WEBVTT 00:00:00.386 --> 00:00:09.379 - It is 430 PM and I'm calling the August 20th, 2026 Board of Health meeting to order. If there is no 00:00:09.379 --> 00:00:18.462 - objection from the board, I would like to amend today's agenda to include an ARBA septic update from 00:00:18.462 --> 00:00:28.894 - Mike Kuzemka to the department update section before Lori's administration updates. Are there any objections? Okay. 00:00:30.146 --> 00:00:41.426 - Seeing none, we'll have that. Are there any other amendments that the board would like to put forward 00:00:41.426 --> 00:00:53.037 - at this time to the agenda? Okay. The next item is approval of the previous meeting minutes. The minutes 00:00:53.037 --> 00:00:59.230 - from the meeting on one moment. So it's that just from. 00:01:00.130 --> 00:01:10.216 - So from July twenty twenty six that you have in your packet have been. Are there any corrections or 00:01:10.216 --> 00:01:21.009 - additions or is there a motion to approve the minutes as districts? I'll make a motion to approve. Second. 00:01:21.009 --> 00:01:27.262 - All in favor? Aye. Aye. Meeting's approved. Minutes approved. 00:01:28.802 --> 00:01:36.020 - Next, we have general public comments, and I will read. The Monroe County Board of Health encourages 00:01:36.020 --> 00:01:44.595 - and welcomes public input. Written comments may be submitted at any time via email at boardofhealth at co.monroe.in.us. 00:01:44.595 --> 00:01:51.884 - During meetings, comments related to specific agenda items will be heard after the board's discussion 00:01:51.884 --> 00:01:54.814 - of that item and prior to taking a vote. 00:01:55.522 --> 00:02:02.815 - At this time, we would like to invite those who would like to comment on any non agenda items to speak. 00:02:02.815 --> 00:02:09.828 - For those attending in person, please sign in at the front of the room and those joining us online, 00:02:09.828 --> 00:02:16.840 - please use the raised hand feature to indicate you would like to provide comment. Each speaker will 00:02:16.840 --> 00:02:24.414 - have three minutes and we ask that you please begin by stating your name for the record. I do think we have 00:02:25.090 --> 00:02:36.198 - Do we have one person signed in or two? I'm sorry, yes, two. Okay, so we have two people signed in and 00:02:36.198 --> 00:02:46.982 - do we have anyone online so that I can go back and forth? Is there anyone with their hand? Okay, so 00:02:46.982 --> 00:02:52.158 - who do we have first on the sign-in sheet? Yes. 00:02:52.386 --> 00:02:58.462 - Yes. Do I stay here or do you want me somewhere different? This way. If you want to just stand. Whatever 00:02:58.462 --> 00:03:04.249 - is easier for you, it makes no difference. I'm going to be very quick. Where should I go? This way. 00:03:04.249 --> 00:03:10.094 - Sorry. Very briefly, hello everybody, and thank you for your service on the floor. It's a crazy time 00:03:10.094 --> 00:03:15.881 - in the verse, and it's important to work with you. My name is Terry Amsworth. My wife and I live in 00:03:15.881 --> 00:03:19.006 - Bloomington. I teach part time at IU with an adjunct. 00:03:19.138 --> 00:03:28.147 - And I'm here though to say a brief word about the Monroe County Health and Equity Council. Brief because 00:03:28.147 --> 00:03:36.899 - I have two minutes left. So it's sort of a cross-sector organization looking to help provide voice to 00:03:36.899 --> 00:03:45.822 - those who may not always be heard fully in health decisions and services in Monroe County environments. 00:03:45.822 --> 00:03:47.710 - And we threw out the, 00:03:48.002 --> 00:03:54.933 - Robert Wood Johnson funded Community Voices for Health Monroe County Grant back 2020-2023 era. And we're 00:03:54.933 --> 00:04:01.535 - now moving forward from there. There's a leadership team. We're doing bits of fundraising and a bit 00:04:01.535 --> 00:04:08.598 - involved in planning processes, including for the County Department of Health for health planning related, 00:04:08.598 --> 00:04:15.398 - and we'll do more of that. I'm here today, keenly though, to get to the main point. We held at the end 00:04:15.398 --> 00:04:17.246 - of last year, November 1st, 00:04:17.730 --> 00:04:23.687 - what we call our first porch party. The porch party is a way to help bring together people to identify 00:04:23.687 --> 00:04:29.703 - their health-related, we see health somewhat broadly, including social determinants of health and such, 00:04:29.703 --> 00:04:35.197 - to talk about their needs and interests. And it was done with the great support of United Way. 00:04:35.197 --> 00:04:38.494 - And by the way, Randy Rogers was on the leadership team. 00:04:38.754 --> 00:04:45.254 - Bob McCack hoped to be here today, but his schedule didn't allow. He'd probably be talking rather than 00:04:45.254 --> 00:04:51.565 - me. But this I wanted to give, and I think there are five members. Is that correct? I thought I had 00:04:51.565 --> 00:04:58.002 - five copies, but maybe I only have four. No, there's five. So if there's five members, I know paper's 00:04:58.002 --> 00:05:04.313 - bad. But nonetheless, what this is is a report of a write-up with some details of this porch party. 00:05:04.313 --> 00:05:08.478 - It was done in conjunction with Habitat. It was held at RCA Park. 00:05:08.738 --> 00:05:15.360 - It was done with support for children who used to be present and participate. It was done with Spanish 00:05:15.360 --> 00:05:21.853 - translations as well as needed. And it had about, as I recall, 60, 70 people there. Not a bad thing. 00:05:21.853 --> 00:05:28.410 - Public engagement is hard. Public engagement about health can be hard. This brought a bunch of people 00:05:28.410 --> 00:05:34.903 - out to talk about their needs, and this report documents that in some way. You have to get a read to 00:05:34.903 --> 00:05:36.446 - get to it a little bit. 00:05:37.282 --> 00:05:43.371 - Here's what we are. Here's the week about the box is done. But I give you that not because I'm going 00:05:43.371 --> 00:05:49.702 - to talk about it a lot. You can read it. Hopefully you can at least. But the cat can be an ally to help. 00:05:49.702 --> 00:05:55.730 - Gage voices and those are readers where you're looking for voices to be engaged. I encourage you to 00:05:55.730 --> 00:06:02.302 - look at it and think about how it can be helpful. There are health related planning processes from different 00:06:02.626 --> 00:06:10.964 - sectors and sources about to begin or thinking about deciding if they will in the strange world we live 00:06:10.964 --> 00:06:19.141 - in. And we're happy to be supported. I will say and wrap up that one of the things we're doing, we're 00:06:19.141 --> 00:06:27.158 - updating one of these publications. Your time is up. No, no, it's way too late. He was wrapping up. 00:06:27.158 --> 00:06:31.166 - Thank you. And thank you for bringing the report. 00:06:31.650 --> 00:06:44.217 - Thank you. Okay, and we have another person for public comment. One moment. There's no one online. Is 00:06:44.217 --> 00:06:56.660 - that correct? Yes. Okay. Please, will you introduce yourself? I regret having to come and spend your 00:06:56.660 --> 00:07:01.342 - time and my time to speak about this. 00:07:01.570 --> 00:07:07.461 - My name is Christina Kempf. I'm a former employee who resigned from my position as public health nurse 00:07:07.461 --> 00:07:13.295 - last month due to working conditions and the treatment I was receiving from the administrator and the 00:07:13.295 --> 00:07:19.415 - health officer. I worked at public health for close to 20 years. The last 10 here in the health department 00:07:19.415 --> 00:07:25.020 - as the parents coordinator, health educator, and for the last five months as public health nurse. 00:07:25.020 --> 00:07:27.422 - In 2022, I was awarded public health hero 00:07:27.650 --> 00:07:33.657 - from the Indiana Public Health Association after being nominated by our previous administrator. I share 00:07:33.657 --> 00:07:39.606 - this to provide context to my background, experience, and dedication in contrast to the concern I will 00:07:39.606 --> 00:07:45.787 - share. I've never been subjected to such a dismissive, unsupported, and at times unprofessional atmosphere 00:07:45.787 --> 00:07:49.310 - as my most recent time here. This is no reflection to staff. 00:07:50.306 --> 00:07:55.854 - I offer this information, not merely as another disgruntled former employee, but to provide insight 00:07:55.854 --> 00:08:01.569 - into possible reasons for high turnover that have plagued this department for the past few years. From 00:08:01.569 --> 00:08:07.172 - February until my time of departure, I was the only public health nurse on staff, except for briefly 00:08:07.172 --> 00:08:12.942 - another nurse who was in training that resigned, and for Kathy Hewitt, who thankfully took on TV during 00:08:12.942 --> 00:08:16.382 - a good portion of my time in addition to her role downstairs. 00:08:16.834 --> 00:08:22.639 - While I was performing my duties and managing multiple aspects of other nurse positions, I could not 00:08:22.639 --> 00:08:28.673 - understand why I was being treated so poorly. I was denied training opportunities critical to the safety 00:08:28.673 --> 00:08:34.477 - of my functions as a registered nurse, and I was denied time off requests that culminated in threats 00:08:34.477 --> 00:08:40.225 - of termination. I felt the need to involve HR in order to obtain approval of FMLA time to take care 00:08:40.225 --> 00:08:44.190 - of my mother whose health declined and passed away during this time. 00:08:44.322 --> 00:08:50.980 - officer who, months ago after meeting with HR, was barred from coming to my office or speaking to me 00:08:50.980 --> 00:08:57.309 - alone, simply continued the same behaviors in Lori's presence, who had no objections. It seemed 00:08:57.309 --> 00:09:04.495 - counterproductive to me to treat a dedicated employee with considerable experience, institutional knowledge, 00:09:04.495 --> 00:09:10.494 - lifelong interests of public health, and a desire to continue to learn new skills in a way 00:09:10.658 --> 00:09:15.993 - that I could conclude that it was only intended to encourage me to resign, therefore leaving Monroe 00:09:15.993 --> 00:09:21.381 - County with zero public health nurses. I was not willing to continue to be taken advantage of simply 00:09:21.381 --> 00:09:27.195 - because I was the only nurse willing to accept the impossible task of covering the duties of three positions 00:09:27.195 --> 00:09:32.583 - in the clinic with no adjustment in the expectation of what was involved that would be possible. Nor 00:09:32.583 --> 00:09:38.131 - was I willing to risk my license through potential needless vaccination errors that could occur without 00:09:38.131 --> 00:09:39.038 - proper training. 00:09:39.490 --> 00:09:45.242 - And I was not willing to be continued to be subjected to the type of treatment either I know any employee 00:09:45.242 --> 00:09:50.289 - who previously left on your kind of health department voluntarily or involuntarily deserved. 00:09:50.289 --> 00:09:55.824 - At some point, one has to begin to consider what were the actual problem lines. I truly hope, I truly 00:09:55.824 --> 00:10:01.251 - do hope the best for this department and success for the clinic for the sake of our residents, that 00:10:01.251 --> 00:10:07.166 - future nurses that are brought in can receive appropriate training to be competent in their assigned duties. 00:10:07.426 --> 00:10:13.663 - and that they and all employees can be treated with basic respect. A packet of important information 00:10:13.663 --> 00:10:20.023 - will be shared. I think that's you, Dr. Robinson. And I encourage all board members to at least review 00:10:20.023 --> 00:10:26.568 - the covered letter, which kind of details a lot more specifics and some of those things that I am sharing 00:10:26.568 --> 00:10:32.126 - here, along with emails that kind of support my position. I do thank you all for what you 00:10:32.802 --> 00:10:46.470 - offer to Monroe County and serving here on the boards. Thank you for your time and consideration. 00:10:46.470 --> 00:10:59.998 - Thank you. Thank you. The next item on our agenda is department updates and we'll start with the 00:11:00.482 --> 00:11:07.822 - ARPA septic update with model. For the ARPA septic program, it ends and systems have to be installed 00:11:07.822 --> 00:11:15.090 - and be built by September 30th this year. We have four remaining systems in various stages that are 00:11:15.090 --> 00:11:22.431 - in production or getting ready to begin production. So we're coming to the tail end of it. So on the 00:11:22.431 --> 00:11:23.230 - wastewater 00:11:23.330 --> 00:11:29.991 - We're just hoping for good weather right now so we can get those systems completed. I've already been 00:11:29.991 --> 00:11:36.586 - in contact with the homeowners and installers that if you don't think you can meet that deadline, we 00:11:36.586 --> 00:11:43.181 - need to terminate the contract and that money is going to be allocated somewhere else. And could you 00:11:43.181 --> 00:11:49.842 - speak just a little bit because we have an item to and a memorandum to discuss later on about some of 00:11:49.842 --> 00:11:52.062 - the challenges in getting. Those. 00:11:52.290 --> 00:11:57.983 - projects approved and all the working parts. And that may be, you know, Laurie's world to tell us that. 00:11:57.983 --> 00:12:03.567 - And, and so, because we have some funding that we had to return already to different departments. Um, 00:12:03.567 --> 00:12:09.151 - so we couldn't use all the funds. Um, just for the ARPA program, I mean, at first it started with the 00:12:09.151 --> 00:12:14.625 - application process and that began late 2024, like I'll say third or fourth quarter. That's when we 00:12:14.625 --> 00:12:18.238 - started getting the nuts and bolts of it together. And then some, 00:12:18.434 --> 00:12:25.311 - some systems weren't, I think one system got put in place into that in the end of 2024 because of the 00:12:25.311 --> 00:12:32.054 - weather. But in 2025 with weather conditions and whatnot, a lot of those projects got delayed until 00:12:32.054 --> 00:12:39.201 - 2026 this year, but some did get installed. But now with weather constructions, site restrictions, right? 00:12:39.201 --> 00:12:45.943 - Communicating with the homeowners, the contractors, the auditors, there's a lot of moving parts and 00:12:45.943 --> 00:12:47.966 - pieces to it and just getting 00:12:48.194 --> 00:12:54.832 - To the end stage and get it getting a proper invoice and fulfilling contract is it's been pretty rigorous 00:12:54.832 --> 00:13:01.282 - processing a lot of communications. So. Thank you so much. You're welcome. Does anyone have questions? 00:13:01.282 --> 00:13:07.920 - So, has the project overrun the expected time due to weather considerations? And if so, how's the weather 00:13:07.920 --> 00:13:10.174 - now? Compared to what was expected. 00:13:10.370 --> 00:13:16.016 - Every some every season is different. But like the weather is not looking good right now. We've gotten 00:13:16.016 --> 00:13:21.772 - rain all throughout this week. There's more rain coming this weekend. We just need them in certain sites 00:13:21.772 --> 00:13:27.746 - or they retain more water than other sites here in Monroe County whether it's the highlands or the lowlands. 00:13:27.746 --> 00:13:33.228 - So a lot of contractors believe they can get the systems in but it's still we need them days of dry 00:13:33.228 --> 00:13:39.422 - weather to get those systems in because they can't really begin the system installation without a soil test. So. 00:13:40.482 --> 00:13:46.524 - And the federal guidelines are pretty specific, so it has to be done by. There's a drop drop that dates 00:13:46.524 --> 00:13:52.392 - and speak. Yeah, yeah, that's the 930. So if you can't, they can't get it in or installed, installed 00:13:52.392 --> 00:13:58.551 - and built by 930. Unfortunately any work leading up to it. If you miss that deadline, you're not. There's 00:13:58.551 --> 00:14:04.419 - no back pay so. Yeah, then also with the installers, I'm a lot of. Installers that they're beginning 00:14:04.419 --> 00:14:09.822 - to work without like half payment in. So I mean they are not getting paid into the very end. 00:14:10.210 --> 00:14:17.305 - They have, they have limitations as well. So. Thank you so much. You're welcome so much. So look, how 00:14:17.305 --> 00:14:24.330 - many have been. Completely installed on the top of my head. I don't want to guess, but I can get you 00:14:24.330 --> 00:14:31.494 - those numbers. So. I can email like, or to help or I can send the Lori to get them out. So, yeah, just 00:14:31.494 --> 00:14:39.006 - so we have a sense of. Before remaining, but how many did we actually manage. To do to improve this is the. 00:14:39.426 --> 00:14:46.354 - Health and well-being of the county. I can get you guys those numbers tomorrow too. Thanks. This may 00:14:46.354 --> 00:14:53.282 - be futile, probably is, but is there anything that we can do as a Board of Health? We just need good 00:14:53.282 --> 00:15:00.690 - weather right now. As right now, we just need good weather. Get those systems in. I mean, because September 00:15:00.690 --> 00:15:07.550 - 30th is coming. We can take a boat. We can do a rain dance. No more rain dance. No more rain dance. 00:15:08.418 --> 00:15:19.681 - I don't know if that takes a resolution by the board. Thank you. You're welcome. Thanks. Our next update 00:15:19.681 --> 00:15:31.481 - is from Lori administration and we have. And OK, just to start off with vital records, the Indiana Department 00:15:31.481 --> 00:15:36.094 - of Health has completely stopped providing 00:15:36.290 --> 00:15:42.935 - the burial transit permit forms that we used to get from the state. So vital records is essentially 00:15:42.935 --> 00:15:49.846 - having to develop their own system for these forms, printing, distributing, and tracking these permits. 00:15:49.846 --> 00:15:56.624 - The system that they have in place so far is going smoothly without any issues, but that's one change 00:15:56.624 --> 00:16:03.403 - that they've been working on. The director and assistant director will be attending the Indiana Vital 00:16:03.403 --> 00:16:04.798 - Records Association. 00:16:04.898 --> 00:16:13.157 - ball conference that's going to be held in French like in October of this year. Year to date as of August 00:16:13.157 --> 00:16:21.104 - 18th vital records has had 81% of their customers who have been able to meet the health first Indiana 00:16:21.104 --> 00:16:28.895 - residency restrictions and the remaining 19% still has to be served by that non HFI funded employee 00:16:28.895 --> 00:16:30.142 - that they have. 00:16:32.130 --> 00:16:39.296 - We have recently interviewed 2 candidates for nursing positions. Neither candidate has moved forward 00:16:39.296 --> 00:16:46.887 - in the recruitment process at this time. 1 is just recently finished school and has not taken the obsidian 00:16:46.887 --> 00:16:53.982 - for licensure yet. And the other has concerns about a lack of a manager coming into the department. 00:16:54.818 --> 00:17:02.015 - But we currently have 60 open case investigations that need to be started. There's a total 00:17:02.015 --> 00:17:10.004 - of 108 investigations in the work list and the queue. So we have Kathy Hewitt is still continuing to 00:17:10.004 --> 00:17:17.913 - cover TB and the LTBI patients assisting with our cyclospora cases, assisting with additional cases 00:17:17.913 --> 00:17:24.478 - when time permits. Lenea is helping with our lead case management. Mike is doing a 00:17:24.834 --> 00:17:34.377 - a great job with the animal bites and the tick-borne illnesses, so helping to relieve some of that from 00:17:34.377 --> 00:17:43.553 - the work list. The cases that we have currently, the new 108, what you're describing is included in 00:17:43.553 --> 00:17:53.005 - that? Yes. OK. So the 108, so there's 60 that have not been started as of today. Of that 108, the rest 00:17:53.005 --> 00:17:54.014 - remaining, 00:17:54.114 --> 00:18:00.147 - are being worked on. So some of those you just worked on continually over time. Maybe you have to try 00:18:00.147 --> 00:18:06.358 - to reach back out to a patient because you couldn't connect with them the first time. If there's someone 00:18:06.358 --> 00:18:12.864 - who on medication, so those are just stay kind of active until they can be closed out. The Indiana Department 00:18:12.864 --> 00:18:18.838 - of Health is actually the one that then will review a lot of those cases and then close them out. So 00:18:18.838 --> 00:18:21.086 - there are ones that stay open because 00:18:21.730 --> 00:18:29.379 - there's periodic check-ins or it's being waited on for the state to review. Does that help? Do we have 00:18:29.379 --> 00:18:36.953 - these staff members who are able to start working on the 60 cases? We really don't have the capacity. 00:18:36.953 --> 00:18:44.454 - They're trying to little by little work on those high priorities. So the high priority cases, we get 00:18:44.454 --> 00:18:49.726 - notification to begin working on those. Some of the lower level cases, 00:18:50.242 --> 00:18:58.468 - are just sitting there until we're able to get capacity and to start working on those. Monroe County 00:18:58.468 --> 00:19:06.775 - has had a total of eight cyclist forward cases since May 1st of this year. Statewide, there have been 00:19:06.775 --> 00:19:14.919 - over 2,000 cases. Moving into the maternal child health, our coordinator currently has eight active 00:19:14.919 --> 00:19:19.806 - participants in the quit for two smoking cessation program. 00:19:19.970 --> 00:19:28.006 - Six of those are prenatal and two are postpartum. She's distributed 154 bottles of the donor breast 00:19:28.006 --> 00:19:36.042 - milk since April. So that program with the milk bank is continuing to be successful and busy. She's 00:19:36.042 --> 00:19:44.238 - gonna be partnering with the Bloomington Mobile Integrated Health on September 25th. They're gonna be 00:19:44.238 --> 00:19:47.774 - hosting a car seat safety inspection clinic 00:19:48.226 --> 00:19:57.002 - This will be held from 3 to 6 PM. And in addition to the safety checks, they will have car seats available 00:19:57.002 --> 00:20:05.614 - if they have a family that arrives and it's damaged expired. The child has outgrown that type or weight. 00:20:05.614 --> 00:20:12.094 - And these car seats will be coming from the state's automotive safety program. 00:20:13.378 --> 00:20:21.435 - I'm here in the health department. We have seen an increase in referrals from the Hanna Center and tandem 00:20:21.435 --> 00:20:29.188 - just due to supply. So we're able to provide those families in need with car seats so they still have 00:20:29.188 --> 00:20:37.017 - access to those resources. So we've seen an increase in the ones that we are distributing. She's going 00:20:37.017 --> 00:20:43.326 - to be starting the goal program. So that's the get on board active living program. 00:20:43.522 --> 00:20:51.563 - This is in collaboration with Indiana University. This goes from September 15th to November 10th, and 00:20:51.563 --> 00:20:59.840 - from six to 7.30 PM at the Bannetburg Community Center. This is a free program. It's families, children, 00:20:59.840 --> 00:21:07.803 - age seven, with children, age seven to 17. And the families have children that are younger to seven. 00:21:07.803 --> 00:21:11.902 - Child care is available at the center on site while 00:21:12.002 --> 00:21:19.952 - the program sessions occur. Essentially, during the nine weeks, families participate in interactive 00:21:19.952 --> 00:21:28.300 - games, hands-on cooking demonstrations, taste tests, and then they're able to learn about food, physical 00:21:28.300 --> 00:21:36.568 - activities, sleep, and building a positive self-image. Our disease intervention and harm reduction team 00:21:36.568 --> 00:21:40.702 - are still doing drop-in testing on Thursdays from 6 00:21:40.962 --> 00:21:47.500 - three to six PM. They're seeing at least four different people at each session. So continuing to go 00:21:47.500 --> 00:21:54.627 - well, they're also able to bring in patients who might not, they might not be able to connect with otherwise 00:21:54.627 --> 00:21:58.942 - during these drop in times, which is helping with their workload. 00:22:00.194 --> 00:22:09.433 - They are going to be attending Pride Fest on August 22nd and two different IU Welcome Week events providing 00:22:09.433 --> 00:22:18.586 - educational materials, supplies, and promoting free services. On September 26th, we'll be offering testing 00:22:18.586 --> 00:22:27.397 - at the Brown County Pride and offering pre-testing October 3rd at the Spencer Pride. Specifically with 00:22:27.397 --> 00:22:28.766 - harm reduction, 00:22:29.090 --> 00:22:37.466 - They have had 34 participants for the HIV and HCV wrapping testing services in one month. This is the 00:22:37.466 --> 00:22:45.677 - highest amount of people who have been tested in a single month for the entire duration of the harm 00:22:45.677 --> 00:22:53.314 - reduction program. So far this year, nine new hepatitis C cases have been identified through 00:22:53.314 --> 00:22:57.502 - these pre-testing services. They are continuing to 00:22:57.634 --> 00:23:04.842 - work on the Narcan Behind Every Bar program with the City of Bloomington, so that's going well. They're 00:23:04.842 --> 00:23:11.980 - now allowing local businesses to have individually scheduled trainings for Naloxone for staff members. 00:23:11.980 --> 00:23:18.910 - NYX is the next business scheduled for training in September, and Liberty Bird is in the process of 00:23:18.910 --> 00:23:19.742 - scheduling. 00:23:22.114 --> 00:23:29.908 - Our preparedness director and coordinator are scheduling back to school vaccination events in collaboration 00:23:29.908 --> 00:23:36.547 - with the Indiana Department of Health. These will be held at the libraries in mid September 00:23:36.547 --> 00:23:43.764 - and a drive-through event in late September. They have distributed public health emergency supplies 00:23:43.764 --> 00:23:51.774 - to 76 individuals in August so far. This includes the three-in-one flu and COVID tests and summer safety kits. 00:23:51.874 --> 00:23:59.720 - that include a small sunscreen, cooling cloth, tick remover, and informational card, and other safety 00:23:59.720 --> 00:24:07.413 - educational materials. And they are preparing for an upcoming local emergency planning committee, a 00:24:07.413 --> 00:24:15.105 - functional exercise event that's going to be held in September. And I do have a presentation that I 00:24:15.105 --> 00:24:21.182 - want to go through next. If there aren't any questions about this information. 00:24:22.498 --> 00:24:33.673 - question about the burial the very beginning yes is our form in coordination with our surrounding counties 00:24:33.673 --> 00:24:44.640 - since we often have cross county burial issues that i do not know so i was just learning trying to learn 00:24:44.640 --> 00:24:51.742 - more about this today um and i don't haven't seen the form that the 00:24:52.066 --> 00:25:00.247 - permit that they've actually developed and how that compares to other counties. But I certainly asked 00:25:00.247 --> 00:25:08.349 - about that. What's the consistency? I know that we have bodies that come here or have to go to bring 00:25:08.349 --> 00:25:17.011 - our funeral directors are going across county lines and it just for a sense of ease and their understanding 00:25:17.011 --> 00:25:21.182 - would be great for it to be coordinated regionally. 00:25:21.634 --> 00:25:38.857 - Or at least on our little tongue. Thanks. Any other questions? Do you have that? Do you have that? Okay. 00:25:38.857 --> 00:25:48.862 - So I know there's a lot on the agenda. I'll try to be brief. 00:25:52.290 --> 00:26:01.010 - Okay. So I just wanted to take some time to have a discussion about the nursing services. So in working 00:26:01.010 --> 00:26:09.478 - on gathering information, I decided to first start with taking time to gather some employee feedback 00:26:09.478 --> 00:26:17.694 - on the different divisions that we currently have in the department and how they are functioning. 00:26:17.826 --> 00:26:25.134 - So these first question, what challenges would your division experience without a defined management 00:26:25.134 --> 00:26:32.588 - structure or manager overseeing division operations? The feedback here to this question has identified 00:26:32.588 --> 00:26:40.258 - a lack of structure, direction, and accountability as significant challenges without a defined management 00:26:40.258 --> 00:26:41.054 - structure. 00:26:42.498 --> 00:26:51.074 - Employees also express concern that without a manager with division specific knowledge and authority, 00:26:51.074 --> 00:26:59.649 - there are unclear expectations about roles and who to lean on for division specific guidance. I won't 00:26:59.649 --> 00:27:09.150 - read off each of the individual feedback. The next question, what are the benefits to having a division manager? 00:27:09.890 --> 00:27:17.102 - The feedback to this question consistently identified a division manager as the important source of 00:27:17.102 --> 00:27:24.818 - leadership, structure, accountability, and expertise. Employees expressed how a dedicated manager provides 00:27:24.818 --> 00:27:32.030 - a clear point of contact when they have questions, when they need guidance, or for decision making. 00:27:35.010 --> 00:27:42.135 - How could public health and community safety be impacted without a division manager? These responses 00:27:42.135 --> 00:27:49.543 - seem to highlight concerns that the absence of a division manager could directly affect the department's 00:27:49.543 --> 00:27:56.597 - ability to respond effectively to public health needs. Employees emphasize the importance of having 00:27:56.597 --> 00:28:03.934 - a qualified leader available to provide timely guidance, coordination, and support for decision-making. 00:28:04.930 --> 00:28:14.110 - One experience back in COVID in a pod identified an example of how the absence of a designated leader 00:28:14.110 --> 00:28:23.200 - creates confusion when unexpected situations arise. I want to lead this into what I am proposing for 00:28:23.200 --> 00:28:28.510 - a case for sequenced hiring plan for the nursing services. 00:28:29.090 --> 00:28:36.530 - Um, I feel that the recommended hiring plan should include first starting with securing that health 00:28:36.530 --> 00:28:44.043 - services director as the anchor of the manager of our health services. Then moving into the clinical 00:28:44.043 --> 00:28:51.557 - assistant and public health nurses. And then moving into developing and requesting the creation of a 00:28:51.557 --> 00:28:53.566 - nurse supervisor position. 00:28:56.130 --> 00:29:03.229 - So what I'm proposing is phase one, hiring the health services director. So building clinical nursing 00:29:03.229 --> 00:29:10.259 - services without an established manager creates a really significant gap between hiring nurses and a 00:29:10.259 --> 00:29:17.706 - clinical assistant and having the infrastructure necessary to ensure that staff are prepared and competent 00:29:17.706 --> 00:29:24.318 - to practice within the local health department scope of services. The health services director 00:29:24.450 --> 00:29:33.167 - really be establishing the foundation. So continuing into phase one, some of those initial responsibility 00:29:33.167 --> 00:29:41.473 - course, they would have to complete the required trainings through the Indiana Department of Health, 00:29:41.473 --> 00:29:50.190 - develop what competency validation processes they're going to use to train, evaluate, do skills checkoffs 00:29:50.190 --> 00:29:53.726 - with the nurses and the medical assistant. 00:29:54.466 --> 00:30:02.415 - refine clinical documentation standards, lead recruitment and selection of nurses and a clinical assistant. 00:30:02.415 --> 00:30:10.070 - I really feel here in the department when we have managers of divisions and there's vacancies that they 00:30:10.070 --> 00:30:17.873 - are able to take ownership and review the candidates, perform those interviews and select the individuals 00:30:17.873 --> 00:30:24.350 - that they feel are best for their team. Starting with having a health services director 00:30:24.802 --> 00:30:32.602 - this person would then be able to lead the recruitment of the nurses and the clinical assistant to build 00:30:32.602 --> 00:30:40.030 - that strong team unit. Of phase two, build the nursing services team. So the purpose of this hiring 00:30:40.030 --> 00:30:47.459 - structure really is to establish safe, organized and sustainable nursing services within the health 00:30:47.459 --> 00:30:48.350 - department. 00:30:48.898 --> 00:30:56.554 - So rather than simply filling positions, the health department can ensure that every nurse receives 00:30:56.554 --> 00:31:04.133 - competency validation, clear escalation pathways for medical issues and concerns, ongoing clinical 00:31:04.133 --> 00:31:12.478 - performance feedback, and access to appropriate clinical management. The public health nurse training period 00:31:12.610 --> 00:31:19.820 - during weeks one through three is really focused on mandatory trainings. We've been using a six weeks 00:31:19.820 --> 00:31:27.031 - training period that's primarily, it's really just been focused on online trainings. They don't have, 00:31:27.031 --> 00:31:34.524 - have not had the hands-on training experience without a nurse supervisor or nurse director to do hands-on 00:31:34.524 --> 00:31:41.310 - training. While this is going on, the health services director would still be actively engaged. 00:31:41.506 --> 00:31:48.630 - support the nurses with that hands-on training, ensure trainings are being completed timely to meet 00:31:48.630 --> 00:31:56.323 - target timelines, being able to use validation tools and skills assessment, and then leading and finalizing 00:31:56.323 --> 00:32:03.589 - the hiring process to onboard a clinical assistant. So some examples for weeks one through three with 00:32:03.589 --> 00:32:09.502 - the clinical assistant, reviewing with the health services director, the workflow. 00:32:10.050 --> 00:32:18.330 - learning and training on church vaccine program management all of our different systems scheduling clinical 00:32:18.330 --> 00:32:26.150 - supply management clinical activities within their scope emergency procedures and opening and closing 00:32:26.150 --> 00:32:27.070 - procedures. 00:32:30.754 --> 00:32:37.675 - So during this time, that also really allows for that one-on-one collaboration with the health services 00:32:37.675 --> 00:32:44.463 - director and clinical assistant. So they can begin forming a strong team to test workflow options, to 00:32:44.463 --> 00:32:51.184 - identify gaps and inefficiencies, be able to refine processes that are needed and develop consistent 00:32:51.184 --> 00:32:52.382 - support routines. 00:32:56.002 --> 00:33:03.960 - Moving into the end of the week three into phase four, be able to bring the nursing team together. So 00:33:03.960 --> 00:33:12.073 - this really is just about now, how can the team begin to continue their training, learning, and working 00:33:12.073 --> 00:33:20.421 - with one another? They can begin applying skills as applicable to their scope as their training continues. 00:33:20.421 --> 00:33:25.726 - They can participate in mock trainings in the clinical environment. 00:33:26.114 --> 00:33:35.407 - begin doing some of the additional trainings that are needed to really get up to speed with skills and 00:33:35.407 --> 00:33:44.791 - competency. And once the nurses complete the mandatory trainings, the health services director can then 00:33:44.791 --> 00:33:54.174 - begin to transition the team into the local health department, orientation and clinical implementation. 00:33:55.426 --> 00:34:03.310 - So some of the ideas for specific tasks to begin those local health department specific orientations 00:34:03.310 --> 00:34:11.585 - for patient care, review the nursing policies and procedures workflows or hands on training and establish 00:34:11.585 --> 00:34:20.094 - individual clinic responsibilities within this team unit. Phase five transitioning into clinical operations. 00:34:21.282 --> 00:34:29.022 - With orientation and competency completed, the department can then transition into more routine nursing 00:34:29.022 --> 00:34:36.688 - operations. The health services director can move towards overseeing and strengthening the established 00:34:36.688 --> 00:34:44.428 - system. Here's just a recommended staffing philosophy that really needs to start with building a strong 00:34:44.428 --> 00:34:48.670 - managerial foundation with the health services director. 00:34:49.058 --> 00:34:57.195 - Then bringing on the nurses, the clinical assistant for training, building clinical support, building 00:34:57.195 --> 00:35:05.730 - the team together, establishing competency and timeframes for launching services, sustainable supervision, 00:35:05.730 --> 00:35:13.707 - and approval of a nurse supervisor position in the future, I think is also going to be key for just 00:35:13.707 --> 00:35:18.334 - long-term success within this division. If we are able to 00:35:18.466 --> 00:35:26.167 - gain approval of a nurse supervisor position, then a transition can occur between the health services 00:35:26.167 --> 00:35:34.095 - director and that nurse supervisor. So here's just an image of that long-term staffing model, the health 00:35:34.095 --> 00:35:41.720 - services director, some of it is on the board, the nurse supervisor, three public health nurses, and 00:35:41.720 --> 00:35:45.118 - one clinical assistant. So this model places 00:35:45.250 --> 00:35:53.133 - an RN supervisor so there is someone overseeing those day-to-day clinical and operational duties and 00:35:53.133 --> 00:36:00.939 - can be a support system for the nursing team that's readily available and they are participating in 00:36:00.939 --> 00:36:08.744 - the clinics. The long-term vision is a health services director and nurse supervisor staffing model 00:36:08.744 --> 00:36:14.910 - that can oversee nursing services and really establish a sustainable division. 00:36:15.810 --> 00:36:24.237 - This will allow the health services director to then function at their appropriate level of leadership. 00:36:24.237 --> 00:36:32.908 - And the nurse supervisor can then become that link between the division leadership and then that frontline 00:36:32.908 --> 00:36:41.254 - service delivery. The director can move into providing that broader direction and the nurse supervisor 00:36:41.254 --> 00:36:45.630 - can then translate that into daily operations. So why 00:36:46.402 --> 00:36:54.156 - is an RN supervisor important? I believe one of the strongest reasons for the department to focus on 00:36:54.156 --> 00:37:02.524 - developing this RN nurse supervisor is to ensure day-to-day clinical safety and compliance. An RN supervisor 00:37:02.524 --> 00:37:10.201 - would provide daily supervision and support. We bring in LPNs and medical assistants. Those are the 00:37:10.201 --> 00:37:15.038 - people handling immunizations, communicable disease. This will 00:37:15.682 --> 00:37:24.441 - When a need arises, they'll essentially have someone there who can recognize and step in. So just try 00:37:24.441 --> 00:37:33.115 - to provide some brief examples of how situation can escalate. So incorrect vaccine documentation. If 00:37:33.115 --> 00:37:41.789 - you have a nurse, they administer a VFC vaccine. The vaccine information is entered incorrectly into 00:37:41.789 --> 00:37:43.678 - the patient's record. 00:37:43.842 --> 00:37:51.441 - Um, many things could occur if you don't have someone who is directly oversee these operations and like 00:37:51.441 --> 00:37:58.821 - the nurse supervisor, then. It could be a long time before it's recognized or realized and then able 00:37:58.821 --> 00:38:01.086 - to be corrected in the system. 00:38:03.714 --> 00:38:12.512 - a vaccine storage temperature excursion. So we have a maternal child health coordinator taking temperature 00:38:12.512 --> 00:38:21.393 - logs identifies that it's outside the appropriate range. There's a vacancy in the health services director. 00:38:21.393 --> 00:38:28.958 - There's no nurse supervisor. And then who does that person go to? So just in this scenario, 00:38:29.314 --> 00:38:37.815 - be trying to go to me and I'm out of the office. The other point contact person is also out of the office, 00:38:37.815 --> 00:38:46.157 - leading to a situation of who do we go to next because that person does not have a manager or supervisor 00:38:46.157 --> 00:38:50.686 - to go to. A patient fainting. You could have two nurses, 00:38:50.818 --> 00:38:57.546 - They've completed their online trainings. They don't have an RN supervisor. They didn't receive any 00:38:57.546 --> 00:39:04.477 - hands-on training. They didn't have an official review by an RN supervisor. So say nurse C administers 00:39:04.477 --> 00:39:11.474 - the vaccine, the patient falls out of the chair. They try to call out for help. The other nurse decided 00:39:11.474 --> 00:39:15.646 - to take an early lunch. There's no one else in the clinic and 00:39:16.098 --> 00:39:24.251 - Essentially, without the supervisor, the nurses were left to try to rely on one another. A needle stick, 00:39:24.251 --> 00:39:32.093 - a blood fluid exposure. This could be an example of the clinical assistant sustaining a needle stick 00:39:32.093 --> 00:39:40.012 - injury. Not sure about what to do. They don't have a supervisor immediately available to go to. Maybe 00:39:40.012 --> 00:39:45.758 - they're uncertain. They don't know whether the incident is urgent or not. 00:39:45.986 --> 00:39:52.829 - Maybe no without that supervisor there in the space with them, whether they should continue patient 00:39:52.829 --> 00:39:59.672 - care or leave the patient to determine what they should do next for their injury. Managing multiple 00:39:59.672 --> 00:40:06.720 - tasks and responsibilities. You have a clinical assistant who might be rooming patients, answering the 00:40:06.720 --> 00:40:14.590 - phone, trying to cover walk-ins, cleaning rooms. They need to take a patient down the hall to file records to pay. 00:40:15.074 --> 00:40:22.569 - And the other nurses are busy doing other tasks, clinical assistants overwhelmed, not sure what to do. 00:40:22.569 --> 00:40:30.355 - You have an RN supervisor there. They can step in and provide real time assistance to then begin directing 00:40:30.355 --> 00:40:37.923 - what to do next and help assist. You could have two nurses who know about work, but there's not anybody 00:40:37.923 --> 00:40:44.254 - to coordinate it. So perhaps employees are aware there's multiple high priority tasks. 00:40:44.674 --> 00:40:53.548 - Some tasks are missed. It's not because they don't care or they don't know. They don't have a designated 00:40:53.548 --> 00:41:02.507 - supervisor who's coordinating clinical and operational priorities on a day-to-day basis. An RN supervisor 00:41:02.507 --> 00:41:11.804 - can step in to identify, prioritize, assign, follow up, and verify. So bringing in long-term an RN supervisor 00:41:11.804 --> 00:41:12.734 - would help 00:41:12.898 --> 00:41:21.206 - cover clinical oversight and operational oversight. Without an RN supervisors, we know that responsibilities 00:41:21.206 --> 00:41:29.286 - don't disappear. They're simply being distributed informally among employees who don't have the authority 00:41:29.286 --> 00:41:37.289 - training or designated responsibility to necessarily perform them. An RN supervisor is an organizational 00:41:37.289 --> 00:41:40.414 - safety net, might not be highly visible, 00:41:40.578 --> 00:41:47.959 - if things are functioning well or appropriately, but it's certainly going to become apparent when something 00:41:47.959 --> 00:41:54.931 - unexpected happens. It's not about whether nursing services can operate without an RN supervisor. The 00:41:54.931 --> 00:42:02.107 - question really is when something goes wrong, who's responsible for recognizing the problem, determining 00:42:02.107 --> 00:42:08.190 - the response, directing staff, escalating the issue and ensuring the matter is resolved. 00:42:09.794 --> 00:42:18.453 - Currently there is a gap and that's one of the reasons why I think that it's really important to consider 00:42:18.453 --> 00:42:27.112 - building in an RN supervisor to this health services division. Just to briefly kind of circle back around 00:42:27.112 --> 00:42:34.709 - to why, so why were three different positions, the public health nurse communicable disease, 00:42:34.709 --> 00:42:39.774 - school liaison, and then just our general public health nurse 00:42:40.002 --> 00:42:47.627 - created. So these are three slightly different positions. They have different titles, but this allowed 00:42:47.627 --> 00:42:55.769 - the creation of primary, secondary and backup duties to have more clearly defined roles and responsibilities. 00:42:55.769 --> 00:43:03.246 - The case for clearly defined roles and responsibilities. This is really about accountability, having 00:43:03.246 --> 00:43:08.798 - a predictable workflow and a mechanism for resolving competing priorities. 00:43:09.602 --> 00:43:16.817 - Can't really expect nurses who are expected to see what needs to be done and work out priorities among 00:43:16.817 --> 00:43:24.101 - themselves. That can appear flexible and team focused, collaborative, but it really creates an informal 00:43:24.101 --> 00:43:31.316 - system where responsibility, authority and accountability is unclear. Shared responsibility could lead 00:43:31.316 --> 00:43:38.110 - to no responsibility. If all three nurses are responsible for everything, it creates issues with 00:43:38.434 --> 00:43:46.868 - determining who is responsible for actually completing what task. You could have all three nurses who 00:43:46.868 --> 00:43:55.385 - they may have aligned thoughts or they might just be working on their own and it just lead to an issue 00:43:55.385 --> 00:44:03.902 - of lack of clarity. A staff should not have to negotiate priorities while also providing patient care. 00:44:04.610 --> 00:44:11.049 - You have three nurses working on different priorities. You have an unscheduled patient walks in. Each 00:44:11.049 --> 00:44:17.614 - nurse probably feels that their current task is important. However, without a supervisor, they now have 00:44:17.614 --> 00:44:23.927 - to negotiate amongst themselves. Who's going to stop what they're doing? Whose task is more urgent? 00:44:23.927 --> 00:44:30.744 - Who's going to finish the work that got interrupted? Who has the authority among them to make the decision? 00:44:30.744 --> 00:44:32.638 - And what should be postponed? 00:44:33.282 --> 00:44:40.986 - Expecting nurses to continually determine among themselves what is most important places and additional 00:44:40.986 --> 00:44:48.838 - management responsibility on clinical staff where a dedicated supervisor can be that independent decision 00:44:48.838 --> 00:44:56.615 - maker who can say which nurse handles the patient and the remaining work. For example, that's management 00:44:56.615 --> 00:45:03.134 - and it's not something that should have to be routine routinely negotiated among peers. 00:45:03.490 --> 00:45:12.228 - This presentation is good, but it sounds like you're trying to convince us. Are you practicing this 00:45:12.228 --> 00:45:20.965 - for someone else? This needs presented really, I think, to the commissioners. We need to get out of 00:45:20.965 --> 00:45:29.703 - the schedule and just do a presentation and also for the council. I don't think there's anyone here 00:45:29.703 --> 00:45:32.062 - that needs to be convinced 00:45:32.354 --> 00:45:40.704 - that this isn't a good plan and that nurses play an important role. I mean, even nurse supervise your 00:45:40.704 --> 00:45:48.972 - position. At least I see the logic in this. But I don't think we need to be convinced of this. But I 00:45:48.972 --> 00:45:57.158 - think this should be done as a presentation to someone in authority. And the final question I have, 00:45:57.158 --> 00:45:59.614 - how realistic is this that we 00:46:00.546 --> 00:46:09.490 - we can implement this in the current environment. That's why I really feel like without using the staffing 00:46:09.490 --> 00:46:18.017 - agency to bring in that director first. So we have a staffing agency recruiting. They know people who 00:46:18.017 --> 00:46:26.877 - are qualified can come in. They have that background experience to be able to get that foundation settled 00:46:26.877 --> 00:46:28.382 - to then have that 00:46:28.706 --> 00:46:37.569 - point person and that support to then bring in their team. And that's really a lot of the feedback that 00:46:37.569 --> 00:46:46.092 - we've been getting from some of the applicants and some of the nurses. We don't have that person to 00:46:46.092 --> 00:46:54.614 - go to. Then that's really important, especially for that direct clinical work and for the hands on. 00:46:54.614 --> 00:46:56.830 - I'm almost done. I don't. 00:46:57.538 --> 00:47:06.748 - Um, but I think in part with this, I, I want to make sure that, um, are we aligned on a strategy? Um, 00:47:06.748 --> 00:47:15.778 - and for what we think should be the steps being taken. Um, and the importance really of that public 00:47:15.778 --> 00:47:24.446 - health nurse supervisor, if you look at our other divisions and they have that middle line, um, 00:47:24.770 --> 00:47:36.735 - senior or assistant director and that helps provide that extra layer of day-to-day support, backup coverage 00:47:36.735 --> 00:47:47.924 - and protection in my mind to the health department. Yes. So that's a great presentation. Did you, is 00:47:47.924 --> 00:47:51.358 - this sort of some standardized 00:47:52.066 --> 00:47:59.155 - presentation or something that you've sort of developed in Oval? So I've been developing it, just kind 00:47:59.155 --> 00:48:06.381 - of trying to piece together over time, like what are some of the different strategies? So if we've tried 00:48:06.381 --> 00:48:13.400 - bringing in nurses without that support system, we know that that hasn't worked well. So what are the 00:48:13.400 --> 00:48:16.222 - different, what are the, what's the next 00:48:16.770 --> 00:48:24.897 - phase that you can try to really be able to create a stronger foundation. And then that's what I think 00:48:24.897 --> 00:48:32.946 - is just taking time to say, I don't really think this is going to work with until we get those levels 00:48:32.946 --> 00:48:41.388 - of supervision in there. So when looking at the board here, I have trouble with recognizing what's written 00:48:41.388 --> 00:48:45.886 - because I have color blindness. So is that very top one? 00:48:46.210 --> 00:48:54.303 - HSD, that's what we're talking about. That's the position, right? Yes. So that is our currently approved 00:48:54.303 --> 00:49:02.164 - vacant health services director. I want to verify that. So we do have approval, but we don't have the 00:49:02.164 --> 00:49:10.334 - candidates. So we have candidates. We have interviewed candidates once they learn the scope that changes. 00:49:10.334 --> 00:49:15.806 - And we have candidates through a staffing agency, through the emergis. 00:49:16.194 --> 00:49:23.309 - to come into that role. Yes, the emeritus spiel in our. Yeah, correct me if I'm wrong though. What you've 00:49:23.309 --> 00:49:30.155 - got written there. The difference is here in this proposal. We have the health services director with 00:49:30.155 --> 00:49:36.934 - these three nurses directly reporting position. She's talking about is in the middle is what there's 00:49:36.934 --> 00:49:43.847 - a public health supervisor and a clinical assistant which we don't have. No, we do. We didn't get this 00:49:43.847 --> 00:49:45.726 - nurse. We did get that one. 00:49:45.826 --> 00:49:54.506 - Yes, but we don't have anyone for the clinical assistant to be supervised under or by or or trained 00:49:54.506 --> 00:50:03.534 - or or go to. And so for similar and also different reasons, the public health nurse focused on maternal 00:50:03.534 --> 00:50:12.649 - child health. That's similar in that our maternal child health coordinator doesn't have a support person 00:50:12.649 --> 00:50:15.166 - to go to. There's no backup. 00:50:15.522 --> 00:50:22.689 - capacity. So there are programs that at the beginning of Health First Indiana, she received training, 00:50:22.689 --> 00:50:29.927 - we got the program materials, that was all part of the process of building the new position for Health 00:50:29.927 --> 00:50:36.954 - First Indiana, but those haven't been able to be implemented because there's just not capacity. I'm 00:50:36.954 --> 00:50:44.894 - probably the only colorblind, red-green colorblind person in the room. If we could get that, if we could get the 00:50:44.994 --> 00:50:52.221 - like a bright blue and a yellow. Okay. Cause right now I see two colors. I see black and then I see 00:50:52.221 --> 00:50:59.592 - some other not black, but I can't tell the difference. And it makes it difficult for me to understand 00:50:59.592 --> 00:51:06.891 - that what's filled and what isn't. Okay. So let's see. So, um, we said this is vacant. Yeah. We hear 00:51:06.891 --> 00:51:12.094 - positions are vacant. Yeah. Clinical assistant. This is vacant, but we, 00:51:12.866 --> 00:51:19.555 - don't have, we haven't included this in the grant. They just moved to the nursing, so we don't have 00:51:19.555 --> 00:51:26.378 - grants. So that's, we're not trying to actively fill that. We're also not actively trying to fill the 00:51:26.378 --> 00:51:33.535 - senior community health specialist for the tobacco MRC. The tobacco MRC duties got moved into two separate 00:51:33.535 --> 00:51:38.686 - positions. The tobacco was moved into the maternal child health coordinator. 00:51:38.818 --> 00:51:46.815 - The MRC was moved into our director of public health preparedness. The senior community health specialist 00:51:46.815 --> 00:51:54.510 - those duties was helping a lot with the community health assessment accreditation and harm reduction. 00:51:54.510 --> 00:52:02.356 - So we haven't been actively don't have approval to fill that. That work is being done by our population 00:52:02.356 --> 00:52:08.542 - health and outreach. But this is still the master plan. We hope to be able if we. 00:52:08.770 --> 00:52:16.776 - All right, we're going to fill all the spots then we have these positions. This is what I can envision. 00:52:16.776 --> 00:52:24.859 - Could we change one of those two colors to the blue instead of whatever it is? Yeah. Or could you simply 00:52:24.859 --> 00:52:32.634 - circle the ones that have not been approved that Michael also? That's great. Yeah. The blue there is 00:52:32.634 --> 00:52:37.022 - really good. That I can see. So let me ask the question. 00:52:37.602 --> 00:52:45.959 - Just so we're clear, I'm also in support of this. But the question that comes to my mind immediately 00:52:45.959 --> 00:52:54.233 - is, as on this paper, the only issue I would have is explain to me why the health services director 00:52:54.233 --> 00:53:02.506 - cannot do everything you just described as it is on this page with the three nurses. Because to me, 00:53:02.506 --> 00:53:03.582 - I feel like, 00:53:03.810 --> 00:53:10.445 - That's one person that person is checking that's a nurse. Why can that person not be the backup, 00:53:10.445 --> 00:53:17.422 - the trainer, the quarterback, all of those things that you're proposing the public health nurse do is 00:53:17.422 --> 00:53:24.399 - I feel like that's the hurdle you're going to have to jump to convince that we need funding for this. 00:53:24.399 --> 00:53:27.614 - Why does it have to be two separate positions? 00:53:27.842 --> 00:53:36.444 - Um, so for a couple, so the health services director position was originally created. When we were not 00:53:36.444 --> 00:53:44.795 - doing the nursing services that we've absorbed from health, so that position was already overseeing 00:53:44.795 --> 00:53:53.230 - responsible for overseeing the other areas, the other programs once we knew that we were going to be 00:53:53.230 --> 00:53:57.406 - taking on the health services, those duties that. 00:53:57.666 --> 00:54:04.945 - were being covered by their RN supervisor that in essence got lumped into and our nurses got lumped 00:54:04.945 --> 00:54:12.369 - into this director role. So the old way would have been the health services director would be meeting 00:54:12.369 --> 00:54:19.647 - with a nursing supervisor that IU health was employing at community health who then had these other 00:54:19.647 --> 00:54:25.470 - people. So this is basically recreating that same structure that we try to just 00:54:25.730 --> 00:54:32.982 - You won't into the health services director position. Similarly, some somewhat. However, our nurses 00:54:32.982 --> 00:54:40.670 - actually cover more duties than the IU health nurses were because they're also covering all of the health 00:54:40.670 --> 00:54:41.758 - first Indiana. 00:54:41.922 --> 00:54:50.185 - for public health services. So for example, we used to have one full-time dedicated school health liaison. 00:54:50.185 --> 00:54:58.061 - So that was regional, but we had one full-time dedicated school health liaison. That's now been added 00:54:58.061 --> 00:55:05.475 - to one of the nurse on top of those nursing duties. Our programs, trauma and injury prevention, 00:55:05.475 --> 00:55:10.494 - let's see, chronic disease. So some of the programs trying to be 00:55:10.850 --> 00:55:19.664 - developed and worked on specifically for Health First Indiana have been lumped into the public health 00:55:19.664 --> 00:55:28.650 - nurse position. So these are not simply covering the same duties. They're covering the same duties that 00:55:28.650 --> 00:55:37.463 - were covered by IU Health in addition to Health First Indiana for services. So my suggestion would be 00:55:37.463 --> 00:55:39.710 - in your presentation that 00:55:39.842 --> 00:55:49.537 - Articular piece needs to be very evident. Because the whole time I was listening to why can't this person 00:55:49.537 --> 00:55:59.049 - be doing this job? I now that I understand it makes complete sense to me. I also think that practically 00:55:59.049 --> 00:56:05.726 - we've seen that the health services director could be out of the office. 00:56:06.210 --> 00:56:11.745 - And then how do you balance that? Do you have to make sure the director is always here eight to four? 00:56:11.745 --> 00:56:17.388 - Can they leave? Do they have to check and make sure? Because if they're covering for the maternal child 00:56:17.388 --> 00:56:22.923 - health coordinator, that's how my schedule currently is. She has to tell me when she's going to be in 00:56:22.923 --> 00:56:28.458 - the office and out of the office because then I have to put it on my calendar to try to be backup for 00:56:28.458 --> 00:56:33.342 - the people who are coming in for maternal child health services. It would be similar with 00:56:33.538 --> 00:56:39.434 - The director having to coordinate that and with the nurses so say you have the school health liaison 00:56:39.434 --> 00:56:45.505 - nurse who's out in the community at the schools providing tobacco education, you have the public health 00:56:45.505 --> 00:56:46.206 - nurse who's 00:56:46.306 --> 00:56:53.250 - out in the community providing services for fall prevention. You have the communicable disease nurse, 00:56:53.250 --> 00:57:00.193 - maybe they're on vacation, maybe they are here, but again, then you don't have anyone here. So again, 00:57:00.193 --> 00:57:07.273 - it's falling on who are those backup layers that are picking up the day-to-day activities or the people 00:57:07.273 --> 00:57:14.285 - walking in or the emergent situations that might be coming up. It's also hard to tell whether it could 00:57:14.285 --> 00:57:15.646 - be done because we, 00:57:16.482 --> 00:57:26.020 - You don't have anyone currently in the role. But we do get a lot of feedback that it's a it's a lot 00:57:26.020 --> 00:57:35.939 - of work lumped into one and. If we had sorry more questions, I'm just trying to think how are you going 00:57:35.939 --> 00:57:46.430 - to get questions right? If we had this public health nurse supervisor, do we still need a clinical assistant? 00:57:46.658 --> 00:57:53.423 - to the health services director? Well, I think that would depend on who's going to be doing the billing, 00:57:53.423 --> 00:57:59.995 - scheduling, answering the phone, cleaning and turning over the rooms, doing the inventory. Same thing 00:57:59.995 --> 00:58:06.438 - now. If we don't have a clinical assistant, say we get two nurses in, well, then who's dividing up? 00:58:06.438 --> 00:58:13.075 - Who's going to be answering the phone? Who's covering Joey when Joey walks in wanting a test? So would 00:58:13.075 --> 00:58:14.750 - that position then report 00:58:14.882 --> 00:58:21.274 - instead of to the health services director to then the public health nurse supervisor as proposed? 00:58:21.274 --> 00:58:27.731 - I think so. OK, yes. To me, that's one of the most important positions. You've got to have somebody 00:58:27.731 --> 00:58:34.575 - to answer the phone and take the patients where they need to be taken. I mean, this all makes good sense. 00:58:34.575 --> 00:58:41.290 - I totally agree with you got to hire the director first because that person got set the vision and then 00:58:41.290 --> 00:58:43.614 - that person got to sell the vision. 00:58:43.778 --> 00:58:52.313 - to all the additional nurses that you're going to hire and create and organize the team. So I think 00:58:52.313 --> 00:59:01.361 - that makes absolutely good sense. To me, I got bogged down sometimes the responsibilities of the director 00:59:01.361 --> 00:59:10.493 - versus the supervisor. You've got to make very clear what those different duties are in order for anybody, 00:59:10.493 --> 00:59:13.054 - I think, to accept this plan. 00:59:17.666 --> 00:59:32.754 - Okay so action. Grant. Yes. May I. Yes. So I think that there are two things I want to offer and suggest. 00:59:32.754 --> 00:59:46.846 - One is the while the board has approved Lori's going ahead to pursue contracting the board has not 00:59:47.042 --> 00:59:58.630 - actually approved the emeritus contract itself. So that seems really crucial. The other part is that 00:59:58.630 --> 01:00:11.135 - I know that the question is going to be, especially when you go to ask for a public health nurse supervisor, 01:00:11.135 --> 01:00:14.462 - the question is going to be, 01:00:14.946 --> 01:00:24.611 - Why do you need a nurse supervisor when you don't have any nurses? There is no doubt in my mind, that's 01:00:24.611 --> 01:00:34.090 - going to be a major question, particularly from council, is why are you asking us for this thing when 01:00:34.090 --> 01:00:44.126 - we don't have nurses? So yes, I understand. And we tried to hire a director that was pretty much a failure. 01:00:44.834 --> 01:00:58.030 - And clearly the second line is absolutely the nurses and that services director being able to train 01:00:58.030 --> 01:01:12.414 - and do that supervisor role. One of those nurses may rise, I would hope, like cream to the top as an evident 01:01:13.218 --> 01:01:21.548 - person to move into that role. But I don't think that you are ever going to get counsel to approve a 01:01:21.548 --> 01:01:29.960 - nurse supervisor before you have nurses, no matter how good the presentation is and how much sense it 01:01:29.960 --> 01:01:38.289 - makes to the board. I think that you are going to bat your head against the wall. And that's just my 01:01:38.289 --> 01:01:41.918 - impression of counsel and what the feedback 01:01:42.658 --> 01:01:51.024 - So then what I continue to have is people like Christina who came to talk to us and say, well, I'm being 01:01:51.024 --> 01:01:59.230 - asked to do all of these things because there's no one else. And so, I mean, there are a lot of moving 01:01:59.230 --> 01:02:07.278 - pieces and parts. So I think we just need to decide on an action as a board. Do we continue? I think 01:02:07.278 --> 01:02:11.102 - the decisions are, do we continue to try to ask 01:02:11.202 --> 01:02:18.676 - cooperation with the commissioners because that's going to be an issue when we talk about the marriages 01:02:18.676 --> 01:02:26.006 - contract and then also with council to try to create this so that we can be successful in keeping our 01:02:26.006 --> 01:02:33.480 - funding essentially so we can recruit people have staff keep our funding for health first funds because 01:02:33.480 --> 01:02:38.942 - if we don't if we don't if we are able to provide these services get people 01:02:39.842 --> 01:02:48.680 - then this part of what we do is going to go by the wayside. So we are at a juncture where we're gonna 01:02:48.680 --> 01:02:57.518 - have to decide, are we going to give up on these services? And which I think would be insane. I mean, 01:02:57.518 --> 01:03:07.742 - this is why we're here. And so we're trying to recreate what IU had provided for us. So do we keep hammering at that? 01:03:07.842 --> 01:03:15.231 - It does the board want to do that or are we at a juncture where we say, hey, you know, this is super 01:03:15.231 --> 01:03:22.986 - difficult. We can't provide what we need to provide. I don't I don't want to be at this point, but that's 01:03:22.986 --> 01:03:30.814 - I feel that's where we're that's where we are. Let me say something. So in the presentation with the seat. 01:03:31.138 --> 01:03:38.291 - sequenced hiring plan. So that's why the long-term vision for the nurse supervisor was built in. That's 01:03:38.291 --> 01:03:45.375 - later in the phase. So you have the director, the director comes on board, recruits the staff that the 01:03:45.375 --> 01:03:52.734 - director wants for their team, getting the nurses and the clinical assistant, and then you're moving on to 01:03:52.834 --> 01:04:01.692 - It's still going to be months and months and months to get through council to get approval and build 01:04:01.692 --> 01:04:10.637 - a job description and budget to start for in 2027. So, so not now, but that's the long term stability 01:04:10.637 --> 01:04:15.198 - plan and. That wouldn't be now we'd be focusing on. 01:04:15.842 --> 01:04:24.814 - Who is our person we're going to get in here as that anchor for the director and let them bring in and 01:04:24.814 --> 01:04:33.786 - build their teams. OK, so do we need do we need? A motion on behalf of the board to give you the tools 01:04:33.786 --> 01:04:42.583 - to do what you need or do we? I think I need clarification on what is the direction I can move in or 01:04:42.583 --> 01:04:45.022 - that so basically you want. 01:04:45.218 --> 01:04:52.500 - Do you want a yea or nay on this plan, right, on this, what you have outlined up here? Yes, that's the 01:04:52.500 --> 01:04:59.923 - plan that I see. And some of that happens immediately now. And the long-term vision is the public health 01:04:59.923 --> 01:05:07.064 - nurse supervisor and the public health nurse maternal child help. Those will be coming into the full 01:05:07.064 --> 01:05:14.558 - picture in 2027. I think those are critical positions that the health department needs for that long-term 01:05:14.882 --> 01:05:20.941 - strong units. But what you're proposing is this middle part of what we're looking at here. You would 01:05:20.941 --> 01:05:27.120 - say we're going to post the health service director, fill that position once it's filled, then we fill 01:05:27.120 --> 01:05:33.119 - the bottom three. Yes. And then we're going to come back and get the middle one that's in red. Yes. 01:05:33.119 --> 01:05:39.298 - Health services director, nurses, clinical assistant, director can bring all the clinical team in. And 01:05:39.298 --> 01:05:40.798 - then in that process, we 01:05:40.994 --> 01:05:48.828 - be working on anything to build the supervisor. And then at that point, you might have one of the three 01:05:48.828 --> 01:05:56.512 - nurses who maybe can grow into the supervisor role or move into the maternal child health nurse role. 01:05:56.512 --> 01:06:04.196 - So we're needing a motion to approve this with the modifier of including for adding the public health 01:06:04.196 --> 01:06:10.750 - nurse supervisor, moving the proposal that we had from may of this year. That correct? 01:06:10.850 --> 01:06:21.900 - Yes, you've approved adding creating those positions, adding those positions to the budget. So. You're 01:06:21.900 --> 01:06:32.629 - saying that we need a motion to propose that we hire the health services director first. I think it 01:06:32.629 --> 01:06:39.710 - for the hiring sequence for the plan. Or who are we hiring first? 01:06:42.178 --> 01:06:48.819 - I mean, is it? Again, I can't, I don't feel like I can hire a clinical assistant. We did have nurses, 01:06:48.819 --> 01:06:55.785 - right? So it would have made sense when we got approval for that, but we don't have an RN for the clinical 01:06:55.785 --> 01:07:02.360 - assistant to report to. We don't have someone in that supervisor or director role. So who's going to 01:07:02.360 --> 01:07:08.871 - train that person? If we have a medical assistant, there's without again, that director who was the 01:07:08.871 --> 01:07:12.126 - clinical assistant. Who's doing these duties now? 01:07:12.322 --> 01:07:20.981 - Now we're providing them, but now we're just in a slip shot. Where was Christina on this? She was the 01:07:20.981 --> 01:07:29.725 - public health nurse communicable disease. OK, so Kathy Hewitt is covering some of those duties. Linnea 01:07:29.725 --> 01:07:35.582 - is covering some of the duties. Mike is covering some of the duties. 01:07:36.226 --> 01:07:43.308 - Our maternal child health coordinator Aubrey is doing the non-clinical, non-nursing duties. Me, the 01:07:43.308 --> 01:07:50.390 - administrative assistant, the director of vital records, are trying to keep up with the temperature 01:07:50.390 --> 01:07:57.685 - logs and the inventory for the vaccines. But this is also a problem. We need a VFC vaccine coordinator 01:07:57.685 --> 01:08:04.837 - and a backup coordinator for those programs. So if we hired an RN, you're saying even if we hired an 01:08:04.837 --> 01:08:05.758 - RN, we don't 01:08:06.818 --> 01:08:13.308 - That person couldn't start without the cell services director. Is that what you're saying? 01:08:13.308 --> 01:08:20.724 - We don't want them. If I think based on our past experiences, they don't have that system and structure 01:08:20.724 --> 01:08:27.927 - and supports person. In the hands on training, who's going to determine whether they have the skills 01:08:27.927 --> 01:08:35.486 - to move forward with providing services? All right, I'm going to attempt to make a motion. I motion that. 01:08:35.906 --> 01:08:43.654 - Uh, with the, with the current approved positions that we have that we post and hire the positions in 01:08:43.654 --> 01:08:51.478 - the order of health services director first. With after that person is hired and trained, we then post 01:08:51.478 --> 01:08:58.238 - and hire the three clinical nurses and the clinical assistant position as a second tier. 01:09:00.802 --> 01:09:07.525 - So just as a discussion, so what happens if we do that and then it takes a year. Or so can the health 01:09:07.525 --> 01:09:14.249 - services director be giving vaccines and answering the phone until we get until we get. Where we need 01:09:14.249 --> 01:09:21.038 - to be to some certain extent, but I think that's where the staffing agency comes in because. They have 01:09:21.038 --> 01:09:27.960 - the people they know, for example, they have. People who they can bring on and is that potentially going 01:09:27.960 --> 01:09:29.278 - to lead to to more. 01:09:29.666 --> 01:09:37.380 - Oh, I don't like this. I'm going to leave. It might. But unless we start paying a lot of money for posting 01:09:37.380 --> 01:09:44.590 - these jobs, we're not getting applicants. Do we need to have the discussion about the agency before 01:09:44.590 --> 01:09:52.016 - we vote on the motion? Or do you need to do public comment? We have. So what public comment do we have 01:09:52.016 --> 01:09:56.126 - to do? Let's take I think we can do them separately. So. 01:09:57.954 --> 01:10:06.013 - Lenea, do you need Michael to say the motion again? No, I forgot. Okay. So is everyone comfortable or 01:10:06.013 --> 01:10:14.073 - someone comfortable to do a second of the motion? I second the motion. All in favor? Hold on, we have 01:10:14.073 --> 01:10:22.132 - to do public comment. Oh, yes, I'm so sorry. Yes, I'm sorry. We have to have public comment before we 01:10:22.132 --> 01:10:27.742 - vote. Yes. Anyone with their hand up who wants to make public comment? 01:10:28.418 --> 01:10:45.024 - Online. Okay. Seeing none. We shall take a vote. Do. Okay. Motion passes. Okay. So the next item to 01:10:45.024 --> 01:10:55.486 - discuss is the emeritus healthcare staffing update. So. Can I. 01:10:55.650 --> 01:11:05.439 - Well, I wasn't speaking. So we had a contract. Lori was working with Dave on making some adjustments 01:11:05.439 --> 01:11:15.422 - to the contract. There were a few items that needed changed. There, you know, ongoing, she was working 01:11:15.422 --> 01:11:22.110 - with emeritus and had some potential people who we could maybe hire. 01:11:22.626 --> 01:11:33.438 - from from that if we were able to get a contract et cetera. And I believe at the commissioners meeting 01:11:33.438 --> 01:11:44.251 - they rescinded the emeritus contract as as was correct as it was correct at that time. So I think that 01:11:44.251 --> 01:11:50.654 - emeritus is our I think it's a viable option to get us staff 01:11:51.618 --> 01:12:01.198 - And so what I would like to see is that we ask Dave to make the amendments that he thought were appropriate, 01:12:01.198 --> 01:12:10.339 - get that contract to us. If he is able to do that before the next meeting, we maybe even have a special 01:12:10.339 --> 01:12:19.392 - session to talk about the contract and vote on it so that we can move forward. So that's my assessment 01:12:19.392 --> 01:12:21.150 - or other additions. 01:12:21.634 --> 01:12:30.758 - Um, you know, not a whole lot. I mean, it's been, I think that they just want legal wants some changes 01:12:30.758 --> 01:12:39.616 - made that I was unaware of specific changes. Um, and so just need to have those things changes made 01:12:39.616 --> 01:12:48.651 - so it can go, um, to the board for approval. And then the commissioners, um, why was it rescinded? It 01:12:48.651 --> 01:12:51.486 - is so I said, why? Because, um, 01:12:52.386 --> 01:12:59.874 - there well because the board did not specifically approve this contract but it's not essentially this 01:12:59.874 --> 01:13:07.802 - contract either if changes are being proposed and try to be worked out. Absolutely I think that's something 01:13:07.802 --> 01:13:15.143 - I missed. It's been a long time and just trying to actively work and get positions filled and I set 01:13:15.143 --> 01:13:20.062 - the contract to legal in June. We had a phone conversation he said 01:13:20.194 --> 01:13:27.389 - got the contract looks pretty straightforward. I did not realize that there were changes that the county 01:13:27.389 --> 01:13:34.242 - wanted to have made and I just pursued kept trying to chug along in a panic and so we're just gonna 01:13:34.242 --> 01:13:41.301 - now have the changes made. Does Emeritus operate as an agent to hire to help us hire people or do they 01:13:41.301 --> 01:13:48.222 - operate as like a staff solutions, a local staff solutions where they actually employ the people and 01:13:48.386 --> 01:13:54.811 - Yes. So when they're under the contract, unless it's a direct placement. So if it's a direct placement, 01:13:54.811 --> 01:14:01.174 - then you can pay the fee and someone would come on as a county employee attempt to hire. So the person 01:14:01.174 --> 01:14:07.475 - who was interested in the director position, it could be attempt to hire. So they're, they're working 01:14:07.475 --> 01:14:13.406 - for a marriage. We're just paying, but then they would come on as a health department employee. 01:14:16.450 --> 01:14:24.459 - So every month that they work for us into perpetuity, we're paying, giving our marriages some money 01:14:24.459 --> 01:14:32.709 - for that person. Yes, you're paying that rate, which it is more, but we're not paying for the benefits 01:14:32.709 --> 01:14:40.638 - of a county employee, which our benefits are really high. So marriages provides benefits for them. 01:14:43.106 --> 01:14:50.348 - We have some proposals, I think, in the last meeting or the one before that will be discussed. Certain 01:14:50.348 --> 01:14:57.730 - positions, creating positions and are having change in the salaries and I think those included benefits. 01:14:57.730 --> 01:15:05.534 - So I'm having a hard time understanding. How that fits in with this, so I think it might be that. Approval to. 01:15:05.826 --> 01:15:11.625 - move the health services director to that special occupations at the rate of $36 per hour. Okay. 01:15:11.625 --> 01:15:18.141 - So council, um, did approve that it's posted as $36 an hour. Um, we haven't had anyone who's been interested 01:15:18.141 --> 01:15:24.478 - in moving further in the recruitment process, kind of after those initial stages. We also had discussions 01:15:24.478 --> 01:15:30.516 - regarding the budget and I think that might be what you're remembering as we're trying to figure out 01:15:30.516 --> 01:15:34.462 - how much is the position for cost. But from a budget perspective, 01:15:35.394 --> 01:15:45.240 - The not having to pay benefits and then paying the fee is that a wash for it's close. I mean, it is 01:15:45.240 --> 01:15:55.875 - still more expensive question. Okay, so. You don't really need a motion. Well, do we need a motion actually 01:15:55.875 --> 01:16:04.638 - to ask Dave to work on. Updates to the contract that we can then present at the next 30. 01:16:05.314 --> 01:16:13.238 - I'm not necessarily sure. I called over to the legal department today and asked them if they could get 01:16:13.238 --> 01:16:20.930 - those updates to us. I was hoping to not just put the motion. Yeah, let's just do it. A motion that 01:16:20.930 --> 01:16:28.931 - we send this contract back to legal to have the amendments made that were necessary from legal and then 01:16:28.931 --> 01:16:33.854 - bring it back to the board for an official approval. Do I have? 01:16:34.274 --> 01:16:44.885 - A second and then we'll ask a public discussion. Okay. And then any public comment? Seeing none. Vote. 01:16:44.885 --> 01:16:55.392 - All those in favor? Aye. Motion passes. May I ask a question for a moment? Yes. Do we need to make a, 01:16:55.392 --> 01:17:01.470 - were you asking for us to vote tonight on these positions? 01:17:01.730 --> 01:17:08.758 - because what we did before were to get a motion or anything. What I motioned before was for the ones 01:17:08.758 --> 01:17:15.856 - that were already approved did not include those newer ones that you were proposing. Do we need to do 01:17:15.856 --> 01:17:23.094 - anything with that tonight? I think it would be beneficial so we don't delay. The council has said that 01:17:23.094 --> 01:17:30.122 - they don't want to hear requests for new positions until we're all aligned with the direction that's 01:17:30.122 --> 01:17:31.166 - going forward. 01:17:31.650 --> 01:17:39.381 - So you need a motion from us to say you may move forward to counsel regarding both of these positions 01:17:39.381 --> 01:17:47.416 - or just the public health nurse supervisor? I would say both of them. They're both proposed in the budget 01:17:47.416 --> 01:17:55.071 - for 2027. Public health nurse supervisor, public health, maternal child health. Is that a supervisor 01:17:55.071 --> 01:17:59.998 - at the end of that or just public health, maternal child health? 01:18:00.930 --> 01:18:10.251 - coordinator. I think it would be one of the supervisor position titles are we can figure out. Well, 01:18:10.251 --> 01:18:20.131 - we have to define it so that it's clear to the council. So what positions would you like us to supervisor 01:18:20.131 --> 01:18:29.918 - positions, public health nurse supervisor for the three public health nurses and a maternal child health 01:18:30.946 --> 01:18:42.522 - public health nurse supervisor. That would kill me. I second. Will that work? Okay. And do we have a 01:18:42.522 --> 01:18:54.099 - couple of comments? Okay. Seeing none, we have a second and all in favor. Sorry to move backwards. I 01:18:54.099 --> 01:18:59.486 - just realized that. Thank you. Yes, thank you. 01:19:01.410 --> 01:19:11.664 - Motion passes. Okay. So we are going to go through the next few new business items all of which will 01:19:11.664 --> 01:19:22.121 - require votes. So the first item is 2027 Health Net excuse me Health Net HIP contract approval. That's 01:19:22.121 --> 01:19:30.142 - the Homeless Initiatives Program. You have this contract in your packet. My I. 01:19:30.530 --> 01:19:44.889 - review this, I just had a question about item five, which is the insurance requirement. We needed a 01:19:44.889 --> 01:20:00.254 - confirmation from our current contract. So the Monroe County Health Department actually has a malpractice. 01:20:00.706 --> 01:20:09.713 - Contact and so we were trying to get our hands on that. Oh, you have it. No, I'm sorry. What did I do? 01:20:09.713 --> 01:20:18.545 - Oh, that training and supervision. Oh, I'm so sorry. It's probably I'm backing up. It's probably not 01:20:18.545 --> 01:20:27.727 - relevant if the based the sequence hiring plan occurs because the clinical assistant would be supervised 01:20:27.727 --> 01:20:29.214 - by the director. 01:20:29.474 --> 01:20:38.552 - We've got a motion. Okay. Well, so we, well, we don't, we need to table it or do we just need to. Say, 01:20:38.552 --> 01:20:47.982 - we have, we'll have. Okay, so, Lori, we. We're going back, I'm sorry to all continuing business discussion 01:20:47.982 --> 01:20:56.795 - of nurse supervisor and MCH nurse positions. And I, unless I'm mistaken, I think we covered that in 01:20:56.795 --> 01:20:58.910 - our. Discussion or not. 01:20:59.202 --> 01:21:09.034 - Number three training and supervision of clinical assistant. OK, I'm sorry. Training and supervision 01:21:09.034 --> 01:21:18.964 - of clinical assistant Lori. So the purpose of having this item for discussion was to discuss if if we 01:21:18.964 --> 01:21:28.894 - don't. Bring on a health services director first and start move towards this plan and we have nurses. 01:21:29.762 --> 01:21:37.077 - one, two or three. And then we're going to hire a clinical assistant. Who are they going to be overseen 01:21:37.077 --> 01:21:44.111 - by? Who's going to train them and supervise them? However, I feel as though if we are going to move 01:21:44.111 --> 01:21:51.566 - forward with the plan to bring on the health services director and then the three nurses and the clinical 01:21:51.566 --> 01:21:55.646 - assistant, that that issue will be resolved by that plan. 01:21:58.594 --> 01:22:09.042 - a motion that we table number three, training its group as a clinical assistant until after a time in 01:22:09.042 --> 01:22:19.490 - which the health services director is employed. I second. Is there a public comment? Seeing none, all 01:22:19.490 --> 01:22:27.582 - in favor? Aye. Motion passed. Okay. So moving to new business, discussing the, 01:22:28.066 --> 01:22:37.985 - Homeless Initiative Program with Health Net for 2027, a contract. This is an item for approval of the 01:22:37.985 --> 01:22:48.682 - contract. However, what I don't know from item five is if we have enough coverage from our current conference 01:22:48.682 --> 01:22:57.726 - for medical malpractice. I do not have the answer to that question yet. We've reached out to 01:22:58.274 --> 01:23:08.204 - Um, who has the policy to try to get a copy of the policy. No, 1 has been able to confirm. That we currently 01:23:08.204 --> 01:23:17.405 - have this coverage or that we need to add. Okay, so if someone could make a motion to add this item. 01:23:17.405 --> 01:23:23.326 - Until until we can have more information until our next meeting. 01:23:23.746 --> 01:23:30.126 - I'd like to make a short statement then I'll make the motion. Oh, yes. My statement is that it seems 01:23:30.126 --> 01:23:36.758 - to me that if we go to an expert and say, hey, do I have enough coverage, they're going to automatically 01:23:36.758 --> 01:23:43.706 - tell you no. That means that I do make the motion that we table this discussion until we have the information 01:23:43.706 --> 01:23:50.338 - needed to make a reasonable decision. And how much is this? How much are we? It's a million. No, I mean, 01:23:50.338 --> 01:23:53.054 - how much? 135,000. Oh, I'm sorry. 135,000. 01:23:54.850 --> 01:24:05.055 - And that's the same funding we gave in last year, right? The same amount, yes. They were asking for 01:24:05.055 --> 01:24:15.668 - additional money, which we didn't approve. As 155, they wanted that 20,000 to use. We have been helping 01:24:15.668 --> 01:24:23.934 - to purchase some supplies that we've been able to help support with the glucose, 01:24:24.194 --> 01:24:38.832 - I second the motion. Okay. Any public comment? Sarah? Yes. I'm crazy about this program. I think it's 01:24:38.832 --> 01:24:53.758 - great. I love the data that we got about the drop-off in patient C in the ER during those hours. What I 01:24:53.986 --> 01:25:04.716 - really would be curious to know is, and I'm sure it's gonna be really hard for us to obtain, but it'd 01:25:04.716 --> 01:25:16.077 - be very interesting to know how much IU has saved because of this program. And I don't know if our director 01:25:16.077 --> 01:25:23.966 - could help us even begin to understand what the financial benefit has been 01:25:25.634 --> 01:25:32.894 - from this drop off of the homeless population being seen during those hours. So it's in the, it is in 01:25:32.894 --> 01:25:40.368 - the reporting and metrics section of E. It says of those seen by hip street medicine compare with visits 01:25:40.368 --> 01:25:47.985 - to IU health emergency department. So if you are wanting to make, are you? I'm just, I'm asking in general 01:25:47.985 --> 01:25:54.462 - that we know what the numbers looked like. Cause we saw that report and that was fabulous. 01:25:54.722 --> 01:26:03.739 - We had a graph, we had all sorts of information, but I'm wondering what the financial benefit to IU 01:26:03.739 --> 01:26:12.846 - Health is from this action on our part and that of Health Net. Because I think that it's, I think it 01:26:12.846 --> 01:26:22.404 - should be substantial and that patients who have been, I think it's also a clear benefit to the community 01:26:22.404 --> 01:26:24.478 - who wants to be served 01:26:25.218 --> 01:26:33.606 - in the emergency room and that they can be seen much more rapidly. And that's why I'm saying, I don't 01:26:33.606 --> 01:26:42.405 - know how one would even begin to wrap their head around it, but I suspect that there is a way of beginning 01:26:42.405 --> 01:26:50.710 - to understand the financial benefit. So as of July, the first time no longer the medical director of 01:26:50.710 --> 01:26:52.766 - the emergency department 01:26:52.962 --> 01:27:01.155 - I've given those duties off to Dr. Matthews. I did have a discussion with Mr. Ross and he doesn't know 01:27:01.155 --> 01:27:09.110 - the answer and I don't think anyone knows the answer. I don't think that there's been, there's been 01:27:09.110 --> 01:27:17.462 - a, you can say you've decreased this number or there's been a decrease in the number of people who visit 01:27:17.462 --> 01:27:21.598 - the emergency department, but it's hard to say that 01:27:21.954 --> 01:27:28.587 - it was related solely to these changes. And then the amount of money that saved, I don't know if they've 01:27:28.587 --> 01:27:35.095 - made that determination, but I didn't get that number from Mr. Ross when I had the discussion with him 01:27:35.095 --> 01:27:41.602 - when I was still medical director. I am in favor of having a discussion with IU Health regarding this, 01:27:41.602 --> 01:27:47.982 - but I don't know how to get those numbers. Yeah, I don't know how to quantify it. And I'm sure there 01:27:47.982 --> 01:27:49.246 - must be some method 01:27:49.570 --> 01:28:01.466 - Maybe somebody who's really smart about this will be able to. But I know that when I talked to the health 01:28:01.466 --> 01:28:12.913 - administrator for the state, she was very excited when I told her what we saw in terms of numbers and 01:28:12.913 --> 01:28:19.422 - the impact that these Health First Indiana funds had had. 01:28:19.682 --> 01:28:28.563 - not only for the homeless homeless population themselves, but in terms of real use of these funds to 01:28:28.563 --> 01:28:37.796 - deal with people and benefit the whole community again, because there is more availability for emergency 01:28:37.796 --> 01:28:45.182 - services than for the rest of us. So I think one of the problems that you run into, 01:28:46.370 --> 01:28:52.404 - how to quantify it in the face of IU Health having its own initiatives outside of the community health 01:28:52.404 --> 01:28:58.262 - or the street nurse doing the thing that they do. There's other initiatives of which I'm aware that 01:28:58.262 --> 01:29:04.355 - were ongoing and ramped up over the past couple of years as well that were also designed to keep people 01:29:04.355 --> 01:29:10.565 - out of the emergency department. And I think that's where you run into problems with saying, well, here's 01:29:10.565 --> 01:29:15.134 - the financial benefit. So because we've benefited you, why don't you help us? 01:29:15.490 --> 01:29:22.095 - I think it's very difficult to quantify it. Not impossible. I don't know. But I think when you approach 01:29:22.095 --> 01:29:28.700 - IU Health and when we approach IU Health, we have to keep that in mind that that's going to be a likely 01:29:28.700 --> 01:29:35.115 - response is what I would imagine. And I think that's reasonable to say that because I know there are 01:29:35.115 --> 01:29:41.783 - other efforts to decrease these visits that may not be necessary. So thank you. That was really helpful. 01:29:41.783 --> 01:29:45.086 - So still seeing no raised hands for public comment. 01:29:45.378 --> 01:29:59.969 - We shall vote on Dr. Teaves' motion. All in favor? Aye. Motion passes. Okay, and now we're going to 01:29:59.969 --> 01:30:11.934 - talk about the full blood pressure screenings by the maternal child health organ. 01:30:13.986 --> 01:30:22.102 - So the question is, so originally this goal program was built into our felt nurse school liaison position. 01:30:22.102 --> 01:30:30.066 - When that position became vacant, we had already previously been in an agreement with Indiana University 01:30:30.066 --> 01:30:38.106 - and we were working towards providing this program. So I spoke with our maternal child health coordinator 01:30:38.106 --> 01:30:40.382 - to see, you know, do you have 01:30:40.482 --> 01:30:47.480 - capacity and interest in taking this on and when would this maybe best work with your schedule. So through 01:30:47.480 --> 01:30:54.281 - further discussion with that she identified that working and working with Indiana University fall would 01:30:54.281 --> 01:31:00.821 - work. So as part of that process we were really hoping to be able to collect biometric data that we 01:31:00.821 --> 01:31:04.222 - could help to track program evaluation and outcomes 01:31:04.482 --> 01:31:12.965 - Since our maternal child health coordinator is not a nurse, the question is, do we feel that it would 01:31:12.965 --> 01:31:21.947 - be appropriate and okay for her to be trained under our standing orders to be able to do the blood pressure 01:31:21.947 --> 01:31:30.014 - screenings for those 13 and older as part of the program so that we can still collect that data? 01:31:31.458 --> 01:31:36.937 - Is it purely to collect data as a population data or is it to collect data and then act upon it and 01:31:36.937 --> 01:31:42.470 - in individuals cases, for example, if someone has been going to school, you take a 50 year old blood 01:31:42.470 --> 01:31:48.113 - pressure, it's 200 over 130. Is there an action that's to be taken? And if it's not, if it's elevated, 01:31:48.113 --> 01:31:53.866 - but not emerging within needs to go to the emergency department. Is it, is there some action to be taken 01:31:53.866 --> 01:31:55.838 - by them or is it simply to collect? 01:31:56.002 --> 01:32:02.917 - data on a population basis. So the standing order does outline the certain criteria and then what action 01:32:02.917 --> 01:32:09.766 - should be taken. So if that was identified, you should seek help immediately. You should follow up with 01:32:09.766 --> 01:32:17.010 - a doctor in a certain period of time. So those would be the recommendations and the guidance to my knowledge. 01:32:17.010 --> 01:32:24.254 - Is it possible for us to read those? I got to tell you, we get people from offices all the time that are sent 01:32:24.770 --> 01:32:30.288 - or emergent, you know what I'm talking about? So dumb. Emergent blood pressure readings that are not 01:32:30.288 --> 01:32:35.752 - emergent blood pressures because like 180 over a hundred, oh my God, you got it with VR right away. 01:32:35.752 --> 01:32:41.270 - And there's nothing to do for that patient if they're not having symptoms. You're not dying. Go back 01:32:41.270 --> 01:32:46.897 - to your primary care. Is there some way that we can just, I'm adding on to our work, but can we review 01:32:46.897 --> 01:32:52.798 - those guidelines and maybe look at them and see if they're appropriate? Sure. We have all that information. 01:32:55.426 --> 01:33:05.810 - What kind of blood pressure cuff is this person using? Is it electronic or is it? Yes, it's electronic. 01:33:05.810 --> 01:33:16.293 - So do we want more information on the standing orders or can we amend those at some later time and prove 01:33:16.293 --> 01:33:23.582 - that the maternal child health coordinator with appropriate training can 01:33:23.842 --> 01:33:30.999 - assess blood pressures for those over 13. I would like to see those and review them and also review 01:33:30.999 --> 01:33:38.371 - the type of training and review the training that they're going to receive to make sure that it's that 01:33:38.371 --> 01:33:45.671 - is reasonable for that situation. It gives a whole force of leads sometimes in these electronic blood 01:33:45.671 --> 01:33:52.542 - pressure monitors. Okay, so can I have a motion to table this until we gather more data for any 01:33:52.706 --> 01:34:08.711 - address it at the next meeting. And do I have a second? Second. And do we have anyone wanting to make 01:34:08.711 --> 01:34:22.206 - public comment? And seeing none, we'll take a vote. All in favor? Aye. Motion passes. 01:34:22.306 --> 01:34:40.840 - I motion. Okay. No. Okay. So our next item is to discuss the part-time public health nurse request. 01:34:40.840 --> 01:34:43.806 - All right. Yes. 01:34:44.610 --> 01:34:51.358 - So again, and just trying to think and consider different options for our nursing services actually 01:34:51.358 --> 01:34:58.377 - had some candidates who are not interested in part time, but they would be interested or not interested 01:34:58.377 --> 01:35:05.125 - in full time, but they would be interested in a part time opportunities, even if it were just short 01:35:05.125 --> 01:35:08.702 - term or if it were long term kind of here and there. 01:35:08.802 --> 01:35:16.269 - Additionally, just considering the large picture of, you know, you could abruptly lose a nurse and then 01:35:16.269 --> 01:35:23.449 - have a vacancy. It would be really nice and easy to be able to have a, I'll say pool, although it's 01:35:23.449 --> 01:35:30.844 - not necessarily a pool, but maybe one or two part-time nurses that you could call upon and see if they 01:35:30.844 --> 01:35:38.526 - have any availability to help cover specific services that need to be performed for the health department. 01:35:38.882 --> 01:35:48.640 - Essentially, it's not about adding overall capacity. It's about being able to have options so that we 01:35:48.640 --> 01:35:58.877 - have a flexible staffing model. In my mind, this is similar to PRNs at hospitals. They'd only be scheduled 01:35:58.877 --> 01:36:07.678 - when organizational needs occur. They'd only be used within the existing funding available. 01:36:07.938 --> 01:36:15.523 - would have the ability to maintain our clinical services. Um, now this it's hard to say, I think the 01:36:15.523 --> 01:36:23.108 - council number one wants to define job descriptions. So what are these part-time nurses going to do? 01:36:23.108 --> 01:36:30.618 - Has the board approved that you can move forward with part-time nurse positions? And, um, how do we 01:36:30.618 --> 01:36:36.926 - know what we're going to pay them if we don't have a defined part-time position for 01:36:37.282 --> 01:36:43.613 - the nurses. I think that you have to kind of include a lot of those different duties and activities 01:36:43.613 --> 01:36:50.134 - because you might not know, you might just be wanting to call your part-time nurse and see if they can 01:36:50.134 --> 01:36:56.656 - participate in a vaccine event for the community. You might have coverage that's needed for one of the 01:36:56.656 --> 01:37:03.430 - nurses because they have to be off for two or three or four weeks and to be able to provide some stability 01:37:03.430 --> 01:37:07.102 - for those services. So I think it can make it challenging 01:37:07.618 --> 01:37:15.946 - to pin down just very limited duties and responsibilities. But overall, I think that being able to have 01:37:15.946 --> 01:37:24.515 - the option to have short-time nurses to fill gaps would be really important, again, just for the long-term 01:37:24.515 --> 01:37:33.163 - stability. Are we looking to say, yes, let's go evaluate this, let's try to help with the job descriptions, 01:37:33.163 --> 01:37:36.126 - or are we looking for something else 01:37:37.154 --> 01:37:44.860 - board tonight. I think the first move would be that you approve going to council to request that we 01:37:44.860 --> 01:37:52.952 - can develop part-time nurse positions. What do you define as part-time and hours? Well it would be under 01:37:52.952 --> 01:38:01.121 - the benefit and I don't know what that is at the county but I don't know if that's 24 or 28 they wouldn't 01:38:01.121 --> 01:38:05.822 - be able to exceed that certain amount of hours that could be 01:38:06.370 --> 01:38:14.757 - Over time for the year that makes them eligible for benefits. I think that it's a difficult. I think 01:38:14.757 --> 01:38:23.144 - long term. In an ideal world, it would be great. I think it's going to be hard. Very difficult to go 01:38:23.144 --> 01:38:31.614 - to council, especially with all the current changes we're trying to make. That is just my assessment. 01:38:35.778 --> 01:38:44.758 - And can you tell us, Lori, what is council's position on part-time employees? My understanding is that 01:38:44.758 --> 01:38:53.651 - they are, not only is there this hiring freeze, but they do not want any part-time employees. Is that 01:38:53.651 --> 01:39:02.020 - correct or not? I did not, I am not aware that they don't want any part-time employees, period. 01:39:02.020 --> 01:39:05.246 - But yes, there is the hiring freeze. 01:39:05.538 --> 01:39:17.705 - And my understanding from Council Administrator is they are not going to approve part 10 of those. That's 01:39:17.705 --> 01:39:29.643 - my understanding. I may be in for that, but that's what I have heard. And so I'm wondering whether this 01:39:29.643 --> 01:39:35.038 - is, I think, again, I think that Lisa put this 01:39:35.394 --> 01:39:44.373 - under the best of circumstances, if this were, if we were independent of the limitations that are imposed 01:39:44.373 --> 01:39:52.844 - on us by council and commissioners, that would make perfect sense. We know that on Miller Drive, we 01:39:52.844 --> 01:40:01.315 - had part-time positions, we had two part-timers, and so maybe more, three? I think it was more than 01:40:01.315 --> 01:40:04.958 - that. They had a couple that were working. 01:40:05.346 --> 01:40:17.408 - So I mean it was great they they liked it but this council you're never going to get that proposal through 01:40:17.408 --> 01:40:28.681 - and that even asking the board to approve something that is not going to happen when you take it to 01:40:28.681 --> 01:40:34.430 - council. Ultimately I'm afraid it looks like we're 01:40:35.010 --> 01:40:44.316 - just getting beaten down. And so I would just suggest that, you know, wait until things get a little 01:40:44.316 --> 01:40:53.897 - looser and work with council, help them begin to maybe with new liaisons. We don't know. But, you know, 01:40:53.897 --> 01:41:02.558 - as we know things financially across the county and the state are going to become much worse. 01:41:04.130 --> 01:41:14.654 - much worse for all government. And so to try to get through to them what and why this is, I think is 01:41:14.654 --> 01:41:26.115 - a losing proposition. And I honestly don't believe we can take any more losses at council's door, personally. 01:41:26.115 --> 01:41:31.742 - Yes, it looks like we're fighting the good fight, but 01:41:33.666 --> 01:41:43.046 - I don't know that it behooves the board to ask for things that unlock them. I was not aware that if 01:41:43.046 --> 01:41:52.801 - council has said they don't want part-time positions period. So if that's the case that's not something 01:41:52.801 --> 01:41:54.302 - I was aware of. 01:41:55.202 --> 01:42:00.684 - You know, when we have people reaching out to say, hey, I know about this change that happened with 01:42:00.684 --> 01:42:06.276 - IU Health. I can't come on full time, but I'm really passionate about the health department. I'm more 01:42:06.276 --> 01:42:11.868 - than happy to come on in a part-time capacity. And we see the work that needs to be done and we're in 01:42:11.868 --> 01:42:17.406 - this critical situation. I think that it means a lot to me. And it's really important that I explore 01:42:17.406 --> 01:42:23.217 - every single avenue that can be explored to try to get the services into the community. And that's simply 01:42:23.217 --> 01:42:24.478 - what I'm trying to do. 01:42:24.962 --> 01:42:31.507 - I get it. I will say that respectfully, I want to take a different position and not try to bend. Please. 01:42:31.507 --> 01:42:37.928 - I believe if I look at the world, if I look at the state of our government, federal and statewide, and 01:42:37.928 --> 01:42:44.162 - if I said 10 years ago, this is where we're going to be, I would have said you're out of your mind. 01:42:44.162 --> 01:42:50.645 - That's not going to happen. And I think that because you never know which way the wind is going to blow 01:42:50.645 --> 01:42:52.702 - and pendulums being as they are, 01:42:53.474 --> 01:43:01.189 - I would say if we have a vision and we have a reasonable vision that can help them improve the health 01:43:01.189 --> 01:43:08.752 - outcomes of the people in our community, then I think we should propose it to the council because I 01:43:08.752 --> 01:43:16.542 - do believe fortune favors the bowl. I agree too. I, you know, my, my opinion is, you know, we are from 01:43:16.542 --> 01:43:22.366 - my perspective, we serve the community. Um, and if ultimately we think that, 01:43:22.626 --> 01:43:30.620 - Hey, you know what? We're not getting bites on these positions. We've got the services we need to provide. 01:43:30.620 --> 01:43:38.466 - We have people calling and saying, I can give you four hours here, four hours there. If if council wants 01:43:38.466 --> 01:43:46.086 - to shoot it down, council council can shoot it down publicly in the in the white of the community and 01:43:46.086 --> 01:43:49.598 - see that we as the Board of Health are saying, 01:43:50.018 --> 01:43:56.244 - And here's what we need. We care. And, and council has said no. So we're doing our, we're trying to 01:43:56.244 --> 01:44:02.656 - do our job. He did it on record. Right. That's right. On the record. Yeah. And that's how people vote. 01:44:02.656 --> 01:44:09.256 - Um, you know, and that, so having people put stuff on records is important. It doesn't really make sense. 01:44:09.256 --> 01:44:15.855 - They don't really want part-time people because you have to work a certain number of hours to be eligible 01:44:15.855 --> 01:44:19.902 - for benefits. I mean, I think it's, it's 21, I think in private. 01:44:20.450 --> 01:44:30.811 - my practice, you have to work 21 hours a week, or you have to put in benefits, even though I will go 01:44:30.811 --> 01:44:41.377 - on record as saying I was provided. Let's be clear. But legally, you're not obligated to do it for any 01:44:41.377 --> 01:44:50.302 - more than 21 hours. At least that's what it was. And so I'm all in favor of requesting 01:44:50.466 --> 01:44:59.228 - part-time positions, making our position known, and let's see what happens. Yeah, I agree. Make them 01:44:59.228 --> 01:45:08.076 - shoot it down in public. It sounds as if that's going to happen, and it really needs to be made clear 01:45:08.076 --> 01:45:17.185 - how many of the positions at IU, of our IU nurses I know that were part-time. I think that understanding 01:45:17.185 --> 01:45:19.614 - that this has operated very 01:45:19.874 --> 01:45:31.069 - It should be and effectively with Parkland people may hope that I just I want you to be aware that it 01:45:31.069 --> 01:45:42.044 - may be a real losing game. And you know what? I think that all I can do is try. Yeah, that's right. 01:45:42.044 --> 01:45:47.422 - I'm the one in the chair every day trying to get 01:45:48.194 --> 01:46:00.345 - people in here to do the services. Okay. So what. What motion would be most helpful at this juncture? 01:46:00.345 --> 01:46:12.257 - So it gives you time. To do what you need to do to get everything ready. I think the 1st step is it 01:46:12.257 --> 01:46:14.878 - has to go to council. 01:46:15.266 --> 01:46:24.949 - for approval to move forward to develop a part-time position during the hiring period. So you need a 01:46:24.949 --> 01:46:34.632 - motion to. Yes. So how many, so in an ideal world, how many part-time positions would you like to? I 01:46:34.632 --> 01:46:42.494 - think two would be okay. And I think that it's important to clarify that when I'm 01:46:42.626 --> 01:46:49.418 - thinking about this, I'm thinking more of that PRN capacity. We're going to call our agreement and we're 01:46:49.418 --> 01:46:56.016 - going to say we need some help, not your schedules for 20 hours a week, period. Correct. Because over 01:46:56.016 --> 01:47:02.744 - the past few weeks, if we would have had that person, for example, that reached out, it would have been 01:47:02.744 --> 01:47:09.212 - really nice to say, absolutely, let's get you in here tomorrow. And we'd be providing some services 01:47:09.212 --> 01:47:12.382 - right now. And so I don't think that it's a lot. 01:47:12.642 --> 01:47:19.236 - Could we, instead of calling them part time nurses, could we call them PRN? Is that something we can 01:47:19.236 --> 01:47:26.026 - do? Like, can we just name it PRN? You can type whatever you want. OK. I think PRN makes it more clear. 01:47:26.026 --> 01:47:32.946 - It sounds better. I think that's a little easier pill to swallow. Does that work in the county structure, 01:47:32.946 --> 01:47:39.866 - though? I do not know the answer to that. Do they have as needed positions? I guess, yeah, because that's 01:47:39.866 --> 01:47:41.694 - an interesting, like, if we 01:47:41.954 --> 01:47:49.791 - give a part-time position and then we give them zero hours. Like, is that a problem? I don't think so. 01:47:49.791 --> 01:47:57.705 - Cause I, my understanding, I don't know what's changed from when I've been here and what's current now, 01:47:57.705 --> 01:48:05.771 - but it's my understanding that you would be scheduling them at the capacity that you need up to 20 hours. 01:48:05.771 --> 01:48:11.934 - Um, and some of them are temporary, just seasonal. Um, so again, it would, yeah. 01:48:12.770 --> 01:48:22.102 - So is the part-time language okay? Or should we do as mean? I don't know what the title is. Sounds like, 01:48:22.102 --> 01:48:31.256 - oh yeah, that's a good idea. Supplemental. Yeah, I think that sounds better because I think if you say 01:48:31.256 --> 01:48:40.500 - part-time, they're going to be thinking about how many full-time equivalents are you creating? And that 01:48:40.500 --> 01:48:42.366 - supplemental or PRN, 01:48:42.690 --> 01:48:53.152 - They may not even understand PRM because they're not in the business. Yeah. Okay. So can I, Oh, well, 01:48:53.152 --> 01:49:03.921 - yeah. Can I have a motion? So the motion to go to the council to ask to develop a supplemental positions 01:49:03.921 --> 01:49:12.126 - as needed as supplement positions as needed or what is it? Public health nurse. 01:49:12.354 --> 01:49:40.830 - I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. 01:49:41.794 --> 01:49:56.346 - and I have a vote. All in favor? Aye. Motion passed unanimously. Okay, so now we have approval of septic 01:49:56.346 --> 01:50:08.542 - replacement modem, or sorry, yeah. Memorandum. So this is the contract that is amending 01:50:08.802 --> 01:50:18.625 - The language that shows that the funds, excuse me, we will reduce the inter-agency agreement by $252,712.91 01:50:18.625 --> 01:50:27.811 - for the septic program because those funds are being moved to other programs because we couldn't get 01:50:27.811 --> 01:50:37.270 - those funds used for the septic program because of the federal guidelines and meeting all the criteria, 01:50:37.270 --> 01:50:38.270 - et cetera. 01:50:38.498 --> 01:50:49.721 - Whether yeah, and then. So we have to vote on the changes for the contract. So I need a motion. I'll 01:50:49.721 --> 01:51:01.055 - make a motion to approve the. Amendment or the change to the. It's the right and then. The changes us 01:51:01.055 --> 01:51:07.166 - make a motion. To approve the changes in the contract. 01:51:08.546 --> 01:51:24.561 - I second nothing and we have public comment. Seeing none all in favor. The next item is approval of 01:51:24.561 --> 01:51:38.174 - the Red Cross Agreements. I do too. That's why we have. So I know it's five and six. 01:51:38.754 --> 01:51:46.752 - Sort of go together as far as the Red Cross agreement goes, but public health preparedness. So our division 01:51:46.752 --> 01:51:54.305 - has been looking at how can we expand some of our training in the community and Lenea has looked into 01:51:54.305 --> 01:52:01.710 - some different options. She's received training and if you're comfortable talking about it, I think 01:52:01.710 --> 01:52:04.894 - you're the most qualified person to do so. 01:52:05.026 --> 01:52:14.966 - Sure, so I've received the search engine training to be a Red Cross authorized adult and pediatric CPR 01:52:14.966 --> 01:52:24.906 - first aid as well as basic life support, baby center course, the associated coursework there. And what 01:52:24.906 --> 01:52:34.846 - we would like to do is to add to our preparedness education the opportunities to take the CPR training 01:52:35.074 --> 01:52:49.271 - I don't want to be accurate. And then to offer the babysitter. I think it's. Awesome. The agreement. 01:52:49.271 --> 01:53:04.030 - If we did everyone receive the agreement before the meeting today, it was too large. Okay. Okay. Can we. 01:53:04.226 --> 01:53:12.362 - um paper copies yeah distribute paper copies and then does that mean we need to load on it at a later 01:53:12.362 --> 01:53:20.338 - time i would say it's a subject can you summarize it yeah i don't really need a paper copy actually 01:53:20.338 --> 01:53:28.315 - i mean we've actually i think it's been a long time we've been discussing this and there's actually 01:53:28.315 --> 01:53:32.542 - been a lot of back and forth i've actually been like 01:53:32.930 --> 01:53:39.899 - I don't think we can do this. This is going to be a lot. And then circling back around because of counting 01:53:39.899 --> 01:53:46.412 - processes. Right. OK. What other ways can we can we actually maybe do this. So we've worked out the 01:53:46.412 --> 01:53:53.185 - program so you're going to be developed a form that individuals would complete a Microsoft form to sign 01:53:53.185 --> 01:53:59.958 - up for the classes. OK. And then you all register and we would register them and then either they could 01:53:59.958 --> 01:54:02.238 - turn through by the records office 01:54:02.338 --> 01:54:09.257 - Um, or in the phone, we're going to be able to do that. And then as long as that's before they show 01:54:09.257 --> 01:54:16.175 - up for the past. So this is the general public would go on the website, find this form, fill it out 01:54:16.175 --> 01:54:23.370 - and then you're providing the training. Okay. They're either bringing in the payment or they're calling 01:54:23.370 --> 01:54:29.182 - vital records to make the payment over the phone or collecting those fees and then. 01:54:29.282 --> 01:54:36.278 - The Red Cross is going to invoice us because of our payment structure. That's really the process that 01:54:36.278 --> 01:54:43.479 - we need to be able to use. So we collect the fees, and then we receive the invoice through the Red Cross 01:54:43.479 --> 01:54:50.886 - to pay that, and we're using their materials. So it's all Red Cross materials, and we'll take the materials 01:54:50.886 --> 01:54:56.510 - every few years. And in order to stay current as an inspector, you have to review 01:54:56.674 --> 01:55:07.006 - I need to make sure that you've seen those materials with no access to it and. Grant funding will be 01:55:07.006 --> 01:55:17.441 - used to purchase the supplies to start. The program and that's been cleared and taken care of through 01:55:17.441 --> 01:55:19.998 - the. If we need ongoing. 01:55:20.098 --> 01:55:27.441 - We could also use Health First Indiana. So both Bryce and Linnea's positions will be Health First Indiana 01:55:27.441 --> 01:55:34.368 - funded next year. So they'll be obtaining verifying residency anyway. So we need to supplement with 01:55:34.368 --> 01:55:41.572 - other funds in the future. The rate of survival of out-of-hospital cardiac arrest bystander CPR started 01:55:41.572 --> 01:55:47.806 - is five times greater than if it isn't. It's ridiculous. They go to King County, Seattle, 01:55:48.322 --> 01:55:54.302 - your sense of surviving out of the hospital card, the rest is so much higher than anywhere else. 01:55:54.302 --> 01:56:00.652 - It's just, it's a great program. Yeah. And then the thing is the beauty of it, it doesn't even matter, 01:56:00.652 --> 01:56:06.879 - you know, count this number. It's just get it started. Just start pumping out of their chest. It's a 01:56:06.879 --> 01:56:13.044 - world of difference. So our motion I think is to approve the agreement with the Red Cross. Is that, 01:56:13.044 --> 01:56:16.126 - is that the threat? Okay. So can I have a motion? 01:56:16.834 --> 01:56:34.673 - Okay. And do we have any public comment? Seeing none. All in favor? Aye. Motion passes unanimously. 01:56:34.673 --> 01:56:40.382 - Okay. The code change proposal. 01:56:41.506 --> 01:56:49.589 - Now I noticed there are two. Yes. So as part of developing this program for implementation in the health 01:56:49.589 --> 01:56:57.903 - department, we would need to actually add into our fee code what the fees are that are going to be charging 01:56:57.903 --> 01:57:06.140 - the public for these services. So there are two different proposals based on two different fee collections 01:57:06.140 --> 01:57:09.758 - and what is actually being covered. Let's see. 01:57:10.242 --> 01:57:19.882 - So, one is covering the cost of providing the service. So, our supplies, our personnel typically, that's 01:57:19.882 --> 01:57:21.534 - what we would do. 01:57:21.826 --> 01:57:29.366 - what are you charging to just cover your expenses? So not making any profit. One is if we want 01:57:29.366 --> 01:57:37.621 - to intentionally subsidize fee costs, which is legal, we could do to provide a discount and essentially 01:57:37.621 --> 01:57:45.559 - not collect fees that would be covering the full amount of us providing the services. Again, talked 01:57:45.559 --> 01:57:50.718 - with Linnea about this and you can speak to it and I think it's, 01:57:51.458 --> 01:58:00.100 - I felt it was appropriate and fine to have both options and then the board can discuss what structure 01:58:00.100 --> 01:58:08.997 - they think is best for the department and the community. Did we get some idea of how much the base would 01:58:08.997 --> 01:58:17.808 - be? Page five. So yeah, on page five, the red is different copies at the same time. The higher amounts, 01:58:17.808 --> 01:58:20.350 - the other has a lower amount. 01:58:20.738 --> 01:58:36.505 - There's calculated okay. That's it. Second, one is the baseline. So, yeah, the talk of labor actually 01:58:36.505 --> 01:58:45.470 - often. So, it sort of, it doesn't take all of it out. Um, 01:58:45.570 --> 01:58:59.976 - But basically, it's known that all of the expenses into. So, there's no, no additional. Here it is. 01:58:59.976 --> 01:59:14.526 - The actual expense of materials and it covers much of the. The inspection Boston, the higher amount. 01:59:14.882 --> 01:59:21.521 - covers all of our expenditures, assuming that we have the minimum enrollment for the class. So this 01:59:21.521 --> 01:59:28.557 - would be the model that you'd use for like a revenue generating class. So it would mean that the expenses 01:59:28.557 --> 01:59:35.395 - associated with the labor and teaching reports, as well as all of the equipment and supplies utilized, 01:59:35.395 --> 01:59:42.233 - and the certification fee, which is what we then would owe to your cost, I would be fully covered with 01:59:42.233 --> 01:59:44.158 - a minimum of three students. 01:59:44.418 --> 01:59:58.386 - Okay, so. Yes, maybe, unless unless it's unless we only get three. Right. Right. So. What if I heard 01:59:58.386 --> 02:00:13.598 - correctly. The initial upfront costs of this are being paid out by grants that we've already gotten. Correct. 02:00:14.082 --> 02:00:21.810 - Okay, so when we host a class, what is the cost we include? The cost per class is the sort of fixed 02:00:21.810 --> 02:00:29.848 - labor cost, which is how many hours it takes to teach the course. And then the certification fee, which 02:00:29.848 --> 02:00:37.576 - is what we are invoiced by the. And those are all listed and those are in agreement. So. Oh, so the 02:00:37.576 --> 02:00:41.054 - 65 versus the 105 for the, for the 1st line. 02:00:41.154 --> 02:00:48.439 - Right. For example, the certification fee or that $65, for example, is, I think, $55. So $55 of that 02:00:48.439 --> 02:00:55.724 - goes directly to the Red Cross to pay for the certificate. And the remainder is paying for the, just 02:00:55.724 --> 02:01:03.154 - the supplies that are distributed, like the little first aid type of thing. Yeah. All right. So we're, 02:01:03.154 --> 02:01:10.078 - and what's the maximum size of a class? So you said three is the minimum. Three is the minimum. 02:01:10.178 --> 02:01:18.922 - 10 is the maximum budget based on the fee budget that we included. It doesn't sit right with me to make 02:01:18.922 --> 02:01:27.498 - money off the endeavor. I think these are pretty steep fees, honestly. Given what people make to live 02:01:27.498 --> 02:01:36.158 - in this town, what people are making in this town, these are pretty steep fees in my opinion. I agree. 02:01:42.050 --> 02:01:50.983 - And are we, is IU Health community group doing any of these classes? I thought their trauma and injury 02:01:50.983 --> 02:01:59.742 - prevention team provides them in the community. I was one of them, American Heart Association. Amy's 02:01:59.742 --> 02:02:07.634 - group I'm talking about. Yeah, Amy's group has, they do these things. I thought they still 02:02:07.634 --> 02:02:11.710 - did the babysitting and those kinds of things. 02:02:12.162 --> 02:02:22.711 - Lisa at the school the Lisa school health I know at least was during the babysitter thing some of the 02:02:22.711 --> 02:02:33.466 - spurs. I have a comment. My meter is going to run out in about five minutes. No longer than I expected. 02:02:33.466 --> 02:02:38.430 - What's okay do we have any do we have a motion. 02:02:40.418 --> 02:02:46.747 - Or which proposal you would like to. I'm trying to. We've been talking about finance. We've been talking 02:02:46.747 --> 02:02:52.956 - about all of those stuff. Like, are we offering these classes? What's a month? We'd offer it every two 02:02:52.956 --> 02:02:58.984 - months. We'd offer it weekly. Our proposed schedule with our prepared network education would be to 02:02:58.984 --> 02:03:05.072 - offer it one to two times per month, depending on what the initial response is, and then to offer it 02:03:05.072 --> 02:03:08.990 - maybe seven, four, three times per year. It's like that matters. 02:03:09.154 --> 02:03:17.638 - in regards to if we go, I agree, we should go with the lower fees. But if you're going to take a hit 02:03:17.638 --> 02:03:26.206 - of $500 every time you do this, that's going to probably matter at some point. In building a capacity 02:03:26.206 --> 02:03:33.850 - for your workload, how that might function. I understand that. So maybe I don't understand 02:03:33.850 --> 02:03:38.974 - it. My understanding is proposal one is a break even charge. 02:03:39.490 --> 02:03:47.468 - Proposal two is a make money charge. Is that not right? Proposal two is a break even at three participant 02:03:47.468 --> 02:03:55.447 - charge. Okay. And proposal one is a break even at 10 participant charge. I see. Okay. Okay. Okay. That's, 02:03:55.447 --> 02:04:02.974 - that's, and that's why I've been asking the questions, right? Like, yeah, that's what they're going 02:04:02.974 --> 02:04:07.038 - to, yeah. I'd say that the barring grant funding, um, 02:04:07.970 --> 02:04:16.427 - Additionally, coming out of somewhere, um, the absolute lowest that we could ever try to be, we don't 02:04:16.427 --> 02:04:24.718 - have to pay to the boss. Yeah. It's like for that, uh, I think in 65 is my first one. Um, maybe 55. 02:04:24.718 --> 02:04:33.092 - So can we, can we do something like three seems, seems small to me and 10 seems big. Can we amend it 02:04:33.092 --> 02:04:36.574 - to make it somewhere in the middle? Like. 02:04:37.026 --> 02:04:44.226 - I think it's set by, is it set by the Red Cross or? The maximum is set by the Red Cross. Technically, 02:04:44.226 --> 02:04:51.426 - the minimum could be whatever you see fit for the expense assessment. They recommend at least two. My 02:04:51.426 --> 02:04:58.696 - preference is to have them in pairs. So, either having four, six, eight, or 10 participants. Sure. But 02:04:58.696 --> 02:05:05.826 - I would hate to take the hit on, let's see this point out, take a $5,000 hit twice a month on all of 02:05:05.826 --> 02:05:06.814 - these things. 02:05:08.034 --> 02:05:16.298 - You know, if it's $200, that might be different. Can we set it at, like, six and vote for a proposal 02:05:16.298 --> 02:05:24.643 - that says we break even at six? So that's what I was going to ask. Could we motion to do proposal one 02:05:24.643 --> 02:05:32.988 - but have a minimum number of participants of six? Or we cancel the class? Yeah. Can we do that? We'll 02:05:32.988 --> 02:05:36.670 - probably end up in the class being canceled. 02:05:36.898 --> 02:05:44.369 - A lot well, or whatever the number is. Yeah, yeah. Um, we, I mean, like, if we go by our preparedness 02:05:44.369 --> 02:05:51.840 - and diversity forces, which are free of charge. They kind of coming waves, so we'll have some classes 02:05:51.840 --> 02:05:59.238 - where we'll have. 10 to 15 participants and then other classes where only 3, you know, is registered 02:05:59.238 --> 02:06:06.270 - actually. Have you moved it to a quarterly or a couple of times to try to get people. Maybe by. 02:06:06.946 --> 02:06:11.404 - Yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, 02:06:11.404 --> 02:06:15.862 - yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, 02:06:15.862 --> 02:06:20.321 - yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, 02:06:20.321 --> 02:06:24.779 - yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, 02:06:24.779 --> 02:06:29.237 - yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, 02:06:29.237 --> 02:06:33.695 - yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, 02:06:33.695 --> 02:06:36.318 - yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, 02:06:37.634 --> 02:06:45.223 - I understand the thinking, but I don't want to add more parameters to your name is day to day. I don't, 02:06:45.223 --> 02:06:52.521 - I don't know. I don't, I'm not, I'm not a big thing. Which just to give, give not set parameters so 02:06:52.521 --> 02:06:59.891 - that she can just do manage the classes without having to cancel the classes and then meet criteria. 02:06:59.891 --> 02:07:07.262 - And it's just going to be a bigger hassle. So just set it. We're going to have it every other month. 02:07:07.554 --> 02:07:15.973 - Yeah, we have a minimum of four or or just set every other month and that's it and we charge every other 02:07:15.973 --> 02:07:24.232 - month and then we're going to reevaluate what these classes are, right? And if they're massively full, 02:07:24.232 --> 02:07:32.250 - we can add more. Okay, and then. So we need a motion. Is that by monthly every other month? I think 02:07:32.250 --> 02:07:34.014 - I've said that. Yeah. 02:07:34.242 --> 02:07:46.358 - And then are we saying fee schedule number one. We can have a motion. I motion that we adopt fee schedule 02:07:46.358 --> 02:07:58.132 - proposal number one with a frequency of the public health preparedness education at every other month. 02:07:58.132 --> 02:08:03.390 - I second. And do we have any public comments? 02:08:04.034 --> 02:08:13.358 - No saying none. All in favor. Motion passes. Okay. So would any board members or the health officer 02:08:13.358 --> 02:08:23.054 - like to make any additional comments before we adjourn? I have one comment and I know it keeps you from 02:08:23.054 --> 02:08:31.166 - Google columns, but we, what do we know about the VAX care? That we said we wanted to. 02:08:31.618 --> 02:08:39.199 - So, I, I connected with help. And for more information, what specifically that they were looking for, 02:08:39.199 --> 02:08:46.780 - and I knew that Dr Robinson was out of town. I suggested that we, when I couldn't make them to better 02:08:46.780 --> 02:08:54.509 - understand the feedback I received with disregard, there was requests from back there. They were trying 02:08:54.509 --> 02:09:00.158 - to look at a way to avoid having to reenter in all of the information, but. 02:09:00.482 --> 02:09:10.237 - you know, just disregarding but kind of moving forward. Thank you. Yeah. Thank you. Thank you. Yeah. 02:09:10.237 --> 02:09:20.088 - Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. 02:09:20.088 --> 02:09:26.462 - Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.