Northern Nye County Hospital District Board of Trustees– Northern Nye County Hospital District Board of Trustees Meetings - Regular Meeting

Thank you.

Thank you.

it's because we live in the boonies hey i've shown up here haven't you

Your call cannot be completed as dialed. Please check the number and. Welcome to Nye County. There are currently three other participants in the conference.

Thank you.

Good afternoon, everyone. I'd like to call the regular board meeting for the Northern Knight County Hospital District for July 16th to order. Please join me in the pledge. I pledge allegiance to the flag of the United States of America and to the Republic for which it stands, one nation under God, indivisible, with liberty and justice for all. Thank you, everyone. We're having just a small difficulties. We don't have any, no video, right?

But we have audio.

Okay. And then who do I have on the phone?

Kristen's on the phone.

Oh, hi, Kristen. How are you doing?

Hi, Don. I'm good.

Okay. And who else do we have on the phone?

You have Denise Ferguson on the phone. Can you hear me?

Hi, Denise, how are you doing?

I'm good, thank you.

Okay, that's it, just two right, right now?

And here's Valeria with Sonoba Dental Center.

Valeria, gotcha.

Yes.

How are you doing?

Good, how are you?

All right, let's go. Good, thank you. All right, let's get this rolling, because this looks like a long agenda. Item two, general public comment, three minute time limit per person. Action will not be taken on matters considered during this period until specifically included on an agenda as an action item. Do I have anybody for a public comment? Anybody online? Hearing nobody, let's go to item two. Approval of the July 16th, 2026 agenda. I say we leave it as it is and we'll work our way through it. Does everybody agree?

I'm good with that, but that's item three, not two.

And remove item seven.

What's that?

Remove item seven, she said.

Okay, so we'll remove item seven. All right. Everybody else good with the item three? Approval of the 16th agenda? Item four, announcements. Announcements. Do you have anything, my dear?

I don't right now.

Do you have anything? Do you have anything?

I do.

Okay.

I need to let everybody know on the board that Nancy Massage called me tonight and she wants to resign from the board. She wanted to try to make it through the end of the term, but she says she's just got too much stuff going on. It's just too stressful for her.

So we still have four people.

All right. So Item five, I don't see any emergency items. Do you guys? Item six, trustees, ladies and gentlemen, comments. This item limits the topics and issues proposed for future workshops and agendas. Again, nothing, nothing. This is going faster than I think. Item seven, or no, excuse me, item eight, no action. Presentation and discussion by Kristen Umina for the Northern Nye County Hospital District. July 2026 board update. Okay, Kristen, sorry I murdered your name. You're up.

No worries. Everyone does. You're not the only one. Hope everybody's doing good. I sent Andrea a little sheet. Did everybody get one? I just kind of have what's been going on in June.

Got it.

Awesome. So I put at the top just kind of a cutout of your guys' grant that shows, you know, the $2 million in grant funds, what your guys' cost matches, and what the total amount of the grant was. And it shows the extended date to May 31st, 2027, which is what our extension got approved to. Everything in the middle is just kind of some details about stuff I've been up to, in case anyone wonders. And then I just wanted to talk about... how things are going with the bank. And at the bottom, I put, we have about $490,000 that can be immediately reimbursed. So hoping to get you guys that money as soon as possible.

And- Okay, and we talked to the DA, the DA.

Okay.

Sorry, we did talk to Brian Coonsey, the DA, and I've got a voice message from him and said, we can go ahead and open up an account. in the Northern Nye County Hospital District's name with the Nevada State Bank. We just gotta make sure that we work with the county for accountability process and that. So we'll address that today on there.

I did see that on the agenda and Andrea had let me know about that too. So that's great. I'm still waiting on a couple of things from Dilber, but he got with me, I think yesterday saying that he's almost done with it. And then that will make the change in scope for the project. He's sitting right here smiling. Oh, hi, Gilbert. Yeah, so I'm just waiting on that, and then we can move forward with the change in scope request, and then hopefully everything goes smoothly with that approval.

Okay, great. Any questions for Kristen?

I just love seeing the actual paperwork updates because after almost two years of not, it's amazing to see actual being done.

Yes. Okay, so we'll get back with you tomorrow, Kristen, because we should have that account opened up and get you the numbers that you need so we can start moving forward.

That would be great. I wish you guys all the best of luck with tonight's meeting. And if there is questions that come up when you guys are talking about Hope Las Vegas or Dilbert's MOU, just text me and I can call back in if you need me tonight.

Okay. Sounds great.

Awesome. Thank you. All right. Bye.

Bye. Okay. So item number nine, discussion by Northern High County Hospital District July 2026, medical services and needs. We've just been putting this in here every meeting so that we can openly discuss where we want to move forward to. But I think our action items are going to cover pretty much what we need to do. So.

If Denise would like to speak, this probably would be there. Oh, yeah.

Denise, why don't you take this opportunity and talk with us?

Yeah. So I know you reached out last week and I kind of talked to you about where we were with the grant for the transformational submission that you guys turned in. Talking to your grant writer at Great Basin, they turned in the negotiation process and when we were on that call, the negotiation committee and the subcommittee for the state then indicated that they then have to turn that around to CMS and CMS then has to review it. and that the likelihood of them sending us a letter of approval is around the end of September or the beginning of October. And to get the approval letter is what you need in writing. You need to just proceed with even moving forward with funds. So any funds or any people we hire, anything we do before that date would not be covered by the grant, which kind of was a surprise, I think, to a lot of us. because we were assuming that we could get started a lot sooner than that. Secondarily, with this grant, I think talking to Joe and myself and the grant writer, they came back and said that there was a stipulation that for a new facility, they would not agree to a 12-month funding, but only six. I think myself, Joe, and the grant writer all put in supporting documents to state that any new clinic that you would develop, especially in a community that has been really going around for years with various vendors and kind of a lack of trust in building that, is going to require more than a six-month commitment for that. So really we're kind of waiting for what they come back with our appeal, which I don't think we'll get until September or October. Right now, I've already, based on choosing a name in a prior meeting, I've secured the domain name. I've secured an MPI for the clinic. We've been doing the paperwork part of developing the clinic so that we can move forward with that. And I'm going to probably start, even on my own dime, hiring some staff around September, October, so that we can get some people in the community going. But realistically, I'm going to send you guys a contract next month. And it's going to outline kind of like hopefully by the assumption of what the grant should come back to you guys in October is that the first six months will be covered. We need to figure out what do we do after that. And so I'm going to put a couple options for you guys to look at. Either you have funds to cover some of that for us if we're not whole. Maybe we do a 50-50. I'm not really sure. financially or where you want to be with that. So those are discussions we're going to have to have. The commitment to hire the providers is well over $650,000 for our hospital. So it's not something I can do without really talking to you guys about that agreement. So those are things we want to talk about.

OK. Any questions for Denise?

Not right now. You're still on, go ahead. I don't have any questions, but I would like to take the opportunity to discuss about some issues with the building, with the hospital building. Taking into account that she mentioned the flex town, and I understand that the plan is to use that money to replace the AC. I mean, you may understand that right now our patients and our staff is having difficulties with the hot temperatures as well of the materials inside or the sensitive materials that we have inside. So we are open the clinic, the dental office is open to work together with the hospital board to find a solution prior that money is received if possible. You know the hot summers that we have in the area, and well, it's all willing to find a solution as soon as possible.

absolutely and and we understand that too so repairing of if it's the one unit that covers the dental facility we'll work on that right away i do have a question um the building i know when you when you go into the patient waiting area that one is there like a vent or anything in that door so we can fan some of the heat from some of that at night because the rest of that building I know like the main clinic side of it, the waiting room, all of that is usually quite cool in there. Is there, even the bedrooms, everything. So is there a way that even as we're waiting for some of the air conditioning and things to be fixed and all that stuff, whether it's a fan that's put in there and like a hole cut in the door, some vending or something that's put in there that can help recirculate the air because a lot of that heat is accruing in that side where it's not accruing in the rest of that building.

So our staff, Yeah, so our staff is bringing fans and other devices to keep the lobby and the quarters as cool as possible. But definitely with the temperatures being higher every day, those things are not being working, you know, much. That's our concern. We have been using the fans. And the situation is that, you know, they cannot, the staff cannot sleep well in the quarters. The staff and the patients are sweating during the day. It's been a uncomfortable situation, yeah.

Okay, when's the next dates for your dentist to come in?

So the dentist is coming August 6th. August 6th. Yeah, August 6th. He's staying at the building. He's sleeping in the building that day. However, or administers, you know, or staff, the front desk is there every Wednesday and Thursday morning.

Okay.

So part of the issue, because my husband and I have been in there, is this The AC units that are in there that are being used temporarily are not being vented correctly, and that's what's creating more heat in there. And so I've asked Cindy to, you know, tell me a little bit more information, let me in on that other side so that we can see that nothing's been triggered. I have not gotten a response back on that information. So there's got to be some working on both sides because there is some things that we can fix. And the lobby is cool because it's on that other part of that AC unit. But I think part of the other issue is the thermostat in the living quarter side has been touched and messed with so many times that I think it's made it bounce out, if that makes sense. But I honestly think because it is working, we've heard the furnace running. Yes, the issue is that we can't get them on the other side to see if something's tripped because it went while they were there during that timeframe.

Okay. Valeria, we will work on it. I'll be up there tomorrow.

Okay, thank you very much. I really appreciate it.

Okay, and I'll get with Joe because Simerson's who we're going to most likely come in and have them replace it. So maybe I'll find out how soon they can be up here and or at least repair the one that takes care of the clinic part for the dental part. Okay, we'll take care of it.

Thank you.

Denise, did you have anything additional? I'm sorry.

No, I just wanted to kind of give an update on that the timeline has changed because of the fact that funding from the government has changed for us. So just kind of making sure if you guys hadn't heard that from your grant writer,

um that joe and the grant writer and i were all told that you know when we can actually start this process has moved like about three months so i have a question regarding this because maybe i'm not understanding um and i don't know if it's directed at denise or just kind of in general because the if the funding shifted and everything else with it because there are other projects tentatively that may be working with or working relying on you know some of this accounting on some of this um are we overstepping if the hospital board steps in to assist with some of this before the grant So we can't do any of this.

Anything that was written on the grant cannot be touched until we get the grant certification. But we can do other things.

Okay. Correct, Denise? I can do backfilling stuff that we need to do contract-wise. And, you know, as a hospital, if I choose to hire some staff, like a staff manager, there's some lab staff that I need to hire that actually need to get certified through the state in phlebotomy and drug screening and a whole bunch of stuff that takes about three months. And so we'll do that on our own salary line and not through anything that we would get reimbursed because it wouldn't be before the grant got approved. But we were told in our meeting that we would get a letter, all of us would get a letter around the beginning of October that had approval and then it would outline what they got approved and exactly what number. And then they would allow you to start submitting in November, some of the reimbursements, which, you know, just to be honest, like there isn't a doctor out there that's going to work in November and December when that's their first month because of the holidays. So honestly, probably the earliest we're open in this clinic is January.

Okay, but in the meantime, I know we have to get the x-ray machine and a couple other machines recertified and calibrated, so we can work on that too.

Yeah, we've contacted the state. My lab technicians have contacted the state on the lab equipment and then one of the things I was gonna bring up is if it's possible for us to set up a time next Friday where I can bring my radiology director out. She's contacted the state and is aware that they notified us that the unit has been disserviced or taken out of service. So she just needs to go there, look at a few more things, even though we took pictures. She needs to do a few things, and then we'll set up our physicists and our process for the state to approve that equipment. So we're doing some of that stuff right now. I just need to, my radiology director wasn't one of the people on the tour last time, so I need to bring her out like next Friday if anybody's available to just like open the door for us or something. If it's unlocked, we'll just go in, or you guys give us parameters in which to do that.

Hi, Denise. It's Elizabeth. Hey, I will get your contact information from Andrea, and I will email you and give you my phone number and stuff. If you guys will call me whenever you want in, I can come open that door and let you in. Awesome. Yeah, because then we'll get – Pretty much whenever. I'm home all day.

Then we'll get that going, and then Sandy and I are working with our insurance companies to add this location as a – X ID structure underneath ours and get insurance contracts going. So we're trying to do all the stuff that we need to, so that when we can start seeing patients, we don't have those hiccups. Um, but just kind of wanted to give you an update on what we've been doing.

Okay. Sounds great. And if you need us to move forward with anything, let us know.

I appreciate it. And if you need me at all, you're welcome to email me or call me. I'm always available. Um, If not, I will give you time back on your meeting.

Okay, thank you.

Thank you very much. Have a good day.

You too. Okay, so.

I have a question since we do have Valeria on the phone. July 2nd of this year, the letter of promise for the doctor's salary expired. Have you guys had a backup plan on behalf of that?

Valeria, are you still on? Yep.

Yes, I'm still here. Well, we did not use or never withdraw that money because it was intended to support a full-time dentist, and it hasn't happened yet. So we raised our offer to find a full-time doctor using additional donations other than the ones that you gently offered to us, but so far no candidate has been interested. So the foundation has been absorbing all these costs ourselves. And, well, is it possible that we make a new request so we can, you know, regenerate that request from us to the hospital district? We would like to count with that... with that money, of course, in order to meet or compromise with the future full-time dentist.

Okay. Would you have any problems with us soliciting or looking for dentists?

Not at all. Not at all. Any help is good for us, and we appreciate it. At least in the last over six months we have interview around four candidates and you know they go to the interview and then drop the offer and it's been you know it's been hard to find someone but yes if you can please help us with that we we will appreciate it very much for those that have dropped the offer have they told you why they've dropped the offer is it finances is it housing is there like what are the concerns on why they don't want it Well, basically, most of those, most of those, it does explain much, but definitely one of the concerns were, first, that Sonopa is very far from a big city, and second, that they would like to benefit, like medical, dental, well, dental, we can provide that, but medical and other benefits like 401K and things like that, that 401K with matches, of course. And also the salary was a concern. That's why with additional donations that we have received, we increased the offer. At the beginning, we have $120,000 as an offer, and right now it's $180,000. And still, you know, it looks like it's not attractive enough.

Mm-hmm.

Valeria, what is a competitive offer right now for an entry-level dentist?

So I think that 180 is a good rate for a new dentist. But additional, the thing with our office is that additional to the salary, they have student loans repayment, which is around, $50,000 extra that they get to pay any debt they may have. So at the end, the salary will be around $230,000. So, I mean, it's not a bad offer. It's just that I think that, you know, people is not being very interested in rural areas lately. And that's sad, in my opinion.

I mean, it's a- So we're looking for a young single dentist that wants to get his feet wet.

Exactly, yes.

And possibly start his own, okay.

Well, a lot of the, like the loan forgiveness, I know the statement about offers one, you commit, I think it's five years, they pay X amount of dollars for things like those. Those are the ones you work with, with getting with it. But the concerns I have is, In the year since we've signed that letter, unfortunately, one of the things, and I talk with the guys often with it, is lack of communication with it. If you're having struggles in the last year of getting one of these dentists and stuff, or even if you're from here on moving out with it, communicate and say, hey, we need some help in some of this with us. We can start working out or we have partners that we can start working with and see if maybe we can help you on our side in being able to get this service here. Yeah, a couple days, twice a month does not work for me for a service that has been here for I don't know how long. So I would like to see that either expand or figure it out.

Yeah, let me let me let me please. Thanks for bringing that into the conversation. Because that's one of the issues we also have had. I don't know if everybody is aware, but we hire a full a part time doctor. His name is Dr. Camden. since January, and he's a part-time, and we pay him very premium rates to go to the office. And also the same happens with the hygienist. They go to the office regularly twice a month, four days a month, two Fridays and two Saturdays. This has been consistent since then with one or two issues for personal problems that he has had, But we have tried to increase the days that we offer services to the community. But this is the thing. When we have the doctor there, paying him this rate, we pay him if he sees one person or if he sees 15. And the times that we have tried to increase the days we see people, we have a lot of no-shows or last-minute cancellations. This is a really, really financial impact for us. If the patient don't go there, we still have to pay the doctor. And so what we are trying to do is keep the schedule, you know, making sure that he can produce enough at least to break evens. And we, of course, would like to be open more days, but we cannot have him there, him or the hygienist, without demand because it's going to be a loss for us. And that's one of the problems we have had. We would love to be three days at least every week or every other week, but definitely the demand is what is stopping us from that.

Okay. We will try to work with you and see if we can locate somebody that would be willing to come up here too. I don't know what to tell you about the short notice cancellations or whatever, but I know a lot of people when they have problems dental wise, they need to get it taken care of immediately. They can't wait two or three weeks. So they'll go someplace else, but we'll work with you on that. Yes.

Yeah, sounds good. I mean, if you find someone interested, just let me know. I will send the offer. We have four part-time doctors. I will send the one that we have for full-time doctors. And we are open to negotiate in order to have something that can work for everybody.

Okay, sounds good.

Can you email Andrew the job description specifically of what you're looking for so we know when we're advertising and trying to work and help with some of this, we have specifics on what you want?

Absolutely, absolutely.

Thank you.

Okay, thank you, Valeria.

Thank you. By any chance, does the board have any other questions for us? I would love to address that, any of those.

Nope, no other questions. I just looked. We're good to go.

Okay. I would like just to add one little thing, and it's that insurance coverage. This is just a public announcement. We are working. We have already started to work in network with a list of insurance, so the prices are going to be even more affordable for the community. The process has started. We are being approved for some of them, but there is still a lot of insurance that are on the process and will be ready in around, I mean, it takes like between four and 16 weeks to have the completed process done. But as soon as we have all the list of the insurance we are in network, that's going to be, post in our social media or in the town social media so everybody can know that we are not only offering out-of-network services, but in-network services, Medicaid, and also a seating fee schedule based on income. Okay, great.

Thank you very much.

Thank you.

Okay, let's go to item, I'm gonna call that 10. Let's go to item 11 for possible action. Discussion, deliberation, and possible action to approve and amend and approve or deny signing a memorandum of understanding MOU with Hope Community Resources of Las Vegas. I said we did 10.

No, we did nine.

Oh, no, we didn't. Jeez, okay. You wanna read this?

Yeah, you want me to translate it for you?

10.

You want me to bring flashcards and set them up for you?

10 for possible action. Discussion, deliberation, and possible action to approve, amend and approve, or deny remodeling the existing hospital building for use as an extended care facility and all that encompasses. Okay. Gaffney?

No, I'm going to get you flashcards that have, like, one, two, and you can, like, put a thing on so you can see what's going on.

We have to make that decision. Are we going to move forward with using the hospital billing and remodeling it and turn it into an extended care facility?

I think considering the fact that it has sat empty for almost 11 years, because next month will be 11 years since the hospital officially closed with it and truthfully closed. We can't open her as another hospital building. We can't do the rest of it. It's something that benefits our community and the surrounding communities. And it benefits the elderly that are here and all the stuff with it. And it finally takes care of the people that truthfully have been, in all honesty, been neglected the most within the area. And so I would like to see this.

I would concur. Just seeing that we have the opportunity here to serve Northern Nye County with an extended care facility where, you know, they don't have to spend, you know, three, four, five months in Reno or Carson City or Las Vegas and then have to find transportation to come back once they, you know, made it through physical therapy or whatever. I think this is a great benefit to Northern Knight County and all of our surrounding communities.

We can keep families together. So I would like to make the motion that we approve. Item 10, the remodeling of the existing hospital building to use an extended care facility and all of that that encompasses.

Second. Okay, I have a motion and a second. Any further discussion? If not, call for the vote. All in favor say aye. Aye. Any opposed? Any sustained? Okay, passes 3-0. Okay, so we're moving forward. Hallelujah. Can I do number 11 now?

You know what the 11 looks like?

Number 11 for possible action. Discussion, deliberation. She's going to have another arm broke before she leaves tonight. Discussion, deliberation of possible action to approve, amend and approve or deny signing a memorandum of understanding MOU with Hope Community Resources of Las Vegas.

Dilbert, if you would please.

I asked Dilbert to be here because everybody should have gotten the MOU and read it, but I want him to explain it to you guys.

Use little words, though. Words are hard for Don today.

Small words for her. I'll keep it very simple. Say your name and spell it for the record. It is now.

Dilbert Cruz, representative of Hope Community Resources out of Las Vegas. And it's D-I-L-B-E-R, last name Cruz, C-R-U-Z. The MOU basically authorizes us to start requesting grants on behalf of Hope Community Resources to work towards the extended care and behavioral health center. Because it's not only going to be an extended care, we're actually going to be attaching a behavioral health And the reason why they both work together is because a lot of the grants that we're working with are part of the VA. And most of those programs require a behavioral program to be attached in order for them to qualify for a lot of those benefits. So that's what the MOU is, gives us authorization to start working and start applying for grants start applying for permits to start submitting for licensing and, and, um, pretty much, you know, work on your behalf. And that's pretty much, uh, the main concept of that. And there's three points that we discussed, uh, in the MOU is the extended care, uh, behavioral health and housing because that, you know, that's also a major part of this project that we're, we're bringing along. It's also gonna include housing for the veterans that can be, you know, live on their own. They don't have to be part of the extended care. So I'm open for any questions you may have.

What's this gonna cost us?

Nothing.

I like that already.

Yeah. Yeah, all that, everything will be running through grants. Like I said, there's so many different programs out there. The main one is with the VA, we are working extensively with the VA. It's not gonna be 100% VA. The reason why we're not doing 100% VA is because if we go that route, then we will not be able to accept the civilian seniors and all that. So that's the reason why we're combining it.

Is there an escape clause in here?

Yes, 30. days, uh, that you, and you know, like we discussed it before it on, uh, you, you always need to make sure that you're, you know, that y'all are covered. So you're not happy with us 30 days written notice. And I need it for, for Ms. Elizabeth. Yeah, absolutely. Of course we can always, I mean, we always need to sit down and discuss and always try to come to a solution. But if, if y'all are not happy with anything that, you know, we're doing, uh, you can always kick us out.

Now, did you want him to give you daily reports or weekly or monthly?

Or I would like when we have meetings that yes, there's reports and communication and updates. Um, as we had, you know, kind of conversed a little bit before with it as the project moves forward and stuff with it, stay updated.

And, and, Oh, absolutely. That's the communication has to be the most, the most important thing. I mean, uh, You know, if you want weekly, I would prefer weekly, but if you don't want it monthly.

I'm good with weekly. Monthly, I don't care.

I would think once the thing, once the project is over. Yeah, but at the beginning, I think that weekly needs to be very important because there's so many moving parts, especially at the beginning. But then afterwards, you know, monthly will be more than enough.

I do have one question. Your mental health clinic one, is that going to be able to, I thought I saw it in here, maybe not. the therapist and stuff that you have coming down, are they going to be able to operate as a crisis intervention team as well?

That's the main, they have to be crisis intervention specialists.

They'll be here so we can, is it going to operate only in that facility or are they going to be able to say we have one that involves like our ambulance that is calling going, Hey, we have a patient that's doing this. Are they going to be able to bring them to those providers or have those providers go to them?

Um, Right now, original plan is bringing them to the provider. Okay. Once, I mean, if we see that there's more than enough need that we need to hire someone to go and do home visits, that we can visit that later in the future. But as of right now, we'll be bringing them into the facility. Okay.

Just like the clinic.

Just like the clinic. Okay.

I'm trying to find the thing so I can word it the right way. I make the motion to approve signing the Memorandum of Understanding with Hope Community Resources of Las Vegas as they have that written as item number 11.

Second.

Okay, I have a motion and a second. Any further discussion? All for the vote. All in favor say aye. Aye. Aye. Any opposed? Nope. Passes 3-0. There you go. Thank you, Dillard.

Thank you.

Okay, item 12. Possible action, discussion, deliberation, and possible action to approve and amend and approve or deny signing a management agreement with Hope Community Resources of Las Vegas to oversee the remodeling, construction, and extended care facilities.

I do have a question to start this one off. Is it going to be a concern or an issue with the fact that that says 101 Radar Road and not 825 South Main? 825 is the actual physical location of the hospital building. Under client. I don't know if that address was.

Well, no, the client we are, Northern Knight County Household District 101 Radar Road, that's the courthouse here. That's how it's set up.

I didn't know if it needed to have the other one on there as well.

We maybe should put in there doing business at facility 825 or whatever.

Okay, we can change that if you need us to.

or just added into it. Again, I like number seven. Compensation contractor will charge the client a fat fee of zero for services. Yeah, that's a fat fee, all right. Okay, anything else you guys see?

The biggest thing with that is just to make sure that I stay on top of the communication with all of the contractors and with Kristen. Right now, because we have such a tight time limit with them, we were able to get them extended up until May. but we already have a very tight timeline right now. The first thing that we have to submit, it has to be submitted within 90 to 120 days. Well, we already lost almost 30. So now I'm at 60 days and that's just the first initial design in the front phase. So this gives you the authority to move forward instead of having to wait for us to... Yeah, it gives me authority to start working and start signing contracts and get them moving. and get them paid.

And there's something in here that says that we can't come up with a money yield from the bill, right?

Yeah, no, I said that Don will pay for it.

That's not what I meant. All right, gentlemen and ladies.

I'm good. Then I will make the motion to approve signing the management agreement with Hope Community Resources of Las Vegas to oversee remodel and construction of extended care facility I do have one caveat. I would like to that again. Obviously, it's become kind of the theme I have with it. It's just communication as this is going with updates so we can see.

Second. I have a motion and a second. Any further discussion?

Nope.

Call for the vote. All in favor say aye. Aye. Aye. Any opposed? Passes 3-0. Thank you. Thank you. Item 13. possible action, discussion, deliberation and possible action to approve, amend and approve or deny opening a bank account in the name of Northern Nye County Hospital District to be used to facilitate the HRSA grant and the Rural Health Transformation Grant. So we put this in here because when we talked to Kristen, in order to get any of this money reimbursed, there has to be an account with that name on it. Nye County does not have that. Nye County has Nye County's account. I talked to the DA. The DA said, yes, we could, between our rounds, to open up that account with Nevada State Bank, but then we have to work with the county to make sure it's transparent and they see the funds and everything.

Right now, there's $490,000.

Waiting for an account to put it in, huh?

Yeah, like Kristen mentioned, right now there's $490,000 already sitting in reimbursement that can be, you know, put into your account, because I know right now there's a lot of expenses that are accumulating. But as soon as that gets done, she can start working on it, and HRSA reimburses fairly quickly. We're looking at four or five days.

I would make a motion that we open up the Northern Knight County Household District bank account at Nevada State Bank, and I would like to see Elizabeth's signature and Dave's signature on it. I don't want to be on that just because of my position on this board. And that needs to be set up as two signatures. And if we need money to open it, I'll cut a check and make it out to Northern Knight County Household District and we can get reimbursed later on.

I would like to clarify for this, for your agenda, where it says HRSA grant and rural health. clarify that we can, or add however you do with it, that it's for any future ones that we have this struggle with as well. Not just those two.

Okay. And this was mainly what we needed, but I agree. Well, can we add that at any time? Any future grants will be run through our account?

Or can we add that as like action item for later to make that decision to move in? Let's do that. Yeah, the agenda item does not list that.

Okay, so we'll keep it with the HRSA grant and the Rural Health Transformation Grant. And then we can bring it up as another agenda item as we move forward.

Yeah, because there are going to be some of the grants that we're going to be doing will be passed through grants, which means they will have to go through the county. Most of them will go through HOPE. but there are going to be some that are going to be passed through the, so you want to be able to have access to that and not go through, you know, through Perron, you have full access to that.

Okay, so that was my motion.

Second.

So now I have a motion and a second. Any further discussion? No. Good. I'll call for the vote. All in favor say aye. Aye. Aye. Any opposed?

Nope.

Passes 3-0. Can you guys get that done tomorrow? Okay. Can we open it without you there?

I have to teach class tomorrow. The only issue that you're going to have is that I will be hunting down for signatures every time I need to.

You're hunting them too? Just letting you guys know that.

That's part of the reason she's probably glad you're not there. She doesn't have to find you.

She doesn't need a security badge.

I am around on Fridays. You know that. All right, let's move on. Item 14, possible action, discussion, deliberation and possible action to approve, amend and approve or deny implementing an education reimbursement program to assist local medical professionals with schooling. So on this one here, Brian Coonzie, the DA, wanted us to table this so that he could come up with some kind of a plan. I'm doing an education reimbursement list.

This has been tabled for like four months now.

So after speaking with Brian, he wants, we can move forward, but we just need to specify some parameters for these next few agenda items. We might have to come back on number 17. But then again, some of these kind of tie together. So if one worked, then you don't have to hear the other. They're just all there too, depending on how you guys want to move. We just need to have some parameters with how you guys want to move forward with it. We can always do a policy. Yes, this item has been tabled a few times. we can do a future policy sitting down with him and doing that, but there's gotta be a little bit of language put into these motions.

So I do have a question though, but so for this action though, we are not discussing the details of that. We are only discussing putting an education reimbursement plan in place. So that's where we're at right now. We're not discussing the details of establishing this reimbursement plan.

Right. So 14 could be tabled because that's more of like the policy type or 15. We can hear 16 if you want to move forward with that one with the parameters written in it, because that's more the item that's been tabled a few times.

Well, I think because there's specifications within 16 and 17, we can actually, I think, should be able to move forward with those and come back to 14 and 15.

If you guys are in agreement, we'll table 14, 15, and 16. We'll work on that with Brian, but let's do 17.

No, hang on. We can table 14 and 15. 16 and 17 we can act on. Because they're within specifications specifically of what is to be determined. And those ones, those are separate ones we already, with it 14 and 15, we can formalize and then come back.

Okay, the only reason I'm saying this is because 16 mentions Stacey Johnson and 17 mentions Stacey Johnson. Oh, it's...

So that is the one that you guys can do the parameters with?

Yeah. Right.

Which is what I spoke of.

I would like, like I said... I think we can table 16, but I want to get 17 taken care of tonight because we have been pushing that off. You guys good?

Yeah, please. Who are you? Marie Peterson, P-E-T-E-R-S-O-N, nurse practitioner.

The medical lady in charge.

So before we actually table 14, I think I'm kind of sitting along with David is, This is just saying that we're agreeing to implement an education program, not that we have one built, not that we actually have any details to it, but just that we're agreeing that we're going to have one. If tabling, it means we can still move forward with other action items and not agree that we have to have a program. And I think that that's acceptable. But if we're saying that, we can't move forward with other items without having an education reimbursement program. And I think we're kind of losing out on all the other agenda items.

Well, and I think to be quite honest, we, like I said, we've tabled this quite often. We've had stuff with it. So I, I think we should table 15. That's the specifications. 14, we can make the vote to approve saying, yes, we're going to do this. 15 and 16 have parameters already in it that will cover what we need for it. And then that way we can take care of, agree to one or deny one, boom, boom, and be done. And then that way we can finally move forward and clarify this in the right direction instead of move forward two steps and back 12.

Okay, I agree. And let's go back and open up item 14 for possible action, discussion, deliberation, and possible action to approve, amend and approve, or deny implementing an education reimbursement program to assist local medical professionals with schooling.

I don't have a discussion, but I can make a motion.

Go ahead.

I make the motion that we approve implementing an education reimbursement program to assist local medical professionals with schooling, with that caveat that as the policy is developed in the future, that be the policy that's applied.

I'll second that. Okay. We've got a motion and a second. Any further discussion? If not, call for the vote. All in favor? Aye. Say aye. Aye. Any opposed? All right. We've got our policy in place. Now.

We tabled 15, item 16, sir.

Well, we got the fact that we're going to put a policy in place. Okay.

We tabled 15, 16.

We'll table 15, 16.

No, we tabled 15. We can act on 16.

Okay. 16, for possible action, discussion, deliberation, and possible action to approve, amend and approve, or deny reimbursement for cost of education to Tonopah Primary Care and Stacey Johnson for amounts to be determined.

Okay.

Can I do stitches? No.

Staples?

No. I trust all the medical professionals out here and the dog more than I trust you, Doctor. Okay.

Good idea. Okay, so the agenda item here said reimbursement is for $2,000 for Stacey Johnson to Tonopah Primary Care and what's the $1,000 So is it 3,000 total?

Yes. So there's two different payments that were made already in retro, and so we're just looking to see if we can get assistance with reimbursing those two together as 3,000.

So this leads right into item 17.

That's why you couldn't table one without, and I don't want to table them no more.

Okay. What do you guys want to do? You want to approve 15 or 16?

Yes.

Make a motion.

Then I make the motion. Hold on. We got to hang up. Hold on.

So on item 16, we combine multiple of those. So it's not just one or multiple. So you guys need to do each page. So you don't do a motion. You need to do each page individually. Yeah, because there's three of them in there. Because if you make a motion, you're only making a motion on the first one that is there. There's multiple requests in... Okay. In that.

So there's a request for February of 2000, May for $1,000, education funding's $5,000 monthly, and then the reimbursement amount of 19,803.34.

So there's two different ones that have to do with Stacey Johnson, and then there's another one that has to do with future workforce building.

Yeah.

Yeah.

Okay, so the, hang on, I'm trying to read how this is put in here. And then there's one more at, after Stacy's backup for 2000 for a CNA training for new employee that needs this program.

Correct. And we could possibly wrap that into the 5,000, but again, we can discuss that.

Okay. So hang on, let me clarify, cause I'm trying to understand the papers and broken wings, not working. So the 17, or item 17 for the 5,000, because all the papers are kind of squished into one.

Yes.

The education for the 5,000 monthly, that is to continue the schooling, correct?

Correct. So this is really our workforce build. And so if I can just kind of give a little bit of a preface as to what I'm thinking on this one, or do we want to tackle the previous expense items?

I think the... Oh, okay. Okay.

Because we've got two different focuses here. So one is actually reimbursement for the $3,000, which has already been spent on expenses, as we've discussed before. And that is specifically reimbursement to the Stacey Johnson education piece. Then we ended up, it comes to me as a company, correct, because we've already actually put it out. Then the next one actually is her nursing school reimbursement. And that one is for her program. So you'll have that up there as well.

That's the 19,034.

Correct. Yes.

I'm so excited. I remember that number. Sorry, I couldn't find it. I was trying to remember it.

So I almost think that those two actually make sense to kind of like tackle those first before we try to go into the future.

I think the paper that's in here on the 5,000 monthly should actually be 17.

No. So that's where I'm trying to clarify that.

Okay.

So we're, we're going to say the Stacey Johnson foundation. We're focusing on one student here. This is just so we could justify where she's at already with her program. So she's like 75% finished with her program already. And so this is us looking in retro and saying, look, if the work can help her out, she can continue on and finish the last 25%. And then we have a local RN resource that you've actually helped to build. And she does have her letter of commitment with this. where she's looking at once she graduates, which we're talking about another year from now. And then there's the licensure timeframe that goes in. From the time she becomes licensed, she is actually committed to working five years further. So literally we're already looking at, she's already supporting Tonopah currently right now, has for the last two years. We're looking at about six year further commitment and probably seven. And I expect it would be longer. It's just that her contract will no longer be binding her. but she has no intentions of walking away from us.

Okay, so here's my take on this. In the agenda item, it said Stacey Johnson will complete three months of employment with Marie Peterson or Northern Knight County Hospital District after graduation.

So I'm not sure how that agenda item came out that way because the way it was actually submitted there was nursing school reimbursement for Stacey Johnson for nursing school classes already taken and paid for And then the actual commitment letter actually shows that she's signing up for a five-year contract. So I don't know how it got on. I have a copy of that.

Are you talking about 17? Yeah. So 17 was added by Gwen because this was a discussion that was from the June meeting that was carried over to this meeting.

Where does the three months come in?

Oh, I know what that is. That is the summer qualification so that she could keep going through the summer. That's what that conversation is. That is the X amount of dollars per month from, I think it was June, July, and August that would continue that between work expenses and everything else. That's what that one is.

So that was a side conversation, but not actually submitted. It was just a discussion during the meeting and apparently came through.

I think Gwen actually submitted it for us.

Because we were kind of shocked to see that it was three months.

That's why I've never had a three-month plan. Okay, that's why I'm confused because I'm reading going, we have two different things. I got you.

You're always confused.

All of these work together, but they don't, and that's why we need to address them separately. Okay, so 17 was the summer recovery one. That's why it says three months, that she would still continue with the three months of working through it as she did this part. 16 is all the rest of that.

And that was also to go along with the fact that we were looking at that three-month plan because we didn't have this education program policy and system already built within the boards.

Okay, so now I know I'm confused. Okay, that's why we're reading papers. Wait a minute, because we have, that's what this one is, Dawn. That's what this is. Community Health Workforce, $5,000 monthly. That's what that one is. That's different.

That's different.

So here's my suggestion. Let's vote to reimburse Ms. Marie Peterson the $2,000 and the $1,000. That's $3,000. That's the start, yes. Okay, that's the first part.

Okay. Then I will second that motion. No, I have to make that motion.

No.

Everything in one? Okay. Okay. Okay.

I think we need a whiteboard.

Yeah, I need some sticky notes.

Right. When we talked to the DA on the $5,000 one on 17, he said that was fine, except we can't cut a check to Stacy. We can pay the college and continue paying. Is that what gets you going or keep you going?

The problem is you can't submit a check to the college unless you pay for the whole term up front. So we had to.

And how much is the whole term?

I'm already in the middle of it. And I already have a payment plan going.

So you'd have to cut it to the Dr. Peterson Education Fund with the little notes on there that says Stacy's Education, blah, blah, blah, on it.

Well, and that's where we needed to have the DA put it in legalese.

He said it can be done as a scholarship. We can't. Whoa. back date payments for past education wise, because then it opens the door for everybody to come and ask for their back. So we could future pay and use as a scholarship and make those payments directly to the school. Because if we make it directly to the individual, then it would, there's no guarantee that that's actually going towards the schooling. So that is why that is written the way it is. Gotcha.

The parameters are listed. So my understanding on back pay, so she's got $19,000 already paid in to schooling, correct? Correct.

I've paid, where's the paper? It's on the back. It's 24s. So, so far I've paid $24,030.85 just for tuition, not including all the other fees or everything else. And then, so the 5,000 would get me through the summer. And then if you wanted to pay a check to the school for next term, if you guys decide to do that later, it would be 12,700 for the term.

So if we can't pay it back to the school, can we make it that we pay it what's coming, the $12,000? Because we can't pay it to her.

You can award a scholarship for a specific amount, and then, yes, we would need the schooling information, and then we can make that payment directly to them.

Repeat what that number is, please.

So it was lower, but I got an email yesterday saying they're increasing the tuition.

Mm-hmm.

So as of my next term, it'll be $12,700 for a full term. And that'll be my last full term if everything goes according to plan and they let me do what I want.

Is that even? $12,700.

We'll just do even. I'll take care of the change that comes up later.

Okay.

Stacey, does that include any, like, education? It includes books. Okay. So that's everything?

Yes.

Okay. Thank you.

So the only thing I was suggesting is because Brian Kunze said, the DA said we can't back pay, but can we, in our policy, once we get it set up, for every additional year that she stays here, we give her reimbursement of so much of her schooling? Yeah, but she's got to put in a year's time.

It's like a commitment thing with it. I'm here so many years, you know, and you sign a commitment thing of, okay, I've made three years to get your sign on bonus.

Your total thing so far is $24,000. So if we go, you're going to stay for five years, we'll assist you with getting your degree. But for every year you stay from this point forward, we'll give you a percentage of that $24,000 back. So if you stay the five years, you'll get reimbursed 100%.

It's like a retention bonus.

Yeah. Yeah, I think that would have to be a separate action item, though.

I think that's something that we could address and we get counsel and then add that to the policy on item 15.

But I want to make sure they know we're not just throwing that out, you know. And as far as the $5,000 a month goes, I think we need to talk about that because right now we are, I got to be very careful with our money because of what the grant's going. We have to pay everything up front and I have to make sure we have that money.

So what I'd like to actually say with that is, okay, so I can hear a lot of planning about the buildings that we're going to build and the companies that we're going to bring in. And I think it's wonderful that we're going to try and have some care services, a care center, but we're going to need staffing.

Yes.

And in order to build that staffing locally, so we don't keep having the same turnaround, you know, we've got many, many companies in here. And the failure point that I can see is that we don't have local staffing available for them to hire. So if we actually take our little meager budget, and again, 5,000, I realize there's not some money, but that's a small startup for us to be able to say, and I do have some job descriptions here, but It's a small startup for us alongside with the board and everyone else who's focusing on these other larger projects. If I'm given 5,000 a month to work on education, I can build Tonopah, a nice base workforce may not be the biggest ones. We've got a big investment going on with Stacy here for the RN part, but you need a lot more than one RN. We're going to need CNAs for that long-term care facility. You're going to need nurses for that. And we do have individuals that are actually interested. just over the last, what, six months of having that bulletin running out there saying I'm hiring, we've had some very well-qualified individuals walk through. We've also had some of our younger people in our community that want to do it. So I love the fact that we're going to focus on the building part of it, but I'd like to build the staffing right alongside with it. And so that's where I'm looking at. I mean, this is a small investment. And so I would really request that you let me take the people that I currently have and keep building your skillsets. That 5,000 will let me send them to school for a phlebotomy course might be $2,000, but I can move it faster and I can appreciate that we have to go through this board process for each one. But if we have to do this for each one of them, it's going to slow them down. If I have a budget and I will set up a separate bank account. So there's plenty of accountability. You'll know exactly how it's being spent, where it's going. there will be agreements with them of saying, if I'm getting my phlebotomy piece, I'm going to have a two-year commitment and it'll be to Tonopah. So that's where I'm looking at again, meaning it is a monthly amount that I'm asking for, but that's because I want to be able to continue to keep proceeding forward with let's train them up. So by the time that this long-term care facility is ready, we have five or six CNAs ready to go.

I would like to be devil's advocate for this one, considering how long we spent giving $45,000 a month to a clinic that didn't do a damn thing. And there was very minimal with it. To me, $5,000 is a simple ask.

Okay, but the only caveat I'd like on that is you just said $5,000 to build it locally. Yes. But then you said they're going to sign an agreement to work strictly for you.

No, for Tonopah.

Okay.

That's for Tonopah.

Okay, so they have to say in Tonopah whether they're working for you, the clinic.

Anyone that's done.

Okay.

There are accountability contracts. They're not specifically hers. They're ours so that we can say, we as the hospital board have given you X amount of dollars. If you do not agree to stay in Tonopah, or even as it gets to the point where it moves on and say they move into assisting with Round Mountain or Esmeralda, you don't agree to stay in this area. then you will pay that back with this so that it does help the extended care and Mount Grant and all the rest of those with it.

It's building that county. I mean, that's literally what it is.

Literally the build your own, grow your own program.

Yeah. And you've got high school students. I've got them in my office. You've got people that are interested, but their interest will only last so long. So if I don't act when they're interested, you'll lose that and they go off to somewhere else. And then you can't get them out of the big cities because once they get the big paycheck, they don't want to leave it. So that's really where, you know, again, the secret is to find people that want to live here. You hear about how hard it is to find a dentist. We have an individual in Tonopah that wants to become a dentist, but we need to act on it. So again, finding those people that are actually interested, they're already local. You're not going to have all the housing issues. You're not going to have all the transportation issues and you don't have to pay them high. It's like trying to run your business with the agency staff. You can't do it forever. It always collapses, unfortunately. So yes, it'll be for Tonopah. And I'm not saying Tonopah primary care. This is Tonopah.

This is Northern Knight County. Northern Knight County.

That's how it will be written.

So I don't want to make the motion because this is a lot with it. But I think I can summarize. We're going to attempt this. And I'm going to murder this hysterically. So we'll giggle about it later. OK. So because of all the 16 things with it. So I'm going to. We can do one bubble or I have to do one per page? Okay, so part, fine, we'll do part A, part B. I make the motion for part A that we do the reimbursement for the training or the scholarship, excuse me, scholarship, whatever, however that needs to be worded, for the $2,000 in February and the $1,000 in May. Part B is the $5,000 a month to Dr. Peterson's office as she builds her workforce For how long? I think it's five years. Actually, this is, yeah, so we'll provide a five-year contract.

We didn't put a link on it, but if you want to put it for five years.

Why don't we put it for a year at a time?

I think that's good. Yeah, I think that's good.

See how it's working.

And we may have to adjust it because if we need more and we're building higher levels, we may want to adjust it. I think a year is great.

Also, with understanding or a little subcontext, asterisk, whatever, that's Nye County specifically for clarification that it's not just with Tonopah Primary Care, it is Northern Knight County stuff. And then the C, I think if I'm getting this right, I'm probably going to screw this up, the scholarship for moving forward for the $12,700 for the future education for that. That covers A, B, and C of all those pages.

If we're talking about the $2,000 for the CNA? Okay.

I'm not sure.

We will actually just let that one ride, and I'll use that $5,000 that's going to get approved, and we'll use it for that.

Okay. So A is the scholarship for the $2,000 and the $1,000. B is the $5,000 a month for the workforce. For one year.

Workforce development for Knight County.

Yep, for one year for that. And then C is the scholarship for $12,700 to cover the next thing of education.

Second.

Okay. Okay. So I have a motion and a second. Any further discussion? No, because that was a lot of words and a lot of numbers.

I am. We're going to have to do some paperwork for finance. Just to give you a heads up, this is not going to happen overnight.

That's fine.

We appreciate the support.

We're moving forward. It's not tabled anymore.

We want to build Tonopah.

I want to build Tonopah. It's going to be a long time.

Eventually I will need to.

Even if she retires, and I use that loosely in quotations for those that cannot see it, you still have the advisement where you get a little advisor role where you're like, I'm not fully active but still giving knowledge. She's going to be forever.

You want to hear that part of it? It's called, I want to teach so I can build the next generation. So, yes, train the one that will come run the field for me, and I'll continue as an instructor.

Woo-hoo. Sorry. Okay. Call for a vote. Let's do it. Is everybody ready? If there's no further discussion, I'll call for the vote. All in favor say aye. Aye. Aye. Aye. Thank you. Thank you. Any opposed? All right. Passes 3-0.

All right. Moves everything in the right way. We're building our own. We're building the facilities. We're doing the things. It's finally actions happening after I don't know how long. It makes me happy.

So what number was that that we just beat up? 16. That was 16 or 17? 16. 16.

17 is the $5,000 a month for the summer.

17 we can table, because that's just a... Yeah. Okay, because we're not going to do that. 18, for possible action, discussion, deliberation, and possible action to approve, amend and approve a priority list for the Rural Health Transformation Program grant. That's put in there every month, too, just so we can talk about it. Joe, where are we at on that? What's coming up on the rural grants list? Nothing? Nothing's open right now?

We just need to start handing microphones out when you walk in and be like, here, that way nobody... Joe Westerman, Town Tonopah, W-E-S-T-E-R-L-U-N-D. And they haven't released anything for the upcoming grants, but we will have to start coming up with ideas on what we want to go for in the second round.

What is the second round?

It's the same as the first.

But we missed three parts of the first round, right? Or four parts of the first round?

We didn't put anything in in those. They told us to put everything into the flex and they would decide what we wanted to do with it. But we are talking, I am, and I know Denise is, to Jason Blake about, and he's a director of the RHTP, about we have to look at more than six months of funding. There's a lot of people who won't come to the clinic because they've been disappointed so long. And we just need to start getting Mount Grant to build a rapport.

We need to start advertisement and community outreach type events now.

Right, yep.

We need to meet and greet.

We have that list. I would like to revisit the list after we, I just think we need to concentrate on getting the clinic open, get all that stuff going. But I think the new stuff is gonna come out in October also. So we have to start looking into getting our grant writing going again. So I have been paying attention to what's going on. Once we have a little bit more feedback on when we're gonna do that, I'll let you guys know. But I did want to comment on the last item. If we want to be successful in this town medically, that was a huge step forward. And you got to try and keep local. And I'm hoping on the next round of money, because I don't know if it got approved in this last round, but we're trying to get Great Basin, Nye County School District, and the coalition to work together on doing dual credits. And I think that's going to work hand in hand with what Marie's working with. So.

Well, I also think, you know, our 14 for medical professionals, not only do, does it help the higher ups towards the doctors and nurses and things like those, your EMS responders, things like those, some of those classes and stuff that they offer that are absolutely invaluable, like they have EMS Expo. you're looking at about $2,000, 2,500 to send somebody to go do that. The class of the offer, that's the top of the line. That's the new toys that are coming out. That's the new equipment, the new skills, new NRMT stuff. That's where they need to be with it. And people here can't afford it. And so being able to build this program and work for it in doing this, whether it's through grant options or other options with it, absolutely I think needs to be a precursor and a footing of how we move forward from here on out is making sure that that kind of things are taken care of first.

but it's a whole lot easier to retain people who grew up here than it is to recruit people to make them stay here. So anyways, I applaud your guys' decision on that. Thank you. Thank you, Joe.

Okay, so.

Uh-oh.

Sorry.

You got to turn the mic on. Is there a green light?

Deb Cobb, COBB. I just want to say, listening to all of this, if we, when we move forward with Matt Brown and we have people that are local working, it's going to build that trust faster. We're not going to go, they're not going to go to these strange people anymore. It's just kind of worn it out. So we get these locals in there. I don't care if they're in training, but those faces that we know, it's really going to help move this forward.

Okay.

Thank you.

Anything else for 18? and move forward with that. Good? Yeah. Okay, let's move to 19. For possible action, discussion and deliberation on augmenting the annual budget as presented and approved due to capital outlay not being needed.

This was Gwen's.

Gwen, are you online? So I'm not understanding of what she meant.

I say because she's not here to explain that we table it. We table it next month.

Okay. Let's table 19 then until we get more information. I see the budget, but I think we're going to be able to spend everything in it. Item 20 for possible action, discussion, deliberation to approve or deny funding the purchase or purchasing a POCU as portable ultrasound equipment in the amount of $15,000.

I have a question on this one. Okay. Mainly because, where is it?

Marie Peterson, P-E-T-E-R-S-O-N. Come on, it's in here somewhere. You see two versions there?

Well, no, I was trying to, this is not cooperating. Actually, what I'm asking is, is in our current clinic building we have right now, we have a portable ultrasound machine.

So I haven't seen that portable ultrasound machine. I'm not sure what specs it has. The last time I heard with that machine, I heard that it was missing a part. They couldn't get it.

So there are actually two ultrasound portable ones in there. One is their newer one that sat in like the cross from the triage observation, whatever that room thing is supposed to be. People have time to come take a look at things.

Might be good.

If it'll work and it's currently not being utilized, I would rather it be utilized.

And if it would work with what I'm understanding that it should, it doesn't have any missing parts or pieces and it's functional, that might be working well. So I just recently had the opportunity to attend a eight hour workshop for POCUS. That's point of care ultrasound, which means you bring it to the patient's bedside. The two different versions that I put on there, one is about 6,000. That one is a little hand carry pocket thing that would actually allow me just to take my cell phone right to the bedside. That's very portable, very easy and gives a lot of good information. It may not quite be the quality of the one that's the 15, which is why I included both of them for options. Looking at that one is giving us a lot more detail. So you're looking at being able to identify if someone's in heart failure. My big idea here with this ultrasound part, one is faster diagnosis. It's also allowing us to save our EMS team from transporting people that maybe don't need to be transported. You can actually identify pneumonia with a little small portable. So again, if the machine over there is actually really is a portable and it's functional, that'd be great.

computer screens on it, all the attachment things are on it, whole bunch of the lubricating jelly stuffs on it. I'll get with you and we'll go open it up and take a look.

Okay, that sounds great.

Okay, so can we make a motion then? Okay, so our policy on the household district is we're not going to give you money to buy something. We will purchase it. It'll belong to the household district. We'll put it on perpetual loan to you.

I'm good with that.

Just like what we're doing with the other stuff, with the x-ray machines at the clinic and all the other stuff.

I'm sorry, one thing I will say about the one with the 15, which I don't know about the other one, is that it actually does come with the ability. And again, age on the other one may not come with the ability for it to transmit the images to someone who is very skilled, other specialists that I would like to be able to see the findings that I'm seeing and give me more details. So being that I've had eight hours worth of training, I am not an expert. it'll take me at least six to eight months before I'm going to feel like I've got that level. So that's where I would look at the 15 and say that actually gives you the ability to send it off to a physician and have them also assist with interpretation, i.e. Dr. Rowan in Bishop, California, cardiologist who would be excellent at helping us identify heart failure, not heart failure, real time.

Okay. So instead of letting this drop, can we approve this with the understanding that the other one, it meets the requirements that you want. We'll just bring that one over. If not, then we approve.

Then we can go forward with, and I also have, I paid that invoice. So that other ultrasound machine is only about two and a half, three years old. I have all the information for her. I will email that over to you so that you can see the, That would be great.

And I'm good with either one of them, whichever one just meets the necessary need.

Okay. So what kind of a motion do you want to make? Go ahead.

I'm going to ask a question. So knowing what kind of coverage and care that we need here in Tonopah, I would prefer that we look at the more expensive options so that, you know, we do, you know, we have the ability to assess individuals that are in cardiac arrest or, or, you know, you know, whatever, you know, conditions they have that we can identify that. So for me, The small portable $6,000 portable.

It doesn't fit.

It does not fit what our needs are for Northern Knight County Hospital District.

To me, it's a matter of higher level of care. What's best for the patient with it. That $15,000 one provides multiple with it. It provides her with more options. So if she's sitting there going, hey, this looks kind of wonky, but I'm not 100% sure, she can send it off. And it truthfully is providing highest level of care for the patients. I'm saying that.

And that's exactly what we talked about.

Right. So just to be transparent on that. The $15,000 is not the $30,000. So you're not getting the Pontiac. You're not getting the Ford. The $15,000 one, you're probably getting, let's put it in the toilet section. But if you're looking for the Cadillac, you're probably talking $30,000.

So the Bentley, the Rolls?

Right, yes. No Ben's Rolls. Okay.

I also, actually, I will, can I modify a little bit? I know you said you wanted to do some of this and with it one or the other with it, but I see both. We already own one, so we're not taking any expense with it. And then that way, if there is an issue with this or this becomes an issue, we have a secondary backup.

Well, you also could think about the idea of those people that are rolling through with the ambulance and they need to have something taken to them. You're not going to take the rolling one out there, but you can take a pocket held. So in this training program, that I attended, they actually showed the purpose for both. They have a lot of hospitals that actually walk through their rounds and they're catching. And so in primary care, you're looking at preventative, you're looking at catching things early. And then of course you're looking at the emergency side and wanting you to catch things that are the big, the big bad ones. And so you're going to get some good options with that.

So then to clarify, cause it just finally clicked in my brain what I was trying to actually say. Um, If the one over that's at the clinic doesn't work, I make the motion, we spend the 15,000 to buy the machine that works for it to get it obviously to be our machine on perpetual forever loan. If it does work and for assistance, I would like to caveat, we can buy the smaller one that she needs with it to make it ease of care for her as well. So you're still gonna spend some money, but that way it'll assist if one works or one doesn't and you have a backup, if something happens to this one, you at least have something.

Well, the other thought would also be is we're trying to grow the other clinic and bring other physicians in with Mount Grant. Now they may already have their own equipment, but if you have an ultrasound on both ends of the track, you're not, it's kind of like making sure both the physicians have a stethoscope.

Yep. So I'm those words. Did you get that Andrea? It recorded.

It'll be one of the 75 pages you have to go through. Hmm.

Sounds like it was the Benz. Yeah, I think it was the Benz. It's got, and there's a lot of attachments and things and fancy foofoo. So, but I'll get with you and we'll open it and you can play with it.

Okay. Do I have a second? Second. Any further discussion?

Yeah.

Let's call for the vote. All in favor say aye. Aye. Any opposed? Passes 3-0.

Thank you. Do you want to spend any more money while you're up there? You asked me what I wanted. I came up with it.

No problem. It makes me happy because for the last couple of years that I've been on the board, it literally feels two steps forward, 12 steps back. We're not moving.

Spending money always makes you happy. It does because of what it's for.

We're taking care of our providers. We're taking care of the patients and the members of town.

I've got my eye on one. Thank you, Marie. You're welcome. Thank you.

Moving on, item 21 for possible action, approval of invoices for payment. I see $81,689.12 in invoices, two months for REMSA, Dan MacArthur for our audit, Ring Central, which is the credit.

That's our digital phone.

And then Central Nevada Harbor, which is? the locks that we did replace.

We did actually, yeah, for clarification for those, just for transparency with it, the locks that were on the Connex boxes over by the records building, we couldn't find the key. Kicker is I did find the key after we put new ones on there. So it does have locks. Those keys are actually in the office building up there. And we did open said Connex boxes and found a bunch more equipment that's in there. So there's like little meals on wheels cart. I think it's a portable x-ray thing that's in there. There's some more hospital beds. There's a whole lot of treasures in there.

I made a mistake. So your backup actually does not include the one I sent out and that's uploaded.

For Jimmy Cardenas? For Jimmy Cardenas. Okay, there's another one for Central Nevada Hardwood.

Yes, and that's been uploaded in the system.

And how much was it?

Give me just, I apologize, give me just one second. I have it, I apologize. When you said it, I knew there was one more.

It was only like $1,400, if I remember. Correct.

And is that quarterly or did we find out what that one was actually for?

So his includes, because it is included in the backup. So his has, it has January, February, March, April, May, June of cleaning at $240 per month. He has been called out to work on the clinic by Tonopah Dental. So that is in the cleaning leads. or $140, and then it looks like he purchased some toilet paper. So the grand total is $83,283.10. Hang on. $83,000? No. Oh, okay. I'm thinking for Jimmy.

No, no, no. Jimmy says $1,593.98. What was the total again? Grand total $83,283.10.

And I do apologize.

And the weeds are at the direction of who?

Yeah, that's going to be changed too.

Yeah, let's make sure that's changed, please.

If Tonopah Dental decides they're going to start requiring work, they're going to pay for it.

I will be sending that email out because there's been a lot of call outs up there that has not been authorized by you or I. Yeah, because if they're going to do that, then that bill needs to go to them, not to us without prior authorization.

Then I make the motion we pay the $83,283.10 to include two months of REMSAs, Daniel MacArthur's, Ring Central, the hardware, and then the bills for Mr. Jimmy and his cleaning and weed pulling and all that other adventures.

That's Central Nevada.

Maintenance.

Second.

All right, I got a motion and a second. Any further discussion? If not, I'll call for the vote. All in favor say aye. Aye. Any opposed? Nope. Passes 3-0. Item 22, general public comment. Seeing nobody.

One here, I stayed for a while. I just opened the phone, and I would like just to, well, first, thank you for having me today and for the hard work working for the community you do. I have a quick question, and it is, in order to renew or send or endorsement for the full-time dentist and not for another year how do you would like us to proceed do you want us to add it in the next agenda or do you prefer to handle in a different way i would like it handled in an agenda item um

as well as, and I do have the request when they come in with it, I would like kind of how we had before where it was, this is the plan, this is what it's used for, this is our business plan on how we'd like to maintain open hours, expectations, blah, blah, blah, all the things.

Even if it's, Valeria, even if it's just a one-year extension of the previous one, we need to bring it in front of the, as an agenda item, that's all.

Sounds good. Okay. You will have it. Thank you very much.

Okay. Thank you. Marie.

Marie Peterson, P-E-T-E-R-S-O-N. So I just wanted to share an article, and I love that we're making the progress that we are. This is actually from the American Journal of Medicine, and it's written by a primary care physician, Dr. Shab Javed, MD. And it actually really summarizes very well what we're dealing with in our rural environment. So I'm not going to read the whole thing, but he did a really, really good job. And I love where we're going with our workforce build. So his introduction, as he says, as a primary care physician working in rural healthcare, I have seen firsthand the profound challenges that rural populations face in accessing timely and adequate healthcare. These disparities are not just theoretical. They manifest daily in the lives of my patients, many of whom struggle with the barriers of geographic isolation, limited healthcare infrastructure, and workforce shortages. These gaps not only lead to worse healthcare outcomes, but also intensify the difficulties of managing chronic conditions, preventing illnesses and promoting overall well-being. Through this publication, I hope to shed light on these pressing issues, offering evidence-based recommendations and actionable strategies that can help policymakers, healthcare providers, and community organizations tackle these disparities and improve the healthcare outcomes for rural populations. And I absolutely agree with him to all that. He goes in and talks about the gaps, which we have actually heard about a lot with, but he comes in this section with innovative And this is the part I really wanted to share with us because it's where we're at. He talks about addressing these challenges faced by our population with mobile health clinics. Combating health care work shortages is the area that I've decided to focus in on because it's somewhere I feel I can make a difference to. And I can appreciate that we're bringing in different companies. We actually have some of our insurance companies are also trying to bridge this gap. So we just had Optum bring a mammogram van in today, and they served a large amount of our residents with mammograms. That's a big step. Combating healthcare work shortages, he goes into specifically loan forgiveness, professional development opportunities for medical professionals who are choosing to work in the rural areas. But immensely, the part I'm really focusing on is expanding access to community health workers and training local residents in basic healthcare practices could also provide more immediate care options That's the immediate care option that I'm really looking at. And in conclusion, he says the healthcare disparities faced by rural populations are a complex and urgent challenge that requires innovation and collaborative solutions. Healthcare providers in rural health areas consistently witness how geographic isolation, workforce shortages, economic challenges, and cultural factors significantly impact residents' ability to access the care they need. These issues contribute to higher mortality rates, unmanaged chronic conditions, which he mentioned earlier, And ultimately it's through the collective action driven by evidence-based strategies and a steadfast commitment to equity that we can improve healthcare outcomes and ensure that rural populations have access to the care and resources necessary to thrive. So that's my public comment for let's all work together. Thank you for your support. I appreciate us all trying to actually bridge these gaps and just little small tools, again, giving us the ability to actually make that difference. And that's where you're going to find in those that you recruit from your local community, community. They have the heart. Why do we live here? We have to ask ourselves that when we're trying to recruit people from the outside, why do they want to live here? We can build it ourselves because we have a reason to live here. And if we're just recruiting them, they only stay for a little short period. So let's invest in our community. Thank you.

All right. Thank you. Anybody else for public comment? Seeing no one. Let's move on to item 23. Any last-minute announcements?

Yeah, I would.

I would like to, because unfortunately people don't attend this as much as I wish they would.

As we go through and move forward with some of these, some of the summarizations of what we're doing, where we've approved to the extended care facility and some of, like with Mount Grant coming in, I would like to take some of these updates to the town board meetings. and start updating those and start really communicating with our public. Because I know one of the biggest issues, whether it's hospital board side or clinic side or anything else moving forward, truthfully, to an extent, the community does not have a trust with it. And we need to build it, forge it, maintain it. And if we can start presenting those, whether it's, you know, Matt Grant coming soon and starting some of the advertisements on it, you know, as we have, Dilbert and I had spoken before about as we get ready to move this, embracing the history of remodeling and changing a clinic or the hospital building, letting the public have their moment to say goodbye with things or, you know, embrace some of the stuff as we move forward, really opening up and being transparent with what we're doing and moving forward with it. And if town board meetings are the way to start with this or have an open house, say, hey, this is what we're doing. We need to start engaging our community and building that trust, not only for that, for any people we partner with in the future, but keeping and maintaining it for us as well. Showing that we are actually providing a service and a benefit in the community. We're not just sitting here meeting on Thursdays and teas and dawn.

So I think that's a good, good, good option. You volunteered to go to all these different communities, you know, and let them know, hey, we have this, you know, we're going to have this available for you. So whether it's Gavs, Duckwater, you know, Round Mountain. we need to get that information out to them.

Unfortunately, so many, you know, yeah, we focus because we live in Tonopah, so we focus on Tonopah. Or some people, they live in Ramah and they focus. We have all these little ones, you know, you have Current Creek and Duckwater and all these places that unfortunately, because they're so far in the outlying of it, they get neglected. I want them to make sure they're not neglected. They're not being isolated. We still care. We still want to be there. We want to help them and help that they need or resources they need or advice or whatever with it. I want to make sure they know that we're all still here with it and willing to assist and benefit and kind of partner with all of it i want to make sure that truthfully we do it because i think as i was bragging you know push communication with it i think to an extent we kind of fall short we don't let them know what's going on we've been dealing with this rural health grant for what six eight months now managing doing some of this stuff with it how many times have we actually reached out with the public and said hey guys this is what we're doing what do you think what do you need We have an entire extended care that we've been working, communicating and involving, engaging with for now a few months with it. I don't know how many people actually have understanding that this is what's coming or a clinic that's coming in or new equipment and machines that are being brought in. This stuff needs to be brought out and put out with it because we're improving, hopefully, at least in my hope, that we're improving the healthcare and stuff with it. We have an education program that now we can start with it and working with it and being able to build and go through with some of this. We can't just sit here in a building and say, hey, this is great. The kids start school in three and a half weeks. I'm going to have from like 830 to two.

Well, and I think that, you know, the other option is when people come through town, they don't know what we have here. And they do see that, you know, we did have, you know, Frontier Medical Group. Guess what they don't see with that sign?

Nothing. It looks like it's still open.

Well, they also don't see that there's a dental clinic in there. So. They have, you know, even people in town have no idea that we have a dental clinic and that facility that can service them.

Well, that's now that we have the hours that are open, you know, that Valeria made the comment of what days they're open. We can reach out and the podium thing that's over by the ambulance bar, make sure that they can put on with those.

Well, and I know that just a. Stick up for them. I've seen it on the reader board, dental clinic.

Well, and I've seen more around Facebook. So the communication is being put out there, but I want to make sure that we still stick with it and keep it out there because if we lax even in the slightest, we're going to lose it.

Yeah, I agree. But we also need to have that physical presence. Without a physical presence where someone can look on the side of the road and say, hey, they have something there for us. Even if they're coming through and something's going on and they're like, hey, you know, look, there's a dental clinic. I can stop there.

Well, we can make sure that they know that not only do these facilities here, but they have all of our support with it.

Yeah.

You know, Matt Grant coming soon. I want to do meet and greet. I know they're not looking until open until possible in January with it. I want to start a meet and greet now, start building that rapport now.

Well, I'm wondering how many people in the community actually know that we have paramedics full time.

So I think truthfully, whether it's a, Hey, sit down, but I want, I want to take some of this stuff. You know, we start say 20 plus town board meeting and see how it moves from there and progress it with it and start letting people know.

I can tell Joe is just looking forward to having you there every two weeks.

I'm there anyways.

No, good idea. Good idea. Like you said, and Denise mentioned that, you know, in order to build rapport with Mount Grant, we're going to have to start getting out in the community.

So here's a thought. You know, coming up in about a month, we do have an event called Summer Soiree at the mining park.

I say we start getting like Mount Grant and start interacting.

And so I'm thinking that, you know, if we get Mount Grant and we get Hope and Marie to come in, and put up tables and say, hey, we are here to help you, or we're coming in to provide this service for you. I think that would be a great outreach for the community out here.

I think that's one step further, some of our paramedics and stuff with it. I know, you know, some of the stuff, our ambulance services, one they did before, you know, that used to be, it's hot with some of those, you know, they used to do some like their vitals checks and things like those and let the students gain practical hours and start engaging these people. Yeah.

The dental group could say free extraction today only.

Don's going to jump right in. But being able to have these groups that walk in, you know, how many people, our clinic's been, our dental clinic's been here a couple years. How many people actually know they're here? I did not until the newspaper had seen it because I caught it by accident. And then when they did the visit with the kids' school, that's the only way I knew they were here. So, you know, being able to, not only be open and transparent with what we're doing, but prove to the public that we're supporting the groups that are there.

Did you also know what the urgent care had in there before you went in there?

I had been in there a couple of times before for some things, and I swear every time I walked in, it was something different. And now I'm like, oh. That's a mistake.

So just so you know, I found out that they had an x-ray machine back in 22.

I actually found out the day, what was right after Frontier left, we were walking in there, and I was like, why does this door have this? Oh, that's what that is. So, yeah, we're learning.

I didn't have to pay the bill. That was before my time. All right.

I see number 24. I was just going to also suggest that we invite the newspaper up here because there's been nothing in the newspaper. If that's something that you guys would be offended by me inviting them for one of your next meetings and the events that you guys are going to be participating at because that does reach a lot of the elderly that do not have Facebook, that do not have, you know, but I also suggest that Tonopah Dental also advertise in other areas, billboards, et cetera. They're,

future dates that they have because that is one thing that i know a lot of complaints are is that they do not they're not aware of the actual dates and they're not knowing the insurances and everything else so well in that clinic sign that's up there um you know it's not really an ultimate it's more of a question but the one that says you know about urgent care whatever was it can we do like a split for it so you have here's the dental clinic here's it so they're actually like kind of out on the road advertisement of like hey what's here I don't know how Mount Grant is doing that or if they're doing that, but we need to... We put it in the grant.

Yeah, okay.

That way we can make sure because that way we're advertising what's there. I know part of the other side will have their own thing with it, but that way it's more out on the road.

When you're talking like this, we should go and... have something at the senior center, too, so they understand that we have this available.

Especially as that one moves along with it, that needs to be a priority that's updated specifically with the seniors. Medical care that's coming in, resources and equipment that are done.

Phone numbers they can call.

Yes.

Okay. Anybody else for announcements? Yeah. Sure.

Yeah. I'm good with number 24.

Item number 24, adjourn. Thank you, everyone. This went faster than I thought.