Hancock County Board of Health - Regular Meeting

Good afternoon. The Hancock County Board of Health meeting is now being called to order on September 9th, 2025 at 5:31 p.m. This meeting is being recorded and streamed for public viewing. And by participating you acknowledge that your image, voice and comments may be captured and may be publicly available. First thing uh are we set Crystal for approval of minutes from the last meeting? No, we do not have a sufficient quorum for that.

Okay, very good. So we will table approval of the minutes until we have sufficient quorum. Uh just for the record and for our knowledge, how many sets of minutes are we in a rears now? Five.

Five. Okay. Very good. Well, hopefully we'll we'll we'll we'll we'll pull those together soon. Okay. Returning to matters we have been working on specifically with respect to Health First Indiana. Um anything you need to advise us before we move in uh to address Health First Indiana matters? Um we've been talking a lot with the um Hancock Health the requests that they have brought to us. Um there we do have a couple of representatives here to help answer any questions that you might have. Um I do have I had a couple of people send me questions. So if if those are not answered, you know, we'll make sure that we go through that and get those answered, too. So

very good. for just for the benefit of those who may be watching or for recorded later, we've been talking with uh Hancock Health regarding a proposal they brought to us and and uh that was tabled at our last meeting because board members felt they needed some additional information. So, we are going to address that right now. And I think Joel, you're here if you'd like to uh talk with us. Uh members of the board, I know some of you had some questions. If we could address those uh to Joel right now, this would be a good time to do Would you just identify yourself in the record, please? Yep. Greetings, everybody. Joel Hungate. I'm the executive director of strategy and integrated well-being with Hancock Health. Thank you. Anyone have questions they want to bring back from last meeting? I've got a few. Great.

Yeah.

Um Joel, thanks for thanks for being here. Um what I do know is we're going to invest $429,000 in a used RV to be purposed as a mobile clinic. Uh, I also know we have access to the unit for 4 days a month. Now, um, services and screenings that we're going to provide are free to Hancock County residents. Uh, and Hancock Health is responsible for the maintenance Hancock County first. So, what I'd like to know, what are the terms of the expiration of the access? How many months do we actually get the the uh use of the vehicle per year?

Yeah. Uh so how many years? Um have you had a chance to see the forwarded there's uh a proposed contract that was out. Um there's a proposed proforma on the number of years uh in involved in this scenario. And then just some points of clarity. Something you provided at the last uh we we provided it in response to the questions that you sent from the last meeting. You've seen these. I've seen all of your questions. Yeah. So I I I'd be happy to run through and answer. I apologize. I'm looking. We we have not you have not seen that proposed contract. Okay. We can send that any of the response from I have not had any last meeting. We can forward.

I hate to be reiterative if if we have it. But if we don't have it, we're going to have to we're going to have to to loop back and and ask you to to share that with us, Joel. I'm sorry.

No, no, you're good. Um and happy to run through that because you were so kind to send the question sequentially in an email uh that Dr. Sharp was able to forward to me. Um so the the run of the questions here, the investing $429,000. So a little semantics, we would be buying the unit. So, we are going to purchase a a a mobile clinic that would be a dual exam room mobile clinic. There's a possibility it could be remanufactured. There's a possibility it could be brand new. It just depends on what route we go when we purchase the clinic. What we've proposed in the contract is that we would enter into a professional services agreement with Hancock County on the government side with the health first dollars. two tranches of $214,000 $214,500 for a grand total of $429,000 over two years. And in exchange, we will handle all operational considerations, provide staffing for four community days every single month uh that we would work in concert with the the team at the health department to identify locations and the types of screenings we'd be able to provide. and we make that available for 60 months or for the length of life of the asset. We benchmarked it at 60 months. Um just not knowing what you don't know about the the longevity of any of the assets or if something happens and we end up having to reinvest in one or buy another. Um, but the idea is that we would only be one bite from the apple and that we create a partnership that through Hancock Health's operational support ongoing, this goal is to get us started in acquiring it through the professional services agreement that'll defay the cost in order to get us to the point where we're we're willing to make that capital investment and then we will shoulder that cost and maintain that agreement well beyond the first two years that we're discussing. Um, and we'd like to keep it going in perpetuity as long as we have the working asset. Um, because when we're not using that mobile clinic for the free community

screening days, we'll be using it in the community for Hancock Health-based events, whether it's with our direct primary care clinics, serving employers all over Hancock County, uh, or having our own screening days, events that we support, whether it's like the mental health event today, uh, the county fair. You can imagine our goal would be to co-brand it with the county and make it a mainstay that if anybody in the county sees it out and about, we'd be advertising where it's going to be and what kind of services would be available. Uh and that it would be um sort of a destination for those sorts of access points. Um, and again, the big impetus here is how can we make sure that we're finding people where they are and serving them where they are, and we're also contributing the electronic medical record so we can track those engagements and those outcomes over time. A and I think that's a twofold value here. Number one, we'll be able to go to where people are and serve them at an access point that may not exist with infrastructure or depending on their transportation, social determinant barriers. they may be accessing healthcare with us for the first time. Secondly, we're going to have the data. So whether that's the biometrics, whether it's screening, whether it's follow-up, our goal with this would be to create care coordination for those folks, whatever that right front door for healthcare looks like, whether that's helping them get back here to the county health department, aligning with Jane Paulie and our folks on that side, depending on the payer mix, if they're Medicaid eligible patient, for instance, or if they want to find us at Hancock Health, we would be helping them land for a next step, and then we'd be able to report all that back to the state of Indiana through the Health First um KPIs that they're tracking with regard to what they were hoping the dollars would be deployed towards. Um and that's where I think I think the electronic medical record would be critical is that if we have that information now we can start to put real ROI on what this sort of intervention looks like society and then track that back whether we're using the Fairbanks numbers. Um and then the email that I just sent uh Crystal I forwarded

you the the doc package that had all of that. Um the we we have a a quick treatise done by Fairbanks and Dr. Near Manenny who's one of the architects of Health First Dollars who's a friend that had helped us think about well if we're going to target things from a lifestyle standpoint and meet people where they are and screen them. What if you do the minimal effective dose? What if you do the really low hanging fruit? Let's establish care. Let's measure blood pressure. Get you connected to a next step. do things like body composition, motivational interviewing, care coordination, and connect people with our behavioral health specialists if they need connections to either the connection center uh or vaccinations. Really, the world would be our oyster, and we get into a cadence with the county health department on deciding what would those screenings look like, where, how we're going to do it. Uh but our commitment would be to shoulder the operational cost ongoing and be a force multiplier for both the goals of the county health department but also Hancock County and health access in general. So I I hope that gives a little bit of a lay of the land of what we were hoping to accomplish with the unit but functionally and then according to the contract we'll own the unit and that'll make us liable for all the insurance, all of the gas, all the preventative maintenance, all the mechanic work, providing a driver staffing, etc. Uh, and then we would love to work with the county health department if they would want to share staffing or work with us and come alongside any of these events, but our commitment would be to make sure that operationally it's a turnkey solution and we'd be deploying in the community under the guise and in partnership with the Hancock County Health Department for specific initiatives on those community screening days. Um, does that help answer that question a little bit? Okay.

Yes. Would we be providing more free screenings, more types of screenings with the mobile unit than we're already doing with uh the nurses? Yeah. Currently,

I I I think you could have the same variety of screenings that you could offer in that setting. And that's what's beautiful about a dual exam room, mobile clinic. You'd be able to replicate that experience, but take it to a larger volume of people and then have the electronic medical record track them over time. Uh, and that's probably the biggest benefit is the longitudinal impact of being able to screen individuals, connect them to care, and have history and physical data on those individuals that may or may not have access to that. And and I know that is something that is not necessarily going to walk into the door with them here at the county health department. A lot of times we're dependent on that.

We have nurses and cars that can provide those services as well. And if it's data you need, I don't know why we couldn't pull that information together.

Yeah, I think it's the lack of the electronic medical record that you have right now. U so the HIPPA compliance is important. Uh and then tracking that patient interaction longitudinally because you may lose them to followup for vast stretches of time. And to be able to have that history and physical data allows us to make better clinical decisions as to what's the appropriate next step of care with a mind and an eye on what are those social determinants keeping them from accessing it. So we're hoping to remove two of those barriers which is make that access free and then take it to the people wherever they happen to be or create an accessible community event um at scale. And that's the beautiful part is with an entity like uh or with a with a with an apparatus like a dual exam room mobile clinic the patient flow we can be rooming people taking history and physical data getting them into the EMR while our practitioners are either seeing or we're doing screens or we create an environment where there's different if you think about it like a highway. We want to get everybody on a highway towards the preventative lowhanging fruit things they can do for health and give them the right exit ramps. uh and that would help us facilitate that at the point of care for folks. Do

you have projections and the numbers that you think you're going to see based on what what's happening now? And and

so the the volume and what I think is really interesting, we took a lot of the data that was being captured say for instance at the soup kitchen when the county health department would deploy one of our nursing staff to the soup kitchen to help measure blood pressure for instance. So we took some of the impact of that, ran it backwards through the health first um architect near Minckenny's calculations on the societal benefit and the total cost of care benefit by just establishing blood pressure screenings and then we applied the types of volumes that we see at Hancock Health uh and being able to take that to people in event to base capacity. So in the attachments that we'll forward, you can take a look at that, but the the numbers end up being um mostly a function of the same type of testing and the same type of impact that you have on a per capita basis at the county health department, but helping it scale. And then we would the cost operationally of scaling.

Other questions? Just to clarify a little bit, I think at one time there was some question as just exactly what personnel would be manning these clinics and what could be provided to the people.

Yeah. So we had originally benchmarked and staff Wilson and I worked together on the team that delivers on the direct primary care clinics. We have a medical director oversight with an advanced practitioner model. So, if you can imagine here for health screening days, most likely medical assistants andor our our clinical nurse manager Jodie Shaker would be our our lion share of the folks that are out there and she's an RN by trade. Uh the other aspect the other opportunity that we'd be able to deploy depending on what type of screening we're performing would be our nurse practitioners. Uh and then that way you have kind of the the full suite of landing places for folks to capture data to follow up and meet the patients where they are from a screening standpoint. in that if you need to see a practitioner or if if it was an event focused on making a connection with a practitioner, that's definitely a possibility. Um the trick is with that is the scale factor. So it's a it's a function of how many people you're hoping to serve for that specific deployment because of the amount of time we would want to take with each individual meeting with an advanced practitioner like a nurse practitioner.

The other 317 days or however many left that you guys get to use the vehicle, is there a charge for the services you provide? It it depends. So often times there won't be because we're thinking about using this as our mobile deployment of either community activations or our produce prescription programming in our clinical exercise adjacent nutritional programming that we take to the people. Much of it would be focused on population health. The only time a charge would be applied not on a per use basis but it would be an extension of our direct primary care clinics that employers and municipalities and many of the schools pay us for. So it would be a force multiplier for those health outcomes at our schools, Hancock County government, for our own associates here, the city of Greenfield, a handful of other employers in in and around Hancock County.

Got a guess on what kind of revenue you're talking about?

Uh well, it it'd be hard to attribute it to the clinic itself because we're already collecting that revenue. So it wouldn't change. We wouldn't be charging more. We'd be extending that service to folks inside, too. So I'll give you a great example, Eastern Hancock. So Eastern Hancock is one of our direct primary care clinic customers. Geographically, probably the most isolated of relative to Hancock Health's infrastructure where we can see them in our direct primary care clinics because we have a location at Brandy Wine Plaza, McCordsville, New Palestine, and then at the Gateway facility at I7 and Mount Comfort. They're accessing our clinics, but they have to drive quite a distance. if we were to do on-site biometrics or if we were able to bring that and make that available to the teachers on a revolving basis, it would be an extension of a service that they're already paying for. So that we could probably find a way to say, "Oh, well that would allow us to serve our our employer partners better and maybe there's a blended value for that, but we won't be charging extra for access to it." If that makes sense.

What about your Nighttown clinic? So the Nightstone Clinic it doesn't currently support based on but you have a new plan and it's already been approved and just waiting for you. I mean I I don't know when the buildout is but I know there's one.

Yeah. So that one's a function and and that is that is definitely something that we've considered is um for folks on that side of things. Now we would be focusing our mobile clinic on Hancock County uh is the idea that it would be deployed within Hancock County primarily. uh the nighttown clinic, the space constraints and then the use of that space might not necessarily be a direct primary care clinic. Uh so by way of just lexicon here, primary care is different from our direct primary care clinics. Uh direct primary care, think of that as capitated per employee per month pricing for unlimited access to that primary care service. Our primary care clinics proper, we bill insurance and it's like a traditional healthcare interaction. Um, so those two aren't necessarily the same and they don't necessarily occupy the same space mostly from uh back office logistics. Yeah,

Joel, maybe to to make to to reduce that fairly complex picture to something simple and and you may not be able to make this guesstimate and that that's okay, but could you just give us a guesstimate out of the those days that you will be using that? What percentage of the usage would be revenue generating versus no revenue generating?

Yeah. Well, well, and again, none of the revenue would be based on accessing the mobile clinic. Right. Right. So, so from from that perspective, it would be trying to assign a blended percentage of what we're already collecting, right, to the clinic. Um, so about the only way that I could think of creating some sort of calculation on that, the number of clinic hours that would be housed in a mobile clinic, we could figure out the number that we could provide relative to how it would be deployed because it wouldn't be necessarily deployed in a revenue generating capacity to borrow that nomenclature every single day. It'd be more of a revolving cadence to go to our existing customers as an extension of that service. But again, if you could imagine that that opens up a another day of clinic slots once a week or two times a week any given month, right, then that that would be maybe a 15% increase in our clinic availability, 20%. Um, so you could probably assign some monetary value on that, but it depends on the employer and it depends on the utilization. So, it's it's hard to say, but but I I I would imagine that not trying to back my way into the number that you just requested, relative to our current availability, uh we if you if the current availability is 100%, think of it as adding 15 or 20% of capacity to our clinic. Yeah.

Other questions? I'd like to put I don't want to put Crystal on the spot. Talk louder. I don't want to put you on the spot, Crystal, but do you the the Health First Indiana dollars? I think we have two years worth. What percent is that? $420,000 roughly of that of the total funds that we've received. Well, it's the the amount has been different every year. So, so in 2024, it was about 50%. I'm sorry, Crystal. Are you at a microphone? Oh, well you that's what you told me, right?

Got it. Um, so the the amount of health first dollars has been different every year and forgive me I don't have exact numbers but um in 2024 um it was about it was 800 some thousand and so the 429 would be about 50%. Right? Um this year it was 1.5 so we're looking at 25%. Next year we are looking at just over $400,000 and in 2027 we're looking at just over $400,000. So So if you took that budget alone it would we wouldn't have enough to cover but the but the 400,000 420 whatever the the amount is that's a one time

correct. So if you take 24 and 25, if I my math is correct, we we had about $2.3. Correct. And they're talking 420ome roughly one6 which is what um 16 of our two years. Okay. I just rough roughly we had calculated 18 looking at the number one district

and again going back to that it would be just that that bololis of the professional service agreement would be the only bite of the apple here. Um and to Crystal's point wanting to help preserve and not make that a burdensome commitment for the county with the variability of funding that's going to come from the state over the years to follow. Um, so our ask on that front would be this gets the flywheel turning, we'll keep it turning.

How do you where's where's the funding come for this? If you're going to uh access more people and provide screenings for more uh folks out there, how are you funding that? if we're I mean if you're not making bringing revenue in for it that you can pay for the RV or or the the mobile clinic yourself um how are you going to support that?

Yeah. So um right now the the opportunity for us always on care coordination is that people eventually downstream utilize health care. So all of health care is connecting with patients early and often and if they need to be coordinated to something downstream, we hope that they choose Hancock Health. So the only way that in healthcare economics, which it's a a a wildly labyrinthian and complicated thing, but it's very it ends up boiling down to this. It's price times quantity less our cost and that that's the opportunity for the hospital. Um now margins in healthcare are hard to come by. A lot of ours we would fund this through our capital budget where we would allocate to the $429,000 to purchase the unit upfront and that's an investment for us in number one the mission work of getting more people access to healthcare and then number two connecting them to the next best step which could be services at Hancock Health. Uh and that's the opportunity downstream if there was going to be any revenue generation. Not that we're banking on it the way that this um the health first dollars would help defay costs. we have the ability within our direct primary care clinics um because of the the robust robust service and business that we we operate there that we can absorb this sort of service operationally as an extension of that. So we're not necessarily worried about it monetizing itself to a high level to pay the unit back. This collaboration with Health First makes this entire thing accelerate. Otherwise, I would have to wait until either the capital budget or the proforma purely on what you just described could justify a probability weighted multiple return on that investment. With the health first dollars, we could do it sooner and go bigger faster because it would defay the risk.

What if you guys did make the investment and then we would take our fund and pay you for the screenings that that we require?

I mean, is that a possibility where you guys would Yeah. So, uh that that's posited in the the professional services agreement where the amount that we're requesting helps us defay that cost faster. If it's less than that amount, it would just delay the the timing for us to purchase the asset because the capital dollars, right? So, the exchange here is that professional service agreement allows us to take the risk on the capital dollars because we know it's going to defay some of the cost in the first two years. not all of it but but a good chunk of it and then that gives us the flywheel where we can build something that sustains for years to come. So the initial the hospital or the um county's initial investment how long is that good for that that buys how much time how many years worth of benefit and then what happens and and this may have already been discussed. I apologize for being a little bit late but what happens after that? What's what's the what's the you know um cost I guess from a health department from a county standpoint after that initial investment going forward?

Yeah. Um so um the the term that's that's proposed uh for everyone's review in the professional service agreement would be 60 months 60 6 years.

Yeah. Five years. Um and and the idea behind that was trying to a conservative estimate for number one figuring out what the the the cost per day and I broke that down in a couple of the tables inside of the presentation that you could see and you could run the numbers if you wanted. We'd be happy to provide some of the labor data. I broke it out in kind of a cost line item per uh standpoint, but the idea was trying to give the county incredible value for the cost of the asset and all of the labor, the electronic medical record, the follow-up, the care coordination um in concert with our our partners at the county health department um and make that valuable because you'd be hardressed at the rate that we're proposing to be able to rent something like this and do this at scale with the labor that would be provided. Um but we chose 60 months because of the lifespan of the asset. So that's the biggest variable, right? We could get to 60 months and say, "Yeah, you know what? This the the the clinic's limping along and we're going to have to replace it or it's going to be large mechanical investment." And that would be something that Hancock Health would contemplate operationally. So we and if the county wanted to come back and said, "Hey, this has been a roaring success. Let's expand it." Of course, we could talk about that 5 years from now. Um but our but our goal would be this initial bolus. We're not coming back for another bite of the apple. um sustain it, measure all of those outcomes, report those outcomes back to the state and and the Department of Health to say, "Hey, look, look at this incredible initiative that we aligned with in Hancock County, the number of lives it was able to touch, and the the sort of impact whether that's establishing primary care where there wasn't, measuring and and figuring out, hey, there's hypertension and it's untreated. Let's get them connected to treatment." Whatever those next steps are, we've got a very robust calculus to help us build that ROI. But if after five years if you know if you know if it was going well you know it sounds like that this health first dollars is going to decrease and so if it's if it's that you know if it's such a good success you know how do how does the county continue that after five years without really the

funds to you know if we're only going to get $400,000 you know per year after that or maybe even less who knows like how if it is a success and the county wants to continue that How how does that look? I mean because obviously you know this is money that is in a sense extra right now. It's not something that can be counted on you know going forward. I mean in five years who knows I mean exactly it may not even there might maybe may be zero dollars and so um you know I mean it's you know starting something and then not being able to see it through after that if it is a success. I mean what does that look like you know going forward?

Yes. Uh so I I think worst case scenario in all of that is even if it is a success but it's financially untenable to move it forward we will have exhausted the lifespan of the asset and then we figure another way to collaborate or another way to do this best case scenario and what we're planning on doing and again not to um obligate the hospital for 60 months from now because you just don't know um but the idea would be that by that time the amount of growth and impact in the ability and programming that we would wrap around that we would continue that investment. Um, and and that's how we're approaching it is that it would become part of our budgeting cycle to allocate for depreciation and plan on replacing the asset when its usable lifespan is up. Now, we hope to get much more than 5 years out of the the mobile clinic. And I think based on the people that we've talked to when we were doing our diligence, 7 to 10 years is entirely possible. Um it's a matter of just good preventive maintenance and taking care of the unit while we're out and about. Um so the answer to that not trying to prognosticate and say hey the future will be thus but it's every intention that we would be the partner with the county health department and Hancock County in general that we are currently and continue to amplify that especially if it's a success because that's equal parts mission and opportunity for all of us to to connect with folks where they need to um from a healthcare perspective. So that and again the the idea that the unit itself benchmarking its lifespan at 60 months I think is very conservative. So that's why we started there. That's also a negotiable item if if we wanted to say hey could we extend this with some sort of caveat for the the the unit being out of function for wear tear or something beyond our mechanical you know prediction let's say. then we could we could contemplate that in the contract as well and extend the timeline or have the ability to autorenew and keep the party going. Um, but our intention would be to keep this moving forward without

coming back asking for any more of those dollars unless the county wanted to. But after five years, I mean, is there any idea what the what from a from a county budget standpoint, I mean, what that what that looks like? Or would it be, you know, hey, we're, you know, we're going to, it was a success. You know, we're just going to kind of allow you guys to use it. Or if if the county wants to continue to use that, you know, asset going forward, you know, is there some sort of a financial obligation then from the from the county standpoint in order to continue that um, you know, to continue that? I mean I know 5 years is hard to predict but I mean

you know probably something that we need to think about if if you know if we make an investment you know of that magnitude now in five years what is the return on it because

you know I don't know that the health department gets a whole lot of direct benefit back from it really I mean you know yes we're reaching out to people with screenings and things like that but you know that all the treatment and things like that is all of that's you know all of that potential revenue is is you know going towards the hospital, none of that revenue is really coming towards the health department. So, it's kind of an investment, but not really an a potential income stream from the health department standpoint. So, going forward, you know, I was just kind of wondering how that how that looks because all the downstream revenue is going into the into the hospital and zero of it is coming, you know, so there really isn't any return on from a county standpoint, there really isn't any return on investment. I would challenge that. So I so I think twofold. Number one, um talking with Dr. Weaver, if you want to ensure or create the highest probability surface area that there would be funding for something like this, we need to do something bold that gets to people. Um because when they look at it and they say, "Oh, what what happened with the health first dollars?" Well, if it was nothing, they're not going to send any more. Um right. And and our our policy makers have said as much. Um secondly, the ability for care coordination to happen to whatever the right front door happens to be most certainly is county health department could be Jane Pauling, it could be Hancock Health if that they wanted or if it's something the county health department cannot do. What I think this offers from a return on investment is the idea that the staffing, the scale, the operational support, the ability to to invest in something like this and sustain it long term without it becoming burdensome to the county's budget. That's where Hancock Health can step in and be that partner that's taking this out into the community and helping deliver on that service that otherwise probably wouldn't have been possible from staffing and other operational considerations. So, I would imagine the the ROI is scale. Uh the ROI is more lives impacted, more people connected, and we're going to

need that more than ever as one of the fastest growing counties. And with a rapidly changing and shifting demographic and needs that are going to shift with that from a health access standpoint, um I see this as helping us all go to where the puck is going to be on that front. Uh so that that would be my push back on I I think the ROI for the county would be more in line with the ROI like Fairbanks would calculate on helping take people off the sidelines of not accessing health and what they're costing society because all spheres converge on health. It's the the rising tide that's going to float all the boats for opportunity, for a better, more prepared workforce, for a better and um economic environment to draw businesses and opportunity to our county and to sustain the type of productivity, presentism, absenteeism, the burdens of that, help alleviate that from our employer population. Um, and again, that's what's so powerful about aligning the right stakeholders like we're proposing here is that we would have a very robust network to connect people to the right front door for healthcare. Uh, and I think oftentimes, especially for the the screening days, Dr. Capen would be the county health department. Um, and in particular, if it's folks that we identify, and you know how this goes, we'll see them for a screening, we'll realize there are gaps in care and we can make those referrals or build those connections, whether it's missing vaccinations, it's missing preventive checkups, missing imaging opportunities, it's colonoscopies, mimography, it's all the things that we know work, but a lot of times people forego because of either cost or they just can't get there. Um, and we're hoping to bridge that gap on behalf of the folks that need it. Joel, the the scenario that I'm I guess fearful of is and we could look at 60 months and then with Crystal I'm sure we can run the numbers and see does that make sense for us. But what happens in my mind the worst scenario is the engine blows or we have some catastrophic

damage that happens in two years. What is our guarantee that we're going to get five years out of this equipment? Yeah, the professional service agreement. So if the engine blows up that I'm sorry, I'm just seeing it. No, it's okay. If it blows up, that becomes our problem, right? And that's also why we would carry insurance and all the other things. One or you set something up and immediately No, there there's no obligations.

There's no um there's no hard like um service obligations posited in the contract. Not to get too far into the legal, but the idea that what we would do is work flexibly with the county to reschedule the event and either fix the unit, rent something, reinvest, but that we would fulfill that obligation for the length of the service agreement. So that that would become our problem, not the counties, and then we'll have a guarantee for that. That Yep. That that would be contemplated in in the contract. Yes. Told I understand. I I I been looking for your email this morning. I can't find it. Okay. Uh, but do you have a legal agreement that is ready to be reviewed by our legal? Yes. Yes, we do. Okay.

Yep. And uh and yeah, Gary, if you if you Let me make sure I got the date right here for you. August 15th. If you take a look at that um Oh, well, that might be why. If if you weren't logged into or if you if it wasn't hitting your um Hancock County government email, that might have been why it didn't come across your phone. I didn't check there. I checked the health Yeah. Yeah. But but you might be the case. You have that document. Yes. That could be. Yeah. We we'd be able to forward that. Um and uh that's that's been approved on our side by our our general counsel and again ready for red lines um and contemplation by the the board and council.

Did we address the questions that had been submitted? I think for the most part. Okay. board members. Uh obviously we've got some documents that we didn't we don't have in front of you right now that provide a lot of details. Um I was hoping we could call the question to get an up or down vote on this today. Uh but do you feel you need to see those documents because that there there's a lot of detail. I do that we don't have in front of us right now that that's kind of shifted or or grown since the original proposal you gave us. Correct.

Um mostly just clarification. It's the same proposal. Um the details haven't changed um because we didn't want to pull the rug on any of the financial asks or requirements for that. So the only thing that I think has changed is the format in which we presented it in the doc package that was just forwarded. So you'll have a professional services agreement, the breakdown of the presentation that we had shown before. So that one will be very familiar if you had a chance to take a look at that. And then the uh the health first back calculation if you look at ROI for the county productivity um the avoidance of um or I guess the the ROI on avoidable deaths if we're able to establish the screening cadence and what that means for our workforce.

Yep. One other question, maybe we've talked about this before, but are there any other counties around that are going through a program like this that we can draw data from to see what they're doing?

Yeah, absolutely. So, as a part of our diligence, actually, um, Aspire is federally qualified health center serving Marian County. They have an incredibly robust mobile clinic service that goes out and meets people both in indigent populations if you can imagine um encampments for folks experiencing houselessness tent cities all the way to um community screening days and things like that but across Marian County Indianapolis metro area uh they're doing it a handful of counties have actually used some the health first dollars to facilitate programming like this uh across the state and it's been a part of our road show diligence talking to a handful of them and say, "Hey, how's that going? What are some things to think about?" And how long have those been going on? They've been five years.

A lot of them started at at the outset of the health first dollars being deployed. So, um two plus years now. Uh at that point, when when you think about the the two big tranches they released over the last 18 24 months, um that's when a lot of those programs took off because they had the capital to get them going. in a variety of um ways in which they've partnered to do that. But the majority of them would not be the county taking control or the county health department rather taking control of the asset because of the operational burden and then the you know being equipped or having to staff up to say yes we're going to manage a mobile clinic. So, a lot of them would find partners and that's um a good example of how like an Aspire partners with somebody um entities in the community to bring the mobile clinic to them. Uh and theirs would offer it's a little more social determinant focused. So, it's it's primary care with a nurse practitioner medical screenings and uh they'll they'll have some folks cycle in to do light dentistry and things like that. I will say that Joel did send me an email this morning which I still can't find and he answered every single question very nicely and then attached I think was the proposed contract. So

if you could maybe send that to Crystal and Crystal could okay and you could disperse it to everyone. But it was very nice email. I just can't find it. Oh, no. It happens. We're good. I have a few comments. I was Thank you. If I I know I asked some questions of staff at the last meeting as we were considering this. I I'm interested in anything else from staff right now. Okay. Please. Anybody else have anything before I start?

Okay. Um just a couple of things. Um I don't want you guys to think we're not doing anything with the Health First dollars. we have four staff members that are doing some outstanding work. So, um for it to be eluded that nothing is happening is not true. Um and just that was not meant to be.

Um the other um mobile unit that I have toured um was actually purchased and owned owned by the health department. Um, and for the life of me, I'm sitting here trying I can picture it's a county. Um, but um, they actually own and have that unit for themselves. Um, so that's the only other one that um, that I have actually toured and um, seen. Um, the um, we do have some issues currently. I'm a little um concerned with the ability to get information and for clients to be referred out um because we currently have tried and tried and tried to work with um a what's the like it's a referral number

um central scheduling

central scheduling if we have a patient that um and that has not worked yet um so I am a a little concerned about that possibility. Um and um sorry I'm a little nervous. Um and um th this I as the director of the health department I would be remiss to say that if I didn't say that this essentially and and first of all I am with whatever you guys decide we will we will support it either way. So, I don't want don't take this as I'm against this or anything. I just want to put it out there that this is essentially taking one year of that staff the ability to um retain them. So, if we make this investment, it's taking one year off of that amount that we have to keep them employed. So, um I love my staff and so I just I just want to make sure that we we keep that in I mean this is this is a huge investment has huge potential right but I it is also potentially taking um that that year of staffing away um depending on and especially since we don't know what HFI looks like in the future. We know 2026 and 27 numbers but after that we have no idea. Um so I just want to put that out there. Um, but like I said, I think it has great potential. I think there are some fantastic things we can do. We when the HFI dollar started and we were able to hire those staff members, we've been doing some pretty amazing things anyway with just a cooler and our own vehicles. Um, but you know, like Jules said, the you know, you could have a couple of

people being seen and run through the process at a time. Um it it could it could be amazing. So um that's those are those are my comments. Okay. Any questions for Crystal at all or or any of the staff?

Um and and Joel, I think yeah what you're doing out you're thinking outside the box and I think that's great. But at the end of the day, if we're spending $85,800 a year and we're trying to reach more people, can we effectively do what we think we're going to do with this investment? If you had $85,800 for the next five years to to to to hire people and maybe another car or two and access these folks for these screenings, are we really going to do that much better with the mobile unit? That's my question. I I I just don't know if it's really cost effective.

That's unfortunately. Unfortunately, we don't have crystal ball, right, to be able to say this is going to be, you know, super effective or any of that. So, I I unfortunately we don't have an answer for that. No, we don't. And and unfortunately, this is one of those things where we're going to have to do it in order to find out whether it's effective, right? But at this point, the downstroke of doing it is is the pointed question. you know, can can we can we do that? Is that going to work for all all partners? Britney.

Hello. I am Britney um Cecil, the public health nurse. Um so, as the county public health nurse who is out kind of doing this, um I do have a couple thoughts. Um so, I I do think that this could be a really good thing. I the what I where I see the biggest problem in connecting those individuals to those services is going to be our insurance. So the problem that I have actually getting them to see that provider is insurance purposes. So, if Hancock can't see them because they don't see Medicaid patients, us being on a bus is not going to make a difference. Um, if they're going to have to then go to Jane Polly, yes, we're still going to be able to make that warm handoff, but we're not going to be able to kind of move that needle and follow them all the way through that. Um, so I feel like that is still a growing pain there. Um, I think it is just a lack of providers as well, but I don't know if we're going to be able to to make that difference um with this funding. I mean, that, you know, that's a whole different conversation. Um, so I don't think I think it's a great thing to try to reach these people because we don't know what the true problems are. I only have this small population that we're seeing. So to be able to get out there and to expand that to see kind of what do we have? What is the true need of the members of our community? What does that look like? Maybe the bus is not the solution. You know, maybe it is we need more providers. I don't know.

That help a little bit.

Questions? Well, one thing we could probably do if there's history and data that's already been put together with some of the the mobile units that are out there, if we could look at that information and then just try to, you know, figure out how that would apply to Hancock County and what, you know, if we're missing out on servicing folks, that might tell us. I don't know based on the way we're doing it current. But again, I'd want to know that the $85,800 that we couldn't do it the way you're doing it now and be more effective than we would be with the, you know, get a bigger bang for our buck is all

under a scenario um that um we didn't invest the I'm sorry, the the uh county health department didn't invest the initial $420,000. Do you have a rough guesstimate or this may be an unfair question, but do you have a rough guesstimate of what you would charge us to use the unit?

Yeah. So, um, we Yeah. So, we we have those line items broken out and it would be in that ballpark that you see in the in the presentation. Uh, to give you an idea, fully loaded, I'll just pull it up. So, if you're thinking about a per DM total cost about $1,800, it's positing $1,787.50 for a day rate for something like that that includes all staffing, supplies, EMR, that sort of thing. Um, and I was able to back to one of the first questions. Um, because I think it's a question of scale. Uh, and to Crystal's point, um, my my comment on the Health First dollars was not to allude that great work isn't happening here. I'd like to make sure that that's that's noted. Um, never the intention more of the hypothetical of showing up with with bigger impact I think incre increases the opportunity that more funding gets released for the types of initiatives that we're talking about. And the scale factor I think is what's the opportunity at hand in working with the great work that they were already doing. We looked at um blood pressure screenings that happened that were deployed from September of 2024 to February of 2025. Uh, and they did 68 blood pressure checks, a lot of which would happen at the Kenneth Butler soup kitchen. Um, and then looking at that at the Fairbanks numbers would assume that nine of those people unknowingly had hypertension. Connecting them to care based on the numbers that are out there in that ROI model was a $329,000 elevation for the county. So that's what was done by the health department. Um when we deployed screenings over our employed populations um at Hancock Health we saw 354 and 1410 of them were hypertension with 560 plus with treatment and follow-up and that's that using the same equation is about $50 million of impact. Um, so that not to say right, wrong or indifferent. The the idea I think is scale and the question is how can we

reach more folks be a force multiplier for all entities involved and use some of the scale factor that we as the the county hospital and a regional health network can bring to amplify those outcomes that you're tracking and delivering on already. I think that's the opportunity here. Further further questions for anyone? If not, I it really I I don't believe we play we ever put this in the form of a motion. Um so at this point I if if we I I'm going to well I can't do it. I'm the chairman, but I'm going to need somebody to give me a motion to uh act on this proposal as it exists. Um, and then we can we can discuss where we go from there. But I I believe

not want to look at the contract some of the

we I I would like we we may and Ray what we can do is we can put it in the form of a formal motion which we've not had to this point. We can ret that motion if we need to gain additional information. I just want to try to move this thing forward. Um Hancock Health has has been good in coming forward, has been very patient as we've considered this. Uh a variety of things have caused this to take longer than any of us would have wanted. Uh and unfortunately, we've had yet one more hitch and not getting information. Sorry, Joel. Uh so we could table, but I would like to get it in the form of a motion that we can then begin to to work on uh and and eventually end up with an up or down vote. I I I I want to honor the work that Hancock Health has put into this and and move forward in some way if we can. Do we have a motion? table it personally, but

we really don't have a motion to table right now and and I I don't have the minutes in front of me, but I don't believe we have a formal motion on this to table at this point, do we? You have the minutes from the last meeting and it was it was table. It was we tabled consideration. Unfortunat Greg, help me out. I don't we never truly had a formal motion to consider the proposal. No, we we need that, don't we? The motion was to table it pending answer response of your questions and review of the contract which you've not yet tonight you've received some responses to your questions. So we could leave it tabled. You could leave it tabled and do it for and then but we need to look at the contract before because a lot of

the monetary questions I don't know necessarily will be answered by the contract but the guarantees the strength of that those representations that Joel's made tonight and uh will be should be in that contract. So that may or may not change how anybody looks at it. I I don't know. So the matter is currently tabled. Do we wish to leave it tabled? Do you feel like you need additional information? Chris can forward Joel's documents to us. Greg look at the and and obviously we can review the contract as well. How does that sound? Right, Joel? I hate the fact that we're going to have to continue to delay this,

but it looks like that's what we're going to need to do. If we can get that information out to board members, um, I'll send it tomorrow. Tomorrow morning and, uh, let's get this on the agenda. Um, I I would love to for all of us to to commit if we can to getting an up or down vote on this at our next meeting so that we don't keep dangling a community partner out there. I'd like to I'd like to move. You can always have a special meeting if you wish between as well to address this issue, but that's up to you, too. You don't have to wait till your next meeting can really up to the board. I will leave that to board members. Any any discussion?

I wouldn't suggest any sooner than a month, but I mean Okay, we meet every three. So that would every two this year and we have to discuss about the next meeting date anyway. That's under new business. So okay, we could talk about Well, we can leave it for that and then see if you want come back and circle back around if you want to address a a special meeting, too. Let's let's let's circle back around and talk about the potential of a special meeting as we look at that meeting agenda item. Then Joel, I apologize. We're going to have to lay this a little further. I appreciate you being here and I appreciate you sharing the the detailed information for us. We will uh we'll get that digested and move forward. Thank you so much for talking. Thank you.

Okay, if there's nothing further on that item, we will move to Southern Hancock AED requests. Want to approve the minutes from last meeting? No. Uh do you have we have Can we circle back? Let's let let us Okay, thank you, John. Let us let us circle back and approve some minutes here. Let's not waste that opportunity. It's okay.

Very good. Thank you. Oh, uh, Ray Ray, sorry. Gentlemen, gentlemen here last time. Hold on, gentlemen. Time out. Yeah,

you cannot have conversations like that in the course of this public meeting. The public has to be able to hear any comments and discussions that you have among yourselves. I know when we used to meet uh in the other room, we did those kinds of things. But now that we are being livereamed and videoed, uh we cannot have what sidebar concept? We we will stand corrected for clarity and and I will make sure uh Dr. Sharp was talking with me about the fact that Joel's documentation which he has seen does thoroughly answer a lot of the questions. I'm sure it does. And we were simply talking uh Ray if you just want to repeat what you said to me.

Yeah. I just wondered why we didn't have the contract from the get-go the beginning of the uh presentation. important, but we'll get it now and we'll we'll address it. That's not Yeah, it this is this has just grown and and yeah, obviously we're moving forward, but we're not moving forward. I I I think is where we're at here. And the contract is part of moving forward. We had a proposal in front of us that was well detailed. Obviously, everything's driven by the contract. Now, the contract's available. So, we'll we'll reconsider all of that,

get Greg to look at the uh documents, and we'll move forward. and we'll also consider ourselves corrected on sidebar conversations. All right. Thank you, Greg. And again, thank you, Joel. Uh moving Oh, we got some uh minutes in front of you. So, you have minutes of the May 13th meeting uh 2025 and January 14, 2025 in front of you. These meeting these minutes could not be approved prior due to lack of quorum of individuals who were in attendance at those meetings. Uh, we do have those individuals in attendance now. We can I think double check double check on those and make sure that I didn't overlook somebody. I think I think I pulled the right two.

Mhm. Yeah. Okay. I I think we're good. Okay. I think we're good. So, you just have to have four, right? Yeah. And yes, the right four. And And we do have the right four present. It's it's a bit of a key keyhole scenario here. And um so we do we can approve those minutes today. you have those in front of you. I and and we've received them before. I will give you a minute to review those and I will entertain a motion to approve when you are ready and you can do them individually or together. How if the same four people can vote on each of those and and and and they are so yes, we we could we could do them as a uh as a block.

Move to approve. Uh one or both. I move to uh the I move to approve the minutes from January 14th 25 and May 13. Okay. Do we have a second? I second it. We have a motion to approve the May 13th and January 14th minutes which have been submitted. All those in favor signify by saying I. I approve. Same sign. Minutes are approved. Thank you. So So now we have I believe three remaining. Yes.

Okay. Moving on to uh Southern Hancock School under Health First Indiana. Okay. So they have asked they are trying to become a let me find the wording here a heartsafe school and in that that requires AEDs be available within so so many walking distance what so much walking distance or brisk walk or something I don't know is the is the words um so they have asked um if we may be able to their ultimate ask is six AEDs primar they would like three to begin with and then if we could do three more um as portable options um they found some pricing well first of all I do need to say that um I just as an administrative decision anything that's asked over $1,000 I will be bringing to you guys I'm not comfortable making those larger decisions. So that's why you may you may be approving a lot more um um purchases because of that. Um but so they they found some pricing um for all three that is for the first three it's about $6,400 and the next three it's about $11,000. Um, we have tried to purchase through this AED superstore that they found. Um, and it has much better pricing, but we can't because they want payment upfront and we can't do that. Um, so I'm not sure if the school can or not. Um, so I um, first of all, and then and then they mentioned that they have applied for some grants. So, we followed up with the school today and the New Pal Education

Foundation is going to be getting them one AED. So, that takes us down to five. They asked Hancock Health um they've been in contact with somebody there. They'll know sometime in September, but they weren't given a specific date. And then they tried an AEDgrant.com and that was not going to work. So, um we may be down to four. Um it may be five that they're actually asking for. So, um, but I was happy that they were able to provide us that and that they were trying to seek some other funding. Um, so I don't know if you guys would like to do that. We also have the fund 8955 that is um it's COVID money and school liaison money that we could use instead of the health first dollars if we chose to go ahead and fulfill this. Um, so and it has a healthy budget 900 some thousand. I think the 8955

you read my mind is you tell me it's a healthy budget. Okay. Very good. Um, so um, so I just uh I mean I think they would like to move forward with this if you guys would be comfortable on voting for that. Um, but that is um, what that ask is. What's what's the the difference in the price? One set of three was 6,400 and the other set of three was $1,100.

Well, the first one had a coupon. So, I don't know if it's still available. Um, but so, but it might become more expensive because that is that includes the cabinets and everything because those would be the the ones inside. The next three are portable ones that they would use for cross country, band, and um athletics. So, and what's the price difference going through the one you have to pay upfront for? Do you know? Well, that that is that if we would purchase them, we're probably about $1,000 $750 to $1,000 more per unit. More? Yeah, they're going through the prepayment. Uh,

that's who she quoted, but I don't know if she I don't know if she's purchased any through them to even know if she could. Okay. Um, we also have the opportunity to say we will give you 15, you know, like $15,000 towards the purchase of AEDs or we could have her purchase them if she thinks that she can do this and then just we would they could invoice us and we would reimburse the school. So, we have some options if you guys are interested in that. If their board agrees, they have a means to pay for them upfront. Uh, whereas we can't, I would think. Yeah. Yeah. They they there there's a mechanism if if their board supports that there's a mechanism for them to be

yeah we tried to go through them when we purchased the AEDs for the boys and girls club and it was a disaster. So, um, so anyway, okay, let me first of all say I'm not a board member for anybody who might be watching this. That that doesn't matter because they can't hear you, doc, because you're not talking. Anyway, let me clarify that I am not a a board member. I'm the health officer for the county. But, um, I wonder, have they approached any employers, large employers in the county? I would think this would be a wonderful

um community service by a large employer. And the second question is is um my guess is that we're going to have three other school corporations standing in line for the same funds. So I ju just just to comment on that. Yeah, possibly. I mean I I don't know. She she just those are the three that Newell Education Foundation, the Hanco Hancock Health and Aedgrant.com were the three things that she said that she had applied for. Um, so I don't know anything about any other employers. So, questions, comments from board members.

Well, it sounds like I mean, I think, you know, Gary's right. I mean, if if Southern Hancock is applying, I mean, I'm sure Eastern and and the others are probably going to apply. So, I guess, you know, as we think about it, you know, if we, you know, set a budget, you know, budgetary amount to say, well, you know, give them 15,000. I mean, I think we have to kind of look at that saying, okay, are we comfortable doing that potentially two more times. Um, and I mean, I, you know, and I'm not the financial guy, but, um, but just to throw that out there. I mean, I think it sounds like a good idea. I think, you know, um, I don't know anything about how many they would need. I mean, Jim, you might know more. I mean, I don't know what the numbers are. If six is it's

sufficient, plenty, too many, I don't know. it it I know they all have them. I'm familiar with one school district who has quite a few. No one has the number that would bring them to the standards that New PAL is attempting to achieve. What's the name of the program again? Heart safe. Project Adam saves lives hearts safe school.

That if you meet those standards, you're pretty AED rich, which I is a great thing. I mean there there is an AED close anywhere at any time. It's a wonderful standard. It's also very expensive and and and you're right. I you know it would not be inappropriate for three other school districts to approach us and ask for a similar thing. Three private schools. Yeah. St. Michael's Zion Lutheran and Guys Monosuri too. Now they're not going to have the footprint that Right.

Right. And and my concern would be if we were to bring one school to that standard, then that expectation might be there for others. And and again, this is it's a wonderful program. I'm saying nothing negative about it, but it's a lot of AEDs. And the larger the district, the the more active your your students are, the the more outreach you have, the more you have to have because it it it it keeps them pretty close at hand.

Why don't we I mean I mean I we don't there's nothing to say we have to give them all six or five or four, right? I mean we could say, you know, okay, you know, like you know, reaching out to other community partners. I mean, we would say, okay, since we have to kind of be mindful of other schools coming to us, you know, we will get, you know, whatever we determine as an appropriate budget, you know, it sounds like these things are maybe what three grand a piece from what you get from here. But I think I think the ones I've purchased, and I should have looked it up, I think they were 35 to 3,800 I think each. I mean if you said you know hey we'll you know we'll you know give you enough money for two or for three you know whatever you know whatever as a as a as a board or as a department you know we decide that way it kind of um you know makes it even from from a a larger scale standpoint I mean you know instead of being on the hook for you know 10 you AEDs for this school and 15 for this school you know maybe if we kind of set a limit and said hey you know we'll help you out with three the hospital you know I mean they have deep pockets I mean they're going you know, they provide one and this other grant's going to provide one and you know, maybe they need fundraisers, things like that. But I mean, I think it's a great idea, but you know, we don't necessarily have to do all five requested.

Sure. Sure. Would would would u anyone like to make a suggestion what that number might look like? I would I mean I would propose I mean I you know again from a budgetary standpoint if we said you know we would you know we would you know be able to provide up to you know up to three potentially um I mean that'd be what about 10 10,000 ballpark wise

um so you know um so we would be you know up to I mean I think if you qualify that that way if a school says well hey we only need one um you know then then um you know maybe maybe there's a little bit of a less of an outlay but given that's what I would propose is to just provide a a dollar amount and says you know we will you know we will offer up to this amount if you request AEDs from us this is what we're willing to willing to pay I I agree I I thought he was going with the number of units but I think it's better if you set a cap from a dollar standpoint not knowing what those units may or may not cost going forward so

again if if it's a $10,000 cap or whatever the cap is the motion would be best to say that we will pay for 10,000 up to $10,000 worth of AEDs and then on a reimbursement basis and then they can purchase as many as they can and they would purchase them and then just Yes. Yeah. Some some of them actually already have ongoing contracts with providers. Okay.

So and and their their cost is yet different. Some of them have service contracts where provider comes in each month and actually checks them out and makes sure that they're ready to go and certifies them each month. So, I I I thank you, Greg, for that proposal because that that amount per unit is going to vary drastically among the the the schools, but um I I I do like the idea of a flat proposal. So, if if somebody would like to put that number in the form of a motion motion of $10,000.

Okay. It's been moved that we provide each county public school or each uh we're going to have to determine who qualifies for this because you've also got potential charter schools and and other entities in the play. I would say you deal with them on a case-byase basis rather than making a broad motion. Now, just this you have a request from Southern Hancock. If uh Dr. Harden's motion is to allow up to $10,000 in expenses for AEDs for Southern Hancock, then as those others come to you, you can evaluate their need and other resources and go forward

and and there's probably well, we'll deal with a question about public versus private if that arises. So, and that sounds like a wonderfully worded motion. Oh god. Which Dr. I hope YouTube caught it. Which Dr. Harden made? Somebody like the second. Good job. I just want to make make sure that the cost is anywhere between 6,400 and 11,000 per unit. Oh, no. That's not per unit. That is um Yeah, she with the coupon the three was going to be about 6,400. Got it. And then the next three were 11,000. Okay. And watch for more coupons.

Yeah. So, so we we have a motion that we provide at this point. New Palestine with $10,000 for the purchase of AEDs subsequent to their request. Is there a second? Second. Been moved and seconded. All those in favor signify by saying I. I. I. Oppose. Same sign. Been moved. I think Crystal, from a budgetary standpoint, take that money from where you think Okay, I'll take it from the school fund then. That that that would be my recommendation, but I I I'll I'll allow you to take where you feel it works with your budget best.

Okay. Very good. Moving on to old business 2026 budgets. Um just a quick update, the everything was passed. Um they did um they lowered Dr. Sharp's salary by $50 after the raise. And so I I don't know. Um and then they took I didn't even know that.

They are um the council is um trying to cut back on attorney contractual amounts. So we had 8,000 budgeted. they took it to 4,000 and then they moved our postage from 2500 to a,000. Um, and those are the only changes they made to all of our budgets. So, we'll consider that a win.

So, those Oh, and I'm sorry, they we did make another change because nobody noticed before budgets started that we have 27 pays next year instead of just the 26. So, the council um has has um agreed to fund fully fund the 27th pay. There was talk about taking everybody's salary and spreading it to 27 pays rather than just the 26th, but then that takes some people's salaries lower than this year. And they they did do um decide to go ahead and fully fund that 27th pay out of one of their funds. So, that's all I have for that. Very good. And that was simply for advisement.

Yes. Okay, thank you. New business staffing updates. Um Kelsey will be returning. She starts on Monday. Um um the grass was not greener and so she is coming back and um so we're excited that she'll be she'll be back and able to really hit the ground running this time. Um and um I am doing interviews when they show up this week for um the other position. We've had trouble with people confirming dates and then not showing up. So, um that so those are the um staffing updates. Okay, very good. Next meeting date.

So, in two months um that is Veterans Day and we have that day off. We can meet that night. Um or we can adjust that and um move it up so we can deal with the Hancock Health request sooner or we can do whatever you guys want. But that's that um that date in November is Veterans Day. Yeah. And it' be nice to move it. I'll be out of town that date anyway. So I I think it's up to us. Would we like to adjust that? Um, we can either move that up into October or we can just adjust it one week forward or back. Uh, if if you'd like one week forward would be would be election day.

Well, let's not do that. There there is not an election this year. Election this year. Okay. Oh, that's true. There is nothing. So, sorry. It is it is the day. We just don't have an election. Um, I mean, it would all have to be subject to me confirming that this room is available as well. We have that trick now too that we have to

um I I'll I mean the other the other opportunity folks is we could uh we could move forward into mid October and that will allow you time to consider the Hancock Health proposal and we can move we can get back to them in a little more expeditious fashion If we meet in October and still avoid the need for a special meeting, I'll just uh take a proposal or a motion on on our next meeting date.

I will probably be gone midocctober, but but I think but I'm I would recuse myself from the voting on that proposal anyways. I think so. So So that wouldn't it wouldn't but but you would count towards the quorum. Yeah. Yeah. But yeah. So probably mid-occtober I mean you know your your mid mid-occtober dates are the 14th 21st and 28th 28th's a little late but uh I'm gone the 21st so 28th the 14th 28th works for me would be two weeks early

28th be two weeks early probably still sufficient to to move things forward a little bit for Hancock health as Well, I will be out the 28th. I just need four of you. Well, who's good then? I'm I could be I can be here for all four Tuesdays. I could be here the 28th. I'm good. The 28th. I'm good. But okay. Motion. Make a motion. October 28th. Next meeting. change our next meeting to October 28th. Need a second. Second.

Been moved and seconded that we meet at 5:30 on October 28th as an alternate to our scheduled meeting on the 11th. All those in fa favor signify by saying I. I. Oppos? Same sign. Meeting has been changed and I'll confirm that that this is available. It looks like it should be. Um, but I will. And once you've confirmed that, if you'll then send that out an email confirmation for all of us so that we can get that on our calendar. Don't forget to notify the newspaper and post that as well for your public meeting. Okay. Thank you. Very good. Thank you all. Meeting dates taken care of. We have a nuisance pool issue. Derek,

not to come back so soon with another one. I I thought you I thought you said we had these all taken care of.

Yeah, I thought we did. Then the next week started. Um, I'm going to keep this short and sweet. Um, I will have a little bit more information for you guys to consider at the next meeting. Um, just once we've kind of gotten the legal process underway a little bit further and I've kind of got a little bit more time to prepare with some stuff. Um, basically this pool, we had a complaint on it a couple years ago. It got taken care of. I didn't hear anything about it. I heard about it last year again. Had an issue. Mosquito season ended. Just kind of fell by the wayside. And then this year, as soon as mosquito season started, multiple complaints came back in. Um, I sent out a letter on July 1st and then subsequently like every two weeks after that with fines and everything pursuant to our new vector and pest abatement code. Um, never have had any response. Um, none of the letters get picked up or signed for anything like that. So, I've gone ahead and forwarded that on to Gregum so that we can go ahead and start legal proceedings moving forward with that with the intent that this one doesn't drag on for three or four years like the last one did. Um there are a few Yeah, we're we're hopeful that it won't last that long, I guess. But, um basically just wanted to bring that as an update so that you guys know what's going on over there.

Um and I guess, yeah, like I said, at the next meeting I'll have more information for everybody to consider. Um, I'd like to take a a different approach to this, but I want to pres present it to you guys first and get your hearings on it first, uh, before we make any decisions on moving forward with these kinds of situations. So, I'll present those at the next meeting so that you guys have a rundown of of what I'm looking at and everything. We can go over those a little bit more in detail. Good. Any questions? Thank you, Derek. Thank you. We have no other new business. We'll move on to staff reports. Anything, Dr. Dr. Sharp. Nothing that we haven't discussed. Okay. Nothing. Uh Brener, Derek, environmental

other than the nuisance pool. Nothing's really serious uh right now. We're moving forward. Everything's been a little bit slow um with septics and stuff, but we're working through getting our uh last few of our secondary pool inspections done. That's something that we instituted a couple years back um once we finally had the the manpower to get around to everything again. getting ready to go back into secondary tattoo shop inspection and stuff like that. We've opened up six new pools in the past two weeks, which is kind of crazy um that we're starting so late in the season with opening these pools and four new tattoo artists andor shops have opened in the past three weeks. How are we doing with vector control? How how has the how has the year been so far?

To be completely honest with you, it's been extremely crazy to say the least. Uh the past couple years I've had one two complaints. I've been just doing routine surveillance, working with my municipalities on any kind of abatement, anything like that. This year has been completely topsyturvy where I've been hardly able to do any surveillance because I'm so busy doing enforcement. Um right after I got the last nuisance pool figured out, we had about nine unique complaints come in that I had to address. abandoned pools, neglected pools, stagnant water, um, and privately owned properties, things like that that I've had to go and treat and follow up on and enforce on and things like that. Uh, so surveillance numbers have been down a lot, but our treatment numbers have been way up where they were the past couple years. So, it's not really where I'd like it to be. I'd like for it to be, you know, really good on both ends, but with what I've got right now as far as, you know, basically it's me doing the trapping and it's me doing the enforcement and it's me doing the treatment, you know, I feel like we're in a pretty good place with that.

Very good. Any other questions? Derek, do you know of any uh any numbers? Um, a patient of mine had a a West Nile case. Um do you know of any other cases kind of that have been reported in the county or the numbers that I'm aware of are reported through IDOH office of medical entomology and they don't have any track to Hancock County as locally acquired. Um there are some in there's one in Madison County, one in Hamilton County, and I think two or three in Marian County. And then there I think we're up to a total of five or six confirmed human cases now. And the others are in like Stuben and uh Warick County. You know, they're a pretty good distance away.

There's there's several in Monroe County. My granddaughter goes to IU and they sent out information to all the students about avoiding being outside before Yeah. getting dusk or dawn.

Yeah. And I've been working, you know, public education pretty good. I'm talking to all my municipalities. I've I've given them a ton of information to put on their local boards to, you know, give out at meetings if they do that kind of thing. talking with street departments, trying to get in with some other uh town councils because there's some aversion to messaging and doing treatment in some of our municipalities. So, I'm trying to get, you know, through that a little bit. But, as far as human cases, I only know of the ones that are reported through those. So, I'm not aware of any locally acquired, but we are in the worst summer as far as West Nile virus populationwise since 2012. And that was a a pretty bad year when it came to human cases. Anything else?

Thanks, sir.

Thank you all. Let's see. Hello. Um, I just kind of did a summary of what we have as far as permits issued. Um, so we have right now we have 58 yearly mobile permits issued, 75 temporaries, 194 restaurants, 51 markets, four cers, 18 vending, and 23 schools. So, um, we're about we're ahead of last year with the restaurants and with the mobile units. Um, we've had some new openings. The Waw Wa, um, I'm not sure if they've totally opened yet, but they've been okayed to open. Um, we have a Indian restaurant in Fortville that opened. Um, there's also an Ember Coffee Place that has applied, um, but they're not open yet. McCord Squares, another venue in McCordsville that's got several places going into there. Leo's Market went in there. They are open. um a place called Maple and then there's a Taco Bell also going in in McGordsville. Um we also have in the Mount Comfort area the Quickway opened and then there's a racetrack going to open there as well they're building. Um we also have um Smashed Midwest Burgers is going in where Tour of Italy was. They're not open yet though. And Triple Boba and sweets. So, um, I did kind of the summer has been quite crazy with all the events going on. I would made a list of so you have an idea of how many every weekend there's

been like Strawberry Festival in Shirley, Fortville Summerfest, Pensy Trail Festival, New Pal Summer Festival, um the flat 50, deep depot concerts Saturday and Friday, um the 4H fair, Cammy's Cause, Cumberland food truck Fridays Now, Fortville Food Tuck Fridays, now Daniel Vineyard has events. Um, the Gist Monasury School had an event. Um, the New Pal High School had it for their choir. They called in some food trucks. So, and we have more to come up. New PAL October Fest. Um, New Pal Jamfest, Fortville Winterfest, New Winterfest, and the big one, Riley Festival. So, it's just been we've been every weekend having to go somewhere to do a food truck temporaries. It's been a little crazy. So, um we are still in the process of writing the new ordinance to adopt the new code. So, I'm still working on that. Um uh let's see. Michael's been helping. We developed a new inspection sheet. So that we wrote up um to be more of a riskbased inspection reflection of that. So it's got a lot of in out not applicable or not observed checking that we're checking food temps and that kind of thing. Um we've had our first um shared kitchen come in. So that's been where restaurants or mainly it's for food trucks to go in as their commissary if they have to cook food ahead of time. They rent space from this facility and

they rent space if they need to store their food, service their vehicle, get fresh water, empty their dirty water, all that kind of thing. So it's a big facility. It's um in Mount Comfort. It's American Nut Butter. They're a wholesale company and they make these nut butters. They used to make cookies and stuff, but they stopped doing that. So, they had these two full kitchens that they're going to rent out. So, that's kind of a new adventure trying to navigate how to uh inspect that or make sure they have enough space for all the people they're going to have come in. uh with that is the responsible party the owner

the owner of the shared kitchen. The owner of the shared kitchen. Yes. Yes. As opposed to the users of the shared kitchen.

Well, um I guess at some point I mean I everybody that uses that shared kitchen will have to have a permit through us. So, it doesn't necessarily mean I have to do an inspection every time at the shared kitchen, but I will probably intermittently go to the shared kitchen just to make sure how they're operating and they're providing all this all the what they need to the people. And they have contracts. He showed me the contracts he's got with, you know, what they're providing and and that kind of thing. And he requires that they have a permit. and he requires that they be have food manager certifications and that kind of thing. So, he's been really good. He was a person that had rented a kitchen at some point, so he knows the ins and outs and not having them sign a big contract and all that kind of thing. So, um, on the food truck, the new, uh, law that went through, House Bill 1577, I think we touched on it last or maybe two meetings ago, um, that the state is now going to issue a state license, but the counties are still going to be responsible for taking in the money, doing the inspections, um issuing the licenses. So, that hasn't been worked out how that's going to affect us and what we're going to have to do and how they're going to split it up. Um, I have been asked um by the state department of health um as a member of the sixth congressional district to be on a workg group to help develop how they're going to do that. So, I haven't

committed to it yet, but I probably will. Um, so anyway, I do have a summary of the code of that uh House Bill 5 or 1577. If you guys would want to read it, I can give that to you. Um, but um I'll just let you read it. It's It's not real long, but um it's just a summary of what the bill says. It's not the total bill. So, does anybody have any questions? Nothing. No. No. Okay. Thank you. I'll pass this out to you. Okay. Nursing. No updates from nursing. Yes. She has to come up again to come up.

I was ready to move on.

No, I I really don't have a whole lot. Um, so we have just finished up um back to school immunizations. Um, so all of our county schools um have done their exclusion clinics. Um, so that is done. Um, yay. Um, so we are rolling right into CO and well to flu season. Um so we have started offering flu shots in the health department. Um COVID vaccines are still kind of up in the air. Um waiting on ACIP to vote um to see kind of what that looks like and then that will determine um what we're going to do. Um word right now um nobody in the county is going to have the COVID vaccine um for anybody under the age of 65

pretty much. Um, so I feel like that is going to definitely lean on the county health department's shoulders for that. Um, more to be determined um, at a later time. Um, communicable diseases are pretty stable at the moment, I guess. Um, nothing new there. Um, and everything else is course, I guess. Questions? I I missed the COVID vaccine thing. I was reading that other thing. Sorry.

Um we're waiting on ACIP. Um so they meet the 17th and 18th um to adopt whatever they're going to adopt. Um I have heard from the pharmacies and several offices that they are not even carrying the vaccine at all and if they do it will be for 65 plus only. But so there so private insurance is not covering it. Is that No, they will cover it but they don't want to mess with risk factors or um anything like that from my understanding. So um the FDA has approved it for I think it's 65.

You're right. 65 plus. No questions asked. You just give it. Gotcha. 12 to 64, you have to have one underlying health condition. And then kids, we we don't know. Um so they everybody has kind of taken a pause and said 65 plus we will do but we're not doing anything for anybody else. Are they actively doing 65 plus? Not yet. Okay. Not yet.

Yeah. um be in and how Indiana legislation is wrote for the state department of health, we have to wait on ACIP. Um so as of right now, I've had a conversation with Dr. Sharp. We are going to wait on ACIP to meet and then I will get with him to see if we have to have another discussion to have to see if he needs to write a specialty order um standing order for us to administer that or if we will follow ACIP recommendations. So all of that is still to be determined. Very good. Yes. Questions? Thank you.

Anything from vital records? Anything from preparedness? No. No. Crystal.

Um, really quickly, you guys all have the financial reports. Um, so I don't know if you want to buzz through those really quickly. These are all the funds that act, well, that's not true. Um, we do have the donation fund um that I did I failed to include on here. um that has three or$4 thousand dollars in it. Um we are in the positive for the preparedness grant which does not always happen. We actually have all of our invoices and the state has reimbursed those. So that's good. Um, like I said earlier, that fund 8955, that's the one I will take, that's the school one, and that's where I'll pro I'll take those um, AEDs out of. Um, the 1161 is that's the health first money. Um, When I look at percentages, it looks like we're in in a good position. Actually, probably ahead of where we ought to be.

Yes, we we do a lot on a little. So, um we try to be pretty mindful of how we spend things. I I think uh you're to be commended. We're budgetarily we're well ahead of where we should be in a in a tough environment. So yeah. Um any questions on those?

Nope. Okay. There's not.

All right. Um and then just one final thing. Um we are looking at um potentially starting a suicide overdose fatality review team. Um so we have a child fatality review team and that is um statutoily required that the prosecutor is the lead of that. And so um we I I I'm the one actually sits on it. It could be anybody, but um um so we we do have that team established in the county, but we are looking at starting a suicide overdose um team. I went and sat in on um Shelby counties. It was hard. It was really hard. Um they reviewed four adults and I actually like knew who one of them was and I didn't realize that and until I went to that meeting. Um so it was it was tough. Um so um but we um obviously the hope is you know what can we do and how do we prevent these deaths. Um so um that uh our our suicide the the rates are alarming like always and I think we also heard from the VA that we have the highest if not one of the highest rates of veteran suicide in our county or in the state as well. Um, so we kind of feel like this is this is a a piece to start the puzzle. Obviously, it it balloons from there, but um so we'll be we we will potentially be looking at starting that team um sometime in the next few months.

So, the intent will be to operate like a child fatality team. Yeah. Yeah. You will serve as a representative? Um I I don't know exactly. I think we in order to get it rolling, I think we're going to have to be the lead agency. Um that is not a requirement um by anybody. Um but I think in order to get things going, I mean, we have access to the death records, we have access to, you know, some medical records, those sorts of things. So um so I think we probably would be the ones

who who would you seek to have sit on that committee? Um well, my initial thought was that I would start um the discussion with um the probation department and kind of the courts and see um what they what they see over there. Um we did um our probation director just left um in the last week or two. Um so I I don't know where that stands. Um obviously the sheriff would probably be involved. I have I took a picture of Shelby County's list to kind of see who they tapped. their court services was the majority of the people that were there. They had health department, coroner's office um and then their um like um major health um was represented by a couple of people as well. So, and and sometimes it can depend on what cases you're reviewing too. Kind of like the child fatality. If there's student at a particular school, we'll pull in those individuals, but the other schools maybe don't need to be involved in that conversation. So, um, it's kind, you know, kind of, it might depend on on what we're seeing, too. So,

thank you for doing that. Having sat on the child fatality team, it is not an easy thing to do. No, it's not, it is not. Appreciate you doing that. But, yeah, the information and the trends you find are good and can hopefully help us prevent prevent the next one.

Yeah, which that is another quick note. um in August the state um we have had um at least 19 infant mortalities from like unsafe sleep um practices. So um we're looking at um providing pack and plays and sleep sacks and those sorts of things and just kind of some education um and also um becoming um certified to teach the safe sleep classes so we can also provide that information to people. I mean, it's you all you can do is a lot of times just get the information and the supplies out to people and just hope that they they do that. Um, they pay attention. So, um, but that was that that number is statewide as well. Um, so that's all I have. Any questions? Nope. It appears we've hit the end of our agenda. We have one more motion. Well, good job staff for the minutes and making a motion to adjurnn.

Okay, we have a motion to adjurnn. We have a second. A second. Move and second that we adjourn. All in favor signify saying I. I same sign. We arejourn. Thank you. What the hell is that?