Board of Health - Regular Meeting

It's officially three o'clock and I would like to bring the July 27th, 2026 Board of Health meeting to order. We shall have to start a roll call vote. Sure. President Osborne here.

Jack Reagan here. Dr. Farber here. Neusha Hintz. Supervisor Lesko here. Dr. Schroepfer. Here. Mary Schraven. Chuck Catlin.

President, Cyberspace.

Veronica Oros. Here. Lorenzo Sierra.

Present.

Katrina Leach. Here. Let the minutes reflect that and Mary Schraven.

Yes. Okay, thank you very much. We shall continue on with the call to the public. I do have a couple of speaker cards for an agenda item, but is there anyone else here that would like to speak before? Seeing none, we shall move on. You all received your minutes a while ago. May I have an approval of the minutes if there are no corrections or adjustments?

Motion to approve.

Thank you. And a second?

Second.

I have a motion and a second. All in favor, state aye. Aye. Opposed? Thank you. The ayes have it. All right. We do have an action item on number three on our bylaws. As a request of the Board of Health to make a motion to retain the bylaws in current... As a reminder, if you remember, in the last year and a half, two years, we have had a great deal of change to the bylaws. So if there is anything that needs to be discussed, please let us know now. Seeing none, may I have a motion to approve the bylaws in their current form? Thank you. And the second? Second. Mr. Sierra. All in favor state aye.

Aye.

Opposed? You guys have it. Let us go. Okay. Number four. We shall now have our annual review of attendance and the Board of Health is required by statute to monitor the attendance of its membership at scheduled meetings and Members who fail to attend three consecutive meetings shall be identified by the staff and reported to the president, blah, blah, blah, blah, blah. Okay. Determine if further action is necessary. No one is falling in that category. However, it is our annual requirement to look at that. Any discussion upon this rule? Okay. Seeing no discussion, we shall move on. Number five, the environmental services fee waiver application. Robert Stratman has a presentation for us and our 17 applicants.

Hello. Hello. Thank you, Madam President and members of the board. Robert Stratman, Deputy Director for Environmental Services. This quarter, we reviewed 17 fee waiver 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 of Health for a waiver of a permit fee. A waiver of a permit fee may be granted only to the operator of an establishment which maintains a current 501 tax-exempt designation from the Internal Revenue Service and who demonstrates to the Board of Health that payment of said fee will cause financial hardship. In addition, a waiver of fee is associated with the administering and issuance of a food employee certificate in compliance with Arizona Revised Statute 41-1080 to 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-12 culinary arts school program or similar curriculum-based program requiring food employee certificates. The organization or sponsoring school district must demonstrate to the Board of Health that payment of said fee will be less fined. Again, all fee waiver applications reviewed this quarter appear to meet the criteria. I'm happy to answer any questions or if the Board has any questions, I respectfully request approval of the applications on the fee waiver application summary sheet labeled P1 through P15 and C1 through C2.

for that presentation. Any questions? I have one. I see an out-of-state entity, Midwest Food Bank. Can you give us a little more insight on that item?

Yes. President, I know we had one

IN THE PAST THAT HAD WAS A TRAVELING. AND WE DON'T HAVE ANYTHING IN THE FOOD CODE SPECIFICALLY THAT IS SORRY IN THE ENVIRONMENTAL HEALTH CODE THAT WE DISCOVERED THIS LAST TIME THAT IS SPECIFIC TO THANK YOU. TO LOCATION BUT THE ADDRESS WE HAVE HERE AND THEY MIGHT HAVE HAD THE INCORRECT INFORMATION ON THE APPLICATION. It is, it's on 725 East Baseline Road, so it's operating in...

So it's in Gilbert and not...

Correct.

So Gilbert is Midwest food. Okay.

Yes.

An Illinois address made sense, but okay. So that was, I appreciate the clarification. Yes. Good with it then. Any other questions? And then I would like to ask for a motion to approve the 17 fee waiver applications.

I'll make a motion to approve the fee waiver applications.

Thank you very much. And a second? I second. Thank you. All in favor, state aye.

Aye.

Aye.

Any against? Ayes have it. Thank you.

All right.

Environmental Services Enhanced Regulatory Outreach Program. Andy Linton will be giving us a presentation.

Hello, Andy. Thank you.

Good afternoon, Madam President, members of the board. My name is Andy Linton. I'm director for Maricopa County's Environmental Services Department. And as was mentioned, we are presenting to the board today an enhanced regulatory outreach program case related to waste transfer stations that our department is in charge of operating. The Environmental Services Department is exploring closure of our six waste transfer stations. And I'm going to provide some background of that. We started down this path of considering closure The role of the Board of Health, of course, with our EROP cases is related to regulatory changes. So this would be, in our case, changes to the Maricopa County Environmental Health Code. The piece of this case dealing with the health code is specific to the fee schedule we have for the transfer stations. The operational decisions aren't regulatory, so it isn't part of the EROP case necessarily. We are using the EROP framework, however, for public participation purposes. So to receive comments from and to hold our public meetings. But again, the regulatory aspect of this case is just related to the food schedule. And I have a slide at the end of the presentation that will talk specifically about what the Board of Health's vote means today. So we currently see three different paths as we've been researching how to operate the transfer stations going forward. The first one is closure of the transfer stations. Second is privatization of the transfer stations. And third would be to go to full cost recovery for the transfer stations. Right now, the transfer users only pay for about a third of the cost to dispose of their waste, and the rest of it comes from the county's general fund. So depending on the operational direction we go, that'll determine what changes we make to the fee schedule. So for example, if we're not operating any of the transfer stations, there wouldn't be a need to have a fee schedule in the code. So that would be the change we would be bringing to the Board of Health when we come for the second meeting, which will be around the beginning of next year. I would like the Board of Health to have a little bit of background as to why we're exploring closure of the transfer stations. Our Waste Resources and Recycling Program has two main functions. One is to monitor and maintain 10 closed landfills. These are landfills that the county used to operate. At six of the 10, landfill locations, the county opened up, to comply with state law, the county opened up transfer stations. So what is a waste transfer station? So the county receives waste and recyclables from residents and transfers that waste to either a municipal or private landfill or a municipal or private transfer station. For example, we have a transfer station in Cave Creek and all the waste that we receive from residents in the Cave Creek area, we transfer to the transfer station that's owned by the City of Phoenix off of the I-17. It's called the Northgate Transfer Station. So we are not the final resting place for the waste. We transfer it to another location. And you can see in the graphic, we put some dollar signs on this just to illustrate that two of our largest expenses, of course, are the personnel costs to run the transfer stations and transfer, transport the waste, And also we pay the same, what they call tipping fees at either the landfill or the transfer station that any customer of those landfills or transfer stations would pay. And I should mention also that the County doesn't operate any open landfills, just maintain the closed down. So these are the locations of our six transfer stations The dates above each transfer station is the date that the landfill closed and the transfer station opened in response to a state law that requires the county provide solid waste disposal services. So when we close the landfills, residents in these rural areas didn't have other locations to take their waste. There weren't other services available. And so the county opened transfer stations at these six locations. We've included the population data. Maricopa County, below each of the transfer stations, you can see in 1985, the population of Maricopa County was about 1.7 million. And when the last transfer station opened, the Cave Creek transfer station opened. In 1999, the population of Maricopa County was almost 2.8 million. And today's population is 4.8 million. And the reason we put that on there is one important point with the mandate that we have from the state. This is to illustrate that with the influx of population, services have followed, either private solid waste providers or municipal solid waste providers. Services are now available in all of these areas. And the reason that's important, and this is the mandate that we have from the state, is that we need not duplicate a service that's already provided by a private enterprise or another political subdivision. So we did a study earlier this year and researched and learned that there are services available in all these areas. Now, when I say we've had some feedback from some of our stakeholders, when the statute says duplicate services, it doesn't mean that those services have to charge the same amount that we charge or that they have to necessarily operate in the same way that we do. It's just that they do receive solid waste disposal services that residents can use. So the county feels this is one reason we went down this road is with that study, we now feel that we're no longer subject to the mandate, that we are meeting the mandate because those services are now available. What initiated this discussion really was a discussion related to our budget. So the current fees that we charge users of the transfer stations only cover about one third of the cost for us to dispose of that waste that they drop off at our transfer stations. And the rest of it comes from the county's general tax base or the county's general fund. You can see that the Cave Creek transfer station by far has the highest volume of users. It has more users than all of the other five transfer stations combined. And that's at the top of the list. And so for every transaction that we make, we fall behind a little bit more in our expenditures.

And so for fiscal year 27,

had to request from the board almost a million dollars worth of general fund money to maintain operation of the six transfer stations. The other third, of course, is covered by the fees that we charge. This is what's currently in the Maricopa County Environmental Health Code in Chapter 1. This is the fee schedule that we currently have for our waste transfer stations. And I apologize for this being a little bit small. Just to give you an example, currently we charge $2 for someone to drop off a bag of trash. We charge $12 for a truckload full of trash or a trailer full of trash. None of our six transfer stations have scales like you would see at most transfer stations and landfills. So we are looking at the volume of trash that customers are bringing to our transfer stations. So again, the changes to this schedule, this is what it currently says, any changes would depend on the operational decisions that are made down the road. We've had a lot of stakeholder engagement on this issue. We understand that the transfer stations are important residents that use the transfer stations. Most of this engagement, we're up to about 600 comments that we received from residents. Most of the engagement have come from users of the Cave Creek transfer station. So you can see that most of them are constituents of District 3 and District 2. residents of Carefree, Cave Creek, Deadfields, Rio Verde, certain parts of Phoenix and Scottsdale also use our waste transfer station in Cave Creek. Most of the stakeholder concerns have to do, I think most of them relate back to affordability. Our prices are far below what the market is currently charging for waste disposal. For example, to drive into the city of Phoenix Northgate transfer station, I think just to get into the transfer station, you're going to pay about $40, $30 to $40, and then it would go up from there based on the weight that you're bringing in, where someone can bring one bag of trash to us for $2, and it costs them $2 or $12 for a truck. So we really are only recovering about a third of what it costs to dispose of this waste. Other concerns from residents have to do with if we make operational changes or raise fees to the transfer stations, people are going to start to dump their trash in the desert. People are going to burn their trash. A lot of it has to do with affordability. We've heard from a lot of people who retirees who are on fixed incomes who are saying it's very cost effective for us to take it. We don't generate a lot of trash and it's more cost effective for us to take the trash to the transfer station than to contract with curbside service. The Board of Health action today. So this is the first time we're bringing this case to the Board of Health. We will come back a second time to the Board of Health with more specific direction on exactly what we're asking the change to be in that fee schedule. Today's Board of Health vote would be just to proceed to the next step in the EROP case, which is to hold the next stakeholder meeting on August 13th. So a vote in favor would allow us to proceed under the EROP case to that stakeholder meeting. A vote in opposition would end the EROP case, and that would simply keep the current fee schedule in place. Again, the operational decisions related to the transfer station are independent of this EROP case, And so those operational decisions can still proceed. This would just be specific to the fee schedule. This is the timeline for the enhanced regulatory outreach program steps. We are currently proposing to hold the second stakeholder meeting on August 13th. This timeline shows that the second Board of Health meeting would be around October. We're most likely going to push that back to the beginning of next year because we're working with procurement to put out a solicitation for any private providers to come in and take over operation of the transfer station. So that's about a three to four month process. And so we might not make the fourth.

Just a moment. Supervisor Lesko, would you like him to finish or would you like a question or something right now? Would you like to say? I see your hand up.

Oh, he can finish. I just didn't know if you could see my hand because I didn't see it on my own screen. He can finish.

All right, go ahead and finish. Then we'll come back to you. Oh, are you finished? Perfect. Okay. All right. Supervisor Lesko, would you have a question?

Thank you very much, Madam Chair. Director Linton, can you uh remind me is so the cave creek one is the most used transfer station correct and um what are the services that people can use if this transfer station closed if i remember right it's waste management and also what the north phoenix transfer station can you remind me yeah madam president members uh supervisor lesko um there are actually five

different companies that offer different types of services in the Cave Creek area. Everything from curbside service to placing dumpsters. The closest transfer station where residents could take waste or bulk items like refrigerators and things like that would be the City of Phoenix North Gate Transfer Station. And that's about 17 miles from the Cave Creek Transfer Station. So it's a little bit more of a distance if they wanted to take it to a transfer station themselves. But these Companies that are operating in the Cape Creek area, they do offer things like bulk pickup, but the cost, again, is much higher than what we're currently charging at our transfer station.

Thank you. And Madam President, Director Linton, can you detail how many of these folks that drop off things at our transfer stations are commercial businesses, versus, you know, a homeowner that, you know, is just dropping off some household trash. Do we have a count on that?

Madam President, Supervisor Lesko, we don't keep track of that. And one of the reasons is a lot of like the commercial landscapers that have magnetic signs on their truck, they know to take the sign off of their truck. And so we can't determine with any surety that they are necessarily commercial businesses, but it seems obvious to us when The same person keeps bringing trailer loads of drywall or landscape clippings and things like that to our transfer stations. We just have no way of determining that definitively. We do suspect that they are coming in commercially. And we also suspect, we found it interesting, we did do window surveys where we would survey customers coming into the transfer station. And there are a number of customers coming in from other municipalities where municipal services are available, including landfill subsidies that they would get if they took their trash to a landfill. but our costs are so low that it's cheap that they prefer to come to our transfer stations because it's so much less expensive.

Yes. And Madam President and Director Linton, if I remember right, some of the people that commented in the stakeholder meeting said, well, why don't you just charge more so that you recover your costs? And if I remember right, we'd have to like really increase the prices to a degree that it's probably even might be more expensive than the uh the private companies uh if i remember right if i remember right right now we charge 12 for a trailer and we'd have to go up to 61 for a trailer to recover the cost is that is my memory correct yeah madam president supervisor lesko uh you are correct if you multiply the our current fees by

about four. That's about where we would be if we were to recover the full cost. Again, so an entity like the City of Phoenix, they own their own active landfill, and they can take their waste to their own landfill. We don't operate any end location for the waste, and so we're paying others to dispose of our waste, and that's where the biggest cost comes to us. And so, yeah, our fees would increase significantly, and we think there's in scale and the fact that other entities own their own landfills, we think our costs would be above what the market's currently charging if we were to go to full cost reduction.

Madam President, I personally am in favor of moving this process forward. I think that we're doing a huge subsidy right now, almost a million dollars for these transfer stations. And the law says that i mean the reason we did it at the time was because there weren't other services available now as maricopa county has grown and expanded there are multiple other services waste services available um and and so i i think that it is the right way to go on to the next the right decision to go on to the next process. Also, I don't think it's fair for government to be competing with private waste companies that can do the jobs themselves. So that's why I plan to vote to move this forward. Thank you.

Thank you, Supervisor Lesko. Before we move on with any other discussion, we do have two public speakers, and I would like to ask for Stacey Mars, if she would come up and give your name, and go ahead and sit right there, Stacey, right next to, yes. I want to sit down? Yes. And just a moment, Stacey. We also have Mary Scraven on the phone now, and we just want to make sure that it's logged into the records that she is here. Thank you. All right. Hello.

I'm sorry I was late, but I'm here.

Thank you. Go ahead, Ms. Morris.

Well, President, Supervisor Lesko, and everybody else, thank you very much for allowing me here to speak today. I am a Cave Creek resident I have used the transfer station, and I pay taxes within the County of Maricopa. My main concern for this is closing this transfer station. As Linton said, it's used. It's predominantly used more than the other stations. And something that I think you touched on was the green waste. green waste, trees. Okay, there's a lot of contractors that come up there and landscapers. And if this transfer station is closed, I truly believe that that will be dumped in the Tonto National Forest and any back area that is not protected land. And that will end up as fuel for fires. aside from looking terrible, or like you had mentioned, and I've seen people burning their own waste, you know, and that, as we know, could be equally as dangerous. And if it does become fuel for fire, that costs the gift. For a lot more money, firefighters and hot shots come and take care of it. And we already had a very active fire season. Other illegal dumping that would Would otherwise end up at the transfer station or things like refrigerators. And I've seen them in the Tonto Forest. They just go down the hill. Even now, with the transfer station being open, there is still a lot of illegal dumping. And how much does that cost the county to clean up? Because I'm sure people call and complain about that. I'm in favor of raising the prices, frankly. Raise them. but you can also like maybe give those senior citizens that say that they are on a fixed income, maybe you can verify and maybe they meet an eligibility for special pricing and those contractors that keep coming with the sheetrock, maybe we can throw a few extra dollars their way. I don't mind paying a few extra dollars more. I'm blessed with my pension because I think that this transfer station is a vital necessity for the community. Cave Creek has increased its population, and maybe you could sit down with the mayor and talk to her as the Cave Creek budget. It's pretty large for 10,000 annual residents, year-round residents, and maybe they can chip in as well to keep it open. I think those are avenues that you can look at. Thank you for your time. Thank you very much.

And Mr. Morris.

Adam President, Supervisor Lesko. My name's Doug Morris. I have a Bachelor of Science in Public Health from Arizona State, minor in Wastewater Management. I live out in the Tonneau Forest on a county out. And there is dumping now, and that dumping will increase if there isn't a place. And I won't go over everything that Stacey said. She is my wife. But I'm also a Tonneau Hills Volunteer Fire And so the added fuel is a true concern. So I'd ask, and to your point, director, there are some things that transfer stations do that a normal commercial hauler isn't going to do. I drop off used motor oil, tires, stuff like that. I also pick up tires because I have five acres and I use them as a backstop to shoot at. Anyways. So since you opened the transfer stations after you closed, 85 to 99, has there been any sort of longitudinal study to see how much trash the county has to pick up after these transfer stations were open? Because that would give you kind of some data points on how much potential trash there might be after they're closed. So the other thing is, and that would give you kind of a delta of the cost that you're avoiding. By running these sites. Now, if it's more than $948,000, maybe you need to keep subsidizing. Like Stacy said, I'm also in favor of increase. I use the transfer station. But I'm one of those pink squirrels. I don't have an alternative. So I recycle heavily. I compost my compostables. But I do haul bags of trash out there. Every once in a while, I'll pick up a truck full. And I have hauled green waste there. And so I would ask that you vote yes to move this forward, but also offer those points just to kind of look at it. Because you're looking at it from a cost accounting perspective, you know, plus minus. And this needs to have a managerial accounting kind of study done, you know, costs avoided, you know, across other departments within the county. Thank you for your time.

Thank you very much. Okay. Is there any further questions, comments from board?

I have one question.

Yes, Anna.

Can the transfer station be taken over by a private entity or does it need to be closed?

Madam President, members of the board, we are looking at having a private entity or even a municipality take over operations of the transfer station but they can be operated by someone else. We're working with our procurement group to put out a proposal and to solicit proposals from these companies, and hopefully that process is going to take about three or four months, and then we should know what that looks like in about three or four months when we get those.

Okay, so closing it is not the only option.

And that's good to hear, those other ideas. As a former council member for a city, I know that our water and our our trash was always what we called an enterprise fund. So it was its sole ownership of that entity and the money that, you know, had to pay for everything, the expenses and the income all were flush. And, you know, if you had to have a subsidy, it was certainly shown to the taxpayers. This is coming here. This is obviously a sizable subsidy that's occurring here. And I do understand that By the closure, what is going to be the reaction to what people do? And it's human nature. They go to what's cheapest and what's easiest sometimes, right? And as you said, they're taking off their signs off their landscaping trucks so that nobody thinks that that's what's happening. you know better. As a business entity, this would be closed years ago because we couldn't afford it. This is just government helping the situation. So I do appreciate that there's other ideas and possible solutions in the mix. So we look forward to hearing that. I hope at the next meeting, if that's when it's brought forward. And what's very funny is that timely, just A week ago, I moved into that county. I'm now officially a county resident that's going to have to go out and get my own private trash collection. So I will be part of that situation. All right. Yes, sir.

Thank you, Madam Chair. Director, what is the timeframe once we sort of get a direction, especially, you know, for the folks that have come out, you know, what does it look like? Whether we privatize, whether we close, whether we raise funds, what are we looking at?

Madam President, members of the board, we would be looking at around the springtime of next year. We should know sooner than that what direction we're going to go. And this very well could be a combination of things. So we run six waste transfer stations. So we could have some closures. We could have some interest in taking them over from private entities. Or we could even go to cost recovery if the direction we were given was to operate them ourselves. But that's the timeline we're looking for. The procurement process for privatization is It takes, as I mentioned, anywhere from three to six months. And so that's kind of going to determine where we land. We're funded through this fiscal year. So any changes we make before the end of the fiscal year is just savings to the county. But we are funded through this year. But we're looking to make the changes or at least provide the community with the direction we're going as soon as possible. Want to follow up, ma'am?

Yes. Do we expect any bites on the privatization end, at least for some of the areas?

Yeah, Madam President, members of the board, we sent out a request, a formal request for information to answer that question. So we would at least have an idea if anyone was interested. And we did receive interest from private entities for all six transfer stations.

Thank you. Any further questions, discussion? If not, then I would ask for a motion to... Agree that we move this forward to the next, I guess, I don't want to say hurdle that has to go through, but the next steps that they are to require. May I have a motion?

Madam President?

Yes, ma'am.

I move that the Board of Health allow the case to move to the next step in the EROP process.

I move that we approve it. Thank you. May I have a second?

I second. This is Mary. I second.

Mary seconds. Thank you. On favor, state aye. Aye.

Aye.

Aye's have it. All right. Thank you. Thank you, Mr. and Mrs. Marks, for coming in. All right. So, number seven. Dr. Fowler, would you like to give us a update? I said director.

Oh, I thought you said doctor. Sorry.

I said director.

Sorry. I'm here for Dr. Staab. Okay.

Gotcha.

So Dr. Staab is on vacation. So I am here with a public health update today. And I just have a few slides for you. I'm going to talk quickly about where we are with measles for return traveler monitoring and our extreme heat response. So let me jump into measles. I'm sure many of you have read about measles recently in the news. Since April 5th, Public Health has reported 25 confirmed measles cases and we've investigated more than 100 suspect cases as part of our enhanced surveillance. The update I've got another slide too. We update weekly on our website. I had a screenshot of our website. And I encourage you to go there if you want to learn more about measles or to see updated numbers. This slide right here is our cumulative cases of measles reported in the US by year. You can see that measles was eliminated in the US in 2000. And you can see where we are now. Yeah, so this is just the, sorry, I was just looking at Dr. Saab's notes. This is just in the context to show you how quickly, how steep the curve is with measles cases being reported in the US. And then this is the look. You can see the most cases right now in the United States have occurred in South Carolina, followed closely by Texas. You can see where we are in Arizona. That's mostly our cases that occurred in the Mojave outbreak, which is also closely tied to the Utah cases, which is right over the border. But you can see where we are in relation to others in the country.

Before you move on, Supervisor Lesko, you had a question?

Yes. Thank you, Madam President. Is that Janine Fowler that's speaking? I can't see from here. It is, yes. OK. Ms. Fowler, can you tell me, do people that, do adults need to get re-immunized if they were immunized as a child? And the reason I ask that is because I know someone that got measles that was immunized when they were a child, but I think there was a certain, he was told there's a certain age or a time where the dose wasn't good or something to that effect. Do you know what I'm talking about?

Answer that? Yeah, I'll let, I was going to let Macrina answer.

So there was a time, and I don't remember the exact time frame, but there was a time where the vaccine was not as effective. So there's a particular age group of adult that truly is susceptible. And I don't know the exact time frame.

The exact age group? Just for content, can you just explain why you're answering it? Because you were with public health. They may not know. I apologize. Who are you, Macrina?

I'm that part. I was with public health for 36 years working in immunizations and part of the large 1989-90 outbreak and several after that. But yeah, and I can go ahead and check what the age group is of that adult. But they truly are at risk and susceptible.

Yeah, if I, you know, this gentleman that I knew was in his 60s, and he was told, even though he had it, that during the time that he got the vaccination, that it wasn't very good. And so I don't know if our public health department has put out a notice, I think it would be good if we haven't, saying we recommend adults in this certain age range get get revaccinated if they choose to.

Right. So if they were immunized between 1963 and 1967, they need to be re-immunized, which would truly make them in their 60s.

Right. And Madam President, has the county considered putting out some type of notification about that? Because it might be, I bet most people do not realize that. that they should get revaccinated, or they're not protected if they don't get revaccinated if they got the vaccine between 1963 and 1967.

President and Supervisor Lesko, this is Janine again. I will discuss with Dr. Staub when he's back in the office later this week, and then I can get back to you with some free information.

Thank you.

Sure. Thank you, and I would say along those lines of a question if you are an older adult that gets measles because of this little fluke in the timing, is it harder on adults versus children that are getting it? I mean, what, or is it, you know, still simply the same? It's just fatigue and it's, you know, the different symptoms of the measles. But I mean, what does it mean to an adult that may receive it versus, you know, kids?

It definitely is hard. I think that's a hard message because adult, there's so many other issues we might have that could impact getting measles. Okay, thank you.

Any other questions, comments? Okay, thank you. Go ahead, go on. Sure.

The next subject that we were going to just touch on is return traveler monitoring. So Local public health departments for years have been responsible for monitoring residents returning from jurisdictions who have been exposed to diseases of high consequence. So this would be things like that many of you may have read about the newest hantavirus, which is called the Andy strain. Recently, we have been responding to travelers returning from East Africa with experiencing an Ebola outbreak. And we just wanted to make you aware of this as part of Local public health, what we do all the time, we have protocols and methodology in place to monitor these individuals. To date, we have monitored more than 100 individuals returning from Africa. Then it wouldn't be July without a little bit about heat. So we continue to be responsive to the extreme heat that we're currently experiencing. We're working closely with 2-1-1, respite centers, cooling centers to try to get as many people as possible in from the extreme heat. Unfortunately, we're still seeing our numbers rise in terms of people dying from extreme heat, but we continue to work hard. And just a reminder that if you want to learn more about what is going on with heat, we update our dashboard weekly, which has... of the current case counts that we are investigating.

So with this sizable difference, was five last year deaths to 18 this year? Did I read that right? Or it was a definite difference from last year to this year. Has there been a recognizable reason, like something's been different? Is there... Like, less stations open? Are there anything that's different from last year? Or is it just, unfortunately, it is what it is? I hate to say it that way. But, you know, is there anything that you could pinpoint right now that you've seen as a difference from last year?

President, I think there's a few things. One, if you recall, we had an unexpected heat wave in April. Was it April? May?

March.

Yes. And that sort of start in that during March is not a time where we normally would have respite or cooling centers open. So we're going to look more closely at that time period. But that doesn't explain everything. We're still, it's a little too early to tell exactly why we're seeing the numbers we're seeing. So we'll continue to probably when the season is over, really dig into the data to understand why our numbers are as high as they are. And I wasn't even, when he's even thinking of March, you know, that's completely out of the... And the other really important factor that you and I talked about a little earlier is our nighttime lows are very high, if that makes sense. So people are having a much harder time cooling off. And if our nighttime temperatures don't come down, it puts... Yes.

Sure, Madam Director. So we, if they die in the county, we count those even if they're a tourist who is hiking and doesn't know really how severe the heat is.

Madam President, members of the board, that is correct, yes. We don't see, I don't want to give the misconception, most of our deaths are people that live here, that they aren't visitors. It does happen, but it's not the majority.

Madam President, I'm sorry. We have Supervisor Lesko also make a comment and also see our Deputy Director, Kelly Williams. Thank you. Supervisor Lesko.

Thank you, Madam President. Correct me if I'm wrong, but aren't most of the heat-caused or heat-contributed deaths also related to drug use? I think that's the majority. And if I remember of the drug use, it's methamphetamines. Is that correct? Is my memory correct? I think most of them are drug, they are also, they also have drugs in their body.

President, Supervisor Lusko, you're absolutely right. It's similar as we've talked about in years past. We see a lot of our confirmed deaths with having drugs in their system, oftentimes methamphetamine, most times polysubstance use, so meth along with another substance.

Yeah. If I remember, it's meth and fentanyl.

And please, in the future, that's an important data point to be giving to the board, you know. So whereas, let's go new, we don't know that. And that would be, I think, important information.

Thank you. Yes, ma'am. Madam Chair, I would just like to share two other points. One is that we actually have more heat sites open this year than we've had in the past, which is wonderful, which means we have more partners than ever. And the second point I want to share is that a third of our deaths related to heat are old. There are individuals who are dying inside, which is we assume are individuals who either don't have access to air conditioning or don't have the funds to turn their air conditioning on. And so oftentimes those are folks that don't have substances in their system. So 27% of individuals who are individuals who we find indoors. And so those are a population that we're also trying to always access. And that's why our Messaging is always take care of yourself and check on your neighbors. Thank you for that. I appreciate that.

Any other questions or discussion?

Thank you.

So our final two fourths of the afternoon. It's election time. And it has been a true privilege to be able to lead our meetings for the last couple of years or as Vice President as well. And so I thank you for allowing me to serve you all. You all, every one of you have read your bios, have great resumes that bring to this wonderful committee. And so I'm really appreciative of who is around our table. But we move forward with our elections. And just as a thing I'm supposed to do is tell you what duties those president and vice president are. And for the president, they shall be to call and preside at all meetings of the Board of Health and the vice president. It is a one-year period. It is renewable for a year. after the one-year term. Also, the vice president, same thing, one-year term, and then renewable, shall be to assume the responsibilities of the president in their absence. So, as we move forward, I would entertain... open nominations for the presidents. And you may nominate yourself or maybe you nominate someone else coming from the floor. Do I have any nominations for president?

Are you still eligible?

No, I've completed my two years. Thank you. So who would like to nominate themselves?

We're not doing rock, paper, scissors, guys. Okay.

Sure, I'll do it.

You'll do it?

He's going to.

I'll try filling your shoes.

Okay, we have a nomination. All righty. Now.

The president, who is that speaking? I don't know who that was. Matt Farber.

All right, Dr. Farber has thrown his name into the hat here. Anyone else?

Yes. I'm sorry? No, you asked the same question we were going to tell you. Are there any other additional nominations? Okay, any additional nominations?

All right, seeing none, we can do this the easy way. And let's see, when we have one person... I will, let's see, by acclamation, I move to elect Dr. Matthew Farber as president of the Board of Health by acclamation. I need someone to actually make that motion. I can't make it, right? So I called for that motion. But whoever's going to stay by acclamation. Okay. Okay. Mary said he moved it and I need a second. Second. Lorenzo seconded. All in favor, state aye.

Aye. Aye.

Opposed? The ayes have it. Now I would like to call for a nomination. Congratulations, sir. A nomination for the vice president.

I'd like to nominate Macrita Leach.

All right. We have a nomination on the floor for Ms. Leach. Anyone else?

This is Mary. I would be happy to serve another year.

Okay. We have our current vice president also putting her name into the hat. Now, since we do have to, I do need to ask Ms. Leach, would you accept that nomination? Yeah, I'll accept that nomination. Okay. And Mary has also nominated herself for renewing of her term. Okay. Now I have to go back to my notes. Okay. Let's see. So we have two. Vice President repeat process. Okay. Now I must conduct a roll call vote for each candidate. person nominated, right? Tell me if I'm doing it right. Okay. All righty. We don't have any secret machine guys. Sorry. All right. So we shall start with our first nomination and that is Ms. Leach. And so we shall have a roll call vote on.

Sure. Dr. Farber.

I'LL VOTE FOR MS. SLEACH.

JACK REAGAN.

I'LL VOTE FOR MS. SLEACH AS WELL.

JOANNE OSBORN. I WILL GIVE MY VOTE TO MY CURRENT VICE PRESIDENT, MARY.

LORENZO SIERRA. Mary Schraven.

I guess myself.

Veronica Oros. I'm going to vote for Mary. Chuck Catlin.

I'm voting for the current vice president, Mary.

Macrina Leach. I'll vote for Macrina.

Dr. Schroeder?

I'll go to Ms. Leach.

Supervisor Lesko?

Oh, this is tough. I really don't know either one very well. So I'll go with Ms. Leach.

Give us one second to tally the votes, please.

No hanging chads.

So, Madam President, the votes are in. Okay.

Yes, thank you for that. I appreciate both our nominees for stepping up. Thank you very much. That is very important to this committee. And so the actual tally is six votes for Ms. Leach and four votes for Mary. So we have it for Ms. Leach. Thank you very much. You shall be our new vice president. all right so the one last item that we have on our agenda is to um president um i apologize um madam president just so they understand when they take their term that's the last part we need to acknowledge they'll be conducting the next meeting correct so i will complete this meeting for today and then um Dr. Farber and Ms. Leach, you will begin at our next, was that October, I think, is our next meeting? Yes. Then you will start us in the fall. All righty. So congratulations. Thank you very much. Our last item on the agenda is the confirmation of that third member of the executive committee, and that is our lovely Dr. Schroeder. And she has no choice, but she's going to. She needs to continue on with us. And so would you like to add any possible discussion to? I'll be happy to continue in this role that I've done this last year. Thank you. And she had been confirmed by the supervisors. So she does actually stay in this position. This is just one of those annual formalities that we need to conduct. So I guess I do still need to have a motion to approve her as still confirming her as the third member of the executive committee. No, I don't. No, because she's appointed by the Board of Supervisors.

They say go. Well, this is weird that this needs to be on here. The reason, let me explain that because I do understand. I'm sorry. This is Vera Sampler. It is a bit confusing. And I shared that with Dr. Schroeder earlier and Dr. Farber before they started the meeting. The reason that it's on the agenda and the reason we like for the board members to understand is that typically the Board of Health has only held one physician, a licensed physician. We are fortunate to have two, Dr. Schroeder and Dr. Farber. Being that Dr. Farber will, as of the next meeting in October, become our president, Dr. Schroeder, elected by Board of Supervisors, automatically is a part of our three-member executive team. So being on the executive committee, according to our bylaws, that means that it is composed of the president of the Board of Health, the vice president, and a licensed physician. Should Dr. Schroeder at any point in time choose to elect or is nominated and accepts that position of president or vice president, that leaves us one man short on the board. And so for that reason, we felt it was necessary to explain that to all members so they understand that. So in speaking again with Dr. Schroeder and Dr. Farber, they understand their roles. They graciously decided to step in that and appreciate that. So Dr. Farber, to you, congratulations. What that means is that Dr. Schroeder obviously will stay appointed up until her term of time. And at the decision of the Board of Supervisors, should that change or terms change, then we'll revisit it. But that's the reason that is on the agenda by statute.

Okay, thank you for that explanation. All right, if there is no further discussion, that is the end of our day. Make sure you get your little ticket stamped, and I would ask for a motion to adjourn this meeting. Thank you, President Osborne.

Yes, thank you for your service. You've been a great president.

Thank you, Mary, and thank you for your help as my VP. All right, I need a second. Do I have to have a second to adjourn? I'll second. Thank you, Mary. All in favor state aye.

Aye.

Opposed, go away. You guys have it. Thank you very much.