WEBVTT 00:00:00.866 --> 00:00:10.419 - I'm going to call the what is today's date this July 2nd meeting of the Board of Health to order. Apologize 00:00:10.419 --> 00:00:19.619 - for a little bit late getting started. We were just waiting to get a quorum in the room but we're ready 00:00:19.619 --> 00:00:24.926 - to get going now. We have everyone in the room. Okay great. 00:00:25.538 --> 00:00:33.020 - If there are any does anyone in the board have any amendments that we would like to propose for the 00:00:33.020 --> 00:00:40.502 - agenda today. I move that we accept the agenda. Okay. Second. All in favor. Aye. All opposed. Okay. 00:00:40.502 --> 00:00:48.507 - So we are going to go forward with this. The first thing on the agenda is the approval of meeting minutes. 00:00:48.507 --> 00:00:55.166 - The minutes from the meeting on. Let's see what was the date of that meeting. I lost it. 00:00:55.970 --> 00:01:04.468 - June 11. No 18. Sorry. Yes. The meeting minutes for June 18th are in your packet. May 21st is here too. 00:01:04.468 --> 00:01:12.802 - Yes. Oh that's right. So actually that one from June ended up being canceled. Okay. Okay. So it's the 00:01:12.802 --> 00:01:21.382 - May 21st. The minutes for meeting on May 21st are distributed in your packets. Are there any corrections 00:01:21.382 --> 00:01:22.526 - or additions. 00:01:22.754 --> 00:01:30.332 - Or is there a motion to approve the minutes as distributed. I'll make a motion to approve as written. 00:01:30.332 --> 00:01:37.761 - All right. Very good. All in favor. Aye. All opposed. Great. All right. So now we are going to move 00:01:37.761 --> 00:01:45.413 - to the general public comment. The Monroe County Board of Health encourages and welcomes public input. 00:01:45.413 --> 00:01:50.910 - Written comment may be submitted at any time via email at Board of Health 00:01:51.394 --> 00:01:58.327 - co.munroe.in.us. During meetings comments related to specific agenda items will be heard after the board's 00:01:58.327 --> 00:02:05.130 - discussion of that item and prior to taking a vote. At that time we would like to invite those I'm sorry 00:02:05.130 --> 00:02:11.674 - at this time we would like to invite those who would like to make comment on any non-agenda items to 00:02:11.674 --> 00:02:18.348 - speak. For those in person please sign in at the front of the room and those joining online please use 00:02:18.348 --> 00:02:19.838 - the raise hand feature 00:02:19.970 --> 00:02:27.412 - to indicate that you would like to provide a comment. Each speaker will have three minutes and we ask 00:02:27.412 --> 00:02:34.781 - that you please begin by stating your name for the record. Is there anyone online would like to make 00:02:34.781 --> 00:02:36.094 - a public comment? 00:02:49.250 --> 00:02:57.009 - recognizes Sarah Rider-Bain. As you know you have three minutes for public comment. I will go ahead 00:02:57.009 --> 00:03:04.379 - and start your time and you may go ahead and introduce yourself first and we'll go from there. 00:03:04.379 --> 00:03:10.974 - As soon as we. There we go. I think you've been allowed to speak. Yeah there you go. 00:03:24.994 --> 00:03:44.068 - on a loud mic maybe. Sorry Dr. Ryder man we're having issues giving you permission to speak. We've got 00:03:44.068 --> 00:03:49.438 - you right where we want you. 00:03:55.490 --> 00:04:06.596 - I think we've got you now. Yay. Yes, I can't show you my face, because let's see if it'll let me. Oh, 00:04:06.596 --> 00:04:18.029 - look at that. Good lord. I can't hear. There's a really weird sound in the background. So several months 00:04:18.029 --> 00:04:23.582 - ago, I asked about the contribution from IU Health 00:04:24.290 --> 00:04:39.685 - or IU Health Foundation to the project through Health Net that is our backpack nurses. And I was told 00:04:39.685 --> 00:04:54.174 - we would be getting that information. I still have not seen it. I don't know if we could simply 00:04:55.682 --> 00:05:05.614 - Tell us what that amount was that apparently IU contributes also. That's the question that remained 00:05:05.614 --> 00:05:07.998 - hanging for me. Thanks. 00:05:35.458 --> 00:05:43.411 - Dr. Ryderband, I'm so sorry about that. We were having trouble hearing, we were trying to turn the volume 00:05:43.411 --> 00:05:51.289 - up and we accidentally activated our TV and so we couldn't hear anything. Could you? Should I ask again? 00:05:51.289 --> 00:05:58.866 - We actually heard a little bit about like an IU Health and Health Net at the very beginning and then 00:05:58.866 --> 00:06:03.518 - we were trying to turn up the volume and lost the other half. 00:06:03.714 --> 00:06:13.105 - If you wouldn't mind, I will go ahead and give you another three minutes. And if you can go ahead and 00:06:13.105 --> 00:06:22.404 - repeat yourself, I'm so sorry. As I was going to say, I don't need three minutes, but several months 00:06:22.404 --> 00:06:30.782 - ago, I posted on Twitter in the next week that I knew Health Foundation makes a health net 00:06:36.290 --> 00:06:44.678 - The Board of Health makes a contribution, a significant contribution, and I was asking since there is 00:06:44.678 --> 00:06:52.983 - a decrease in the amount of VR visits in the evening because of this program that's been instituted, 00:06:52.983 --> 00:07:01.288 - what contribution IU Health has made. I still have not seen that information, although it's supposed 00:07:01.288 --> 00:07:02.686 - to be available. 00:07:05.698 --> 00:07:12.733 - doesn't appear to be on our agenda. So I thought I would ask again. Have you heard me this time? Yeah. 00:07:12.733 --> 00:07:19.905 - Who were we supposed to be hearing this from? Did you who did you did you talk to someone in particular? 00:07:19.905 --> 00:07:27.077 - I was going to tell what IU Health is contributing and there's no financial contribution from IU Health. 00:07:27.077 --> 00:07:34.590 - They are working with they allow the the health and nurse access to our patients in the emergency department. 00:07:34.850 --> 00:07:41.744 - We consult with them and let them know that there are people in his cohort. And there's a multidisciplinary 00:07:41.744 --> 00:07:48.319 - meeting that we have once a month that it includes Health Net and that nurse and people from IU Health 00:07:48.319 --> 00:07:54.894 - as well from community outreach that gets together and discusses the process that we go by to care for 00:07:54.894 --> 00:08:00.830 - that cohort. But there's no financial contribution. Thank you. That's what I wanted to know. 00:08:01.186 --> 00:08:10.389 - Do you know if they've assigned a monetary value to what Health Net has done to keep people from chronically 00:08:10.389 --> 00:08:19.254 - visiting the ER? How many people that is? I think that when Amy gave her update at the end of last year, 00:08:19.254 --> 00:08:28.372 - they have the dash. It was a dashboard. She had Amy shared information, but I don't remember the specifics. 00:08:28.372 --> 00:08:30.398 - There is an amount that 00:08:30.882 --> 00:08:37.716 - is so associated with a decrease in in patients presenting to the emergency department. There's 00:08:37.716 --> 00:08:45.405 - no acknowledgment or there's no statement that says this is caused directly from this. One can hypothesize. 00:08:45.405 --> 00:08:52.880 - But I don't think I says because this has happened we've saved this amount of money specifically because 00:08:52.880 --> 00:08:59.358 - of this. We'll say more along the lines of the percentage or the number of people that are 00:08:59.458 --> 00:09:10.506 - in our emergency department that are unhoused is less than the previous year. Therefore, there's a certain 00:09:10.506 --> 00:09:20.831 - amount of difference in those costs. So there has been a decrease. There has been, yes. We actually 00:09:20.831 --> 00:09:27.646 - saw that in place a month ago. We saw the precipitous decrease in 00:09:27.906 --> 00:09:36.504 - recent visit between, I think it's 4 and 9 p.m. or 4 and 8 p.m. or something in the evening. And that's 00:09:36.504 --> 00:09:45.102 - when I raised the question. Thank you. What would you guys think about having Health Amy Meek come back 00:09:45.102 --> 00:09:53.534 - at our next meeting and give us an update? We couldn't have a section. We're going to reach back out. 00:09:53.666 --> 00:10:00.513 - I'll provide an update from Health Net on the quarterly report I just received and then circle back. 00:10:00.513 --> 00:10:07.495 - I was going to have that group come back. Okay. Very good. I think that sounds like a reasonable plan. 00:10:07.495 --> 00:10:14.478 - I think that that and I'm I represent the board not IU Health when I'm in this room. Yes. I think that 00:10:14.478 --> 00:10:21.663 - it wouldn't be unreasonable for the board to talk to IU Health about and ask for a financial contribution 00:10:21.663 --> 00:10:23.358 - citing presumed savings. 00:10:24.162 --> 00:10:31.434 - I don't know who that would go through, however, I think maybe Amy would be a first stop. And I would 00:10:31.434 --> 00:10:39.062 - propose that both organizations benefit. I mean, we're not asking for the total amount that you're saving, 00:10:39.062 --> 00:10:46.334 - because that wouldn't save IU Health anything. But I would say we could meet in the middle somewhere. 00:10:46.334 --> 00:10:53.534 - And so that would amount to some donation for us for seeing those patients and some savings to them. 00:10:54.274 --> 00:11:03.947 - that as well. That way it seems like a win-win rather than a win-zero-sum break. Well, not a zero-sum 00:11:03.947 --> 00:11:13.620 - actually but our grant is going to help support this program, right? Yes. Okay. Very good. Do we need 00:11:13.620 --> 00:11:23.198 - to do like a voting item to like add something to the agenda next meeting or can we just request it? 00:11:23.586 --> 00:11:44.188 - Any other public comment online. Okay. Seeing none we will move on to the next item in the agenda which 00:11:44.188 --> 00:11:51.518 - is the department updates from Lori. 00:11:51.906 --> 00:12:01.240 - We'll start with our vital records. So going back to May there were 287 birth and death certificates 00:12:01.240 --> 00:12:10.760 - that were processed. 18 percent of those required the one non-Health First Indiana funded employee due 00:12:10.760 --> 00:12:20.926 - to the person living out of state. Since February of this year we've processed payments for over 50 TB tests. 00:12:21.218 --> 00:12:29.331 - So we're seeing a lot of those coming through the door on a regular basis. I wanted to provide an update. 00:12:29.331 --> 00:12:37.138 - So we remember back in December of 2025 the board approved moving forward with the staffing contract. 00:12:37.138 --> 00:12:44.792 - So I've got that paperwork that's been submitted to legal for review and expect to get approval for 00:12:44.792 --> 00:12:50.686 - that agency in the month of July. So the bill rate for this is $65 per hour. 00:12:51.042 --> 00:12:58.897 - They're only paid for hours worked. So if we have a day that we're closed or a holiday the person just 00:12:58.897 --> 00:13:06.676 - would not be paid. But this would be looking at attempt to permanent placement. So essentially how it 00:13:06.676 --> 00:13:14.531 - works is after the contractual worker reaches or has completed 900 hours of work here at this facility 00:13:14.531 --> 00:13:18.878 - then Monroe County could hire that person as an employee 00:13:19.010 --> 00:13:26.806 - and there would not be any charge so that we would essentially take them on as a Monroe County employee. 00:13:26.806 --> 00:13:34.380 - You can hire prior to the 900 hours but if you do so then the agency charges you a fee and it depends 00:13:34.380 --> 00:13:42.176 - on what the starting salary is for that position. So met and talked with those individuals really talked 00:13:42.176 --> 00:13:46.334 - about what we're looking for the needs how it different 00:13:46.594 --> 00:13:54.624 - how it differs from just regular nurse positions and continue that conversation more. As I mentioned 00:13:54.624 --> 00:14:02.812 - I've received the second quarterly report from Health Net. So this was for the months of April through 00:14:02.812 --> 00:14:10.921 - June. So during that time at the Wheeler Mission when they're there on Tuesdays and Thursdays they've 00:14:10.921 --> 00:14:15.294 - seen 19 individuals. There were 11 psychiatric visits. 00:14:15.746 --> 00:14:24.453 - four acute illness, four medication refills, and one visit that was not related to those categories 00:14:24.453 --> 00:14:33.247 - for a wound or an injury. The majority of individuals were between the ages of 46 and 59. One change 00:14:33.247 --> 00:14:41.954 - that we're unsure of is how the street outreach services are going to be impacted given the changes 00:14:41.954 --> 00:14:43.870 - to the statewide law. 00:14:44.098 --> 00:14:52.160 - criminalizing unauthorized camping and sleeping. So we're kind of waiting to see how that might impact 00:14:52.160 --> 00:15:00.613 - the services and those patients that they've been consistently seeing. Our disease intervention specialists 00:15:00.613 --> 00:15:08.596 - have recently began free testing for STIs in the Monroe County Jail. So I think that's something that 00:15:08.596 --> 00:15:13.214 - we've been waiting on for a while. So the jail has agreed. 00:15:13.698 --> 00:15:22.256 - to allow us to come in and provide HIV and hepatitis testing as well. They will continue testing every 00:15:22.256 --> 00:15:30.647 - other week. Indiana has changed the requirements for the AIDS drug assistance program. So now people 00:15:30.647 --> 00:15:39.454 - living with HIV in Indiana county jails can receive assistance the entire time that they're incarcerated. 00:15:39.874 --> 00:15:47.128 - And there's not a cap on how long they can be enrolled in this program. So if any new HIV patients are 00:15:47.128 --> 00:15:54.381 - identified they will be referred to PositiveLink who will assist those individuals with signing up for 00:15:54.381 --> 00:16:01.705 - the assistance program. Long term they plan on doing a collaboration with our harm reduction specialist 00:16:01.705 --> 00:16:07.550 - and two of our disease intervention specialists to go and do this routine testing. 00:16:09.826 --> 00:16:18.075 - For our nursing services, we have started scheduling vaccine appointments. We have had a vaccine patient 00:16:18.075 --> 00:16:25.695 - in just recently. So we're getting regular calls asking about vaccines and our testing services. 00:16:25.695 --> 00:16:33.708 - Right now, those services are just available. We're scheduling appointments on Mondays and Wednesdays 00:16:33.708 --> 00:16:35.358 - between 1 and 4 p.m. 00:16:36.002 --> 00:16:46.046 - and Tuesdays and Thursdays from 8 a.m. to 12 p.m. We'll reevaluate here in the fall once we start getting 00:16:46.046 --> 00:16:55.616 - into flu season and just get a better idea about what our volume may or may not be. From January 1st 00:16:55.616 --> 00:17:05.470 - to July 1st of this year we've closed a total of 85 of our case investigations. That excludes our STI's 00:17:05.826 --> 00:17:14.036 - tick-borne illnesses and animal bites. So busy doing that. The LTBI cases do remain on our 00:17:14.036 --> 00:17:23.330 - open investigations just until those individuals complete all their medications and the state actually 00:17:23.330 --> 00:17:32.803 - closes all the other TB and Class B cases. So sometimes that makes our open queue look larger. So that's 00:17:32.803 --> 00:17:33.886 - going well. 00:17:35.490 --> 00:17:44.009 - The clinical assistant position was approved by council. So we've been receiving applications, doing 00:17:44.009 --> 00:17:52.443 - pre-screening interviews. We're actually receiving quite a few of those. Everything good? Yes. Wow. 00:17:52.443 --> 00:18:00.962 - I think you buried the lead on that. I was going to say Ann. I guess it feels like it's been a while 00:18:00.962 --> 00:18:04.926 - now. It does. It seems like it's been forever. 00:18:05.250 --> 00:18:15.763 - We've had a lot of interest and so still continuing to go through those applications and the screening 00:18:15.763 --> 00:18:25.970 - process those interviews are going going well so anticipate being able to fill that position pretty 00:18:25.970 --> 00:18:28.318 - soon. Let's see so far 00:18:28.610 --> 00:18:39.199 - through the milk bank partnership. We've distributed 119 bottles through our milk access program. So 00:18:39.199 --> 00:18:49.893 - we've just started that just a couple months now. So been really busy with that and that's been going 00:18:49.893 --> 00:18:57.022 - well. How many people have used those 119 bottles? Well, let's see. 00:18:57.506 --> 00:19:06.694 - I did the distribution this afternoon. I think when I was looking at the list, I'd say maybe seven. 00:19:06.694 --> 00:19:16.066 - So you can order up to 10 at a time, and then you would have to place a new order. But that's what we 00:19:16.066 --> 00:19:21.854 - can do for each one. Let's see. Our public health preparedness 00:19:21.986 --> 00:19:29.961 - director and coordinator and some of the department employees will be attending a point of distribution 00:19:29.961 --> 00:19:38.243 - exercise for emergency preparedness next week at Ivy Tech. So that'll be on the 7th and 8th. They generally 00:19:38.243 --> 00:19:46.142 - try to do those about once a year with just to keep employees up to date on those response activities. 00:19:47.714 --> 00:19:55.203 - for Environmental Health Services. Our director has taken on the tick-borne illness case investigations 00:19:55.203 --> 00:20:02.476 - for the time being. We're seeing a lot of those come in as completed. Six in June. Two were lost due 00:20:02.476 --> 00:20:09.965 - to a lack of communication and follow-up and we received just two new cases today. So currently we have 00:20:09.965 --> 00:20:13.278 - three pending cases that are being worked on. 00:20:13.410 --> 00:20:22.681 - And he's completed a total of 73 animal bite cases so far this year. So staying really busy with those 00:20:22.681 --> 00:20:32.401 - activities on top of the regular environmental health services. Do you know a breakdown of the distribution 00:20:32.401 --> 00:20:42.302 - types of animals? I could get that. We used to have that information routinely. Skunks, raccoons, dogs, cats. 00:20:42.466 --> 00:20:51.837 - There's a lot of different ways to filter and run the reports. I've been trying to kind of dig around 00:20:51.837 --> 00:21:01.300 - on that. So I know that it's possible. And it's interesting it's helped to see at the breakdown. FOODS 00:21:01.300 --> 00:21:10.488 - is completing the summer feed program inspections for the schools and moving into population health 00:21:10.488 --> 00:21:11.774 - and outreach. 00:21:12.162 --> 00:21:20.028 - That manager and public health preparedness coordinator recently attended the Cambridge Health Fair 00:21:20.028 --> 00:21:28.524 - so they were providing free blood pressure and blood sugar screenings and handing out educational materials 00:21:28.524 --> 00:21:36.784 - and crisis kits. The population health and outreach manager is continuing to cover our TB LTBI and Class 00:21:36.784 --> 00:21:40.638 - B case investigations and testing as we continue 00:21:41.122 --> 00:21:49.063 - building up our transition of nursing services. She and I have also been working together on 00:21:49.063 --> 00:21:57.602 - grant opportunities and applications to find funding to support our maternal child health services. 00:21:57.602 --> 00:22:06.227 - So we'll continue to keep seeking those opportunities and applying for them. And our Heart Reduction 00:22:06.227 --> 00:22:07.166 - Specialist 00:22:07.394 --> 00:22:16.093 - This will be working with our disease intervention team for those walk-in testing clinics that are being 00:22:16.093 --> 00:22:24.378 - held on Thursdays between 3 and 6 p.m. So I think this Thursday is just the second one that they've 00:22:24.378 --> 00:22:32.829 - had now, but plan to continue that program. And that's what I have for our updates. Can you do the TB 00:22:32.829 --> 00:22:35.646 - testing? Is it the typical, like, 00:22:35.778 --> 00:22:42.445 - The skin test. The skin test or you do in like your quality or not? We do both. Okay you do both. Yeah 00:22:42.445 --> 00:22:48.983 - so if we if we draw I think it's it's pretty easy to draw the labs because then people don't have to 00:22:48.983 --> 00:22:55.521 - come back but we it costs us twenty dollars we send it to the Indiana Department of Health. Okay. So 00:22:55.521 --> 00:23:00.894 - but we have a courier that we can use for that. Okay very good. Thank you so much. 00:23:01.922 --> 00:23:10.732 - Moving on next item is old business and we don't really have anything in that agenda item so we'll move 00:23:10.732 --> 00:23:19.796 - on to new business. So the first item on the new business is a discussion about the public comment policy. 00:23:19.796 --> 00:23:28.352 - You have a copy of the current public comment policy in your packet. In general the idea I think Dr. 00:23:28.352 --> 00:23:31.486 - Robinson had been talking about this 00:23:33.378 --> 00:23:40.810 - If you recall this is actually I was not here yet for this meeting. It was the meeting just before I 00:23:40.810 --> 00:23:48.315 - joined the Board of Health where there was a vote. Yeah. There was the there was a vote for the Board 00:23:48.315 --> 00:23:55.746 - of Health to basically adopt the public comment policy that the county commission uses which is what 00:23:55.746 --> 00:24:00.382 - you heard us do at the graduating meeting. Prior to that this. 00:24:00.546 --> 00:24:08.810 - towards public comment policy was to allow public comment for all items at the beginning of the meeting 00:24:08.810 --> 00:24:16.756 - and not have public comment prior to every single voting item. So for the last year roughly we have 00:24:16.756 --> 00:24:25.099 - done public comment about any non-agenda items at the beginning of the meeting and then we would present 00:24:25.099 --> 00:24:29.310 - voting items and have a small public comment section 00:24:29.666 --> 00:24:38.451 - for each agenda item. The question for the board was to revisit that decision and say might it be prudent 00:24:38.451 --> 00:24:46.821 - as we have not had a lot of agenda item public comments in the last year to revert basically back to 00:24:46.821 --> 00:24:55.109 - the policy prior where you would have a public comment session section beginning of the meeting but 00:24:55.109 --> 00:24:58.590 - that public comment section would include 00:25:00.802 --> 00:25:07.779 - want public comment, including agenda items, do that at the beginning of the meeting, address them, 00:25:07.779 --> 00:25:14.826 - and then as we are moving on to our agenda topics, we would just have motions, get seconds, and vote 00:25:14.826 --> 00:25:22.222 - without providing time for public comment during the actual agenda item. So that's, I think, the question 00:25:22.222 --> 00:25:29.758 - up for discussion. To me, it never made really much sense to comment on something after the vote was taken. 00:25:29.954 --> 00:25:39.424 - I think including all items in the public comment section for all, including agenda, the ones on the 00:25:39.424 --> 00:25:48.895 - agenda for that day, that makes more sense. I agree. Plus people, anyone in the public that wants to 00:25:48.895 --> 00:25:58.459 - make us aware of an issue can send it in writing if they so desire. And it's something we can look at 00:25:58.459 --> 00:25:59.678 - at any time. 00:26:01.250 --> 00:26:09.720 - I agree. Right. Whether it's not in the meeting. Right. Right. I feel it's a little different. I actually 00:26:09.720 --> 00:26:17.870 - like the idea of having people having the ability to comment before a vote on a specific item because 00:26:17.870 --> 00:26:25.860 - sometimes when the item is discussed we discuss the item and then we vote. Sometimes the discussion 00:26:25.860 --> 00:26:30.494 - can bring out points that can be important to the public. 00:26:30.914 --> 00:26:44.421 - And I'd like them to have an opportunity after that discussion, before the vote, to make a point that 00:26:44.421 --> 00:26:59.518 - might affect how we vote. Which is actually what it is now. Right. Yeah. I kind of, I got to feel half, you know, 00:27:04.482 --> 00:27:14.918 - will say in general I think I would agree with your general idea because I think if there is a conversation 00:27:14.918 --> 00:27:24.581 - and there is someone from the public watching that has comment I agree I think sometimes maybe some 00:27:24.581 --> 00:27:33.278 - of the things that we are discussing might bring out a comment. On the other hand I think 00:27:34.498 --> 00:27:44.821 - from my experience over the last year, this process has been very cumbersome. I think we have forgotten 00:27:44.821 --> 00:27:55.542 - multiple times to ask for public comment, because it is cumbersome. And truthfully, the public's attendance 00:27:55.542 --> 00:28:03.582 - to this meeting has not been huge. So I feel like, from my perspective, from our 00:28:04.034 --> 00:28:13.920 - I think allowing public comment by writing is always good. Kaye, you were mentioning people can always 00:28:13.920 --> 00:28:23.711 - submit a public comment even after a vote that we might have to disagree with us or whatever. So it's 00:28:23.711 --> 00:28:28.222 - hard because I feel like in our position it is 00:28:28.354 --> 00:28:39.524 - very cumbersome to request public comment prior to every vote for those reasons. And many of those votes 00:28:39.524 --> 00:28:51.014 - are internal kinds of things. Right. However, there are, I mean, in the past, there have been controversial 00:28:51.014 --> 00:28:58.142 - things that the court has done for, in my tenure, for good reason. 00:28:58.786 --> 00:29:13.738 - And there are opportunities for discussion prior to that to justify why we're doing those things. Actually, 00:29:13.738 --> 00:29:27.998 - it's not an effort to justify it. We feel it's just, but we just state our position. And so, you know, 00:29:28.770 --> 00:29:35.271 - Is that the reason that we're doing this, considering this is that it is cumbersome to do it? 00:29:35.271 --> 00:29:42.464 - And I agree. It is hard to remember, especially when you're running the meeting and trying to keep your 00:29:42.464 --> 00:29:49.725 - mind on all of them, everything, that then to ask for public comment at the end of our discussion before 00:29:49.725 --> 00:29:56.641 - we take a vote is, yeah, it is cumbersome. Yeah, I think I believe the idea behind having, bringing 00:29:56.641 --> 00:29:57.886 - this back up was, 00:29:58.402 --> 00:30:04.830 - you know, for the County Commission to have that policy, it makes complete sense because there's a lot 00:30:04.830 --> 00:30:11.133 - of people that are going to be attending that meeting in the room, online, fighting those things. We 00:30:11.133 --> 00:30:17.437 - haven't had quite as much attendance. And allowing the public comment at the beginning, plus written 00:30:17.437 --> 00:30:23.927 - comment, is that sufficient? Or, you know, I think you make a very good point of, you know, do we allow 00:30:23.927 --> 00:30:27.422 - public comment at the risk of forgetting to ask for it? 00:30:27.810 --> 00:30:38.113 - during our votes. So I think those are the things we're trying to weigh. Well, there's usually someone 00:30:38.113 --> 00:30:48.316 - here who will be paying attention to who's hand is raised online, who they want to say something. And 00:30:48.316 --> 00:30:56.318 - then if we don't ask for comment, then we've diminished that person's position. 00:30:56.482 --> 00:31:06.340 - by ignoring them, but not purposely. So I don't, you know, I'm like halfway on the, I'm on the fence 00:31:06.340 --> 00:31:16.295 - about this too. I see both things and the vast majority of things we ask for public comment and there 00:31:16.295 --> 00:31:25.470 - isn't any. But I don't, I actually don't see the harm in keeping the policy as it is and just 00:31:25.762 --> 00:31:33.843 - understand that there may be times we forget to ask for public comment, but not something we consider 00:31:33.843 --> 00:31:42.321 - controversial. And that would be usually when we wouldn't ask for comment. And just based on my experience 00:31:42.321 --> 00:31:50.878 - is that when we know something is controversial and we expect there to be comment about it, in those cases, 00:31:53.730 --> 00:32:01.550 - necessarily want to hear what they have to say, but but we feel like that we that we need to. 00:32:01.550 --> 00:32:10.118 - And occasionally I'm enlightened by something someone says, you know, so. Alternatively, we could make 00:32:10.118 --> 00:32:18.437 - the public comment section before at the beginning of the meetings and then have the members of the 00:32:18.437 --> 00:32:21.598 - board have the ability to before vote 00:32:22.210 --> 00:32:28.893 - to open it up for discussion if we think it's a controversial topic and we think there's going to be 00:32:28.893 --> 00:32:35.775 - comments. There's people in the room and we think they're here because of that. We can say, hey, before 00:32:35.775 --> 00:32:42.590 - we do this vote, let's see. So have the ability to ask for public comment, but not have the obligation 00:32:42.590 --> 00:32:49.207 - to ask for public comment. I think one of the things that's made it so cumbersome is having to read 00:32:49.207 --> 00:32:50.398 - all this verbiage 00:32:50.658 --> 00:32:57.678 - at the end of every single question. I don't think we have to read it all. We never did that before. 00:32:57.678 --> 00:33:04.628 - I think we can, at the end of each, like before we take a, ever we're discussing an item, before we 00:33:04.628 --> 00:33:11.857 - take the vote, I think we can say, is there any public comment related to this particular agenda voting 00:33:11.857 --> 00:33:19.294 - item? Prior to us taking the vote. Prior to us doing the vote. I think I like, you know, that's not a bad, 00:33:19.682 --> 00:33:26.387 - I'm thinking, you know, in the event there's people in the room that maybe have a comment and we decide 00:33:26.387 --> 00:33:32.898 - maybe we're not going to open that one up, like, then they, you know, is there, is there a situation 00:33:32.898 --> 00:33:39.345 - where a person feels be a little, because actually I wanted to comment on that, but you didn't open 00:33:39.345 --> 00:33:45.598 - it up, right? So that's the case that I kind of would suggest maybe just leave it open as it is. 00:33:47.266 --> 00:33:53.306 - I believe personally, I believe if it's, to your point, going to be a contentious agenda item, if we 00:33:53.306 --> 00:33:59.287 - say public comments at the beginning, we're gonna get all those public comments. Your point is well 00:33:59.287 --> 00:34:05.268 - taken though, would those comments possibly be slightly different after we have had our discussion? 00:34:05.268 --> 00:34:11.249 - Or would it be moved by our discussion to hear where we're coming from? That's true too. Hear where 00:34:11.249 --> 00:34:16.990 - we're coming from. Although I think that they show up, we're gonna feel an obligation to speak. 00:34:17.314 --> 00:34:30.320 - Okay well we've talked it through but is there a motion about this. I make a motion to keep our public 00:34:30.320 --> 00:34:43.958 - comment policy as it stands. I think as it stands we have to read all that verbiage and so forth somewhere. 00:34:43.958 --> 00:34:45.726 - Is that true. 00:34:46.690 --> 00:34:55.160 - If I remember right. You have to open it for public comment before you vote. But we don't have to read 00:34:55.160 --> 00:35:03.960 - the public comment thing right like this stuff. Usually it's just anyone have a would like to make comment 00:35:03.960 --> 00:35:12.512 - on this topic. Okay so we don't have to read this. All right I'll second that. Okay. All in favor. Aye. 00:35:12.512 --> 00:35:15.966 - Aye. It's tough to get it okay. Go along. 00:35:16.226 --> 00:35:27.720 - No post. Okay. I don't like it though. I don't like it either. You make a very good point though. Yeah. 00:35:27.720 --> 00:35:39.214 - Okay. The next item on our agenda is the. Oh yeah. We forgot to ask for public comment about the public 00:35:39.214 --> 00:35:43.966 - comment policy. Dr. Ryderband I apologize. 00:35:44.258 --> 00:35:53.698 - Is there any public comment about the public comment policy and our decision regarding it? And Dr. Ryderband, 00:35:53.698 --> 00:36:02.708 - we see your hand and we're trying to allow you to hear you. There we go. We can hear you. I get to speak 00:36:02.708 --> 00:36:08.286 - again. So yes, you did need public comment on it. And if indeed, 00:36:13.826 --> 00:36:27.729 - It's a strange thing going on. If you want to change, you really need to go through legal. What we were 00:36:27.729 --> 00:36:41.097 - told about making all of the comments at the beginning of the meeting was from legal. They were the 00:36:41.097 --> 00:36:43.102 - ones who said, 00:36:43.778 --> 00:36:54.942 - Yes we need to say all of these things if you're changing the policy. So I just thought I would throw 00:36:54.942 --> 00:37:06.653 - that in. I'm glad you decided to keep it the way it is. But yes we're going to do it when we move forward. 00:37:06.653 --> 00:37:12.126 - Thanks. Thanks Dr. Ryderban. Okay so go back the. 00:37:12.898 --> 00:37:21.265 - Motion on the table. We had a motion in a second. So does anyone want to change a motion based upon 00:37:21.265 --> 00:37:29.884 - what Dr. Ryder-Bandt had to say or? Can we summarize? I couldn't. I couldn't understand what you said. 00:37:29.884 --> 00:37:38.419 - Sarah. Sarah. We. We can just. This is not your fault but we can just barely hear you. It sounds like 00:37:38.419 --> 00:37:42.686 - it's coming through a tiny tiny speaker someplace. 00:37:43.234 --> 00:37:50.898 - Well, and what I'm getting is some kind of cute, un-pumpin' sound when I'm trying to talk. It's like 00:37:50.898 --> 00:37:59.169 - I'm talking to you on the phone, so of course I'm popping up anything I'm going to say. There is a technical 00:37:59.169 --> 00:38:07.365 - problem. Is it interesting that you were suggesting that if we want to change the policy, we would actually 00:38:07.365 --> 00:38:11.614 - need to go through legal? Is that what you were saying? 00:38:11.938 --> 00:38:22.641 - Yeah, any proposal that you have for changing it, like a proposal to not read all of that material at 00:38:22.641 --> 00:38:33.554 - the beginning, anything like that really needs to be vetted through. Yeah, understood. Okay, very good. 00:38:33.554 --> 00:38:41.214 - So I think that's what I heard was, and we're not talking about changing 00:38:41.506 --> 00:38:49.033 - Just to be clear the general public comment section of the policy we're mostly talking about what we 00:38:49.033 --> 00:38:56.560 - would do prior to each vote. And what we have been doing prior to each vote is essentially asking is 00:38:56.560 --> 00:39:04.086 - there public comment on this topic. The policy does not say we need to read through all of that so I 00:39:04.086 --> 00:39:11.166 - think it'll be okay. Okay. So now we can put it up for but we've got a motion and a second for 00:39:11.394 --> 00:39:19.785 - Leaving the policy as it is. All in favor. Aye. Aye. All opposed. Actually I thought we took a vote. 00:39:19.785 --> 00:39:28.176 - We did. We did but we had to re-vote because we forgot to get public comment. All right. Next on the 00:39:28.176 --> 00:39:36.817 - agenda. Moving right along. All right. Next on the agenda we have the health 20-27 budget. So I'm going 00:39:36.817 --> 00:39:41.054 - to turn it over to Lori to talk about the budgets. 00:39:42.530 --> 00:39:51.686 - So you should have received items that just basically outlines our different funding sources so I'll 00:39:51.686 --> 00:40:00.842 - just be getting a brief overview for that. To start off so 1159 that's our local county health fund. 00:40:00.842 --> 00:40:05.918 - So all departments were instructed to you know keep the 00:40:06.466 --> 00:40:15.317 - requests flat essentially so don't ask for increases in our supplies and services. At this time there's 00:40:15.317 --> 00:40:24.253 - no salary increases planned for employees for 2027. So I did make a few changes to some of the positions 00:40:24.253 --> 00:40:33.189 - moving some positions out to an alternative fund and moving some of our wastewater staff into this fund. 00:40:33.189 --> 00:40:35.998 - The reason for that is just that 00:40:36.130 --> 00:40:43.355 - Wastewater has really been getting hit pretty hard with the HFI changes and the Indiana residency 00:40:43.355 --> 00:40:50.950 - requirements with out-of-state individuals who are looking to purchase a home here but who do not live 00:40:50.950 --> 00:40:58.322 - here yet. So hoping to be able to move at least one or two of those employees to this fund for 2027 00:40:58.322 --> 00:41:04.958 - to help kind of offset those challenges. You will see if you go down to the services line 00:41:05.826 --> 00:41:15.845 - So our personal health care line 32410. So previously this was used for the IU Health contract in part 00:41:15.845 --> 00:41:25.573 - to pay for some of those nursing services. And so the idea is to keep that line again requested the 00:41:25.573 --> 00:41:34.814 - same amount and there's a couple of reasons for that. So if we end up with contractual workers 00:41:34.946 --> 00:41:43.325 - through the staffing agreement could use this line to pay for those services. And then the two positions 00:41:43.325 --> 00:41:51.784 - that the Board of Health discussed and voted asking the council council the council for the public health 00:41:51.784 --> 00:42:00.083 - nurse supervisor and the maternal child health nurse. Alternatively those funds in that personal health 00:42:00.083 --> 00:42:02.078 - care line could be moved 00:42:02.274 --> 00:42:11.349 - to fund those positions that they were approved. There's not really a whole lot of other changes in 00:42:11.349 --> 00:42:20.515 - this but happy to answer any questions. On line 18001 the self-insurance that goes from $99,000 to a 00:42:20.515 --> 00:42:29.681 - lot is that due to the fact that you had to hire all these new positions basically because we're not 00:42:29.681 --> 00:42:32.222 - using the IU Health Clinic? 00:42:32.354 --> 00:42:40.438 - Good point. So what happened there is last year we did ask for all of our positions. So the guidance 00:42:40.438 --> 00:42:48.841 - that we received from the Indiana Department of Health was that we should not be pulling insurance funds 00:42:48.841 --> 00:42:57.005 - from our Health First Indiana for vacant positions. And to offset or try to avoid that the idea is to 00:42:57.005 --> 00:42:59.806 - again ask for all of our positions 00:43:00.034 --> 00:43:06.995 - insurance to be pulled from our local county health fund because they just pulled that at the beginning 00:43:06.995 --> 00:43:13.755 - of the year added in. When we have vacancies or people could argue maybe people who aren't using the 00:43:13.755 --> 00:43:20.649 - benefits the state essentially has said you are not dollar you cannot guarantee dollar for dollar that 00:43:20.649 --> 00:43:27.544 - each of those funds are being spent towards the delivery of poor public health services. So that's why 00:43:27.544 --> 00:43:29.150 - we bundled 22 positions 00:43:29.570 --> 00:43:40.420 - request in this $1,159 County Health Fund. But that rate has gone up this year at 16-5 so they expect 00:43:40.420 --> 00:43:50.206 - or I think they hope that it'll go down but right now we're budgeting $18,000 per employee. 00:44:01.698 --> 00:44:12.218 - to move on if no other questions. Okay. So. 1161. Do we vote on these one by one or do we do a myself 00:44:12.218 --> 00:44:22.841 - sum. Usually it's just the entire budget. Okay correct. So 11 or 16 no it is 1161 that's a typo there. 00:44:22.841 --> 00:44:30.782 - That is our new Health First Indiana funding. So this 2027 the board already 00:44:30.882 --> 00:44:39.988 - approved that at the last meeting so no changes there that's already been submitted for next year. Moving 00:44:39.988 --> 00:44:49.009 - on to the 9626 so the reason that we have different spreadsheets for 1161 is that because we essentially 00:44:49.009 --> 00:44:57.771 - get the new funding plus we also have our have old funding from previous years with this Health First 00:44:57.771 --> 00:44:58.974 - Indiana funds 00:44:59.362 --> 00:45:07.066 - Assigning them that year helps us to just be able to better track them and know year to year what we 00:45:07.066 --> 00:45:14.846 - have remaining to work with. So currently we are using some of these funds since we don't know what's 00:45:14.846 --> 00:45:22.474 - actually going to be left at the end of this year. Nothing's been budgeted in 2027 and likely these 00:45:22.474 --> 00:45:27.966 - funds will be used once we get to 2028 to continue spending those down. 00:45:35.778 --> 00:45:45.059 - Then moving on to the next location 96-25 so be looking currently using some of those funds. That is 00:45:45.059 --> 00:45:54.249 - helping to cover the shortage that we have for the decrease that we received just in total from the 00:45:54.249 --> 00:46:03.806 - state funding. And we'll be looking to use leftover funds from this account line in 20-28 for expenses. 00:46:06.978 --> 00:46:14.972 - And then you'll see just the other bucket is from the year 2024. So plan on using these funds up in 00:46:14.972 --> 00:46:22.967 - 2027 because our the fund that our maternal and child health coordinator is in there's not going to 00:46:22.967 --> 00:46:31.281 - be enough funding left to cover her position for the entire year of 2027. So her position will be moved 00:46:31.281 --> 00:46:35.678 - to these funds to continue paying her salary expenses. 00:46:35.778 --> 00:46:45.047 - And then we have just a few of our other positions that will be supported. The Public Health Preparedness 00:46:45.047 --> 00:46:53.791 - Director is currently funded by old grant funds so that position will be moved to the state funding 00:46:53.791 --> 00:47:02.622 - for 2027. You'll see in that the 135,000 in the contractual line that's for the Health Net Contract. 00:47:11.202 --> 00:47:21.412 - questions about those maybe before I move on to the other. So 1168 so those those are old state funds 00:47:21.412 --> 00:47:31.722 - prior to Health First Indiana. Again we'll just be spending these down. We should pretty much use most 00:47:31.722 --> 00:47:40.030 - of these up in 2027. I left a little bit of wiggle room in here just to be able to 00:47:40.194 --> 00:47:47.224 - fall back on this funding, depending on what the county council decides for our local health fund, that 00:47:47.224 --> 00:47:53.984 - that will give us flexibility that we could move costs in here, if necessary. The purpose for funds 00:47:53.984 --> 00:48:01.082 - in the part-time line. So, currently, we don't have any, and there is the hiring freeze. But just adding 00:48:01.082 --> 00:48:02.366 - some in there, our 00:48:02.786 --> 00:48:11.879 - Environmental is used to having a part-time support even if it's just seasonal. So looking to see what 00:48:11.879 --> 00:48:20.883 - 2027 will bring us and if we potentially will have the option to get a part-time environmental health 00:48:20.883 --> 00:48:26.974 - specialist to help support their services. And then the 1206 this is 00:48:27.298 --> 00:48:36.448 - tobacco settlement. This is that old funding our Maternal Child Health Coordinator is currently in. 00:48:36.448 --> 00:48:45.781 - So expect these funds to be used up in 2027 and we'll be able to close this fund out and her position 00:48:45.781 --> 00:48:55.023 - will be moved as shown in the previous forms. 4906. This is old state funding from that local health 00:48:55.023 --> 00:48:56.670 - maintenance fund. 00:48:57.122 --> 00:49:05.203 - So the purpose of this fund was to be able to have funds set aside appropriated and available for use 00:49:05.203 --> 00:49:13.601 - in the event of a public health emergency where we need to purchase supplies or services. We have started 00:49:13.601 --> 00:49:21.841 - using some of these funds this year related to unbudgeted TB and nursing costs that we have been having 00:49:21.841 --> 00:49:25.406 - but don't expect to use more than just maybe 00:49:25.954 --> 00:49:36.211 - 2,500 at the most from this. And so may want to continue trying to work this these funds down. Maybe 00:49:36.211 --> 00:49:46.773 - if but there's not really a whole lot there but it does give a cushion. And then 81-11 that is actually 00:49:46.773 --> 00:49:51.038 - a grant. The reason that we included this 00:49:51.426 --> 00:50:00.124 - with our other budget items is just to help show where we are paying positions. This is bold COVID grant 00:50:00.124 --> 00:50:08.407 - funds. We moved our nursing positions to this to allow them the flexibility to be able to serve any 00:50:08.407 --> 00:50:16.773 - patient regardless of having to verify residency. So again these funding positions in 2027 do expect 00:50:16.773 --> 00:50:21.246 - to have some funds left but definitely under $200,000 00:50:21.346 --> 00:50:37.968 - by the time we get to 2028. Any questions about things that we see on the budget. Any additional thoughts 00:50:37.968 --> 00:50:46.750 - or worry about things you see or don't see or whatever. 00:50:52.130 --> 00:51:00.748 - Is there any areas where you have any real concerns? As far as the budget, when I think about it, it's 00:51:00.748 --> 00:51:09.198 - the change in that residency requirement that really just puts so much restrictions. We had to shift 00:51:09.198 --> 00:51:17.648 - so many costs around and we're constantly trying to navigate that situation and how we're responding 00:51:17.648 --> 00:51:21.246 - to the community's needs while adhering to 00:51:22.210 --> 00:51:30.908 - you know, those stipulations that were put into place. So I think that's really our biggest challenge. 00:51:30.908 --> 00:51:39.521 - So depending upon where the funding is coming from for the position, it dictates who they are allowed 00:51:39.521 --> 00:51:47.966 - to serve that person. Correct. And so, you know, a lot of our employees adapted because we have to. 00:51:48.194 --> 00:51:55.658 - But it does come in, there are times where we have to turn people away, and that's hard to do. And so, 00:51:55.658 --> 00:52:03.485 - and it is a lot of paperwork, and it is an extra burden on the employees to have to get the identification, 00:52:03.485 --> 00:52:10.732 - fill out the paperwork, making sure that we're having that, and then not having a backup when we do 00:52:10.732 --> 00:52:17.182 - run into situations where someone maybe doesn't live in Indiana, or doesn't have a home. 00:52:17.282 --> 00:52:25.060 - I'm just any single example. Septic so people who are going to be moving here but they don't live in 00:52:25.060 --> 00:52:32.916 - Indiana and maybe they want to records requests or they're looking for a permit. Vital records we get 00:52:32.916 --> 00:52:40.848 - a lot of out of state requests so when that employee is not here for whatever reason we typically will 00:52:40.848 --> 00:52:45.854 - refer them to a different county or if they want to wait when he 00:52:46.018 --> 00:52:55.208 - comes back then we could provide the service at that time. Where are these two positions the public 00:52:55.208 --> 00:53:04.582 - health nurse supervisor and the public health nurse NCH. Right now you kind of mentioned we would use 00:53:04.582 --> 00:53:11.934 - the personal personal the 32 410 personal health care to cover those positions. 00:53:12.098 --> 00:53:19.619 - depending upon temp versus hiring would they fall under the 1159 health fund. That's the request that 00:53:19.619 --> 00:53:27.213 - would be made. So when making the request for the positions and if they were approved then funds would 00:53:27.213 --> 00:53:35.029 - be essentially just transferred from that contractual service line to fund those personnel account lines. 00:53:35.029 --> 00:53:40.190 - How does that impact their ability to serve patients who are becoming 00:53:40.354 --> 00:53:49.961 - utilizing their services. Yeah. So they can serve anyone because these are the local county dollars. 00:53:49.961 --> 00:53:59.854 - Okay. Very good. And that's why we had moved the IU Health contract back to the county health fund when 00:53:59.854 --> 00:54:08.510 - those changes happened. Okay. Any additional questions or concerns. Impressive work. Yeah. 00:54:10.850 --> 00:54:19.369 - Is there any motions that would like to be had. Motion to approve the budget. After we do the motion. 00:54:19.369 --> 00:54:27.722 - I had it in my head. All right. So we're going to turn it over to public comment on this particular 00:54:27.722 --> 00:54:36.241 - agenda item. So if there is any public comment online we don't have anyone in the room but if there's 00:54:36.241 --> 00:54:39.582 - any public comment online regarding the 00:54:39.874 --> 00:54:54.432 - budget for 2027. Please go ahead and raise your hand and we will call on you and give you your three 00:54:54.432 --> 00:55:09.278 - minutes. Okay. Seeing no hands I think we're ready to go for a vote. All in favor. All opposed. Great. 00:55:10.690 --> 00:55:18.731 - did it. All right. Well done. I know it wasn't easy. All right. So we're going to move to our last item 00:55:18.731 --> 00:55:26.462 - on new business which is the VaxCare data transfer. So again I'm going to let Lori kind of describe 00:55:26.462 --> 00:55:33.730 - what we're talking about and I believe we've got leave along the call to give us a little bit 00:55:33.730 --> 00:55:38.910 - more background. Yes. So we do have our attorney online today just 00:55:39.650 --> 00:55:47.004 - Just a very brief, I guess, overview. So VaxCare is the third-party billing system that the department 00:55:47.004 --> 00:55:54.501 - has used for many, many years. So this the account was always under the Monroe County Health Department. 00:55:54.501 --> 00:56:01.641 - This is the same account that the IU Health nurses were using when they were under contract with us 00:56:01.641 --> 00:56:05.854 - for the vaccination services. So when we had the transfer, 00:56:06.146 --> 00:56:14.425 - of the nursing services back to Monroe County Health Department. Since this was our account we've retained 00:56:14.425 --> 00:56:22.162 - all of that patient data and the account is essentially Monroe County Health Department. So there's 00:56:22.162 --> 00:56:30.131 - been a little bit of a question about you know that the account and the patient information and so VAX 00:56:30.131 --> 00:56:35.934 - care has requested that they can essentially pull and duplicate all of the 00:56:36.130 --> 00:56:46.652 - information that's within the Monroe County Health Department account and give that to IU Health so 00:56:46.652 --> 00:56:57.490 - that IU Health has all of that information. And I think that's kind of the discussion and I'm not sure 00:56:57.490 --> 00:57:01.278 - what else Dave would like to share. 00:57:05.282 --> 00:57:12.974 - All right, so we'll turn. Why does I need the information? I think it's an administrative burden because 00:57:12.974 --> 00:57:20.374 - they have to type all the information in and if they just have the information and if they're seeing 00:57:20.374 --> 00:57:27.700 - someone who is in our system, then it'll automatically it'll populate with all of that information. 00:57:27.700 --> 00:57:31.070 - Now they could of course reach out to us like 00:57:31.234 --> 00:57:38.243 - with the futures clinic so you know people had an option to get the records they can still come here 00:57:38.243 --> 00:57:45.530 - and get those records or the new Bloomington family planning you know family they they reach out there's 00:57:45.530 --> 00:57:52.470 - a release of records so. There's a there's a huge problem that we can't see the records. Teague and 00:57:52.470 --> 00:57:59.688 - I can't see the records. Will this somehow lead to us being able to see the records from. I don't know. 00:57:59.688 --> 00:58:00.798 - I thought that. 00:58:00.994 --> 00:58:08.129 - Vaxcare was going Vaxcare said that they were my original understanding was that Vaxcare was going to 00:58:08.129 --> 00:58:15.333 - have legal draft an agreement like a data sharing agreement. And then I was told that they just wanted 00:58:15.333 --> 00:58:22.468 - me to approve via email. I said I'm not comfortable I'm not doing that. I'm waiting for an agreement. 00:58:22.468 --> 00:58:30.302 - So they said that they weren't planning on drafting an agreement. They just want an approval via email. And so. 00:58:30.658 --> 00:58:38.626 - I don't know how the transfer will happen, except that they've said that they have the capabilities, 00:58:38.626 --> 00:58:46.672 - and they've said that they have the capabilities to do it without our approval or agreement, but they 00:58:46.672 --> 00:58:54.956 - want our approval. I don't know how the technology side of them actually extracting the data and sharing 00:58:54.956 --> 00:59:00.478 - it works. So, Vacccare just has the vaccine records and the insurance 00:59:00.642 --> 00:59:09.238 - like social security number address their personal life their personal information like where they live 00:59:09.238 --> 00:59:17.586 - who they are like identifiers and their vaccines that's it yes see i don't think that would that the 00:59:17.586 --> 00:59:26.100 - person the the person who got vaccinated would have to give permission that's right so it is not HIPAA 00:59:26.100 --> 00:59:30.398 - protected we know that um because you're going from 00:59:30.754 --> 00:59:37.274 - a health care provider to health care provider. So you don't necessarily need the patient's permission 00:59:37.274 --> 00:59:43.857 - for to go from someone like a if you're coming to see like a primary care doctor and I was like I would 00:59:43.857 --> 00:59:50.313 - like to have your vaccine records. I don't have to necessarily ask your permission. I can just say oh 00:59:50.313 --> 00:59:56.706 - you got them from the health department. I can fax a release of information or call over here to get 00:59:56.706 --> 00:59:59.934 - them without the patient having to agree to do it. 01:00:00.098 --> 01:00:06.914 - It's just the vaccine information. It's just the vaccine information but it's also all this other personal 01:00:06.914 --> 01:00:13.475 - information like their their Social Security numbers their addresses are they on Medicare Medicaid are 01:00:13.475 --> 01:00:19.844 - they that's the kind of stuff that is the concern. Now should we turn it over to Dave real quick to 01:00:19.844 --> 01:00:26.596 - see what other information Dave you might be able to provide us regarding the question we're we're trying 01:00:26.596 --> 01:00:27.934 - to get an answer to. 01:00:28.930 --> 01:00:37.721 - I believe you, well, hold on, maybe. Yeah, he should. I think you are unmuted, Dave. You might try. 01:00:37.721 --> 01:00:46.687 - There we go. Can you hear me? Yes, very. We're having the same problem as we were earlier. It's very, 01:00:46.687 --> 01:00:55.390 - very quiet, but we can hear you. OK, well, I'd sent Lori a proposed statement that basically said, 01:00:58.786 --> 01:01:08.599 - Yeah, I can hear that. Can you still hear me? Yep. That the Board of Health would approve the transfer 01:01:08.599 --> 01:01:18.316 - of the information subject to compliance with HIPAA, Indiana Code 1639.51, and any other laws, rules, 01:01:18.316 --> 01:01:28.510 - or regulations applicable to the sharing of health information. So basically, that just puts it on VaxCare 01:01:28.674 --> 01:01:39.194 - to comply with the law. And it seemed to me that if they felt comfortable with that, then they could 01:01:39.194 --> 01:01:49.609 - proceed as they wished. But all we were saying would be, hey, you can have the information provided 01:01:49.609 --> 01:01:58.046 - you're entitled to it under the law. OK. Thank you. So truthfully, I'm confused. 01:01:58.914 --> 01:02:07.064 - because IU Health has the ability to pull in, I presume, and you can correct me if I'm wrong, when the 01:02:07.064 --> 01:02:15.452 - health department provides vaccinations to patients, you provide the vaccine, you document it in VaxCare, 01:02:15.452 --> 01:02:23.444 - and then you upload it to CHIRP, which is a statewide vaccination system. IU Health has the ability, 01:02:23.444 --> 01:02:28.350 - with a click of a button, with their medical record system to 01:02:28.674 --> 01:02:36.355 - as the patient comes in to see a medical provider, you click the button and it pulls that information 01:02:36.355 --> 01:02:43.885 - out of CHIRP. So if the health department is uploading it correctly and IU Health is adequately, it 01:02:43.885 --> 01:02:51.566 - is as a primary care physician, is part of the standard rooming process to reconcile the vaccinations 01:02:51.566 --> 01:02:57.214 - as you are seeing the patient. It's of course substantially more important 01:02:57.378 --> 01:03:05.796 - for pediatric patients because there's so many more vaccinations given. But IU Health, as the standard 01:03:05.796 --> 01:03:14.377 - process for removing a patient, includes pulling that information in from SHERP. So I guess my confusion 01:03:14.377 --> 01:03:22.877 - lies in why would it be necessary for us to give approval for VaxCare to provide the information versus 01:03:22.877 --> 01:03:26.718 - IU Health continuing their standard process of 01:03:28.162 --> 01:03:35.813 - reconciling it when they see the patient. I don't know the. So I did bring that up because that's one 01:03:35.813 --> 01:03:43.313 - of the first things that I thought of. And the answer that I was given was, well, people can refuse 01:03:43.313 --> 01:03:51.264 - to have their information uploaded and stored in CHIRP. And I said, well, that's the exact type of person 01:03:51.264 --> 01:03:58.014 - who probably doesn't want us sharing their information then without their approval. Yeah. 01:03:58.530 --> 01:04:09.733 - I mean, I've got 14 years of medical practice under my belt in primary care and I have never once had 01:04:09.733 --> 01:04:16.542 - a patient decline having their information uploaded to CHIRP. 01:04:16.738 --> 01:04:25.254 - doing this here in-house shortly, but no, that's what we do. I think that's the process, my understanding, 01:04:25.254 --> 01:04:32.894 - that's expected to be followed and used, especially with our publicly funded vaccines. So, I... 01:04:33.026 --> 01:04:38.380 - by IU Health? Is that kind of the idea IU Health has asked for this information and that's why we're 01:04:38.380 --> 01:04:43.893 - talking about it? Yes and I think part of it is again that administrative burden because there you have 01:04:43.893 --> 01:04:49.353 - to type everything in which I mean I've been over there working in the clinic a little bit and you you 01:04:49.353 --> 01:04:54.655 - do have to type everything in but the system is really pretty straightforward to use. I mean you're 01:04:54.655 --> 01:04:56.510 - if there's not that many I mean it 01:04:57.026 --> 01:05:04.275 - there's not that much. You do have to look through the long line of payers and the insurance, maybe 01:05:04.275 --> 01:05:11.597 - it's matching some of that up again. I'm not, I'm not, not really sure, I guess, but that was one of 01:05:11.597 --> 01:05:18.991 - the reasons VaxCare gave us was that, that it's an administrative burden. It's like they're asking us 01:05:18.991 --> 01:05:25.950 - to share the information to Omnicorp or our county residents information to Omnicorp from some, 01:05:26.402 --> 01:05:34.721 - So, thriller, I'm uncomfortable with it. I guess, I'm just struggling to even figure out why it would, 01:05:34.721 --> 01:05:42.879 - why it's necessary. Why is it necessary? Exactly, exactly. Maybe they can come talk to us. So that's 01:05:42.879 --> 01:05:51.117 - what I was going to say. Like, before we say no, categorically, maybe the right thing to do would be, 01:05:51.117 --> 01:05:52.894 - whoever at IU Health, 01:05:53.410 --> 01:06:00.151 - is representing IU Health in this request. Maybe we have them come to a meeting and say, can you help 01:06:00.151 --> 01:06:07.091 - us understand, like, what is the difference between just uploading this information straight from CHIRP, 01:06:07.091 --> 01:06:13.766 - like we already do, versus having Backscare provide you all of this information, and why do you want 01:06:13.766 --> 01:06:20.507 - the latter? And I'd be concerned with that information somehow winding up in the hands of people that 01:06:20.507 --> 01:06:22.622 - are using it for other reasons. 01:06:22.946 --> 01:06:29.517 - There were some specific, in your emails that you sent us, there were some specific things that could 01:06:29.517 --> 01:06:36.604 - not be done with the data. I can't remember what those were. It was like, I can't remember that. Advertising, 01:06:36.604 --> 01:06:43.046 - selling for research purposes, I think. Selling for research purposes was a good one, because I was 01:06:43.046 --> 01:06:49.037 - worried about that. So they can't do that. Advertising, now I'm trying to remember the next. 01:06:49.037 --> 01:06:51.550 - But the fact is, they can do anything. 01:06:52.130 --> 01:07:02.453 - they can say oh you can't do it and all you need is a legislature saying we're here now we're putting 01:07:02.453 --> 01:07:12.878 - our thumb on it and you can do this now you must do this now. Any questions for Dave or any additional 01:07:12.878 --> 01:07:21.278 - like comments on this or do we have a proposal that you would like to put forward? 01:07:23.778 --> 01:07:33.316 - that we shelve a vote until we have someone from IU Health or from this company talk to us and explain 01:07:33.316 --> 01:07:43.409 - to us the benefits and for benefits and deleterious things that can happen with this and why it's necessary. 01:07:43.409 --> 01:07:50.910 - I will second that motion. Okay we have a motion and a second and we will pause. 01:07:52.066 --> 01:08:00.385 - for public comments. Are there any public comments regarding this particular agenda. Regarding this 01:08:00.385 --> 01:08:08.787 - particular agenda item from regarding Vaxcare and IU Health's request to have the data from Vaxcare. 01:08:08.787 --> 01:08:17.105 - I do see Dr. Dr. Ryder band with your hand up. So we'll go ahead and turn the floor over to you and 01:08:17.105 --> 01:08:19.102 - you have three minutes. 01:08:24.770 --> 01:08:34.734 - I'll scream if I, you know, I don't know if that'll help. David and I got the same noise in the background. 01:08:34.734 --> 01:08:44.329 - I don't know if it's the owl going through the computer. Something weird happens. So the issue, I guess 01:08:44.329 --> 01:08:51.710 - the question I have is whether we feel our public health nurses are going to be 01:08:54.370 --> 01:09:03.871 - and going out into the schools. I mean, we're currently enriching Green Blossom and other schools 01:09:03.871 --> 01:09:13.566 - vaccinating. In which case do we already have all that taxpayer information on the children we have 01:09:13.566 --> 01:09:23.358 - vaccinated in the past? Are we going to have to get that from IU Health if they're still holding it? 01:09:24.098 --> 01:09:36.169 - And since I'm in health I'm going to drive planning on vaccinating the schools in our community. Do 01:09:36.169 --> 01:09:48.240 - we have a plan in place around that. So I think that fits into the discussion somehow because again 01:09:48.240 --> 01:09:53.310 - it's next-care-share information. Thanks. 01:09:54.274 --> 01:10:01.580 - Did anyone hear that in on me? Yeah. No. OK. Yeah. So I'm sorry, Dr. Reitman. We're trying to, like, 01:10:01.580 --> 01:10:09.032 - I can hear, like, every, like, half of what you said. I'm trying to listen, but what did you hear? So, 01:10:09.032 --> 01:10:16.483 - yeah, essentially what VaxCare has said now is that they can duplicate the data so that we would still 01:10:16.483 --> 01:10:23.934 - retain our Monroe County Health Department set. And then that duplication would be given to IU Health. 01:10:24.098 --> 01:10:31.782 - So we've moved past the just transferring back and forth and who owns the patient records to where we 01:10:31.782 --> 01:10:39.391 - can duplicate all of the records. OK, so the idea is the original proposal was just to send it to IU 01:10:39.391 --> 01:10:47.452 - Health. The new would be we keep a copy and IU Health gets a copy. So both has records. Yes, so we should. 01:10:47.452 --> 01:10:53.630 - So if I go in the system, I can see like past school clinics. So we should, if it 01:10:53.922 --> 01:11:04.141 - is just a duplication we should retain our access and then they would have that information as well. 01:11:04.141 --> 01:11:14.258 - Okay. Any additional public comments before we move to vote. Okay seeing none is there any any need 01:11:14.258 --> 01:11:20.126 - to amend the motion on the table based on public comment. 01:11:24.194 --> 01:11:35.622 - Okay. Hearing none. I think we will put it up for a vote. All in favor. Aye. All opposed. Well done. 01:11:35.622 --> 01:11:47.389 - Motion passes. We got there. Okay. So that ends our our new business. So we'll move on to the next item 01:11:47.389 --> 01:11:49.086 - on our agenda. 01:11:49.314 --> 01:11:58.013 - Would any board members or the health officer like to make any additional comments before we adjourn 01:11:58.013 --> 01:12:06.798 - for the evening. I have a comment. I'm not sure people are aware of of the effects of the new law but 01:12:06.798 --> 01:12:15.841 - it may it may be in our come across to us at some point. So there has there has been the ability forever 01:12:15.841 --> 01:12:18.942 - to declare someone gravely disabled 01:12:19.458 --> 01:12:28.538 - You can do it. I can do it. And then once you do that then they can be detained by the system. Please 01:12:28.538 --> 01:12:37.886 - the hospital. The legislation that just passed expanded or just went into effect expanded the definition 01:12:37.886 --> 01:12:47.678 - of gravely disabled to include this. If a person is unhoused and if they are refusing to go to a shelter when 01:12:48.546 --> 01:12:59.219 - conditions are dangerous such as a heat wave or too cold, then they can by definition be declared gravely 01:12:59.219 --> 01:13:09.993 - disabled and detained by the police and then brought to the emergency department and then by the hospital. 01:13:09.993 --> 01:13:15.934 - Who determines the level of which like the it is dangerous 01:13:16.674 --> 01:13:21.965 - Is that defined somewhere like temperature over 90 or you know. No there's no definition. So it is. 01:13:21.965 --> 01:13:27.467 - So who makes that decision. It's the individual police officer police officer or clinician. For example 01:13:27.467 --> 01:13:33.128 - if if you're in the emergency department and you say I'm sick of this I want to leave and it's two degrees 01:13:33.128 --> 01:13:38.736 - outside and you have threadbare clothes and you don't have a place to go so I want to pick you up. Before 01:13:38.736 --> 01:13:44.080 - I could say look I really think you should stay and do everything I could to accommodate you so that 01:13:44.080 --> 01:13:46.302 - you want to stay so that you don't go out 01:13:46.530 --> 01:13:55.645 - and freeze to death, now I can say, no, I think that it's dangerous for you out there. I think the conditions 01:13:55.645 --> 01:14:04.098 - are too harsh and you can't leave. So it puts a burden on us. And of course, I assume that the burden 01:14:04.098 --> 01:14:12.799 - comes with the responsibility as well, but yeah. The community workers that are out, like are they going 01:14:12.799 --> 01:14:14.622 - to be responsible for 01:14:15.138 --> 01:14:21.889 - like holding folks accountable to this? Like our employees, the health department's employees? Not that 01:14:21.889 --> 01:14:28.380 - I'm aware of right now, but I guess that'd be a good question for the attorney. Okay. We literally, 01:14:28.380 --> 01:14:34.937 - it's just in the past week that this has come down to us. These are the effects of the new law. So I 01:14:34.937 --> 01:14:42.142 - don't think anyone's had a chance to really digest it. We're still waiting to hear from our legal for the full 01:14:42.914 --> 01:14:53.482 - Yeah I mean it's an interesting question for the board to you know obviously that's a an interesting 01:14:53.482 --> 01:15:04.259 - position to put a someone in health care or in law enforcement to make that decision. And it is if you 01:15:04.259 --> 01:15:12.734 - take it a step further to think well what if one of our community workers is out 01:15:13.378 --> 01:15:20.490 - talking to people and see someone in really cold weather and doesn't say anything, and then that person 01:15:20.490 --> 01:15:27.328 - ends up dying. Yeah. Are we, is the Board of Health liable for that? Because there's, you know, you 01:15:27.328 --> 01:15:34.304 - would come back and document the conversation, right? And you didn't in dangerous situations, or they 01:15:34.304 --> 01:15:41.552 - end up in the ER with frostbite or something. Yeah. What's the liability? That's an interesting question. 01:15:41.552 --> 01:15:43.262 - To your comment earlier, 01:15:45.762 --> 01:15:59.121 - That's crazy. I didn't know about that. Yeah. I wonder if they actually considered all the possible 01:15:59.121 --> 01:16:13.950 - ramifications. Are you kidding? Dr. Ryderman. I was going to say it's the legislature. Of course they haven't. 01:16:14.114 --> 01:16:28.080 - I'm just wondering if Dave is still here and how this matches. I assume something like that. Dave, what 01:16:28.080 --> 01:16:42.718 - would you know about that? I'm sorry about about liability. The question on liability or? Yeah, I think the. 01:16:43.074 --> 01:16:52.315 - Dr. Moore, I think, brought up an interesting point of the new legislation that allows medical personnel, 01:16:52.315 --> 01:17:01.208 - law enforcement to deem someone, what was the term? Gravely disabled. Gravely disabled and force them 01:17:01.208 --> 01:17:10.014 - to go to housing if they are unhoused, not allow them to leave, for instance, or force them to go to 01:17:10.014 --> 01:17:12.542 - housing if they're refusing. 01:17:12.962 --> 01:17:21.360 - you know, would you know, or what would your opinion be on liability for the board, for some of our 01:17:21.360 --> 01:17:30.177 - community workers out talking to people in the community who, you know, maybe on a day where it is below 01:17:30.177 --> 01:17:38.743 - zero or 100 degrees outside, and then that person ends up having a medical emergency because they are 01:17:38.743 --> 01:17:42.270 - unhoused. Since someone of our employees, 01:17:42.722 --> 01:17:50.805 - had that conversation, documented that conversation, and did not put that person in a place where they 01:17:50.805 --> 01:17:58.731 - were safe, does that put the Board of Health at any liability for not acting on that? For the health 01:17:58.731 --> 01:18:06.813 - department? For the health department? Well, if you're talking about government employees making those 01:18:06.813 --> 01:18:12.542 - decisions, I don't believe that there would be any liability whatsoever. 01:18:12.770 --> 01:18:25.787 - The failure to enforce the law or the making of a decision in good faith under an existing law were 01:18:25.787 --> 01:18:39.195 - released from liability from that. And I think generally, there is no duty that I'm aware of to render 01:18:39.195 --> 01:18:41.278 - aid to anybody. 01:18:42.050 --> 01:18:50.872 - generally speaking. So I just don't see that as being something that would give rise to liability, certainly 01:18:50.872 --> 01:18:59.289 - not to county employees, but to the public at large, I don't think there would be liability for failing 01:18:59.289 --> 01:19:07.626 - to exercise that statute. OK, thank you. Thank you. But then again, you know, it's brand new and we'll 01:19:07.626 --> 01:19:10.782 - just have to see how things shake out. 01:19:14.658 --> 01:19:23.396 - Yeah. Sarah good good thought. Thank you for reminding us that we had Dave on the call. We just don't 01:19:23.396 --> 01:19:32.306 - want to be the example. That's right. Yeah. As the first. Yeah. Yeah. Exactly. Any additional comments. 01:19:32.306 --> 01:19:41.215 - I can't get it asking for comments. All right. Is there any further business for us to discuss or could 01:19:41.215 --> 01:19:43.614 - I have a motion to adjourn. 01:19:45.090 --> 01:19:50.974 - So moved. Second. Third. We're done. Very good. Thank you everybody.