Board of Health - Regular Meeting

Well, hello everyone and we will officially uh bring this meeting to order. The board of health meeting for July 28th, 2025. And may I have a roll call vote, please? Here. Reagan here. Atlan here. Absent Hardy here. Supervisor Leco here. Veronica Oros here. Mary Shraven here. Dr. Stephanie Schroeder here.

Lorenzo Sierra not online yet. We have established a quorum. I'll turn the meeting back to you. Thank you very much. Uh second on the agenda, we call for a call to the public. Do we have anyone signed in for that? You do is this specifically before uh an actual item on the agenda? It is regarding an item on the agenda. So we can wait till that. Okay. Very good. Excuse me. Madam chair, board member Lorenzo just joined us. Amy, if you want to roll call him in, please.

Renzo Sierra, can you hear me?

Yes, present. Hello, Lorenzo. Welcome. Okay, so second on the agenda, we would like to acknowledge um the board of supervisors actions. Uh as you may recall from our uh last quarterly meeting that um Mr. McMillan had resigned and we thanked him for his many years of service and appreciate that. And now we will uh be having a new board member uh joining us. And so uh I'd like to welcome Zach Reagan to the uh board. And it became effective May 7th, 2025 through December 31st of 2027. So welcome. And would you like to tell us about yourself a little bit?

Uh thank you everyone for having me. Uh local Arizona boy. I've grown up here my entire life. uh played baseball all through uh probably since I was eight years old till college. Got into politics and um effectively after that health and um got my EMT in uh specialized emergency response. Um and tactical tactical response. Um yeah, after that um I I combine the two and really kind of help make the uh state and county that I grew up in so much better. Thank you all for having me. Oh, very good. Welcome to

And Madame Chair, I found out that I I I didn't know he was going to be here and I know his mom and dad. Oh yeah, we're like small world sometimes. Telling them. Yes, I can tell on them. Okay. Well, we will try to not make it too painful for you. So, welcome back. All right. Now, oh, well, the next item, introduction of the I Okay. Did you want to add anything?

Okay. All right. See, we're moving right along. Okay. Number four, approval of the minutes. And I will need um to have a motion if there are not any changes to the minutes. Anyone? Oh, motion to approve. Motion to approve. Do I have a second? A second. Seconds. All right, Mary. Thank you very much. Uh, all in favor state I. I. Eyes have it.

Okay. Well, uh, Lorenzo, I have to tell you if you see me jump, it's because that is it's really loud with you. So, it is nothing against you, but we love having you here. That's just It's loud. I don't know if we can turn that down or we'll try. The volume.

All right. Uh, next on our agenda, this is actually one of the housekeeping type of items that annually we will have on our agendas, and that is request um for a motion to retain our bylaws in the current form. uh ones that have been on this board if you recall for the last uh year and a half. We've we've um gone over these bylaws and have a lot of change and um but obviously there's the time if there's something that you want to comment or change. Um if not, I will need uh a motion to accept the bylaws and contain them in the form that they are in.

Any changes to the current form? looked like it. So, may I have a motion to approve? A motion to approve that we accept the bylaws. Thank you, Mary. Second. Thank you. All in favor state I.

I opposed. All right. The eyes have it on. So next we have uh here's another item that we go over annually and that is the uh attendance. Uh obviously four times a year is about all we meet and so attendance is very crucial and we just want to make sure everyone understands the policy and the um things that are in play. If if someone misses three consecutive meetings, uh then there is action that will be required. Do I need to vote on this? It looks like we So, is there any questions about this policy of attendance? None. Okay, then uh it doesn't look like we have anything else to do about this. No, I don't have to have a motion.

President Osborne. Yes. there. The only action is that by statute we're required to have it on our agenda. So, we met that obligation. There's no actions that you have to move on. Thank you very much. And no one is in uh this category of missing three in a row anyway. So, we're doing okay there, too. All right. Moving on to uh item number seven, environmental services fee waiver applications. Is there any discussion or u Mr. Strapman, would you like to give us update on this item?

Madam Chair, members of the board. Thank you. Um uh for this particular meeting, typically we have one request of the board. This time we have two. Um if it pleases the board, I'd like to start with the the first item a on the fee waver, which are the uh requests for approval of fee waivers. So uh this quarter we received 14 fee waiver applications. Of the applications reviewed, staff determined that all meet the criteria outlined in the Maricopa County Environmental. 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 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. Applications for fee waiverss of temporary food establishment fees will be processed on a first come first-s serve basis in accordance with chapter 1 regulation 5A of the environmental health code. The department shall only present a maximum of 25 of such applications per event to the board of health. In addition, uh, a waiver of fees associated with the administering and issuance of a food employee certificate in compliance with Arizona Revide Statute 411080 may be granted to the operator of an establishment which maintains a current 501c3 tech consent designation from the Internal Revenue Service or to a current student enrolled in a K through2 culinary arts program or or similar curricula 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 cause financial hardship. 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 no question, I respect that we request the approval of applications on the fee waiver application summary sheet

labeled P1 through P11 and C1 through C3. Mr. Chapman or on a specific item? If not, then I would entertain a motion to accept these applications. Make a motion. We'll make a motion. All right, Monica. Second. Second. Second. Thank you. All in favor say I. I. Opposed. You guys have it.

Section B. Yes.

Yes. Yeah. And uh madame chair, members of the board, this request is merely an administrative correction due to a duplication that the board, this applicant submitted to the January uh meeting for uh a fee waiver, which the board did approve. Um and there was some confusion related to the application. They sub with the subsequent paperwork that we sent back to the applicant. Uh there was some confusion there and they resubmitted an application for the same fee for the April meeting. Typically filter those out. We missed that particular application. So it ended up on the April which was then same fee was then approved for a waification. So this is merely an administrative correction for the record. This permit fee was waved by the board in January and is effective for the life cycle of that permit fee. So there's no uh change in the status of the waiver that was approved by the board is merely again administrative correction for the record is what this request is.

So do we need to vote for uh accepting that correction or is this just something internally that is being taken care? You're just letting us know letting letting you know. And in terms of it's it's difficult for me to answer the question in terms of whether a vote is required in this instance. Um again is to correct the record um for the duplication. Understood. We've already approved it. Yes. Yes. Y what do you think is I don't think a vote is necessary if it's only uh to let you know what they have done. Um and to correct the record. Thank you very much. Okay. Thank you. Thank you so much.

Right. uh section 8 environmental services enhanced regulatory outreach programs and uh we will start with the presentation by the staff the first item letter A solid waste areas. Yes.

Thank you. Uh madam president madam president members of the board uh Mara County Environmental Service Department is proposing to make four changes to the Maricopa County Environmental Health Code. As most of you know whenever we propose a change to the health code it has to go through the county's enhanced regulatory outreach program. Uh that's a program that provides stakeholders an opportunity to provide comments. Also provides the board of health to provide comments on on whether or not to proceed with these uh proposals. So today we have four different proposals that we're making and four separate presentations. I'm sorry to be the one to bring the agenda to a screeching halt with your presentation. It's always someone.

That's always someone. It's me today. So, uh, the first case that we have is for, uh, refuge collection frequency. Um, I included the timeline for the enhanced regulatory outreach process here on the board. Uh, this one might sound familiar to the board. We did present it to the board in a on April 28th of this year. Uh, we did receive opposition early on for this case. Uh, and the E-ROT process tells us that when we receive opposition, we have to add an additional stakeholder meeting and an additional board of health meeting to get additional input from stakeholders. And so we're at the second had our second stakeholder workshop on June 3rd and we're back here uh today for our second uh presentation to the board of health. Slide, please. So, uh, what we're currently doing and what we're proposing to do. So, currently the Maroba County Environmental Health Code uh, requires twice weekly garbage and refuge collection. Uh the current code also allows for an entity to obtain a variance to do once weekly collection of garbage and refues. Uh what we're proposing in these with these changes is to align our code with the current requirements in the Arizona administrative code that only require once weekly garbage and refuge collection. And those requirements in the state code also allow for a variance but to do less than once weekly pickup. So, we would be looking, what we're proposing to do is to align with that. Next slide, please. Uh, a little bit of background. Uh, Maropa County Environmental Services Department conducts regulatory activities related to solid waste through a delegation agreement with the Arizona Department of Environmental Quality. Uh, last year, ADEQ adopted changes to establish once weekly pickup. It went through their rule changing process, which also has a stakeholder process associated with it. And the new rule that was adopted, as I mentioned, also allows for a variance to collect refues less than once weekly. Next slide, please. A quick summary on our June 3rd stakeholder meeting. We had nine individuals in attendance uh included representatives from the city of

Phoenix, the city of Scottsdale, the city of Chandler, and Republic Services. Uh written comments were also provided by the city of Phoenix, and the city of Scottsdale. Uh the city of Phoenix did provide formal written comments in support of the change and the city of Scottsdale provided comments in opposition to the change. Next slide please. So in summary, the outcome if these were to take effect are as follows. It would establish a new standard to match the rest of the state for once weekly refuge collection. Uh refu collection variance for once weekly collection would no longer be needed. So those would go away and we would establish a new variance for less than once weekly uh pickup. Next slide please. So the recommendation from staff is to approve allow the case to move forward in the enhanced regulatory outreach process. A vote in favor of the case today would allow us to proceed to the board of supervisors for their consideration. A vote uh in opposition to this case would end the EROP case for this proposal and the current requirements would would remain in place. and I'm happy to answer any questions.

So, uh just a quick question and then I'll allow the board to ask any further questions. So from the the last uh quarterly board meeting where this first uh took place in in April and coming to today thinking about this I mean this is I guess some would think that it's less regulatory by it only being once a week. But my question kind of goes back to besides aligning yourself with another policy, what problem are we fixing by going down to one time? And the second question is if you had opposition from a city that um then could go for the variance request, right, and say, "Well, we want to do it twice a week." Is that is that how that would all play out?

Yeah, the variance If these changes took effect, the variance would be to reduce the trash collection frequency even further, not to add in No, I understand that. But I'm just trying to if if there's a city that's against this for whatever reason, um, and they want to stick with two times a week, there's nothing they're changing. Correct. They just don't like the policy in general for the state. And I'll let I'll let our speaker also speak to that. But, um, but I'm just wondering where the situation is that makes this worse. and so doesn't seem like it and that's why I'm kind of asking you about that.

Yeah, Madame President, members of the board, we we have no uh requirement beyond should this take effect beyond one week of pickup. A city could certainly decide to do more frequent uh collection uh if their council and elected leaders chose to do so. Um but it isn't something that we we would require. As far as what the benefit, um, we have 18, most if not all of the refuge collection entities have a variance, uh, for once weekly pickup. So, they're all doing once weekly pickup. And typically where we see uh, for any code requirement where most people are having to get variances for things, um, usually there's a new standard. We we look at the the baseline standard for that as opposed to requiring them to get a variance. And that that is the case here. And this would be a deregulatory effort um and would free up resources within the department as well um that we spend inspecting for these uh refugees collection variances across the valley.

Thank you very much. Okay, any other questions? Yes.

Uh thank you madame chair and Andy. um she already asked the question um but I'm specifically trying to understand the opposition from the city of Scottsdale because in it they said um it would negatively impact participation in the curbside recycling program. Um and then they said it would have a negative impact on revenue. And so if the city of Scottsdale is allowed to do it twice a week, three times a week, five times a week, I don't understand how that would negatively impact their revenue or um or participation in the recycling program. Do you happen to know or or is the speaker that's on the phone from the city of Scottsdale? So maybe that person can answer my question.

Yes. Thank you, Supervisor Resco. So I was allowing I wanted to have the board ask any questions of uh Mr. Linton first and then I was going to have the speaker come up. It's from the public which is from Scottsdale. But any other questions? If not then I'll have the speaker come up. I just one one

question for the Brandy. Uh to me when I've you know done the research myself on this the current literature and all textbooks say once a week. Is that correct? Yeah, it is a a common standard to have once weekly pickup and it it is the most common practice but our practice to do once weekly pickup according to the requirements requires a variance but it is it is the most common practice that we see across the state in other areas.

I have a quick one madam president. I think last time you said that we made money actually from the variances and yet right now you said we that will free up resources. Will it create a negative fund gap for us or will it increase our revenue there by taking this away? Yeah, there is a cost to the variances variance because there is staff time uh associated with the variance where we go out and and inspect a certain number of of of trash containers and so there would be some revenue loss but there would also it would also free up staff time to be able to go and do other activities and so there would be some revenue loss from the variances no longer being the variance uh payment no longer being required but it was not significant the amount it wasn't significant no

so it's almost a wash in a way staff time versus variance income. Madame chair, to that point, I'm going from memory. Wasn't it $15,000? Every city had to pay $15,000 for variance. Madam President, members of the board, it it depends on the size of the city. It we charge according to the number of containers that they use in the city. So, a big city like Phoenix pays $44,000 a year where a city like Scottsdale might pay something around $8,000 a year. Okay. And so, Madame Chair and Andy, you think that the benefits uh outweigh the revenue that's coming in? Correct. Thank you. Okay. Uh Mr. Bennett, would you like to

the record your name and uh where you're from? Sure.

Uh well, thank you, Madame President, uh board members and supervisor Leco. My name is Dave Bennett and I serve as a solid waste uh services director for the city of Scottsdale. Um uh yeah, I'm in opposition of changing the removal of the variant. So um as it I just want to clarify just I'm going to stick to just a public health issue for this meeting only and then we can talk maybe my comments that I made the email. So, as it stands right now, each year, cities across Maricopa County inspect tens of thousands of refuge containers to maintain their solid waste variance. It is if this variance goes away, cities will no longer be obligated to do these inspections. As you can imagine, most cities will stop doing these inspections and will re redirect their uh these resources to other areas. Please keep in mind the county does not inspect refuge containers. They only respond to nuisance complaints with regard to protecting human health from risk of vector born diseases. If this variance goes away, one could argue that we are now putting human health at risk of vector uh vectorborn diseases. Uh, President Osborne, board members, Supervisor Leco, as a reminder, Director Linton stated at the last board meeting, the last board meeting we had here, that the county can keep this variance. The county does have uh does not have to align their solid waste variance to align with the Arizona administrative code. The county currently has codes that are more restrictive than the state. Um, President Osborne, board members, and Supervisor Leco, if possible, I would like to ask Director Linton to explain how removing this variance will improve protecting human health in Maricopa County. Uh, with that, I want to thank you for your time and attention to this

matter. Thank you. Uh, before you answer that, would you like to address your question again?

Yeah, thank you. Thank you, Madame Chair and Mr. Bennett. So, in your opposition, you wrote that it would negatively impact participation in the curbside recycling program and it would have a negative impact on revenue. And I'm trying to understand it because if the city I would assume that if the city council decides to keep twice a week or however many times a week they could. Um, and so how help me understand your your rationale on this. Yeah, Madame President, board members, supervisor Lasco, I the word I left out of there could out of both of those could have an impact. So, keep in mind that all of the cities that maintain this variances um have had infrastructure built in place for 30 years. We've have people dedicated to maintaining this variance. And with our recycling program, one could argue now that we're only required to do once a week refuge service based on I know my fantastic citizens in Scottsdale, they may go, "Hey, uh, I don't want to pay for this. I don't want to pay for once a week service. That's all I want to paid for. So, I want to avoid this whole conversation at all. I don't want to go up in front of council and argue why, you know, the state did this, the county's doing this, and now we're here at this point where we have a group of citizens going, you know, hey, we want to we may want to uh look at our rates and define a special rate just for once a week. So, I want to avoid that whole conversation. And I think what we're trying to do is protect uh the community's health by doing this based on the last board meeting and hearing from Amanda, what's her name?

Bond.

Amanda Bond. Currently, the the county only responds to nuisance complaints. Keep in mind again, as I emphasized before, all of these cities across Maricopa County, you have all these soldiers out there inspecting these cans, and that's going to go away. I'm will it go entirely away? But I can guarantee you a lot of those inspections are going to go from tens of thousands to maybe a few thousand. So that that's that's my case here. And I I really don't think we need to do anything based on and if we can just go step back, the reason why the state did this, correct me if I'm wrong, Andy, is um we had a company called Envision Holdings and they they went to the state and uh convinced the state to do this. All of the stakeholders that were at that meeting were at this meeting before and we really weren't in opposition of that because one they were the state was raising fees 100% 500% even a,000% on some of these fees. We we weren't thinking the county would have to to do this to be honest with you. So that's why that's why uh there wasn't much opposition. Now why isn't there much opposition? We're not seeing seeing other cities. I talked to a few of them. They're not here and I can speak for them, but here's what I heard is this now frees up resources. I can now this is an obligation. I may or may not do that, but now it frees up resources and money. So,

I I thank you for your your input. Um, Mr. Linton, I don't know if you have this information available or not, but I it would be interesting to know uh the cities in Maricopa County. What is this? How how many cities are only one time a week already? I know my city is actually today's trash day and you know both recycling and regular plus Buckeye just went. So I know many in the West Valley are already one time a week uses or you know pickups but by any chance do you have that information of

I do madam president members of the board we we've issued 18 refuge collection variances. A majority of those are to the cities. There are a couple of private trash collection entities like DE like waste management and republic services that also have the variances. So, so I go to one time it's just one time one time and Okay. 18 out of how many cities? That that's the math that I I haven't Okay. Yeah. But it's my understanding that it's the vast majority of the all the major cities at least have a the reference collection. Understood. I see.

Yes. I do have another question of Mr. Linton. Um, when you go I assume this is correct since you just said it once a week could be both recycling and trash that's considered once a week. Yeah. So, in order to Sorry, Madam President. It's on the same day.

Supervisor Leco. Um what we propose the cities give us to get a variance is a plan to mitigate any public nuisances that could occur as a result of collecting trash once weekly. We don't prescribe what needs to be in that plan. We just require and follow up to make sure they're following that plan. That's where a lot of the cities have proposed that on their own to do recycling as a way of diverting some trash away from the main garbage container. Um, cities also propose to do uh inspections of a certain percentage of the can. Again, that's part of their plan. Um, one point I can make is there the cities right now under our current requirement could remove recycling and they could remove these inspections. They would just have to submit a new plan to us that would m that for their variance and then we would inspect to follow to make sure they follow that plan. And so it's on the table now. Um, if they want to change their variance plan, it could be removed. Uh what I guess what I'm asking is if um they pick up like I live in Poria, so they pick up the recycling and the trash on the same day. Would that be considered one pickup a week or two pickups a week?

We only look at the refu Sorry, Madam President. Supervisor Alaska, we only look at the the trash and the refuge collection. Not recycling under this requirement, not not recycling. So, it would be considered one. Sorry to ask you short answer. All right. Thank you. Um, Madam President, yes, I had a question. I think there's a I think under the current variance for Maricopa County, the city's obligated to have that that variance current.

We have to inspect a certain amount of percentage of containers every year. That isn't that isn't an option for us currently. If this goes away, we will no longer be a we will no longer be obligated to inspect containers. Is that correct?

Um Madame President, member members of the board, um the code does require when we issue a variance that the the entity give our staff access to inspect the containers and that and we we're supposed to inspect 1% of those containers a year. Um there isn't an obligation beyond that for a city to include that in their variance plan or their variance requirement. um it's included in a lot of the variance proposals that we do get and that's why often our variance gets associated with recycling but it isn't a requirement or prescription that we make to to the cities. How long do those variances last? The variances, Madam President, members of the board, the variances are renewed yearly.

Yearly. Okay. So if if this became an issue within the totality of Maricopa County, it's something that can be addressed as a stipulation into variances by the board of of supervisors saying, "Listen, um we're having real world troubles with this." And uh now any variance coming through does require a percentage of trash cans inspected annually. I mean, I I'm just kind of thinking, you know, futuristic. If that became an actual problem uh for Maricopa County, would that be correct? Would that be a a proposed way to be able to look at that?

Yeah, Madam President, members of the board, it wouldn't be a require It's not in the current I know it's not. I'm saying in the future if this became an issue if if Maricopa County realized that what Mr. Bennett is saying it's becoming a real problem. You know, I don't know, crazy rats are everywhere and so and the trash cans need to be this situation needs to be addressed. We could annually say, listen, we're changing this. These variances have to come up every year. So, there's a way to control that, but at the right now, it's a deregulation of sorts of things that are 18 cities are already doing. And so, um, I have my answers. All right. Any other questions? Yes, Mary.

Sorry, but wouldn't the variances be going away? Madame President, members of the board, yes, the variances would be going away. Thank you, Mary. So, that's the department would retain the ability to address public health nuisances. And so, if we started to get complaints about once a week pickup and these and that causing problems, we would still go out and respond to these public health nuisances. I would anticipate that if if the benefit of having a permit as we do have some cost recovery for addressing these public health nuisances and some oversight to prevent them. Uh so if we started to see a pattern of a lot of public health nuisances happening as a result of this, we could come back to the board and propose another regulatory change to add something back into our code to um to provide additional oversight. So that that option would be available as you described, Madam President.

Baron Cisco. Yes, sir. Just have one other question for Andy. Andy, how many current problems have we found with once a week in all these 18 cities? We had a lot of problems associated with once a week.

Madam President, members of the board, no, we haven't. We haven't. It's very it's very sporadic. And the argument could be made it's because of the result of the inspections. And um but we're not seeing those those those violations happen during our routine checks. And Madame President, members of the board, that's the point. The point is is that why you're not having those is because there's a variance in place and you have all these resources at your disposal via the cities that are doing this this proactive work for you. So again, my my thing is we do not need to do anything right now. We could keep the the same variance. No one not one city ever has come to you in the last I don't know I've been with the city of Scottdale 30 years. I've been a part of many meetings with all of the cities. No one has petitioned Scottsdale, the county, the state other than that one company. So to the point is why you're not seeing these issues is because we're out there doing the proactive work.

Thank you. And as a former city council member, I understand what you're saying and this really comes back to the cities itself and uh and what they have in their mindset of what's quality within their own city. Okay. Any last questions? Q. All right. So, uh, seeing none, I would ask for a motion or any further conversation. Actually, first I'll ask if there's any further conversation of board. Yes, ma'am.

Madam Chair, um, I do think that I'm just going to tell you my opinion. Uh I think that since it's up to the cities how often they want to pick this up and this is just a minimum. Uh the minimum is one they want to zero uh that they have to get a variance. Um and but if but if Scottdale or any other city wants five a week they could do five a week. And so with that I'm going to uh support this comments. All right. So I'm looking for a motion. I'll jump to extend the read. Appreciate it. Your motion.

Second. Thank you, Miss Har. Uh, all in favor state I I opposed. The eyes have it. Thank you, Mr. Bennett for Thank you. Uh, our second item, mobile home parks, recreational vehicle parks.

Madam President, members of the board, our next E-ROP case is for mobile homes and recreational vehicle parks. Um, next slide. Uh, by way of background, um, these regulatory activities are delegated to us by the Arizona Department of Health Services, oversight for recreational vehicle parks. And I often get asked why do these regulations exist in the first place? Um we are ensuring that the water any water supplied is safe and protected from contamination that sewage is disposed of properly and that other public health nuisances aren't occurring like uh flies, uncontained garbage and refues. Um and these are more likely to occur with recreational vehic because of the transient nature of recreation. Next slide please. What are we currently doing and what are we proposing? Uh so currently Maropa County Environmental Services requires permitting and routine inspections of all mobile home and recreational vehicle parks. Um mobile homes uh don't have wheels. Recreational vehicle parks have wheels. Uh mobile home parks don't tend to move. It costs quite a bit of money to put them down and they tend to to stay in place for a long time. Uh whereas RVs tend to be more transient in nature. So that that's the difference. And currently we inspect both types of parks. Uh what we're proposing with this change is again to align with the state requirements in the Arizona administrative code for recreational vehicle parks. So this alignment with state requirements will result in deregulation because we will no longer be permitting and inspecting mobile home parks that don't offer spaces for recreational vehicles. That's all the state requirements require. So we would be aligning with that. Next slide, please. Uh we held a stakeholder meeting on May 22nd. Uh one stakeholder commented in support of the changes. She appreciated the fact that she would no longer be required to have to process and pay for an annual permit. There were no additional questions, comments, or comments received either in writing or at the stakeholder meeting. Next slide, please.

So, in summary, the outcome of the proposed changes. Uh, so if the group changes are approved to proceed and the board approves these changes, uh, permitting and inspections will only be required for parks that offer RV spaces. And so there's a combination of parks out there. Parks that only do RVs. There are mobile home parks that offer spaces for RVs. So there's kind of a mix. We would only be involved in parks that offer spaces for RV parks. Um we currently permit 467 mobile home parks of all mixes and sizes and shapes. Um we estimate on uh according to our surveys that about 50% of those uh parks would no longer require a permit because they only have mobile homes in the parks. No no RV spaces. Um, any water or sewer infrastructure changes to those parks, regardless of the makeup of the park, would still require permitting through the department for water and sewer infrastructure. And if we did receive any public health nuisance complaints, as with our previous case, we still would be able to address those nuisance complaints just like we would in any residential neighborhood across Maricopa County. Slide, please. Um, so this case we because we haven't received opposition, this is our uh one and only meeting with the board of health. Um the next step would be to take it to the board of supervisors meeting which we tenatively expect to do on September 10th. Um next slide please. Our staff recommendation is to move forward with the proposed changes and again your vote today to approve this would allow us to proceed with the case to the board of supervisors. A vote in opposition would end the E-ROP case and the current requirements would remain in place and I'm happy to answer any questions.

Thank you. Questions of the board. pretty selfexplanatory. All right. If none then I would ask for a motion for approval to approve. Thank you. And a second. Second. All in favor state. I I So says I oppose. The eyes have it. Thank you. Right. Our second item, campgrounds.

Campgrounds. So, the the third E-ROP case is to make changes to our campground requirements. This will start to sound like a little bit of a broken record. We're looking to align our requirements with the state requirements that changed a few years ago. Um, so Maropa County, uh, we regulate campgrounds through a delegation agreement with the Arizona Department of Health Services. Uh, why do we regulate campgrounds? for the same reasons as we do uh recreational vehicle parks because of the transient nature of these these uh entities. Uh to ensure the water supply is safe and protected from contamination, sewers disposed properly and that there aren't uh public health nices occurring at campgrounds across Maricopa County. Slide please. Uh currently uh the requirements in the health code are vague and outdated. Um and I put an example in here. The definition of a campground says that a campground is any tract of land on on upon which persons can camp or picnic and and so you you just in your heads wherever you see a picnic table technically according to the letter of this law we would be in green belts in all the city parks issuing campground permits. So just one example of how these requirements are are are are outdated. So our proposal to provide clarity to our customers and to our staff is to align with the Arizona administrative code. And I apologize there's a typo. says for recreational vehicle parks, I should say campgrounds. And the purpose is to really provide regulatory clarity for customers. Next slide. Again, held a stakeholder meeting on May 22nd for this E-Rock case. Uh we didn't have any stakeholders attend the meeting on May 22nd. Uh the county has uh nine campgrounds, nine campgrounds currently permitted within the county. Six of the nine campgrounds are for Maricopa County Parks. uh Maropa County Parks had an emergency happen on May 22nd when we had the stakeholder meeting. So we had a subsequent meeting with them where we just met met with park representatives on the 30th and we didn't have any oppositions or concerns from parks on on the changes and nor did we receive any

written comments through the website um in the process. Next slide. So to summarize the outcome, if these changes were to be approved, they would have the following effect. It would provide clear definitions for campgrounds and camp sites to help customers determine when permitting and routine inspections are required. Um add add regulatory clarity regard regarding plan submitt requirements. And there would be no impact to the current nine uh campgrounds currently permitted. So in other words, this wouldn't impose any new requirements for any of the campgrounds have to install new equipment or do anything differently than they're currently doing. Slide uh timeline of the process. Again, we didn't receive any opposition. So this is on the expedited track of the E-ROP process. We're here at the board of health meeting. The next step would be to go to the board of supervisors and the staff recommendation would be to proceed with this case. Uh a vote in favor would allow us to proceed to the board of supervisors. A vote in opposition uh would end the e-ro case and the current requirements would remain in place and happy to answer any questions.

Thank you very much. Yes, madame chair and Mr. with this change um reduce our ability to enforce uh against homeless encampments or protester encampments. Um

very good question Madam President for Leco. It would not. Um, typically those are addressed through nuisance other nuisance statutes and also other other laws and ordinance like trespassing are typically the laws that that usually are forced when it comes to those type of activities. And really the intent of this I was a part of the stakeholder process at when they changed the rules and they clarified the rules and the intent all the way along was for recreational camping not for other types of camping and I think the language in the rules uh reflect that reflects that.

Thank you. And so, um, Madame Chair, and right now I don't think they allow, um, camping at, uh, Lake Pleasant anymore. Is that correct, Scott? I don't think they allow camping. Does that have anything to do? Yeah, shore camping. Have any impact on that or enforcement on that or anything like that? Madam President, Supervisor Leco, it would not.

All right. Thank you. So along those lines, um something that I've noticed a great deal of and we come back to clearer definitions between campgrounds and camp sites. I think campgrounds to me is is an organized area of allowing for camping and uh and has those kind of amenities that people may need that you that we're discussing here, campsites. Um, what's more curious in my mind and along what the supervisor stated was I have been seeing and I hate to use the world wildcat, but you see where especially when it's snowbird time, people are coming in in droves in RVs and they're just there and and it looks like it's on county land. I don't know that it's necessarily a city or it's a um they may be there longer than a few days that they're not actually camping. What What is How does this kind of uh define that definition go to what I'm talking about? How are you I guess by law um finding those situations?

Yeah, Madame President, members of the board, that's a very good question. Uh the state law exempts something called primitive campgrounds. So, if there aren't services readily available in that area, they're exempt from all of the the other camp gum requirements. Typically, where we see those types of RVs just parking out on land in the middle of nowhere is on state trust land. And so, we work closely with our state partners and they would they'll go out to make sure they have the proper permits. And if they don't, then typically there's some type of a trespass action taken against those.

Has it increased? Is it just me seeing it? But is it has it become a nuisance at all? Madam President, members of the board, in my time, I've gotten more reports of that. I I my last uh role as on budsman for the county, I I definitely saw an increase over the last, say, five years in those types of reports in different areas of the county. Thank you. Any other uh President Osborne, really quickly, and my my my apologies if I'm loud, I'm trying to whisper now.

It's not your fault. Thank you, Lorenzo. Um, where does uh um race uh race week at Phoenix Raceway fall into the last two uh agenda items? Uh just wondering if uh Aenddale falls into that. Yeah, the county because that would be county property. Yes.

Yeah, very very good question, Madam President, members of the board. Um there are temporary setups. the the the intent of these rules is where someone has designated land for camping and they're offering campsites. That's specific uh from the language in the rule. In those cases, those are usually temporary setups. Again, the county would go out as a part of their routine uh special event types of inspections to make sure the facilities were provided. uh where you have a lot of RVs gathered, it could even uh rise to the level of being an RV park according to the last case that we we talked about and permitting might be required in those cases, but it's very situational. It depends on if they're all on one property owner's land or if they're spread out across the street and rights away and different things. So, every every situ it's a little bit situational depends on how how they're set up, but there is potential to issue either an RV park permit or a campground permit in those in those scenarios if they're set up for uh less than 30 days. That's good question. Uh, Lorenzo, thank you very much.

Okay, else to approve.

As written. Second. Second. Thank you. All in favor say I. I. Post. The eyes have it. Great. Thank you, Mr. That was it, right? Oh, no. One more. Sorry. Okay, last one. Public and semi. Oh, bathing. And I'm so happy everybody bathed this morning. Such an outdated term. It's like going to

I know. You have to really want it. Um, Madame President, members of the board, um, the last EROP case that we have today, and I appreciate your patience in hearing all these cases today, is the variance process for bathing places in Maricopa County. So, the design and construction of public and semi-public pools are delegated to the department through the uh, Arizona Department of Environmental Quality. U, public pools, I think everyone understands pretty well. Semi-public pools would be pools you'd see, say in like an apartment complex. It isn't open to the general public, but all the residents of that facility can go there. Those are all regulated by the county. Uh regulatory oversight ensures that the safety assures the safety of you users by maintaining water quality and preventing accidents and potential health risks to Maricopa County residents. That's why we do these activities. Uh next slide. A little more background on the variance specifically. Uh the Maroba County Environmental Health Code and the Arizona Administrative Code both allow uh for designers to submit for a variance to the requirements that are in the code. Uh and a variance is an approval or waiver that offer authorizes the deviation for one of the more one or more of the requirements if a health hazard, safety hazard or nuisance will not result from the deviation. Next slide. So currently and the reason that we're here so currently America the parameters for us to be able to issue variance is very narrow. The language in our code says that we can only issue a variance for requirements in our code that are more restrictive than the requirements in the Arizona administrative code. And so that really limits the types of things we can issue variances for. What we're proposing is to align with the parameter in the Arizona administrative code. And that alignment is in that second the last bullet point. It allows for a variance upon demonstration by an applicant that an alternate design material, a pertinance or technology is equivalent to a requirement in the code. So basically you can ask for a variance for anything as long as you meet those those parameters that are outlined here. And I have to say that in practice, this

is typically what we've been following is the administrative code anyway. Uh because uh we have so many forward-thinking pro projects here in Maricopa County. The VI resort is a very good example of that in the West Valley where they have these ideas that we wouldn't be able to issue variances for unless we were following the guidance in the Arizona administrative code. So, in a way, this proposed change is really just to clean up our code so that it mirrors what we're what we're actually practicing out there. Uh, next slide. We held a stakeholder workshop on May 20th. Six stakeholders were in attending industry and local municipalities. Uh, there were no questions, concerns, or comments uh throughout the ROP process on any of those changes. Next slide. So, a summary of the outcome if these changes were to take effect. Uh the department's proposal would update the language to mirror the Arizona administrative code. Uh the alignment would provide regulatory clarity and remove that narrower parameter that we currently have in our code to allow these projects to move forward like the virus or because we didn't receive any opposition. Next slide please. This is also on the expedited track. So the next step would be to go to the board of supervisors tenatively on September 10th. And so the staff would recommend to move forward to the next step in the EROP case and a vote in favor would allow us to proceed to the board of supervisors and a vote in opposition would end the case in the current place. I'm happy happy to answer any questions.

You and thank you for the uh example of the the vibe. Any questions or apologies? motion. Favorite thing to do. All right. Thank you, Mary. Second. Thank you, Veronica. All in favor state. I opposed. Eyes have it. Now you can go.

All right. So, next number nine. Oh, those little mosquitoes. Last viral my virus a update. I lived in Fairbanks, Alaska when I was nine years old and I had a sweatshirt that said welcome to Alaska and a big mosquito in the center of it rubbing its little hands. So what they get you anywhere they can welcome you presentation. Yeah. Uh so yeah, I'm Melissa Crusher from the epiologist here with public health. Uh, I've been physician since 2019, I think.

Don Townson. I'm the vector control division manager. Work for environmental services and been here for 34 years.

Uh, so yeah, we're going to review Westnile. Yeah, keep review Nile Maropa County from the human health and vector side. So, I'll take care of human health. Um, so yeah. So, Westnile virus is an arboiral virus, meaning it's a virus transmitted by mosquitoes. Um it in in the US it is the most prevalent and widespread widespread endemic arbo virus. So endemic it up here in in the United States not from another country. Um and we do have it in our mosquitoes here. Uh we typically see on the human side of things human case counts rising week or two after the mosquitoes start testing positive. And John will review mosquito surveillance and all of that slides. Um, and that's just related to the human incubation period. Due to our climate, our West Nile season is April through October, but you can have transmission even outside of that with out of season cases. Uh, next slide, please. Looking at transmission, it's primarily maintained within the birds. The mosquitoes, the birds are the preferred uh food source for the mosquitoes. So, they'll pick it up from a bird, uh, get infected, then go and spread it to another bird or to another mosquito. Um the figures on the right, the horse, the family, the dog are kind of what's called incidental host or unfortunately a dead-end host. Um meaning the virus stops with them. So a mosquito can give it to a person, but they cannot pick it up from a person and spread it to another person or mosquito. Um there is also transmission through blood transfusions, blood or organ transplants. Um however, that's greatly decreased since they've started surveillance on that aspect I think in back in 2003. Um and you can also have some transmission from a mother to baby either during the pregnancy, partration or birth. Um or next slide please. Looking at symptoms. Um so if you were to look at 10 people infected with the virus from a mosquito, uh eight of them or 80% would never develop symptoms.

They'd probably go about their life never knowing they were infected. That blood donation screening network that I mentioned does pick those up though. So we do know what's possible. And whenever they do have a positive, they let us know so we can reach out to those people, find out if they had symptoms, and also provide education. But we do know it's uh looking at the people who do develop symptoms, the majority of them is a feebral illness. So fever, chills, headache, bodyaches, rash, uh pretty short, maybe about a week or two in um how long it lasts. And often those people might not even be seeking care. um either they manage it at home uh with their fluids in bed rest or uh maybe they do go to the the doctor and the doctor says it's a viral infection, right? How many people have had that diagnosis? Um so we don't tend to find out about the the symptoms the feebral people. What we do find out are the more severe presentations the neuroinvasive disease which is the least amount. Right? So if you look at 150 people infected less than or one of out of 150 people infected could have that neuroinvasive disease. Anyone can become neuroinvasive but it is more likely in those over the age of 60 and with underlying medical conditions. Um but it's usually uh encphilitis so that altered mental status or menitis where you have that bad headache sensitivity to light and your neck is so stiff you can't touch your chin to your chest. Uh next slide please. So since uh Westnell arrived in Maropa County um we have had three what are called outbreak years. The first year in 20 2004 followed by 2010 and 2019. Um overall the sorry the darker parts of the bar are the neuroinvasive component. So again you can see that trend of more of neuroinvasive than febral um is being reported to us. Um and overall since this arrived up to 2020 the average number of cases would was 87. And then next slide

we ask questions per slide or do you want us to wait till the end and go back? Um would you prefer to take Sure. Go ahead. Thank you Madam Chair. Ma'am I'm trying to understand uh the last chart um the pyramid. Yeah. And so uh first of all is the reason that these are oranges because they were the highest prevalent. Is that the reason? Yeah, there are outbreak years.

Okay. And then my my question is and maybe I'm in I must be interpreting this wrong. Let's say 2019 it says 77% of the cases I think it means that they had they were neuroinvasive. Is that what that means? But in this chart that you had the clinical spectrum, it said less than 1% are neuroinvasive disease. So help me understand.

So the pyramid is what is possible and then this is what we see. So we like I said um people who have the feebra illness don't tend to go to a doctor. So we only find out about cases if they are laboratory diagnosed. So there has to be a lab test done by a provider. So when they have the fever, they um don't tend to go to the doctor as much as you would for someone who has neuron invasive and those symptoms are a lot more severe and need hospitalization. So it is um they often say that we only see the tip of the iceberg with Westnau virus. For every one neuroinvasive case, you can assume 150 other infections.

Okay. So um madam chair and ma'am so what you're saying is the ones in this chart are the detected ones which were the 1% that you see but there of those 77% are neuro invasive all of these are detected so we do have people get diagnosed with um febral illness so of the 155 cases that were reported in 2019 77% of them were either encphilitis or menitis question really but that's okay. Do you have another question?

No, I just didn't understand the chart said minus negative you know less than 1% and this is 77%. So I think what you're saying I think what you're saying is that you hardly see any the people in the 1% are the ones that you're seeing. Yes. Next chart is I think what you're trying to say. All right. And I'm gonna have a question on the next too. Okay. I started speaking on that one yet. No. Go ahead.

So yeah. So then 2021 happened and we had an unprecedented year where we had 1,487 cases um reported to us and that did represent more than half 51% of the national case count. Um you know that was the a figure uh we consulted with CDC both during the season and after kind of kind of trying to figure out what happened in this year, what was going on and I think John likes to say it was the perfect storm. Um yeah, we had uh nice temperatures for mosquitoes and humans. We had a lot of rain with rain and stand that leads to standing water and with that that attracts birds and mosquitoes. So with all those lovely attributes for us for that year, we had large numbers of birds coming in to help amplify the virus and large number of mosquitoes to help spread it across the valley. So it was just uh numbers we've never seen for mosquitoes and infection rates we haven't seen for mosquitoes that kind of led to that large outbreak that year. you had a question on this one.

I have a question on a lot of these. I'm sorry, but it's interesting. So, the key question I have is why so many cases in Maricopa County? Like you had on this chart in 2021, Maricopa County represents 51% of the national case count. The next um one that you don't have up yet, it says Maricopa County cases account for more than 75% of the cases in Arizona. So, I grew up in Wisconsin. Lots of lakes, lots of rivers, lots of ponds, lots of uh rain, lots of everything. You would think that there they would have we we did have mosquitoes. We had lots of mosquitoes. You Why Maricopa County? It's so dry. I don't understand.

Mosquitoes like it here. Mosquitoes like it everywhere.

Um yeah, it's it's a combination. um warm nights, standing water. It only takes a few days for the life cycle to go from an egg to an adult because it's so warm. Um lots and lots of hiding spots, breeding spots, um you know, underground pipes and under roads and storm drains and different things. So, there's a lot of water throughout Maricopa County that just driving down the road you don't see. Um, you don't know it's there. Uh, but the mosquitoes do and that's where they breed. And especially if you have, you know, for the last two years we had almost no monsoon rain. So, when you look at the years where there's no rain, there's no mosquitoes that are showing up. But that particular year in 2021 there was about every three weeks there was a storm that came through and it was I think it was the third or fourth wetest monsoon that we've had since they started you know keeping records. So the perfect storm was that we had lots and lots of standing water not only all over the place but in people's backyards. Um, lots of breeding going on, lots of birds getting infected and infecting more mosquitoes, amplifying that whole thing in nature, and then that big giant spill over into the human population.

Madam Chair, I I understand what you're saying, but I'm telling you, I lived in Wisconsin. There are tons of mosquitoes. My husband lived in Florida. tons of mosquitoes because it's humid. It's hot. It's hot in the summer in Wisconsin and in Florida. So, all of the same thing applies except there's a lot more water there. And so, I was wondering, is it because we don't do as much fogging? I I'm like trying to understand why Maricopa County in the middle of the desert, you know, we don't have natural streams and creeks and all that stuff. uh you know it's it's dry here. I it doesn't make any logical sense to me and the only thing I could think of is we don't do as much uh you know fogging or something.

We have two species of nighttime biting mosquitoes that um are the vectors for this disease and they're very prevalent throughout Maricopa County. Um, one of them is more associated with farmland and, you know, areas like that. Uh, the other is more associated with urban land. Um, they're also associated with, you know, flood waters and um, swimming pools that aren't maintained. Um so we have a large amount of the mosquitoes present that can pick up the virus and transfer it to birds to amplify and then to to go to people. So we talk about it's it's more about the quality of our mosquitoes not the quantity. So, so Madam Chair, so what you're saying is our mosquitoes have the West Vile N West Nile virus more so than in a wetter climate.

There's a lot of West Nile virus in Florida and Texas and and other areas that are, you know, but we get the share of it. Seems like we get more the line share of we again. Yes, we compete every year. Yes. Uh, welcome Dr. Fan again. Nice to see you.

Yeah, thank you. Uh, President Osborne, Supervisor Leco, I would just add that, uh, I grew up in Michigan, and I think the behaviors of a lot of the residents that grow up in that climate that are used to mosquitoes and bugs. I know I got sprayed down with mosquito repellent by my parents every time I went outside. That's a lot less common here. I raised Arizona kids and I don't think I ever sprayed them with mosquito repellent. And I should know better. I'm in public health, but I think it's some of the human behaviors that we also see the higher rates in um in Arizona and also um as they have mentioned the standing water and the things that happen with our monsoon season are in highly densely populated areas. Whereas when we're seeing them back east and you know in Wisconsin, Michigan, those sorts of things, you're uh more rural located. um you don't see as much of the kind of behaviors because their rain drains easier into the grounds in in populated cities. They have different um when you see rain back in uh uh Detroit, say compared to um of Phoenix, it's not the same kind of behaviors that are seeing with running waters and lots of standing water around um because of just how those cities um deal with climate differently than they do back here. So, I think part of it is the type of mosquitoes we have. Um, and also the behaviors of the humans are a little bit different.

I'd like to see rain. Yeah, be nice. Sure. Yeah. All right. Continue on.

Uh, so yeah. So, since 2021, we've had some lower years. I guess everything's going to be lower compared to that going forward. But um overall we do account for more than 75% of the cases in Arizona. Part of that is that's how much of the population we kind of have here. We have about 60 or 70% of population in Arizona. And also speaks to strongly our provider awareness to know to look for the disease um and and do the testing for it too. Uh next slide. Where are we now? So these slides were made about two weeks ago. Um so it's a little out of date. At that time it was 18. It's 26 now and we have um 26 human cases identified um or reported to us and about nine under investigation. Uh so the graph orange is current is this year gray I'm always thinking about 2021. So the bar graphs are the human cases which are itty bitty at the bottom. Um and then the line graph is the mosquito vector index which I'll just say high level just shows you how infected the the the mosquitoes are with Westnile virus. Um, so we're kind of plotting along, but you know, it all depends on what the rain looks like coming up um for the rest of the year, the monsoon season. But our mosquitoes did start testing positive around miday. Our human cases started showing up about a week or two later. Um, and then our peak was uh the week mid June for so far for human cases. So thinking about with John and I, we reach out on a weekly basis just to start see do we need to meet make any um decisions regarding communication and all that. Um that is where we are right now. Uh next slide and then yeah John will go into more details about the mosquito surveillance system. mosquito surveillance. Um 846 surveillance traps are set every single week throughout Maricopa County. Um that is from a a web page that's available to

residents who can go in, look at the map, try to find, you know, closest um site to their house. Um we monitor that, like I said, on a weekly basis. And based on the surveillance that comes in through those traps, we can either set up fogging um or we can keep track of positive virus that are in the mosquitoes. So you can go to the next slide. This is a internal virus activity map that we keep track of. And this couple weeks old are the cases of positive West Nile virus mosquito samples back that we've collected in Maricopa County as of you know like said a couple weeks ago slide. This is the inspections that we do for mosquito breeding, which is basically street drains, drywalls, you know, all these places that talked about where mosquitoes, you know, like to breed and where water collects. Each one of those red dots is a monthly check that uh field staff go out and look at all those areas. If it's wet, we treat it with larbides. Sometimes if we know that it's going to rain in the next, you know, week or so and that's a lowlying area, we'll go ahead and treat it. Calls a pre-treat. And so there's almost 4,300 of those every single month. And that that number

year after year continues to kind of grow just because we've got new subdivisions going in. We got new areas that have houses that, you know, used to be maybe out in the desert or, you know, in different fl. So that's kind of a a number that that continues to grow, but that's that's done on a monthly basis. Like okay, this is our mosquito management map. This is the same. These are just different colored circles that uh from that other one. But look at this on computer to the fight the bite page. And so next slide. It'll it'll zoom in. Another slide. Next slide. And you can zoom it down to a neighborhood type spec. And it'll tell you the trap number if you click on it again, which I I didn't put another slide in because I thought we were going to try to, you know, but it'll tell you the last time that that crap was inspected. And it'll also show you the last time that the that area um was fogged. So, want to go back one more previous. You'll see the different colors. So purple purple was uh 2024 and currently the orang-ish color was 2025. The darker the shade the more times that area has been treated with adulticide with fogging. Um so that that's part of that map too. Uh, and if you if you clicked on one of those that uh, you know, had fogging done, it would tell you when the last time uh, we bog that square. Each one of those are a square

mile. It's a whole square mile area. Whenever we do next, it is a weekly report that we put out. Usually once we start to get positive mosquitoes and starting to get a little bit warmer. This is a weekly report that we do for positive West Nile virus mosquitoes. We also do another one for positive St. Louis on. Um so it shows you the last two years and kind of how it was for the last two years and then what we're seeing in the current year. Um, like Mel said, we've got a vector index that tells basically how how infected our mosquitoes are that we're seeing that we're collecting on a weekly basis. And in the past, anything once we started getting above a value of three, we would start to see human cases about uh two to three weeks after we saw the mosquitoes.

You would see the human cases. So, we use three as kind of a trigger that whenever I see a three from our our lab, I call Mel and say, "Hey, you know, it's hit a three or you know, you can see the weeks before we're at 2.69. We're getting close." You know, um we do have fluctuations. You can see it went up to six and then back down. Um for the last two weeks we've been below three uh which aren't on here. This was done but uh it will fluctuate. Um we've had values as high as you know over so you have viruses mutate and that's Nile mutates. In 2010, there was a mutation that they called it um AZ10. It was because of our outbreak. Uh it was Arizona 10. It was different than the original strain started in New York. Um in 2022, we had another mutation. And so for the last two years, we've had this West Nile mutation that's a little bit different than we've seen in the past. Depending on how everything goes with humans and with vector index, we may be thinking about wanting to adjust, you know, where our vector index is kind of, you know, is three still good or should we go two and a half, you know, something like that. So, that's something that we're going to talk about probably in the future.

So speaking about yeah speaking about communication um so after our unprecedented 2021 season we did approach CDC Centers for Disease Control to ask for assistance in developing a communication toolkit um based on human case counts uh mosquito information and climate stuff. Um, so we gave them a data set of all of our cases since 2004 to 2021 and they reviewed it for patterns um to try and give us some what we call triggers for uh for communication. Um, this timeline kind of summarizes their findings. Uh, items in orange are when vector and epi meet uh to touch base on what we're seeing and uh what we if we there's any strategies we need to do jointly for communication. Um blue are triggers of to send out communication and that can be either mosquito, human or even weather as you see with the first rain. Um yellows represent holidays and those are kind of our own. Historically we've always increased social media during holidays because we know people are going to be out swimming. So we just remind them to um protect themselves against mosquito bites. Um and then we've developed based on this we do have an internal uh surveillance or yeah aberration detection essentially uh of monitoring all the human detection the human triggers um and we review those on a weekly basis and then we do have birectional communication with vector on a weekly basis as well sending each other I send them my case counts um and they send me their their vector information. So, next slide. Uh, then speaking to that toolkit that CDC provided, um, it was like a package deal, um, with pre-developed messages that we can use when we need them. So, we don't have to think about creating something. We can just copy and paste um, relate relates to the virus prevention um, and control. And then they also identified the communication platforms that we can use from community

outreach to media or social uh, messaging. Um, and then they linked all of that to when to do it. So, for example, the like when we start seeing mosquitoes test positive, we could do a press release or email notification to partners and and in increase our community events. Um, but for the first human case, we could do those same tactics, right, to have the broad message, but that also because we're with public health, we'd include a health alert to our providers to make sure they know the season has started so they know to start looking for it. Um in the past we've also partnered uh to create a module for providers to take uh so they can learn about diagnosing Westnile virus. Next slide.

Okay. So couple years ago we were able to get a vector control educational outreach specialist. um they've been reaching out to schools, HOAs, just all different agencies. Uh so this last fiscal year um at 154 community events uh doing either table uh presentations uh or given out to different types of promotional items to to the people over 84,000 residents. Um, so got kind of cut off, but there's a a toolkit just like the CDC put together. We worked on our own toolkit. Um, yeah, next slide. Um, next slide. This is the toolkit that you'll see on the the bike. Click on mosquito toolkit. There's all kinds of different tabs where can either be for communities or for municipalities. Um there's media on there. So there's like short little video clips if you want to add something to like a social media post. Um there are social media areas in there that you can um draft posts and messages that can be copy and pasted. with media, with pictures, things like that. Um, slide. This is what the toolkit looks like whenever you're on the communities. I did bring um

a promotional No, these are these are door hangers like uh you can request a door hanger if you're an HOA and you want to have a meeting and hand these out to all the residents. Uh we have two different ones. We have one for nighttime biting mosquitoes, which is the cullex. And then we have another for basically the daytime biting 80s egypti um newer mosquito that was introduced about 20 years ago into Maricopa County. It's the little black and white ones that bite you down around your feet and ankles all the time. Those those came from they weren't native to Arizona. Let's put it that way. Um, I have a question.

I'm from more humid areas. Questions. Miss Williams. Madam President, Mr. Townsen, can you describe the different diseases that those mosquitoes carry because they carry different diseases. Correct. Correct. They um 80s egypti is associated with dangi fever, chicken, and zika virus also yellow fever. um black and white ones. That's the black and white. The ankle biters.

That's the That's the ankle biters. They're associated with those diseases. Um they do bite um during the daytime unlike mosquitoes that can't transmit um Westnile virus. Say if I'm sick with West Nile virus and a mosquito bites me, nobody else can get sick from that. If I have dangi fever and an 80s egypti bites me and picks up the virus, it can infect another person. So it can go mosquito to human human again. So um so yeah, that's the diseases that uh it with Mr. Kenny. Madam President and uh I'm sorry I can't see your name from here. on John. Uh obviously this problem is continuing to increase and to note what supervisor noted that Wisconsin is there anything that enhancements and cost effective enhancements we could do with storm water to prevent this continued rise if we're having drains that are open with things or I know in my neighborhood when the water rushes down it fills the park up for four days.

Yeah. It's just asking for it. Is there ways water retention? Yeah. Water better, you know, cost effective.

Yeah. And that and that is basically a a newer design that, you know, in the past 20 years, you you didn't see a lot of, you know, basins for different subdivisions. Now, subdivisions are required to collect all the water within that subdivision and not let it flow off site. So that's why you get these big retention areas. We do have in the Maricopa County drainage manual statement that says, you know, any collection of water needs to be gone in 72 hours. Now, that doesn't always happen because of either the amount coming in or, you know, hardpacked areas, areas that uh, you know, don't percolate and and so you do get that standing water. and our only option is to work with the homeowners association and try to get them to treat that on a regular basis whenever there's whenever there is water standing in that in that area. Oh,

so I'm curious of the different uh and and maybe there's not really one source to point at, but do you find I mean we have we still have a lot of agriculture. We have a lot of you know irrigation type of flooding just even for um farms for homes you have still canals. I mean that water is running so it's not necessarily sitting there. um water retention areas. Obviously, hopefully they're drained by 4 days, but um do you see more of an issue with the green pools versus, you know, an irrigation pool that's constantly monitored and have, you know, you guys are always probably watching them versus, you know, a million homes with pools.

Yeah. the harder the the 4,000 plus sites get monitored on a on a monthly basis. Those are your form drains, your dry wells, places like that. When you have mosquitoes coming out of say uncap swimming pool, those are complaint generated. So, we'll get a complaint from the neighbors and we'll have to go out and investigate, find the breeding source, and abate the problem. What's your What would you say is your number one breeding source? Can you pinpoint that or is it spread out?

Well, we have over 9,000 square miles that we're in charge of. So, you know, that that's another little difference between, you know, a county in Arizona and a county in, you know, Ohio or Florida. They're the size is huge. Um, we get a lot of a lot of backyard breeding. Um there's a lot of information on all of our messaging to tell people check your backyard because if you're getting bit by mosquitoes most the time it's probably coming from your own house you know or very nearby. Um, but you know, almost every time we go to those 4,000 plus sites, they're usually breeding. And that's why we use a larvite that will last for 30 days so that by the time we get back out there again, you know, we're we're not letting them come off as an adult. Um, but yeah, I if if you went out in the field with me, you'd be amazed at all the water that you don't see right now. And you can go to a park that has rip wrap or rocks that are stacked on top, you know, where it comes off the street. You can pull those rocks up and there'll be mosquitoes breeding in the water underneath those rocks. driving by, you think your park is completely dry and you know everything's fine, but uh yeah, there's a lot breeding sites and a huge area to monitor.

Oh, thank you. Did you have a question? Yes, I do have a couple questions. Why is it called West Nile virus? Did it start in Egypt? And next question. Then that would go with Arizona. Yeah. Yeah. And the other question is, what do these traps look like? I'm curious. I'll have to do a write along.

I I I got your question and I printed one out. Uh but I'll explain it. It It's a basically a gallon jug that like an igloo, you know. We drill holes all in the bottom of it. We fill it up with dry ice. So the dry ice comes out of those holes and the mosquitoes because every time you take a breath out you you emit CO2. So dry ice is you know CO2. Mosquitoes think there's some you know huge animal there. They're going to come get a blood mill as they come flying around with CO2. There's a fan right here and then there's a net and the mosquitoes get sucked into the net. So that runs all night long and then in the morning crew will come pick it up, bring it back to the office. We sort the mosquitoes out and our uh internal lab um tests for West Nile and St. Louis and sephilitis. So I printed that out just for you, but it's not in color.

And and where did the name come from? West Nile came from the West Nile Valley in Africa. Yes. Same with Zika. It came from the Zika Zika forest, Africa. Have one more question. Yes. President and Supervisor Leo. I was going to say I have one of these at the end of my street. Just happens to be there. It lives in a tree. You wouldn't know it was there unless you were looking for it. I only know it's there because I see the Maricopa County truck. Um the person can go to collect it every now and then. And I'm always weirdo waving. Thanks. Well, lucky you, Miss Williamson.

And West um I believe if I'm correct, if I remember, they the West Nile virus got to the United States from horses that were imported from Africa. I believe originally it showed up at the Bronx Zoo and they thought it was from uh probably a bird that you know came across the Atlantic. Okay. But but that the Bron the Bronx Zoo was the very first place that the animals start dying from this new virus which was west. Yes. One last question. Um is it known that asymptomatic uh people who had an asymptomatic infection have antibodies?

Yeah, they usually do develop antibodies. So if 90% of people have bestile virus wouldn't get it if they get bitten. If you're infected period regardless if you develop symptoms or not it is thought to offer lifelong protection once uh you have chances are

yes madam president I just have one more question. Do you have an estimated uh count of people that are infected whether asymptomatic or symptomatic? That's probably very tough to judge, but in the Maropa County, I don't have that estimate. Um I mean, yeah, you'd have to have a serial survey to do that. Um I think the latest CDC report did have an estimate for the entire US. I don't Thank you for all the goodies. Oh, yeah. Part of part of the outreach program.

All right. We appreciate it. Thank you very much. Thank you. The mosquitoes bite me every morning. Got the one the Yeah, the daytime biters. Oh, daytime biters. All right. So, for our final item Oh, wait. Did I miss something? Oh, I'm sorry. I can't just write. I apologize. Okay, let's hear about the heat.

Yeah. Um, so I'm going to give a just a brief update on heat. Um, we're going to do a larger update at the next meeting when we have more information, but just wanted to do um to give you some information on what we're doing. Um, I hope you're all enjoying a mild summer because it is not as hot as it looks here now. It's starting to be reflective in our numbers. So, we're all very excited about that. Um, our dashboard is live. I hope you all had a chance to look at our excited to announce it's now a nationally award-winning dashboard. We were uh given a model practice award at the National Association of City and County Health Officials just last week. So, our staff was very excited about that. Um we have about 258 pooling centers around Maricopa County that uh we're working with in one way, shape, or form. And this year, our board of supervisors has committed uh more than 2 million in ARPA dollars for us to continue funding cooling centers in our big cities, Chandler, Phoenix, Tempe, Glendel, Mesa, along with um some of our nonprofits. Um and we're also spending about 1.2 million for other u from other public health grants to support uh heat relief efforts, including uh Solari. Solari is our partner again this year and they're answering heat calls and providing transportation to cooling centers. We'll have more information about that towards the end of heat season. Um, one of the things we're particularly uh proud of is that we've reduced the average cost of rides from $16 per ride to $9.50 per ride this year. So, we're getting people to cooling centers at um more inexpensive rates. Uh we're also making behavioral health connection to riders. Solari is doing that when people call trying to get them into care if they

need that. And we're also uh collecting um data from those riders. What we want to understand is if uh they are Medicaid members because long term we'd really like to get the Medicaid health plans more engaged with their heat response. So we're tracking uh who those individuals are and at the end of heat season we work with access to do a cross match to understand um how many access members we're providing transportation to and our hope is to go back to those health plans and get them to work more collaboratively with us. Um so a few other things that uh we're working on. I hope you've seen the billboards on I 10 and and other freeways around thanks to our uh county office of communications. Clear channels donated all those billboards. which are really cool. They say whatever the temperature is and that's the many reasons you could call 211. Um we've distributed over 21,000 211 cards. So if anyone's interested in 211 cards, please let us know and we can get you some. Uh we're also distributing substance use and heat brochures. Really trying to help people understand the dangers of using substances in our heat. Um we've distributed about uh 12,500 of those. Uh we have done a lot of media interviews. Most of it was is with Dr. Nick Stab who couldn't be with us today, but we've done about uh over 50 media requests since January on heat alone. And um something else we just did recently that we're very proud of is we did a webinar for our all of our partners on addressing substance use in substance use risk and extreme heat. And uh we had about 330 people register and 220 um actually logged in that day, but we're sure that many of them will log in after the fact because we made available. So, we have also distributed

more than a 100,000 electrolyte packets because I what we've really come to realize is that water is great, but water is not enough for people, especially those who are um who are homeless living on the streets. Um St. Mary's is helping us with water. And so we've distributed about um almost 12,000 cases of water and um just worked with um continue to work with partners um most recently we are working um with our epidemiologist to look at hot spots around the county and then we're working with uh street outreach such as Circle the City to then go out into those areas where we're seeing maybe more um heat related illness or heat related deaths to see if there's more impact we can make on the before people end up dying. So, that was just a little flavor of what we're doing for heat this season. Happy to answer any questions, but like I said, we'll come back with a a formal presentation like you saw for West Nile the next week.

Thank you for that. And I and I had asked that this be on the agenda just because we're in the midst of it all and I think it's good to hear about what's going on. And I know that, you know, it's a little premature because you'll have more information when once we're out of of the season, heat season, but I just thought it was, you know, important for us to to hear about it. Sure.

Currently, yes. Um, Dr. Flower from Chandler, all my folks are saying thank you. They wanted to make sure I said that as I sit here. They're overjoyed of what's going on with the program this year. They they see a change. They're reaching people. they're getting them into w uh wraparound services. So on behalf of the folks are that participating, they wanted to say thank you and let's do it again next year. Okay. Thank you. Thanks for that. Yes.

It was recently some I think it was ABC that did an article TV thing about how um the heat deaths weren't being accurately reported. And then I was at an event where um one of the state senators, this was a huge issue to her. And um what what has been your response uh to this negativeity about how apparently they they believe the medical examiner is underounting heat deaths.

Yeah, thanks for that question, Supervisor Leco. Um we try to stay in our lanes. So that that particular story is really for the medical examiner and how the medical examiner is doing his work which we 100% support. We work you know very collaboratively with the medical examiner but I think um we really try to make the message is about this is surveillance that helps us do the work. So on at the end of the day if a few people aren't counted it's not going to change how we're responding to heat. And I I think one of the pieces of that article um insinuated that we weren't weren't responding to people who are um living on the streets when all of our work is is focusing on that population. We know that that p that population is most severely impacted. So, I didn't think that that story it was unfortunate because I think we're on the same team and we're all trying to do the right thing. I don't think it helped.

I like publicity. Or the pen, right? Yes.

Yes. Uh, President Osborne and Supervisor Leco, if I can just because, uh, medical examiner is one of my departments, so I can probably expand on it a little bit. uh because it might be as of interest to the rest of the board. Um in that particular article, we really went back and forth with our communications department on how in-depth we want to go with responding and if that would open up to more questions and concerns and and ultimately in the end we decided to just give our statement of how we uh count heat related deaths and associated deaths. I think what's unfortunate in that article is that um the expert that they got from back east um is a coroner and it's a lot different setup in the state of Pennsylvania of um that role. It's an elected official. um it it is an MD but it's it she's um that particular person is um is a family physician and not a forensic pathologist which is very different of uh determining causes of death and performing a medical exam. And so um our medical examiner uh Dr. Johnston is actually known nationally for creating um in partnership with the medical examiner in Pima County. really um it was Dr. Johnston's work in this field of how do we start to track um heat related deaths and associated heat related illnesses and his model is being used nationally. So when that article came out and it got some even traction um nationally, he got a lot of calls from fellow forensic pathologists saying, "Do you need us to write in and to stand up for you?" Because that particular person in that article that they have looking at those medical exams are not taking into account all of this work and that your team performs that

are experts in this field. And so um I think in that what engine and Janine kind of said this we are continuing to do um what and and stand behind the staff that we know are the experts in this field and counting it and um to the point as if I I don't believe we are missing a lot of um heat related deaths in the way that they are doing their examinations. But if they were they've been doing it this way for many many years. So in the end, it really is the trend we're looking at. And so if we were off by 20 counts last season, then we were off by that same percentage in the season before because we've always um done our exams the same way and counted them the same way. So um in that I feel really confident in what our medical examiner is doing and and they are a model. They've been to conferences to present on it. um they've gone to uh forensic pathologist uh study sessions and brought that before these study sessions to say here's what we're looking at and when we include these in our numbers and when we're saying it's a contributing factor and when it's not a contributing factor and they've had panels of experts all weigh in on this final kind of um tool that they use. So, um I just, you know, unfortunately I think that there's some looking for an opportunity um to kind of say like, oh, they tried to tell themselves that we had a decrease in heat deaths and we don't think that's true.

Um I would say even if we stayed the same, I think we call that a huge win given it was the hottest season on record. Um and if we didn't see our numbers increase like we would normally have expected, that's a huge win for not just the county. I it it's really the entire um cities and towns that all put efforts in um to these cooling centers and and resources and funding to address uh heat related deaths and APS and SRP um having their programs in place for utility assistance, our human services department. So, it's the work of a lot of organizations um that I think called last year uh a win. We're not saying we have it perfectly right and that there's no more opportunities for improvement, but um I think we can be proud of the work that Maricopa County and all of our jurisdictional partners did last heat season. Well, you shouldn't. The fact that it's taken years for Arizona to be recognized for the call out that this is our this extreme weather that is, you know, killing people that is causing all this sickness and, you know, it wasn't recognized for so long in the nation as being a problem. And so, um, you I'm happy that we're finally, um, people are paying attention to to that now. They're not there. Some of them are still climbing the mountains when they're not supposed to be and getting stuck. But that's enough.

Um, all right, Director Fard, you're not done. I was going to give just a quick update on public health funding and um although it continues to be a day-to-day um adventure to understand what's happening at the federal level um what I can today is that um our um SNAP ed grant we were scheduled to end September 30th. The cycle was supposed to begin October 1st. Um we don't we're all pretty confident that funding is not going to come in from the federal government. That is a pass through from the state health department. The state has cancelled that grant. Therefore, uh we will be closing down that grant September 30th.

And you said that was for SNAP.

Well, SNAP ed. So, SNAP, so it's different than SNAP is is um the food formally food stamp program from DEES, but this is a separate grant that really focuses on active living um healthy food access, physical activity. So, um, helping to support those behaviors, but not actually giving the food. Um, so that will impact about 15 of our staff members. Our staff members know and we're working through that right now. And, um, on a happier note, we just received our um, immunization grant. For the first time ever, we have been directly funded from the CDC to administer our immunization grant. Um, formerly we were given the grant through the state health department. Um, this grant it's a little interesting because the way the CDC did it, we are going to administer the immunization grant only for the city of Phoenix. And so it makes it a little bit challenging. Um, but we're working with the state health department. They're going to continue to do the rest of the county and we're working really closely to hopefully make it seamless for everybody involved. Um, but it was a good opportunity for us to apply for this funding. So, uh, it just came through and we're in the process of putting all those pieces together. So, those are the the big updates today.

Questions? Any questions? Thank you. Okay. I know this has been a long um meeting, but we are to the end. elections officers and president, vice president and our physician representative. So ladies and gentlemen, uh guess the way we will go forward with this is first of all I'll ask for a uh open nomination for president and uh you can also nominate yourself give me some indication. I will also say that I I myself am allowed one more year as uh president if that is what the members would like. So if anyone would like to step up to this position please let us know or if you would like to nominate someone.

I nominate Joanne Osborne for president. Second. Thank you. Second. Well thank you. Anyone else would like this? Lorenzo. [Laughter] No, I I I am just agreeing with the uh nomination of you.

Why, thank you, sir. Okay. So, uh, if there are the way that this can go forward is if there are no further nominations, then I may ask for a motion um to be elected by acclamation. And uh, but that does require a motion and require a second. Yes. Does it require a second? And a second. So, may I have a motion? I feel funny even saying this for myself. May I have a motion for myself? No. I move that we elect Joanne Osborne as president of the health board, Maricopa County Health Board. Thank you. I second.

Thank you, Mary. Okay. All in favor state I or does it have to be roll call? Can it be? Yes. So, um, excuse me, members of the board, um, President, take it away, mayor. Um, the way we work with the nominations is we obviously have a nominee on the floor. I believe that's Joanne Osborne. And we do have a motion and a second. Um, are there any other nominations? I believe it's going to ask, but I didn't hear an a or a yay. Are there any other nominations for president specifically? I I did ask that question. I did not hear of anyone, but I did not ask it as a vote. I guess

that's okay. So, now that we have just the one nomination, u members of the board and supervisor Leco, you may proceed with the motion, which you have already gotten the first and the second if that's correct. by acclamation. Correct. And so then if there are none opposed in your normal um setting, you can move forward. And then Amy, you would just um make note for the minutes, the nominations that there were none opposed. And then um Miss Osborne would be continued on for one additional year during her four-year stagger term. I thank you very much. I do see now if multiple nominees conduct roll call. Okay.

Thank you very much. I appreciate your support and I thank you for that. Now, thank you. Uh, we will move on to nominations for a vice president and we have since um, Mr. McMillan had resigned, we definitely needed to bring a vice president on board. So, nominations, self-nominations. One, I can't do this by myself. Oh, come on, President Osborne. I may, if you don't mind. Um, sometimes, um, I'm sorry I'm sitting down. I'm Vera, by the way. Most of you do know me. Um, sometimes people are a little bit unsure what the duties are for president, vice president. So, if you like members of the board, I'm happy to. You really don't have much to do. We're here to help and support you. So we pull a lot in the background to ensure that um Exfolio um or can't even say your last name Janine. I'm sorry. Um Janine runs a smooth operation with the west rest of our county management. Your obligation as vice president will be to back up the president in the event the president is unable to presid over the meeting which you've been to and seen before. You would um actually just confer with us as well as the council uh meeting different topics. So, we're here to really just be your backbone and support the meeting that you need to make sure the meetings are going just like they're going today. But with that being said, should the president and the vice president not be available to preside over a meeting, any board member would be able to run the meeting and we would continue in in that capacity. So, although you may not be president or vice president, you may be asked to conduct and perform a meeting in the same same like manner. So, if that helps any, uh, we're really just here to help you steer the gates open and keep driving the car through the barn, so to speak. That was a bad analogy, but I hate doing.

Thank you very much. Okay, does that help? Now, does anybody want to just jump up and do that? Okay, I'm gonna have to nominate somebody. You're accepted, right? Uh, eeny meenie mighty mo. Okay. I nominate Mary Scraven as a vice president. Do you accept the nomination? Um, yes, ma'am. Thank you. Okay. Thank you. All right. So, I have a motion. Do we have a second? I'll second.

Thank you, Miss Hardy. Okay. So, uh, we have a motion and second by acclamation. All in favor? Correct. All in favor say I. I propose the eyes have it. Lorenzo, thumbs up. Thank you very much. Now, the last uh election we have for a physician representative and truly here at Dr. Schroer. Yes. I would like to nominate you as the physician uh representative. Would you accept that nomination? I accept. Thank you.

Thank you. Um it has to be filled by a medical doctor and um Dr. Farber who has held this position um times in the past is on vacation. So by today, thank you Dr. Sher for uh accepting that nomination. Uh I give the motion. Do I have a second? Second. Second. Second. Thank you, Veronica. We will um have a motion and a second. All in favor say I. I.

Oppos. The eyes have it. Thank you, Dr. Schroeder. Okay, that is the end of our agenda. Is there anything that anyone wants to save for all of us besides did you get your ticket validated for parking? Anything else? have a safe rest of your few months. Welcome to the board, Jack. And uh we'll have to do a motion to May I have an emotion? May I have May I have an emotion? May I have a motion? Sorry.

CP know that they will provide over the next meeting. So your new term is effective. October just for the minute sake. Although you're already pregnant, your attorney will begin presiding over the next meeting October one. So if uh McMillan is with us, we'll call this. All right. Thank you. Motion to adjourn. Yes. Motion to the next meeting is October 28th. October 28th. Hum's optional.

Okay. Um, yes. Now motion to adjurnn. Motion to adjurnn. Second. Second. Second. Yay. All in favor? I. Thank you. We are adjourned.