Board of Health - Regular Meeting

Good now. Okay. So, we are gonna call the meeting of the board of health to order. Let it the records show that mayor Woodford will be coming later and that doctor Vogel is excused at the moment. All right. If we'd all like to rise, we can say the Pledge of Allegiance. I pledge allegiance to the flag of The United States Of America and to the republic for which it stands, one nation under God, made invisible, with liberty and justice for all. Thank you. All right. 2047.

I'm seeking a motion to approve the minutes of the May 14 meeting.

Move to approve. Second. Jones Wolfe.

Are there any comments, questions, changes? Seeing none. All in favor say aye. Aye. All opposed? Abstentions? Motion passes. We are going to go to 250646. This is actually an information item, so we will not be taking a vote on it. There was, just so you know. All right. So Appleton Health Department, annual report. Doctor. Siepers.

All right. I'll, I'll just give a brief summary provide the opportunity for questions. But 2024 was an action packed year. Just to kind of summarize some of the major things that we had done was develop our new electronic health record. So just moving into that health record space, we made increased changes in our weights and measures fee structure and then short term rental enforcement.

And I'll talk about each of those a little bit more in-depth. So the way the report is identified or sort of framed and structured, the 10 essential public health services and the essential public health functions are those are required by state statute in order for us to comply with the application those frameworks. So just as a really clear way to line out that compliance, the document is arranged in the way that those models are laid out. So that's sort of the format. So in the forward section are what we call the foundational capabilities.

And those are things like the support mechanisms that undergird some of our programmatic areas, and so which include communicable disease control, chronic disease and injury prevention, environmental public health, maternal child and family health, access and linkage with care. And then for us, we have a consumer protection function that goes beyond the public health structure. So that's really the format that I'll be using to kind of talk about what happened in 2024. So from a regulatory standpoint, we were on track to right size the weights and measures budget within three to five year period. We, the process of doing that sorry, let me back up.

Our weights and measures program, as you know, also includes a Northeast Wisconsin consortium consisting of 11 partner members. And so with that, we have the obligation to ensure compliance not only for our program but for their program as well. We were running a shortfall in the weights and measures program. From a budgetary standpoint, our revenue did not match what the expenses were. And so we had a it was about a three to four year timeline of fee increases and daily rate increases to get on track to balance that budget.

In a deep dive into our consortium finances and that balance as relates to statutory compliance. In 2024, we did identify that they were out of compliance and that their programs were actually making money, right? And so was element that led us to develop a new fee structure, one that was tiered, that allowed us to bring those consortium communities back into their own compliance as well as balancing the Appleton budget for 2025. But that work had begun in 2024 and was a huge lift. And Eric Maggio had done a fantastic job of developing that and working with partners to adopt that.

So that major was task. Also in 2024, we began the effort to bring short term rentals, often called tourist rooming houses per the lodging license, into compliance. I'll say that in February 2024, about the time we were looking at how to increase our regulatory capacity both in weights and measures but in our environmental health program. That was about the time there were a lot of Post Crescent articles talking about this issue. But we were already on the ground starting to understand how we could tackle it.

We signed a contract with a vendor to provide address location services in July 1. By the time the back end of that work had come into play, we were beginning to issue letters of compliance in December '44. So it took a little bit of time but there was the way the process works it's linked into our back end, our ArcGIS mapping. And so we've got real time data in terms of lot lines and all of that. So took a little bit of time to describe it.

As So I mentioned, we launched our first electronic health record in 2024. Don't need to impress upon you all in terms of what a huge leap that is for our processes. But with the sunsetting of I Series which was the backbone for a number of the different services that we were using in terms of scheduling and some of the other functions, it was it came at the right time. So that's been going great. And we in 2024 developed a training program that one of our public health nurses is leading and has been doing a fantastic job with that.

In addition to Weights and Measures project, one crucial element of that that kind of touches into the technology space is part of the service would say service increase from a standpoint of, okay, we're going to increase our daily rate to our partners for the Weights and Measures program. What are they getting out of that? And one of the things that we developed was to bring all of the billing for the Weights and Measures program into the Weights and Measures program here locally. We actually we did a cost benefit analysis to understand what that could look like. And it turns out we were going to spend less time servicing that program by issuing all the invoices locally and sending them to their respective program partners to then send out.

Or we would send them from the city of Appleton and all the payments would then come to the jurisdictions. And so with that, being able to leverage one corporate phone call to Dollar General to ensure 17 bills are being paid is a much more efficient process than working with each of those jurisdictions to understand, Okay, who's the contact? And well, that one didn't work. Where do I go? That kind of thing.

So that was a huge undertaking in terms of the automation of that bill processing. Essentially what Eric had done was created the most sophisticated macro enabled Excel document I have ever seen. And that is what is sort of backing that. And ordinance development. Most of the noise ordinance work had happened in 2024.

It wasn't finalized through counsel until early twenty twenty five, but that was some work that had taken place. And so we were deeply involved with that. The expanded smoke free zone around the transit center, and thanks to some folks in this room that had helped with increase that to the public library block as well. Some of that policy work. Let me get into that might be a good place to stop maybe for questions on that piece before I go into programmatic.

Are there any questions?

Kathleen? The electronic health record. Yep. Does it talk to the electronic health records of the local systems?

It does not. So we are not using Epic. Epic is priced out of our range. We're using a system called Nightingale Notes. And with Nightingale Notes, it has that capability. But one of the things that we're struggling with here in the state of Wisconsin is to have access to, like read only access to the EPIC system or to the EHRs overall statewide. We need to have individual MOUs with each of

the

hospital systems. And so there isn't a universal. And so every health department has to establish that. And that has not we've been working on that for the last year and a half. And it's a slow process. It's one that does bear fruit. But the systems aren't linked, but the capability for it to become linked is there. So certainly looking forward to that.

Well, took years for those two big systems to make it happen.

Yep, absolutely. Any Great

other questions? Okay.

All right. We look at community health. One of the things that we had done in 2024 was increase the basic needs team. So prior to 2024 that consisted of Brianna, our community resource sorry, our community health supervisor and our coordinated entry specialist. And so with that we did expand one position funded through community development.

Navigator. And the role, the purpose of this role is to help those experiencing homelessness find basic needs. And so that could be anything from housing to warm clothing or linkage to other services, you know, for meals or something like that, anything in that basic needs space. We were we continue to work on our community health assessment in 2024 and we're rounding the the bend on the on the finality of that. But we also simultaneously have been working with the Tri County Community Health Improvement Coalition.

Just a reminder, that coalition is all five health jurisdictions, four hospital systems, and about 20 different community partners all working together to develop a unified regional community health assessment and community health improvement planning process. So that is we're just tidying up, dotting the I's and crossing the T's on the CHA for the Tri County. And then we are we'll have a CHIP here by the September September in in twenty twenty twenty twenty five. Five. So if you look at some of our other areas in terms of our foundational capabilities, we conducted the twenty twenty four point in time counts both in January and July.

You'll notice on the graph and I just want to highlight this because when data change, it raises Do you

have a page number?

Yeah. I'll I'll go to that right now. Just trying Thank you. Pull

that

I'm working from my notes, which are not linked to the page number. But it just occurred to me that it would be really nice to see 14.

35. What's that? 45. 35.

Thank you. Exactly. Page 35. Thank you so much.

I knew I'd seen it.

Yep. So you'll see a huge jump in the January 2024 count and then you see the same or sorry, it's the July 2024 PID count and then you see that same pattern in the January 2025. So the question is has the number of unhoused individuals increased in 2024? The answer to that question is probably, right? However, I want to highlight what has happened in 2024, in July 2024 that is different in previous PIT counts is that prior to 2024, which was not implemented in January, HUD allowed for the sort of period after the pit count to you know, assure counts.

That is, you know, pull out any duplications, those accessing other services, those that were hospitalized, those sorts of things to understand where they were on the night of that PIT count. And which is all that matters for the count itself is where did these individuals spend their time Wednesday night. So with that we have so that did expand from two days to seven days. So that gave us a much longer window to do that work. And then also with the creation of the basic needs team, we've developed a lot of strong community partnerships where we've been able to work directly with them.

And they've allowed us to come in and to be able to sort of like during a Tuesday grab and go, for example, having us be there to ask questions and that kind of thing. That's not something that's happened in the past. So my assessment would be that this is the most complete pit count that we've ever had. Are we seeing larger increases in those experiencing homelessness? That is true.

We are starting to see trends within all of the different data to suggest that that is true. But I just wanted to explain that number because that's the largest shift that we're seeing, that we're not seeing a greater magnitude similar to that one. Sure.

Yep. Mayor?

Just on the point in time count, having participated in a few now, there are folks who, when they become aware that we're doing the point in time count, make themselves scarce on that evening. And so the opportunity to expand that time horizon is important because we may not think about it, but there are folks who do not want to engage with services and don't want to engage with people who are out, trying to engage with them. So, we have found over time that counting folks in different places, different venues, at different times allows us, as Doctor. Sievers mentioned, for a more complete count. But just wanted to make note of that.

If you haven't participated in a point in time count, that's one of the things that I think eye opening to me participating in the program. So I just wanted to share that note. Thank you, Chair.

Thank you. I just have one quick question. When we're doing the summer point in time count, do we ask them where their winter is? I know that we tend to get an influx, or we used to in the past, from different areas in the state that closed their facilities. So they migrate to us.

I'm trying to remember the specific questions on the PIC questionnaire. I don't believe that is on the PIC questionnaire but I'm actually not 100% sure so I can't speak to that. That. There are, you know, so as folks access services at the City of Appleton like pillars, like many, we serve as a no wrong door. It's what they call a no wrong door for coordinated entry.

And coordinated entry is the list in which people will be notified of more permanent housing, right? So through the coordinated entry list, there's frequent follow-up with folks that are on that list. So we do get data from that process. But to your question, I'm not 100% sure if that question is on the PID count question there.

Thank you. Mayor Woodford?

I think also worth noting, the vast majority of clients that Pillars serves come from the Tri County area. So I think it's important to reinforce that while sometimes there's a narrative out in the community that people are coming in from other places far afield to seek services here in the Fox Cities, the fact is that the vast majority of clients that are served by Pillars and others providing these services in the area come from the Tri County area.

I was thinking of Green Bay that closes theirs.

And that's not to say there are not people who move around. There certainly are. I've had conversations with people who found their way to the Fox Valley because they heard that there were services here and they could get some help. But again the vast majority of clients that are served come from right here in the Fox Cities.

And I will note that the continuum of care funding that we receive for our jurisdiction is the Fox Cities and not the city of Appleton. So the pit count does include those areas outside of city of Appleton.

Thank you.

All right.

Now that we got you totally off your notes. Yep.

Typically don't use them so I certainly don't need them and I could just wax philosophical as we use them. But we do have a time. So from an emergency preparedness aspect we're getting into a cadence for tabletop and functional exercises. So saw more of that in this last year. Certainly with just getting folks more familiar with the incident command structure and how to use forms and that kind of thing.

Those were all sort of the focuses of 2024. And we have the good benefit of having our public health emergency preparedness coordinator and the emergency response or the emergency manager being the same person in a single role. We have access to that. Communications, we were working on a number of different projects. Certainly the newsletters are a chief aspect of how we communicate not only with you all but public at large.

We've really enhanced and developed our social media presence in that way and had set the ground work for a new language contract service in 2025. But that work had taken place in 2024. So some exciting things there. Communicable disease, if we're looking at what our nursing division was working on, there was a considerable pertussis outbreak in 2024. You'll see thirty seven point five cases per 100,000, up from zero.

But that was a sort of there's some data in the report that kind of highlight what the state was looking at overall. Sorry about that. So you think you've got all the pages all lined up. Shot past it, here we are. Page burden of disease.

Once you get towards the top, you see smaller case counts but higher rates per 100,000. That's a typical disease pattern pattern for small geographic areas. But if you look at Dane and some of the others, you'll see that La Crosse example. So we also continued our TB skin testing program. If you remember late twenty twenty three we were looking at the fee for service TB skin test program.

This was a need that we kept running up against where we would be contacted looking for fee for service TB skin test services. Many universities, many employers still require TB skin tests. So that is something that we provide. This isn't a huge moneymaker for us. But it's more of a, one, there is that service.

But it also has reduced a sort of opportunity cost. So we have to provide TB skin tests under certain conditions. And that is a free service. And so what happens is we would typically open a vial of material to provide the TB skin test. And we may not do another one for three or four months, right?

So that vial gets thrown away. By turning this into a fee for service, we're not losing the cost of material. In fact, we're in the black on that. So it's more of a reduced opportunity cost on that rather than a huge moneymaker. But we're looking for every little bit that we can on that piece.

Let's see here. Skip over to so we talked about weights and measures. So if we look at our environmental health program, we did see a bit of a flip flop in terms of where the inspections landed. We saw a larger increase in pre inspections or those first time inspections. That is due to the short term rental program coming online as we had talked about.

So you started to see that. You'll see a lot more of that in 2025. We've I think we're currently at 125 short term rental licenses, the most that we've ever had. I expect that we'll hit 50 or sorry, 150, 175 by the end of the year. This becomes 2025 data.

But just to sort of highlight another data point from that program is excuse me. There were so from the work that started in 2024, there were a total of 38 short term rentals that were brought into compliance without being licensed. So what that means is they were short term rentals, operating in short term rentals without a license. And rather than get licensed, they had put them back into the housing market, so either through rental or through sale. So one of data points that we'll track as part of our new performance management process is those number of units that are put back into the housing market, so 38 as a result of that work.

We did see a lot of new restaurants in 2024. I did ask the sanitarians last week, are there any I should visit? They were completely unbiased in that and just said you'll have to see for yourself. Check that out. One thing I glossed over, our child passenger safety program with a car seat option, while we have them are that did continue in 2024.

I will say that we were smart in how we implemented that program. We have seen and we don't understand necessarily exactly what is happening with that program. But we had seen the federal funds for that program actually go away. And for those that had not spent, that was a bit of a clawback. For those, we had already spent our dollars in 2024 for the twenty twenty four-twenty twenty five period.

So we didn't experience a cut in that sense. I think those are the highlights. I will talk a little bit about our financial data just to kind of round it out.

Before we do the finances, does anyone else have any questions on the reports? I just have one on page 33. This is the lead surveillance and enforcement. In 2024, we had 34 children with higher leads and 18 with higher leads. And I noticed that our home inspections were one and our education is five.

Are there other people that are following up with those children because that are I noticed that, like, in 2022, we had 16 educationals, which corresponded to the 17 leads. So I was just kind of concerned what's happening with those kids.

Yeah. That's a great question. Yeah. So if we meet that threshold where there are a lead poisoned child, we will make that contact and go through that process. And that is done through our nursing division.

The home inspections are, as you can see, those are rather rare. That's not something that typically happens. In the instance where the five corresponding with 34, what could be happening in that case and what I'm suspecting is that the so that federal level is 3.5 to, well, lower limit is 3.5. We are not required to make contact at that 3.5.

Oh, okay.

Right? So we make contact at like if it's like two readings over 15 or one reading over 20 is where we make contact. So that's actually a good thing that we're seeing a lower number there because we're not hitting that threshold. That is to say that there isn't there is not a safe level of lead exposure for a child. However, if we look at statewide what is our capacity to be able to deal with this in a local fashion.

We just as a fund finance fact, we probably spend between 20,000 and $30,000 a year addressing lead cases on normal year. 2024 was not a normal year in that case as you can

see. But

if you look at 2022 that was a more typical year. We receive about $7,000 per year to do that work. So it doesn't cover all of that. We do not do medical billing, so we don't have a Medicaid reimbursement piece. We had gone through the process of what would it take to do a medical billing.

And it would actually cost more to have the designation to be a provider to submit to Medicaid than it would be to and that doesn't get into the costs for the vendor to be able to provide medical billing services for us. It would so we just do not have the capacity to be able to do that.

Okay.

Great question, though. Any other questions on that before I go to the finances? I just want to highlight just a couple of numbers. The budget is not that complicated. But a few things I want to highlight. So in the appendix, we are looking at

page 52, I believe. Page 52. Thank you.

I just wanted to get in front of you so we could see that. Well, from the standpoint of sorry, I've got a little bit of a tickle. From the standpoint of revenue generated, generated, if we look at where we were in 2021, we were sitting right around $300,000 And so with the two revenue generating programs that we have, we were running at about right around a 60% loss. So that number should have been higher. Let's look at that.

And then but you could see that by 2025 that had increased. Our projection for 2025 is $782,000,000 and that's a balanced budget. That is adding two FTE to that. But if so it's hard to kind of see, okay, well, had we not added the FTE, does the revenue tell the whole story? But if you look at the levy impact, 2021 is obviously a strange year with most of the department operations being COVID and being offset by COVID dollars.

2022 is a more normal year. But you can see that even with some of the challenges over 2024 and 2025, we're actually we've lowered our levy impact. So if you look at 2025 as in comparison to 2023, still quite a few COVID dollars in 2022 that was mostly nursing at that point. But 2023 is the first budget year that we had that was like independent, like stood look line at at then then just the the pie next chart just gives an a overall view of where it comes from. So 75% of our operations are funded through levy dollars, which does include our revenue services.

So that's the other aspect of the other graph. External funds, those are if we think about the financial resources that are coming to us for funding some of the roles that we have through community development. We have about 1.8 FTE that's funded through there. That 10% portion. The rest is current.

Any questions? Kathleen?

I see 15% of expenses are it's grants. I don't know how to ask the question. Is the grant money secure that you're depending on how much of it is from federal grants, state grants, private grants?

Yeah, that's a great question. Most of the grant dollars that we have, nearly all the grant dollars that we have are either braided federal funding that comes through the state or is federal funding that is a pass through through the state. So we're a subrecipient. I can't answer that question and the fact that I don't know. We've had it's a complicated federal funding landscape right now in the fact that we've been notified of grants that have been ended and then having the state join a multi state lawsuit in some cases has allowed those funds to be spent based on court actions.

So that's kind of where we find ourselves. My general philosophy on this is that, and I think one that we're sharing in the city as a whole, is that this has a we can't rely on a hypothetical context of how we might act in the moment. As of right now, we're planning that those funds are going to come. And if they don't, then we have to develop a contingency around that. And the reason why I say that is because nothing is certain.

I mean we've had due to court action, due to, you know, different conversations with state officials and CDC, you know, grant officers and that kind of thing. There's just a lot of uncertainty in that space. We've been notified that some funding going to be sorry, I can't talk today. Some funding was not going to be renewed in 2026 only to find that it has been. So that's why I'm saying like there's a I can't answer that question because we don't know what's happened until it happens.

I think Mayor Woodford wants to say something.

Yeah, there's a lot I'd like to say. Across a number of city programs and departments, The federal government, particularly the administration, has been taking, I would argue, a rather disorganized approach to their fund what they fund and what they don't. It'd be one thing for us if there was a clear and consistent direction one way or another. This is what we can expect. This is how we need to respond.

But that's not the case, at least so far. Even the federal grant agreement language across programs and departments is different. So some new agreements are incorporating new language or eliminating old language, but inconsistently with other federal grant agreements. And I'd just say this to underscore the point that amid so much uncertainty, we really can't plan. And perhaps that's the point.

But our approach and my approach with our administration is that we will proceed with our plans locally and make any necessary and appropriate adjustments so long as we're not unduly obligating the city to carrying out provisions that we wouldn't be comfortable with or we believe we need common counsel input as the legislative branch before we would proceed with those grants. But we are not putting enormous time and energy into planning around contingencies because that only distracts us from our work. And if we had devoted all of the administrative resources necessary, starting even just a few months ago, to planning and trying to respond or speculate about what might happen if this or if that, then we wouldn't be getting our work done. We wouldn't be providing services to our constituents. And this is why earlier I said perhaps the uncertainty and interruption of local planning is the point, rather than allow that to interrupt and disrupt our work, which is critical for our community.

You've seen it across this report. This is happening across every department in this municipality. We're not going to be distracted. And if we need to make changes, if we need to respond, we will. I think it's important for the Board of Health to know that if we lose federal funding for programs, it could impact our ability to carry out those programs.

We may not have the resources to operationalize every position or portion of positions that would be jeopardized by the loss of funding. But we will do everything we can to continue to provide the services for the community that our community relies on. But we don't know. In the midst of unknowing, though, what we do know is we're going to proceed with our work as long as we can do it and as fully as we can.

Thank you.

All set.

Any other questions? Is that it for the report then?

That's it. That's it.

Okay. So then we're on to 2048, the dangerous animal declaration that I assume has been resolved.

Yes. That has not been, contested.

Yep. That's fine. Okay. That

has not been challenged. Challenged.

All right. So we're safe again. All right. 25.0649, new noise variances. They're attached. Are there any questions?

Wait. So are we not? But the last

one? These were all information items.

Okay. All of them.

Yeah. It was and it was checked with the attorney's office, and it was told that all we had to say was that they were no longer action items. Or information items so we didn't have to take anything That's on okay. Because those were my questions yesterday.

So just on that then, I assume we'll note for the minutes then that these items were taken up as information. That way there's no confusion about it. So that'll be noted in the minutes

to Right. Moulder Housing said it at the beginning, too. But if

I was on time chair, I wouldn't have

So forgive.

We forgive you. You're you're much busier than the rest of us. And we had, I had discussed it with Megan, and we checked with the attorney's office and the clerk's office. And, we could have done receive and file as an action on it too. But they just said to change it to information and have it noted information.

Okay. Thank you.

Any other questions on the news noise noises? Okay. I'm seeking a motion. Oh, go ahead, sir.

If I may. Sure. So this is the first year that we have implemented the noise variance fee. And one interesting thing that we've noted is those that have applied consistently that have not applied this year because of the cost, we haven't seen any issues in terms of complaints and that kind of thing. So I think that the fee is doing what it was designed to do.

Okay. Any other questions? All right. I seek a motion to adjourn.

So moved. Second. JULIEN Second.

In favor say aye. Aye. Opposed? We are adjourned. Thank you all for your time.