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.