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, 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, 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.