Board of Health - Regular Meeting

Okay, so let's get this rolling and uh I will call to order the board of health meeting for January 26, 2026. Welcome everyone and to our our new board member as well. Uh may we have a Sure. President Joanne Osborne here, Jack Reagan here, Dr. Farber, you hesco Stephanie Schroeder.

Welcome. Right on cube. Vice President Mary Shraven here. Catelyn it. Veronica Orals here. Lorenzo Sierra

presum. Okay. So, next we have a call to the public. I do have a couple of uh speaker request forms on specific cases, but I don't believe we have any other people that would like to speak at this. All right. So, moving on. Uh you all should have received uh the minutes from our last meeting and uh if there are no changes, I would ask for a motion to approve.

Motion. Thank you. Do I have a second? Okay. Second. All in favor say I. I. I. Opposed. You guys have it. Okay. So, now we have two new wonderful uh uh board members with us today. And I know that's not here yet. Um but we can go ahead and have you introduce yourselves. And I apolog I was going to do my best to say your names correctly. I you even writing down the pronunciation here. Okay. So Nish already do it. Okay. All right. So could you please introduce yourself? Tell us a little bit about yourself.

Yes. Hi. Um so I'm Nusha Hins. I'm the chief nursing executive officer at Chandler Regional Medical Center, Chandler, Arizona, which is part of our dignity health system. Um I've been in nursing leadership for the last 10 years. I've been a nurse for seven going on 17 years. Um, I've worked in level one trauma centers my whole career. Um, and I'm I'm excited to be here. I have lived in Phoenix for the last 30-ish years. I grew up in Flagstaff. So, um, this is home to me and thank you for having me.

Well, welcome. Wonderful. And, uh, perfect. Sounds like a a great balance for um, this board and very much. Okay. And, uh, go ahead and introduce yourself. Sounds like you haven't been um completely um absent for the from this area. So, not really. My name is McCrina Leech and I have been a nurse for almost 40 years. I'm a graduate of from the UOVA Tucson. I always have to say that when I'm in um Sunundevil Country,

um I worked 36 years at this department, the Department of Public Health. Um I work primarily in prevention, vaccines. I'm a very passionate about vaccines and immunizing birth. Um I just didn't want to just couldn't walk away. I retired in July of last year and I just couldn't walk the wonderful additions to our board. Okay, so let's get rolling here. Uh our item number four, environmental services fee waiver applications and or yes applications. and we are going to have a presentation from Robert Stratman. Would you like to lead us off here, Robert, please?

Absolutely. Thank you, Madam President, and members of the board. This quarter, we reviewed 13 fee waver applications. Of the applications reviewed, staff determined that all meet the criteria outlined in the Maricopa County Environmental Health Code. As a reminder, only an operator of a charitable nonprofit establishment which operates to provide relief predominantly for the poor, distressed, or underprivileged may apply to the board health for a waiver of a permit fee. A waiver of a permit fee may be granted only to an operator of an establishment which maintains a current 501c3 tax exempt designation from the Internal Revenue Service and who demonstrates to the board of health that payment of set fee will cause financial hardship. In addition, a waiver of fees associated with the administering and issuance of a food employee certificate in compliance with ARS uh title 411080 may be granted to the operator of an establishment which maintains a current 501c3 tax exempt designation from the Internal Revenue Service or to a current student enrolled in a K through2 culinary arts school program or similar curriculum based program requiring food employee certificates. The organization and sponsoring school district must demonstrate to the board of health that payment of said fee will cause financial hardship. Again, all fee waiver applications reviewed this quarter appear to meet the criteria. Happy to answer any questions or if the board has no questions, I respectfully request approval of the applications on the fee waiver application summary sheet labeled P1, P10, C1, C3. Any questions? these.

Robert, as a reminder, the Talson Union High School, some of those requested fees are higher than the the normal. Can you uh just remind us as for what the difference is on their student classes?

Absolutely. Pull up the summary. Thank you. Oh, that's traditional. Um, for the for the classes, it's it's based on the u the number of classes and the attendance. So the the more classes it's per because we cap off the number of students uh for the classes and so some will request more than one class and so it's multiples of how many classes they request throughout throughout the entire year. So they'll do it for a year and then we will placeholder them whether it be one or two or three classes that they request and then we will get those scheduled and conduct those classes.

Is it usually the food handlers license? Yeah. All right. That was my only question. So if there are no other questions, I would ask for motion to approve. Make a motion that we approve. Thank you. And a second. Right. All in favor say I. I. Opposed. Have it.

Thank you. Right. Number five, the Environmental Services Enhanced Regulatory Outreach Program, better known as Eorp. uh and have a couple of uh different items here to be discussing or changes and um and Linton would please.

Thank you uh Madame President, members of the board. Uh my name is Andy Linton. I'm the director for the county environmental services department. We have two proposed regulatory changes and I have presentations separate presentations for each of these proposals. As I think most of you know whenever there's a regulatory change being proposed it goes through the county's enhanced regulatory outreach program or sometimes we call it the EROP program. Um we had uh it just creates stakeholder engagement. Uh part of the process is to come to the board of health with these proposals. Uh we will be coming back to the board of health in April with the same proposal. Um today is our first visit to the board of health uh per the E-ROT process and I'll elaborate a little bit more on that process in in the program. So our first uh proposed change has to do with the environmental health environmental services fee schedule and that's contained in chapter one of the Maricopa County mental health code. Uh by way of background uh most of the regulatory activities that we conduct in environmental services are funded through the fees that we collect. Either fees we collect through operational permits that we issue or fees that we collect through uh reviews of projects and things like that. Um in our environmental health division you can see on this slide uh we regulate food establishments, public accommodations and school grounds. And again 100% of the cost of these activities is recovered through fees. Next slide. uh for our water and waste division. These are some of the regulatory activities that they conduct. Uh pools, septic systems, wastewater treatment plants, water treatment plants and infrastructure, uh public water systems, uh solid waste collection, and uh a couple others listed there. And again, 100% of the cost of those regulatory activities are recovered through the fees that we collect. Then finally, next slide.

We at environmental services also uh maintain 10 closed landfills. Uh we have a vector control program that I we presented to the board recently on. We handle public nu nuisance complaints and we have a storm water program. And what's important to point out with these programs is we do not collect fees for these programs. These programs are funded through the county's general fund. And that's that's an important point to our stakeholders uh that are paying fees for like restaurants and pools to know that they're not they aren't subsidizing these other programs that don't have anything to do with the regulatory activities we do in their in their facilities. A little overview of the environmental services budget here. We have a total budget of $47 million. About 26 million of that just under 26 million is rec is uh are the fees that we collect. Uh to give you an idea of the the scope and scale of our work, uh we do about 88,000 inspections a year as a department, 16,000 plan reviews. Uh we have 300 full-time staff. Vector control program set over 42,000 traps last year. We have five regional office and five regional offices and issue 40,000 permits, operational permits. be uh conduct in our inspections under our mandates and our authority are delegated to us from two state agencies from the Arizona Department of Environmental Quality and from the Arizona Department of Health Services. Uh the specific regulations that we oversee are contained in Arizona Revised Statute, Arizona Administrative Code and the Maricopa County Environmental Health Code, which is our local a lot of the regulations that we have both in an Arizona administrative code and our local environmental health code. They're based on federal regulations or federal models. And the example here would be our FDA food code. That's what our local code is based on. Clean Water Act would be another example of a federal regulation that the local regulations are based on. So, this slide summarizes why it is we

we do what we do. We want to ensure that the residents of Maricopa County are being served safe food, they have safe drinking water, access to sanitary sewer systems, uh that diseases aren't being transmitted through uh swimming pools, and we also account for some of the safety aspects of the swimming pools among among other things. Sorry.

Sorry about that.

I'll try to time it that way. Um, so a little bit of background on the fees. Uh, the last comprehensive fee study that was approved by the board of supervisors was in 2006. So it's been about 20 years since we've had a comprehensive uh fee study approved. Uh the board at that time approved the fee model, the fee schedule to be implemented over the subsequent three years. So the last time our permit holders saw an increase was in 2008. Uh not all of our programs were part of the 2006 study. Uh our water and wastewater treatment program wasn't part of that study. So the last time they had fee adjustments were in 19. Um, so almost goes without saying a lot's changed in 20 years in Maricopa County. We've added something like a million residents. Uh, I think the inflation, the consumer price index from 2000 to 2024 is 85% last I looked. So, so inflation's changed quite a bit. Um, and we've certainly seen as the valley has grown, we've seen the uh demands on our staff also increase. So from 2016 to 2024 uh the number of plan reviews have increased uh from almost 11,000 to almost 16,000 plan reviews a year. Our number of operating permits have increased from by 18% from 34,000 to 40,000. Um and we've absorbed all of this work without adding additional staff during this this period of time. um which is which kind of is a a testament to uh resiliency of our staff first of all, but we're also also constantly looking at how we can improve our processes, how we can do things better, how we can be more efficient, how we can incorporate technology for example to to do things to streamline our operations. So most recently with with technology the the we county all the regulatory departments uh are on a new permitting system called permit center as an example and we've been able to eliminate four administrative positions as a result of theies that have come from permit center. So we've done that throughout the years uh to try and keep up with uh the workload.

So why do this fee study now? Uh I think this graph really tells the biggest part of the story. Um, in fiscal year 23, our revenues uh our excuse me, our expenditures began to exceed our revenues and that's been the case over the last three fiscal years. And as we forecast out into fiscal year 27, that line will continue along the same trend. Um, what we've had to do to balance the budget in each of these years is draw from our fund balance. So in during years where uh our expenditures, our revenue exceeds our expenditures, we will put that excess into a fund balance. we're now drawing down that fund balance to balance our budget every year. So, it just isn't a sustainable way of doing business because eventually that fund balance is going to be drawn down to zero. And so, that's why we're here today to talk about fees and recovering additional costs so that we can maintain our operations. So, the same question, why are we doing the fee study and why now? We want to maintain the same level of public health protection and meet our mission. Uh customer service is a really uh important to our customers. The board of supervisors convened an ad hoc stakeholder task force for a few of our programs last year. And one of the first things we heard from this task force was about making sure that we can turn things around quickly, making sure that we had consistent staff and sta uh the right level of expertise doing uh reviews of different projects and all of this um um were recommendations from this task force. So customer service is a big part of what we what we why we want to maintain the same level of service in our department. Uh so two years ago we contracted with MGT consulting services to do this comprehensive analysis of our fees to determine at what level we were recovering our costs and they went through every single line of business and environmental services and you can probably see from information in your packet that we probably have 200 different permit and fee types in our fee schedule. They went through every single one to determine at what level level we were recovering cost and they came out with two recommendations. The first was to adopt the fees at the levels that their model suggested. And the second one was to conduct this type of comprehensive cost is every three to

five years. Basically, don't wait 20 years. Um the impact is is is a lot greater when we wait this long. Um it isn't just uh the inflation, you know, personnel costs and things like that, but but the industries themselves change. Um and a good example of that would be like a public swimming pool that we regulate. public swimming pool in 2006 looks a lot different than a public swimming pool in 2026. They almost look like water parks. So, the extent of our engineering review, the the length of our inspections, it all requires additional resources to be able to do those things that we haven't really been able to account for with our fees because it's been so long since we've made these adjustments. So, the overall uh from the numbers from our consultant uh we were underreovering by 14%. So, we would need to recover an additional 14% overall to recover 100% of our cost. And in this table, it's broken down by our two divisions. Our environmental health division is our food inspection program. And if you look in the column all the way to the right, they're under recovering by 8%. So, it would require an 8% increase to our fees for the environmental health program. Our water and wastewater program, we're under recovering by 25% for an overall uh 14% increase if you needed to 100% cost recovery. I should mention here too that it isn't a 14% increase across the board like some utilities are where 50% water rates or whatever the case may be. This is specific to the line of business uh that we're talking about. So you'll see as I go through some of the examples that some of the fees are actually going down. A few of them are um most of them are going up modestly and a few are going up um up quite a bit. It's all based on the resources, amount of time we're spending doing these different regulatory with but long it's taken. Are there some fees that have just no longer even necessary?

Correct. Yeah, there are a few fees. Sorry, Madam President, uh, members of the board. Yeah, there are there are a handful of fees that we no longer need. And there are also a couple of new fee categories where industry has suggested we we split out like uh in a grocery store, meat markets have changed quite a bit. Most of them, a lot of them are getting their meats in package and they're not cutting up the meats and and and setting them out. So, it takes us less time to do it if it's packaged. So, we created a new permit category for that that has a different a lower fee. So, just a few small examples of new fee categories that we've added, but we're eliminating several as well. So, there's a a table of the comprehensive list of fees that that's included in your packet. Like I said, there are about 200 different fees uh in our fee schedule. So, this is just a sample of some of the proposed changes. Um, so these are fees that are applicable to our restaurants. Um, END stands for eating and drinking. The 10 plus is 10 plus seating. They have more than 10 seats. And the classes are all based on the complexity of the food processes that they conduct. So, uh, a kitchen in a convenience store where they might just be serving hot dogs and pizza. Obviously, it's very simple type of food operation versus a full service restaurant where they're cooking raw animal foods. They they're cooking it up to temperature, maybe cooling it down at night, reheating it the next day. There's just a different level of complexity to the menu and that's what the different classes account for. So the more complex the menu, the more frequent we frequently we inspect those food establishments. And that that's what the differentiation is in the different fees that you see off to the right. So you can see the current fee in the second column, the proposed fee from the model in the third column. Any fee that's listed in green is a fee that's the model proposes go down. And then we also tried as best we could to do some provide some comparison information in some of these tables. Uh it's it's a little bit difficult to find an applesto apples comparison, but we think we've done a good job with some of the comparison information we have here. Uh this particular comparison study is based on the average fees, similar fees from uh Puma County, which is Tucson,

Clark County, which is Las Vegas, uh King County, and the Seattle area, and Salt Lake County. So we took the average of those four and that's what you see in the last uh call. That's how you came up with number was those averaged out. Correct. We average those four jurisdictions and that's what's in the comparison study column. You give us an example of the majority I guess of classes I mean you know of of your sample the permit type the um listed there. What's the majority the line share say?

The majority would be the eating and drinking class 4 permit. That's that's the majority of our full service restaurants. And it's also the biggest part of the revenue that's generated from our in our food inspection program is that is that particular. And what is the smallest the smallest class would be like a kitchen and I'll give just a real world example like a kitchen you'd see like at a QT with a very simple food operation. They would which one which is the permit type?

Uh that would be the END10. I'm sorry. It would be actually a different permit type END 0 to9 seating class two. So because of the simplicity operation but quick doesn't have seating so it's a it's actually different. That's restaurants. Uh our septic program again this is just a sampling of some of the permits. the the most common permit type, the most common review we do is in the first line conventional septic system with less than 3,000 gallons per day. Our current fee is 550. The proposed fee from the model is 757. Uh the comparison information we have is from the Arizona Department of Environmental Quality and there's a range there that you can see that they charge for their on-site wastewater systems. If I'm going too too fast through any of these tables, if you want me to elaborate on any of these permit categories, I'm happy to do so. Next slide. This is our solid waste program. And some of the fees here, they're going either holding steady or going up modestly with one fee that's uh will be going down for our ref use u reference collection variance. Like these are our drinking water permits. Our drinking water permits are are classified by the the population that they serve within their system and the complexity of their system, which are the additional well sites and the additional treatment facilities. slide. This these are the higher population permits that we would issue. So the only permit we have for the above 1 million population obviously would be city of Phoenix. That would be a city of Phoenix permit. When you total all of those fees

up to their system, uh their total fee goes from uh around $34,000 up to $94,000. So there drinking water fine. These are our swimming pool permits. Uh the most common type of permits that we issue on this table are our semi-public bathing and semi-public hydrotherapy permits. Um semi-public are the are the pools you would see in like hotels, apartment complexes, and you can see what the current fees are and they're going up slightly. Comparison information again far right column.

This will be for new builds, correct? not for equity. Madam President, yeah, that's a good question. These are actually operational permits, which are the permits that they have to renew with us every year.

Correct. Yeah, these are the permits under which we do our routine inspections. So we do two inspections on each of these pools every year and this operational permit would fund those inspections that we as I mentioned the the fee schedule the table is contained in chapter one of the Maricopa County Environmental Health Code. There are some other areas of the code where an hourly fee is mentioned in this chapter. Uh the current hourly fee is $130 an hour and the model's proposing that that be raised to $169 an hour. So these these paragraphs with the strikeouts are accounting for the change in the hourly fee. Next slide again going from $130 to $169. Next slide with an hourly rate going from $130 to $169. Next slide. For the overall result of these adjustments, we would be at full cost recovery. 100% of the cost of our plan and permitting activities would be recovered through these fees and this would this would allow us to operate in a fiscally sustainable manner. So we wouldn't be drawing down our fund balance uh year-over-year. As part of the ROP process, we've held 10 virtual in-person and virtual stakeholder meetings with all the different industries that we regulate from October to December. Um we made a couple of revisions to the proposal based on some feedback that we had from stakeholders. There was a little bit of differentiation that they wanted to make uh with our food variance fees which we did. Uh the Poria school district gave us some feedback. Our permits are good one they expire one year from the date they're issued and a school district like Poria probably has somewhere around a hundred permits that expire at all different times during the year based on they were they were issued. Poria asked that we if that we could find a way to have those renew all at the same time so that wasn't administratively burdensome to the district. So we're we're working

on that language. We'll bring that back to the board of health as in April. Uh there was one stakeholder that expressed opposition through all of our stakeholder meetings. The stakeholder was concerned because she operates a nonprofit and she said, "I can't afford for my fees to go up anymore because I'm a nonprofit." And we directed that individual to our fee waiver process, which I think she was happy with that. So our recommend recommend recommendation and request from the board of health today um is to consider allowing the department to move forward in the next step of the enhanced regulatory outreach process which is to have an additional uh round of stakeholder meetings. Uh again we'll be back to the board of health in April and the vote in April will allow us to go to the board of supervisors for final consideration but the vote today is just to allow us to have another round of stakeholder meetings. Fine. And these are the steps in the E-ROP process. We are at the step that's right in the middle. First board of health meeting. Again, we'll have addition, if we're approved to move forward with the E-ROP case, we'll additional round of stakeholder meetings. Be back to the board of health in April. And with the board's approval in April, we would then proceed to the board of supervisors looking at around the end of July time frame.

That's it. You uh questions? Sorry. Actually, for the record, uh Dr. here um and that way rather than Dr. Farber at your question. I'm here.

Yeah, here. So this was very interesting and it allows you to keep your finances in balance for how long if keep rising how long will this even

very good question Madam President Dr. Barber. Um, I think that's one of the reasons that the consultant we contracted with recommended we do this type of study. We look at it every year to see where we're at with cost recovery, but to do a comprehensive study, an in-depth study like this one every 3 to five years because certainly there will be adjustments. And as the economy changes and our revenue changes, the number of permits people are are coming in to get from us, that can change, personnel costs change. So certainly these things are always in flux and we'd like to be able to back with greater frequency. certainly an unders I mean business owner and this is not good financial you know uh preparation for things and I to your point I can understand it conduct analysis of cost recovery every three to five years I think is important plus then there's not sticker shock which is going to happen to many people uh on this now is this going to be uh an I know you have a series of meetings to do uh will this be going into play for the next if approved by the board of supervisors the next year budget. How will that giving municipalities and the different entities here time to adjust their budgets?

Yeah, Madame President, our our plan would be to have the fees become effective upon board of supervisor approval. Um, the fees are due in the month that they were issued and so not all fees are going to be due right when the new fees are are are if your fee is due that month, you pay the new. It looks like the lion share of the fee increase had to do with water. Is that due to infrastructure issues or the

I think infrastructure is part of it. I think the complexity of these systems is part of it. Um I I suspect and we we did we did a little bit of research on this that we we were probably we probably been under recovering for quite a long time. I didn't have access to the 2006 fee fee model information but but to see such a large adjustment in one particular area of our department if it was the data that they used it in 2006 or what but uh it's probably a combination of those factors. because I'll spend a long time. So, all right. Are there any other questions from the We also have three people that have filled out speaker once.

I have a question. I'm just surprised that any of the fees would decrease and is that the best vision while we're doing a big sweeping change? How much were we pulling from the fund? Could we use if there's overages to pay back the fund? It's I'm just surprised to see a little more understanding on

Yeah, it uh Madame President, members of the board, um every every decrease kind of has its story. So, our full service restaurant permit going from a,030 to,5 is a result of some benchmarking that we did in 2017. We realized we were the only jurisdiction in the country that were inspecting routinely at full service restaurants four times a year. Every other jurisdiction was inspecting three times a year. So we reduced the inspection frequency back then to three times a year. Obviously fewer inspections, fewer less time we're spending. I think that's a that that kind of tells the story as to why that fee is is going down slightly. Um regarding your question about reducing fees, yeah, we had the same thought. Could we at least keep them even? uh but we we wanted to be true to the model and and and really uh go with you know ensure that people were paying for what what they were getting now but we we just went with what the model models that's including with drinking water you know we put all we put accurate information into the model and that's what it gave us and we wanted that the model had integrity when we're you know presenting it to the board of health and and to our stakeholders that we followed exactly what came out of the model Yes, madam chair. Um, in terms of the fund balance, what's the ideal amount? You know, is it a percentage of the overall cost? And when do you have a fund balance? Is it where does it sit and is it earning anything on city? Madam President, members of the board, I'm I'm going to answer most of your questions. I think there's one of them that the earnings I'm I'm not sure if I know the answer to, but it sits in a separate uh a separate account, a separate fund balance. It's usually it's generally used for one-time costs when we need to replace vehicles, replace laptops. Um the we try to have I've heard different philosophies. We try to have six month of six months of operating cost in our fund balance and for us that would be about $12 million in our fund balance.

Um I've heard I've been worked for other directors in the past who like to have three three months of operating cost. I think I feel a little bit better about six months, but that's generally it the earnings part. I I can get you an answer to that. I'm just not sure offh hand significant amount to just sitting just sitting. So, uh we have Stephanie Long does say I do not wish to speak. Thank you. Trevor, I'm I know I'm gonna butcher this. Trevor

messed it up. I want to pick on the next topic. On the next one. Okay. Oh, they both. Okay. All right. Thank Okay, Stephan. Thank you. All right. So, any other discussion or questions? And we understand that um this vote is to allow the process to continue. All right. So um having said that, do I have any uh motions to continue? Thank you. And a second. Thank you.

All right. All in favor state I. opposed. All righty, the eyes have it. Thank you very much.

Okay, six minutes later, All right. Okay. Thank you. Let's make sure. All right. Thank you very much. And our our lady has arrived. Thank you. Sorry. Not a problem at all. You But you've missed the fun.

I was listening online. Okay. All right. So, moving on to our next item. And I do have two people signed up for that. And according to the process of our meetings, shall open up this um Okay. So the E-Rock case of ES2025-005 wastewater treatment plants and I have two speakers that have signed up like to the board with their agreement or disagreement. Uh Andrea Cooper and with the city of Phoenix,

can you state your your name and are you host or Cooper have any questions or do we wait till after the after the presentation? All right. Thank you very much. And our next Trevor Good afternoon. I'm Trevor Bajori. I'm the director of the water quality division for the Arizona Department of Environmental Quality. I'm here also in support of moving forward with the work that uh Maroba County ESD is doing with regards to wastewater treatment plants. I've been working with well Andy and Andy's predecessor and Andy's predecessor's predecessor on this topic for quite some time and we're excited to be able to work together on this because I I think it's a good path that we're proposing. Um just a note that Maropa County is the only county in the state that has its own regulation of wastewater treatment plants. ABQ regulates in Maricopa County as well and also in the other 14 counties. Um, and so we we think the proposal that Andy's going to describe will be beneficial to those in Maricopa County and that there will no be no degradation of public or environmental protection.

Appreciate that. All right, Andy, go ahead and start your presentation.

Thank you, Madam President, members of the board. Um, and I appreciate you listening to two uh longer E-ROP cases. Uh, today as Trevor mentioned, uh, this case is related to changes to our wastewater treatment program. Uh, the authority and the mandates to regulate wastewater treatment plants and state statute is given to the Arizona Department of Environmental Quality. As Trevor mentioned, Maricopa County also regulates uh, wastewater treatment treatment plants under our own local authority. And so that's led to having two programs regulating wastewater plants at the same time. The purpose of this proposal is to remove Maricopa County from the regq for this oversight. So a little bit of background on the Maricopa County's program. Uh we do engineering design reviews uh for waste for new wastewater treatment plants and for uh con any construction that's done inside of existing wastewater treatment plants. Uh once it passes our engineering review, we'll issue an approval to construct the plant. Uh once the construction is done, we then issue an approval. We do inspections to verify that it's been built according to the design. We would issue an approval of construction at that point. Uh we also conduct once the plant is up and operating, we conduct operational inspections which include reviews of uh that facility's water quality reports. And lastly, one of the requirements that we review when we're doing our engineering designing design uh review is conformance or consistency with MAGS 208 program. So the Maropa County association of governments has an areawide uh wastewater management plan called MAG 208 and we have to verify that whatever is being proposed to us is included in MAG's uh planning document for their wastewater planning. uh if it's not included in the plan then it would be the responsibility of the applicant to go to MAG and ask for an amendment to have it added to the plan. So as soon as it's in the plan we

proceed with our engineering review project a little bit. Uh we talked a lot about fees so I won't elaborate too much on these. Uh this is the expenditure. These are the expenses and revenue specific to our treatment program. Uh we under recover by about half in this program. So we're only bringing in about half of the revenue we need to to operate this program. um at 100% cost recovery. Um I should point out this is the overall treatment program budget. Maricopa County regulates water treatment plants and wastewater treatment plants. So this budget is specific to to both. Uh the proposal today again is just specific to wastewater treatment plants. Water treat plants are delegated to Maricopa County from DE. So we are the only ones in Maropa County doing again I I mentioned this at the beginning. Uh these activities for wastewater treatment plants are not delegated to Maricopa County. ADQ has retained this authority and this mandate. Uh we do it under the Maropa County Environmental Health Code and as a result both agencies are regulating uh wastewater treatment plants in Maropa County. Next slide. A little bit more on the duplicative regulatory activities. Trevor mentioned that we're the only program uh in Arizona that has its own wastewater treatment engineering review program. Uh this means customers are required to submit their sets of engineered plants to both environmental services and to the state. Uh the operators of these plants are required to receive inspectors from Maricopa County's program and also from the state program. Um when we met with our stakeholders last year as part of the board of supervisors ad hoc stakeholder task force initiative, uh they recognized this right away. This task force was specific to our treatment program and they said, "Yeah, this it is odd that we're having to submit to both agencies. There's a lot of duplicity duplicative work that that we have to do as customers to submit to both agencies." Um and finally there is a statute on the books uh under the regulatory bill of rights that says specifically we have to avoid duplication of other laws and dual

permitting to the maximum extent practicable. And the more our programs have evolved between Maroba County and the state, the more similar our programs have become. And we think that we're trying to comply with this law by by removing wasting from our regulations as well. So what would this look like if this were to be approved at some point in the process? Um so we would propose to discontinue our engineering design reviews and inspection of wastewater treatment plants. Um the department Maroba County would continue to do reviews and approvals for wastewater infrastructure. So all of the infrastructure that carries the wastewater to the wastewater treatment plant that is already delegated to us from ADQ. So we would we would stay involved with that type of infrastructure. Sewer mains, sewer lift stations and also as I mentioned we regulate water treatment plants under our delegation. We would continue to do that. Um, ADQ uh would continue to do their reviews and approvals for wastewater treatment plants in town uh by issuing their aquafer protection permits, verifying conformance with MAG 208 and continuing to conduct operational inspections. So, they would just continue to do their program as they're currently doing in Maricopa County. We held a stakeholder workshop as part of the E-ROT process. It was on December 16th. We had 10 stakeholders in attendance. Uh the comments received during the meeting were supportive and we didn't receive any uh comments in opposition. Um again we did hold a more robust stakeholder process last year not specific to this issue but it was with our our stakeholders that are involved in the treatment program and they they too recognized that there were some changes that needed here to remove duplicative oversight. And again this is our E-ROP timeline. So today we are at our first board of health meeting. uh your approval vote in favor today would allow us to approve see to the next step which would be additional stakeholder outreach. We

would be back again in April. So you're going to have to hear two presentations again in April uh to the board of health to present the case and and any new findings from stakeholders certainly we would present at that point. Uh if we're allowed to proceed from that meeting we would then plan on going to the board of supervisors around the end of June this year. Again, a vote in favor today from the board would allow us to proceed to the next round of stakeholder meetings and a vote in opposition would end the e-ro case. The uh change of not having labor uh work will that help shore up some of this difference of expenses situation?

Yeah, certainly. um looking ahead um and planning, you know, if this program was removed, if these activities were removed, we're maintaining vacancies in this program. We're maintaining our customer service and trying to get the reviews through, but we're also being mindful that there might be some changes and so we would anticipate losing at least uh one or two engineering positions if this were activities were great. Good find. Any other questions from that sign up. So then uh moving forward on this item to approve make a motion that we approve on.

All in favor say I. I opposed. have it. See you in All right. So, moving on. Our fabulous director joined us. Okay. So, and information to share with us today. Is everyone okay if I stay here? I

just want to make sure they can hear you online. We'll speak up. Okay. Um, sorry I was late everyone. I was at a forward meeting. So, that but we wanted to bring you all some exciting updates, give you a little bit of um some final ad numbers from heat season just as we get ready to go into the next heat season. It's always heat season planning season. And uh Nick will also talk a little bit about respiratory virus season. And um if any of you have read the news last few months, I'm sure you've read something about vaccines. So uh Nick is here to answer all your questions and uh give us an update on the vaccine schedule. Nick,

great. Thank you.

So on this slide, uh we just summarize a lot of our activity from uh last summer's heat season. Um so I've had the opportunity to present to you all before. Um you know the backbone of our heat responses the network which is a network of cooling centers and hydration stations um operated by city partners uh community based organizations uh a variety of different um operators. Um so we had a a great turnout um a lot of participation uh from that network uh this year. We also that network um with uh some funding uh opportunities that we've had um the last two summers as well as a lot of that goes out to the community as to how to access the network um and find employees to off during the summer. Um so additionally we do uh daily surveys of those sites. So 4,000 surveys uh looking at how the sites are being utilized. Um our public health liaison in each of their areas of the county um visit those sites, support them um with anything need um connecting them to resources back um at public health. Uh this summer as last uh sorry last summer as the summer before um we worked with uh 211 partnered with 211 um to ensure that folks could find the cooling centers were as opposed to looking on the internet map um as well as getting riots if they needed. Um a lot of education um especially with our substance use uh partners making sure that um understood the increased risk of

drug use uh with heat. um a lot about gave a lot of water out um including electrolytes which was a big push this past summer um and used our um medical reserve corps volunteers um as needed by so next slide. So uh the great news um is that uh as in 2024 and 2025 we did see um another reduction in heat related deaths. So um sorry uh there's a little bit of an issue with the dashboard on the day that I clipped this. Um you can so the total confirmed and under investigation season that's negative99. Um so we did have just over 600 uh heat related deaths um in 2024. Um so the confirmed number this past year um uh is looking to be just around four investigation. So pretty substantial decrease. Um this will be um formally reported uh in probably another month or so once we u complete those cases put out our final reports. Um we are very interested as to what this means. We know um we're looking into impact of last summer's weather compared to summer's be. Um we're hopeful that a lot of this is reflecting the messaging that we're doing and um out of the heat a lot of continued work in this area but um excited by the continuation of the trend seeing these numbers fall.

Um so there you see the 2024 numbers. So you see small decline we had from 23 to 24 once those 25 are moving on uh to respiratory virus season. Oh, sure. Anyone have any questions for one question on your centers and the respit centers? But mostly I'm curious. I mean, what's the percent of use of these? You know, they're 80% full, 20% full. What is the typical?

Yes.

Thank you, Madam President. Um so varies across the system right so um these sites uh as you can imagine some of them are in church wreck rooms some of them are higher buildings like the city of Phoenix runs at their 24-hour sites um so we see utilization on these daily surveys that we're collecting anywhere from say 20 25 30% um they vary at different times of day. We're also asking them to give us head counts for evening hours morning especially as we are asking hours into um what I think is interesting is we are not showing that we are hitting capacity a lot of lot of centers good because I think that shows that we hit a number um that is meeting current need Um, as we look at our numbers, um, especially I mentioned, um, working with our substance use partners, um, we know that large risk continues to be amongst individuals who are using substances, um, who may have difficulty accessing. So again, what we're trying to do is bring the data we are collecting back to our partners so that they can test offering to try and uh I know 2420 to 25 there was a lot of talk about the hours of availability for a lot of centers and I think that was increased. What sort of effect did that have? And then second question was around some of the equipment our local

fire uh uh organizations had and how was that uh in that worked out? Sorry. Thank you. Sierra. Um so um when public health started to be more involved in the heat relief um efforts um we did a survey to find out what what was needed in Um, and certainly those extended hours were a big part of that, right? So, can't operate cooling centers from 9:00 to 5:00 on business hours because we know that a lot of people still need heat relief into the evening hours when it still stays hot into the into the evening, right? Um, and so in the heat relief network, we obviously encourage sites to have those extended hours, to have weekend hours, holiday hours. Um, of course we can really only acquire that of sites that we are funding. So that is part of that understanding that with sites especially the funded sites um that they offer those extended hours. Um but again looking at the survey data we know that there is still some capacity there sites. It also has really been able very helpful having 211 as a partner um because they're able to kind of monitor in real time where the capacity issues are and direct people who are looking for certain sites to those sites that have extended hours. It's really I think important to understand is a semantics thing the difference between centers and respbit. So before we were involved with response the community was very good centers and those places like libraries and people could go but what we learned from our research is that what was needed are respit and what rest bit is someone could go in and take a you know 30

minute nap do that in a library and get kicked up so by opening more respits gave people the ability to come and also we heard This is where pets could go. So we have best bit centers that that really accept. So it's these little things that really do quality. Also, I think what's really sort of exciting is I like to think of heat is also an opportunity for us to help those that are unhoused or suffering from because this is the first time where people actually come to us and we don't have to go to people and we're really looking at how do we braid substance use money with ensure that at these respit centers we're paying like or other community organizations to to be there as much as possible. what we've learned. Second Phoenix, I applaud them because they really um started this. It isn't the first or second time someone comes. Might be the 10th or 15th time and then I've seen you times how long to our advantage to help people.

Dr. Our our opioid dollars will be used in this manner there with primary care. do um there have been partnerships certain times of the day or certain times of the week. company like that, but not really set up for I think want to get it like with a lot of other um how did the the rides go? Because having run big programs and relied on transportation to often get people to appointments, sometimes it's abused by the clients, by the rides, like do we track are those actual rides where a lot of those where the ride doesn't show up? Is it still tallied that way? Should that help? So madam madam chair and members of the board uh we partner with Solari for the rides. We changed the methodology with Solari this year. We discovered that last year uh we had some super users of the system and they were able to determine who those individuals were and they were able to actually help some of those individuals uh case basically case manage them and try to figure out why they were using the system they why they

were using it the way they were last summer. And so this summer, individuals when they called were taken to the closest heat relief site to wherever they were unless for whatever reason that heat relief site did not meet their needs or for example if they were no were asked not to come back to that heat relief site or for example if they had a pet and pets weren't accepted at that heat relief site. So what we found was that greatly increased our budget and we were allowed to take we were allowed to provide more rides over the summer and it worked. That was one of my having tried to manage that getting people that are smart know if that's close they can still get to there even walk into

and the other thing I would say and I I don't think we can thank them enough is that clear channel is a great support for this during the summer they put up on their digital bill awards all over the valley they'll put up the um the temperature and they'll put up 211 and it's it's a great help to help us get the the word out that If people need a ride to call 211 and the more we can get the word out during the summer to call 211 if you need a ride, it really helps. Did a great job.

So, u moving on to respiratory illness. It is that time of year. Um this is a graph um from our um website. We have a dashboard that um looks at all the respiratory all the respiratory COVID, flu, RSV, and then this looks at acute respiratory illness. So, this is um visits to ERS, urgent cares, um meeting a certain criteria. So, this should catch all or most of the respiratory illnesses presenting to health care. Um the dark line at the top is our five season average. Um and the dark bars are this season, light gray last season. So you can see that um we are tracking along um behind both five season average as well as last season um which is not the national story. So um uh next slide please. Specifically looking um ata um again we had a more updated slide um you would see that we are um next bar that has been reported is continuing to downtrend um flu uh can pretty typically have what we call a bifphasic uh pattern so you'll see another peak um and so I don't think that we can say that at a very low uh flu season. Um still need to see what the next couple of weeks brings. Um but um again, a lot of the story this uh flu season has been that this is a really heavyhitting season. Uh the east coast has really seen a lot of flu. Um we certainly have heard from some healthc care partners that they've been seeing

um cases uh in their EPS um but overall looking at the whole community um it is not showing next slide. Um did just want to um emphasize here um when you look at last season so that's that second uh set of bars there. um and you look at 2024 and 25 um you really see the high that flu has on those youngest members of our population. So I think this oftentimes um is under reportported um and I think it's really a message that try and put out there to make sure that we're protecting those uh uh that pediatric population especially when we talk about flu vaccine. And I think this is also important to highlight um the 2024 five flu season um had the highest reported number of flu related pediatric deaths um for any non-pandemic season. Um so again this was a story that I think really unfortunately was not uh told uh to the degree it should have been um and really should be um I think our adding light to why it's vaccinated for

is this a state numbers or sorry these are these are national numbers but certainly reflected in our state all I have fall under. Um, so would dtheria fall under respiratory illness? You were looking at flu.

Yeah. So, so this is really looking at viral respiratory illnesses. Um, obviously that goes along with me as well. Um, so those but those numbers. Um so in in general I don't have the exact numbers prepared to give you um but I mean I think theory we're definitely still seeing significant impact from vaccination and so we haven't seen

never done all I see are oneoff cases they're often traveled I understand that the flu is more severe. You're seeing less numbers, but this is really um I think it is still too early to say. Um we um did have a a cluster. We did a investigation um locally of cases that were all sequenced to be sub. So you may have talked about too um it was the dominant type of a that was circulating in other parts of the world prior to our flu season and it both in the US and locally. Um so we were doing an investigation because we had outbreaks um for that are literally being analyzed uh now I I don't really think we'll be able to say sure our in our hospitalization data it's not

the less severe you the the ARRI so the respiratory illness that's a a metric that respiratory presenting to

what did RSVP season look like Um, no, you don't have a slide. I don't want to put you on the is barely. It has barely the weird season.

Hillary, we don't want that.

I'm fine if it ends well. Okay. Um I'm taking up way more time than I told. Um last uh little section here is regarding um vaccine uh changes in vaccine uh recommendations. So um the big news was on January 5th and human services announced a new childhood immunization schedule. Um this is not typical for how updates are made to um the CDC schedule. Um and so I us who work in this area. Um it was it was surprising um that um change um reduced the number of recommended vaccines children um essentially by taking them and putting them in three different buckets. So they're still all of the immunizations that recommended previously are still on that schedule. They just fall into categories of who's eligible based on their risk factors as well as what level of what level of conversation have with the provider if that vaccine. Um so what what still is a little sticky though because CDC has not yet updated their childhood immunization schedule. There's that. So, there's been this announcement but not the actual on the on the CDC site. Um, also the VFC programs, the vaccines for children uh half of the nation's uh children are vaccinated um has not made any guidance changes in vacines. So,

uh while this announcement we have time to have to change these to get an

so so the issue is a lot of the rules around the FC program CDC refer to CDC committee that generally makes recommendations to the schedule CIP um also what's in the news a lot um last year um for a fairly meeting of of who was on that um board um after the Trump administration. So So EFC rules are tied to ACIP recommendations because this announcement was made by Chris's secretary, not by ACIP. there is some confusion as to how to enact the changes. That's why currently are sitting in a little bit of a gray space um in terms of what it's due. Um, luckily for us in Maricopa County on January 8th, the state um shared a message uh with their partners throughout their their VFC program, their immunization program saying that at this time due to the fact that CDC has not changed their schedule having a change in the VFC program, there's no effect for the vaccine schedule. Uh it's a little bit like treading water and That is how we are currently operating across our immunization. Um and in the guidance we are last question. Next presentation

Oh, I'm sorry. I just wondered is insurance reim as of this time it has so that was even that was even part of the HHS announcement vaccines previously recommended need to be available again change in guidance was really eligible vaccines all the vaccines are still if a parent decides to get the vaccinated that is that is what we're currently operating current understanding.

Thank you. Um so excited today to bring a presentation by our Ryan White program. It's a program that I am guessing many of you have not heard a lot about but it's a fantastic program sorry that we're funded through the federal government and we have an expert in house who's going to share all he knows about running and share some amazing Jeremy

thank you Janine thank you madam president and members of the board um good afternoon I'm Jeremy Harton I am the Ryan white subdivision manager um here with public health and I'm just going to provide a brief uh high level overview of our program, the services it provides and uh some of the outcomes we delivered along. First, we're going to take a look at their funding landscape. Um Ryan White represents a significant federal investment in HIV care nationally. Uh the program distributes almost two billion annually um to support HIV treatment and related services across the country. Some important things to know about Ryan White are that uh funding is structured into several distinct parts. Um each receiving separate funding and serving different roles within the HIV care system. For example, the state of Arizona receives approximately 23 million which includes funding for HIV medications across the state. Um and secondly, a unique feature of the Ryan White program is that funding is awarded directly um from the federal government to local jurisdictions. Today I'm going to be focusing on the 13 and a half million that the America receives directly from the federal government for our Ryan White part A services and our supplemental and the HIV epidemic funding, EH funding. Um, one final note, uh, part A funding. It does cover, our jurisdiction does cover both Maricopa and counties. Next slide. Before we talk about the services and how it's structured, I do want to briefly talk about who Ryan White was in case you aren't aware. Um, because his story is the reason the program exists. uh he was a young man uh who was diagnosed with AIDS at the age of 13 for a blood transfusion in the mid1 1980s at a time when there was very little public understanding of HIV. Then he when Ryan tried to return to school in Indiana he faced significant

discrimination despite not posing a risk to others along with his mother Jeannie White Ger um he fought publicly for his right to attend. His experience gained national attention and helped to change how the country understood HIV, shifting the conversation towards education, science, reasonless passed away in 1990. Um, just a month before he would have been graduating high school. Then later that same year, Congress passed the Ryan White Comprehensive AIDS Resource or Ryan White Care Act, um, establishing the program we know today. So today um the Ryan White program serves people with HIV uh who meet very specific eligibility requirements as defined in federal law qualified for our program. People must uh be HIV positive, live or reside in Maricopa counties um and meet local income requirements. Our local income requirement is set at 400% of the federal level. the uh they updated the uh poverty guidelines just after I submitted these slides and posted them online for 2026. So it's now um about 63,000 uh 400 for individuals, single individual. Um we are also the payer of last resort, meaning uh we can fill gaps when there are other coverage options not available to you. We do uh regularly review annually reverify everyone's eligibility. Um and services are closely monitor to ensure compliance with federal requirements. Um we often describe our services as free or low cost. Um in actuality most of our services are free. There are some that technically do hire us to our providers to have a nominal, but the legislation also says that we cannot recuse services based on

inability to pay being that most of our services. Um we also uh a key accountability feature for uh the rightway program is a jurisdictions are required to have a branch uh that is made up of uh not only providers and community members but we are required to have 33% of our clinical made up of Ryan White clients services HIV that are not affiliated with one of our propritors is financially they're not they're financial interest in one of our providers. So, um, currently nearly half of our council is made up of clients of our services and it helps us to ensure that funding decisions and service priorities are informed by lived experience while still operating within a structured regulated framework. Council is responsible for allocating and prioritizing 85% of our award. Once someone is determined um eligible, we provide a comprehensive set of services designed to keep people and virally suppressed. the minimum of that uh that percentage that they allocate for services 75% school services. These are the ones here on the screen that our planning council has prioritized based on community imp um and client feedback um and uh service use data um as the ones we find out of the next slide. the remaining portion of uh those service dollars uh can be allocated to support services. Um and these are the ones that our planning council has for us to fund. We know that from these services, these wraparounds really do uh

contribute to better health. We're looking at things like transportation to HIV medical appointments um access to healthy food. So, so I've talked about kind of who we serve, some of the services that we provide. Now, I want to show you how that translates into real measurable. Show you the data. Important to understand why this data matters and viral suppress why viral suppression patterns. U equals UNC transmittable means that when a person with HIV who's taking their medication consistently and achieves viral suppression or an undetectable amount of HIV in their body, they cannot transmit HIV sexually. Um this is why HIV viral suppression is not only the most uh important outcome for like mine also uh are um one of the most powerful tools. This is what view looks like in real life. This is data that was shared by uh the health resource and services administration um uh in a presentation earlier this time. in 2025. So among people with HIV in the United States in 2019, about 34% were either unaware of their HIV status or aware but not engaged in care. So those uh orange and yellow uh boxes on the left uh column and that group accounted for approximately 87% transmissions here. In contrast, the 58% of individuals who are virally suppressed count for any new. That's the power of UCL and why programs like Ryan White are vital to ending the

HIV epidemic in our communities. Talked about that. Now we're going to talk about another critical piece which is cost. According to the CDC, each HIV infection that is prevented saves an estimated 360,000 lifetime treatment costs. That means programs like Ryan White don't just improve outcomes, they also reduce long-term strain of our system taxpayer dollars. When we help people feed viral suppression, preventing new infections and avoiding uh future costs. So locally, this is what it looks like. Um, this uh sh slide shows that clients of our white program are nearly 30% more likely to achieve viral suppression compared to other people living with HIV in their counties. The different reflects the impact of consistent medical care, medication access, and support services in that treatment. Um here we just to show you wanted to show you some uh viral suppression outcomes over time. That consistent improvement year after year we see high and improving rates of viral suppression. It tells us that the program is stable, effective, and accountable. And then finally, I just wanted to share some other um uh accomplishments that we had in this past year. First, uh, as I said, almost half of our house members are buying white clients. We actually were up to that 50% mark. Uh, um, we had one individual decide to move on. Um, but, uh, we are still we are recruiting all times as as we speak. Um, but we're well above the federal requirement. Um and uh our clients uh

members actually have been more engaged than ever in the past uh year, year and a half, really helping us to make uh solid decisions around funding and and priorities. Um second, our digital newsletters reach over 5,000 residents, majority of which are clients. Um and we uh achieved an average open rate of those centers of 70% which is nearly double the industry average. Um it really helps uh those news have really helped us gain trust with our audience and our community as well. Um and then finally uh through our ef funded out outreach events and our positively campaign um our program had nearly 40,000 touch points with residents digital promotion, social media uh ads and then local and taken together this uh these outcomes uh really reflect how engaged we are with our community and we're looking to improve health. Um,

thank you Jeremy. Any questions or comments?

I think that's extraordinary. I I wonder I don't know if anyone has any thoughts that related safe our issues our county over transmitted disease are certainly well and you've gleaned from right there has been a coordinated effort to be fund black and white appropriately not like any other. Is it the funding within it? Yes.

That always seems to help, doesn't it? Yes. Certainly helps. At least gets the message out. Yes. Dr. How do you become do you just again get tested and

Yes, thank you for the question. um multiple ways. Uh we have um yes uh we work with um not only with our clinic um public health but also other uh testing agencies to ensure they have the information to connect. So if they're tested, if they test positive, they can actually get them connected within the same day and eligible for services with a primary diagnosis until they have a confirmed particularly for individuals who need insurance. We want to get them right away treatments in care long term but also through multiple venues too. We have people in the jurisdiction used to say that people didn't know about us. So our positive to our ladies and that was our attendant. So I always have to have a motion to adjourn unless you guys just want to hang out. So do I have a motion? All right, a second. Thank you. All in favor? Bye. Thank you very much. Don't forget to get your tickets

stamped.