Board of Health - Regular Meeting

Good morning. It's 11:00 a.m. on May 9th and I call to order the Lake County Board of Health. Uh, Commissioner Lee is out, but we still have a quorum here with myself and Elsa. And the first item on the agenda is the appointment of Kelsey Maxi as director of Lake County Public Health Agency. Our current director, Julie, is stepping down as director, and we would like to start by sending her a note of gratitude uh for all her work and leadership in her time as director of public health, and we wish her the best in her next adventure. Kelsey has been deputy director of public health for some time and has stepped up numerous times to be interim director. She comes with a great deal of knowledge and expertise and we're lucky to have her leading the public health agency in Lake County. Kelsey, would you like to say anything? Yeah, I just want to thank you all for this opportunity. Um, this isn't really how I saw my career going. Um, but I'm really grateful to be here and I was just kind of thinking back on how I'm going to show up differently than I have been over the past few years. Um, and I think the main difference is I was always leaving space for a leader. Um, and I'm looking forward to really um, really taking up that space as the leader um, and guiding this team and working with you all um, and you, Lisa, um, to make public health what this community needs. So, thank you. Thank you. Thank you so much, Kelsey. We're very grateful for you. We know you're very capable. you've done it before and I really love that goal of yours. I think that's fabulous and you don't hear that often from women in leadership to take up more space. It's very courageous. Thanks. Yeah. Do you would you like to make a motion? I do. We have to appoint her. I move to

appoint Kelsey Maxi as our director of public health. I will second the motion and take a vote. I I Kelsey Maxi. Yay, Kelsey. Thanks. Dy appointed. Masle. Yes. I will now pass it over to Kelsey Maxi, director of public health, to provide updates to the board. Okay. Well, first, thank you. Um, and I wish that I had like more exciting updates to dive right into. Um, but that's just not the time that we're operating in right now. Um so the first update is I just spent two days at the public health executive director summit in Denver um with all the public health directors from the state which was really amazing and we had a lot of talks about funding and what that looks like which is mainly no one actually knows what it looks like except it's not looking great. Um there's so many unknowns. So kind of business as usual until it's not. Um, but a direction that we did get is that we locally need to be able to turn around our funding contracts a lot faster than we did in the past because the funding is coming down later than it normally would. Like normally we'd be doing all of this right now and like the state hasn't even gotten the funding to like pass it through to us yet. Um, so there's questions around like will it get passed through? Hopefully still yes, but maybe not. and when it does, it's going to be a quicker turnaround time because the fiscal year that the state operates on starts July 1. Um, so just wanted to express that to this group that normally when we could probably take a couple weeks to turn something around, we're probably looking at like a few days to get things signed and get them back in. Um, so I think that has maybe been made easier with Candace being able to sign some things. Is that right? Okay. Is there anything else that we need to understand about that change and how it impacts this? Candace,

I don't think so. Essentially, I'm I'm able to sign anything 25,000 or less and then it comes up on the consent agenda. Um, if it needs to be reviewed by legal, of course, do that before. Um, and then if they have any questions, they're able to ask me or pull it off to have a deeper discussion. And if it's more than 25,000, how would we address that in that? Didn't it also include like year-over-year contracts? So, normal contracts you have from year regular year. Great. Okay. Yeah, we're not Well, unfortunately, we don't have any large new funding sources coming in. Um, so they should all be very business useful. Um, okay, great. Thank you. I just wanted to discuss that briefly and make sure that as a group we were prepared to tackle that. Um, I would also be remiss not to just talk about the measles briefly. um we haven't seen um outbreaks spreading through Colorado. Um on our state call, they think it's ultimately being a little bit under reportported, but that also means that people aren't in the hospital with measles in Colorado, so it is still a good sign. Um but we've had five cases in Colorado, so it's something that we're still just very um we're ready to spring into action at a moment's notice if and when we get a case or an outbreak that somehow impacts Lake County. Um, just so you all know, we have a communicable disease nurse who works part-time. Um, she's does just is getting a lot of education about communicable disease, but the moment that we have something, she's trained and ready to to kind of handle that and do the contact tracing and, um, do that. An outbreak um would require state support for us. Um, we're ready at the hospital as well. Um, all the physicians have been educated on what to do. We all know the hotline numbers being the reportability of results and so we're ready to Great. Thank you Lisa. You've been a great partner in that. Um and that is something too that while we have less resources, I think as a group we are more prepared for something like that because it's easier for all of us to get

on the same page. Um other counties that were expressing like outliers in medical providers who aren't testing for the measles or who aren't willing to participate in these things. So I think we're really fortunate to have medical providers that are willing to engage. Um, well, we're all so well connected. Yeah. How do uh how do measles how do they present? How do they show up? Bumps, red bumps, high fever, high fever. So 104 105 is not uncommon. Um mostly in the unvaccinated, you know, one vaccine for measles um 95% um efficacy. Um two vaccines for measles is 98%. Um you get your first measles vaccination at 12 months, your second one somewhere between four and six, and that's a lifetime immunity. Um, for those of us who were born before 1971, um, before the current MMR was available, um, they are, um, recommending that you get a booster vaccine, um, just to make sure if you have any, um, uh, um, idea that you didn't get the the current vaccine. Um, you can also get tighters from a primary care provider as well. So, um, you can just be tested to see if you have immunity. Um uh getting back to the question though so high fever um the rash starts on the face and then just kind of migrates down to the rest of the body. Um cough is usually um a presenting factor. The big one is menitis or encphilitis which any viral illness can get you to but that's what people die from. So an outbreak would mean we if it was a child or something we try and quarantine just like co right any other viral illness. Um uh yeah. So um uh presenting into the emergency room. So you know if we see someone who we suspect um uh uh we put them in our negative air pressure room, sequester them, admit them um and then take care of the testing. Um the testing currently has to go to the state. Um uh so there's a you know a courier that will take that down, but there's usually 48 72-hour delay in diagnosis. So we just treat them. There unfortunately is no true treatment other than supportive care. And then a lot of

public health's role in that is to be like, okay, who has potentially been exposed? Are they in the window where we can still vaccinate them if they're not vaccinated or do the um oh gosh, the PEP post exposure. Um and so that's kind of where we jump in is like how can we protect the other people that have been exposed by this and like where can we step in to prevent future um illness. So we have we have good communication and a good plan. Um a lot of measles cases would be challenging for Lake County. So hopefully we don't get there. Well, unfortunately our vaccine rate is still relatively high for the people that we know of. Um so we're we're protected from um multiple people who are vaccinated. All of your healthcare providers, for example, are vaccinated. Mhm. So we won't get sick. Yeah. And the whole staff at St. Vincent did just do tighter checks to make sure all of their immunity is still um at a high level. And some of them had declined a bit so they got revaccinated and that's Yeah. which is fine. And again, those of us who were born before 71 um just popped in, got another vaccine. What's a tighter check? So, it's a blood test to look at your antibodies and so you should have memory antibodies, IGGs, um from the vaccine that you had whenever you had it at 12 months and then at 4 to 6 years. Wow. Yeah. And your body can detect that after all these years. After all these years, our bodies are smart. Wow. If your tighters are low, then you just get another vaccine. So there are often people who just fail to take vaccine because it's one less expensive. It's pretty wild to have like gone through co and I literally understand the things you're saying. Whereas like 5 years ago 5 years ago I would have been like what are you talking about? Okay I believe you. I trust you. Please continue to do your job. I'm like oh yeah no that makes sense. Good job. Good job us. Yeah. It's really wild.

Thank you Kelsey. Yeah. Um, any other questions about that? Is is So, the booster is just for misuses. Is it MMR? It's an MMR. So, you would talk to your primary care provider. You can get the MMR in uh three locations in Lake County, the public health department, of course, and they'll do walk-in vaccinations when they have staff Monday through Thursday. Yeah. Safeway, um, anytime the pharmacy is open, they can do that as well, and you can also walk in, um, uh, and then St. that's in health um through their um primary care center um can do the vaccination for both adults and everyone can do adults and children. And is that a traditional vaccine like an attenuated vaccine or is it only it's a live vaccine? It's a live vaccine. Yeah. Okay. Yeah. Um if you have not been exposed to measles recently, you have no reaction. So thinking that there's no measles here yet, most everyone who gets the vaccine won't even notice. Okay, we'll keep you here all day with questions. So, continue. Yeah, thanks for being here to really I am always answer questions. Everybody has my cell phone number and you just blow it up and I do need it for sure. Um, great. I wanted to also give you all an update on our community health assessment which will ultimately lead into our improvement plan. Um, as has been discussed previously, this is required statutory requirement for public health to do once every 5 years. So, this is our year to do it. Um, we had our advisory committee meet on April 3rd and we had a great attendance in that. We had so many community partners there. It was really um, exciting and amazing. Um, and basically what we did is because we have folks representing what what we truly believe is the different pockets in our community to try to get that whole community representation there. Um, is we all went through an activity to identify like what we're seeing in

our areas of being the biggest issues for our community. Um and the kind of big takeaways that we all we all came up with were um healthcare access and costs, affordable housing um and homelessness or um other things. A lot of things fit into that definition, right? Like a certain amount of people living in a home as people experiencing um homelessness. And um anyways, there's a lot that goes into that. um access to mental health support, um cultural barriers divide and language barriers, um substance use and addiction treatment, food access, and then federal and state funding and policy changes that could severely impact the existing services in Lake County. Um so we are going to kind of formally um put all of that together and then that kind of turns into our assessment of like where are the areas that our community needs the most support. What program currently exists not just in public health but in a nonprofit in Lake County or where who's tackling this issue in the community and if nobody is wow we need to like figure out who's the best um the best agency or organization to do that work. Um, and then once we've assessed all of that, then we move into the improvement plan, which will kind of take us into 2026. Um, and we do have a contractor that's doing a lot of the background work on this for us, which is great. Um, I got a mini grant that is paying him for that. Um, I really hope that that grant opportunity is available again in the fall so that we can continue to pay him to do that. Um cuz while we can do a lot of the community work, a lot of the data collection and putting that together in a way that um that makes sense is really his expertise and that's something that we have in house. So um do you guys have any questions about that? Yeah. When um I'm going to give an

example and then you help me understand where this fits in. Oh, great. If we could go that way. So when we were at our CCI conference, which was like freshman commissioners getting trained, that's when the city council was had the hearing for the um emergency shelter. And I called Tim and I was like, "Hey, is our public health going to show up to advocate for this because we know this is an issue." and he said because we as a board of health had not been seated yet and had not established that as one of our priorities it wasn't appropriate for public health to be showing up in that way having not had direction from the board of health. So I was just wondering does this establish priorities from the board so that you all can go out and advocate in situations like that or when this feels like it would inform it that we could say yes do those things please. When does you maybe help me answer that question? I received direction not to talk about that. So I wonder how that changes and at one point there is I think there's a level of like um comfortability of staff too to advocate you know like not forcing staff to go to meetings to advocate if they didn't want to but certainly because we were in between boards um not having that direction was um challenging um yeah I don't know it can deserve Chris, you want to add anything else? When when do when does the board of health establish the priorities then of what is happening in the community and how we're showing up? I haven't been a part of that before. So, this is a good question and I think

discussion for the group. I think I think it's a really important question. Yeah. Don't you think? I no you can look at me but I don't like Kelsey what do we do? So in years past um uh uh you know yeah we we've done this every five years for dec you know decades. So in years past um we as your uh public health department um came up with our recommendations and so we went through this process right so we identified the players in town we got their thoughts and um uh feelings um uh we um uh never used a consultant before so I don't know how that kind of works um but then um when we have our plan when we know as a public health department what we think we need to focus on then we bring it to this meeting and then you as county commissioners you know um put in your input Um and then we came back with a formal plan. Okay. Um but the board of health um uh was not um uh uh involved until we had something to show you. Yeah. Okay. So, you're showing us the the seed of this plan that won't come out until 2026. And between now and then, if something in the community comes up, like say some great I don't know like treatment facility is proposed would the public health department come to the board of health to say can we show up in this way do they wait does public health wait to engage in that in the past um we have waited so you know we wanted to have a concise plan um for you know what we wanted to present as you know to the to the board of health um but you know that's in the past right we can always do something else. Yeah. Um but I think that this is such an enormous project. Um there are so many um things that need to be serviced that we're never going to be able to satisfy all of them. Um that

that's why we initially bring in all the players. Um and then as the meetings progress, those kind of dwindles right into the core people who really have um something to add to the to the project. And then we present the project and and in some you know sometimes you know the board of health goes that's not what we want to do at all. Um uh so let's add these you know pieces to it um knowing that there are some other things that need to be addressed in our community. But I think that's premature. Well and if we do and please correct me if I misspe here. I imagine if we call something out in the improvement plan that is adopted by the board of health, if we're like public health will advocate for other entities who are supporting this goal or something like that, then we could maybe tie in some type of advocacy for another organization to take on this work who or is already doing the work. Yeah. Right. Like our goal is not to take over the work when someone else is already doing it. Um but find the channel to support it. Right. Does that sound right? Makes sense. Okay. And I would love to tie that in here because I think when public health publicly supports something, I think it makes a difference. It really and I want us to continue to make a difference in that way um and support the important organizations that we have here that are helping tackle public health issues. Like we are very much not doing this alone. So for sure and it's very important too, you know, because we're all tracked for resources that we don't duplicate certain things. And this is the process that allows us to do that every 5 years just to find out who's doing what um so that we can again support one another and not duplicate and waste resource. I think there's varying degrees of advocacy too, you know, like going before the city council with an ordinance and like a formal vote is a lot more public and I think we want to we make want to make sure that we're in line with the board of health, but like a lower degree of just like talking

to community partners like telling them what we're seeing at public health as far as homelessness or substance use or whatnot is a lower degree that I would feel more comfortable with public health doing just as experts in the field. Um, but as you get more public, I guess, um, wanting to make sure you're in line with the board. Yeah, for sure. Does that answer your question? A little bit. We'll see how it goes. Okay. But I would like to move in that direction also. I think that just as somebody who uh as a decision maker, I I appreciate when multiple entities show up to help me understand how important or myriad uh an issue is. So I just want to know how we can show up through public health to tackle any of these things and what you need from us as the board of health to impel, encourage, advocate or like make sure there's structure for you to do that. Thank you for that support. I think we can all navigate and use the board of health to make sure that we are structuring it in that way, right? Because we have to do certain things as the board of health. We have to meet, we have to do the training, but then at the end of the day, we're the humans sitting in here. So, we can direct how a lot of that works. So, I'd love to work with you all to make sure that it is like producing the vision that we would all like to see. Awesome. Let's go. Yeah. Okay. Thank you. Um, any other thoughts or questions about the assessment and future improvement plan? Great. I'm I'm really excited. A lot of these things are issues that we we saw in the last one, right? Like nothing like housing is not new. Some of these other things are not new, but um I'm I'm glad to see that we are talking about substance use, food access, and some of these other things like on a higher level. um because we're we're really

seeing how those things lead into domestic violence and other issues, right? Like if we tackle if we can work to pre in the preventative area of some of these and support people in these areas, I think we're going to see less of other things in our community. So that's exciting. It's like hard to see these as our issues, but also exciting because we're going to work on them. That's great. Um excellent. I also just wanted to give a brief update on bloodled testing. So that was one of our goals that we called out um for 2025 is just to um see an increase in blood testing with CO. We saw a great decrease in blood testing because folks were not doing things in person and that is not something you can do virtually. Um and we are on a really excellent track. Um 2024 was a wacky year for many reasons, but we did 86 blood tests total in 2024. Um and we're already at 56 for this year. So that feels newborns, right? Um or everybody? No, every everybody, but not newborns. Starting at one is when we test for blood, but also pregnant. Our main um group that we're looking at here is children ages 1 to six. Um pregnant and nursing people. Um and then we also will test adults who are concerned, but really lead is most impactful when the brain is developing. So that's why we have that core group. But we also have adults that are concerned about their lead. um levels in Lake County and we don't turn anyone away. So the birth rate um of of Lake County 120 births I don't know the answer. So somewhere um usually between 100 and 120 births per um year. So through 50 we think most of them were children. That's extraordinary. It's almost all children. So we have we went to Brightart and I believe we got every single kid at Brightar tested while we were there which is really exciting. This has been a new way that we've been approaching this outreach is we send all the paperwork out ahead of time and then we test the kids while they're at school.

And if parents want to join us, they are welcome to. But honestly, the peer support of four-year-olds is very beautiful and they really Yes, they really get each other through some tricky things. Um, my son did somehow get Ashley to start giving everyone three toys. I'm not sure, but wow. He was like, I know these people. Yeah, she'll give us more toys. He was right. Um, so that's really exciting. And historically, we have done outreach at school events, but we would get like three to five people um and we targeted it a little bit differently this year. So, we went to um parent teacher conferences and Ashley set up in the nursing office in the center and then whenever a kid would check in for their conference, they had them fill out blood paperwork if they were willing. Obviously, we're not forcing people to do this, but providing that education of why we should be. Um, and then kids who are um in Head Start are required to have their blood tested. So, this removes those barriers. They're already there. Um, and we got almost all the preschoolers tested in that round as well. So, um, we're going to keep doing that and hopefully it just becomes more the norm of, um, of that expectation of, hey, we're going to go to parent teacher conferences and you guys are you're going to get your finger poked, right? That's all it is, a finger poke. It's just a finger poke. Yep. And interestingly enough, although we live in Leadville, um uh the amount of lead poisoning here is still very small. It's consistent with the state's um um averages. Um and it comes from um exposures in the home mostly. Um which is lead based paint. Unfortunately, it's our old houses. Um there's very little lead in the ground. Um even though we are in lead. Yeah. And a lot of folks are like, I want to get my yard medi mitigated and fixed and that's really expensive and it's not like a sure thing because then the snow melts and all new things come back, right? So, we've really focused and a lot of this predates my time at public health, but

on the prevention and education aspect of like there's really simple things that families can do to reduce lead exposure. Um, and I think as we've done that over more than the past decade, do you know when that started? We started doing mitigation um uh um with um uh oh who were the who was the federal government was here doing yes thank you um uh uh in the 1990s. Yeah. So this has been like a long journey and really what we're seeing is not a lot of elevated kids and when they are elevated it's a low level of elevation that we're able to see decreased by like increased handwashing and like wiping down dust out of the home and talking about like flaking paint and like water testing. So, it's um that's really exciting to see success in this area after like a pretty deep dive after through the pandemic. And remember that lead poisoning really means nothing for adults. There's no clinical relevance at all. It's really children with growing brains. And so, it's that year to four, five, is when it's really critical. Unless you're developing the brain in your body, unless you're pregnant. Yes. Another way to say that, Lisa. Yes. Absolutely. You are is absolutely correct. Or you're breastfeeding someone who is um in managed food. So if a child has an elevated level, you guys follow up, go to that, say, "Can we come to the house and look at your house and test?" Yeah. And some of that has shifted over the past year where the state now has home investigators who have a lot more tools than we have, but we have not had to do a lot of home investigations in the past few years. um there was a really heavy run of that and a lot of things I think and through education it's just not hasn't been as necessary but that resource is there. If um if we have a kiddo, we like do small interventions and then we test them again in a couple months to see where they're at. And if they're moving in the right direction, we keep on that. But if they're not coming down or they've gone up, then we absolutely move to um a home

investigation. And um then there are funds if we need to do remediation, we have funds in the trust to um pay for that for the family. It's um can get super expensive and then a little complicated, especially in these older homes, right? because once you take apart one thing then like it's like the domino effect of um so the goal is not to like fully remodel someone's home but just remove the the exposure. Remember too that it is the initial screening is a finger poke and so if you're playing um um you know with a dog who has just rolled through paint right um you're going to have um some on your hands doesn't necessarily mean your level is elevated. So it's always backed up by a van puncture is done by the primary care center. Other questions? Um all my updates are really shifting gears. So now we're going to talk about tobacco retail licensing. Um so the previous board um and in correlation with city council, we approved a tobacco retail license in Lake County. The reasoning behind that is that our Healthy Kids Colorado Colorado data shows us that kids in Lake County are able to purchase tobacco from a tobacco retailer. They are not finding some like secret way to get tobacco. They are walking into our stores and buying it and then leaving. So um and that includes grape juice. Yes. Yes. Tobacco is like an umbrella term for any nicotine containing product. Um, so yeah, chew, all all of these things are like umbrella under that. Um, so we have a tobacco grant. So we worked to get an ordinance passed so that we can regulate this on a local level. Um, the state does tobacco retail licensing. Um, they don't make it to Leville very often. Their enforcement here is ineffective. Um, so regulating it on a local level also allowed us to take it up a few

notches. Um, we have a cap for how many tobacco retailers can exist in the county and in the city. And then we also have added other layers of things that they cannot sell and regulate how they can sell things so that it is not like promoting more tobacco use to minors in our community. Um, happy to dive into any of that more. Um, but we it took a while to get everybody licensed. Um folks, as you can imagine, weren't super excited about paying us for a license and entering into more um regulation, but we did get everybody licensed. Um and then we did our first staff compliance checks, which we chose to do all as educational based. So, we're not enforcing any fines, no fees, like no suspended licenses because we want to be a partner with our retailers in this so that they see us as someone to work with and not someone to work against. Um, and unsurprisingly, all but one of them require us to come back to, right? Because we have some things to work on. Um, which really shows us like the work that is required in this realm because we're not seeing violations just on our local ordinance level. We're seeing retailers that are violating federal laws as well. So, we go in and we go through what we require in our local ordinance, then we check what the state requires, and then we check what the federal government requires. and we're seeing violations in all three of those areas. Um, so we are going to recheck everyone in the next couple months. We're giving them some time to comply, to ask questions, to work with us. Um, and then, yeah, so we're pretty excited about that. It has been quite an undertaking. Um, our food inspector, Alana, has been doing this. Um, but I went out with her to make sure she felt supported and so that there's not only one person in Lake County who understands how this program works. And it was just wildly interesting. The amount of vape options that there are is terrifying. And then we're also seeing a

lot of which is an unregulated substance that kind of acts in the body similarly to an opioid. Um so we're seeing unregulated products that are available in our our stores and there it's not illegal to sell them, right? So we can maybe help advocate for some regulation around those things because we know if minors are getting access to tobacco, they're probably also getting access to credum and to psychedelics that are being, you know, sold and things like that. Um, so it's kind of a beast, but we are excited to start chipping away at some of that to ultimately protect the youth here. Um, and then another part of this program is running underage compliance checks. Um, so our plan with that is we are working with HR to utilize the high school interns that work for the county in the summer and um, we're going to have them sign up to run underage compliance checks with us, which is basically where we send them in. It's more complicated than this with some money and they try to buy tobacco with their ID that shows that they're 16 or 17 or whatever that may be. Um, and if they can purchase tobacco, then we will ultimately then go in and um, work with the retailer on on that. There are some pretty intense um, fines and license suspensions for that. Um, so that's kind of our next step in that program. Do you guys have any questions? That was a long safety issues for you guys. I can imagine that there are some store owners and obviously won't be so happy with this information. Do you ever feel any law enforcement support? We haven't yet. Um, and the goal to keep the underage compliance checks safe is that we wouldn't immediately go in if they do sell to the minor cuz one, we want to protect the minor. We don't want the store to be like, "That's the kid." Um, so we're working with the state on seeing how other people do that, but it sounds like they typically then serve

the notice the next day so that you don't know who the kid was. We have all the information. We'll know. We'll have pictures. We have a whole way to document everything. Um but to protect um the minors who are running this following state guidelines we've done this before. Great. It's a great question. Um in other places the sheriff's offices are the ones who run these underage compliance checks. Um obviously that's the ideal situation, but Lake County is not in a spot where that is something that can currently be done at that level. So we have it written into our ordinance that we will manage that portion of this program. I have a comment. Uh my kids tell me that everybody at school vapes and that they disable the the detector in the bathroom and when they go to the bathroom is just packed with all the kids vaping probably marijuana as well as tobacco. Are you guys working with the school at all or is there any way to We would love to increase our partnership um with the school and I think that we um are on track to continue to move in that direction. Um it's has been a challenge um to get in there when our school also our schools obviously have a lot of other issues that they're trying to work out and getting that to be a priority. um it it hasn't made it yet, but it is we will not quit trying. Um the other partnership is with the Elevate Health. They have the schoolbased health system um uh and they're they would you know excellent partners to be able to do that and so I think as they're figuring out their staffing issues for Lake County um that's just another avenue that we'll ask for helpful. Yeah. Yeah. But ultimately with a lot of our work in tobacco prevention and in like harm reduction and lifelong like use of substances and opiates, we would love to

get some more of our education from public health into our schools. Um, and we are having those conversations and I think I think that we will get in there. Um, I think it just will take some time. There's a misconception that is it a misconception that that's safer than cigarette? It's not sucking on a battery. It's worse. There's you're inhaling gasoline. It's a petroleum product. It's not just the vapor. Well, it's a it's a lipid based um tincture that goes in there. So, they suspend whatever drug it is, either nicotine or THC or, you know, whatever fentanyl um in a lipid- based solvent. And um that's um it's inhaled into the lungs. So when you're inhaling burning organic material, um that's one set of things like a cigarette. Um but the vape cartridges um uh um clearly induce lung disease sooner. Um and there is a whole new um ICD10 diagnosis of vape related lung disease that we almost always see in young people. Now there's a there's an amazing documentary called Big Vape on Netflix. Oh yeah. And it talks about the the like inception of Jewel, you know, like the original vape pen, and how it was sold to us. The hope was that it was actually going to be a a way to deliver nicotine without the coronic effects. Um, but then of course you want to make money on your product and it went from like potentially being a prescription to being a commercial product. And now we have vape. which is a really interesting documentary if you're curious about the beginning of but that's where that misconception comes from is because that was the intention in the beginning um about theratom if it's not regulated then how then is it something that they

actually have to check an ID for yes so in Colorado you do have to at least be 21 to buy cratom but the unregulated portion of it is like how muchratom is it in each thing right because they're going to tell you it's however um milligrams but checking that there's no regulation right um to on the actual product itself okay to you know guarant not guarantee but there's no level of safe oversight yeah or over true for THC though as well when we go buy an edible for example and it says that there's a 40 milligram dose there's no one regulates that so we don't know that it's really 40 millig I don't know the answer we have had this discussion amongst um the commissioners and city council many years ago when marijuana was legalized um about who's going to regulate that and we decided that is something we just can't do um because there's it's such an enormous project um and there's no one from the state or the feds um that regulate that either. So you go and buy your marijuana brownie and it says there's 40 milligrams in there, good luck. Who knows? Yeah. And we don't we don't have like farmtotable cannabis in this town. So it's not like we could locally regulate production, right? But even every leaf is different, right? Yeah. At least in tobacco, we know how much nicotine is per product. There's local retailers in Crater. Yes. A lot. Of the 13, how many? Um, at least four. It was in almost every retailer I went in when I went on the checks with Alana. But you can also get it online, too. Absolutely. Are you I like the the approach of like educating first sounds really in line with how the state health department shifted in the last 10 years. Is the state is the state setting that tone of going in and being education? Are you all just taking that lovely

tactic and applying it? That's all Kelsey. I love that. I took lessons learned from retail food and applied them into Yeah, girl. They worked. They worked. Um, but also the state state was like, "Yeah, this is your ordinance and you get to choose how you enforce it." And what we've learned is that you are an ineffective regulator if you do not have a good relationship. Um, so we are trying to develop that relationship and obviously every retailer is different in retail food and in this, right? Like some people are uninterested in us regardless of how we approach them. Um, but a lot of people we have really excellent relationships with and it is teamwork versus like us being regulators. Um, so yeah, that's been our approach and um, I'm really hopeful that it leads to enforcement with very few violations and let me tell you, I don't want to charge someone $1,000. I have no desire to. Um, you want them to just do it. I would like them to just do it. Yeah. Yeah. Have you um are there other surrounding counties who have their own tobacco local ordinances as well? Yeah, and um Alana went out and shadowed them before we started ours. So, she went on inspections with them. Um and then a lot of our ordinances mirrored off of other ordinances in Colorado counties. Um we did level up a lot of things. We have one of the um the highest level tobacco retail ordinances in the state of Colorado. Um which is pretty cool. Are there um other surrounding counties we could trade interns with? Just so you're not working in your own community to do this with regulation. We could work with HR and consider that. Yes. Just an idea. Yeah. It sounds like in other places they struggle to find the minor the young people who would like to do this work. So it sounds like often like it is the children of the sheriff or you know um you think that'd be cool. I know. And undercover. We're going to like give

them like we're going to buy them lunch and like give them a gift card. I guess pretty sweet. He is a 16-year-old. You know, you're cutting off your buddy's supplies, Jane, which makes unpopular, which is why it'd be cool to work in a different county. Yeah. Yeah. Interesting. Thank you so much, Ky. Any other questions? I know you all were not along the ride for that process. So, if you do have questions along the way, it was like a very deep process and there's a lot of things that we haven't talked about. So, if you have questions or thoughts, please let me know. What's an example of a federal violation? Um, there's a lot of federal violations. Yeah, advertising for vape like ecigarette products out on the outside of your building. So, like for advertising for a certain brand, um, because there are only like four vapes that are FDA authorized and the amount of vape products out there is insane, but the federal government is not regulating that. Well, like they're not enforcing their own regulation on that. But, um, so yeah, you can't you shouldn't have like um geek bars sold here on the outside of your business. So, we're getting there, you know, like um um distance from an elementary school or That's not federal though. That's Yeah. And then we leveled it up. Yeah. Um but yeah, that's that was the biggest one we saw. The other federal ones are like um you can't sell cigarettes in a vending machine and like we're not it's mostly It's funny because we have to ask about that and people are like do people do that? Can we have one? I'm like no. um to the 50s and 60s. I know we totally did that. What are you doing? My old old age, my old life. Yeah. So, we're seeing less um violations in the federal realm, but we are we are seeing mostly that one. Okay.

Well, if you don't have any other questions, I will hand it over to you. Put you on the spot there. our new email situation verified. Um so just wanted to mention to you that we have two more um variances coming in on the OWTS um permitting and so um and and just give you an update next week. Um Kelsey's going to join us for our selection committee. We've got um some applicants um for the OTS position that we're going to um be um interviewing. So hopefully we'll have somebody selected soon and we'll have them on board um and start the training with the state. So um we have no one that has applied. Some of them do have public health backgrounds, but none of them um currently have worked in OWTS before. Um but that's fine. Um this position has always been kind of an in training position um that we um bring in and there's plenty of support through the state um to go through the training in order to um be um successful in this role. So um looking forward to that. Um I will tell you that um we are experiencing what I thought you know was kind of a fluid way to look at plans um that come in in the interim. Um I was using our engineering firm. The last variance we did though um review was a $2,000 review. I've got a call into them to tell them that we can't um sustain that and that how how are we going to do that? The other um option that we may have is I've reached out to David Wilson who has been remarkable in supporting staff when we have certain questions um and whether or not um he would be interested in um assisting us uh through a potential PSA if he were to go out and set up his own insurance and those kind of things. Um you know obviously we can't employ him

because he lives in in Nebraska now. Um he did mention that he does have some capacity to do that. So these two variances the level of review that they need he could do quickly and easily and has done that in his capacity for years with the county. Um so um trying to look at a way he could also provide support to this new member of staff um to just kind of help them if with the training as well. So we'll have we've got it set up for the state training to be done for this onboarding of this position. Um but we'll be um discussing this further with Candace too um whether or not you know this is a viable approach but we at least inquired and there is um some capacity and some um interest in doing that but explained to him that in this role he would have to go out and set up you know some obviously we want him to be insured and and you know it's just being a contracted service. So he they were going to um explore the possibility of that and we will further discuss that with Candace. Um but certainly very capable. He holds the certifications. He holds the knowledge and expertise and also the knowledge of the Lake County vernacular. So I think that he could be a resource and interest. But we'll dive into that a little bit more Candace and maybe further engagement on a short-term basis and Kelsey too on that as well. And how long is the training? The training should be able to do and maybe you'll recall Kelsey. I think he went through just a couple months of training. It's not a like six month could be accomplished within like 11 weeks. Yeah. And this is a really good time to do that because we're going into the summer. So the opportunities for shadowing other counties is like there right now. Like if it was October and November, then we're starting to see like not really being able to do some of that work. Exactly. And so we have I

have also got a call into Summit County. That's who David shadowed. Um and then they even came for a couple of his inspections early on before he was kind of put out to do his own inspections without um uh some mentoring. So we we've had that relationship with them in the past. So reaching out to explore if we can do that again. So we sent David to summit and he worked with um those crews out in the field um for that experience and then they came up and shouted him a little bit on his first inspection. So we've set up that kind of or at least communication pathway so far. Any chance in contracting with him perhaps for the same kind of work that you might want to use David for? reason to ask is if he's in Kansas, it's a little bit more complicated and expensive to set up a company here in Colorado not here in Colorado to do that. So, I didn't know if there'd be an opportunity to have some sort of anou or we can I think I think I'm going to be pushing the envelope just asking on capacity for this other piece. Um, but we could we could look we do have two sets different sets of regulations. There similarities of course but we are two different so we could ask um if that support would be there but I guess I I just thought that um we had contractors in other states. I know that employment is we do but usually they they're ones that have larger operations that the cost setting up here in Colorado makes sense for them. If it's just a while type of thing that might be challenging. Sure. Sure. But I'm just trying to anticipate if he's like says, "Yeah, I'll do that." And then we start from the county attorney's office saying, "Well, you need to check all these boxes." Like, "Oh, this is going to be expensive." Right. So, we did talk about, you know, what it would take to set up um, you know, a company and and get the insurance that we would need to be able,

you know, I said the insurance is the big piece. Um, so look and see what that means. Explore that if you do have an interest in whether it's viable or not. So it may not be it may be cost prohibitive based on the return of the investment there or you know that it's a one time thing. He's not actually looking to start the company. So it may be not an option but we just at least um so far he's been super gracious when we have little asks um to assist with things. I just feel bad about paying for it. Yeah. So um so we we keep it to a minimum and we are looking for that support for him summit. The wonky part kind of a little bit with the state is that Chuck retired um and who had really had you know we had established a really great rapport um with so we're working through our new contacts in the state. So we had we're having some transition moments but really great idea to explore if summit would you know be able to do these varants for instance the alternative OTS looks for us. Yeah. So um because $2,000 is obviously cost both from a pass through expense or cafe expenses can't continue to do these through the engineering company I thought that we had on board. So the other question is we would like um for these new variances consideration in June. We don't need um maybe to to figure out what that hearing date would be just now but fairly soon because we do have to get notices out to adjacent property owners um in order to hold the public hearing on the variances. So um but that's a 15-day notification. So we'll wait for maybe establishing a time in June and then we can work from there. So I'm just asking for consideration for a date in June and that coordination

with them come and let us know when or if we usually work with Sandra when we're scheduling so we can see all three commissioners. So just make the request to Sandra and Candace. Yeah. Especially without Andy here. Like we have no idea what his rate is going to look like. He's gone a lot in June. Form would be too just like you. Yeah. And he'll be he'll be participating as much online as possible. Yeah. Okay. But Sandra is the only one who can see it. Okay. Yeah, that sounds great. I'll send the request over to Sandra and Candace for a public hearing on the variances in June. Thank you. Yeah. Well, then before we wrap up, as we are like relatively a new group here, um is there anything else you all would like to see some from board of health meetings? Is it helpful if we just prepare updates and like things that we need guidance on? Um I just want to make sure it's a good the best use of everyone's time and quarterly meetings are still okay. Yeah. quarterly meetings work for me. Yeah. Very interesting. So, can we set the next one? We have to wait for Sandra. Sorry. But yes, I can start. I can get the ball rolling on the second one. The next one. Yeah. Um, for some reason it was not on my calendar today. So, let me just make sure. Yeah, I just Okay. Yes. Yes. Um, great. Kelsey, how about before we um before we 2026 when we get all of our community health assessment improvement,

our new plan? Mhm. Could we get updates on the current plan? Like, hey, this is where we're at in terms of trying to tackle this priority and priority. This is going to require a little bit of background. So, the current plan is not public health specific. Okay. It was done in coordination with other community entities, which we do want to get back to that, but um what was produced was previously determined to not be what the group was looking for. Um so we have really just been putting out fires ever since I've worked here. So um Okay, I cool. Am I answering that? Did I answer that question? You did. Thank you so much. next year meeting. We'll talk about this. Yes. Yeah. Um but no, we are not measuring our current work off of the past improvement plan. Got it. I'd be happy to review that if it feels like it would be a good use of time, but I I would advise that we don't Could you just send it to me? I'm just curious. Yeah, it's actually on our website. It's called the Health and Happiness. Oh, yeah. Okay. That's what we're working That's what we're not working off of, but that's what was produced. Yeah. I would say that a lot of our work is indirectly tied to that but it did not have like I said very measurable public health actions in it. So that was produced by largely by St. Vincent. Yes. So there was discussion um years ago um about kind of sharing the burden um of that and because of co and everything else um decided to take the lead um but it was really not a workable document that the other entities needed. Got it. It was just kind of to satisfy the um requisite requirements. Okay. A lot of tension surrounding um what was produced. I can feel it. Yeah. Yeah. I wasn't even involved in it, but somehow I have feelings about it also. So, I look forward to next year when we're

I'm really looking forward to this one. And that's why we were very um specific about the contractor we were working with so that we end up with like measurable smart a smart plan. Cool. Thank you. All set. Anything else? Thank you. It's 11:57 and this concludes the May 9th board of health uh quarter of the meeting. Thank you, chair. Vice chair, interim chair. Thank you, Matt. Thank you, Vice Chair. So, I got in here.