vitamins that aren't readily
- available, and it's minimum
- $35 a pop for 90 days. Did we ever decide approximately how many women need these? Well, she under 150
- within a year. And then the question is, I was asking Lori earlier, who exactly are they distributed
- to? And apparently this
- our supplies been going to tandem and we have no actual contract with tandem, which is kind of interesting
- that the health department has been giving this over to tandem, but without any kind of actual agreement
- in place of our providing this to them. So does this, I guess I would ask the board
- Do you want it to go to our maternal infant care folks and the people who are under our umbrella, or
- are we handing them off to other organizations? If they're expired, you hand them off. No, just kidding.
- Let's see.
- Can I ask a clarifying question? 150 women, is that 150 women for their whole pregnancy or 150 bottles
- we're talking about? Under 150 bottles. Okay, so that's less than 150 women. So that's a lot less women.
- Yes, that's 50-ish, roughly. Yeah. Okay, and that's how many we were distributing. Yeah, that's what
- we got from the vitamin angels that, yeah.
- That doesn't include the amount that we were giving to candidates. That is what you gave to them. Do
- we have anywhere in our budget that we could buy 50 bottles or whatever we need for these pregnant women
- with what they need? It would be 150 bottles times $30.
- of five thousand dollars basically it's 4500 so then i think the question is can we find that money
- now and can we find that money in the future and i think we'll have a better idea of next year you know
- next month about where it is but is the thirty dollars based on what retail value of the vitamins are
- what i mean i or is that what
- let's say TheraLogix is willing to give us the vitamins they're going to expire, if to continue, what
- would they be willing to send? I looked on Amazon, our usual retailers, and it was somewhere in the
- range of $32 a bottle for these. That's what they would retail for.
- whether we could get a wholesale price from one item. Amazon takes a cut and then the people that sell
- it make it profit. Actually, I'm just wondering if we went straight to this company, what they would
- be willing to give us, to sell us the bottles. We could certainly. I certainly think that we should,
- I would say we take this. Yeah. It solves the problem for three months.
- Yes, I think we continue to try to look for. This could be continuing business. I mean it is. Well,
- certainly, but ongoing and continuing business. But I would like to what I would like to see the board
- do is this make a decision today as to whether or not we're going to accept these. And I think so. The
- question is, can we help? Maybe 75 patients, yes, over the course of the next few months and
- they will be, these patients will be taking vitamins, whereas they wouldn't have before, given that
- it has the 400 micrograms of folate acid. What was the other place that? Oh, like one a day, there were
- a number of different vitamins. No, no, I mean the other group in town that we were giving them to.
- Tandem, okay. In my opinion, I think it doesn't,
- I think we can either distribute them from our facility or tandem. If those patients are used to coming
- there or using that resource, then I think I don't have a problem with them utilizing the vitamins as
- well. But I don't know what other opinions folks have. I mean, it sounds like if we have... Is that
- acceptable? It sounds like if we have a total of 50-ish women
- including ones from Tandem, I would agree with you. It seems like if they give us 50 bottles worth,
- I'd rather give them to women who need them regardless of where they're accessing it versus letting
- them sit on the shelves and aspire. So I would make a motion that we accept the therianatal core vitamin.
- We need to ask for public comment before we do that.
- Do we have anyone who would like to comment on this item about the prenatal violence? No, okay. Now
- you may make an option, please. Pursuant to my previous comments, I'd like to make a motion that we
- accept the therianatal core
- vitamins, prenatal vitamins being offered to us. We don't know how many bottles that we're gonna get,
- right? Well, whatever, how much they're offered. And distribute them ourselves or through tandem so
- that we make sure all five bunches are distributed. So, sorry. I'll second. All in favor? Aye. Aye.
- Okay, motion passes. Our next item is about our 2027 Health First Indiana budget items. So that, you
- reference your packet. I would like to point out that having that.
- having comment right before you make a motion or after, well, actually before you make a motion is new.
- So I apologize to her for getting ahead of myself. Technically, the motion can be made and seconded
- and the same way that there's comment and discussion that also can be when the discussion happens, as
- long as it occurs before the vote. That's true. It's supposed to happen
- after the motion's made, then the inspection. Yep, my mistake. Sure. Okay, so in your packet, you have
- a couple of items showing the fees, and then you have the one that's showing all of the positions that
- are related, I believe, to HFI.
- And I'll let Laurie speak to this. Sure. So our 2027 funding for Health First Indiana is the same amount
- as it is this year. So that's $826,000 roughly. So this is basically showing you what positions that we can
- go ahead and plug into this budget for 2027. The positions that are highlighted in yellow are the positions
- that we will be looking for to be covered by different buckets of money, essentially different funding
- sources. So all of these positions do align with the core public health service. So no issues with that
- and meeting the compliance for that. We have included FICA and PERF
- in this. What we have been doing is what was recommended by the Indiana Department of Health is that
- we include all of the self-insurance into the county health fund. So that's how it will be budgeted
- because the county pulls all of the funds even for vacant positions. So the problem that we were running
- into is that
- funding was being pulled from the Health First Indiana dollars for positions that were vacant that were
- not actually delivering core services. So to ensure that every dollar is tied to the delivery of a core
- public health service, we will be budgeting the self-insurance into our county health fund.
- looking at probably going to be around $450,000 for 2027 so that will take a really large portion of
- our county health fund. Just additional some expenses budgeted in here for 2027. Other supplies so help
- to cover costs for cleaning supplies, vehicle repairs, maintenance supplies and in the service category have
- Funding set aside for travel, mileage, training, and development for all employees across the department.
- And the services and charges will be covering our workers comp, vehicle insurance, building insurance,
- our subscription fees, and fees that we pay to the Indiana Department of Health for the lab. So some
- things to consider. We have been funding Health Net for that homeless, for their homeless initiative.
- And that has been at $135,000 the year. So one thing I think the board will need to consider is whether
- we want to look at a way to continue funding that in 2027. And we might want to look at a part time
- line and do still have the hiring freeze that is going on, but having money and approval to be able
- to hire part time might be a good idea to offer us some flexibility.
- Is that, are they going to let us do that? That I don't know. They've been really inflexible to this.
- As a matter of fact, this is sort of related to this, and this may not be something you have off the
- top of your head. Do you have a dollar amount that we've had to
- forgo, give back to the state in terms of grant funding or whatever for this, because we haven't been
- able to hire people, can we assign a dollar value to that? If you don't have it now, then we'll talk
- later. Yeah, well, I think that the disease intervention, I can't remember what that, if that was an
- additional 65,000, but we're really running into the challenge of not being awarded new
- grants that would require positions so we have applied for some new grants that would support additional
- positions you know a few hundred thousand dollars but with the hiring freeze does that make that challenging
- but i could find out that is receiving those grants uh are they contingent upon having someone available
- to fill that spot so
- services we can't even but even when we have the money yes exactly we can't get someone even when the
- 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
- going to talk more about that and keep asking and going publicly and saying hey you know we need cooperation of
- arms of government to be able to provide services for our people in Monroe County. I mean, I just feel
- like, again, this is different than County Highway and this is just different and we're at risk. So
- the thing is right now we're in this key spot where if we do not continue to be able to provide the
- services for HFI,
- and prove to the state that we can do that, then we will essentially just lose our funding. So I don't,
- I really don't understand why there's a lack of cooperation. I agree with Dr. Robinson. We need to keep
- on doing what we're supposed to be doing. So I think we, we should, we should continue, we need to as
- a board, I think continue to push the issue and be
- proactive and say hey, this is what we need and continue to go. Asked to go before the board and I think
- you know as we progress that you know Lori will go and give health Department updates and will keep
- saying either she or she and I together saying hey, you know. This is critical because if you don't
- make some decisions now. In a different direction, we're essentially going to lose funding. I don't.
- I don't understand the.
- Which comes back to why I would like to have a dollar amounts assigned to monies that we are not going
- to get because we can't hire people. And as you recall, I mean, I was beat up in the council for not
- allowing, you know, for giving up our clinic downstairs and returning those federal dollars, which of
- course came back once the clinic continued under
- different management, but they keep harping on that, and I'd like to harp on them for a change. I think
- it's important to underscore maybe both, because I think if you aren't familiar with medicine,
- when you say, we're going to lose such and such a thing, they go, I don't know what that means. What
- does disease monitoring mean? I don't know what that is. But if we say, this is why this
- this is what this position is, this is what they are doing for your community, and this is why it's
- important, without this, we are going to lose our ability to do that for our community, and that will
- be on you. And that's exactly what I heard in reverse. Yeah. And the close of the family planning clinic
- downstairs was, this money is coming into the county and we're giving you, we're gonna have to give
- this money back because you're closing the clinic.
- There were many reasons, but you know that, and I, my point was, well, it opened up two to three months
- later under different management and that money is still flowing and those services were available.
- However, the services that we're by, we're gonna forego because we can't hire the people are not coming
- into our training. No one else is doing this. And no one else is gonna be doing it.
- I mean, IU was doing it before and, you know, they're, well, anything. It's not just the dollar amount
- that we're losing because we're not getting it, but it's also the money that we already have and we
- can't spend it because we can't hire someone because we don't get the blessing of the council for the position.
- We have the money, it's there. We just need the okay to hire a person. Will we lose that money if we
- don't hire someone? At least at the leadership symposium last week, there was a lot of talk about this,
- about how the legislators want instant ratification. They want to see instant results and
- They don't understand that chronic disease is something long-term that we invest in over time. They
- want to see the answers yesterday. And indeed, the issue for across the state is if we aren't providing
- these services, the state indeed will not be giving us the same HFI funding because they're going to
- say, you haven't spent it.
- The issue for us, of course, is that we can't spend it because council won't allow us to spend our HFI
- funding to take care of these positions. So it's kind of a catch-22. Yes, it's fairly clear that the
- state will not be granting the same amount of HFI funding if it hasn't been spent. They're going to
- say, oh, you're just wasting our time and our money.
- I don't have the answer, but I know that there are people across the state, across all of the health
- departments in the state that are equally concerned, you know, from either a council or a commissioner
- point of view, or just the inability to find personnel to fill positions. And that's a big issue right
- now. So thank you, Sarah.
- So my question is, in this budget, are we, so when we do a proposed budget, can we, I guess, add items
- that we would like to see approved, and then they can just say no? Do you know what I'm, do you see
- what I'm saying? Like, we need these positions, we would ask for it in the budget, and then they vote
- on it, or that's not how this works, because I'm concerned
- We have, I think we have a set of funds that's around. I don't know, is it around? The 400,000 that
- got cut last year. Can we go back and ask and put that in our budget and say this is our proposal and
- then they can just say no? Or is that not how that works? So for the state funds we can only submit
- a budget for this dollar amount for exhibit.
- When it comes to the local county funds, you could ask for what you would like to ask for and then ultimately
- they make the decision.
- We do still have remaining, because of some of the challenges that you all have just discussed, we do
- still have some remaining funds from 2024 from HFI which will help fund some of these positions. We
- also still have some older state funds before the HFI which will help cover some of these positions.
- So then I think we'll be looking at how much
- Does the board want to request Monroe County Council invest in the health department for 2020 simple?
- So where on this we have the approximately $450,000 for the contract for IU. So where is that absorbed
- in the 2027 budget so we can provide services that they were providing? How do we do that with this budget?
- So we had moved the IU Health contract out of Health First Indiana into the local health fund when the
- change came about the Indiana residency. So those dollars are currently sitting in the county health
- fund. And so those remaining dollars, part of those dollars are funding the communicable disease nurse position
- And there are still some remaining funds that we would like to be able to use to fund the clinical assistant
- position and help continue supporting costs for our nursing services that we are now taking on. That
- was the position you're going to ask Council for? It did not make it. Yes.
- So before we vote on this budget as further discussion, I can talk about this. So in your packets, we
- have the current org chart for Monroe County. We discussed this last time then comparing that to the
- org chart for Allen County.
- I don't think we had visuals, so yeah. OK, so so I'm going to repeat some things maybe from last time.
- So if you look at the population of Allen County, approximately 400,000 in 2024, I believe, and you
- can look at Monroe County's. Population then we're like 32% of Allen County's population. And so.
- If you look on their org chart, they have 23 full-time employees who answer to their medical director
- to do infectious disease, immunization clinics, case management, HIV prevention, and it's a little different
- org chart, but the point is, so there's 23 full-time employees, 30% approximately is,
- would equal eight full-time employees for Monroe County to do these positions. If you look at, then
- they have a statistical and information support division, and they have a total in that section of eight
- full-time employees. And so Monroe County would need about two full-time employees. Currently,
- we have four. I'm going back to the,
- part, the medical part. So we have four full-time employees that provide infectious disease, case management,
- and some of our prevention. And so I think that we need four additional positions to make up for the
- employees that we've lost when we
- lost the IU health contract. So in my mind, we need those additional positions and we need probably
- two positions that allow us to obtain data, work through data, do the statistical analysis and all of
- those services. And
- 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
- really the bottom line is yes, our org chart is a little different than Allen County, but these are
- the things that we need to provide services for Monroe County citizens in a proper fashion. So the details of the,
- Step-by-step in the county government asking for this is, you know, we meet with resistance at each
- turn because you have to get with approval, which is defining the position, what it should pay. And
- then it has to go through the council and it has to go through PACS also and then through council next. So,
- I don't know how much of that process we can sort of, well, we can't bypass the process, understood,
- but is this the point where we ask for what we need in the budget and then go figure out the details
- at a later time and keep asking for what we need? So that's my question to the board. And I don't know
- if, you know, the ins and outs of all of that is,
- county government, but we can work through that. I think if we don't ask for it, we will never, if we
- never get it, if we sort of keep saying, well, you know, they're not going to approve it or whatever,
- then if we never ask for it, and the public doesn't see that we asked for it, then we will never have
- the possibility of getting it. So this is just my opinion. But we do not have enough, you know, boots
- on the ground,
- scenario is we do not have enough people to provide the services that we're both required to provide
- and that Monroe County citizens deserve as their taxpayers and and we're trying to provide the services
- that they need. So how many people do we currently need here?
- I'm not even sure I could follow all the reasoning that you had, and I've been here for a long time,
- so I'm not sure you guys followed it, but maybe you could. And I'm not saying it was, you didn't explain
- it well, but yeah. But how many people do you currently need to hire to cover the services that we need
- to provide? I would say five.
- Do I have additional? And the most important of those would be somebody really, and that would be like
- the clinical assistant position that we're currently trying to get. The clinical positions, yeah. Nursing,
- director, someone to oversee the vaccine program,
- is really important. But we need communicable disease nursing staff. We need nursing staff for the vaccines
- and clinical support staff. And we need more maternal child health staff because she's only one person.
- And as we saw when she's out of the office, then those services
- 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
- already being a backup for four positions and now with the maternal child health so that's five and
- we need we need backup upon backup upon backup so to be able to function so basically we need five positions
- I mean that would that would
- at least allow us to be operating at capacity. I mean, our full. If I heard you right, you said six.
- I said six. Yeah, you're right. Actually, you're right, six, because I wasn't looking at this. So if
- you look at the proposed one, and we've made some other changes, but really to structure this out, how
- some of our most efficient
- divisions are like environmental health services and vital records, we need that additional extension
- because this is our coverage. So we don't have additional built-in coverage with these nursing positions.
- So when you're already short on staffing for that, there's no other resources to pull from. And maternal
- child health, there's only one person there. So we need a second person there. We do have the capacity.
- We could be providing a lot more with those services.
- but definitely with our nursing services as well. Okay. So six, how much additional money do we need?
- The money that we already haven't got. So I would ask them, um, full time benefited under 300,000. Okay.
- So the three positions.
- So you said six. OK, that's so these three that are kind of dotted lines proposed. Those are ones that
- are not already approved, right? Those are correct, like they don't exist. The other ones we have received.
- We have funding for, but have not received approval to hire. We have funding and positions available
- for these. OK, so really we're just asking. Six total that we don't have that we need to hire.
- three approved, three we need to get approval for. Thank you. Is that in order to fulfill the requirements
- that the state has for us, states and groups do these things and just to fulfill those things? So, Dr.
- Robinson, I would agree. I think that we need to ask for what we need, not what we think we're going
- to get told yes. I think we need to be very loud and clear to the citizens of the county that
- here's what we need and the board has the opportunity to, I'm sorry, the council has the opportunity
- to give that to us if they choose to, but if they don't want to, that is their call. So I would agree
- with you. Okay, so Lori, we have in this budget, you have the funding listed for public health nurse
- school liaison.
- Is that true? I'm just trying to that is not true. So that's currently funded. That is currently funded
- through the school grant. And the public health nurse communicable disease is county funded, so that's
- covered from the funds that did not go to IU health. OK, the public health nurse position is currently
- in 2026 HFI. The idea is to move that to an alternative
- funding source, such as the school grant or county. So to provide flexibility, you know, with, yeah,
- with the residency. Okay. So you're saying for the purpose of this budget, there's three positions that
- are not on this proposed budget. Correct.
- Okay. And that's the maternal and child health assistant, the senior public health nurse and the health
- services assistant. Is that right? Those are new positions that would have to be approved. These three
- positions are not in. Got it. Wait, say it again. This, the maternal child health assistant is not on
- the budget. Correct. Senior public health nurse, not on budget. Correct. Health services assistant. No. Okay.
- So we ask if it doesn't get put on the agenda, our hands are tied. Correct. But we just keep asking.
- We keep asking and we keep going to give updates and we keep going to give public comment. So can I
- have a motion?
- Well, one moment. So these positions, Lori, would just, would you have an idea of them being, do we
- have to vote on a proposed amount? Of course, I would say. So can you give us an idea of what these
- folks should be paid
- I mean, I would say, according to the salary ordinance, is that what you mean? No, what do we think
- these people need to be paid in order to be able to hire the person we need with the credentials we
- need? So, well, so it's hard for a good example is
- People in Bloomington are traveling to Morgan County for positions because Morgan County is paying their
- 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
- hours? Is it 36, 35? So that's 65, 520.
- for a year, 65,520. So are each of these positions, well, are each of these positions nurse positions
- or no? No, so this one is, and this one is a supervisor, so it should ideally be more than these nurses.
- This is that clinical assistant, so that's what came back as a comment, which is basically a clerical page
- type position, so I think around $21 an hour is what the county ordinance is. And the maternal child
- health is not required. It would not necessarily be required to be a nurse, but it would be really nice
- to be able to have a nurse for that, to work with our community health worker on just some of the perinatal
- services and be able to provide a little bit more. So I would say these two, you would want nurses
- that we wanted at least medical assistant. Okay. So the nurses were 65 and the medical assistants. 65,
- 520 for the nurses and the medical assistant. And benefits? Yes. So the medical assistant position would
- be 43,680.
- to add benefits to all of those. What's the cost of the benefit package? Well, so self-insurance right
- now for 27 is $18,000, purpose 14.2% of the salary and FICA is 7.65% of the salary. So probably... Okay.
- Just one thing. So are we thinking the 65 for these and then? Like. Are these are these positions in
- the budget? Are the public health nurse public health nurse? So we put there in the budget at the current
- county salary. What is that? So it's not. Yeah, it's $28 now. So you would.
- So what we're describing, what we're discussing should be considered a higher pay rate for those three.
- Is that what you're... Right, so they wouldn't let... So I couldn't just submit a budget to council
- for and say we want you to pay these people this amount. They'll say this is what it's classified as.
- So that would be a separate process.
- I can tell you that, again, at the symposium, I went to every table of health administrators,
- health officers, and asked, how do we find public health nurses? And I was told, good luck. You know,
- that one person at least suggested to me that within five years, all public health nurse positions will
- probably be medical assistants because we can't compete
- with the $30,000 sign-on bonuses and the salaries that hospitals are willing to pay because they can't
- find nurses either. So there's a sense across the state that indeed we're going to, you know, we may
- get lucky and find nurses who are deeply committed to serving the public and are willing to endure
- whatever the county is willing to pay, but it's going to be challenging at best. I needed to share that
- with you guys because we're really up against a wall here between what council is allowing us to pay
- people and the in availability basically of nursing personnel who
- really before they come on board, don't really have knowledge of public health nursing and what it entails
- and have that particular state of mind. They've all been trained essentially as hospital nurses. And
- when I looked online today, looking at what health
- Companies who are doing home health care are willing to pay nurses. We are really in a hole because
- across this state, home health agencies are willing to pay as much, but usually much more than what
- we can afford according to council.
- I would say it's not just for the nurse and either just positions in general from Monroe County. Compared
- to other. So I think the question is, do we ask for? These do we ask for these three positions? And
- do we ask for?
- the 65,000, knowing that would include the benefits, or we do, we ask for 80,000, which is the going
- rate to be competitive and includes benefits. And I will say, you know, that other departments have
- gone to the council, asked for SO positions, those are special positions for people who are required
- to be, for instance, an engineer,
- the county highway and that person was making I don't know I think it was 120 or 130 and that was approved
- even though there's a hiring freeze so it's not impossible and you know those SO the you know I'm not
- sure how it will work but these may be a couple of them may be SO positions that we ask for so
- They are skilled. Yeah, there's definitely, I mean, there's only around their license, their skills.
- Right. That's what we need. That's what we need. We ask for what we think we need. Yep. Okay, so I will
- need a motion. How do you want to proceed with that? We need to do
- three separate motions for all three positions or a motion to include all three? Probably three separate
- motions. So do we want public comment before we make the motions in second or do we want to motion and
- second each one and then have public comment? If we do public comment for all three of them before,
- can you do that? Let's do that. So do we have anyone online or in the room who wants to make public comment
- about the 2027 proposed HFI budget. Okay, seeing none, we shall proceed with our motions. For which
- year is this? 2025-26 or 26-27? This budget that will be working on is for 27.
- Isn't it the 1611 local budget rather than the HFI budget? One moment. HFI budget was on my agenda.
- Is that not correct? It says 237 HFI. So this is the 2027 HFI budget. And the reason that you're getting
- this tonight is because I have to submit it to the state before June 1st.
- So these these proposed new positions are not budgeted for this and would not be budgeted in this if
- we would my understanding as you would be saying to ask for that in the county health fund.
- Is that correct? Yes. So if we ask for these one last question, we asked for these. Do we have the job
- descriptions and stuff already written up to create them? So we're going to ask for them and then.
- I motion to add to the 2027 proposed budget a position entitled on this org chart, which is the proposed
- 2026 chart. The senior public health nurse position, which would be, we believe paid roughly $65,000
- with benefits
- it's up to $80,000 and we would do the appropriate math to get them that exact number for that. So I
- propose we add that to the 20-27 budget. Second. All in favor? Aye. Okay, motion passes. Does anyone
- have another motion regarding maternal and child health assistance?
- Make a proposal that we ask for in our budget based upon the 26 Monroe County organizational chart that
- we add, or ask for funding for maternal child health assistant with approximate salary of, what do we
- have? 65,520. 65,520 plus benefits up to? 80. 80,000. All in favor?
- Before we have a motion on the. Third position, the health services assistant, so that would be for
- a medical assistant. So with the going rate, the. Hourly wage for the annual salary would be $43,680.
- So. With benefits we.
- probably need to discuss what that number, we think that number approximately should be. And keeping
- in mind, so the tricky part about that one, I believe is that the three positions that we have in the
- budget, including public health nurses, we can sort of price that position higher than the public health nurse.
- What is that? Yeah, what is that pay? That is the 48. And someone says an hour. OK, so. And what is
- that number? Is that here on the budget somewhere? Sorry, no, those are not included in 2027. It wasn't
- 26. It's budget is 60,807. Is that right? Oh, for the director.
- No, it says the public health nurse. That seems wrong. Okay. For some reason, but. So we just need to
- estimate some benefits for the health services assistant position. And again, the total annual for the
- annuals or rather for the hourly pay equated to annual pay is $43,680.
- It would be less because the way we calculated the benefits for the other two were percentage based,
- right? For the most part, so it would be less than the. Well, we had originally calculated the other
- two. Do you want me to grab a copy of the salary over that's that happened on my desk? Yes, that would
- be good. Okay, that would be helpful. Can I ask a question going back for a moment? I don't know if
- I'm allowed to, but did I hear that the maternal.
- Child health assistant. It's going to be paid up to $80,000. Right, because she's thinking they need
- to be a nurse so that that person provides backup. In the staffing. So there's nurse backup. Yeah, no,
- I mean, our maternal. It looks by your org chart. That individual is.
- subordinate to the coordinator who certainly is not paid at that rate. So it seems a bit odd that you
- would want to pay that person $80,000 up to $80,000 in a subordinate position to the maternal child
- health coordinator. Yeah, she has a good point. So the the assistant is
- The maternal child health assistant is subordinate to the coordinator. It seems kind of crazy that that
- person would make a fortune. Same as a nurse. Yeah, I'm confused. Okay, so yeah, so we need to. So this
- is not correct. That's what we just did. Well, I think it depends on what what the board is then saying
- the people above should be paid at because it's.
- The similar situation with the health services director that salary is currently 59,187,000 so. These
- would all have to be increased to. That's not that's not good work, but we we pay more for medical licensed
- professionals. I know there are people that are above me in my organization and they don't make that
- big. For example,
- have a medical license and I think we pay more for that. Is that the thinking behind that? We're looking
- for nurses. Nurses are competing with other entities that will pay nurses more based upon their licensure.
- I think the whole situation is a large challenge because then I think we run into a situation where
- you have other health department employees who
- who then, you know, well, I have a master's degree or I have this specialized certification, but so
- where do you kind of find the balance between what are you going to pay your clinical staff compared
- to the rest of the department employees that still have to have a degree or specialized education? Just
- because, for example, an LPN, that's a one year certificate and it is specialized, it's in high demand
- because it's a service, but then if you have someone, well, I have a master's degree,
- but I'm making $20,000 less a year, where do you kind of find the balance, I guess? In my understanding,
- or at least the way I look at it, and I may be wrong, but we're competing against a medical system that
- pays more for people with a medical license specifically to practice, as opposed to a master's or a
- PhD. Yes. And so if we're trying to draw people to do the positions, and they can go somewhere else,
- and with their license make a lot more money,
- we're gonna have a hard time drawing those people. Correct, and because we're not offering hiring bonuses
- and such. That's my logic. Well, I guess my question still is, does the assistant to the maternal and
- child health coordinator need to be a nurse? And what kind of nursing role would that person play in
- that position?
- I don't think that I would have to, but I think it would offer us a lot more flexibility with the type
- of maternal child health services that you're paired with a community health worker and someone that
- has those nursing skills and the types of services like perinatal navigation, for example, that we could
- offer and provide. So. Yeah, yeah, I think it's about changing the title. Yeah, because I think the
- title doesn't work.
- for what you're saying. And I guess it will be in the definition of that person and the job description.
- But the way it's written now, it's like, I can't imagine it. So thanks for the clarification. That's
- really what I needed. So should we change the language to make it more palatable, to make it make more
- sense and remove our motion and change the language?
- And maybe change the organizational charts so they're not reporting to the coordinator. So what are
- the? What are the job descriptions should, listing the qualifications and so forth. The assistant could,
- for instance, be at the end. What are the requirements?
- My last question was, do we know, and she may be the one who needs to answer this, but the requirements
- of the maternal and child health coordinator, like is that
- I presume it's a non-clinical physician. I think she wants it to be an LPN so that that person can provide
- coverage when other people are gone or and be have some flexibility. And that's a coordinator or that's
- the? The coordinator doesn't have that. So the coordinator is a like non-clinical? Yes. Okay. She has a
- BA or BS, but no specialized training. Okay. So maybe a solution would be to change the name of the
- maternal and child health assistant to maternal and child health nurse. Yes. Yeah. Okay. Right. Well,
- should we wait for Lori here? We should wait for Lori.
- It's already back in the room. I will motion that on the 2026 Monroe County Health Department organizational
- chart proposed 19 May, 2026 page that the maternal and child health assistant position be renamed maternal
- and child health nurse. I second. Do you want me to include the financing? Okay.
- and that we also attend the 2027 proposed budget with a nurse salary, which is 60, 65, 520 with benefits
- approaching roughly $80,000. And we add that to the 2027 proposed budget. Second. All in favor? Aye. Okay.
- So yes, you were gonna tell us about, so the maternal child health coordinator is an associate's degree.
- So we're back to, do you have some sort of comparable position for this MA position that would give
- us an idea about how much to add for benefits
- And FICA, if the baseline is $43,680? So the clinic manager position that was in the futures clinic
- was a Comet C, which the base salary is $44,245,000. And how much were the benefits for that?
- Uh, if it's full time, 35 hours, I've been full benefits, 18,000 for self insurance, 14.2% for perf
- instead of the 65.5. Okay. Times 21%. That's 18,000. Yeah.
- So for the medical assistant, 21,000 times 21% is 4,400. That's another 18,000 to be. I would say let's,
- I would propose that we consider increasing that salary to maybe 60. The base salary, 43,680,
- and I mean, we can do the,
- Details, I'm not sure. Are we able to submit a motion for a vague amounts to be calculated later? Can
- we do that and then like, sign on to it via email or something?
- because we really need to have the specific number of surety, right? Like, I think it would be, this
- is what we want the annual salary to be, or this is what we want the hourly rate, and then plus we want
- it to be full-time benefited. Okay. So if we say that, then it covers us and we can make the calculation
- later. Okay. So do we need to make addendums to the other two motions? Yes. Since I placed both motions,
- Can I attend both motions simultaneously? So I would attend the motion that I initially put forth about
- the senior health public senior public health nurse to turn on to allow for the financing to suggest
- twenty eight dollars an hour. Is that correct? That's correct. OK, we did.
- 36. 36 is what Morgan counted. $36 an hour plus full-time benefits and remaining the ranger of the motion
- stands. Okay. Second. All in favor. Aye. Okay. Next. The second one would be the maternal and child
- health nurse that we've already motioned to rename. I would addend my motion to also pay that position
- $36 an hour and make it full-time benefits. Second. All in favor? Aye. Okay. And since you're on a roll
- for the Health Services Assistant. I make a motion to, on the 2026 Monroe County Health Department org
- chart proposed 19 May, 2026, the Health Services Assistant position
- be added to the 2027 proposed budget for the county health fund at a pay rate of, what do we say, 22?
- 21,000. What do we do, 21? Well, so what aligns with what the futures was $24.21. $24.31 an hour plus
- full-time benefits.
- Second, second, all favor. Okay. Okay. Okay. All right. Yes. Did you address this position? Yes. Oh,
- yes. So, can you tell me what that is? Thirty six. Thirty six dollars. Okay. Yes.
- So in the health services director, there's one. So this one, just providing information, this position
- makes 3252. And that does require a nursing degree. These require a nursing license.
- So this person requires an RN? Yes, the same? Yes. So I think. We should probably put that on to the
- ones who are interested. You could do that. Make a motion to change the salary of the health service
- director taken from the 20-25 Memorial County Health Department additional chart proposed 19 May 2026
- for the 2027 budget.
- to change their hourly rates to $36 an hour with full-time benefits. All in favor? Aye. Probably we
- just need a vote on this proposed 2027 Health First Indiana. Oh, okay. Yes.
- Okay. We need to propose a motion with the additions we've already made. I was going to say the adjustments.
- Well, so I would say because these other changes were related to the county health fund, that that would
- be separate. This is just approving this to be submitted before June 1st. This is a CFI. Correct. Take
- the motion to
- approve the proposed 2027 HFI budget as shown in the chart that was given to us. Do I have a second?
- I second that. All in favor? Aye. Public. Oh, I'm sorry. Yes. Do we have anyone needing to make public
- comment? Anyone with their hands up? Okay.
- All in favor? Aye. Okay, motion passes. So moving on to new business. Does anyone have any business
- to discuss? I'm not sure why the plate is for food.
- or so much out of whack from what they've been in the past. Why they increased it? Well, that was because
- the increase because it was like they've been running like 5,000 and late fees and then all of a sudden
- now it's almost 30,000. For the fees collected? Yeah. Uh-huh. So that was based upon the changes that
- were made increasing the amount of the late fees charges.
- And so they surveyed different health departments across the state of Indiana, the foods division did,
- and kind of looked at what other people were doing to try to get organizations into compliance and came
- up with that. Okay. So looking at this fee schedule for the birth certificate fees, death certificate
- fees, and the total vital records fees, we're significantly below that.
- More than this time in the years, that's something that just hasn't been adjusted. We expected that
- it will get to that level by the end of the year. For the birth or for the death? Either. Oh, well,
- we would think that it'll get close to that amount, but we have seen deaths go down over time, which
- so we have been having less revenue just because of that. And. It's right. It's going to start down as well.
- And we did. I mean, as I recall, we actually increased fees, not substantially, but a little bit. A
- little bit. And the state, all health departments now, if you go in from another county, you're supposed
- to issue different county adjustments. But not all counties do that. Right.
- Any further board member or health officer comments? Sure. So one, I want to extend deep gratitude to
- Lori and to Kathy and to Linnea for stepping up during our recent episode of meningococcal meningitis
- in the community. They've done Yeoman's work.
- deeply grateful to all three of you for everything that you did in helping us contain and control it.
- Reminding the public that meningococcal meningitis is something that we have a vaccine for and that
- vaccinations matter. They save lives. This is a disease that is potentially deadly. Fortunately, this
- individual is
- still in the intensive care unit and apparently is beginning to show some recovery, which is good news
- after more than a week. And I guess I also just want to remind the public that this is how the health
- department serves our community by containing outbreaks, by watching over not only
- our food sources when we are out in community, but also our health on an ongoing basis. And that's really
- why it is important for us to be able to pay the employees that we have and to bring in the people we
- need to help us manage public health in Monroe County. That's it. Thank you.
- All right, any other comments. Okay, seeing none, we shall adjourn. Thank you. I motion to adjourn.
- Everyone in favor.