- It is 430 PM and I'm calling the August 20th, 2026 Board of Health meeting to order. If there is no
- objection from the board, I would like to amend today's agenda to include an ARBA septic update from
- Mike Kuzemka to the department update section before Lori's administration updates. Are there any objections? Okay.
- Seeing none, we'll have that. Are there any other amendments that the board would like to put forward
- at this time to the agenda? Okay. The next item is approval of the previous meeting minutes. The minutes
- from the meeting on one moment. So it's that just from.
- So from July twenty twenty six that you have in your packet have been. Are there any corrections or
- additions or is there a motion to approve the minutes as districts? I'll make a motion to approve. Second.
- All in favor? Aye. Aye. Meeting's approved. Minutes approved.
- Next, we have general public comments, and I will read. The Monroe County Board of Health encourages
- and welcomes public input. Written comments may be submitted at any time via email at boardofhealth at co.monroe.in.us.
- During meetings, comments related to specific agenda items will be heard after the board's discussion
- of that item and prior to taking a vote.
- At this time, we would like to invite those who would like to comment on any non agenda items to speak.
- For those attending in person, please sign in at the front of the room and those joining us online,
- please use the raised hand feature to indicate you would like to provide comment. Each speaker will
- have three minutes and we ask that you please begin by stating your name for the record. I do think we have
- Do we have one person signed in or two? I'm sorry, yes, two. Okay, so we have two people signed in and
- do we have anyone online so that I can go back and forth? Is there anyone with their hand? Okay, so
- who do we have first on the sign-in sheet? Yes.
- Yes. Do I stay here or do you want me somewhere different? This way. If you want to just stand. Whatever
- is easier for you, it makes no difference. I'm going to be very quick. Where should I go? This way.
- Sorry. Very briefly, hello everybody, and thank you for your service on the floor. It's a crazy time
- in the verse, and it's important to work with you. My name is Terry Amsworth. My wife and I live in
- Bloomington. I teach part time at IU with an adjunct.
- And I'm here though to say a brief word about the Monroe County Health and Equity Council. Brief because
- I have two minutes left. So it's sort of a cross-sector organization looking to help provide voice to
- those who may not always be heard fully in health decisions and services in Monroe County environments.
- And we threw out the,
- Robert Wood Johnson funded Community Voices for Health Monroe County Grant back 2020-2023 era. And we're
- now moving forward from there. There's a leadership team. We're doing bits of fundraising and a bit
- involved in planning processes, including for the County Department of Health for health planning related,
- and we'll do more of that. I'm here today, keenly though, to get to the main point. We held at the end
- of last year, November 1st,
- what we call our first porch party. The porch party is a way to help bring together people to identify
- their health-related, we see health somewhat broadly, including social determinants of health and such,
- to talk about their needs and interests. And it was done with the great support of United Way.
- And by the way, Randy Rogers was on the leadership team.
- Bob McCack hoped to be here today, but his schedule didn't allow. He'd probably be talking rather than
- me. But this I wanted to give, and I think there are five members. Is that correct? I thought I had
- five copies, but maybe I only have four. No, there's five. So if there's five members, I know paper's
- bad. But nonetheless, what this is is a report of a write-up with some details of this porch party.
- It was done in conjunction with Habitat. It was held at RCA Park.
- It was done with support for children who used to be present and participate. It was done with Spanish
- translations as well as needed. And it had about, as I recall, 60, 70 people there. Not a bad thing.
- Public engagement is hard. Public engagement about health can be hard. This brought a bunch of people
- out to talk about their needs, and this report documents that in some way. You have to get a read to
- get to it a little bit.
- Here's what we are. Here's the week about the box is done. But I give you that not because I'm going
- to talk about it a lot. You can read it. Hopefully you can at least. But the cat can be an ally to help.
- Gage voices and those are readers where you're looking for voices to be engaged. I encourage you to
- look at it and think about how it can be helpful. There are health related planning processes from different
- sectors and sources about to begin or thinking about deciding if they will in the strange world we live
- in. And we're happy to be supported. I will say and wrap up that one of the things we're doing, we're
- updating one of these publications. Your time is up. No, no, it's way too late. He was wrapping up.
- Thank you. And thank you for bringing the report.
- Thank you. Okay, and we have another person for public comment. One moment. There's no one online. Is
- that correct? Yes. Okay. Please, will you introduce yourself? I regret having to come and spend your
- time and my time to speak about this.
- My name is Christina Kempf. I'm a former employee who resigned from my position as public health nurse
- last month due to working conditions and the treatment I was receiving from the administrator and the
- health officer. I worked at public health for close to 20 years. The last 10 here in the health department
- as the parents coordinator, health educator, and for the last five months as public health nurse.
- In 2022, I was awarded public health hero
- from the Indiana Public Health Association after being nominated by our previous administrator. I share
- this to provide context to my background, experience, and dedication in contrast to the concern I will
- share. I've never been subjected to such a dismissive, unsupported, and at times unprofessional atmosphere
- as my most recent time here. This is no reflection to staff.
- I offer this information, not merely as another disgruntled former employee, but to provide insight
- into possible reasons for high turnover that have plagued this department for the past few years. From
- February until my time of departure, I was the only public health nurse on staff, except for briefly
- another nurse who was in training that resigned, and for Kathy Hewitt, who thankfully took on TV during
- a good portion of my time in addition to her role downstairs.
- While I was performing my duties and managing multiple aspects of other nurse positions, I could not
- understand why I was being treated so poorly. I was denied training opportunities critical to the safety
- of my functions as a registered nurse, and I was denied time off requests that culminated in threats
- of termination. I felt the need to involve HR in order to obtain approval of FMLA time to take care
- of my mother whose health declined and passed away during this time.
- officer who, months ago after meeting with HR, was barred from coming to my office or speaking to me
- alone, simply continued the same behaviors in Lori's presence, who had no objections. It seemed
- counterproductive to me to treat a dedicated employee with considerable experience, institutional knowledge,
- lifelong interests of public health, and a desire to continue to learn new skills in a way
- that I could conclude that it was only intended to encourage me to resign, therefore leaving Monroe
- County with zero public health nurses. I was not willing to continue to be taken advantage of simply
- because I was the only nurse willing to accept the impossible task of covering the duties of three positions
- in the clinic with no adjustment in the expectation of what was involved that would be possible. Nor
- was I willing to risk my license through potential needless vaccination errors that could occur without
- proper training.
- And I was not willing to be continued to be subjected to the type of treatment either I know any employee
- who previously left on your kind of health department voluntarily or involuntarily deserved.
- At some point, one has to begin to consider what were the actual problem lines. I truly hope, I truly
- do hope the best for this department and success for the clinic for the sake of our residents, that
- future nurses that are brought in can receive appropriate training to be competent in their assigned duties.
- and that they and all employees can be treated with basic respect. A packet of important information
- will be shared. I think that's you, Dr. Robinson. And I encourage all board members to at least review
- the covered letter, which kind of details a lot more specifics and some of those things that I am sharing
- here, along with emails that kind of support my position. I do thank you all for what you
- offer to Monroe County and serving here on the boards. Thank you for your time and consideration.
- Thank you. Thank you. The next item on our agenda is department updates and we'll start with the
- ARPA septic update with model. For the ARPA septic program, it ends and systems have to be installed
- and be built by September 30th this year. We have four remaining systems in various stages that are
- in production or getting ready to begin production. So we're coming to the tail end of it. So on the
- wastewater
- We're just hoping for good weather right now so we can get those systems completed. I've already been
- in contact with the homeowners and installers that if you don't think you can meet that deadline, we
- need to terminate the contract and that money is going to be allocated somewhere else. And could you
- speak just a little bit because we have an item to and a memorandum to discuss later on about some of
- the challenges in getting. Those.
- projects approved and all the working parts. And that may be, you know, Laurie's world to tell us that.
- And, and so, because we have some funding that we had to return already to different departments. Um,
- so we couldn't use all the funds. Um, just for the ARPA program, I mean, at first it started with the
- application process and that began late 2024, like I'll say third or fourth quarter. That's when we
- started getting the nuts and bolts of it together. And then some,
- some systems weren't, I think one system got put in place into that in the end of 2024 because of the
- weather. But in 2025 with weather conditions and whatnot, a lot of those projects got delayed until
- 2026 this year, but some did get installed. But now with weather constructions, site restrictions, right?
- Communicating with the homeowners, the contractors, the auditors, there's a lot of moving parts and
- pieces to it and just getting
- To the end stage and get it getting a proper invoice and fulfilling contract is it's been pretty rigorous
- processing a lot of communications. So. Thank you so much. You're welcome. Does anyone have questions?
- So, has the project overrun the expected time due to weather considerations? And if so, how's the weather
- now? Compared to what was expected.
- Every some every season is different. But like the weather is not looking good right now. We've gotten
- rain all throughout this week. There's more rain coming this weekend. We just need them in certain sites
- or they retain more water than other sites here in Monroe County whether it's the highlands or the lowlands.
- So a lot of contractors believe they can get the systems in but it's still we need them days of dry
- weather to get those systems in because they can't really begin the system installation without a soil test. So.
- And the federal guidelines are pretty specific, so it has to be done by. There's a drop drop that dates
- and speak. Yeah, yeah, that's the 930. So if you can't, they can't get it in or installed, installed
- and built by 930. Unfortunately any work leading up to it. If you miss that deadline, you're not. There's
- no back pay so. Yeah, then also with the installers, I'm a lot of. Installers that they're beginning
- to work without like half payment in. So I mean they are not getting paid into the very end.
- They have, they have limitations as well. So. Thank you so much. You're welcome so much. So look, how
- many have been. Completely installed on the top of my head. I don't want to guess, but I can get you
- those numbers. So. I can email like, or to help or I can send the Lori to get them out. So, yeah, just
- so we have a sense of. Before remaining, but how many did we actually manage. To do to improve this is the.
- Health and well-being of the county. I can get you guys those numbers tomorrow too. Thanks. This may
- be futile, probably is, but is there anything that we can do as a Board of Health? We just need good
- weather right now. As right now, we just need good weather. Get those systems in. I mean, because September
- 30th is coming. We can take a boat. We can do a rain dance. No more rain dance. No more rain dance.
- I don't know if that takes a resolution by the board. Thank you. You're welcome. Thanks. Our next update
- is from Lori administration and we have. And OK, just to start off with vital records, the Indiana Department
- of Health has completely stopped providing
- the burial transit permit forms that we used to get from the state. So vital records is essentially
- having to develop their own system for these forms, printing, distributing, and tracking these permits.
- The system that they have in place so far is going smoothly without any issues, but that's one change
- that they've been working on. The director and assistant director will be attending the Indiana Vital
- Records Association.
- ball conference that's going to be held in French like in October of this year. Year to date as of August
- 18th vital records has had 81% of their customers who have been able to meet the health first Indiana
- residency restrictions and the remaining 19% still has to be served by that non HFI funded employee
- that they have.
- We have recently interviewed 2 candidates for nursing positions. Neither candidate has moved forward
- in the recruitment process at this time. 1 is just recently finished school and has not taken the obsidian
- for licensure yet. And the other has concerns about a lack of a manager coming into the department.
- But we currently have 60 open case investigations that need to be started. There's a total
- of 108 investigations in the work list and the queue. So we have Kathy Hewitt is still continuing to
- cover TB and the LTBI patients assisting with our cyclospora cases, assisting with additional cases
- when time permits. Lenea is helping with our lead case management. Mike is doing a
- a great job with the animal bites and the tick-borne illnesses, so helping to relieve some of that from
- the work list. The cases that we have currently, the new 108, what you're describing is included in
- that? Yes. OK. So the 108, so there's 60 that have not been started as of today. Of that 108, the rest
- remaining,
- are being worked on. So some of those you just worked on continually over time. Maybe you have to try
- to reach back out to a patient because you couldn't connect with them the first time. If there's someone
- who on medication, so those are just stay kind of active until they can be closed out. The Indiana Department
- of Health is actually the one that then will review a lot of those cases and then close them out. So
- there are ones that stay open because
- there's periodic check-ins or it's being waited on for the state to review. Does that help? Do we have
- these staff members who are able to start working on the 60 cases? We really don't have the capacity.
- They're trying to little by little work on those high priorities. So the high priority cases, we get
- notification to begin working on those. Some of the lower level cases,
- are just sitting there until we're able to get capacity and to start working on those. Monroe County
- has had a total of eight cyclist forward cases since May 1st of this year. Statewide, there have been
- over 2,000 cases. Moving into the maternal child health, our coordinator currently has eight active
- participants in the quit for two smoking cessation program.
- Six of those are prenatal and two are postpartum. She's distributed 154 bottles of the donor breast
- milk since April. So that program with the milk bank is continuing to be successful and busy. She's
- gonna be partnering with the Bloomington Mobile Integrated Health on September 25th. They're gonna be
- hosting a car seat safety inspection clinic
- This will be held from 3 to 6 PM. And in addition to the safety checks, they will have car seats available
- if they have a family that arrives and it's damaged expired. The child has outgrown that type or weight.
- And these car seats will be coming from the state's automotive safety program.
- I'm here in the health department. We have seen an increase in referrals from the Hanna Center and tandem
- just due to supply. So we're able to provide those families in need with car seats so they still have
- access to those resources. So we've seen an increase in the ones that we are distributing. She's going
- to be starting the goal program. So that's the get on board active living program.
- This is in collaboration with Indiana University. This goes from September 15th to November 10th, and
- from six to 7.30 PM at the Bannetburg Community Center. This is a free program. It's families, children,
- age seven, with children, age seven to 17. And the families have children that are younger to seven.
- Child care is available at the center on site while
- the program sessions occur. Essentially, during the nine weeks, families participate in interactive
- games, hands-on cooking demonstrations, taste tests, and then they're able to learn about food, physical
- activities, sleep, and building a positive self-image. Our disease intervention and harm reduction team
- are still doing drop-in testing on Thursdays from 6
- three to six PM. They're seeing at least four different people at each session. So continuing to go
- well, they're also able to bring in patients who might not, they might not be able to connect with otherwise
- during these drop in times, which is helping with their workload.
- They are going to be attending Pride Fest on August 22nd and two different IU Welcome Week events providing
- educational materials, supplies, and promoting free services. On September 26th, we'll be offering testing
- at the Brown County Pride and offering pre-testing October 3rd at the Spencer Pride. Specifically with
- harm reduction,
- They have had 34 participants for the HIV and HCV wrapping testing services in one month. This is the
- highest amount of people who have been tested in a single month for the entire duration of the harm
- reduction program. So far this year, nine new hepatitis C cases have been identified through
- these pre-testing services. They are continuing to
- work on the Narcan Behind Every Bar program with the City of Bloomington, so that's going well. They're
- now allowing local businesses to have individually scheduled trainings for Naloxone for staff members.
- NYX is the next business scheduled for training in September, and Liberty Bird is in the process of
- scheduling.
- Our preparedness director and coordinator are scheduling back to school vaccination events in collaboration
- with the Indiana Department of Health. These will be held at the libraries in mid September
- and a drive-through event in late September. They have distributed public health emergency supplies
- to 76 individuals in August so far. This includes the three-in-one flu and COVID tests and summer safety kits.
- that include a small sunscreen, cooling cloth, tick remover, and informational card, and other safety
- educational materials. And they are preparing for an upcoming local emergency planning committee, a
- functional exercise event that's going to be held in September. And I do have a presentation that I
- want to go through next. If there aren't any questions about this information.
- question about the burial the very beginning yes is our form in coordination with our surrounding counties
- since we often have cross county burial issues that i do not know so i was just learning trying to learn
- more about this today um and i don't haven't seen the form that the
- permit that they've actually developed and how that compares to other counties. But I certainly asked
- about that. What's the consistency? I know that we have bodies that come here or have to go to bring
- our funeral directors are going across county lines and it just for a sense of ease and their understanding
- would be great for it to be coordinated regionally.
- Or at least on our little tongue. Thanks. Any other questions? Do you have that? Do you have that? Okay.
- So I know there's a lot on the agenda. I'll try to be brief.
- Okay. So I just wanted to take some time to have a discussion about the nursing services. So in working
- on gathering information, I decided to first start with taking time to gather some employee feedback
- on the different divisions that we currently have in the department and how they are functioning.
- So these first question, what challenges would your division experience without a defined management
- structure or manager overseeing division operations? The feedback here to this question has identified
- a lack of structure, direction, and accountability as significant challenges without a defined management
- structure.
- Employees also express concern that without a manager with division specific knowledge and authority,
- there are unclear expectations about roles and who to lean on for division specific guidance. I won't
- read off each of the individual feedback. The next question, what are the benefits to having a division manager?
- The feedback to this question consistently identified a division manager as the important source of
- leadership, structure, accountability, and expertise. Employees expressed how a dedicated manager provides
- a clear point of contact when they have questions, when they need guidance, or for decision making.
- How could public health and community safety be impacted without a division manager? These responses
- seem to highlight concerns that the absence of a division manager could directly affect the department's
- ability to respond effectively to public health needs. Employees emphasize the importance of having
- a qualified leader available to provide timely guidance, coordination, and support for decision-making.
- One experience back in COVID in a pod identified an example of how the absence of a designated leader
- creates confusion when unexpected situations arise. I want to lead this into what I am proposing for
- a case for sequenced hiring plan for the nursing services.
- Um, I feel that the recommended hiring plan should include first starting with securing that health
- services director as the anchor of the manager of our health services. Then moving into the clinical
- assistant and public health nurses. And then moving into developing and requesting the creation of a
- nurse supervisor position.
- So what I'm proposing is phase one, hiring the health services director. So building clinical nursing
- services without an established manager creates a really significant gap between hiring nurses and a
- clinical assistant and having the infrastructure necessary to ensure that staff are prepared and competent
- to practice within the local health department scope of services. The health services director
- really be establishing the foundation. So continuing into phase one, some of those initial responsibility
- course, they would have to complete the required trainings through the Indiana Department of Health,
- develop what competency validation processes they're going to use to train, evaluate, do skills checkoffs
- with the nurses and the medical assistant.
- refine clinical documentation standards, lead recruitment and selection of nurses and a clinical assistant.
- I really feel here in the department when we have managers of divisions and there's vacancies that they
- are able to take ownership and review the candidates, perform those interviews and select the individuals
- that they feel are best for their team. Starting with having a health services director
- this person would then be able to lead the recruitment of the nurses and the clinical assistant to build
- that strong team unit. Of phase two, build the nursing services team. So the purpose of this hiring
- structure really is to establish safe, organized and sustainable nursing services within the health
- department.
- So rather than simply filling positions, the health department can ensure that every nurse receives
- competency validation, clear escalation pathways for medical issues and concerns, ongoing clinical
- performance feedback, and access to appropriate clinical management. The public health nurse training period
- during weeks one through three is really focused on mandatory trainings. We've been using a six weeks
- training period that's primarily, it's really just been focused on online trainings. They don't have,
- have not had the hands-on training experience without a nurse supervisor or nurse director to do hands-on
- training. While this is going on, the health services director would still be actively engaged.
- support the nurses with that hands-on training, ensure trainings are being completed timely to meet
- target timelines, being able to use validation tools and skills assessment, and then leading and finalizing
- the hiring process to onboard a clinical assistant. So some examples for weeks one through three with
- the clinical assistant, reviewing with the health services director, the workflow.
- learning and training on church vaccine program management all of our different systems scheduling clinical
- supply management clinical activities within their scope emergency procedures and opening and closing
- procedures.
- So during this time, that also really allows for that one-on-one collaboration with the health services
- director and clinical assistant. So they can begin forming a strong team to test workflow options, to
- identify gaps and inefficiencies, be able to refine processes that are needed and develop consistent
- support routines.
- Moving into the end of the week three into phase four, be able to bring the nursing team together. So
- this really is just about now, how can the team begin to continue their training, learning, and working
- with one another? They can begin applying skills as applicable to their scope as their training continues.
- They can participate in mock trainings in the clinical environment.
- begin doing some of the additional trainings that are needed to really get up to speed with skills and
- competency. And once the nurses complete the mandatory trainings, the health services director can then
- begin to transition the team into the local health department, orientation and clinical implementation.
- So some of the ideas for specific tasks to begin those local health department specific orientations
- for patient care, review the nursing policies and procedures workflows or hands on training and establish
- individual clinic responsibilities within this team unit. Phase five transitioning into clinical operations.
- With orientation and competency completed, the department can then transition into more routine nursing
- operations. The health services director can move towards overseeing and strengthening the established
- system. Here's just a recommended staffing philosophy that really needs to start with building a strong
- managerial foundation with the health services director.
- Then bringing on the nurses, the clinical assistant for training, building clinical support, building
- the team together, establishing competency and timeframes for launching services, sustainable supervision,
- and approval of a nurse supervisor position in the future, I think is also going to be key for just
- long-term success within this division. If we are able to
- gain approval of a nurse supervisor position, then a transition can occur between the health services
- director and that nurse supervisor. So here's just an image of that long-term staffing model, the health
- services director, some of it is on the board, the nurse supervisor, three public health nurses, and
- one clinical assistant. So this model places
- an RN supervisor so there is someone overseeing those day-to-day clinical and operational duties and
- can be a support system for the nursing team that's readily available and they are participating in
- the clinics. The long-term vision is a health services director and nurse supervisor staffing model
- that can oversee nursing services and really establish a sustainable division.
- This will allow the health services director to then function at their appropriate level of leadership.
- And the nurse supervisor can then become that link between the division leadership and then that frontline
- service delivery. The director can move into providing that broader direction and the nurse supervisor
- can then translate that into daily operations. So why
- is an RN supervisor important? I believe one of the strongest reasons for the department to focus on
- developing this RN nurse supervisor is to ensure day-to-day clinical safety and compliance. An RN supervisor
- would provide daily supervision and support. We bring in LPNs and medical assistants. Those are the
- people handling immunizations, communicable disease. This will
- When a need arises, they'll essentially have someone there who can recognize and step in. So just try
- to provide some brief examples of how situation can escalate. So incorrect vaccine documentation. If
- you have a nurse, they administer a VFC vaccine. The vaccine information is entered incorrectly into
- the patient's record.
- Um, many things could occur if you don't have someone who is directly oversee these operations and like
- the nurse supervisor, then. It could be a long time before it's recognized or realized and then able
- to be corrected in the system.
- a vaccine storage temperature excursion. So we have a maternal child health coordinator taking temperature
- logs identifies that it's outside the appropriate range. There's a vacancy in the health services director.
- There's no nurse supervisor. And then who does that person go to? So just in this scenario,
- be trying to go to me and I'm out of the office. The other point contact person is also out of the office,
- leading to a situation of who do we go to next because that person does not have a manager or supervisor
- to go to. A patient fainting. You could have two nurses,
- They've completed their online trainings. They don't have an RN supervisor. They didn't receive any
- hands-on training. They didn't have an official review by an RN supervisor. So say nurse C administers
- the vaccine, the patient falls out of the chair. They try to call out for help. The other nurse decided
- to take an early lunch. There's no one else in the clinic and
- Essentially, without the supervisor, the nurses were left to try to rely on one another. A needle stick,
- a blood fluid exposure. This could be an example of the clinical assistant sustaining a needle stick
- injury. Not sure about what to do. They don't have a supervisor immediately available to go to. Maybe
- they're uncertain. They don't know whether the incident is urgent or not.
- Maybe no without that supervisor there in the space with them, whether they should continue patient
- care or leave the patient to determine what they should do next for their injury. Managing multiple
- tasks and responsibilities. You have a clinical assistant who might be rooming patients, answering the
- phone, trying to cover walk-ins, cleaning rooms. They need to take a patient down the hall to file records to pay.
- And the other nurses are busy doing other tasks, clinical assistants overwhelmed, not sure what to do.
- You have an RN supervisor there. They can step in and provide real time assistance to then begin directing
- what to do next and help assist. You could have two nurses who know about work, but there's not anybody
- to coordinate it. So perhaps employees are aware there's multiple high priority tasks.
- Some tasks are missed. It's not because they don't care or they don't know. They don't have a designated
- supervisor who's coordinating clinical and operational priorities on a day-to-day basis. An RN supervisor
- can step in to identify, prioritize, assign, follow up, and verify. So bringing in long-term an RN supervisor
- would help
- cover clinical oversight and operational oversight. Without an RN supervisors, we know that responsibilities
- don't disappear. They're simply being distributed informally among employees who don't have the authority
- training or designated responsibility to necessarily perform them. An RN supervisor is an organizational
- safety net, might not be highly visible,
- if things are functioning well or appropriately, but it's certainly going to become apparent when something
- unexpected happens. It's not about whether nursing services can operate without an RN supervisor. The
- question really is when something goes wrong, who's responsible for recognizing the problem, determining
- the response, directing staff, escalating the issue and ensuring the matter is resolved.
- Currently there is a gap and that's one of the reasons why I think that it's really important to consider
- building in an RN supervisor to this health services division. Just to briefly kind of circle back around
- to why, so why were three different positions, the public health nurse communicable disease,
- school liaison, and then just our general public health nurse
- created. So these are three slightly different positions. They have different titles, but this allowed
- the creation of primary, secondary and backup duties to have more clearly defined roles and responsibilities.
- The case for clearly defined roles and responsibilities. This is really about accountability, having
- a predictable workflow and a mechanism for resolving competing priorities.
- Can't really expect nurses who are expected to see what needs to be done and work out priorities among
- themselves. That can appear flexible and team focused, collaborative, but it really creates an informal
- system where responsibility, authority and accountability is unclear. Shared responsibility could lead
- to no responsibility. If all three nurses are responsible for everything, it creates issues with
- determining who is responsible for actually completing what task. You could have all three nurses who
- they may have aligned thoughts or they might just be working on their own and it just lead to an issue
- of lack of clarity. A staff should not have to negotiate priorities while also providing patient care.
- You have three nurses working on different priorities. You have an unscheduled patient walks in. Each
- nurse probably feels that their current task is important. However, without a supervisor, they now have
- to negotiate amongst themselves. Who's going to stop what they're doing? Whose task is more urgent?
- Who's going to finish the work that got interrupted? Who has the authority among them to make the decision?
- And what should be postponed?
- Expecting nurses to continually determine among themselves what is most important places and additional
- management responsibility on clinical staff where a dedicated supervisor can be that independent decision
- maker who can say which nurse handles the patient and the remaining work. For example, that's management
- and it's not something that should have to be routine routinely negotiated among peers.
- This presentation is good, but it sounds like you're trying to convince us. Are you practicing this
- for someone else? This needs presented really, I think, to the commissioners. We need to get out of
- the schedule and just do a presentation and also for the council. I don't think there's anyone here
- that needs to be convinced
- that this isn't a good plan and that nurses play an important role. I mean, even nurse supervise your
- position. At least I see the logic in this. But I don't think we need to be convinced of this. But I
- think this should be done as a presentation to someone in authority. And the final question I have,
- how realistic is this that we
- we can implement this in the current environment. That's why I really feel like without using the staffing
- agency to bring in that director first. So we have a staffing agency recruiting. They know people who
- are qualified can come in. They have that background experience to be able to get that foundation settled
- to then have that
- point person and that support to then bring in their team. And that's really a lot of the feedback that
- we've been getting from some of the applicants and some of the nurses. We don't have that person to
- go to. Then that's really important, especially for that direct clinical work and for the hands on.
- I'm almost done. I don't.
- Um, but I think in part with this, I, I want to make sure that, um, are we aligned on a strategy? Um,
- and for what we think should be the steps being taken. Um, and the importance really of that public
- health nurse supervisor, if you look at our other divisions and they have that middle line, um,
- senior or assistant director and that helps provide that extra layer of day-to-day support, backup coverage
- and protection in my mind to the health department. Yes. So that's a great presentation. Did you, is
- this sort of some standardized
- presentation or something that you've sort of developed in Oval? So I've been developing it, just kind
- of trying to piece together over time, like what are some of the different strategies? So if we've tried
- bringing in nurses without that support system, we know that that hasn't worked well. So what are the
- different, what are the, what's the next
- phase that you can try to really be able to create a stronger foundation. And then that's what I think
- is just taking time to say, I don't really think this is going to work with until we get those levels
- of supervision in there. So when looking at the board here, I have trouble with recognizing what's written
- because I have color blindness. So is that very top one?
- HSD, that's what we're talking about. That's the position, right? Yes. So that is our currently approved
- vacant health services director. I want to verify that. So we do have approval, but we don't have the
- candidates. So we have candidates. We have interviewed candidates once they learn the scope that changes.
- And we have candidates through a staffing agency, through the emergis.
- to come into that role. Yes, the emeritus spiel in our. Yeah, correct me if I'm wrong though. What you've
- got written there. The difference is here in this proposal. We have the health services director with
- these three nurses directly reporting position. She's talking about is in the middle is what there's
- a public health supervisor and a clinical assistant which we don't have. No, we do. We didn't get this
- nurse. We did get that one.
- Yes, but we don't have anyone for the clinical assistant to be supervised under or by or or trained
- or or go to. And so for similar and also different reasons, the public health nurse focused on maternal
- child health. That's similar in that our maternal child health coordinator doesn't have a support person
- to go to. There's no backup.
- capacity. So there are programs that at the beginning of Health First Indiana, she received training,
- we got the program materials, that was all part of the process of building the new position for Health
- First Indiana, but those haven't been able to be implemented because there's just not capacity. I'm
- probably the only colorblind, red-green colorblind person in the room. If we could get that, if we could get the
- like a bright blue and a yellow. Okay. Cause right now I see two colors. I see black and then I see
- some other not black, but I can't tell the difference. And it makes it difficult for me to understand
- that what's filled and what isn't. Okay. So let's see. So, um, we said this is vacant. Yeah. We hear
- positions are vacant. Yeah. Clinical assistant. This is vacant, but we,
- don't have, we haven't included this in the grant. They just moved to the nursing, so we don't have
- grants. So that's, we're not trying to actively fill that. We're also not actively trying to fill the
- senior community health specialist for the tobacco MRC. The tobacco MRC duties got moved into two separate
- positions. The tobacco was moved into the maternal child health coordinator.
- The MRC was moved into our director of public health preparedness. The senior community health specialist
- those duties was helping a lot with the community health assessment accreditation and harm reduction.
- So we haven't been actively don't have approval to fill that. That work is being done by our population
- health and outreach. But this is still the master plan. We hope to be able if we.
- All right, we're going to fill all the spots then we have these positions. This is what I can envision.
- Could we change one of those two colors to the blue instead of whatever it is? Yeah. Or could you simply
- circle the ones that have not been approved that Michael also? That's great. Yeah. The blue there is
- really good. That I can see. So let me ask the question.
- Just so we're clear, I'm also in support of this. But the question that comes to my mind immediately
- is, as on this paper, the only issue I would have is explain to me why the health services director
- cannot do everything you just described as it is on this page with the three nurses. Because to me,
- I feel like,
- That's one person that person is checking that's a nurse. Why can that person not be the backup,
- the trainer, the quarterback, all of those things that you're proposing the public health nurse do is
- I feel like that's the hurdle you're going to have to jump to convince that we need funding for this.
- Why does it have to be two separate positions?
- Um, so for a couple, so the health services director position was originally created. When we were not
- doing the nursing services that we've absorbed from health, so that position was already overseeing
- responsible for overseeing the other areas, the other programs once we knew that we were going to be
- taking on the health services, those duties that.
- were being covered by their RN supervisor that in essence got lumped into and our nurses got lumped
- into this director role. So the old way would have been the health services director would be meeting
- with a nursing supervisor that IU health was employing at community health who then had these other
- people. So this is basically recreating that same structure that we try to just
- You won't into the health services director position. Similarly, some somewhat. However, our nurses
- actually cover more duties than the IU health nurses were because they're also covering all of the health
- first Indiana.
- for public health services. So for example, we used to have one full-time dedicated school health liaison.
- So that was regional, but we had one full-time dedicated school health liaison. That's now been added
- to one of the nurse on top of those nursing duties. Our programs, trauma and injury prevention,
- let's see, chronic disease. So some of the programs trying to be
- developed and worked on specifically for Health First Indiana have been lumped into the public health
- nurse position. So these are not simply covering the same duties. They're covering the same duties that
- were covered by IU Health in addition to Health First Indiana for services. So my suggestion would be
- in your presentation that
- Articular piece needs to be very evident. Because the whole time I was listening to why can't this person
- be doing this job? I now that I understand it makes complete sense to me. I also think that practically
- we've seen that the health services director could be out of the office.
- And then how do you balance that? Do you have to make sure the director is always here eight to four?
- Can they leave? Do they have to check and make sure? Because if they're covering for the maternal child
- health coordinator, that's how my schedule currently is. She has to tell me when she's going to be in
- the office and out of the office because then I have to put it on my calendar to try to be backup for
- the people who are coming in for maternal child health services. It would be similar with
- The director having to coordinate that and with the nurses so say you have the school health liaison
- nurse who's out in the community at the schools providing tobacco education, you have the public health
- nurse who's
- out in the community providing services for fall prevention. You have the communicable disease nurse,
- maybe they're on vacation, maybe they are here, but again, then you don't have anyone here. So again,
- it's falling on who are those backup layers that are picking up the day-to-day activities or the people
- walking in or the emergent situations that might be coming up. It's also hard to tell whether it could
- be done because we,
- 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
- of work lumped into one and. If we had sorry more questions, I'm just trying to think how are you going
- to get questions right? If we had this public health nurse supervisor, do we still need a clinical assistant?
- to the health services director? Well, I think that would depend on who's going to be doing the billing,
- scheduling, answering the phone, cleaning and turning over the rooms, doing the inventory. Same thing
- now. If we don't have a clinical assistant, say we get two nurses in, well, then who's dividing up?
- Who's going to be answering the phone? Who's covering Joey when Joey walks in wanting a test? So would
- that position then report
- instead of to the health services director to then the public health nurse supervisor as proposed?
- I think so. OK, yes. To me, that's one of the most important positions. You've got to have somebody
- to answer the phone and take the patients where they need to be taken. I mean, this all makes good sense.
- I totally agree with you got to hire the director first because that person got set the vision and then
- that person got to sell the vision.
- to all the additional nurses that you're going to hire and create and organize the team. So I think
- that makes absolutely good sense. To me, I got bogged down sometimes the responsibilities of the director
- versus the supervisor. You've got to make very clear what those different duties are in order for anybody,
- I think, to accept this plan.
- Okay so action. Grant. Yes. May I. Yes. So I think that there are two things I want to offer and suggest.
- One is the while the board has approved Lori's going ahead to pursue contracting the board has not
- actually approved the emeritus contract itself. So that seems really crucial. The other part is that
- I know that the question is going to be, especially when you go to ask for a public health nurse supervisor,
- the question is going to be,
- Why do you need a nurse supervisor when you don't have any nurses? There is no doubt in my mind, that's
- going to be a major question, particularly from council, is why are you asking us for this thing when
- we don't have nurses? So yes, I understand. And we tried to hire a director that was pretty much a failure.
- And clearly the second line is absolutely the nurses and that services director being able to train
- and do that supervisor role. One of those nurses may rise, I would hope, like cream to the top as an evident
- person to move into that role. But I don't think that you are ever going to get counsel to approve a
- nurse supervisor before you have nurses, no matter how good the presentation is and how much sense it
- makes to the board. I think that you are going to bat your head against the wall. And that's just my
- impression of counsel and what the feedback
- So then what I continue to have is people like Christina who came to talk to us and say, well, I'm being
- asked to do all of these things because there's no one else. And so, I mean, there are a lot of moving
- pieces and parts. So I think we just need to decide on an action as a board. Do we continue? I think
- the decisions are, do we continue to try to ask
- cooperation with the commissioners because that's going to be an issue when we talk about the marriages
- contract and then also with council to try to create this so that we can be successful in keeping our
- funding essentially so we can recruit people have staff keep our funding for health first funds because
- if we don't if we don't if we are able to provide these services get people
- then this part of what we do is going to go by the wayside. So we are at a juncture where we're gonna
- have to decide, are we going to give up on these services? And which I think would be insane. I mean,
- 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?
- It does the board want to do that or are we at a juncture where we say, hey, you know, this is super
- 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
- I feel that's where we're that's where we are. Let me say something. So in the presentation with the seat.
- sequenced hiring plan. So that's why the long-term vision for the nurse supervisor was built in. That's
- later in the phase. So you have the director, the director comes on board, recruits the staff that the
- director wants for their team, getting the nurses and the clinical assistant, and then you're moving on to
- It's still going to be months and months and months to get through council to get approval and build
- a job description and budget to start for in 2027. So, so not now, but that's the long term stability
- plan and. That wouldn't be now we'd be focusing on.
- Who is our person we're going to get in here as that anchor for the director and let them bring in and
- build their teams. OK, so do we need do we need? A motion on behalf of the board to give you the tools
- to do what you need or do we? I think I need clarification on what is the direction I can move in or
- that so basically you want.
- Do you want a yea or nay on this plan, right, on this, what you have outlined up here? Yes, that's the
- plan that I see. And some of that happens immediately now. And the long-term vision is the public health
- nurse supervisor and the public health nurse maternal child help. Those will be coming into the full
- picture in 2027. I think those are critical positions that the health department needs for that long-term
- strong units. But what you're proposing is this middle part of what we're looking at here. You would
- say we're going to post the health service director, fill that position once it's filled, then we fill
- the bottom three. Yes. And then we're going to come back and get the middle one that's in red. Yes.
- Health services director, nurses, clinical assistant, director can bring all the clinical team in. And
- then in that process, we
- be working on anything to build the supervisor. And then at that point, you might have one of the three
- nurses who maybe can grow into the supervisor role or move into the maternal child health nurse role.
- So we're needing a motion to approve this with the modifier of including for adding the public health
- nurse supervisor, moving the proposal that we had from may of this year. That correct?
- Yes, you've approved adding creating those positions, adding those positions to the budget. So. You're
- saying that we need a motion to propose that we hire the health services director first. I think it
- for the hiring sequence for the plan. Or who are we hiring first?
- I mean, is it? Again, I can't, I don't feel like I can hire a clinical assistant. We did have nurses,
- right? So it would have made sense when we got approval for that, but we don't have an RN for the clinical
- assistant to report to. We don't have someone in that supervisor or director role. So who's going to
- train that person? If we have a medical assistant, there's without again, that director who was the
- clinical assistant. Who's doing these duties now?
- Now we're providing them, but now we're just in a slip shot. Where was Christina on this? She was the
- public health nurse communicable disease. OK, so Kathy Hewitt is covering some of those duties. Linnea
- is covering some of the duties. Mike is covering some of the duties.
- Our maternal child health coordinator Aubrey is doing the non-clinical, non-nursing duties. Me, the
- administrative assistant, the director of vital records, are trying to keep up with the temperature
- logs and the inventory for the vaccines. But this is also a problem. We need a VFC vaccine coordinator
- and a backup coordinator for those programs. So if we hired an RN, you're saying even if we hired an
- RN, we don't
- That person couldn't start without the cell services director. Is that what you're saying?
- We don't want them. If I think based on our past experiences, they don't have that system and structure
- and supports person. In the hands on training, who's going to determine whether they have the skills
- to move forward with providing services? All right, I'm going to attempt to make a motion. I motion that.
- Uh, with the, with the current approved positions that we have that we post and hire the positions in
- the order of health services director first. With after that person is hired and trained, we then post
- and hire the three clinical nurses and the clinical assistant position as a second tier.
- So just as a discussion, so what happens if we do that and then it takes a year. Or so can the health
- services director be giving vaccines and answering the phone until we get until we get. Where we need
- to be to some certain extent, but I think that's where the staffing agency comes in because. They have
- the people they know, for example, they have. People who they can bring on and is that potentially going
- to lead to to more.
- Oh, I don't like this. I'm going to leave. It might. But unless we start paying a lot of money for posting
- these jobs, we're not getting applicants. Do we need to have the discussion about the agency before
- we vote on the motion? Or do you need to do public comment? We have. So what public comment do we have
- to do? Let's take I think we can do them separately. So.
- Lenea, do you need Michael to say the motion again? No, I forgot. Okay. So is everyone comfortable or
- someone comfortable to do a second of the motion? I second the motion. All in favor? Hold on, we have
- to do public comment. Oh, yes, I'm so sorry. Yes, I'm sorry. We have to have public comment before we
- vote. Yes. Anyone with their hand up who wants to make public comment?
- Online. Okay. Seeing none. We shall take a vote. Do. Okay. Motion passes. Okay. So the next item to
- discuss is the emeritus healthcare staffing update. So. Can I.
- Well, I wasn't speaking. So we had a contract. Lori was working with Dave on making some adjustments
- to the contract. There were a few items that needed changed. There, you know, ongoing, she was working
- with emeritus and had some potential people who we could maybe hire.
- from from that if we were able to get a contract et cetera. And I believe at the commissioners meeting
- they rescinded the emeritus contract as as was correct as it was correct at that time. So I think that
- emeritus is our I think it's a viable option to get us staff
- And so what I would like to see is that we ask Dave to make the amendments that he thought were appropriate,
- get that contract to us. If he is able to do that before the next meeting, we maybe even have a special
- session to talk about the contract and vote on it so that we can move forward. So that's my assessment
- or other additions.
- Um, you know, not a whole lot. I mean, it's been, I think that they just want legal wants some changes
- made that I was unaware of specific changes. Um, and so just need to have those things changes made
- so it can go, um, to the board for approval. And then the commissioners, um, why was it rescinded? It
- is so I said, why? Because, um,
- there well because the board did not specifically approve this contract but it's not essentially this
- contract either if changes are being proposed and try to be worked out. Absolutely I think that's something
- I missed. It's been a long time and just trying to actively work and get positions filled and I set
- the contract to legal in June. We had a phone conversation he said
- got the contract looks pretty straightforward. I did not realize that there were changes that the county
- wanted to have made and I just pursued kept trying to chug along in a panic and so we're just gonna
- now have the changes made. Does Emeritus operate as an agent to hire to help us hire people or do they
- operate as like a staff solutions, a local staff solutions where they actually employ the people and
- Yes. So when they're under the contract, unless it's a direct placement. So if it's a direct placement,
- then you can pay the fee and someone would come on as a county employee attempt to hire. So the person
- who was interested in the director position, it could be attempt to hire. So they're, they're working
- for a marriage. We're just paying, but then they would come on as a health department employee.
- So every month that they work for us into perpetuity, we're paying, giving our marriages some money
- for that person. Yes, you're paying that rate, which it is more, but we're not paying for the benefits
- of a county employee, which our benefits are really high. So marriages provides benefits for them.
- We have some proposals, I think, in the last meeting or the one before that will be discussed. Certain
- positions, creating positions and are having change in the salaries and I think those included benefits.
- So I'm having a hard time understanding. How that fits in with this, so I think it might be that. Approval to.
- move the health services director to that special occupations at the rate of $36 per hour. Okay.
- So council, um, did approve that it's posted as $36 an hour. Um, we haven't had anyone who's been interested
- in moving further in the recruitment process, kind of after those initial stages. We also had discussions
- regarding the budget and I think that might be what you're remembering as we're trying to figure out
- how much is the position for cost. But from a budget perspective,
- The not having to pay benefits and then paying the fee is that a wash for it's close. I mean, it is
- still more expensive question. Okay, so. You don't really need a motion. Well, do we need a motion actually
- to ask Dave to work on. Updates to the contract that we can then present at the next 30.
- I'm not necessarily sure. I called over to the legal department today and asked them if they could get
- those updates to us. I was hoping to not just put the motion. Yeah, let's just do it. A motion that
- we send this contract back to legal to have the amendments made that were necessary from legal and then
- bring it back to the board for an official approval. Do I have?
- A second and then we'll ask a public discussion. Okay. And then any public comment? Seeing none. Vote.
- All those in favor? Aye. Motion passes. May I ask a question for a moment? Yes. Do we need to make a,
- were you asking for us to vote tonight on these positions?
- because what we did before were to get a motion or anything. What I motioned before was for the ones
- that were already approved did not include those newer ones that you were proposing. Do we need to do
- anything with that tonight? I think it would be beneficial so we don't delay. The council has said that
- they don't want to hear requests for new positions until we're all aligned with the direction that's
- going forward.
- So you need a motion from us to say you may move forward to counsel regarding both of these positions
- or just the public health nurse supervisor? I would say both of them. They're both proposed in the budget
- for 2027. Public health nurse supervisor, public health, maternal child health. Is that a supervisor
- at the end of that or just public health, maternal child health?
- coordinator. I think it would be one of the supervisor position titles are we can figure out. Well,
- we have to define it so that it's clear to the council. So what positions would you like us to supervisor
- positions, public health nurse supervisor for the three public health nurses and a maternal child health
- public health nurse supervisor. That would kill me. I second. Will that work? Okay. And do we have a
- couple of comments? Okay. Seeing none, we have a second and all in favor. Sorry to move backwards. I
- just realized that. Thank you. Yes, thank you.
- Motion passes. Okay. So we are going to go through the next few new business items all of which will
- require votes. So the first item is 2027 Health Net excuse me Health Net HIP contract approval. That's
- the Homeless Initiatives Program. You have this contract in your packet. My I.
- review this, I just had a question about item five, which is the insurance requirement. We needed a
- confirmation from our current contract. So the Monroe County Health Department actually has a malpractice.
- Contact and so we were trying to get our hands on that. Oh, you have it. No, I'm sorry. What did I do?
- Oh, that training and supervision. Oh, I'm so sorry. It's probably I'm backing up. It's probably not
- relevant if the based the sequence hiring plan occurs because the clinical assistant would be supervised
- by the director.
- 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,
- we have, we'll have. Okay, so, Lori, we. We're going back, I'm sorry to all continuing business discussion
- of nurse supervisor and MCH nurse positions. And I, unless I'm mistaken, I think we covered that in
- our. Discussion or not.
- Number three training and supervision of clinical assistant. OK, I'm sorry. Training and supervision
- of clinical assistant Lori. So the purpose of having this item for discussion was to discuss if if we
- don't. Bring on a health services director first and start move towards this plan and we have nurses.
- one, two or three. And then we're going to hire a clinical assistant. Who are they going to be overseen
- by? Who's going to train them and supervise them? However, I feel as though if we are going to move
- forward with the plan to bring on the health services director and then the three nurses and the clinical
- assistant, that that issue will be resolved by that plan.
- a motion that we table number three, training its group as a clinical assistant until after a time in
- which the health services director is employed. I second. Is there a public comment? Seeing none, all
- in favor? Aye. Motion passed. Okay. So moving to new business, discussing the,
- Homeless Initiative Program with Health Net for 2027, a contract. This is an item for approval of the
- contract. However, what I don't know from item five is if we have enough coverage from our current conference
- for medical malpractice. I do not have the answer to that question yet. We've reached out to
- Um, who has the policy to try to get a copy of the policy. No, 1 has been able to confirm. That we currently
- have this coverage or that we need to add. Okay, so if someone could make a motion to add this item.
- Until until we can have more information until our next meeting.
- I'd like to make a short statement then I'll make the motion. Oh, yes. My statement is that it seems
- to me that if we go to an expert and say, hey, do I have enough coverage, they're going to automatically
- tell you no. That means that I do make the motion that we table this discussion until we have the information
- needed to make a reasonable decision. And how much is this? How much are we? It's a million. No, I mean,
- how much? 135,000. Oh, I'm sorry. 135,000.
- And that's the same funding we gave in last year, right? The same amount, yes. They were asking for
- additional money, which we didn't approve. As 155, they wanted that 20,000 to use. We have been helping
- to purchase some supplies that we've been able to help support with the glucose,
- I second the motion. Okay. Any public comment? Sarah? Yes. I'm crazy about this program. I think it's
- great. I love the data that we got about the drop-off in patient C in the ER during those hours. What I
- really would be curious to know is, and I'm sure it's gonna be really hard for us to obtain, but it'd
- be very interesting to know how much IU has saved because of this program. And I don't know if our director
- could help us even begin to understand what the financial benefit has been
- from this drop off of the homeless population being seen during those hours. So it's in the, it is in
- the reporting and metrics section of E. It says of those seen by hip street medicine compare with visits
- to IU health emergency department. So if you are wanting to make, are you? I'm just, I'm asking in general
- that we know what the numbers looked like. Cause we saw that report and that was fabulous.
- We had a graph, we had all sorts of information, but I'm wondering what the financial benefit to IU
- Health is from this action on our part and that of Health Net. Because I think that it's, I think it
- should be substantial and that patients who have been, I think it's also a clear benefit to the community
- who wants to be served
- in the emergency room and that they can be seen much more rapidly. And that's why I'm saying, I don't
- know how one would even begin to wrap their head around it, but I suspect that there is a way of beginning
- to understand the financial benefit. So as of July, the first time no longer the medical director of
- the emergency department
- I've given those duties off to Dr. Matthews. I did have a discussion with Mr. Ross and he doesn't know
- the answer and I don't think anyone knows the answer. I don't think that there's been, there's been
- a, you can say you've decreased this number or there's been a decrease in the number of people who visit
- the emergency department, but it's hard to say that
- it was related solely to these changes. And then the amount of money that saved, I don't know if they've
- made that determination, but I didn't get that number from Mr. Ross when I had the discussion with him
- when I was still medical director. I am in favor of having a discussion with IU Health regarding this,
- but I don't know how to get those numbers. Yeah, I don't know how to quantify it. And I'm sure there
- must be some method
- Maybe somebody who's really smart about this will be able to. But I know that when I talked to the health
- administrator for the state, she was very excited when I told her what we saw in terms of numbers and
- the impact that these Health First Indiana funds had had.
- not only for the homeless homeless population themselves, but in terms of real use of these funds to
- deal with people and benefit the whole community again, because there is more availability for emergency
- services than for the rest of us. So I think one of the problems that you run into,
- how to quantify it in the face of IU Health having its own initiatives outside of the community health
- or the street nurse doing the thing that they do. There's other initiatives of which I'm aware that
- were ongoing and ramped up over the past couple of years as well that were also designed to keep people
- out of the emergency department. And I think that's where you run into problems with saying, well, here's
- the financial benefit. So because we've benefited you, why don't you help us?
- I think it's very difficult to quantify it. Not impossible. I don't know. But I think when you approach
- IU Health and when we approach IU Health, we have to keep that in mind that that's going to be a likely
- response is what I would imagine. And I think that's reasonable to say that because I know there are
- other efforts to decrease these visits that may not be necessary. So thank you. That was really helpful.
- So still seeing no raised hands for public comment.
- We shall vote on Dr. Teaves' motion. All in favor? Aye. Motion passes. Okay, and now we're going to
- talk about the full blood pressure screenings by the maternal child health organ.
- So the question is, so originally this goal program was built into our felt nurse school liaison position.
- When that position became vacant, we had already previously been in an agreement with Indiana University
- and we were working towards providing this program. So I spoke with our maternal child health coordinator
- to see, you know, do you have
- capacity and interest in taking this on and when would this maybe best work with your schedule. So through
- further discussion with that she identified that working and working with Indiana University fall would
- work. So as part of that process we were really hoping to be able to collect biometric data that we
- could help to track program evaluation and outcomes
- Since our maternal child health coordinator is not a nurse, the question is, do we feel that it would
- be appropriate and okay for her to be trained under our standing orders to be able to do the blood pressure
- screenings for those 13 and older as part of the program so that we can still collect that data?
- Is it purely to collect data as a population data or is it to collect data and then act upon it and
- in individuals cases, for example, if someone has been going to school, you take a 50 year old blood
- pressure, it's 200 over 130. Is there an action that's to be taken? And if it's not, if it's elevated,
- but not emerging within needs to go to the emergency department. Is it, is there some action to be taken
- by them or is it simply to collect?
- data on a population basis. So the standing order does outline the certain criteria and then what action
- should be taken. So if that was identified, you should seek help immediately. You should follow up with
- a doctor in a certain period of time. So those would be the recommendations and the guidance to my knowledge.
- Is it possible for us to read those? I got to tell you, we get people from offices all the time that are sent
- or emergent, you know what I'm talking about? So dumb. Emergent blood pressure readings that are not
- emergent blood pressures because like 180 over a hundred, oh my God, you got it with VR right away.
- And there's nothing to do for that patient if they're not having symptoms. You're not dying. Go back
- to your primary care. Is there some way that we can just, I'm adding on to our work, but can we review
- those guidelines and maybe look at them and see if they're appropriate? Sure. We have all that information.
- What kind of blood pressure cuff is this person using? Is it electronic or is it? Yes, it's electronic.
- So do we want more information on the standing orders or can we amend those at some later time and prove
- that the maternal child health coordinator with appropriate training can
- assess blood pressures for those over 13. I would like to see those and review them and also review
- the type of training and review the training that they're going to receive to make sure that it's that
- is reasonable for that situation. It gives a whole force of leads sometimes in these electronic blood
- pressure monitors. Okay, so can I have a motion to table this until we gather more data for any
- address it at the next meeting. And do I have a second? Second. And do we have anyone wanting to make
- public comment? And seeing none, we'll take a vote. All in favor? Aye. Motion passes.
- I motion. Okay. No. Okay. So our next item is to discuss the part-time public health nurse request.
- All right. Yes.
- So again, and just trying to think and consider different options for our nursing services actually
- had some candidates who are not interested in part time, but they would be interested or not interested
- in full time, but they would be interested in a part time opportunities, even if it were just short
- term or if it were long term kind of here and there.
- Additionally, just considering the large picture of, you know, you could abruptly lose a nurse and then
- have a vacancy. It would be really nice and easy to be able to have a, I'll say pool, although it's
- not necessarily a pool, but maybe one or two part-time nurses that you could call upon and see if they
- have any availability to help cover specific services that need to be performed for the health department.
- Essentially, it's not about adding overall capacity. It's about being able to have options so that we
- have a flexible staffing model. In my mind, this is similar to PRNs at hospitals. They'd only be scheduled
- when organizational needs occur. They'd only be used within the existing funding available.
- would have the ability to maintain our clinical services. Um, now this it's hard to say, I think the
- council number one wants to define job descriptions. So what are these part-time nurses going to do?
- Has the board approved that you can move forward with part-time nurse positions? And, um, how do we
- know what we're going to pay them if we don't have a defined part-time position for
- the nurses. I think that you have to kind of include a lot of those different duties and activities
- because you might not know, you might just be wanting to call your part-time nurse and see if they can
- participate in a vaccine event for the community. You might have coverage that's needed for one of the
- nurses because they have to be off for two or three or four weeks and to be able to provide some stability
- for those services. So I think it can make it challenging
- to pin down just very limited duties and responsibilities. But overall, I think that being able to have
- the option to have short-time nurses to fill gaps would be really important, again, just for the long-term
- stability. Are we looking to say, yes, let's go evaluate this, let's try to help with the job descriptions,
- or are we looking for something else
- board tonight. I think the first move would be that you approve going to council to request that we
- can develop part-time nurse positions. What do you define as part-time and hours? Well it would be under
- 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
- be able to exceed that certain amount of hours that could be
- Over time for the year that makes them eligible for benefits. I think that it's a difficult. I think
- long term. In an ideal world, it would be great. I think it's going to be hard. Very difficult to go
- to council, especially with all the current changes we're trying to make. That is just my assessment.
- And can you tell us, Lori, what is council's position on part-time employees? My understanding is that
- they are, not only is there this hiring freeze, but they do not want any part-time employees. Is that
- correct or not? I did not, I am not aware that they don't want any part-time employees, period.
- But yes, there is the hiring freeze.
- And my understanding from Council Administrator is they are not going to approve part 10 of those. That's
- my understanding. I may be in for that, but that's what I have heard. And so I'm wondering whether this
- is, I think, again, I think that Lisa put this
- under the best of circumstances, if this were, if we were independent of the limitations that are imposed
- on us by council and commissioners, that would make perfect sense. We know that on Miller Drive, we
- had part-time positions, we had two part-timers, and so maybe more, three? I think it was more than
- that. They had a couple that were working.
- So I mean it was great they they liked it but this council you're never going to get that proposal through
- and that even asking the board to approve something that is not going to happen when you take it to
- council. Ultimately I'm afraid it looks like we're
- just getting beaten down. And so I would just suggest that, you know, wait until things get a little
- looser and work with council, help them begin to maybe with new liaisons. We don't know. But, you know,
- as we know things financially across the county and the state are going to become much worse.
- much worse for all government. And so to try to get through to them what and why this is, I think is
- a losing proposition. And I honestly don't believe we can take any more losses at council's door, personally.
- Yes, it looks like we're fighting the good fight, but
- I don't know that it behooves the board to ask for things that unlock them. I was not aware that if
- council has said they don't want part-time positions period. So if that's the case that's not something
- I was aware of.
- You know, when we have people reaching out to say, hey, I know about this change that happened with
- IU Health. I can't come on full time, but I'm really passionate about the health department. I'm more
- than happy to come on in a part-time capacity. And we see the work that needs to be done and we're in
- this critical situation. I think that it means a lot to me. And it's really important that I explore
- every single avenue that can be explored to try to get the services into the community. And that's simply
- what I'm trying to do.
- I get it. I will say that respectfully, I want to take a different position and not try to bend. Please.
- I believe if I look at the world, if I look at the state of our government, federal and statewide, and
- if I said 10 years ago, this is where we're going to be, I would have said you're out of your mind.
- That's not going to happen. And I think that because you never know which way the wind is going to blow
- and pendulums being as they are,
- I would say if we have a vision and we have a reasonable vision that can help them improve the health
- outcomes of the people in our community, then I think we should propose it to the council because I
- do believe fortune favors the bowl. I agree too. I, you know, my, my opinion is, you know, we are from
- my perspective, we serve the community. Um, and if ultimately we think that,
- Hey, you know what? We're not getting bites on these positions. We've got the services we need to provide.
- We have people calling and saying, I can give you four hours here, four hours there. If if council wants
- to shoot it down, council council can shoot it down publicly in the in the white of the community and
- see that we as the Board of Health are saying,
- And here's what we need. We care. And, and council has said no. So we're doing our, we're trying to
- do our job. He did it on record. Right. That's right. On the record. Yeah. And that's how people vote.
- Um, you know, and that, so having people put stuff on records is important. It doesn't really make sense.
- They don't really want part-time people because you have to work a certain number of hours to be eligible
- for benefits. I mean, I think it's, it's 21, I think in private.
- my practice, you have to work 21 hours a week, or you have to put in benefits, even though I will go
- on record as saying I was provided. Let's be clear. But legally, you're not obligated to do it for any
- more than 21 hours. At least that's what it was. And so I'm all in favor of requesting
- part-time positions, making our position known, and let's see what happens. Yeah, I agree. Make them
- shoot it down in public. It sounds as if that's going to happen, and it really needs to be made clear
- how many of the positions at IU, of our IU nurses I know that were part-time. I think that understanding
- that this has operated very
- It should be and effectively with Parkland people may hope that I just I want you to be aware that it
- may be a real losing game. And you know what? I think that all I can do is try. Yeah, that's right.
- I'm the one in the chair every day trying to get
- people in here to do the services. Okay. So what. What motion would be most helpful at this juncture?
- So it gives you time. To do what you need to do to get everything ready. I think the 1st step is it
- has to go to council.
- for approval to move forward to develop a part-time position during the hiring period. So you need a
- motion to. Yes. So how many, so in an ideal world, how many part-time positions would you like to? I
- think two would be okay. And I think that it's important to clarify that when I'm
- thinking about this, I'm thinking more of that PRN capacity. We're going to call our agreement and we're
- going to say we need some help, not your schedules for 20 hours a week, period. Correct. Because over
- the past few weeks, if we would have had that person, for example, that reached out, it would have been
- really nice to say, absolutely, let's get you in here tomorrow. And we'd be providing some services
- right now. And so I don't think that it's a lot.
- Could we, instead of calling them part time nurses, could we call them PRN? Is that something we can
- do? Like, can we just name it PRN? You can type whatever you want. OK. I think PRN makes it more clear.
- It sounds better. I think that's a little easier pill to swallow. Does that work in the county structure,
- though? I do not know the answer to that. Do they have as needed positions? I guess, yeah, because that's
- an interesting, like, if we
- give a part-time position and then we give them zero hours. Like, is that a problem? I don't think so.
- Cause I, my understanding, I don't know what's changed from when I've been here and what's current now,
- but it's my understanding that you would be scheduling them at the capacity that you need up to 20 hours.
- Um, and some of them are temporary, just seasonal. Um, so again, it would, yeah.
- So is the part-time language okay? Or should we do as mean? I don't know what the title is. Sounds like,
- oh yeah, that's a good idea. Supplemental. Yeah, I think that sounds better because I think if you say
- part-time, they're going to be thinking about how many full-time equivalents are you creating? And that
- supplemental or PRN,
- They may not even understand PRM because they're not in the business. Yeah. Okay. So can I, Oh, well,
- yeah. Can I have a motion? So the motion to go to the council to ask to develop a supplemental positions
- as needed as supplement positions as needed or what is it? Public health nurse.
- 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.
- and I have a vote. All in favor? Aye. Motion passed unanimously. Okay, so now we have approval of septic
- replacement modem, or sorry, yeah. Memorandum. So this is the contract that is amending
- The language that shows that the funds, excuse me, we will reduce the inter-agency agreement by $252,712.91
- for the septic program because those funds are being moved to other programs because we couldn't get
- those funds used for the septic program because of the federal guidelines and meeting all the criteria,
- et cetera.
- Whether yeah, and then. So we have to vote on the changes for the contract. So I need a motion. I'll
- make a motion to approve the. Amendment or the change to the. It's the right and then. The changes us
- make a motion. To approve the changes in the contract.
- I second nothing and we have public comment. Seeing none all in favor. The next item is approval of
- the Red Cross Agreements. I do too. That's why we have. So I know it's five and six.
- Sort of go together as far as the Red Cross agreement goes, but public health preparedness. So our division
- has been looking at how can we expand some of our training in the community and Lenea has looked into
- some different options. She's received training and if you're comfortable talking about it, I think
- you're the most qualified person to do so.
- Sure, so I've received the search engine training to be a Red Cross authorized adult and pediatric CPR
- first aid as well as basic life support, baby center course, the associated coursework there. And what
- we would like to do is to add to our preparedness education the opportunities to take the CPR training
- I don't want to be accurate. And then to offer the babysitter. I think it's. Awesome. The agreement.
- If we did everyone receive the agreement before the meeting today, it was too large. Okay. Okay. Can we.
- um paper copies yeah distribute paper copies and then does that mean we need to load on it at a later
- time i would say it's a subject can you summarize it yeah i don't really need a paper copy actually
- i mean we've actually i think it's been a long time we've been discussing this and there's actually
- been a lot of back and forth i've actually been like
- I don't think we can do this. This is going to be a lot. And then circling back around because of counting
- processes. Right. OK. What other ways can we can we actually maybe do this. So we've worked out the
- program so you're going to be developed a form that individuals would complete a Microsoft form to sign
- up for the classes. OK. And then you all register and we would register them and then either they could
- turn through by the records office
- Um, or in the phone, we're going to be able to do that. And then as long as that's before they show
- up for the past. So this is the general public would go on the website, find this form, fill it out
- and then you're providing the training. Okay. They're either bringing in the payment or they're calling
- vital records to make the payment over the phone or collecting those fees and then.
- The Red Cross is going to invoice us because of our payment structure. That's really the process that
- we need to be able to use. So we collect the fees, and then we receive the invoice through the Red Cross
- to pay that, and we're using their materials. So it's all Red Cross materials, and we'll take the materials
- every few years. And in order to stay current as an inspector, you have to review
- I need to make sure that you've seen those materials with no access to it and. Grant funding will be
- used to purchase the supplies to start. The program and that's been cleared and taken care of through
- the. If we need ongoing.
- We could also use Health First Indiana. So both Bryce and Linnea's positions will be Health First Indiana
- funded next year. So they'll be obtaining verifying residency anyway. So we need to supplement with
- other funds in the future. The rate of survival of out-of-hospital cardiac arrest bystander CPR started
- is five times greater than if it isn't. It's ridiculous. They go to King County, Seattle,
- your sense of surviving out of the hospital card, the rest is so much higher than anywhere else.
- It's just, it's a great program. Yeah. And then the thing is the beauty of it, it doesn't even matter,
- you know, count this number. It's just get it started. Just start pumping out of their chest. It's a
- world of difference. So our motion I think is to approve the agreement with the Red Cross. Is that,
- is that the threat? Okay. So can I have a motion?
- Okay. And do we have any public comment? Seeing none. All in favor? Aye. Motion passes unanimously.
- Okay. The code change proposal.
- Now I noticed there are two. Yes. So as part of developing this program for implementation in the health
- department, we would need to actually add into our fee code what the fees are that are going to be charging
- the public for these services. So there are two different proposals based on two different fee collections
- and what is actually being covered. Let's see.
- So, one is covering the cost of providing the service. So, our supplies, our personnel typically, that's
- what we would do.
- what are you charging to just cover your expenses? So not making any profit. One is if we want
- to intentionally subsidize fee costs, which is legal, we could do to provide a discount and essentially
- not collect fees that would be covering the full amount of us providing the services. Again, talked
- with Linnea about this and you can speak to it and I think it's,
- I felt it was appropriate and fine to have both options and then the board can discuss what structure
- they think is best for the department and the community. Did we get some idea of how much the base would
- be? Page five. So yeah, on page five, the red is different copies at the same time. The higher amounts,
- the other has a lower amount.
- There's calculated okay. That's it. Second, one is the baseline. So, yeah, the talk of labor actually
- often. So, it sort of, it doesn't take all of it out. Um,
- But basically, it's known that all of the expenses into. So, there's no, no additional. Here it is.
- The actual expense of materials and it covers much of the. The inspection Boston, the higher amount.
- covers all of our expenditures, assuming that we have the minimum enrollment for the class. So this
- would be the model that you'd use for like a revenue generating class. So it would mean that the expenses
- associated with the labor and teaching reports, as well as all of the equipment and supplies utilized,
- and the certification fee, which is what we then would owe to your cost, I would be fully covered with
- a minimum of three students.
- Okay, so. Yes, maybe, unless unless it's unless we only get three. Right. Right. So. What if I heard
- correctly. The initial upfront costs of this are being paid out by grants that we've already gotten. Correct.
- Okay, so when we host a class, what is the cost we include? The cost per class is the sort of fixed
- labor cost, which is how many hours it takes to teach the course. And then the certification fee, which
- is what we are invoiced by the. And those are all listed and those are in agreement. So. Oh, so the
- 65 versus the 105 for the, for the 1st line.
- Right. For example, the certification fee or that $65, for example, is, I think, $55. So $55 of that
- goes directly to the Red Cross to pay for the certificate. And the remainder is paying for the, just
- the supplies that are distributed, like the little first aid type of thing. Yeah. All right. So we're,
- and what's the maximum size of a class? So you said three is the minimum. Three is the minimum.
- 10 is the maximum budget based on the fee budget that we included. It doesn't sit right with me to make
- money off the endeavor. I think these are pretty steep fees, honestly. Given what people make to live
- in this town, what people are making in this town, these are pretty steep fees in my opinion. I agree.
- And are we, is IU Health community group doing any of these classes? I thought their trauma and injury
- prevention team provides them in the community. I was one of them, American Heart Association. Amy's
- group I'm talking about. Yeah, Amy's group has, they do these things. I thought they still
- did the babysitting and those kinds of things.
- Lisa at the school the Lisa school health I know at least was during the babysitter thing some of the
- spurs. I have a comment. My meter is going to run out in about five minutes. No longer than I expected.
- What's okay do we have any do we have a motion.
- Or which proposal you would like to. I'm trying to. We've been talking about finance. We've been talking
- about all of those stuff. Like, are we offering these classes? What's a month? We'd offer it every two
- months. We'd offer it weekly. Our proposed schedule with our prepared network education would be to
- offer it one to two times per month, depending on what the initial response is, and then to offer it
- maybe seven, four, three times per year. It's like that matters.
- in regards to if we go, I agree, we should go with the lower fees. But if you're going to take a hit
- of $500 every time you do this, that's going to probably matter at some point. In building a capacity
- for your workload, how that might function. I understand that. So maybe I don't understand
- it. My understanding is proposal one is a break even charge.
- Proposal two is a make money charge. Is that not right? Proposal two is a break even at three participant
- charge. Okay. And proposal one is a break even at 10 participant charge. I see. Okay. Okay. Okay. That's,
- that's, and that's why I've been asking the questions, right? Like, yeah, that's what they're going
- to, yeah. I'd say that the barring grant funding, um,
- Additionally, coming out of somewhere, um, the absolute lowest that we could ever try to be, we don't
- have to pay to the boss. Yeah. It's like for that, uh, I think in 65 is my first one. Um, maybe 55.
- So can we, can we do something like three seems, seems small to me and 10 seems big. Can we amend it
- to make it somewhere in the middle? Like.
- I think it's set by, is it set by the Red Cross or? The maximum is set by the Red Cross. Technically,
- the minimum could be whatever you see fit for the expense assessment. They recommend at least two. My
- preference is to have them in pairs. So, either having four, six, eight, or 10 participants. Sure. But
- 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
- these things.
- You know, if it's $200, that might be different. Can we set it at, like, six and vote for a proposal
- that says we break even at six? So that's what I was going to ask. Could we motion to do proposal one
- but have a minimum number of participants of six? Or we cancel the class? Yeah. Can we do that? We'll
- probably end up in the class being canceled.
- A lot well, or whatever the number is. Yeah, yeah. Um, we, I mean, like, if we go by our preparedness
- and diversity forces, which are free of charge. They kind of coming waves, so we'll have some classes
- where we'll have. 10 to 15 participants and then other classes where only 3, you know, is registered
- actually. Have you moved it to a quarterly or a couple of times to try to get people. Maybe by.
- Yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah,
- yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah,
- yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah,
- I understand the thinking, but I don't want to add more parameters to your name is day to day. I don't,
- 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
- that she can just do manage the classes without having to cancel the classes and then meet criteria.
- And it's just going to be a bigger hassle. So just set it. We're going to have it every other month.
- Yeah, we have a minimum of four or or just set every other month and that's it and we charge every other
- month and then we're going to reevaluate what these classes are, right? And if they're massively full,
- we can add more. Okay, and then. So we need a motion. Is that by monthly every other month? I think
- I've said that. Yeah.
- And then are we saying fee schedule number one. We can have a motion. I motion that we adopt fee schedule
- proposal number one with a frequency of the public health preparedness education at every other month.
- I second. And do we have any public comments?
- No saying none. All in favor. Motion passes. Okay. So would any board members or the health officer
- like to make any additional comments before we adjourn? I have one comment and I know it keeps you from
- Google columns, but we, what do we know about the VAX care? That we said we wanted to.
- So, I, I connected with help. And for more information, what specifically that they were looking for,
- and I knew that Dr Robinson was out of town. I suggested that we, when I couldn't make them to better
- understand the feedback I received with disregard, there was requests from back there. They were trying
- to look at a way to avoid having to reenter in all of the information, but.
- you know, just disregarding but kind of moving forward. Thank you. Yeah. Thank you. Thank you. Yeah.
- Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.
- Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.