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.