WEBVTT 00:00:00.354 --> 00:00:15.261 - Maybe we should have move a financial reporting with Eric up to maybe number two, one moment, for department 00:00:15.261 --> 00:00:29.758 - updates. No, this is new business. So can we move it up? That way he doesn't have to be here a long time. 00:00:29.986 --> 00:00:43.461 - Can I have a motion for that. Okay second. All in favor. All right. Okay so we can move that item. The 00:00:43.461 --> 00:00:57.982 - minutes from the meeting on September 22nd the executive sessions on this on September 17th and September 28th 00:00:58.434 --> 00:01:06.625 - and the special session on October 12th have been distributed. Are there any corrections or additions 00:01:06.625 --> 00:01:15.297 - or is there a motion to approve the minutes as distributed? I motion to approve the minutes as distributed. 00:01:15.297 --> 00:01:23.488 - I'll second. All in favor? I follow. Motion passes. Regarding public comment, the Monroe County Board 00:01:23.488 --> 00:01:27.262 - of Health encourages and welcomes public input 00:01:27.810 --> 00:01:34.542 - Written comments may be submitted at any time via email at Board of Health at co.monroe.in.us. During 00:01:34.542 --> 00:01:41.341 - meetings, comments related to specific agenda items will be heard after the board's discussion of that 00:01:41.341 --> 00:01:48.139 - item and prior to taking a vote. At this time, we would like to invite those who would like to comment 00:01:48.139 --> 00:01:55.070 - on any non-agenda item to speak. For those attending in person, please sign in at the front of the room. 00:01:55.234 --> 00:02:02.924 - and those joining us online, please use the raise hand feature to indicate you would like to provide 00:02:02.924 --> 00:02:10.538 - comment. Each speaker will have three minutes and we ask that you please begin by stating your name 00:02:10.538 --> 00:02:18.228 - for the record. Do we have anyone? Well, is there anyone in the room who would like to make comment? 00:02:18.228 --> 00:02:23.710 - Okay, and is there anyone online who would like to make public comment? 00:02:26.434 --> 00:02:36.320 - Is there, is there anywhere? Okay. Seeing none, we will move on to department updates. So our 1st update 00:02:36.320 --> 00:02:45.923 - is with Linnea with administration. Yeah, so waste water monitoring of COVID and food specifically to 00:02:45.923 --> 00:02:54.302 - pay. They currently show a moderate level in the community. Food is a little surprising. 00:02:54.594 --> 00:03:03.621 - starting more slowly this year. As of October 7th, the Indiana Department of Health reported that there 00:03:03.621 --> 00:03:12.561 - had been 28 new cases of measles statewide in 2026. By yesterday, that number had doubled to 53 cases. 00:03:12.561 --> 00:03:19.678 - You do have a map in your packet showing where those cases are about to count to. 00:03:20.450 --> 00:03:26.751 - There have been no suspected or confirmed cases in the county this year. Relatedly, public 00:03:26.751 --> 00:03:33.951 - health preparedness, staff, and the population health and outreach manager attended a tabletop exercise 00:03:33.951 --> 00:03:41.221 - with Indiana University Emergency Management and Student Health Services this week, focused on the local 00:03:41.221 --> 00:03:48.284 - response, so there'd be a positive measles case at the university. I know having talked to Dr. Action 00:03:48.284 --> 00:03:50.430 - for the board, I believe that. 00:03:50.850 --> 00:03:57.209 - For vital records, the director and assistant director attended the Indian Revital Records Association 00:03:57.209 --> 00:04:03.507 - health conference at French Leth. The focus of the conference was records retention, law, and policy. 00:04:03.507 --> 00:04:09.743 - Of note, assistant director, Jessica Deegan, resaged the Sally Meisenheimer Award, named in honor of 00:04:09.743 --> 00:04:15.979 - a former Middle County Health Department registrar who passed from cancer a few years ago. According 00:04:15.979 --> 00:04:17.214 - to the IVRA, quote, 00:04:17.314 --> 00:04:24.559 - Recipients of the Sally Meisenheimer Award have been a motivating factor in the Indiana Vital Records 00:04:24.559 --> 00:04:31.947 - Association. Nominees have donated their time and energy to make our membership strong and influential. 00:04:31.947 --> 00:04:39.050 - They have worked to develop another for us to realize. So congratulations to you. For environmental 00:04:39.050 --> 00:04:43.454 - health services, the ARPA subject program has been completed. 00:04:44.546 --> 00:04:50.549 - Two geography professors are interested in collaborating with the department to produce high resolution 00:04:50.549 --> 00:04:56.726 - risk maps and ticks for mineral county, which could be very helpful for tackling outbreaks of vector-going 00:04:56.726 --> 00:05:02.498 - diseases. The PHS director has also invited County GIS coordinator, John Bailey, to assist with map 00:05:02.498 --> 00:05:08.386 - development. The Food Division is working with County Legal to update the mobile ordinance because of 00:05:08.386 --> 00:05:09.598 - legislative changes. 00:05:10.146 --> 00:05:16.795 - Phuoc is planning a mobile operator meeting for December to discuss the new state-guide license, planning 00:05:16.795 --> 00:05:23.382 - reviews, and the licensing process. On October 15th, several cases of illegal and dangerous sniper DDVP, 00:05:23.382 --> 00:05:29.341 - active ingredients, diphyllidose, were confiscated in Marion County at the department complex, 00:05:29.341 --> 00:05:35.739 - an international grocery store, and a distribution ramps. The Office of the Indiana State Council was 00:05:35.739 --> 00:05:38.750 - notified. We just received an alert about that. 00:05:39.234 --> 00:05:45.605 - If anyone does have that in their possession, make sure to not use it to go to physical contact with 00:05:45.605 --> 00:05:52.102 - them. Health services. Population Health and Outreach staff are on the Monroe County Substance Use and 00:05:52.102 --> 00:05:58.472 - Order Awareness Commission, or SUDEP, which held the Monroe County Recovery Summit at the Convention 00:05:58.472 --> 00:06:05.159 - Center for almost 200 participants in September. SUDEP also held the now incredible Paint the Town Purple 00:06:05.159 --> 00:06:07.934 - Celebrate Recovery event on September 15th, 00:06:08.226 --> 00:06:14.128 - to continue to build recovery support and connections within the community and celebrate those in the 00:06:14.128 --> 00:06:20.029 - recovery. Population health staff also participated in a eight week train the trainer course on three 00:06:20.029 --> 00:06:25.816 - key ways of understanding the overdose crisis. The training included content delivery and education 00:06:25.816 --> 00:06:31.602 - to create a foundation of understanding and a new way of thinking about the overdose crisis. It was 00:06:31.602 --> 00:06:37.214 - a collaborative effort experience that brought past participants from many different backgrounds 00:06:37.602 --> 00:06:43.945 - including law, medicine, recovery organizations, policy advocates, and farm reduction programs. 00:06:43.945 --> 00:06:50.619 - And finally, our disease intervention and population health staff continue to offer free walk-in STI 00:06:50.619 --> 00:06:57.755 - testing on Thursdays right now from 3 to 6 p.m. in the middle. Services include free rapid and confidential 00:06:57.755 --> 00:07:04.825 - testing for chlamydia, malaria, syphilis, HIV, and HCV, free naloxone and testing strips, and free condoms 00:07:04.825 --> 00:07:07.006 - and other misdirection supplies. 00:07:09.858 --> 00:07:21.957 - Awesome. Thank you. Does anyone have any questions or comments? All the stuff came along. So what is 00:07:21.957 --> 00:07:34.415 - the substance that you referenced that was found in? My understanding is it's a pesticide. It is highly 00:07:34.415 --> 00:07:39.806 - toxic. It is not legal in the United States. 00:07:40.290 --> 00:07:49.800 - It was in Marion County. It was in Marion County. It was presumably brought in from some foreign source 00:07:49.800 --> 00:07:59.493 - and has been confiscated. But if for some reason there are other quantities of it, please, please, please 00:07:59.493 --> 00:08:09.278 - don't use it. Is it being used? I'm naive. I'm trying to think. Is it being used for its intended purpose? 00:08:10.402 --> 00:08:26.239 - Drug of abuse or is it not that I don't know. That's what I'm saying. I'm wondering if they're changing 00:08:26.239 --> 00:08:38.878 - it. Thank you. Next, we're going to hear some updates from Eric with financial and 00:08:39.042 --> 00:08:48.514 - He is, I think part of why I asked Eric to come was to educate us and let us know about our budget and 00:08:48.514 --> 00:08:57.986 - to kind of define where we are. I know it's not budget season, we just went through that, but at least 00:08:57.986 --> 00:09:07.550 - so that we can be thinking about how we can use our funds, especially come January when we start having 00:09:07.842 --> 00:09:16.963 - discussions with the board and then working with county council, et cetera. So, Eric. So you should 00:09:16.963 --> 00:09:26.084 - each have a copy of the 12th Department's 2026 Act response. It's a basic report that I brought up, 00:09:26.084 --> 00:09:34.110 - but you'll see in the first column that we have our council through 2026 appropriations 00:09:34.594 --> 00:09:45.214 - And then we'll have the 2026 expenses up through September 30th. And the last column is basically what 00:09:45.214 --> 00:09:55.525 - we have remaining for 2026, which is coming in really good. If you know, the health fund, which has 00:09:55.525 --> 00:10:00.062 - a large remaining amount of appropriations, 00:10:00.674 --> 00:10:14.432 - In that appropriations, there are the COVID-19 funds that are currently appropriated, which is $746,573.79. 00:10:14.432 --> 00:10:28.318 - That is for special use in that. So those funds do not supplant our current budget. So coming down the road, 00:10:28.450 --> 00:10:37.361 - We will have to decide where those funds need to be spent. I do have all the documentation as far as 00:10:37.361 --> 00:10:46.447 - what we received, what was paid out on the funds, as well as the letter from Dr. Box talking about how 00:10:46.447 --> 00:10:55.358 - the funds should be spent. And so moving forward, we can hopefully find programs to understand that. 00:10:55.810 --> 00:11:03.904 - I did break them down, so we do have the grant separated from there to move forward. And currently, 00:11:03.904 --> 00:11:12.160 - we have the preparedness, the DIS, harm reduction, crisis COAD, which we're using the remaining funds 00:11:12.160 --> 00:11:20.335 - for those from there for the positions. I was in the syringe services program. Just having completed 00:11:20.335 --> 00:11:23.006 - getting everything taken care of 00:11:23.106 --> 00:11:35.095 - Yes, as far as appropriations for the medical material. Anybody have any questions? So for that first 00:11:35.095 --> 00:11:47.672 - item, can you get to the members of the board, the letter detailing responsibilities for that? Definitely. 00:11:47.672 --> 00:11:51.198 - So to be clear, do we have to 00:11:51.810 --> 00:11:59.998 - decide how to appropriate the funds for the $700,000 in 2026. So those funds are very reasonable. So 00:11:59.998 --> 00:12:08.349 - they're currently appropriated in 2026, which is going to be difficult to spend anything at this point 00:12:08.349 --> 00:12:16.699 - in the year. We have 70 lines for 2027. They're currently being held with a dollar in each line. We'll 00:12:16.699 --> 00:12:21.726 - have a supplies line, a services line, and an equipment line. 00:12:21.922 --> 00:12:31.724 - So it's decided. So those are set. We'll just, I'll, we'll have to go to council for appropriation on 00:12:31.724 --> 00:12:41.334 - the funds. Okay. And that, but they are ready to give the judgment. We can get those started. Okay. 00:12:41.334 --> 00:12:48.926 - They'll carry over on the health fund. Be happy to go each year. I do have it. 00:12:49.634 --> 00:12:57.204 - full dollar amount track so it will be easier to this is what we have and know what we have and just 00:12:57.204 --> 00:13:05.149 - have to decide where it needs to be appropriated or supply services or equipment. Okay great. Does anyone 00:13:05.149 --> 00:13:13.019 - have questions for Eric? I would do a little bit more broad like on that on the back of this page you've 00:13:13.019 --> 00:13:19.390 - got remaining appropriations what of that do you need to spend five years over here? 00:13:20.834 --> 00:13:37.788 - What expires? Other than the COVID funds, it just reburts back to the funds. Gotcha. Thank you. You're 00:13:37.788 --> 00:13:50.462 - welcome. All right, very good. Thanks so much. You're welcome. So we may add 00:13:50.690 --> 00:14:02.309 - to our agenda for next month discussing what we want to do with those funds. Do we need a motion on 00:14:02.309 --> 00:14:14.741 - that? Do we need a motion to add it? Okay. Okay, for old and continuing business, you have in your packets 00:14:14.741 --> 00:14:20.318 - several part-time- We missed the- I'm so sorry. 00:14:20.418 --> 00:14:28.098 - I missed it. My mistake. I had it aired there. So actually, so we have the Meningococcal response after 00:14:28.098 --> 00:14:47.518 - action report. And I would like, Linnea, for you to give us an update there. Yeah. So, on 1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1- 00:14:47.618 --> 00:14:55.440 - The first summer, you have the after I can afford in your. It's the stuff you know, very clear. And 00:14:55.440 --> 00:15:03.262 - I'm not going to go over any, you know, as a team, this is a public document. The public is open to 00:15:03.262 --> 00:15:11.397 - the. And this was our, our team's first experience managing that rapid infectious disease event of this 00:15:11.397 --> 00:15:15.934 - time. I think this will be able to touch for our systems. 00:15:16.450 --> 00:15:22.919 - And you were successful in leading our statutory obligations and identified some of the challenges that 00:15:22.919 --> 00:15:29.201 - should be addressed with an incidental license. The response team included Director of Public Health 00:15:29.201 --> 00:15:35.546 - Preparedness, health administrator Lori Kelly, population health coverage manager, and health officer 00:15:35.546 --> 00:15:41.890 - Dr. Sarah Riebermaat. Bryce, we also facilitated the after action review as part of his duties as the 00:15:41.890 --> 00:15:43.134 - flexibility manager 00:15:43.682 --> 00:15:50.198 - The review was attended by myself, the health administrator, and Ms. Hewitt. On May 14th, 2006, the 00:15:50.198 --> 00:15:57.301 - Indiana Department of Health, notifies the Monroe County Health Department of a probable that any properties 00:15:57.301 --> 00:16:04.078 - can actually be moved by any school corporation. Because post-exposure federal access only works within 00:16:04.078 --> 00:16:10.920 - a tight window, we need to coordinate contact identification, medication access, and notification within 00:16:10.920 --> 00:16:12.158 - 24 hours per IDHR. 00:16:13.954 --> 00:16:20.143 - By the following morning, every identified contact had been reached and either received local access 00:16:20.143 --> 00:16:26.576 - or documented a refusal, which is consistent with their statutory response. Many aspects of our response 00:16:26.576 --> 00:16:32.826 - worked really well. Our staff worked well outside their normal hours and outside their general duties 00:16:32.826 --> 00:16:38.647 - and timelines were absolutely met. IUH provided pre-written communication templates and strong 00:16:38.647 --> 00:16:42.078 - epidemiological support that enabled a prompt response. 00:16:42.850 --> 00:16:50.003 - MCCSE and IOH collaborated quickly and smoothly to identify post-contacts. Civil flexation was procured 00:16:50.003 --> 00:16:57.087 - and dispensed rapidly despite this not being a routine health department function at this time. We did 00:16:57.087 --> 00:17:04.034 - identify some gaps. Emergency public information and family warning. There was some confusion around 00:17:04.034 --> 00:17:10.430 - the approval process for public messaging and public communications were sent out outside of 00:17:10.562 --> 00:17:17.296 - the department's established public information officer legal process. As for public health surveillance 00:17:17.296 --> 00:17:23.837 - and epidemiological investigation, a tough-to-date school emergency contact list was not available at 00:17:23.837 --> 00:17:30.250 - the time of the incident, following a recent staff departure from our school leads on public health 00:17:30.250 --> 00:17:36.791 - emergency decision. This day, we slowly made mention of the coordination with MNC-CFC, so it was very 00:17:36.791 --> 00:17:40.254 - quickly worked out. Medical comprehensive dispensing. 00:17:40.450 --> 00:17:46.561 - There was no clearly defined backup prescribing authority in place if the health officer were to be 00:17:46.561 --> 00:17:52.916 - unavailable during the injured incident or in the flight during the response. Operational coordination. 00:17:52.916 --> 00:17:59.027 - Roles and responsibilities weren't clearly defined for such a small strength point of dispensing of 00:17:59.027 --> 00:18:05.199 - a child. Decision-making authority was unclear. Internal communication risks. Contact people lacking 00:18:05.199 --> 00:18:07.582 - secure messaging or HR infrastructure. 00:18:07.938 --> 00:18:14.952 - After hours, contact information for county support services was landed, and facility access was constrained 00:18:14.952 --> 00:18:21.515 - on key availability. But none of these gaps prevented the successful emergency response, but they did 00:18:21.515 --> 00:18:28.015 - cost us time and added stress to staff who were already working outside during one of our hours. The 00:18:28.015 --> 00:18:34.578 - primary concern, of course, is what happens if the next event has a tighter margins or other feedback 00:18:34.578 --> 00:18:36.766 - and factors. The recommendations, 00:18:36.866 --> 00:18:42.733 - Uh, maybe after action review, formally clarify the communications improvement process, including how 00:18:42.733 --> 00:18:48.945 - and under what circumstances the health administrator as designated public information officer can delegate 00:18:48.945 --> 00:18:54.869 - that role and ensure that all involved are trained in that process prior to the next incident response 00:18:54.869 --> 00:18:57.630 - and consider designating the deputy to the PIA. 00:18:59.074 --> 00:19:06.149 - 2. Develop HIPAA compliant internal comms to help with rapid coordination, ensuring that contact lists 00:19:06.149 --> 00:19:13.361 - are up-to-date and accessible by phone-related parties. 3. Establish a 24-hour Health Department contact 00:19:13.361 --> 00:19:20.504 - number and designate staff to monitor for that. 4. Develop after-hours contact lists for county support 00:19:20.504 --> 00:19:23.870 - functions to facilitate unlocking doors, etc. 5. 00:19:23.970 --> 00:19:30.074 - Develop standing orders for outbreak medications requiring rapid dispensing and consider if any of these 00:19:30.074 --> 00:19:36.235 - have to be canned. Four, explore alternatives for rapid access to commonly required outbreak medications. 00:19:36.235 --> 00:19:42.048 - Six, identify alternate providers authorized to prescribe medications or make some of the decisions 00:19:42.048 --> 00:19:48.210 - under most circumstances. Seven, develop medication reference diets for response staff, including dosing, 00:19:48.210 --> 00:19:53.790 - contraindications, patient screening questions, pharmacy procedures, and prescription guidance. 00:19:55.458 --> 00:20:02.004 - 8, create standardized templates, including contact investigation forms, medication box, patient screening 00:20:02.004 --> 00:20:08.366 - forms, prescription templates, situation reports, and incident action plans as appropriate. 9, maintain 00:20:08.366 --> 00:20:14.667 - readily available supplies, including medication bottles, labeling materials, dispensing supplies, and 00:20:14.667 --> 00:20:20.478 - standardized targeting templates. 10, clearly defined for small action, small scale incidents, 00:20:20.642 --> 00:20:26.522 - roles and responsibilities, decision-making authority, and alternates, delegation with authority and 00:20:26.522 --> 00:20:32.635 - under what circumstances, response window versus medication treatment windows, and activation procedures 00:20:32.635 --> 00:20:38.981 - for after hour incidents. Some of these items, particularly delegation, authority, policy, and understanding 00:20:38.981 --> 00:20:45.095 - what the board supports with, the board is reviewed, we comment about putting in staff, we seek to touch 00:20:45.095 --> 00:20:49.694 - on things in our doors, and we make the action on this. Others, I do see them. 00:20:54.114 --> 00:21:13.903 - Yes. So I think I think we have a lot of processes to put in place so that we have an adequate response. 00:21:13.903 --> 00:21:23.326 - I think that's going to require coordination with 00:21:23.874 --> 00:21:37.734 - the health officer and with staff and with the board as those are developed and then can be approved 00:21:37.734 --> 00:21:53.790 - by the board. I also would reference that we have in our packet an after action brief or the meningococcal case that 00:21:54.434 --> 00:22:05.186 - specifically references personnel or rather, well, yes, personnel issues, but this is available for 00:22:05.186 --> 00:22:16.261 - public consumption. So if you could comment on that as well. So I'll just add a few items just to give 00:22:16.261 --> 00:22:23.358 - some clarity on my summary of the act that I can look forward to. 00:22:24.482 --> 00:22:31.988 - So with regard to the Public Information Officer, in our County Emergency Plans and also in the Health 00:22:31.988 --> 00:22:39.640 - Administrator Job Description, the PIO is designated as their way. During the COVID response, the Health 00:22:39.640 --> 00:22:46.927 - Officer communicated with the Health Administrator after the fact. She had been in contact with the 00:22:46.927 --> 00:22:54.142 - press and during the subsequent public meeting provided updates on the patient's condition without 00:22:54.274 --> 00:23:00.763 - clear documentation of people from the patient or DIO or an operational institute. During the process, 00:23:00.763 --> 00:23:07.252 - there were points at which the head administrator did have difficulty getting in touch with the health 00:23:07.252 --> 00:23:13.866 - officer. And there was a need to find back up prescribing authority if the health officer could continue 00:23:13.866 --> 00:23:20.229 - to be available. The health officer determined PDP to be a single dose of 500 milligrams of oral and 00:23:20.229 --> 00:23:22.686 - occipital flexation for an individual. 00:23:23.106 --> 00:23:29.308 - but did decline to order sufficient PEP to cover all identifiable contacts, or to identify alternative 00:23:29.308 --> 00:23:35.690 - PEPs should secure boxes and be content indicated for any of those contacts. This did require effectively 00:23:35.690 --> 00:23:41.892 - the rules to seek PEP through their primary care providers rather than the health department EIP. When 00:23:41.892 --> 00:23:48.394 - the response team contacted like your primary care providers to notify them that patients would be reaching 00:23:48.394 --> 00:23:50.622 - out for those prescriptions for PEP, 00:23:50.914 --> 00:23:57.978 - We were told by the staff that they would likely not be able to get that information out to all of them 00:23:57.978 --> 00:24:05.110 - from all this time. The health officer did indicate that she preferred that the close contacts interface 00:24:05.110 --> 00:24:12.039 - with their own primary care providers and encouraged to get vaccinated. I will add that only a few of 00:24:12.039 --> 00:24:19.375 - the contacts had not had both MSCV4 doses or even had the vaccine. So most of those were at least partially 00:24:19.375 --> 00:24:20.190 - vaccinated. 00:24:20.674 --> 00:24:27.221 - The contacts vaccination statuses were included on the list provided by MCCSC and there's a standard 00:24:27.221 --> 00:24:34.352 - question we ask them to contact tracing as well. While in the past health officers have written prescriptions 00:24:34.352 --> 00:24:40.834 - for identified post-contacts in their name, the self-professor ordered the doses of circumflexation 00:24:40.834 --> 00:24:48.030 - in the health administrator's name and processed it through their personal insurance. The health administrator 00:24:48.194 --> 00:24:58.566 - So, two of the corrective actions, formally clarifying the communications approval process and delineation 00:24:58.566 --> 00:25:07.678 - under PIU rule and identifying alternative prescribing theory responding directly to studies. 00:25:18.370 --> 00:25:32.230 - We can work internally on. We're seeing these protocols so that. We have them formally available so 00:25:32.230 --> 00:25:47.614 - that we can respond appropriately. Then we have our next emergency. So are we suggesting that we would have a? 00:25:49.378 --> 00:26:05.827 - I think that's one option. Quick access to a supply that's not directly located on the site would be 00:26:05.827 --> 00:26:14.622 - another option. I think it's difficult to coordinate. 00:26:15.490 --> 00:26:22.615 - multiple prescriptions. So it might be easier to have it here. Yes. You know, there are some issues 00:26:22.615 --> 00:26:30.026 - with that in terms of, you know, does the medication expire and et cetera. But it might be. First thing 00:26:30.026 --> 00:26:37.222 - is the same thing in my office. I had emergency medications that were renewed periodically so that I 00:26:37.222 --> 00:26:40.286 - didn't let them expire, forgot about them. 00:26:41.090 --> 00:26:51.686 - Uh, so I would think that we would have, could have some system that would allow a small drive for one 00:26:51.686 --> 00:27:01.974 - of, uh, antibiotics or whatever, uh, in the office and the sauce would be relatively small compared 00:27:01.974 --> 00:27:09.278 - to the time of the chance that we miss someone. Three people were, uh, 00:27:10.242 --> 00:27:17.197 - We're involved in this in terms of the people that were offered prophylaxis. Is it such a small number? 00:27:17.197 --> 00:27:23.951 - I can't say. Yeah, it was less than 10. Yeah, this was a very small number. So we're very fortunate. 00:27:23.951 --> 00:27:30.839 - Yes. Well, I would say some of these protocols we're talking about may be complicated to come up with, 00:27:30.839 --> 00:27:37.995 - but need to be done as soon as humanly possible, because it's only a matter of time before we have measles 00:27:37.995 --> 00:27:39.934 - case. Only a matter of time. 00:27:40.258 --> 00:27:50.789 - Yeah, for sure. The plans in place for larger scale incidents, it really is a smaller scale for the 00:27:50.789 --> 00:28:02.057 - decision bill. And just a truth in your comment about not having them on site, what would be the advantage 00:28:02.057 --> 00:28:07.006 - to not having it on site? Yeah. If you had it, 00:28:07.170 --> 00:28:14.504 - For instance, I think at some point we talked about there's a small supply that the Iowa emergency department 00:28:14.504 --> 00:28:21.571 - has on hand, then they are responsible for replenishing them, making sure that they don't expire. They're 00:28:21.571 --> 00:28:28.438 - handing them out frequently that way they probably don't expire. So it is no longer our responsibility 00:28:28.438 --> 00:28:31.838 - here to do that. We would kind of farm that out to 00:28:32.194 --> 00:28:39.842 - wherever. In this case, we were talking about, I think, the emergency department at IU health, but. 00:28:39.842 --> 00:28:47.719 - That makes sense. But yeah, I mean, I like for Cipro, 20 tablets of Cipro would cost $10 or something. 00:28:47.719 --> 00:28:55.519 - So it was just a matter of getting it. And that's going safely. Yeah, yeah, yeah. Just except getting 00:28:55.519 --> 00:29:00.414 - it, yes. Yeah, that might actually be a good ultimate solution. 00:29:05.186 --> 00:29:19.339 - Any other comments or concerns? Okay. I would just like to make one clarification. In one pager where 00:29:19.339 --> 00:29:32.382 - it says that I was, I did not participate, did not attend or respond to the event invitation. 00:29:33.122 --> 00:29:44.529 - I just want to clarify that the event invitation was a, not even an email to my health officer address. 00:29:44.529 --> 00:29:55.826 - It was a date and time for a meningococcal hot wash. And I've asked any number of people hot wash was, 00:29:55.826 --> 00:30:01.310 - and I assume that Jargon may be familiar to some. 00:30:01.890 --> 00:30:11.483 - I looked it up in the dictionary so I could find out what it meant. But it was at a date and time where 00:30:11.483 --> 00:30:21.168 - I was already committed. And I had no interest in any hot wash, whatever that was. If I had been invited 00:30:21.168 --> 00:30:31.038 - to an after action event, I would have responded appropriately. But hot wash, I had no idea what that was. 00:30:31.682 --> 00:30:38.627 - So I just thought I would make that clear. It's in the second paragraph. So just to let you know, hotwash 00:30:38.627 --> 00:30:45.441 - is a term that's regularly used in incident response. So it's included in all of the main training that 00:30:45.441 --> 00:30:51.993 - we do with your greener. It's required for stock. It's also part of our preparedness training. It's 00:30:51.993 --> 00:30:58.610 - something that's part of the ongoing process for the staff. It's also used in the military, which is 00:30:58.610 --> 00:31:00.510 - where it actually came from. 00:31:01.442 --> 00:31:14.581 - in terms of an event where you then go and wash down those weapons that you used in that event. Again, 00:31:14.581 --> 00:31:27.847 - not common violence. And so I would, I guess, invite any invitation in the future to anyone to an after 00:31:27.847 --> 00:31:30.398 - action report event 00:31:30.978 --> 00:31:42.885 - to actually state that. So it'll be abundantly clear what it is they're being entitled to. That's all. 00:31:42.885 --> 00:31:54.561 - Our next item is approval of part-time job descriptions. You have in your packet actually four, this 00:31:54.561 --> 00:31:59.070 - four different job descriptions. So I, 00:31:59.234 --> 00:32:09.501 - wants to make an explanation and then Linnea add to that. So the four positions are instead of public 00:32:09.501 --> 00:32:19.768 - health nurse, one that is part-time, so there are adjustments for that. Another one that is part-time 00:32:19.768 --> 00:32:26.814 - as needed, public health nurse. Another for part-time school liaison. 00:32:27.938 --> 00:32:40.340 - and another for our time communicable diseases assistant. And the relevant job description changes are 00:32:40.340 --> 00:32:52.742 - marked out and then added the changes in red. And I think that the thinking behind this is that we can 00:32:52.742 --> 00:32:57.438 - maybe recruit some part-time employees 00:32:57.602 --> 00:33:06.836 - a little easier than the full-time persons just trying to get our staff or our staffing needs met. 00:33:06.836 --> 00:33:16.257 - But Linnia, I like your assessment. Yeah. So what this does is like the board of requesting a number 00:33:16.257 --> 00:33:25.118 - of months ago, he has needed a public health minor's position for a term PRM. And I'd say that 00:33:25.666 --> 00:33:35.979 - We had a contract with IU Health. I think it was only done in the rest of the summer, some integration 00:33:35.979 --> 00:33:46.392 - was part time. And there was at least some interest in public health financing for individuals who were 00:33:46.392 --> 00:33:54.302 - not available for a full-time position. They were not in a full-time position. 00:33:54.914 --> 00:34:05.007 - the option of having a chronic physician is given a little flexibility amount. It also separates out 00:34:05.007 --> 00:34:15.400 - from the clinical tasks for the school liaison and community disease investigator roles, which the core 00:34:15.400 --> 00:34:24.894 - functions do not actually require clinical tasks and have been performed by non-clinical staff 00:34:25.410 --> 00:34:38.157 - Previously and currently. Right now, those surveys are effectively being done by the fairness staff. 00:34:38.157 --> 00:34:51.030 - Years ago when we had surveys on staff here in-house, that was under the fairness as well. It has for 00:34:51.030 --> 00:34:54.942 - the human-able disease camping 00:34:55.170 --> 00:35:03.968 - that's currently being done by our population health and outreach manager and also the result. And not 00:35:03.968 --> 00:35:12.680 - a clinician, it's the old group running the practice and being able to be part of it. Contact tracing 00:35:12.680 --> 00:35:21.478 - is part of it, but they're just one of these ones. So in the past, like during the COVID response, for 00:35:21.478 --> 00:35:24.638 - example, there were all response and 00:35:24.898 --> 00:35:34.184 - uh, contact phasing case that were first found when they're under the population of, you know, 00:35:34.184 --> 00:35:44.643 - that were, you know, long-term hurdles. Um, and that being such a core function. Precious disease tracking 00:35:44.643 --> 00:35:53.342 - and immune space management aspect, um, in space. And so the development of the clinical 00:35:53.666 --> 00:36:01.869 - requirement for a full-time staffer who's also gonna have to visit us. So these changes, and most of 00:36:01.869 --> 00:36:10.559 - the descriptions, they seem somewhat stylistic, but then the last one for the communication, communicative 00:36:10.559 --> 00:36:18.681 - diseases assistant seemed more extensive. How did these changes come about, and where did they come 00:36:18.681 --> 00:36:20.062 - from originally? 00:36:21.378 --> 00:36:31.159 - So the provisions were made by an adoptive pathway to it. My family is an infant and has a lot of experience, 00:36:31.159 --> 00:36:40.050 - so I was able to speak about that aspect of it. And basically, we just pulled out all of the things 00:36:40.050 --> 00:36:44.318 - that require a license, but that are not legal. 00:36:57.122 --> 00:37:07.240 - Before we ask for public comment, do the board members have any other questions or concerns about the 00:37:07.240 --> 00:37:17.160 - language and the job description changes? So we need to pull these each. We can do them as a batch. 00:37:17.160 --> 00:37:26.782 - That would be fine. I have a question about the part-time school liaison one on the second page. 00:37:27.138 --> 00:37:37.222 - It says, participate in cross-training with other clinical divisions for provision of maternal child 00:37:37.222 --> 00:37:47.506 - health, nursing services, STD exams, and related communicable disease prevention services within SCOPE 00:37:47.506 --> 00:37:55.294 - as needed. That sounds clinical to me. It says here, nursing license forward. 00:37:55.586 --> 00:38:04.058 - we're saying doesn't have to have a nursing license. Can a non-clinical person actually be cross-trained 00:38:04.058 --> 00:38:12.450 - in all these things? Or is that what the within scope is supposed to cover? So within scope covers most 00:38:12.450 --> 00:38:20.599 - of that. Ultimately, maternal child health non-nursing services would be a non-clinical. So they can 00:38:20.599 --> 00:38:25.118 - tell them, for example, for the child care coordinator, 00:38:25.506 --> 00:38:33.786 - that you were absent. Providing better education, better meditation counseling, things like that. Meditation 00:38:33.786 --> 00:38:41.685 - counseling may be considered medical, but it doesn't require any kind of license to practice, it's just 00:38:41.685 --> 00:38:49.433 - a sort of function. Okay, so by saying within scope, you allow this person, if it does have a nursing 00:38:49.433 --> 00:38:55.358 - license, to be able to do a few of these additional things, but if not, okay. 00:38:56.130 --> 00:39:12.572 - Thank you. Okay, does anyone have any requested changes before we have a motion? Any public comment? 00:39:12.572 --> 00:39:22.014 - We have to make the motion first and then public comment. 00:39:25.250 --> 00:39:36.058 - No, but I would make a motion that we approve the job descriptions, the full job descriptions as amended. 00:39:36.058 --> 00:39:46.561 - That's going to be correct. I have a second. All right. And do I have public comment regarding the job 00:39:46.561 --> 00:39:48.702 - description changes? 00:39:56.066 --> 00:40:25.918 - All right. So can I have a vote, please. All those in favor. 00:40:26.146 --> 00:40:50.881 - new business, that is the approval of the grant amendment for additional D.I.S. funding. That's in your 00:40:50.881 --> 00:40:54.686 - packet as well. 00:40:55.170 --> 00:41:02.536 - Our BIS program is entirely grant funded by the state. The BIS program provides three confidential services 00:41:02.536 --> 00:41:09.971 - to help prevent and secure effective infections. Services include STI and HIV testing, targeted application, 00:41:09.971 --> 00:41:17.201 - length of use of wear, case follow-up to ensure proper treatment and prevent the infection, and education 00:41:17.201 --> 00:41:24.158 - outreach to promote prevention and safe practices. Our BIS has over 16 Indiana counties at this time. 00:41:24.322 --> 00:41:35.440 - It was kind of a week servings, but I was benefiting from it. The amended amount, here's the additional 00:41:35.440 --> 00:41:46.131 - $110,000, we'll get it through February of 2027. This is one of those grants where we often receive 00:41:46.131 --> 00:41:51.262 - an amendment for it pretty close to the wiring. 00:41:58.882 --> 00:42:08.899 - So just so I'm clear, there's, that is the amendment for the 110,000. Yes. So it's very individual amount 00:42:08.899 --> 00:42:18.538 - to cover the next eight months. Okay. So do I have a motion to accept this adjustment, the DIS grant? 00:42:18.538 --> 00:42:27.326 - So motion. Second. Is there anyone who wants to give public comment regarding the DIS grant? 00:42:37.090 --> 00:42:49.445 - Okay, saying none, can I have a vote? All in favor? Aye. Motion passes. So the next item on our agenda 00:42:49.445 --> 00:43:01.680 - is to discuss the health officer contract. Yeah, the financial reporting, new business. We moved that 00:43:01.680 --> 00:43:06.238 - item. We moved that. Excellent, Eric. 00:43:06.498 --> 00:43:15.233 - Let's do that. So I would like to open discussion regarding the Monroe County Board of Health's contract 00:43:15.233 --> 00:43:23.884 - with the health officer, Dr. Sarah Lagerbrand. I'm referencing page one, number four, which reads, this 00:43:23.884 --> 00:43:32.286 - agreement may be terminated by the health board or Dr. Lagerbrand at any time with or without cause. 00:43:32.674 --> 00:43:40.695 - and the health board may remove Dr. Ryderbrand as the local health officer at any time with or without 00:43:40.695 --> 00:43:48.482 - cause. When making this decision, board members should consider that terminating the health officer 00:43:48.482 --> 00:43:56.503 - via the without cause choice means there is no discussion of reasoning. And as I referenced last time, 00:43:56.503 --> 00:44:02.110 - should we have this as an agenda item that we would give Dr. Ryderbrand 00:44:02.466 --> 00:44:12.025 - an opportunity to speak with us. Is there anything that you would like to say, Sarah? Sure. I was going 00:44:12.025 --> 00:44:21.216 - to read into comments, but I will. Did I bring an attorney with me this afternoon? No. Why would I? 00:44:21.216 --> 00:44:30.499 - I don't know what it is that I'm even accused of other than displeasing members of the Monroe County 00:44:30.499 --> 00:44:32.062 - Board of Health. 00:44:32.546 --> 00:44:39.778 - by taking lawful action without their blessing. If I regret anything is that back in August, when I 00:44:39.778 --> 00:44:47.226 - told the chair, I wish to have an executive session with the board, I accepted her refusal. It did not 00:44:47.226 --> 00:44:54.964 - simply go ahead and schedule the meeting. Had I posted that proposed executive session, then board members 00:44:54.964 --> 00:45:00.894 - would have been informed of the issues that I was experiencing prior to my action 00:45:01.186 --> 00:45:10.232 - on the afternoon of September 10th. I'm sad because not one of you reached out to ask what was going 00:45:10.232 --> 00:45:19.637 - on that I would act in a manner that you must have seen as precipitous. I've known two of you for nearly 00:45:19.637 --> 00:45:30.206 - four years. Did you really imagine that I would not reply? Or were you under orders? Are you not independent thinking 00:45:30.658 --> 00:45:38.883 - curious individuals, or had you all entered a state of hive mind? I also didn't bring an attorney because 00:45:38.883 --> 00:45:46.797 - I sense that the hearing you propose to hold is nothing more than a display of the power of the board 00:45:46.797 --> 00:45:54.557 - to fire me at will. I don't believe, given the questions I was asked at the closed session that you 00:45:54.557 --> 00:45:59.678 - held, that any of you is interested in the whys or the wherefores 00:46:00.098 --> 00:46:10.520 - but only wanted to uncover an excuse to dismiss me. My action was not capricious. I considered it long 00:46:10.520 --> 00:46:21.246 - and hard. I spoke at length with people at IDOH who understood what I was up against. It also was clearly 00:46:21.246 --> 00:46:28.734 - not retaliation. Since the HR director, a county attorney, and I were all 00:46:28.962 --> 00:46:37.093 - Equally bewildered by this faceless accusation made my Ms. Kelly at our last encounter. I'm not willing 00:46:37.093 --> 00:46:44.911 - to ignore protocol to address the derisable accusations apparently made under oath in her complaint 00:46:44.911 --> 00:46:52.964 - against the county and me. The fantastical nature of the complaint should tell you everything that you 00:46:52.964 --> 00:46:58.046 - need to know about how she construes truth. Caveat emptor folks. 00:46:59.266 --> 00:47:07.240 - The job of health officer was not a position that I sought. I was asked by the former board chair and 00:47:07.240 --> 00:47:15.057 - her predecessor, Dr. Pritchard, to take on the role and I did not leave at the chance. I considered 00:47:15.057 --> 00:47:23.031 - the position and whether I could make a difference if I came out of my very comfortable retirement to 00:47:23.031 --> 00:47:28.190 - do something for this county. I knew that I had made a difference 00:47:28.322 --> 00:47:35.193 - in the two years I sat on the board, often asking questions that no one else was willing to ask, such 00:47:35.193 --> 00:47:42.065 - as when did the health officer last have a performance review? While this duty falls to the board, it 00:47:42.065 --> 00:47:48.802 - had never occurred. It was only this summer that I learned that in more than four years on the job, 00:47:48.802 --> 00:47:56.077 - the health administrator had never received a performance review. It seems that there had been a reluctance 00:47:56.077 --> 00:47:57.694 - to perform such a task. 00:47:58.722 --> 00:48:06.638 - I hope that any future health administrator will have the opportunity to learn and improve from confidential 00:48:06.638 --> 00:48:14.335 - input by the board, the health officer, the health department managers, and administrators for the county 00:48:14.335 --> 00:48:21.961 - council and commission. I had wanted to believe that working side by side with the health administrator, 00:48:21.961 --> 00:48:27.262 - I could relieve some of the burden and the stress that was evident to me 00:48:27.586 --> 00:48:35.456 - as an astute clinician for my first days on the board. I learned early on when I became a health officer 00:48:35.456 --> 00:48:43.326 - that this would be extremely challenging and it only became more so. I know that as I completed my first 00:48:43.326 --> 00:48:51.571 - year, my performance evaluation indicated that I was clearly doing my job, except for at least one individual 00:48:51.571 --> 00:48:54.494 - who indicated that I was intimidating. 00:48:55.490 --> 00:49:02.922 - I can well imagine the source of that characterization, but I did not ask. I believe we are each responsible 00:49:02.922 --> 00:49:09.740 - for our feelings of fear or inadequacy and that owning our vulnerability with honest curiosity is a 00:49:09.740 --> 00:49:16.831 - special kind of power. I could go on about what I could envision for the board's engagement in learning 00:49:16.831 --> 00:49:24.126 - and community engagement, but I suspect it might fall on deaf ears. I can only hope that new board members 00:49:24.226 --> 00:49:31.999 - may infuse some creative and critical thinking and commit to working with other stakeholders as well 00:49:31.999 --> 00:49:40.156 - as to public engagement. Partnership is key in creating a robust public health presence in our community. 00:49:40.156 --> 00:49:47.851 - In four years, I have only seen a committee created once when SB4 preceded our HFI funding. Perhaps 00:49:47.851 --> 00:49:53.854 - the board will form a committee that will educate the members about the basic 00:49:54.050 --> 00:50:01.202 - precepts of public health, which might be useful when setting priorities and long-term visioning. Maybe 00:50:01.202 --> 00:50:08.560 - the board will choose to learn about county budgeting as I did from Kim Schell, the council administrator. 00:50:08.560 --> 00:50:15.574 - Very useful information for a board that is mandated to oversee finances. Maybe the board will choose 00:50:15.574 --> 00:50:23.070 - to reflect at the start of every meeting on the mission of the health department and the vision of its board 00:50:23.266 --> 00:50:31.271 - in support of that mission. Maybe the board will perform a self-examination of its own performance with 00:50:31.271 --> 00:50:39.429 - respect to its statutory obligations. In one of these days, perhaps at least one board member will accept 00:50:39.429 --> 00:50:47.434 - the health officer's invitation to participate in the now annual IDOH symposium in order to learn more, 00:50:47.434 --> 00:50:50.974 - interact with peers and leaders in the state. 00:50:51.362 --> 00:51:07.601 - and to aspire to greatness in Monroe County. Well, anything's possible. It has been interesting partnering 00:51:07.601 --> 00:51:19.742 - with you all, and I do love you, but I am done. I resign effective immediately. 00:51:24.802 --> 00:51:37.449 - So Dave, does that, does that render the contract that we have with Dr. Ryderbrand now terminated because 00:51:37.449 --> 00:51:49.500 - she resigns? Yeah, she terminated it under the terms of the contract. Okay. So do we have to vote to 00:51:49.500 --> 00:51:54.750 - accept her resignation? I don't believe so. 00:51:54.882 --> 00:52:06.097 - Okay, so finding ourselves without a health officer. We have a lot of business to conduct. Dr. 00:52:06.097 --> 00:52:18.375 - Paul Broderick, who currently serves as the Northern County Health Officer, has indicated that he would 00:52:18.375 --> 00:52:23.806 - be willing to serve as interim health officer 00:52:24.450 --> 00:52:35.853 - for a few months for us. This is of course pending his approval or rather approval by our commissioners 00:52:35.853 --> 00:52:46.927 - and also pending approval of his board to allow him to do that because he currently serves in Morgan 00:52:46.927 --> 00:52:52.190 - County. So I would like to, if the board is in, 00:52:52.418 --> 00:53:04.424 - Agreeance with that, I would like to have a motion to, well, we'll have to work on a contract. I would 00:53:04.424 --> 00:53:16.430 - like to have a motion to place Dr. Paul Roderick as the interim health officer pending approval by the 00:53:16.430 --> 00:53:22.142 - commissioners and pending approval by his board. 00:53:23.650 --> 00:53:37.954 - second. All in favor, and I'd like to do a roll call. Oh, I'm so sorry. Yes, we need public comment. 00:53:37.954 --> 00:53:52.542 - Seeing no one for public comment. I'd like to take a roll call vote. Kay? Yes. Steve? Yes. I vote yes. 00:53:52.898 --> 00:54:05.465 - Yes. Yes. Passes unanimously. Would any board members like to make any additional comments before we 00:54:05.465 --> 00:54:18.157 - recess? What's our procedure for moving forward with finding a new permanent health officer? And what 00:54:18.157 --> 00:54:22.014 - do we do in the interim until? 00:54:22.498 --> 00:54:32.210 - There's a debut set, because Dave can, Paul, can you take over that position? The health officer should, 00:54:32.210 --> 00:54:41.923 - something happened. So the commissioners would have to approve, I believe there's a form for them, Lise. 00:54:41.923 --> 00:54:52.190 - So how can we get that before the commissioners, Dave? I will talk to them tomorrow. I might see them tonight. 00:54:52.514 --> 00:55:01.027 - plan commission hearing, we're going to have about five minutes. But we'll try to get down as an emergency, 00:55:01.027 --> 00:55:09.304 - as a threat and destruction of the governmental function, because Sarah is no longer the health officer. 00:55:09.304 --> 00:55:17.423 - So anything that's stamped, issued by the health department with her name on it cannot be issued until 00:55:17.423 --> 00:55:21.758 - we have some replacement, which we need to do quickly. 00:55:22.754 --> 00:55:32.300 - Logistically, it would be approval by the commissioners who sign off, approval by his board. Then there's 00:55:32.300 --> 00:55:41.756 - literally a stamp, I believe he has to get a signature and then have the stamp available so that permits 00:55:41.756 --> 00:55:51.391 - can go out, etc. Then coordinating for any health emergencies or questions, etc. I personally hate leaving 00:55:51.391 --> 00:55:52.382 - that open. 00:55:52.866 --> 00:56:00.472 - tomorrow something happens. I think we're at risk and the community's at risk. Do we have any mechanism 00:56:00.472 --> 00:56:08.151 - where we can assign someone to that temporary duty before the interim health officer takes over? There's 00:56:08.151 --> 00:56:15.464 - nothing in the statute that addresses this situation. So we would need to call the state health who 00:56:15.464 --> 00:56:22.558 - also has to include any appointment of a health officer. We'll get them involved in our morning. 00:56:22.786 --> 00:56:35.801 - see what they might seem to ask. So then how, what is the process then we'll have to post the health 00:56:35.801 --> 00:56:49.202 - officer position? Yes. Okay. Or yeah, post it, talk around and see if there's anybody interested. Okay. 00:56:49.202 --> 00:56:51.006 - And so we'll, 00:56:51.746 --> 00:57:04.345 - Wait to hear from you tomorrow. Meanwhile, are we still advertising or looking for our health administrator's 00:57:04.345 --> 00:57:16.142 - position to be replaced? Has that been posted? Yes. And actually, I think Steve and Lene and Kathy are 00:57:16.142 --> 00:57:21.182 - reviewing applications that we've received. 00:57:21.282 --> 00:57:48.382 - for the health administrator. Dave, other concerns from your end? No, we just need the answers. Great. 00:57:50.114 --> 00:57:59.195 - If there is no objection, we will adjourn this regular meeting at the Board of Health. The time is 528. 00:57:59.195 --> 00:58:08.014 - One question. Yes. Are you going to cancel the hearing, obviously? Yes. So we will cancel the public 00:58:08.014 --> 00:58:16.222 - hearing that was directly following this meeting. So that's canceled. So everyone knows that. 00:58:19.458 --> 00:58:28.926 - I have to have those to close. So we'll finish at 529. Thank you. Thank you.