- I'm going to call the what is today's date this July 2nd meeting of the Board of Health to order. Apologize
- for a little bit late getting started. We were just waiting to get a quorum in the room but we're ready
- to get going now. We have everyone in the room. Okay great.
- If there are any does anyone in the board have any amendments that we would like to propose for the
- agenda today. I move that we accept the agenda. Okay. Second. All in favor. Aye. All opposed. Okay.
- So we are going to go forward with this. The first thing on the agenda is the approval of meeting minutes.
- The minutes from the meeting on. Let's see what was the date of that meeting. I lost it.
- June 11. No 18. Sorry. Yes. The meeting minutes for June 18th are in your packet. May 21st is here too.
- Yes. Oh that's right. So actually that one from June ended up being canceled. Okay. Okay. So it's the
- May 21st. The minutes for meeting on May 21st are distributed in your packets. Are there any corrections
- or additions.
- Or is there a motion to approve the minutes as distributed. I'll make a motion to approve as written.
- All right. Very good. All in favor. Aye. All opposed. Great. All right. So now we are going to move
- to the general public comment. The Monroe County Board of Health encourages and welcomes public input.
- Written comment may be submitted at any time via email at Board of Health
- co.munroe.in.us. During meetings comments related to specific agenda items will be heard after the board's
- discussion of that item and prior to taking a vote. At that time we would like to invite those I'm sorry
- at this time we would like to invite those who would like to make comment on any non-agenda items to
- speak. For those in person please sign in at the front of the room and those joining online please use
- the raise hand feature
- to indicate that you would like to provide a comment. Each speaker will have three minutes and we ask
- that you please begin by stating your name for the record. Is there anyone online would like to make
- a public comment?
- recognizes Sarah Rider-Bain. As you know you have three minutes for public comment. I will go ahead
- and start your time and you may go ahead and introduce yourself first and we'll go from there.
- As soon as we. There we go. I think you've been allowed to speak. Yeah there you go.
- on a loud mic maybe. Sorry Dr. Ryder man we're having issues giving you permission to speak. We've got
- you right where we want you.
- 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,
- look at that. Good lord. I can't hear. There's a really weird sound in the background. So several months
- ago, I asked about the contribution from IU Health
- or IU Health Foundation to the project through Health Net that is our backpack nurses. And I was told
- we would be getting that information. I still have not seen it. I don't know if we could simply
- Tell us what that amount was that apparently IU contributes also. That's the question that remained
- hanging for me. Thanks.
- Dr. Ryderband, I'm so sorry about that. We were having trouble hearing, we were trying to turn the volume
- up and we accidentally activated our TV and so we couldn't hear anything. Could you? Should I ask again?
- We actually heard a little bit about like an IU Health and Health Net at the very beginning and then
- we were trying to turn up the volume and lost the other half.
- If you wouldn't mind, I will go ahead and give you another three minutes. And if you can go ahead and
- repeat yourself, I'm so sorry. As I was going to say, I don't need three minutes, but several months
- ago, I posted on Twitter in the next week that I knew Health Foundation makes a health net
- The Board of Health makes a contribution, a significant contribution, and I was asking since there is
- a decrease in the amount of VR visits in the evening because of this program that's been instituted,
- what contribution IU Health has made. I still have not seen that information, although it's supposed
- to be available.
- doesn't appear to be on our agenda. So I thought I would ask again. Have you heard me this time? Yeah.
- Who were we supposed to be hearing this from? Did you who did you did you talk to someone in particular?
- I was going to tell what IU Health is contributing and there's no financial contribution from IU Health.
- They are working with they allow the the health and nurse access to our patients in the emergency department.
- We consult with them and let them know that there are people in his cohort. And there's a multidisciplinary
- meeting that we have once a month that it includes Health Net and that nurse and people from IU Health
- as well from community outreach that gets together and discusses the process that we go by to care for
- that cohort. But there's no financial contribution. Thank you. That's what I wanted to know.
- Do you know if they've assigned a monetary value to what Health Net has done to keep people from chronically
- visiting the ER? How many people that is? I think that when Amy gave her update at the end of last year,
- they have the dash. It was a dashboard. She had Amy shared information, but I don't remember the specifics.
- There is an amount that
- is so associated with a decrease in in patients presenting to the emergency department. There's
- no acknowledgment or there's no statement that says this is caused directly from this. One can hypothesize.
- But I don't think I says because this has happened we've saved this amount of money specifically because
- of this. We'll say more along the lines of the percentage or the number of people that are
- in our emergency department that are unhoused is less than the previous year. Therefore, there's a certain
- amount of difference in those costs. So there has been a decrease. There has been, yes. We actually
- saw that in place a month ago. We saw the precipitous decrease in
- 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
- when I raised the question. Thank you. What would you guys think about having Health Amy Meek come back
- at our next meeting and give us an update? We couldn't have a section. We're going to reach back out.
- I'll provide an update from Health Net on the quarterly report I just received and then circle back.
- I was going to have that group come back. Okay. Very good. I think that sounds like a reasonable plan.
- I think that that and I'm I represent the board not IU Health when I'm in this room. Yes. I think that
- it wouldn't be unreasonable for the board to talk to IU Health about and ask for a financial contribution
- citing presumed savings.
- I don't know who that would go through, however, I think maybe Amy would be a first stop. And I would
- propose that both organizations benefit. I mean, we're not asking for the total amount that you're saving,
- because that wouldn't save IU Health anything. But I would say we could meet in the middle somewhere.
- And so that would amount to some donation for us for seeing those patients and some savings to them.
- that as well. That way it seems like a win-win rather than a win-zero-sum break. Well, not a zero-sum
- actually but our grant is going to help support this program, right? Yes. Okay. Very good. Do we need
- to do like a voting item to like add something to the agenda next meeting or can we just request it?
- Any other public comment online. Okay. Seeing none we will move on to the next item in the agenda which
- is the department updates from Lori.
- We'll start with our vital records. So going back to May there were 287 birth and death certificates
- that were processed. 18 percent of those required the one non-Health First Indiana funded employee due
- to the person living out of state. Since February of this year we've processed payments for over 50 TB tests.
- So we're seeing a lot of those coming through the door on a regular basis. I wanted to provide an update.
- So we remember back in December of 2025 the board approved moving forward with the staffing contract.
- So I've got that paperwork that's been submitted to legal for review and expect to get approval for
- that agency in the month of July. So the bill rate for this is $65 per hour.
- They're only paid for hours worked. So if we have a day that we're closed or a holiday the person just
- would not be paid. But this would be looking at attempt to permanent placement. So essentially how it
- works is after the contractual worker reaches or has completed 900 hours of work here at this facility
- then Monroe County could hire that person as an employee
- and there would not be any charge so that we would essentially take them on as a Monroe County employee.
- You can hire prior to the 900 hours but if you do so then the agency charges you a fee and it depends
- on what the starting salary is for that position. So met and talked with those individuals really talked
- about what we're looking for the needs how it different
- how it differs from just regular nurse positions and continue that conversation more. As I mentioned
- I've received the second quarterly report from Health Net. So this was for the months of April through
- June. So during that time at the Wheeler Mission when they're there on Tuesdays and Thursdays they've
- seen 19 individuals. There were 11 psychiatric visits.
- four acute illness, four medication refills, and one visit that was not related to those categories
- for a wound or an injury. The majority of individuals were between the ages of 46 and 59. One change
- that we're unsure of is how the street outreach services are going to be impacted given the changes
- to the statewide law.
- criminalizing unauthorized camping and sleeping. So we're kind of waiting to see how that might impact
- the services and those patients that they've been consistently seeing. Our disease intervention specialists
- have recently began free testing for STIs in the Monroe County Jail. So I think that's something that
- we've been waiting on for a while. So the jail has agreed.
- to allow us to come in and provide HIV and hepatitis testing as well. They will continue testing every
- other week. Indiana has changed the requirements for the AIDS drug assistance program. So now people
- living with HIV in Indiana county jails can receive assistance the entire time that they're incarcerated.
- And there's not a cap on how long they can be enrolled in this program. So if any new HIV patients are
- identified they will be referred to PositiveLink who will assist those individuals with signing up for
- the assistance program. Long term they plan on doing a collaboration with our harm reduction specialist
- and two of our disease intervention specialists to go and do this routine testing.
- For our nursing services, we have started scheduling vaccine appointments. We have had a vaccine patient
- in just recently. So we're getting regular calls asking about vaccines and our testing services.
- Right now, those services are just available. We're scheduling appointments on Mondays and Wednesdays
- between 1 and 4 p.m.
- and Tuesdays and Thursdays from 8 a.m. to 12 p.m. We'll reevaluate here in the fall once we start getting
- into flu season and just get a better idea about what our volume may or may not be. From January 1st
- to July 1st of this year we've closed a total of 85 of our case investigations. That excludes our STI's
- tick-borne illnesses and animal bites. So busy doing that. The LTBI cases do remain on our
- open investigations just until those individuals complete all their medications and the state actually
- closes all the other TB and Class B cases. So sometimes that makes our open queue look larger. So that's
- going well.
- The clinical assistant position was approved by council. So we've been receiving applications, doing
- pre-screening interviews. We're actually receiving quite a few of those. Everything good? Yes. Wow.
- I think you buried the lead on that. I was going to say Ann. I guess it feels like it's been a while
- now. It does. It seems like it's been forever.
- We've had a lot of interest and so still continuing to go through those applications and the screening
- process those interviews are going going well so anticipate being able to fill that position pretty
- soon. Let's see so far
- through the milk bank partnership. We've distributed 119 bottles through our milk access program. So
- we've just started that just a couple months now. So been really busy with that and that's been going
- well. How many people have used those 119 bottles? Well, let's see.
- I did the distribution this afternoon. I think when I was looking at the list, I'd say maybe seven.
- 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
- can do for each one. Let's see. Our public health preparedness
- director and coordinator and some of the department employees will be attending a point of distribution
- exercise for emergency preparedness next week at Ivy Tech. So that'll be on the 7th and 8th. They generally
- try to do those about once a year with just to keep employees up to date on those response activities.
- for Environmental Health Services. Our director has taken on the tick-borne illness case investigations
- for the time being. We're seeing a lot of those come in as completed. Six in June. Two were lost due
- to a lack of communication and follow-up and we received just two new cases today. So currently we have
- three pending cases that are being worked on.
- And he's completed a total of 73 animal bite cases so far this year. So staying really busy with those
- activities on top of the regular environmental health services. Do you know a breakdown of the distribution
- types of animals? I could get that. We used to have that information routinely. Skunks, raccoons, dogs, cats.
- There's a lot of different ways to filter and run the reports. I've been trying to kind of dig around
- on that. So I know that it's possible. And it's interesting it's helped to see at the breakdown. FOODS
- is completing the summer feed program inspections for the schools and moving into population health
- and outreach.
- That manager and public health preparedness coordinator recently attended the Cambridge Health Fair
- so they were providing free blood pressure and blood sugar screenings and handing out educational materials
- and crisis kits. The population health and outreach manager is continuing to cover our TB LTBI and Class
- B case investigations and testing as we continue
- building up our transition of nursing services. She and I have also been working together on
- grant opportunities and applications to find funding to support our maternal child health services.
- So we'll continue to keep seeking those opportunities and applying for them. And our Heart Reduction
- Specialist
- This will be working with our disease intervention team for those walk-in testing clinics that are being
- held on Thursdays between 3 and 6 p.m. So I think this Thursday is just the second one that they've
- had now, but plan to continue that program. And that's what I have for our updates. Can you do the TB
- testing? Is it the typical, like,
- The skin test. The skin test or you do in like your quality or not? We do both. Okay you do both. Yeah
- 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
- come back but we it costs us twenty dollars we send it to the Indiana Department of Health. Okay. So
- but we have a courier that we can use for that. Okay very good. Thank you so much.
- Moving on next item is old business and we don't really have anything in that agenda item so we'll move
- on to new business. So the first item on the new business is a discussion about the public comment policy.
- You have a copy of the current public comment policy in your packet. In general the idea I think Dr.
- Robinson had been talking about this
- If you recall this is actually I was not here yet for this meeting. It was the meeting just before I
- joined the Board of Health where there was a vote. Yeah. There was the there was a vote for the Board
- of Health to basically adopt the public comment policy that the county commission uses which is what
- you heard us do at the graduating meeting. Prior to that this.
- towards public comment policy was to allow public comment for all items at the beginning of the meeting
- and not have public comment prior to every single voting item. So for the last year roughly we have
- done public comment about any non-agenda items at the beginning of the meeting and then we would present
- voting items and have a small public comment section
- for each agenda item. The question for the board was to revisit that decision and say might it be prudent
- as we have not had a lot of agenda item public comments in the last year to revert basically back to
- the policy prior where you would have a public comment session section beginning of the meeting but
- that public comment section would include
- want public comment, including agenda items, do that at the beginning of the meeting, address them,
- and then as we are moving on to our agenda topics, we would just have motions, get seconds, and vote
- without providing time for public comment during the actual agenda item. So that's, I think, the question
- up for discussion. To me, it never made really much sense to comment on something after the vote was taken.
- I think including all items in the public comment section for all, including agenda, the ones on the
- agenda for that day, that makes more sense. I agree. Plus people, anyone in the public that wants to
- make us aware of an issue can send it in writing if they so desire. And it's something we can look at
- at any time.
- I agree. Right. Whether it's not in the meeting. Right. Right. I feel it's a little different. I actually
- like the idea of having people having the ability to comment before a vote on a specific item because
- sometimes when the item is discussed we discuss the item and then we vote. Sometimes the discussion
- can bring out points that can be important to the public.
- And I'd like them to have an opportunity after that discussion, before the vote, to make a point that
- might affect how we vote. Which is actually what it is now. Right. Yeah. I kind of, I got to feel half, you know,
- will say in general I think I would agree with your general idea because I think if there is a conversation
- and there is someone from the public watching that has comment I agree I think sometimes maybe some
- of the things that we are discussing might bring out a comment. On the other hand I think
- from my experience over the last year, this process has been very cumbersome. I think we have forgotten
- multiple times to ask for public comment, because it is cumbersome. And truthfully, the public's attendance
- to this meeting has not been huge. So I feel like, from my perspective, from our
- I think allowing public comment by writing is always good. Kaye, you were mentioning people can always
- submit a public comment even after a vote that we might have to disagree with us or whatever. So it's
- hard because I feel like in our position it is
- very cumbersome to request public comment prior to every vote for those reasons. And many of those votes
- are internal kinds of things. Right. However, there are, I mean, in the past, there have been controversial
- things that the court has done for, in my tenure, for good reason.
- And there are opportunities for discussion prior to that to justify why we're doing those things. Actually,
- it's not an effort to justify it. We feel it's just, but we just state our position. And so, you know,
- Is that the reason that we're doing this, considering this is that it is cumbersome to do it?
- And I agree. It is hard to remember, especially when you're running the meeting and trying to keep your
- mind on all of them, everything, that then to ask for public comment at the end of our discussion before
- we take a vote is, yeah, it is cumbersome. Yeah, I think I believe the idea behind having, bringing
- this back up was,
- you know, for the County Commission to have that policy, it makes complete sense because there's a lot
- of people that are going to be attending that meeting in the room, online, fighting those things. We
- haven't had quite as much attendance. And allowing the public comment at the beginning, plus written
- comment, is that sufficient? Or, you know, I think you make a very good point of, you know, do we allow
- public comment at the risk of forgetting to ask for it?
- during our votes. So I think those are the things we're trying to weigh. Well, there's usually someone
- here who will be paying attention to who's hand is raised online, who they want to say something. And
- then if we don't ask for comment, then we've diminished that person's position.
- by ignoring them, but not purposely. So I don't, you know, I'm like halfway on the, I'm on the fence
- about this too. I see both things and the vast majority of things we ask for public comment and there
- isn't any. But I don't, I actually don't see the harm in keeping the policy as it is and just
- understand that there may be times we forget to ask for public comment, but not something we consider
- controversial. And that would be usually when we wouldn't ask for comment. And just based on my experience
- is that when we know something is controversial and we expect there to be comment about it, in those cases,
- necessarily want to hear what they have to say, but but we feel like that we that we need to.
- And occasionally I'm enlightened by something someone says, you know, so. Alternatively, we could make
- the public comment section before at the beginning of the meetings and then have the members of the
- board have the ability to before vote
- to open it up for discussion if we think it's a controversial topic and we think there's going to be
- comments. There's people in the room and we think they're here because of that. We can say, hey, before
- we do this vote, let's see. So have the ability to ask for public comment, but not have the obligation
- to ask for public comment. I think one of the things that's made it so cumbersome is having to read
- all this verbiage
- at the end of every single question. I don't think we have to read it all. We never did that before.
- I think we can, at the end of each, like before we take a, ever we're discussing an item, before we
- take the vote, I think we can say, is there any public comment related to this particular agenda voting
- item? Prior to us taking the vote. Prior to us doing the vote. I think I like, you know, that's not a bad,
- I'm thinking, you know, in the event there's people in the room that maybe have a comment and we decide
- maybe we're not going to open that one up, like, then they, you know, is there, is there a situation
- where a person feels be a little, because actually I wanted to comment on that, but you didn't open
- it up, right? So that's the case that I kind of would suggest maybe just leave it open as it is.
- I believe personally, I believe if it's, to your point, going to be a contentious agenda item, if we
- say public comments at the beginning, we're gonna get all those public comments. Your point is well
- taken though, would those comments possibly be slightly different after we have had our discussion?
- Or would it be moved by our discussion to hear where we're coming from? That's true too. Hear where
- we're coming from. Although I think that they show up, we're gonna feel an obligation to speak.
- Okay well we've talked it through but is there a motion about this. I make a motion to keep our public
- comment policy as it stands. I think as it stands we have to read all that verbiage and so forth somewhere.
- Is that true.
- If I remember right. You have to open it for public comment before you vote. But we don't have to read
- the public comment thing right like this stuff. Usually it's just anyone have a would like to make comment
- on this topic. Okay so we don't have to read this. All right I'll second that. Okay. All in favor. Aye.
- Aye. It's tough to get it okay. Go along.
- No post. Okay. I don't like it though. I don't like it either. You make a very good point though. Yeah.
- Okay. The next item on our agenda is the. Oh yeah. We forgot to ask for public comment about the public
- comment policy. Dr. Ryderband I apologize.
- Is there any public comment about the public comment policy and our decision regarding it? And Dr. Ryderband,
- 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
- again. So yes, you did need public comment on it. And if indeed,
- It's a strange thing going on. If you want to change, you really need to go through legal. What we were
- told about making all of the comments at the beginning of the meeting was from legal. They were the
- ones who said,
- Yes we need to say all of these things if you're changing the policy. So I just thought I would throw
- 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.
- Thanks. Thanks Dr. Ryderban. Okay so go back the.
- Motion on the table. We had a motion in a second. So does anyone want to change a motion based upon
- what Dr. Ryder-Bandt had to say or? Can we summarize? I couldn't. I couldn't understand what you said.
- Sarah. Sarah. We. We can just. This is not your fault but we can just barely hear you. It sounds like
- it's coming through a tiny tiny speaker someplace.
- Well, and what I'm getting is some kind of cute, un-pumpin' sound when I'm trying to talk. It's like
- 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
- problem. Is it interesting that you were suggesting that if we want to change the policy, we would actually
- need to go through legal? Is that what you were saying?
- Yeah, any proposal that you have for changing it, like a proposal to not read all of that material at
- the beginning, anything like that really needs to be vetted through. Yeah, understood. Okay, very good.
- So I think that's what I heard was, and we're not talking about changing
- Just to be clear the general public comment section of the policy we're mostly talking about what we
- would do prior to each vote. And what we have been doing prior to each vote is essentially asking is
- there public comment on this topic. The policy does not say we need to read through all of that so I
- think it'll be okay. Okay. So now we can put it up for but we've got a motion and a second for
- Leaving the policy as it is. All in favor. Aye. Aye. All opposed. Actually I thought we took a vote.
- We did. We did but we had to re-vote because we forgot to get public comment. All right. Next on the
- agenda. Moving right along. All right. Next on the agenda we have the health 20-27 budget. So I'm going
- to turn it over to Lori to talk about the budgets.
- So you should have received items that just basically outlines our different funding sources so I'll
- just be getting a brief overview for that. To start off so 1159 that's our local county health fund.
- So all departments were instructed to you know keep the
- requests flat essentially so don't ask for increases in our supplies and services. At this time there's
- no salary increases planned for employees for 2027. So I did make a few changes to some of the positions
- moving some positions out to an alternative fund and moving some of our wastewater staff into this fund.
- The reason for that is just that
- Wastewater has really been getting hit pretty hard with the HFI changes and the Indiana residency
- requirements with out-of-state individuals who are looking to purchase a home here but who do not live
- here yet. So hoping to be able to move at least one or two of those employees to this fund for 2027
- to help kind of offset those challenges. You will see if you go down to the services line
- So our personal health care line 32410. So previously this was used for the IU Health contract in part
- to pay for some of those nursing services. And so the idea is to keep that line again requested the
- same amount and there's a couple of reasons for that. So if we end up with contractual workers
- through the staffing agreement could use this line to pay for those services. And then the two positions
- that the Board of Health discussed and voted asking the council council the council for the public health
- nurse supervisor and the maternal child health nurse. Alternatively those funds in that personal health
- care line could be moved
- to fund those positions that they were approved. There's not really a whole lot of other changes in
- this but happy to answer any questions. On line 18001 the self-insurance that goes from $99,000 to a
- lot is that due to the fact that you had to hire all these new positions basically because we're not
- using the IU Health Clinic?
- Good point. So what happened there is last year we did ask for all of our positions. So the guidance
- that we received from the Indiana Department of Health was that we should not be pulling insurance funds
- from our Health First Indiana for vacant positions. And to offset or try to avoid that the idea is to
- again ask for all of our positions
- insurance to be pulled from our local county health fund because they just pulled that at the beginning
- of the year added in. When we have vacancies or people could argue maybe people who aren't using the
- benefits the state essentially has said you are not dollar you cannot guarantee dollar for dollar that
- each of those funds are being spent towards the delivery of poor public health services. So that's why
- we bundled 22 positions
- request in this $1,159 County Health Fund. But that rate has gone up this year at 16-5 so they expect
- or I think they hope that it'll go down but right now we're budgeting $18,000 per employee.
- to move on if no other questions. Okay. So. 1161. Do we vote on these one by one or do we do a myself
- sum. Usually it's just the entire budget. Okay correct. So 11 or 16 no it is 1161 that's a typo there.
- That is our new Health First Indiana funding. So this 2027 the board already
- approved that at the last meeting so no changes there that's already been submitted for next year. Moving
- on to the 9626 so the reason that we have different spreadsheets for 1161 is that because we essentially
- get the new funding plus we also have our have old funding from previous years with this Health First
- Indiana funds
- Assigning them that year helps us to just be able to better track them and know year to year what we
- have remaining to work with. So currently we are using some of these funds since we don't know what's
- actually going to be left at the end of this year. Nothing's been budgeted in 2027 and likely these
- funds will be used once we get to 2028 to continue spending those down.
- Then moving on to the next location 96-25 so be looking currently using some of those funds. That is
- helping to cover the shortage that we have for the decrease that we received just in total from the
- state funding. And we'll be looking to use leftover funds from this account line in 20-28 for expenses.
- And then you'll see just the other bucket is from the year 2024. So plan on using these funds up in
- 2027 because our the fund that our maternal and child health coordinator is in there's not going to
- be enough funding left to cover her position for the entire year of 2027. So her position will be moved
- to these funds to continue paying her salary expenses.
- And then we have just a few of our other positions that will be supported. The Public Health Preparedness
- Director is currently funded by old grant funds so that position will be moved to the state funding
- for 2027. You'll see in that the 135,000 in the contractual line that's for the Health Net Contract.
- questions about those maybe before I move on to the other. So 1168 so those those are old state funds
- prior to Health First Indiana. Again we'll just be spending these down. We should pretty much use most
- of these up in 2027. I left a little bit of wiggle room in here just to be able to
- fall back on this funding, depending on what the county council decides for our local health fund, that
- that will give us flexibility that we could move costs in here, if necessary. The purpose for funds
- in the part-time line. So, currently, we don't have any, and there is the hiring freeze. But just adding
- some in there, our
- Environmental is used to having a part-time support even if it's just seasonal. So looking to see what
- 2027 will bring us and if we potentially will have the option to get a part-time environmental health
- specialist to help support their services. And then the 1206 this is
- tobacco settlement. This is that old funding our Maternal Child Health Coordinator is currently in.
- So expect these funds to be used up in 2027 and we'll be able to close this fund out and her position
- will be moved as shown in the previous forms. 4906. This is old state funding from that local health
- maintenance fund.
- So the purpose of this fund was to be able to have funds set aside appropriated and available for use
- in the event of a public health emergency where we need to purchase supplies or services. We have started
- using some of these funds this year related to unbudgeted TB and nursing costs that we have been having
- but don't expect to use more than just maybe
- 2,500 at the most from this. And so may want to continue trying to work this these funds down. Maybe
- if but there's not really a whole lot there but it does give a cushion. And then 81-11 that is actually
- a grant. The reason that we included this
- with our other budget items is just to help show where we are paying positions. This is bold COVID grant
- funds. We moved our nursing positions to this to allow them the flexibility to be able to serve any
- patient regardless of having to verify residency. So again these funding positions in 2027 do expect
- to have some funds left but definitely under $200,000
- by the time we get to 2028. Any questions about things that we see on the budget. Any additional thoughts
- or worry about things you see or don't see or whatever.
- Is there any areas where you have any real concerns? As far as the budget, when I think about it, it's
- the change in that residency requirement that really just puts so much restrictions. We had to shift
- so many costs around and we're constantly trying to navigate that situation and how we're responding
- to the community's needs while adhering to
- you know, those stipulations that were put into place. So I think that's really our biggest challenge.
- So depending upon where the funding is coming from for the position, it dictates who they are allowed
- to serve that person. Correct. And so, you know, a lot of our employees adapted because we have to.
- But it does come in, there are times where we have to turn people away, and that's hard to do. And so,
- and it is a lot of paperwork, and it is an extra burden on the employees to have to get the identification,
- fill out the paperwork, making sure that we're having that, and then not having a backup when we do
- run into situations where someone maybe doesn't live in Indiana, or doesn't have a home.
- I'm just any single example. Septic so people who are going to be moving here but they don't live in
- Indiana and maybe they want to records requests or they're looking for a permit. Vital records we get
- a lot of out of state requests so when that employee is not here for whatever reason we typically will
- refer them to a different county or if they want to wait when he
- comes back then we could provide the service at that time. Where are these two positions the public
- health nurse supervisor and the public health nurse NCH. Right now you kind of mentioned we would use
- the personal personal the 32 410 personal health care to cover those positions.
- depending upon temp versus hiring would they fall under the 1159 health fund. That's the request that
- would be made. So when making the request for the positions and if they were approved then funds would
- be essentially just transferred from that contractual service line to fund those personnel account lines.
- How does that impact their ability to serve patients who are becoming
- utilizing their services. Yeah. So they can serve anyone because these are the local county dollars.
- Okay. Very good. And that's why we had moved the IU Health contract back to the county health fund when
- those changes happened. Okay. Any additional questions or concerns. Impressive work. Yeah.
- Is there any motions that would like to be had. Motion to approve the budget. After we do the motion.
- I had it in my head. All right. So we're going to turn it over to public comment on this particular
- agenda item. So if there is any public comment online we don't have anyone in the room but if there's
- any public comment online regarding the
- budget for 2027. Please go ahead and raise your hand and we will call on you and give you your three
- minutes. Okay. Seeing no hands I think we're ready to go for a vote. All in favor. All opposed. Great.
- did it. All right. Well done. I know it wasn't easy. All right. So we're going to move to our last item
- on new business which is the VaxCare data transfer. So again I'm going to let Lori kind of describe
- what we're talking about and I believe we've got leave along the call to give us a little bit
- more background. Yes. So we do have our attorney online today just
- Just a very brief, I guess, overview. So VaxCare is the third-party billing system that the department
- has used for many, many years. So this the account was always under the Monroe County Health Department.
- This is the same account that the IU Health nurses were using when they were under contract with us
- for the vaccination services. So when we had the transfer,
- of the nursing services back to Monroe County Health Department. Since this was our account we've retained
- all of that patient data and the account is essentially Monroe County Health Department. So there's
- been a little bit of a question about you know that the account and the patient information and so VAX
- care has requested that they can essentially pull and duplicate all of the
- information that's within the Monroe County Health Department account and give that to IU Health so
- that IU Health has all of that information. And I think that's kind of the discussion and I'm not sure
- what else Dave would like to share.
- All right, so we'll turn. Why does I need the information? I think it's an administrative burden because
- they have to type all the information in and if they just have the information and if they're seeing
- someone who is in our system, then it'll automatically it'll populate with all of that information.
- Now they could of course reach out to us like
- with the futures clinic so you know people had an option to get the records they can still come here
- and get those records or the new Bloomington family planning you know family they they reach out there's
- a release of records so. There's a there's a huge problem that we can't see the records. Teague and
- I can't see the records. Will this somehow lead to us being able to see the records from. I don't know.
- I thought that.
- Vaxcare was going Vaxcare said that they were my original understanding was that Vaxcare was going to
- have legal draft an agreement like a data sharing agreement. And then I was told that they just wanted
- me to approve via email. I said I'm not comfortable I'm not doing that. I'm waiting for an agreement.
- So they said that they weren't planning on drafting an agreement. They just want an approval via email. And so.
- I don't know how the transfer will happen, except that they've said that they have the capabilities,
- and they've said that they have the capabilities to do it without our approval or agreement, but they
- want our approval. I don't know how the technology side of them actually extracting the data and sharing
- it works. So, Vacccare just has the vaccine records and the insurance
- like social security number address their personal life their personal information like where they live
- who they are like identifiers and their vaccines that's it yes see i don't think that would that the
- person the the person who got vaccinated would have to give permission that's right so it is not HIPAA
- protected we know that um because you're going from
- a health care provider to health care provider. So you don't necessarily need the patient's permission
- for to go from someone like a if you're coming to see like a primary care doctor and I was like I would
- like to have your vaccine records. I don't have to necessarily ask your permission. I can just say oh
- you got them from the health department. I can fax a release of information or call over here to get
- them without the patient having to agree to do it.
- It's just the vaccine information. It's just the vaccine information but it's also all this other personal
- information like their their Social Security numbers their addresses are they on Medicare Medicaid are
- they that's the kind of stuff that is the concern. Now should we turn it over to Dave real quick to
- see what other information Dave you might be able to provide us regarding the question we're we're trying
- to get an answer to.
- I believe you, well, hold on, maybe. Yeah, he should. I think you are unmuted, Dave. You might try.
- There we go. Can you hear me? Yes, very. We're having the same problem as we were earlier. It's very,
- very quiet, but we can hear you. OK, well, I'd sent Lori a proposed statement that basically said,
- Yeah, I can hear that. Can you still hear me? Yep. That the Board of Health would approve the transfer
- of the information subject to compliance with HIPAA, Indiana Code 1639.51, and any other laws, rules,
- or regulations applicable to the sharing of health information. So basically, that just puts it on VaxCare
- to comply with the law. And it seemed to me that if they felt comfortable with that, then they could
- proceed as they wished. But all we were saying would be, hey, you can have the information provided
- you're entitled to it under the law. OK. Thank you. So truthfully, I'm confused.
- because IU Health has the ability to pull in, I presume, and you can correct me if I'm wrong, when the
- health department provides vaccinations to patients, you provide the vaccine, you document it in VaxCare,
- and then you upload it to CHIRP, which is a statewide vaccination system. IU Health has the ability,
- with a click of a button, with their medical record system to
- as the patient comes in to see a medical provider, you click the button and it pulls that information
- out of CHIRP. So if the health department is uploading it correctly and IU Health is adequately, it
- is as a primary care physician, is part of the standard rooming process to reconcile the vaccinations
- as you are seeing the patient. It's of course substantially more important
- for pediatric patients because there's so many more vaccinations given. But IU Health, as the standard
- process for removing a patient, includes pulling that information in from SHERP. So I guess my confusion
- lies in why would it be necessary for us to give approval for VaxCare to provide the information versus
- IU Health continuing their standard process of
- reconciling it when they see the patient. I don't know the. So I did bring that up because that's one
- of the first things that I thought of. And the answer that I was given was, well, people can refuse
- to have their information uploaded and stored in CHIRP. And I said, well, that's the exact type of person
- who probably doesn't want us sharing their information then without their approval. Yeah.
- I mean, I've got 14 years of medical practice under my belt in primary care and I have never once had
- a patient decline having their information uploaded to CHIRP.
- doing this here in-house shortly, but no, that's what we do. I think that's the process, my understanding,
- that's expected to be followed and used, especially with our publicly funded vaccines. So, I...
- by IU Health? Is that kind of the idea IU Health has asked for this information and that's why we're
- talking about it? Yes and I think part of it is again that administrative burden because there you have
- to type everything in which I mean I've been over there working in the clinic a little bit and you you
- do have to type everything in but the system is really pretty straightforward to use. I mean you're
- if there's not that many I mean it
- there's not that much. You do have to look through the long line of payers and the insurance, maybe
- it's matching some of that up again. I'm not, I'm not, not really sure, I guess, but that was one of
- the reasons VaxCare gave us was that, that it's an administrative burden. It's like they're asking us
- to share the information to Omnicorp or our county residents information to Omnicorp from some,
- So, thriller, I'm uncomfortable with it. I guess, I'm just struggling to even figure out why it would,
- why it's necessary. Why is it necessary? Exactly, exactly. Maybe they can come talk to us. So that's
- what I was going to say. Like, before we say no, categorically, maybe the right thing to do would be,
- whoever at IU Health,
- is representing IU Health in this request. Maybe we have them come to a meeting and say, can you help
- us understand, like, what is the difference between just uploading this information straight from CHIRP,
- like we already do, versus having Backscare provide you all of this information, and why do you want
- the latter? And I'd be concerned with that information somehow winding up in the hands of people that
- are using it for other reasons.
- There were some specific, in your emails that you sent us, there were some specific things that could
- not be done with the data. I can't remember what those were. It was like, I can't remember that. Advertising,
- selling for research purposes, I think. Selling for research purposes was a good one, because I was
- worried about that. So they can't do that. Advertising, now I'm trying to remember the next.
- But the fact is, they can do anything.
- they can say oh you can't do it and all you need is a legislature saying we're here now we're putting
- our thumb on it and you can do this now you must do this now. Any questions for Dave or any additional
- like comments on this or do we have a proposal that you would like to put forward?
- that we shelve a vote until we have someone from IU Health or from this company talk to us and explain
- to us the benefits and for benefits and deleterious things that can happen with this and why it's necessary.
- I will second that motion. Okay we have a motion and a second and we will pause.
- for public comments. Are there any public comments regarding this particular agenda. Regarding this
- particular agenda item from regarding Vaxcare and IU Health's request to have the data from Vaxcare.
- I do see Dr. Dr. Ryder band with your hand up. So we'll go ahead and turn the floor over to you and
- you have three minutes.
- 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.
- I don't know if it's the owl going through the computer. Something weird happens. So the issue, I guess
- the question I have is whether we feel our public health nurses are going to be
- and going out into the schools. I mean, we're currently enriching Green Blossom and other schools
- vaccinating. In which case do we already have all that taxpayer information on the children we have
- vaccinated in the past? Are we going to have to get that from IU Health if they're still holding it?
- And since I'm in health I'm going to drive planning on vaccinating the schools in our community. Do
- we have a plan in place around that. So I think that fits into the discussion somehow because again
- it's next-care-share information. Thanks.
- Did anyone hear that in on me? Yeah. No. OK. Yeah. So I'm sorry, Dr. Reitman. We're trying to, like,
- I can hear, like, every, like, half of what you said. I'm trying to listen, but what did you hear? So,
- yeah, essentially what VaxCare has said now is that they can duplicate the data so that we would still
- retain our Monroe County Health Department set. And then that duplication would be given to IU Health.
- So we've moved past the just transferring back and forth and who owns the patient records to where we
- can duplicate all of the records. OK, so the idea is the original proposal was just to send it to IU
- Health. The new would be we keep a copy and IU Health gets a copy. So both has records. Yes, so we should.
- So if I go in the system, I can see like past school clinics. So we should, if it
- is just a duplication we should retain our access and then they would have that information as well.
- Okay. Any additional public comments before we move to vote. Okay seeing none is there any any need
- to amend the motion on the table based on public comment.
- Okay. Hearing none. I think we will put it up for a vote. All in favor. Aye. All opposed. Well done.
- Motion passes. We got there. Okay. So that ends our our new business. So we'll move on to the next item
- on our agenda.
- Would any board members or the health officer like to make any additional comments before we adjourn
- for the evening. I have a comment. I'm not sure people are aware of of the effects of the new law but
- it may it may be in our come across to us at some point. So there has there has been the ability forever
- to declare someone gravely disabled
- You can do it. I can do it. And then once you do that then they can be detained by the system. Please
- the hospital. The legislation that just passed expanded or just went into effect expanded the definition
- of gravely disabled to include this. If a person is unhoused and if they are refusing to go to a shelter when
- conditions are dangerous such as a heat wave or too cold, then they can by definition be declared gravely
- disabled and detained by the police and then brought to the emergency department and then by the hospital.
- Who determines the level of which like the it is dangerous
- Is that defined somewhere like temperature over 90 or you know. No there's no definition. So it is.
- So who makes that decision. It's the individual police officer police officer or clinician. For example
- 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
- outside and you have threadbare clothes and you don't have a place to go so I want to pick you up. Before
- I could say look I really think you should stay and do everything I could to accommodate you so that
- you want to stay so that you don't go out
- and freeze to death, now I can say, no, I think that it's dangerous for you out there. I think the conditions
- are too harsh and you can't leave. So it puts a burden on us. And of course, I assume that the burden
- comes with the responsibility as well, but yeah. The community workers that are out, like are they going
- to be responsible for
- like holding folks accountable to this? Like our employees, the health department's employees? Not that
- I'm aware of right now, but I guess that'd be a good question for the attorney. Okay. We literally,
- it's just in the past week that this has come down to us. These are the effects of the new law. So I
- don't think anyone's had a chance to really digest it. We're still waiting to hear from our legal for the full
- Yeah I mean it's an interesting question for the board to you know obviously that's a an interesting
- position to put a someone in health care or in law enforcement to make that decision. And it is if you
- take it a step further to think well what if one of our community workers is out
- talking to people and see someone in really cold weather and doesn't say anything, and then that person
- ends up dying. Yeah. Are we, is the Board of Health liable for that? Because there's, you know, you
- would come back and document the conversation, right? And you didn't in dangerous situations, or they
- end up in the ER with frostbite or something. Yeah. What's the liability? That's an interesting question.
- To your comment earlier,
- That's crazy. I didn't know about that. Yeah. I wonder if they actually considered all the possible
- ramifications. Are you kidding? Dr. Ryderman. I was going to say it's the legislature. Of course they haven't.
- I'm just wondering if Dave is still here and how this matches. I assume something like that. Dave, what
- would you know about that? I'm sorry about about liability. The question on liability or? Yeah, I think the.
- Dr. Moore, I think, brought up an interesting point of the new legislation that allows medical personnel,
- law enforcement to deem someone, what was the term? Gravely disabled. Gravely disabled and force them
- to go to housing if they are unhoused, not allow them to leave, for instance, or force them to go to
- housing if they're refusing.
- you know, would you know, or what would your opinion be on liability for the board, for some of our
- community workers out talking to people in the community who, you know, maybe on a day where it is below
- zero or 100 degrees outside, and then that person ends up having a medical emergency because they are
- unhoused. Since someone of our employees,
- had that conversation, documented that conversation, and did not put that person in a place where they
- were safe, does that put the Board of Health at any liability for not acting on that? For the health
- department? For the health department? Well, if you're talking about government employees making those
- decisions, I don't believe that there would be any liability whatsoever.
- The failure to enforce the law or the making of a decision in good faith under an existing law were
- released from liability from that. And I think generally, there is no duty that I'm aware of to render
- aid to anybody.
- generally speaking. So I just don't see that as being something that would give rise to liability, certainly
- not to county employees, but to the public at large, I don't think there would be liability for failing
- to exercise that statute. OK, thank you. Thank you. But then again, you know, it's brand new and we'll
- just have to see how things shake out.
- Yeah. Sarah good good thought. Thank you for reminding us that we had Dave on the call. We just don't
- want to be the example. That's right. Yeah. As the first. Yeah. Yeah. Exactly. Any additional comments.
- I can't get it asking for comments. All right. Is there any further business for us to discuss or could
- I have a motion to adjourn.
- So moved. Second. Third. We're done. Very good. Thank you everybody.