[0:50] We ready? Yep. All right. So, we'll call

[0:56] this meeting to order. So, I mean, it's

[1:01] early. What time did you say? 09:01. Oh

[1:04] 09:01 okay. All right so the obvious turning

[1:11] off our cell phones. Do any committee members

[1:15] have any disclosures or conflicts of interest? Okay.

[1:23] Any adjustments to the agenda? No? Okay. Move

[1:31] to approve the agenda. I would make the

[1:35] motion. Okay. All right. I did not add

[1:44] on here public comment but that would be

[1:47] right now. Yes. Okay, so we'll open it

[1:52] up for public comment. Have two. Start with

[1:59] Candace Jones. Candace if you could just name

[2:05] give your name and address for the record.

[2:08] Sure Candace Jones PFOS three thousand one hundred

[2:11] twelve Pagosa Springs. Thank you advisory committee members

[2:15] for your service Your careful attention to the

[2:19] details and vision for public health provide an

[2:22] essential framework for this transition. Many residents rely

[2:25] on services now provided through the San Juan

[2:28] State of the Public Health. And I know

[2:30] you folks have them in mind when you're

[2:32] doing this work. So for the sake of

[2:35] Archuleta County residents and visitors, I hope everyone

[2:38] prosecuting the elements of the transition will be

[2:40] equally committed to maintaining service levels. So thank

[2:44] you. On the question of the health board

[2:47] composition, the commissioner should embrace the board of

[2:50] health as an opportunity to engage people in

[2:53] the community who have relevant expertise and experience

[2:56] to perform the practice of public health in

[2:59] Archuleta County. Public health connects dots between community

[3:03] and environmental conditions and individual health. The more

[3:07] points of contact the county has to engage

[3:10] with the community, the better informed public health

[3:12] priorities and practices will be now and over

[3:16] time. Commissioners will not be closed out of

[3:18] public health by appointing others to the Board

[3:21] of Health. They could for example designate one

[3:23] seat to be filled by a commissioner. In

[3:25] any event the commissioners will have a vital

[3:28] role in funding and overseeing the administration of

[3:30] the health department as it does with other

[3:33] departments of the county government. As a practical

[3:36] matter, the commissioners are stretched with their current

[3:39] duties. I hear the commissioners lament demands on

[3:42] their calendars frequently when I attend their meetings.

[3:46] The county administrator and county attorney are also

[3:49] no doubt stretched. The advisory committee members have

[3:52] divided amongst themselves reviewing San Juan Basin Health's

[3:55] files to understand linkages between programs funding and

[3:59] staff. You the committee have asked basic questions

[4:04] about the grant contracts, continuation of grant funding,

[4:09] and the application process for grants. San Juan

[4:12] Basin Health also has agreements with partners to

[4:14] provide services and undertakings to provide services that

[4:18] extend outside the health district to other counties.

[4:22] Why has this log through those contracts not

[4:25] already been done by county staff? We are

[4:28] coming up on a year since the San

[4:30] Juan Basin Health Board voted recommended provision and

[4:33] four months since Archuleta and Lymphatic Missions were

[4:36] made official. Had the foundational work understanding contacts

[4:40] and assets which already been done by county

[4:42] staff, the advisory committee could have jumped directly

[4:45] into questions about service priorities and similar questions

[4:49] that could shape what the Archuleta Health Department

[4:51] will be. Board of Health and the Board

[4:54] of County Commissioners should work in tandem. Each

[4:57] can bring something different and valuable to the

[4:59] public health administration. At least some of the

[5:02] current commissioners acknowledged last year their minimal awareness

[5:06] of San Juan Basin health services and understanding

[5:09] of public health generally. Now is not the

[5:12] time for commissioners to reject the aid of

[5:14] competent, caring, and interested citizens to contribute to

[5:18] the public health of our community. Thank you.

[5:21] Thank you. So next we have Leigh Stoeffer.

[5:39] My name is Leigh Stoeffer, I live at

[5:40] 99 Perry Winkle Drive In Drive. And I

[5:45] too would like to thank the volunteers for

[5:47] their service to the community. I really appreciate

[5:49] your efforts and I know that you have

[5:51] a big task ahead of you. I attended

[5:53] your last meeting and I also attended the

[5:55] oversight meeting last week and first of all

[5:58] I would like to take a moment to

[6:00] enter the public record that the Asthma and

[6:03] Allergy Foundation of America has a very strong

[6:05] online recommendation against the use of hydrogen peroxide

[6:08] nebulizers. This practice is not considered safe and

[6:13] will not be administered by healthcare personnel with

[6:16] practiced evidence based medicine. This intervention was mentioned

[6:19] several times last week in your meeting. This

[6:22] is a good segue to express my deeply

[6:24] felt hopes that we'll be hiring a director

[6:28] who is a believer and practitioner of evidence

[6:31] based medicine and not quackery. I am very

[6:35] interested in the answer to the question posed

[6:37] here last week and that is who will

[6:39] be interviewing the Chiefs Director? In our search

[6:43] for a well qualified individual I think we

[6:46] should consider this person will be interested in

[6:49] just who they will be reporting to. A

[6:51] board of expertise in areas related to public

[6:54] health or a county board of commissioners who

[6:57] oversaw the dissolution of the public health partnership

[7:00] because of what some consider to be political

[7:03] differences. I believe that the composition of the

[7:06] County Board of Health may greatly influence the

[7:08] quality of individual we will be able to

[7:11] attract for the director position. The report by

[7:15] the Otero Group for Laplata County clearly states

[7:18] that County Boards of Health composed of members

[7:21] of differing expertise relevant to public health have

[7:25] better health outcomes than most composed of County

[7:28] Boards of Commissioners. At last week's oversight meeting

[7:31] Mr. Woodman expressed his support for the Board

[7:34] of County Commissioners as Board of Health at

[7:36] least in the beginning. I understand the desire

[7:40] to make this transition a little faster and

[7:42] easier, but I submit that the beginning is

[7:45] probably the most important time to have a

[7:47] board that is composed of people with expertise.

[7:52] The Board of Health actual expertise could be

[7:54] very helpful in getting this department off to

[7:57] a good start and it would avert the

[7:59] impression that this is indeed a political process

[8:03] and might also help recruiting qualified director and

[8:06] staff. Thank you. Okay. Consent agenda there's one

[8:22] just the approval of the meeting minutes from

[8:25] last week. Does anyone have any make a

[8:30] motion for accepting that? A motion. I'll second.

[8:39] Excuse me, this is Suzanne. Yes. In the

[8:47] minutes from last week, I had a question

[8:51] about them. There was for the approval of

[9:00] the interim director and the director, the way

[9:06] it read, it reads Suzanne and I can't,

[9:11] I don't have the minutes in front of

[9:13] me. Suzanne and another person, I can't remember

[9:17] who it was, approved or seconded the motion.

[9:22] I think it should be seconded the motions

[9:25] because there were two motions or else it

[9:28] needs to be clearly shown that there was

[9:32] one motion for accepting the interim and there

[9:36] was another motion for accepting the permanent director.

[9:43] And I seconded one and the other person

[9:47] seconded the other. Also in that part of

[9:51] the minutes, Suzanne is spelled wrong, it should

[9:53] be s u s instead of s u

[9:59] So were there two motions one for the

[10:04] director one for the transitional? Okay so that

[10:07] needs to be broken out. I thought somebody

[10:13] could buy them at the end. You guys

[10:18] tell me. They were two separate. No there

[10:22] were two separate motions. And does anybody recall

[10:29] who did the I made the motion for

[10:33] the transitional one. I might have made the

[10:40] motion for the permanent one as well. I

[10:43] think you did too. I think he made

[10:46] the motion for both. I think I seconded

[10:53] the transitional and I think the other person

[10:57] seconded the permanent. Okay. Do we know who

[11:04] seconded for the permanent? Okay. I'm just gonna

[11:12] write a note and be done with that.

[11:15] It wait. Wait. It was hold on. Kathy

[11:33] seconded the permanent. That's what's on. Okay. All

[11:39] right. I'll make those changes. And so can

[11:43] we get a motion to approve the minutes

[11:48] as amended? So moved. Second. Okay. Thank you,

[12:00] Suzanne. I'll make those changes. All right. Discussion

[12:06] items. Structure of Board of Health. So I

[12:16] passed out the local Board of Health that

[12:19] I got this I got from I believe

[12:25] I got this from San Juan Basin Public

[12:27] Health this was in their little snippet of

[12:34] all sorts of things that have to do

[12:35] with Port of Health. And then I also

[12:40] gave you the local public health agency structure

[12:44] that doing a survey of all the county

[12:46] Colorado counties that I was about three quarters

[12:50] of the way done with. We were we

[12:53] probably should focus at category two and three

[12:58] specifically three. The categories are broken out by

[13:02] the state and we are a category three

[13:06] currently category 3B but about to be or

[13:10] I don't know if it passed to go

[13:12] to a 3A but that's pretty much just

[13:15] for salaries for the county. Is it elected

[13:17] officials? It's population based, is that how they're

[13:20] divided up? That's part of it, but it's

[13:26] a rather complicated matrix to include miles of

[13:31] road then. And then when it says self,

[13:34] what's that? That they are not part of

[13:37] a group, like a district. There's only, most

[13:41] of them are self other than And their

[13:43] boards are independent of a district. Well, like

[13:46] we were part with La Plata County with

[13:48] San Juan Basin. There are like Los Animas

[13:51] shares with I don't how to say that.

[13:56] It's its own it's own standalone health department.

[14:01] Thank you. Right. Mary thank you for doing

[14:04] this first of all from the investigation committee

[14:07] notes there were a couple I left my

[14:09] pizza at home but I think it was

[14:12] Alamosa, Rand and Gilpin but I think one

[14:19] more of those has just the three commissioners

[14:21] but in the minutes from one of the

[14:23] counties interviewed they talked about wanting to add

[14:27] healthcare professionals to their boards and every report

[14:32] that Doctor. Bruce made she said that many

[14:35] counties felt that way that the board of

[14:38] commissioners needed some help from healthcare professionals. Okay.

[14:45] What we can do as a group is

[14:48] come up with a consensus of how we

[14:50] think we should be and either just give

[14:54] a verbal thing to the oversight committee or

[14:57] we can direct a memo from us to

[14:59] submit to the oversight committee and to the

[15:01] commissioners. That would be my vote to give

[15:05] them a formal recommendation on what we believe

[15:10] would be the best way to do the

[15:11] structure. Can we talk about this in just

[15:14] terms of what the pros and cons are

[15:16] for the different structure and pardon my ignorance

[15:18] on this like I'm sorry I didn't get

[15:20] a chance to look at this or really

[15:22] kind of delve into it but what are

[15:24] the pros and cons? I mean, the two

[15:25] ladies who spoke bringing some really good points

[15:28] about having expertise in the area of public

[15:30] health to add to the county commissioners in

[15:38] terms of having that structure, it's obviously expertise

[15:41] ties to the community from different, guess some

[15:46] of the points of contact which I guess

[15:48] I hadn't thought about it that way but

[15:49] it makes sense. What are some of the

[15:51] other I guess pros and cons of having

[15:54] people on there beyond just County commissioners? I

[15:58] think, sorry, I think part of the whether

[16:03] we want to admit it or not perception

[16:05] in the community I think is a bit

[16:09] tainted politically and I believe that the community

[16:16] would view and respect Lord of Health at

[16:20] a greater level if we had real healthcare

[16:24] people on And it's not about control. Think

[16:31] it's perfectly fine to have County Commissioners on

[16:36] the board that makes sense for them to

[16:39] be involved and have a level of control

[16:42] But I think that the community itself, I

[16:45] think would look very favorably on our board

[16:50] if we had some outside folks on And

[16:53] it has to be a minimum if it's

[16:55] okay, so it could be a minimum of

[16:57] five if it's not just the three commissioners,

[17:00] right? But it could be up to nine

[17:01] or so. Our county, it's a minimum of

[17:05] three. Right. And I don't even know if

[17:09] it has a maximum. I thought it was

[17:11] seven. So you could have, like I'm just

[17:17] making this up, you could have four healthcare

[17:20] professionals and three commissioners, or you could have

[17:22] one commissioner and any number of, as long

[17:26] as it's an odd number. Correct. I think

[17:31] the literature is pretty clear about public health

[17:33] areas, anybody speak to this better than I

[17:37] can, that when you have a board of

[17:39] public health, that is not just limited to

[17:43] county commissioners who don't have expertise in public

[17:47] health, that the outcomes have been better. Yeah.

[17:50] So that's what I would remember also and

[17:53] again even if just if you had one

[17:56] commissioner who has a real passion for public

[18:00] health and that would be the contact person

[18:02] I don't think that was a case in

[18:04] the past and quite frankly you know it's

[18:08] time to get away from that and have

[18:11] somebody really to communicate back to the other

[18:13] commissioners what happens. I think that's what I

[18:17] would move for to have a broader board

[18:22] you want all those different talents out there.

[18:25] Well, think the report that you mentioned and

[18:27] the consultants actually read it that was done

[18:28] by the University of Colorado School of Public

[18:31] Health, you know, communities show better health outcomes,

[18:34] they show better financial, not necessarily less financial,

[18:38] but better use of financial resources that they

[18:41] typically get more outside funding from grants and

[18:45] other sources than just county or state funds.

[18:49] Mean their evidence brief was really thorough around

[18:52] you know the fact that there's pretty clear

[18:56] health outcomes when you have additional folks on

[18:59] board of health. Know and I would say

[19:02] like I don't know how we if we

[19:04] can designate, but I think there needs to

[19:06] be at least one person with public health.

[19:09] Because if we don't get a director that

[19:10] has a public health background, primary care or

[19:15] providing medical care and the public health lens

[19:17] are really different in a lot of ways.

[19:21] And so I think that guiding programming and

[19:23] things like that, like having someone with the

[19:26] public health lens is really important, especially in

[19:29] the beginning to get this all off the

[19:31] ground. Once it's rolling and things are kind

[19:33] of established and we have all that stuff

[19:35] out there but I mean it's just there's

[19:37] such a spectrum of things that fall outside

[19:39] of you know the idea of providing care

[19:42] right it's about prevention. Like community prevention, individual

[19:48] prevention, right? So from the public health standpoint,

[19:51] how do we bring in this idea of

[19:54] community based prevention work and education in order

[19:57] to have better health outcomes, right? So less

[20:00] people are having to go for service, hopefully.

[20:05] I think that that you know and I

[20:07] haven't done a lot of research outside of

[20:08] this but there was a ton of things

[20:10] that they cited from the University of Colorado's

[20:13] report It was just a summary but there

[20:17] are definite indications that having other folks in

[20:22] the board of thumb would be really important.

[20:24] But I do think because the financial oversight

[20:28] and management is coming from the county that

[20:30] there needs to be at least one if

[20:31] not two seats for commissioners because you know

[20:35] they have to play together to be able

[20:37] to, right? They're housed and employed by the

[20:40] county but I feel like we need that

[20:42] additional expertise to help direct the programming and

[20:48] the stand up in the community. And I

[20:51] also think that the healthcare profession in general

[20:54] has a whole to crawl out of because

[20:55] of public distrust that's been created over this

[20:58] pandemic and I think it would really help

[21:01] for there to be healthcare people on the

[21:03] board to, you know, reassure that we're on

[21:07] the community side and contact issues. That's a

[21:10] great point that we have a lot of

[21:11] work to do to improve the image of

[21:13] healthcare. How would those non BOCC members be

[21:21] selected? It usually looks like an appointment from

[21:26] what I read. I don't know if we

[21:27] could go outside of the box and do

[21:29] it more like La Plata Electric does. They're

[21:31] like, there's an election, there's like a vote

[21:33] of some kind. I don't know what that

[21:35] would mean if that would make it more

[21:36] political or not. It makes it very expensive.

[21:40] I mean, you know, to run an election.

[21:42] Yeah. We would like for the hospital to

[21:43] have to run an election for our board.

[21:45] Yeah. It was about $40,000 I wonder, could

[21:49] this group just put forward some recommendation? Maybe

[21:52] we do a call. I mean, if if

[21:53] we choose to make this recommendation to the

[21:56] BOCC and they accept it, I wonder if

[21:58] the process could be an open call or

[22:01] something for interested individuals and maybe even some

[22:03] members from this board be interested since there's

[22:06] some good people on this board, But then

[22:10] maybe the recommendations then could come from this

[22:13] group as some vetted members because I think

[22:16] when you say healthcare professional that could mean

[22:19] a whole gamut of people. You want to

[22:22] just kind of make sure it's someone who

[22:24] really feels passionately about public health and uses

[22:28] evidence based practices and all those good things.

[22:32] Do you think that call will be very

[22:34] similar to what they did to convene this

[22:36] committee that there were I guess I wonder

[22:39] if we need to go outside the committee

[22:40] if we can just start with this group

[22:43] and the people that want to participate and

[22:46] then put out a call, people get interested,

[22:49] this job may have been too big for

[22:50] some people but anyway, I would not be

[22:56] opposed personally, you all have to decide about

[22:59] speeding the health board with the commissioners and

[23:02] then breaking up after that. I personally would

[23:07] not be interested in continuing. I mean, I'm

[23:10] happy to be on this, but just because

[23:13] of my day to day with being the

[23:15] town manager, I mean, it's very interesting work

[23:18] and I'm happy to help in this transition,

[23:20] but I don't know that I should be

[23:21] on the board of health moving forward, but

[23:26] be happy to help support the selection process

[23:28] recommendation. The first thing that we would need

[23:31] to do is send recommendation. Yeah. We've oversight

[23:36] committee and their committee. Right. We'd rather spend

[23:42] time today to say I can do because

[23:44] if they say no, right. I'm not sure

[23:51] which one said it, maybe both said it

[23:53] different ways, but I would totally agree with

[23:56] the number one, this group's expertise outside of

[24:02] maybe everybody in the health industry here is

[24:05] extremely talented. I'm going sound like an economist

[24:10] here because I would like to thank the

[24:13] staff and or the BOCC for putting this

[24:15] group together. I mean, they didn't have to

[24:18] do that. I think it was a great

[24:19] move, you know, to move this thing forward.

[24:23] And there has to be a level of

[24:24] trust with whoever comes out of this group

[24:29] or a potential board. But I would, as

[24:33] an ex commissioner, I would totally agree that

[24:36] the number one, the time commitment, you know,

[24:39] we were assigned to sit on the San

[24:41] Juan Basin have one year at a time

[24:43] when I was back when and you guys

[24:47] all know, I'm not an expert in health.

[24:50] Whereas there's people in here that would give

[24:55] really good insight, think, to a board made

[24:58] up of commissioners and outsiders would be my

[25:03] 2¢, and whether it's three commissioners of two

[25:07] health, or you know, majority of health, one

[25:12] or two commissioners, whatever it may be, I

[25:14] do think the public would look at that

[25:16] real favorably right now. And gosh, we've got

[25:21] a clean slate. I think this would be

[25:23] a really good way to keep it clean,

[25:26] keep it as far away from political as

[25:28] possible. It's not, we had that conversation, it's

[25:32] not possible to keep politics out of everything,

[25:34] but this group even board should try our

[25:39] best to, you know, stay out of that.

[25:42] And and I think I would be like

[25:44] you. I I don't I would not have

[25:46] an interest as long as you all felt

[25:47] good financially. I don't bring a whole lot

[25:50] other than that, but I do think it

[25:53] helps people do big time. So, and it

[25:59] is a time commitment. I got these commissioners

[26:02] that do have a full plate. And it's,

[26:05] it doesn't matter when they should have a

[26:09] full plate and I think they do. So

[26:13] it is a five year, the board itself

[26:15] is a five year term and how do

[26:18] you stagger folks when we create a board

[26:21] all at one time? I think that it's

[26:26] a good question. Think that you would start

[26:29] off with by desire, maybe and then, you

[26:37] know if everybody says oh yeah, you know

[26:39] it's not a problem, then maybe do it

[26:41] by library. I mean honestly there's really, you

[26:44] know it's really difficult to begin that process

[26:49] because you don't have, there's nothing established. Yeah.

[26:52] So you're starting from doing it. Yeah, didn't

[26:54] know if there was something that was established

[26:55] that I just didn't know about, create a

[26:57] new board. I mean, I think, you know,

[26:59] you can start with like every, you know

[27:02] two years and one person falls off and

[27:04] he brings one last on. The one nice

[27:05] thing about the five year term is that

[27:07] the commissioners are going to be in and

[27:08] out of that but a five year board

[27:10] right then brings the historical knowledge and expertise

[27:12] of not standing it up. And, know, I

[27:17] mean, I think if we think about composition,

[27:19] because we're making a recommendation, do we need

[27:21] to recommend how many and that? I think

[27:23] we should be as specific as possible. I

[27:26] agree. You know, I mean, I think, and

[27:29] I don't know like an open call again

[27:30] depending on what we think the obligation is

[27:33] going to be. We may get a different

[27:34] group of interested parties if it's not a

[27:37] weekly two hour plus research commitment that we

[27:42] all made sitting here. Know there may be

[27:44] other people who are in the field who

[27:47] are just busy and couldn't commit to this

[27:49] process who may be willing to be on

[27:50] the Board of Health. So I don't know

[27:51] that you know another open call would hurt

[27:55] just to see what the interest is from

[27:57] the community and understand who's available with what

[27:59] expertise. It's certainly you know we're sitting here

[28:04] so that sometimes makes it easy but it

[28:07] doesn't necessarily make it. Since we were all

[28:11] selected by the commissioners to sit on this

[28:13] committee we may need to do something again

[28:15] just to really keep that like a political

[28:18] arm's length of saying we want to know

[28:21] everyone who's potentially interested but that's just This

[28:25] is a very operational committee, right? And so

[28:27] the board of health would not be an

[28:30] operation, you would have people that did the

[28:32] operation reporting to the board of health. So

[28:36] it would be totally different. Yeah, that's a

[28:39] good point. So I think that since the

[28:42] rule, the act states that it should have

[28:45] at least five members, but then it says

[28:47] if you have less than 100,000 people, you

[28:49] can do a three week report and And

[28:51] the board of county commissioners may designate something

[28:53] to county board of health if there was

[28:55] not a separate board of health prior to

[28:56] the effective date of the act. So it's

[29:00] almost like that's having just the county commissioners

[29:03] on it is the least desirable of the

[29:06] options here. Would recommend, and I'd say we

[29:09] all agree with This is the first time

[29:12] seeing this, again, as usual, thanks for the

[29:15] handouts. And Derek, you may know this, the

[29:19] second part of that that was just read,

[29:22] the first part in counties with populations of

[29:25] less than 100,003 member board may be appointed.

[29:29] The Board of County Commissioners may designate itself.

[29:32] If there was not a separate Board of

[29:34] Health prior, is that a legal question? Or

[29:37] do you know the answer? Was there business

[29:41] considered San Juan Basin Health a previous board?

[29:45] We are two separate board of health. So

[29:47] what San Juan Basin has is completely separate

[29:50] from what we're going to have. So we

[29:52] do not have a board of health in

[29:54] effect. Okay, I would make a recommendation of

[29:59] a minimum of five, and we can maybe

[30:04] leave it to the commissioners if they want

[30:06] to have a three and two, or do

[30:09] we wanna recommend a two and three or

[30:11] a one and four? I guess I feel

[30:14] like the majority should probably be non. So

[30:22] either three, two, one and three public health,

[30:26] two commissioners, or four. I agree. I think

[30:34] it should be a majority of non board

[30:39] of commissioners on the health department board, I

[30:43] think that will send a message to the

[30:49] community that it is community based and not

[30:55] politically based. Sally, any comments, Ashley? No. I

[31:07] think if we get bigger than five, we're

[31:11] gonna have a hard time staffing it with

[31:13] people with the writing backgrounds because we have

[31:16] a limited pool of potential folks. I think

[31:19] you're interested in serving those kind of terms.

[31:21] I think five is good. I don't know

[31:23] if I, you know, I think given all

[31:26] the other things that commissioners are on, it

[31:28] probably makes sense to only have one, you

[31:32] know, representing the three on the board only

[31:35] for the sake of time. Does it make

[31:36] sense to have two spending that amount of

[31:38] time in those meetings? Because it is going

[31:41] to be pretty, I mean, it's going to

[31:42] be timely between now and the end of

[31:43] the year. It's going to be timely. Once

[31:46] it's established, it's going to have a different

[31:49] role. And once there's a director on staff,

[31:54] then that director will ease even our burden

[31:58] or whoever's on the board's burden between now

[32:01] and the end of the year because that

[32:03] person should really be a guide to what

[32:07] needs to happen. Suzanne, we're having some technical

[32:11] difficulties. Could you just say something so we

[32:13] can see if we can hear you better?

[32:19] Can you hear me better now? A little

[32:22] bit. Sounds like her internet connection. All right.

[32:28] Thanks for checking, Jamie. Appreciate it. All right,

[32:31] we're doing the best we can. Thank you.

[32:33] Speak louder, Suzanne. All right so process wise

[32:44] you were saying something about a memo but

[32:46] is a motion insufficient that would be reflected

[32:48] in the notes or do we need to

[32:49] put together a memo that explains the reason

[32:54] for this recommendation or do we even need

[32:57] to? Either one would work. The motion would

[33:00] be obviously good today. A memo would need

[33:02] to be created and approved next week. I

[33:05] mean, I'm happy to put together that with

[33:08] some of the data from the two sources

[33:10] that I read as far as supporting our

[33:12] recommendation, if that would be helpful. Thanks, Ashley.

[33:15] But next week we're not meeting. We're not

[33:17] meeting next week. You're right. Do it at

[33:22] the next meeting as far as the formal

[33:24] memo or without That be the twenty seventh

[33:26] or we could Get email. Could we We

[33:29] would approve it via like, I could get

[33:33] each one of your approvals, and then we

[33:36] would actually Cathy could sign it, and then

[33:38] we could actually ratify it at the twenty

[33:40] seventh meeting. Because I do think it's important,

[33:42] right, I think for the process of hiring.

[33:44] I don't know where we're at. Maybe Derek

[33:46] can give us an update on that. But,

[33:48] you know to have some of these things

[33:50] in front of the commissioners so they can

[33:52] make their decisions because I think that will

[33:55] potentially impact who applies and how they choose

[33:58] to then you know make some of these

[34:00] decisions and so the sooner we can make

[34:03] that formal recommendation the better. Yeah, think that

[34:09] the email format would probably be really good

[34:12] and get that voting forward too. It's long

[34:15] way for motion that we send a memo

[34:19] to be written and approved by email with

[34:22] the evidence based in there that we recommend

[34:28] the Board of Health be combined members or

[34:30] if they are not county commissioners and want

[34:33] to take this account. And experts in public

[34:36] health experts public health for this okay. Did

[34:42] you get that? I guess you're taking just

[34:45] thinking about grammar. Want the name of my

[34:49] speaker. Sorry, Sally let it is. Quick question

[34:57] for both. Would this be interim or is

[35:01] this for January 1? I think we're talking

[35:06] about I think we're talking about now. We're

[35:07] talking about setting it up, saying that's a

[35:09] good day situation. Okay. And if that's the

[35:12] case, does this group go away and that

[35:14] group take over? Eventually it will go away.

[35:20] Often to the same thing, it's been a

[35:21] volatile combination. I mean, I think that similar

[35:28] to what La Plata County did, we can

[35:32] appoint a Board of Health, they just would

[35:34] have no authority until January. Okay. You've had

[35:42] a motion was there a second? I'll second.

[35:44] Mary, go ahead. Mean the other thing that

[35:48] we may need to discuss to add to

[35:51] our recommendation Oh I'm sorry I'm not. She's

[35:54] not a voting member. I'll Okay. All All

[36:01] in favor say we should call the vote.

[36:03] Fair aye. Was anyone opposed? Suzanne Poe. Sand?

[36:11] Aye. And you know I don't know if

[36:17] this is something or when this gets decided,

[36:20] but, know, there was some discussion in some

[36:22] of these articles around the Board of Health

[36:23] being an advisory group versus like a policy

[36:26] making group. Right. And so I don't know

[36:28] how that gets designated. I don't know if

[36:30] that gets designated once it's formed and they

[36:33] determine that themselves or if that's something we

[36:36] need to weigh in on as this committee.

[36:37] That may require a little more digging into

[36:41] what's appropriate. I mean, I think based on

[36:45] our discussion, feel like maybe need to be

[36:48] a little bit more of a policy directive

[36:51] group and not just an oversight advisory committee.

[36:55] But I think those are things we need

[36:57] to consider as part of this as well.

[36:59] I do too. As far as the structure.

[37:01] I do too especially between now and go

[37:05] live. Right. January because there is a lot

[37:07] of there are a lot of policies in

[37:09] the past we put in place and again

[37:11] back to the director, you know the director

[37:14] someone who has a lot of experience and

[37:16] should be helping us with that path forward.

[37:22] But those are some differences I saw in

[37:24] some other reading around the Board of Health

[37:27] itself and how it's designated. So I think

[37:30] those are just things we need to be.

[37:32] Especially when we're doing our research too, right,

[37:34] what are there implications for either one of

[37:37] those based on programming and things that are

[37:39] out there in other communities? You know, pros

[37:43] and cons of the setup outside of just

[37:49] the size and Any other comments on that

[37:59] topic? Leanne, come on. Go ahead and not

[38:10] waste her time and break her own. We

[38:13] had asked Leanne Delon to come to because

[38:19] at our first meeting we had so many

[38:21] questions for us, they want basic public company

[38:23] asked her to give us kind of the

[38:27] overall view structure. Yeah. Could I interject real

[38:32] quick? So I have to leave at 10:00.

[38:35] And Leanne's kind of long winded. Should I

[38:40] smack him? Any time get a chance, right?

[38:46] Can I just jump into just a status

[38:49] on the record position? Yeah. So we did

[38:55] advertise last week that that all completed. So

[39:00] it was posted on Tuesday afternoon. We do

[39:05] have a flyer that was created so that

[39:09] it can go out to professional organizations as

[39:11] well, or anybody that has any desire for

[39:14] it. Did get one applicant thus far, an

[39:20] individual that does have some background related to

[39:24] that. I just scanned it this morning, but

[39:28] it appears that probably does meet the minimum

[39:32] requirements. Currently resides in Texas, but that's the

[39:36] only applicant that we have thus far. So,

[39:40] I know that there's another question about this

[39:45] is going to be up to the the

[39:47] commissioners as far as who that person reports

[39:51] to as far as the direct supervision. Yes.

[39:55] I know there has been discussion about it

[39:57] that just for maintenance of county structure that

[40:03] that person would answer me that that's definitive.

[40:08] Is how it's all set is set up

[40:10] here the county that all all director positions

[40:12] report to you? Yep. The only county staff

[40:17] that reports to the board directly is the

[40:19] county manager and the county attorney right everyone

[40:22] else works for Derek. Okay. Is that your

[40:28] preference? Or I mean, are the pros and

[40:33] cons? I mean, I don't know why we

[40:35] would do something different. Yeah, I think it's

[40:37] well, I think yes, that would be, that'd

[40:42] be my preference because it's being set up

[40:44] as a set up. Being set up as

[40:46] a department, it's not being set up as

[40:48] a standard loan Right. You know, I think

[40:53] it could just create some other issues, I

[40:59] guess. What Okay. Is that for the interim,

[41:02] or does that go beyond January 1? It

[41:05] would be for both. Like I said, that

[41:09] that has not been definitively established at this

[41:13] point, but that is in my discussion with

[41:16] them that has been their conversation. Should we

[41:20] make a recommendation from this group or is

[41:23] that if that's a if it's a county

[41:27] policy we don't know that we would need

[41:31] to unless we wanted to change that. I

[41:35] don't know if it's a policy it sounds

[41:37] like it's still up in the air. Well,

[41:39] it's not a policy, it's just, it's a

[41:42] practice for sure. As Mary said, there's only,

[41:47] statutory, there's only two employees of the board

[41:51] and that was the manager and the attorney.

[41:56] What's the wording on the job description I

[41:58] can't remember the very first page they talk

[42:00] about can't remember the firm it's not. Who

[42:04] did it report to? Supervision received? Yes. Okay.

[42:09] So we left it pretty broad. It does

[42:13] say County Commissioners and County Board of Health.

[42:18] Well, said we changed it. Okay. So it's

[42:24] County Commissioners or designee or County Board of

[42:26] So there's an open line with commissioners and

[42:34] having a commissioner on the board of health

[42:36] will keep that open conversation with the commissioners

[42:39] that you know you're I guess I'm wondering

[42:44] if their reporting to you will be different

[42:46] than their responsibility to the board of health

[42:48] this Director Attorney. Yeah, does get a little

[42:55] convoluted because everybody that's going to be in

[43:00] the health department is a county employee. And

[43:05] so the way that it needs to flow,

[43:08] and this is just my opinion, is if

[43:12] it remains the same as all the other

[43:14] county departments, then it maintains consistency in everything.

[43:21] When the employee does not answer through the

[43:28] county manager, and then are they a department

[43:31] head, are they, however they consider. I think

[43:35] it just lends to some confusion. And if

[43:42] that's the case, then I think it also

[43:44] changes the entire pay structure and everything else.

[43:48] But the weird part of it is, so

[43:51] the department or the people that report to

[43:54] you, they don't have separate boards that are

[43:57] gonna be that they're going to be also

[43:59] reporting to you, Planning Commission. It's not unusual.

[44:04] Yeah, planning, you know, and community development. They

[44:08] have, they all have boards. So how do

[44:11] those boards interface with you then? Do they

[44:13] make recommendations to you? Do they make recommendations

[44:16] to the commissioners if something's not going well

[44:18] that they see that you might not? So

[44:23] they don't have any, how do I say,

[44:25] employment decisions, those boards. It's just advisory and

[44:32] their roles and responsibilities. But it's, yeah, it

[44:37] has nothing to do with employment. Of course

[44:40] they can always, they can always come to

[44:44] me, but it's to be the commissioners. I

[44:50] mean, it's not different than the town right

[44:53] so we have employees who report to the

[44:55] tourism board the planning you know things like

[44:58] that outside boards but our employees of the

[45:02] town direction. I think that keeps it clean.

[45:06] It could get messy if you had a

[45:09] department head director who was reporting to this

[45:13] board and then like where are they in

[45:17] the organizational structure of the county? It could

[45:20] create some challenges. I truly believe that. The

[45:29] board of health isn't doing anything related to

[45:32] staffing. We're doing policy procedures, you know, regulations,

[45:38] oversight. So it is kind of two separate

[45:43] responsibilities. It's clarification, it's a lot more clear.

[45:50] And then it's boost you what we have

[45:52] here. I would, as far as interviewing, I

[45:57] mean I would think that, I I would

[45:59] certainly participate but I would create an interview

[46:04] panel of appropriate knowledge, individuals. And I would

[46:13] certainly draw in from outside. And honestly, I

[46:19] would probably be the only one from the

[46:21] county government to participate, the rest I would

[46:24] bring in from outside. So there wouldn't necessarily

[46:27] be standardized questions like? There absolutely would. They

[46:31] would be the same questions, if you will,

[46:35] you know, just for legality. So everybody gets

[46:37] asked the same questions. You can always expand

[46:40] on those questions. Everybody gets asked the same

[46:43] questions. But if you know, can certainly go

[46:47] down a path on an answer that comes

[46:51] out of, know, right. And, but so you're

[46:57] not just held to those exact works. Good.

[47:04] Okay. Cool. Thank you. I'll see you on

[47:12] Zoom tomorrow. As soon as I can get

[47:15] I'll get there. I just don't know how

[47:18] soon I get out of my yeah. Try

[47:22] to figure it out. So Derek's coming. Oh

[47:27] okay, I was gonna say your work session

[47:29] next Okay, I think it would help me

[47:40] if we went around because I don't know

[47:42] everybody. So I'm really happy with Sam one

[47:44] place in the hospital. Andrea Phillips, town manager.

[47:50] Ashley Wilson. I work for Rise Above Violence

[47:52] but have a master's in public health. I'm

[47:56] Sally Kennedy, I'm retired. I'm Kathy Campbell, I'm

[48:00] retired and a glutton for punishment. I'm John

[48:04] Ransom, used to be a commissioner here and

[48:08] now I think I'm retired. And then Suzanne.

[48:15] Yeah, Suzanne Bryant, I'm a registered dietitian. Awesome.

[48:23] Derek, Mary. Thanks having me. I have, I

[48:30] can do some slides maybe just to get

[48:33] the conversation started. I don't really, you know,

[48:35] I think a lot of what we're doing

[48:37] here is kind of Q and A, but

[48:39] what I was going to do, and Derek

[48:40] is absolutely right, am open to it. I

[48:43] have a kind of some, I have a

[48:46] slide deck that we do during our budget

[48:48] presentation that we do for the sets of

[48:51] commissioners every year and we'll do it for

[48:55] the commissioners multiple times at our board of

[48:58] health meeting, which is also a public meeting

[49:01] multiple times when we're adopting our budget so

[49:03] that everybody is kind of playing from the

[49:05] same sheet of music. So what I was

[49:07] thinking just to kick off this conversation is

[49:10] go through those budget intro slides for you

[49:13] all, which will give you just some background

[49:15] on how things were structured in the past.

[49:19] I don't know that it's the most important

[49:21] thing because your job is obviously the future

[49:23] and what you're doing next, but I think

[49:25] just having some basis about where we've been

[49:28] may help in some decision making going forward.

[49:31] So this is our final product for adopting

[49:34] our budget. Janet, thank you so much for

[49:37] reading my mind and getting slides. Janet's sharing

[49:39] the slides from us a long time ago.

[49:42] So we go to the next slide, it

[49:44] describes what San Juan Basin Public Health's mission,

[49:47] vision, and values are. So I'm not gonna

[49:51] read it to you. I'll just give you

[49:52] guys a second to read it. It shouldn't

[49:54] be surprising what the mission and vision of

[49:58] a local public health agency. And then after

[50:02] we go over our mission, which is to

[50:03] protect human and environmental health and inspire well-being,

[50:07] we kind of go through and we do

[50:08] this every year multiple times when we're doing

[50:10] our budget season. So this goes through kind

[50:13] of the legal structure for a multi county

[50:15] health district. So believe that's what's next. Oh,

[50:21] look at that. Okay, so legal structure for

[50:23] a multi county health district is we Post

[50:28] World War II, there was a governor of

[50:30] Colorado that was really, yeah, I'm sure I'll

[50:35] tell the story this way. The governor of

[50:36] Colorado post World War II was very concerned

[50:39] that Colorado had fallen behind in public health

[50:42] across the state. There were high rates of

[50:44] tuberculosis, there was poor sewage, there was environmental

[50:47] runoff, there were some agricultural diseases that were

[50:51] having economic fallout and also having human health

[50:55] fallout. And so there was Florence, Doctor. Florence

[50:58] Sabin moved back to Colorado. She'd grown up

[51:01] here and that she had gone to the

[51:03] East Coast at a very illustrious, very, very

[51:06] ahead of her time career putting together, doing

[51:10] research and public health. And she came back

[51:12] to Colorado and she was tasked to make

[51:15] suggestions to how we would improve health in

[51:18] Colorado. And she visited 60, I don't actually

[51:20] know if there were 64 counties at the

[51:22] time, but she visited every single county and

[51:25] then visited every state rep to work through

[51:28] a suite of laws to catch Colorado up

[51:31] in public health. This happened in '19 She

[51:34] completed her work in 1947. They were signed

[51:37] into law in 1948. There was a package

[51:40] of eight bills, and one of those bills

[51:43] in the state of health laws created the

[51:46] opportunity for counties to go in together to

[51:48] do public health as a multi county district.

[51:52] So that's why when you talk about multi

[51:54] county districts in Colorado, they often were formed

[51:57] in 1948 because of a response to this

[52:01] legislation that was passed. So Archuleta and La

[52:04] Clada Counties were one of the multi county

[52:06] districts that started 1948. We actually had other

[52:09] counties. So it was a larger district starting

[52:11] in 1948. And then the Public Health Act

[52:14] in Colorado was not touched until 02/2008. So

[52:18] we have a habit of really getting ahead

[52:20] and then falling really far behind. So Colorado

[52:24] not updating its law until 02/2008. Once that

[52:27] law was re upped in 02/2008, it required

[52:30] the counties involved. So Arch 11 and Plata

[52:33] County had to redo the agreement, which is

[52:38] done in a resolution by the county commissioners

[52:40] to perform in a multi county district to

[52:44] meet the statutory obligations of local public health.

[52:47] So we were formed in 1948 and then

[52:50] reformed in February '9 actually, because the act

[52:54] was passed into Were you on the commission

[52:56] then? Well, then you should be telling this

[52:59] I'm doing great. I'm just glad you can

[53:01] still remember the So reformed in 02/2009 in

[53:06] response to the public health act of 02/2008.

[53:10] And then that's all described in this slide,

[53:13] which I guess I could have, instead of

[53:14] just relying on that little history lesson, could

[53:16] have just looked at the slide, but this

[53:18] gives the references to what the Colorado statutes

[53:21] are if you want to go look at

[53:22] them. And I imagine you all have started

[53:25] with that. Yes, so that's where we are.

[53:28] So then the next slide, thanks, Janet, just

[53:32] gives you some summaries of what's in these

[53:34] statutory obligations. I won't go through these then

[53:36] if you all have started there. I would

[53:38] also be aware that there are statutory obligations

[53:40] and then there will be subsequent rulemaking by

[53:43] the State Board of Health. There may be

[53:45] other commissions like water quality, air quality, hazardous

[53:49] material commissions at the state, which are separate

[53:52] from the Board of Health, which also may

[53:54] do rule making that would involve obligations of

[53:57] local public health. So while it starts in

[53:59] statute, it then allows other boards and commissions

[54:02] to follow-up with rules and regulations, and that

[54:06] then becomes part of the puzzle of what

[54:09] local public health does. So this is, again,

[54:13] here we just pull out kind of the

[54:15] big pieces of the statutory obligations. You all

[54:18] have reviewed all of those, it sounds like,

[54:20] so I'm not going to go through them.

[54:22] So then I think we have one more

[54:23] slide on statutory obligations. And then let's see

[54:26] what's in our next slide. It's like a

[54:29] Price is Right, What's Behind the Next Door.

[54:31] Okay, so then historically, because I think there

[54:34] has been questions when there was the Health

[54:37] Investigative Committee and lots of discussion around how

[54:40] was this structured, there were some questions to

[54:42] see the contract between San Juan Basin Public

[54:45] Health and the county and how does it

[54:46] all work. And then I think our county

[54:48] commissioners and county administrator with some more history

[54:51] on this would understand why there's not a

[54:52] contract because it's formed by resolution and then

[54:56] the statute actually describes how a multi district

[55:00] operates. And so there isn't a contract back

[55:04] and forth between the counties. The multi county

[55:06] district operates with this proportional allocation of operational

[55:10] costs. So with that, the counties, Lapata and

[55:14] Archuleta County were following the statutory framework rather

[55:18] than creating. And it wouldn't make sense to

[55:20] create a separate contractor MOU because this is

[55:25] already in statute. So So what it talks

[55:27] about is proportion to the county size. And

[55:31] so in this case, we roughly say that

[55:33] La Plata has four times the residence of

[55:36] Archuleta, which is actually shockingly close to accurate.

[55:40] It's like 70,000, so let's say 70,000, but

[55:45] we give you an exact number for the

[55:47] proportional. So when we talked about after their

[55:51] statute, there were rulemakings, so if we go

[55:54] to the next slide, Janet, this one is

[55:56] hard to read, but this is the subsequent

[55:58] rulemaking. I'll walk through this and I don't

[56:00] know if you guys have already seen this

[56:02] one. Okay, everybody has, great. In 2019, the

[56:06] State Board of Health re upped the core

[56:09] services into a new foundational capabilities and foundational

[56:16] services. So prior to that, there were eight

[56:19] core services and seven of them had minimum

[56:21] standards. And that stuck from sometime after 02/2008

[56:25] to 2019. '20 '19, we went with the

[56:28] foundational services and capabilities. This was to create

[56:32] some opportunity for change in the local public

[56:34] health system beginning in 2020. We did experience

[56:38] significant change in the local public health system

[56:41] beginning in 2020, but not based on this

[56:44] new rulemaking, based on other events. But what

[56:50] we did as an agency is we had

[56:54] many years ago decided that we would budget

[56:57] to the court services so that especially our

[57:00] county commissioners could see exactly where the local

[57:04] If organized our org chart and our staffing

[57:08] and our budget to the court services, it

[57:12] would be easier to see what core services

[57:15] are adequately funded, what core services are not

[57:18] adequately funded, and then where the local contribution

[57:22] from the local counties goes. So that had

[57:25] been our habit. So in 2019, when the

[57:29] state board upgraded from seven to 12, we

[57:33] kind of scratched our head and said, all

[57:35] right, this is going to be kind of

[57:36] tricky to redo our org chart and our

[57:38] budget towards these 12 services and capabilities, but

[57:42] it's important to do because it really draws

[57:45] a line for the local community. This is

[57:48] where we can access funding, and this is

[57:50] where it's more difficult to access funding, and

[57:53] this is where the dollars go. So this

[57:56] is the seven core capabilities. And the core

[58:01] capabilities are cross cutting, which means they have

[58:04] to be applied to the five foundational services.

[58:09] And this is now how we budget. So

[58:11] if you've looked at the San Juan Basin

[58:13] public health budget online, I didn't break copies

[58:15] of it, but you will see we are

[58:17] following these. We actually one or two week

[58:20] collapse. So we don't have 12, I think

[58:22] we have 10 areas of budgeting. But I

[58:25] think we tried to do that to make

[58:26] it very clear. It should help you all

[58:29] in your work going forward because we can

[58:31] demonstrate here's where there is access to state

[58:37] funding. The majority of the funding comes from

[58:39] the state of Colorado for foundational service or

[58:41] capability and here's where there's really not and

[58:45] that will figure into your decision making about

[58:47] what services and programs you want to deliver.

[58:51] So then the next slide is how we

[58:55] budget at San Juan Basin, which is a

[58:58] very robust process of building it from the

[59:00] ground up, taking the budget to public, meaning

[59:03] all the special district rules and regulations in

[59:05] the state of Colorado to make that a

[59:07] very public process. So that is just that

[59:10] calendar. I don't think it's really relevant for

[59:12] you all, but it really just demonstrates the

[59:14] transparency and the commitment we have made at

[59:18] San Juan Basin. I'm trying to think if

[59:20] there's anything else in here. Let's get you

[59:23] want to cut we'll just run through down

[59:25] it. Our 2023 budget priorities, I think this

[59:29] is probably important because if we're looking for

[59:33] continuity to ensure that both counties, if moving

[59:38] to single county agencies, really want to build

[59:42] on the success of San Juan Basin. And

[59:44] we do have to say, I mean, Juan

[59:45] Basin is, we offer a robust suite of

[59:50] services. The average health department in The US

[59:53] that serves 50,000 to 100,000 residents has between

[59:57] twenty eight and thirty eight employees and has

[1:00:00] a much smaller offering of programs and services.

[1:00:03] So we have, in addition to our obligations,

[1:00:07] really worked to bring additional programs to give

[1:00:10] families the bright start in life. And we're

[1:00:13] very proud of that work. So in our

[1:00:16] 2023 proposed budget priorities, we really proposed to

[1:00:20] our Board of Health kind of continuing in

[1:00:23] that vein. And so, these were our budget

[1:00:25] priorities in 2023. And actually, I think I

[1:00:31] will go through these. Was obviously retaining and

[1:00:34] recruiting staff. I think everyone's aware that there's

[1:00:36] workforce issues in government and in all kinds

[1:00:38] of sectors right now, especially in places where

[1:00:42] we are seeing the cost of living outpace

[1:00:45] the wages, which I think we're all challenged

[1:00:47] within Colorado. So we are especially in these

[1:00:50] beautiful mountain towns. So we had made that

[1:00:52] a '23 priority. We also worked through some

[1:00:56] of our steady state programs, because many of

[1:00:58] our steady state programs did not get. I

[1:01:01] mean, just going to be perfectly honest, they

[1:01:02] didn't get the attention that they needed over

[1:01:05] the course of pandemic. So it was a

[1:01:07] redoubling of efforts around our steady state programs

[1:01:10] and then working to have an ability to

[1:01:13] scale our communicable disease response efforts. So we

[1:01:16] do like tremendous partnership work with Pagosa Springs

[1:01:20] Medical Center, for example, in disease. But as

[1:01:24] we know, these are unpredictable when we have

[1:01:27] a response demands more resources to when it

[1:01:32] doesn't. So we need the flexibility there. So

[1:01:35] that was part of our 'twenty three budget

[1:01:37] priorities. And then working through some of these

[1:01:40] cross cutting foundational capabilities, which we saw on

[1:01:43] the previous slide, that had been newly introduced

[1:01:47] in 2020. So we also wanted to redouble

[1:01:49] efforts to work through those. And then the

[1:01:53] last bullet is prepare for a successful transition

[1:01:56] from a Mumelzi County local public health to

[1:01:58] single county led departments. So here we are,

[1:02:01] we're tackling the last bullet. So I don't

[1:02:04] know that I need to go into the

[1:02:05] budget in great detail. I just want to

[1:02:07] kind of show you how we've thought about

[1:02:09] the work and then answer any questions you

[1:02:11] all have about kind of how we organize

[1:02:15] and how we could be of service to

[1:02:16] you as you go through this very complex

[1:02:20] set of decisions over the next couple of

[1:02:23] months. And just a verification, we noticed in

[1:02:28] the contracts that we've sent over that June,

[1:02:31] the June, a lot of grant funding, other

[1:02:34] funding expires. Everything. And has the San Juan

[1:02:37] Basin already started requesting funds for the last

[1:02:42] part of the year? So we're not quite

[1:02:46] into the second quarter of the calendar year.

[1:02:48] Okay, so first of all, observation. Things change

[1:02:51] over June 30 to July 1. That is

[1:02:53] because many of the things that we do

[1:02:56] in partnership with the state of Colorado are

[1:02:58] on the state fiscal. This is this tremendous

[1:03:01] wacky problem that the state budgets from July

[1:03:05] to June and counties budget from January to

[1:03:08] December. It makes up It's just another one

[1:03:12] of those things that makes the complexity of

[1:03:15] what we do sometimes off the charts because

[1:03:17] you have to track every one of your

[1:03:19] funding sources, both in the calendar and in

[1:03:24] the state fiscal because you're tracking towards two

[1:03:27] different budgetary allocations. So with that, we often

[1:03:32] start the negotiations for the next, say fiscal,

[1:03:36] the second quarter of the calendar, which is

[1:03:38] the last quarter of the fiscal. So those

[1:03:42] conversations will start in detail April, May, June,

[1:03:46] or July 1 starts. Now that said, we

[1:03:50] have been meeting with CDPHE. We have dozens

[1:03:54] of revenue contracts with CDPHE, and every program

[1:03:58] manager in our organization has been in specific

[1:04:02] contact with their co lead at the CDPHC,

[1:04:07] both on the program side and on the

[1:04:09] fiscal side to determine that San Juan Basins

[1:04:13] contracts will go July 1 to twelvethirty one

[1:04:15] and then January 1 because they won't be

[1:04:18] able to go beyond. They turn into calendar

[1:04:20] year contracts. So they'll go January 1 to

[1:04:23] June 30, that they'll have to work with

[1:04:25] the two counties. So it's likely that some

[1:04:30] of the new funding would bleed into '24

[1:04:32] and then just divide it. San Juan Basin

[1:04:39] won't be able to sign sign into '20

[1:04:41] So when we get the new contracts, they'll

[1:04:44] have to be scopes of work and contracts

[1:04:47] that end twelvethirty But you're absolutely right to

[1:04:52] be thinking about what it looks like in

[1:04:54] '24 because what's also happening in second quarter

[1:05:00] calendar, which is fourth quarter fiscal, is that's

[1:05:03] when the state legislature is making decisions. And

[1:05:06] if they make decisions that look exactly the

[1:05:09] same from the prior year, that there won't

[1:05:11] be enough money for the single county agencies

[1:05:14] to each do their thing. So this conversation

[1:05:17] has been happening at the state level for

[1:05:20] quite some time because they have to adjust

[1:05:23] their budgeting on their side to accommodate the

[1:05:27] changes that we're making here. Bell Ann was

[1:05:33] here last week, which gave me a lot

[1:05:35] of comfort. Oh good. I thought she was

[1:05:37] very good, but to follow-up Kathy's question, it's

[1:05:42] my understanding that, like you just said, this

[1:05:45] will go through twelvethirty one and then the

[1:05:47] next six months, Does Archuleta County need to

[1:05:50] be ready in that September, October timeframe, just

[1:05:54] to follow-up with at least what I understood

[1:05:56] from Bel Air. We have to notify the

[1:06:00] state for the funding of the six months

[1:06:04] in '24. Yes. We'll be going different. Yes.

[1:06:08] Yes. You will all need to both single

[1:06:11] county agencies will need to be in communication

[1:06:14] with CDPG. And quite frankly, I think it's

[1:06:18] preferable to be in communication April, May, and

[1:06:20] June rather than September, October, because this is

[1:06:24] when the decisions are made for the state

[1:06:27] fiscal. State fiscal goes July 1 to June

[1:06:31] '20 '4. Now that may feel to you

[1:06:33] all and I think both counties feel like,

[1:06:36] okay, well then we can negotiate for January

[1:06:39] at the end of this year, but those

[1:06:40] decisions are made. Yeah, because they're made up

[1:06:44] through the state legislative budgeting process. This is

[1:06:54] why Derek left because I am long winded.

[1:06:56] But I try to really think about like

[1:06:59] where the question's coming from. And so if

[1:07:01] I'm giving you more information than you need,

[1:07:03] know, cut me off, but I'm trying to

[1:07:05] really draw the picture of how all the

[1:07:07] pieces fit together because it's not as easy

[1:07:10] as it looks. Thank you. Looks. Does it

[1:07:14] look easy? Okay. Nothing is easy. Have two

[1:07:22] other questions. One is, as a citizen, looking

[1:07:31] back at your public health department that you've

[1:07:33] led for a long time, what gaps do

[1:07:37] you see that affect regards on the county?

[1:07:43] I think it's a great question. We do

[1:07:46] a community health assessment and we work through

[1:07:49] a public health improvement plan and that came

[1:07:52] into feeding in the 02/2008 Public Health Act,

[1:07:55] right? But what didn't come into being, let

[1:07:57] me backtrack for a second. Public health is

[1:08:00] funded, not just in Colorado, but really everywhere

[1:08:04] in very siloed pots of money that don't

[1:08:08] touch each other and don't integrate well. And

[1:08:11] so it leaves it kind of stultified and

[1:08:14] not really nimble to meet community need as

[1:08:17] community need emerges because we are kind of

[1:08:21] stuck with And the other problem is, and

[1:08:23] there's been a lot being written about this

[1:08:24] now post pandemic, is that oftentimes the funding

[1:08:27] is asynchronous to the largest need in a

[1:08:33] community. So if we look at, even if

[1:08:35] we like any type of communicable disease, it's

[1:08:40] gonna have an exponential growth and then there's

[1:08:43] gonna be some work to contain and bring

[1:08:45] it back and then the funding follows because

[1:08:48] then we have congressional decision making, state decision

[1:08:51] making, and then local government. So we end

[1:08:54] up with very siloed pots of money and

[1:08:57] often at the wrong time for the The

[1:09:00] need. That we're having at the time. So

[1:09:02] we have to have that baseline. So then

[1:09:05] in 02/2008, based on the Public Health Act,

[1:09:08] we are asked to do public health needs

[1:09:12] assessments in communities and write public health improvement

[1:09:15] plans. But what's interesting about that legislation is

[1:09:18] that it required that side of it, but

[1:09:20] it didn't free up any non committed, non

[1:09:23] restricted dollars. So if you go into a

[1:09:26] community and determine, you know, the largest need

[1:09:28] in this community is more quality early childhood

[1:09:33] education because that's what sets kids up for

[1:09:36] the healthiest life that we can have, greatest

[1:09:39] potential of health going forward. And we live

[1:09:42] in a childcare desert, and that's something that

[1:09:45] we want to contribute to on the public

[1:09:46] health side, that would be something a community

[1:09:49] may discover into a community health assessment and

[1:09:52] public health improvement plan. No money followed. So

[1:09:56] what was legislated was the assessment and the

[1:09:58] plan, and then you're kind of on your

[1:10:01] own to go seek funding for it. So

[1:10:03] when you say what needs do we see,

[1:10:06] we see needs everywhere. We see room and

[1:10:09] opportunity to do early child, to do family

[1:10:12] formation, to have more resources for substance use,

[1:10:22] children. There's lots of interest right now, I

[1:10:26] think a lot of this is post pandemic,

[1:10:28] is we're having a crisis of school age

[1:10:31] mental health, young adult mental health. So prevention

[1:10:35] programs, that realm, we have had some significant

[1:10:39] suicide clusters in Archuleta and in the Plaquette

[1:10:43] County. But again, with that asynchronous categorized funding,

[1:10:47] identifying it in the community health assessment and

[1:10:51] public health treatment plan does not create a

[1:10:54] straightforward path number addressing it in the community.

[1:10:56] Are block grants available for those types of

[1:11:03] needs? The answer is sometimes, right? I mean,

[1:11:07] is when everything is kind of pieced out,

[1:11:10] then the answer and I mean, pieced out,

[1:11:14] like pieced out that kind of when everything

[1:11:16] is in small funding streams, I can't answer

[1:11:21] that in what, yes. Money becomes available, sometimes

[1:11:25] it doesn't. We're seeing in Southwest Colorado currently,

[1:11:32] we're seeing a resurgence of sexually transmitted infections

[1:11:36] and syphilis, and we're seeing syphilis in pregnant

[1:11:39] women, right? This is such a public health

[1:11:42] story that because we saw such a suppression

[1:11:45] of these infections for decades with good public

[1:11:49] health, then the funding moved on to other

[1:11:53] things that seemed more pressing and the virus

[1:11:56] or the bacterias don't go okay because the

[1:12:00] funding in our eyes have gone other places.

[1:12:03] And so we have providers diagnosing diseases today

[1:12:07] that they haven't seen. They read about it

[1:12:09] in medical school that nobody had actually seen

[1:12:12] and we're seeing this. Southwest Colorado has some

[1:12:15] high rates of pathogens related to sexual transmission

[1:12:21] as well as substance use disorder. We're seeing

[1:12:23] this kind of step up together and we

[1:12:27] aren't prepared for it and this is not,

[1:12:30] we're not unique. This is a kind of

[1:12:32] rural Colorado problem and a rural problem all

[1:12:35] across the country. So the issue that we

[1:12:37] suffer from is when we cut up our

[1:12:40] funding and only give it to what is

[1:12:42] happening now, we lose track of things we've

[1:12:45] been successful with and they come back and

[1:12:48] then they come back more expensively. That is

[1:12:51] the difficulty of what we do with public

[1:12:53] health. So the things we can do are

[1:12:56] huge and endless, but the things we're funded

[1:12:59] for are often very specific. Sorry, Andrea. No,

[1:13:04] was just gonna ask about, so it kind

[1:13:06] of sounds like an iceberg, right? So, you've

[1:13:09] got above the waterline or kind of the

[1:13:11] nice to, I don't wanna say nice to

[1:13:13] have public health programs, but kind of things

[1:13:15] that have discretionary funding attached. Underneath that waterline

[1:13:19] is stuff that we need to figure out

[1:13:21] how to have a base level of funding

[1:13:22] for no matter what. And so that's maybe

[1:13:25] from local dollars. Are there other sources that

[1:13:28] you've seen around the state that people looked

[1:13:31] into some kind of, so if it's not

[1:13:33] state or federal, is there a local like

[1:13:36] for property tax or is there some funding

[1:13:39] source that you're aware of that some communities

[1:13:41] have? So the county contribution that's required by

[1:13:47] law, think presumably if it comes out of

[1:13:49] the county, covers is likely coming from property

[1:13:52] tax. I haven't seen public health have a

[1:13:57] specific public health mill, but there are hospital

[1:14:02] districts and health districts and there are in

[1:14:05] some places, health districts that have relationships with

[1:14:10] community health in addition to supporting hospitals. And

[1:14:15] I don't have, you may have, I don't

[1:14:18] know the whole interplay between, I think there's

[1:14:21] designations, there's a hospital district and a health

[1:14:24] district and there are some different rules or

[1:14:26] there, I actually don't know the special district

[1:14:28] rules on that. Right. Yeah, I mean, are

[1:14:32] a special district health district. We receive, you

[1:14:34] know, funding from our county from the mill

[1:14:38] levy on million dollars a year, which is

[1:14:42] two weeks of operation Which is right. Is

[1:14:45] it because of the spread? But that is

[1:14:47] the fact and yeah. I'm not in any

[1:14:50] way presuming that that's where the answer is.

[1:14:52] Of the communities there have seen some different

[1:14:56] commitments made with health districts if they have

[1:14:59] the broader, but it would depend on one.

[1:15:02] And I think there's, I can only think

[1:15:03] of two in Colorado that have gone that

[1:15:06] route where the health district, but it doesn't

[1:15:09] actually support the local public health agency, it

[1:15:12] supports community health programs outside of the public

[1:15:16] health agency. But there are two that do

[1:15:19] that and they have probably a much higher

[1:15:21] male or a large right. So I hear

[1:15:24] what you're saying it sounds like you're very

[1:15:26] wary of kind of chasing these different funding

[1:15:29] pots because then you kind of take your

[1:15:30] eye off of the basic level of services

[1:15:34] that may reflect the true need in the

[1:15:37] community. It's just really underfunded, correct? Yes, I

[1:15:43] mean, there's some, I was just reading a

[1:15:48] study over the weekend that says 50% of

[1:15:51] the work from '2, after the two thousand

[1:15:56] and eight recession that to where we are

[1:15:58] today is 50% of the workforce we had,

[1:16:01] because that's where things really changed. And the

[1:16:03] reason that they changed is there was this

[1:16:05] idea that if we had more access to

[1:16:11] health insurance, then we would need less safety

[1:16:15] net of care. And so there were cuts,

[1:16:18] there was actually supposed to be part of

[1:16:19] the Affordable Care Act was supposed to have

[1:16:21] a dedicated public health funding stream. That funding

[1:16:24] stream at the federal level has not come

[1:16:27] to fruition. That money has gone other places.

[1:16:31] So without that dedicated funding stream, there has

[1:16:35] just been a real backsliding in what's available

[1:16:39] in most local communities. So, what is the

[1:16:46] likelihood that we could resolve our differences and

[1:16:51] stay in the district? That was a good

[1:16:55] question. And you're directing that question to me.

[1:17:05] Well, I'll answer a different question. I will

[1:17:07] say that San Juan Basin Public Health has

[1:17:09] obviously since 1948 worked to provide services to

[1:17:15] multiple counties in Southwest Colorado. We're very proud

[1:17:19] of the work that we've done. I'm unbelievably

[1:17:23] proud and impressed with the staff that we

[1:17:26] have. We have a staff that just turns

[1:17:29] themselves inside out when there's a call to

[1:17:32] action to create something or get something done

[1:17:35] in a community. And I very much enjoy

[1:17:41] the ability to work with such tremendously committed

[1:17:45] staff and would love to see how we

[1:17:48] can continue that. So I feel like a

[1:17:56] lot of these questions have been budgetary. I

[1:17:58] think more programmatically. Sure. I just have a

[1:18:01] couple you know when it comes to like

[1:18:04] some of our top three sort of mortality

[1:18:06] issues right so like heart disease, diabetes, cancer

[1:18:09] like what are the prevention programming you guys

[1:18:12] are currently sort of involved in? I feel

[1:18:14] like you know some of those things like

[1:18:16] we need to be ready and in place

[1:18:18] to sort of in lieu of reconciling that

[1:18:24] our health department needs to be ready to

[1:18:26] take on in some form. So can you

[1:18:28] describe what some of those are looking like

[1:18:30] currently for you guys or how you're addressing

[1:18:32] some of those things? Yeah, and it depends

[1:18:33] on if you wanna look at that from

[1:18:35] like a primary, secondary or tertiary prevention model.

[1:18:38] And since now that you have said that

[1:18:41] you have an Miles hour, I figured I

[1:18:42] might as well just go with that, right?

[1:18:44] Or we're doing, because a lot of times

[1:18:46] what you see in rural public health is

[1:18:49] you may be doing some of the screening

[1:18:52] and the early diagnosis. And we at some

[1:18:55] point were was doing that work back in

[1:18:58] the day when there was so much less

[1:19:00] healthcare in Archuleta County, right? When I started,

[1:19:04] oh, so actually I was gonna say when

[1:19:06] I started in public health, but it's when

[1:19:08] I started in public health, I was working

[1:19:09] in domestic violence and sexual assault and working

[1:19:11] really closely back with Carmen Hubbs a million

[1:19:15] years ago and the only healthcare in Archuleta

[1:19:18] County was the, I think it was called

[1:19:19] the Mary Fisher Clinic and I never for

[1:19:21] some reason don't know the story of who

[1:19:24] Mary Fisher was and how she had a

[1:19:25] clinic made better but I would love to

[1:19:27] know the story someday. So at that point,

[1:19:32] local public health is doing more of the

[1:19:35] early intervention screening and diagnosis, but we've had

[1:19:38] a tremendous growth and proliferation of healthcare. Know,

[1:19:42] Cagosa Springs Medical Center has a rural health

[1:19:44] clinic, there are some special designations there about

[1:19:47] how rural health clinics serve populations. There's other

[1:19:50] inputs into the healthcare realm. So at that

[1:19:55] point, we shifted our work into care coordination

[1:19:57] and patient navigation because it doesn't make sense

[1:20:01] that we replicate what's available in healthcare. So

[1:20:05] then that gives us the ability, and this

[1:20:07] is where I think the ACA by putting

[1:20:09] the funding towards public health and then having

[1:20:13] it never come to fruition is where things

[1:20:16] went like this, right? We get people health

[1:20:18] insurance, we get more early screenings, diagnosis, more

[1:20:22] early intervention, we should see some improvement. But

[1:20:26] then how do we go further upstream and

[1:20:29] figure out what is making people think, right?

[1:20:32] So, you know, it's the early childhood nutrition

[1:20:35] programs, it's the family formation, the earlier intervention.

[1:20:39] A lot of what becomes your health as

[1:20:42] an adult happens when you're zero to two

[1:20:45] years old in your family environment. So we

[1:20:48] focus on more programs for early family formation.

[1:20:54] And then we should see the benefit of

[1:20:56] that decades out, right? Is that easy to

[1:20:59] measure? Is that easy to talk about? Absolutely,

[1:21:03] positively not. But that's the best we can

[1:21:07] do that for heart disease, different, I mean,

[1:21:12] cancers are tracked to our early childhood, then

[1:21:16] there's environmental inputs, right? So what are we

[1:21:18] doing? One of the things we're working on

[1:21:19] right now is, I'm gonna like knock on

[1:21:22] wood, wildfire events, we are learning so much

[1:21:26] more about what the exposure from the PM

[1:21:29] 2.5 and wildfires focus. So we just went

[1:21:32] to a national foundation and got some funding

[1:21:37] for a pilot program for clean air shelters

[1:21:39] because we know that we live in communities

[1:21:41] where people don't have no reason to have

[1:21:44] a sophisticated HVAC when you live in mountain

[1:21:47] communities with mountain reasons, right? Well, then you

[1:21:50] have wildfires and you have no way to

[1:21:51] keep your indoor air clean. So we're looking

[1:21:54] at piloting some programs with clean air shelters

[1:21:57] because we're finding things like the PM 2.5

[1:22:00] in wildfire smoke is that much more damaging

[1:22:04] than the PM 2.5 that we're exposed to

[1:22:06] all the time, right? So we're working through

[1:22:10] piloting things like that because of the communities

[1:22:13] that we live in. There aren't examples in

[1:22:16] Colorado Clean Air Shelters for Wildfire. This is

[1:22:19] an idea that we heard was piloted in

[1:22:22] California. We said we want to bring that

[1:22:24] to Colorado. We're one of only five organizations

[1:22:28] in the country that received this public private

[1:22:32] partnership, high living money from Devotemont Foundation. So

[1:22:36] we'll do those types of things. And we

[1:22:38] say, how do I, if I have an

[1:22:40] idea, how do I get it funded? We

[1:22:42] write it down, we shop it, we try

[1:22:43] to leverage relationships. And if it's got some

[1:22:46] hook that it's new, it's different, then we

[1:22:49] can maybe get it piloted because there's not

[1:22:52] often the bandwidth to pilot things in rural

[1:22:56] communities. The only other thing I was thinking

[1:23:02] and looking through some of your reports I

[1:23:04] don't see and I could have just missed

[1:23:05] it in the piles of documents. I was

[1:23:11] just curious about the breakdown of like the

[1:23:14] services and like the number of people that

[1:23:16] are accessing those in Archuleta versus La Plata.

[1:23:19] I see the big numbers and again it's

[1:23:21] probably similar but I haven't seen it so

[1:23:24] I don't know Mary if you know where

[1:23:25] it is that you can tell me or

[1:23:27] if you know what it might be called

[1:23:28] Leanne. When we talked last week, you mentioned

[1:23:32] an incentive to me, which I did share

[1:23:34] with the board chair. I haven't shared with

[1:23:36] the committee just because I was gonna bring

[1:23:37] it up today, but Archuleta County, the investigative

[1:23:41] study committee received that information in 2021. So

[1:23:46] they received it broken down by it does

[1:23:50] help understand not fully funded requires agency contribution

[1:23:54] not fully funded, not fully post medical funding.

[1:23:57] And it talks about 8% of clients serve

[1:23:59] result in our society for each of the

[1:24:02] pillars. So they range from eight to 36%

[1:24:05] depending on the program. So what so is

[1:24:08] there a total number? I'm just like, how

[1:24:10] many people, right? 8% is all fine and

[1:24:13] great until it's one person or two people.

[1:24:18] As you guys move through this process, we

[1:24:21] can share more detailed information. Most of us,

[1:24:25] so we have, there was a lot of

[1:24:30] question about how much money do you spend

[1:24:33] in one county versus the other county. And

[1:24:35] we were charged with serving a jurisdiction. So

[1:24:39] we didn't have our staff members and all

[1:24:42] of our budgeting track time between how you

[1:24:45] know, like, you know, would I, you know,

[1:24:47] fill out my time with you differently, because

[1:24:49] I came over here, you know, it's just

[1:24:51] like we weren't having on the expense side,

[1:24:55] that type of tracking, because it wasn't required

[1:24:57] because we were funded to serve the jurisdiction.

[1:25:00] On the programmatic side, we of course have

[1:25:03] lots of data around 36% of our WIC

[1:25:07] clients reside in Archuleta County versus 64% residing

[1:25:13] in La Plata County. And the nurse family

[1:25:16] partnership, it's 30% in Archuleta versus 70%. In

[1:25:21] SafeCare, was SafeCare was actually a program that

[1:25:24] we picked up that the Archuleta County Human

[1:25:26] Services Director at the time really asked us,

[1:25:30] can you pick this program up because it's

[1:25:32] going away from our community? So we had

[1:25:34] an over representation there. Then in other programs,

[1:25:37] it's not twentyeighty, it's tenninety, right? So we

[1:25:43] have that information. And as you guys get

[1:25:46] further down this, I think that some of

[1:25:50] that information should be in the contract documents.

[1:25:54] If it's not, we can start giving you

[1:25:56] estimates around that work because I would be

[1:26:00] interested in it prior to 'twenty. Right? Like

[1:26:04] historically, what did it look like? Right. You

[1:26:08] know, I mean, there were also lots of

[1:26:10] programs, and I don't know if there's a

[1:26:11] way to connect around, you know, what was

[1:26:14] offered out of the Eighth Street Building and

[1:26:16] when and how some of those went away.

[1:26:18] I know a lot of it's related to

[1:26:19] like grants go away, right, but I think

[1:26:22] it would be interesting to see like historically

[1:26:25] some of those services and like the funding

[1:26:27] streams and like when they went away because

[1:26:30] I think what I'm hearing from the community

[1:26:32] is they remember some of those things and

[1:26:33] they really want some of those things but

[1:26:35] historically being able to then have an answer

[1:26:38] to say there's no funding streams. That was

[1:26:40] funded by X, X is morphed into Y.

[1:26:43] And a lot of that would be changes

[1:26:45] with the Affordable Care Act, which has allowed

[1:26:48] the program. You can't have the level of

[1:26:51] health care without a pay source community members.

[1:26:57] And now that that got passed, have, but

[1:26:59] then some of the changes to say, what

[1:27:03] did it look like before pandemic and what

[1:27:04] did it look like after? I'll also say

[1:27:06] pandemic sort of distorted everything because there were

[1:27:09] things like, you know, WIC is one of

[1:27:12] our high volumes programs and WIC is a

[1:27:14] great program. Well, we saw WIC numbers, we

[1:27:18] saw some declining WIC numbers before the pandemic,

[1:27:21] we saw some increased WIC numbers during the

[1:27:23] pandemic. Now that the SNAP benefits are being

[1:27:27] wound back with the end of the public

[1:27:28] health emergency, we expect to see more WIC

[1:27:31] enrollment rates. So there's nothing in our building

[1:27:37] that's not touched in some way by the

[1:27:38] pandemic. We can absolutely give the kinds of

[1:27:42] numbers. Yep. Great. Would y'all be interested in

[1:27:47] seeing what the investigative committee was presented to

[1:27:51] them in October 21? Is that in their

[1:27:53] document? It was not in the docus. Yes,

[1:27:57] do not understand the three. Oh, That'd be

[1:28:00] great. It's again, it just it was what

[1:28:03] they heard from them. So I think we

[1:28:06] ought to know what that was. They did

[1:28:10] guide the commissioners. So it says thirty to

[1:28:15] thirty five percent of communicable disease investigations are

[1:28:18] in Archuleta County, then you're gonna say, how

[1:28:20] many do you think so? I have some

[1:28:22] of that information, 20% of sexual health and

[1:28:25] cancer prevention is here, 25% of environmental is

[1:28:31] here, 30% of on-site inspections, and 33% of

[1:28:38] septic permits were Archuleta County. I mean, I

[1:28:41] just think it helps speak to staffing, know,

[1:28:43] if there's a hundred WIC clients but that's

[1:28:45] only 20% because there's so many in La

[1:28:47] Plata, right, that tells us something about how

[1:28:49] many people we need to run a program

[1:28:52] versus the percentage. I understand why the report

[1:28:55] percentages that you guys are looking at dollars.

[1:28:57] Well, if we have the numbers someplace else,

[1:28:59] right? You that's not they're never in some

[1:29:01] place. Right? Right. But you know, you know,

[1:29:04] but I think that it's helpful just because,

[1:29:07] you know, when we're trying to think about

[1:29:08] how how to staff departments, you know, if

[1:29:12] there's five, then how does this one person

[1:29:14] maybe wear three hats versus in, you know,

[1:29:17] La Plata, maybe that person served a whole

[1:29:20] lot because Well, on that April, May and

[1:29:23] June activity that we discussed when we should

[1:29:25] be visiting with the state and I'm saying,

[1:29:28] you know, last quarter of the state fiscal

[1:29:30] or second quarter of the calendar is also

[1:29:32] where that information comes from because the state

[1:29:35] will say, We're funding you at this level

[1:29:39] because our demographic information is that the size

[1:29:45] of the target population is X, the uptake

[1:29:48] of that program is Y, so we expect

[1:29:51] your client load to look like Z, so

[1:29:55] that has to be staffed at this FTE

[1:29:57] level, right? And that's why you want to

[1:29:59] be doing this with the state April, May,

[1:30:02] and June. The other complication, which I'm just

[1:30:04] going to throw out there, I think this

[1:30:06] one's going to be kind of hard to

[1:30:07] hear because none of this is fun, but

[1:30:09] some of the programs at the state, they're

[1:30:12] not going to want to chop it to

[1:30:14] too small program, right? So at the metro

[1:30:19] region where Tri County Tri County made steps

[1:30:22] towards breaking up, and I think that sort

[1:30:24] of emboldened some decision making about other health

[1:30:28] districts breaking up, they are serving millions of

[1:30:31] people at Tri County. So when they break

[1:30:33] up into Douglas Adams and Arapahoe, the state

[1:30:36] contracting side will take one contract and contract

[1:30:39] three times. It triples their administrative burden, but

[1:30:43] it serves millions of people. We have to

[1:30:46] remember for fifty six thousand and 14000 is

[1:30:49] the state realistically going to double its administrative

[1:30:54] burden for that small number of people? And

[1:30:57] again, this is why I highly encourage that

[1:30:59] these conversations cannot wait until third and fourth

[1:31:05] quarter of the calendar, which is at the

[1:31:08] Tri County, a lot of those conversations happen

[1:31:10] third and fourth quarter, but you're dealing with

[1:31:12] larger numbers of people, there's going to be

[1:31:15] more negotiations for smaller numbers of people. So

[1:31:18] based on your work with the state what

[1:31:23] is our best move and ideally who should

[1:31:27] be having those conversations if we haven't hired

[1:31:29] a director yet in order to get us

[1:31:31] into this ballgame and start thinking through those

[1:31:34] things so that especially as we're thinking about

[1:31:36] programming and staffing, know, mean, do we sit

[1:31:40] on those with you guys as you're like,

[1:31:42] right? Are we all in those together because

[1:31:44] you guys are doing the first half of

[1:31:46] the fiscal year? Like it just seems like

[1:31:48] it's convoluted. You may not know but no

[1:31:51] and we introduced your conversation when we're negotiating

[1:31:54] for the second half of this calendar year

[1:31:56] but I think the sooner that, so if

[1:32:00] there's, if I don't know what the timeline

[1:32:03] is for completing that recruitment and search, but

[1:32:08] the sooner that that happens, then there's a

[1:32:11] person who can start having those conversations. And

[1:32:15] it's with direction and input from you all

[1:32:17] about which programs in what order and how

[1:32:19] do we prioritize this. We're trying to get

[1:32:21] you all the information so you can figure

[1:32:23] out how to prioritize it. And I think

[1:32:25] your questions about numbers served is hugely important

[1:32:28] and we'll be happy to work on that,

[1:32:30] but also that's going to come from these

[1:32:33] negotiations by the state. How many people are

[1:32:39] currently in your funding department of San Juan

[1:32:42] based Mill? How many people work on that

[1:32:44] process? We have an assessment and planning that

[1:32:51] has three staff members that support all of

[1:32:55] the program managers. So we have that skill

[1:32:58] set diffused across the programs. So if you,

[1:33:03] what's your favorite thing in public health? Early

[1:33:08] child. Okay, perfect. So if you're working in

[1:33:10] early childhood and you say, I really want

[1:33:13] this early childhood nutrition, this is my dream,

[1:33:17] I want this. So you are more likely

[1:33:20] than our data and our assessment and planning

[1:33:25] team to come across opportunities. When you come

[1:33:27] across an opportunity, you as the subject matter

[1:33:30] expert on our staff can seek support from

[1:33:33] our assessment and planning team, but you are

[1:33:35] the subject matter expert in bringing in funding

[1:33:39] to your department, which is sometimes a little

[1:33:42] bit different than how other organizations are set

[1:33:46] up. But we, because there's such diversity of

[1:33:50] the programming, we have every program manager and

[1:33:53] every division director with expertise in seeking funding

[1:33:57] to sustain their programs. That's so valuable. And

[1:34:00] that's going to be something extremely hard for

[1:34:02] us to do. I've got an Just curious

[1:34:10] there, Kathy asked a tough question reconciling. I

[1:34:14] like that question. Is there a possibility where

[1:34:17] Archuleta could work with La Plata in that

[1:34:21] role? Going forward? The funding? To work together

[1:34:26] on funding? Well, or to contract with La

[1:34:31] Plata to help with that if we can

[1:34:34] pull that together. So I can only speak

[1:34:37] for San Juan Basin, I can't speak for

[1:34:39] any county, but some of the question I

[1:34:42] can put on the table is like, you

[1:34:44] know, kind of the how's, how do we

[1:34:47] start, know, we know what the what's are,

[1:34:48] we want to figure out what our programs

[1:34:50] are, and we want to get them, get

[1:34:55] the funding and the delivery mechanism in place.

[1:34:58] Those hows could happen in a variety of

[1:35:01] ways but I can't speak to how La

[1:35:03] Plata County would have been. So are you

[1:35:08] involved with the I think La Plata County

[1:35:13] has already formed the board itself. Yes. Are

[1:35:16] you involved in that? What is the makeup

[1:35:21] of that board? Are there any county commissioners

[1:35:24] on No. They do not have county commissioner

[1:35:28] representation. It's all public people from the community

[1:35:30] and public health people. Seven? Is it five

[1:35:33] percent? Seven. No, something commissioner. Seven. So they're

[1:35:38] looking to hire director I'm assuming and you

[1:35:41] may not know this but are they going

[1:35:42] to report to the county manager or are

[1:35:45] they going to report to the school or

[1:35:48] do you know? They have not released their

[1:35:52] solicitation so once that is released I think

[1:35:55] that will be clear. Okay interesting yeah we

[1:35:58] were just having that conversation earlier about reporting

[1:36:00] structures and stuff like that. When is the

[1:36:03] assessment due or can we finish the new

[1:36:06] assessment that's in The survey is open through

[1:36:09] the first week in April. Okay. This survey

[1:36:12] data is one component. So what's required in

[1:36:15] statute is public health improvement plan. How to

[1:36:18] get to your plan can be things like

[1:36:22] a community health assessment. It can also be

[1:36:25] a survey or an analysis of secondary data,

[1:36:29] or it can be a combination of the

[1:36:31] two. So there is a community health assessment,

[1:36:34] there are also focus groups with specific target

[1:36:37] populations, and there are key informant interviews. All

[1:36:40] of those together will provide quantitative and qualitative

[1:36:44] primary data sources, but then it will be

[1:36:47] synthesized with secondary data sources, which are not

[1:36:51] always complete for small communities like counties of

[1:36:55] 14,000 people. So there may be some aggregate

[1:36:58] secondary data that is then used together to

[1:37:01] produce the report. We will be able to

[1:37:04] provide preliminary information on the primary data sources,

[1:37:09] but that takes some time to sift through.

[1:37:12] May and June, we do not intend to

[1:37:14] go public with that. It would be more

[1:37:16] in the summertime as some of the secondary,

[1:37:19] as we're benching it to what we can

[1:37:22] validate through secondary data sources. Because in the

[1:37:26] surveys, we have trouble getting a lot of

[1:37:29] people to respond to them, right? And the

[1:37:31] demographic who uses. Yeah, we have like 1,100

[1:37:36] responses now across the two counties. So as

[1:37:39] long as that has an eightytwenty split, then

[1:37:41] in theory, according to the statisticians we're working

[1:37:44] with, that's statistically valid. But if it over

[1:37:48] represents one group and under represents another group

[1:37:50] or, I mean, we have to be honest,

[1:37:52] like our perceptions don't always match. So if

[1:37:57] we ask people about, how do we achieve

[1:38:01] our highest potential of health, most people will

[1:38:03] immediately go to healthcare and say, well, as

[1:38:06] long as I'm getting my blood pressure screened

[1:38:07] at my healthcare provider, then I'm tackling, addressing

[1:38:12] this need without actually saying, but what we

[1:38:15] find is things that we do in other

[1:38:18] socioeconomic decisions have outsized impact on our heart

[1:38:22] health, right? And that's why we don't simply

[1:38:25] rely on the community responses. We bench it

[1:38:29] to secondary data and evidence based programming in

[1:38:34] communities because we want to tie up the

[1:38:36] pieces together more comprehensive. I had a question

[1:38:41] about the emergency prepared response and it's not

[1:38:44] well formulated in my brain so bear with

[1:38:46] me here but I understand you had a

[1:38:50] group of people, employees that actually were assigned

[1:38:53] that role and it may be the same

[1:38:56] answer to Kathy's but I see this emergency

[1:39:00] preparedness preparedness as a thread that every program

[1:39:02] is responsible for So, it the same relationship

[1:39:06] where the program director of each of these

[1:39:09] services It's a both end. So, we have

[1:39:13] just like we have an assessment and planning

[1:39:15] team that can support program managers to get

[1:39:17] their grant applications out the door or do

[1:39:20] the research. We have a, in this case,

[1:39:23] we have a state funded emergency preparedness and

[1:39:27] response team. And then that they work to

[1:39:32] prepare each department. So when we talk about

[1:39:36] emergency response, some emergency response can be your

[1:39:39] continuity of operations if there's a event in

[1:39:43] your community that doesn't allow your agency to

[1:39:46] perform its duties, right? But then some of

[1:39:49] it beyond that then is also serving the

[1:39:52] community. So if we talk about like a

[1:39:55] wildfire event or flooding event or an emergency

[1:39:58] communicable disease event, but what we did with

[1:40:01] the COVID response, because so many other things

[1:40:03] once we started having stay at home orders

[1:40:06] so many other programs were no longer in

[1:40:08] effect so we created a new org chart

[1:40:10] and moved everyone from their steady state role

[1:40:14] into their emergency response role at the early

[1:40:17] part of the pandemic. So I'm wondering how

[1:40:20] that works with contracts. Suppose we contract for

[1:40:23] an agency here to provide immunizations, who's going

[1:40:27] to lead that effort to if another communicable

[1:40:31] disease pandemic came down? Okay, so what you're

[1:40:34] asking is if you parse out pieces in

[1:40:37] the community, but you need to mobilize for

[1:40:39] a public health effort. So I think that

[1:40:44] it's much more seamless if it's within the

[1:40:46] organization, if it is parsed out and you

[1:40:49] would need to mobilize external to the organization,

[1:40:52] it would have to be something that's addressed

[1:40:54] in the contracting at the front side. Okay,

[1:41:00] that helps. I haven't seen a model like

[1:41:03] that but I'm assuming you know that there

[1:41:05] would be a model like that. But you're

[1:41:08] saying how would you step up quickly to

[1:41:10] address a conflict? Well yeah step up and

[1:41:13] also have somebody that's in charge of it

[1:41:15] who's thinking ahead of the game and on

[1:41:18] top of it you know looking at the

[1:41:19] data coming down from CDC and so forth.

[1:41:23] Not waiting to the last oh my gosh

[1:41:25] we need to get people who are going

[1:41:26] to give injections you know. Thank you. No,

[1:41:32] that's a great question. So we kind of

[1:41:37] divvied up our areas of research. And one

[1:41:43] of the areas that Suzanne and I are

[1:41:45] looking at is environmental health. And would it

[1:41:48] be okay if we contacted Brian or maybe

[1:41:52] other members of the staff if we had

[1:41:53] specific questions about staffing levels of programs, things

[1:41:57] like that. We have a single point of

[1:41:59] contact within our agency for transition questions. Oh

[1:42:03] okay. Because it's just we so you know

[1:42:05] with healthy communication with everyone's talking to everybody

[1:42:08] but we're going with hub and spoke here

[1:42:10] because we've addressed a lot of pieces that

[1:42:12] can be duplicated. So the single point of

[1:42:15] contact for whatever you've been assigned to will

[1:42:17] be Sherry Dugdale, who will then get it

[1:42:19] out in the organization and all of the

[1:42:22] questions because what we'll do is we'll put

[1:42:24] the answer probably in the Dropbox and then

[1:42:26] other people will have access to it. So

[1:42:29] I totally understand like I know you know

[1:42:31] Brian, you have a great relationship. You're like,

[1:42:33] hey Brian, how does this work? I'm going

[1:42:34] to ask that you go through Sherry and

[1:42:36] Sherry and an Alex. Okay. I will get

[1:42:38] her. It's just because I feel like the

[1:42:42] volume of work that we might be doing

[1:42:43] together for the next ten months might be

[1:42:46] kind of prohibitive to allow for relaxed. So

[1:42:52] we're just going to go with this very

[1:42:53] stringent got to go through the single credit

[1:42:55] cost. So the independent consultant that you had

[1:42:59] that came in and did the presented you

[1:43:01] with the results, how accurate do you feel

[1:43:04] that is and Which consultant ought to be

[1:43:08] or how do you sit on top of

[1:43:09] I always was in La Plata County. Oh,

[1:43:13] that's La Plata, yes. That's right. Yes. If

[1:43:17] you're asking if it comports with my experience

[1:43:20] as a local public health agency, I would

[1:43:23] say many components of that do comport with

[1:43:28] our experience. There may be some details that

[1:43:31] we would have come to a different conclusion

[1:43:35] because there is such kind of arcane details

[1:43:41] around how we put the money in to

[1:43:43] make it all work. Do you feel that

[1:43:48] you are understaffed, overstaffed at San Juan Basin?

[1:43:55] Because I think the things that we can

[1:43:59] do in public health and the ways that

[1:44:01] we can improve well-being and protect health are

[1:44:04] so vast that I think there's always room

[1:44:08] to go in more direction. And then I

[1:44:11] think to Sally, right, to Sally's point, if

[1:44:15] we had more programs and services, because there

[1:44:18] are so many ways that we can improve

[1:44:19] health for residents of any place in America,

[1:44:23] then when we're faced with the whether it's

[1:44:26] highly pathogenic avian flu or we're faced with

[1:44:31] another, God, let's not think about another coronavirus

[1:44:35] we're faced with, the more programs and services,

[1:44:37] the more nimble you are to then respond.

[1:44:41] And the other ability you have is to

[1:44:44] catch things earlier as they are, you know,

[1:44:47] come roaring back, right? So like, if we

[1:44:50] use the example of syphilis coming back in

[1:44:53] parts of the country where we're starting to

[1:44:55] see, you know, children be born with eyesight

[1:44:59] issues, which we haven't seen in generations, right

[1:45:02] the sooner that you if you have more

[1:45:04] staff programming to move into other things the

[1:45:08] more you can touch up in the most

[1:45:10] space. Did you have there's a program in

[1:45:15] the somewhere that I read your references a

[1:45:18] volunteer medical course did that activate during the

[1:45:22] pandemic did you get volunteers from it? We

[1:45:25] did yes we had tremendous numbers of volunteers.

[1:45:28] Do you happen to know if that happened

[1:45:30] here? Yes yes yep Yep, across the jurisdiction.

[1:45:34] Wow, love it. Heard about that. There was

[1:45:37] a reaction that was bad here. Bruce spoke

[1:45:40] at our last meeting who said that she

[1:45:43] feels that's a need in Archuleta County is

[1:45:47] getting, it's like almost home health, right? Getting

[1:45:49] whether they're volunteer or paid, but people who

[1:45:52] can actually go to people's homes and provide

[1:45:56] services. We can't really be so intimidated about

[1:45:59] that. Very specific. Here are the rules and

[1:46:02] regulations. Very specific. I mean, all that. That

[1:46:07] is not something that we want to do.

[1:46:10] Medications for oxygen and other durable medical equipment.

[1:46:15] Again, that's what they were asking for at

[1:46:17] that last meeting. But that is not within

[1:46:21] the scope of public health. Mean, the home

[1:46:29] health desk services. I think, you know, they

[1:46:32] were referring to oxygen and blah blah blah.

[1:46:36] And I don't, but who provides that in

[1:46:38] our community? Mercy. We have really good response

[1:46:40] from public. Do we? I guess it's a

[1:46:44] whole branch. It's not only are we really

[1:46:47] siloed within public health of what we do,

[1:46:50] but then all of public health and healthcare

[1:46:52] is really siloed. So if we were to

[1:46:55] step into home health, we would have to

[1:46:58] comport with all. And so, and HIBES did

[1:47:00] public health in some rural communities with home

[1:47:03] health, Yes, and they held federal contracts. Over

[1:47:07] time, again, this is going with the evolution

[1:47:10] of once you have more healthcare available in

[1:47:14] a community, including home health, including long term

[1:47:20] care facilities, then what the public health agency

[1:47:23] does is different and starts to be more

[1:47:26] upstream because we don't step on other, But

[1:47:31] if those things don't exist, then there's a

[1:47:33] whole different conversation. They exist now. Sounds like

[1:47:36] that there were community members here who did

[1:47:39] not have access to home health, didn't know

[1:47:42] how to access it or they were they

[1:47:45] homebound or whatever. Yeah, you don't really know,

[1:47:50] from a point of view of who provides

[1:47:52] home health care, it is through Mercy, they

[1:47:55] have an office that they rent from a

[1:47:58] building that we own on our campus. And

[1:48:01] then they come and the response I get

[1:48:04] from my Swenwick Rural Health Center and Hospital

[1:48:07] program is that they are quick to respond

[1:48:10] and very helpful but obviously somehow in our

[1:48:12] community we're missing some people that didn't have

[1:48:16] that access. I mean, and that makes sense.

[1:48:19] And then there's community connections, has the contract

[1:48:22] for options for long term care, which is

[1:48:25] how people that are either on Medicaid or

[1:48:29] Medicare or both have personal care and this

[1:48:34] is different than skilled nursing. It's how they

[1:48:37] have personal care to remain in their health

[1:48:40] but once we're in oxygen then we're in

[1:48:43] skilled nursing. I don't believe that personal care,

[1:48:48] but personal care for folks that want to

[1:48:51] remain at home is through the Community Connection

[1:48:54] Single Entry Point Program. So that's the other

[1:48:57] thing, I mean, and that's the care coordination

[1:48:59] piece is having the map in your brain

[1:49:00] of how to operate because it's sort of

[1:49:03] mind numbing that this is not a design

[1:49:06] system. This is a system that's grown organically

[1:49:09] in a million different ways. And then any

[1:49:12] individual is trying to navigate something that makes

[1:49:15] no sense, because no one would design it.

[1:49:18] That's right. I'm not 100% sure about that.

[1:49:22] So what does it look like for you

[1:49:23] guys with, like, there a reporting structure where

[1:49:27] you're sort of learning these pieces from our

[1:49:30] different partners, So from the hospital and from

[1:49:33] the urgent care and from Archuleta Integrated, like

[1:49:36] how does that look for the health department?

[1:49:39] Is there a way that they report to

[1:49:41] different things? Is it just about you know,

[1:49:44] some of those like diseases that are coming

[1:49:46] forward? Like what is that? Well, I think

[1:49:49] depending on what type of programming we're talking

[1:49:51] about, so if talking about an infectious disease,

[1:49:54] then there's required reporting from healthcare to the

[1:49:58] public health discipline. Some things are, you know,

[1:50:01] in different timelines and when these happen to

[1:50:03] be reported. And does that report to those

[1:50:05] like the local health departments? Is that for

[1:50:06] the state health And then back down by

[1:50:08] law, it's both, which is very confusing. Again,

[1:50:10] it's not the design system. Nobody would design

[1:50:13] a system that way. But healthcare has to

[1:50:15] report local and state, and then has, you

[1:50:19] know, it's best to just do both because

[1:50:21] it's hard to tell where, right. But then

[1:50:23] in environmental issues, if there's a spill, that's

[1:50:26] going to hit surface water, or if there's

[1:50:29] an issue with the discharge permit, then there's

[1:50:32] that has to be reported to the environmental

[1:50:34] side of the state health department, then either

[1:50:37] it gets kicked to us or it's in

[1:50:39] their regulatory framework, but we'll go out and

[1:50:42] do a bursary first look to tell them

[1:50:45] what the level of acuteness is and how

[1:50:47] quickly they should get someone on the ground.

[1:50:50] So there's things like that. Then for like

[1:50:52] kind of longer term things like if there's

[1:50:55] a community mental health or substance use or

[1:50:59] a rise in infections and teens or that

[1:51:03] sort of thing, we'll work with a variety

[1:51:05] of community partners. And it's some of it's

[1:51:08] very formal reporting structures, some of it's very

[1:51:11] informal, based on relationships, where do you see,

[1:51:14] you know, where there's collaborative management project, which

[1:51:18] is a required program at human services, or

[1:51:22] teens who need extra help and support, it's

[1:51:25] required that public health serve on that. So

[1:51:28] that's a way that we formally have our

[1:51:31] finger on the pulp of what's going on

[1:51:33] with teens and young adults, but then we're

[1:51:35] serving on that where we have the formal

[1:51:37] relationship, we're always building the informal relationships to

[1:51:40] keep each other in the same conversations. Another

[1:51:44] formal one would be child fatality. I'm trying

[1:51:46] to like separate out between formal and informal.

[1:51:48] Child fatality review teams, that would be places

[1:51:51] where we would identify needs in community and

[1:51:54] then either make suggestions for state policy or

[1:51:57] look at local policy. For average child fatality

[1:52:00] reviews only happened in Denver for the whole

[1:52:03] state about like maybe five or probably about

[1:52:06] five years ago, there was state legislation that

[1:52:08] said, you know, maybe it's the locals looked

[1:52:10] at the child's fatality, there may be some

[1:52:13] local knowledge because how we think about some

[1:52:16] of these things in Denver is different than

[1:52:18] how we think about them on the ground.

[1:52:20] When I'm kind of giving that talk about

[1:52:23] why the child fatality moved from Denver here,

[1:52:27] there may be a place that you know

[1:52:28] is a swimming hole and drownings are a

[1:52:32] very high, what's the word I'm looking for,

[1:52:38] we have high prevalence of drownings, and drownings

[1:52:40] are totally preventable. So, if someone in Denver

[1:52:43] is reading about a child fatality and drowning,

[1:52:46] they may see it very differently than you

[1:52:48] do on the ground because you cannot picture

[1:52:50] exactly where that drowning occurred. So, that has

[1:52:54] become more localized, but it can also turn

[1:52:57] into a larger policy, you know, over larger

[1:53:00] education. So formal and informal and relationships. Any

[1:53:09] more questions? Have a question. Suzanne. Can you

[1:53:15] hear me? Yes. When I was reviewing the

[1:53:24] information under contracts, especially for environmental health or

[1:53:28] environmental services. I wanted to be sure I

[1:53:32] understood how they're using the word credentialed when

[1:53:36] we're looking at our research and it said

[1:53:41] credentialed yes or no. What I first thought

[1:53:44] credentialed was, then I thought maybe that's not

[1:53:47] the definition. Can you tell me what credentialed

[1:53:53] means in the background information? So as we

[1:53:59] went through our program services and how they're

[1:54:03] paid for, we made an internal exercise to

[1:54:07] list of staff what needed to be credentialed

[1:54:10] so that you all, in taking on this

[1:54:12] very complex Byzantine job that you've taken on,

[1:54:18] can start thinking about, if I'm recruiting staffing

[1:54:21] for this, do I need to recruit staff

[1:54:24] with existing credentials? Or is this on the

[1:54:27] job training? So we put notes in each

[1:54:31] contract about that. Our environmental health staff is

[1:54:37] not externally credentialed. It is on the job

[1:54:40] training, but there are best practices and standards

[1:54:45] that one would like to see those individuals

[1:54:49] obtain to perform best practices in community. So

[1:54:54] does externally credential mean licensing? You're a licensed

[1:54:59] registered dietitian, but then internally, so for environmental,

[1:55:05] there's internal training, obviously, on how you would

[1:55:07] inspect a septic and tons of rules and

[1:55:10] regulations. But then on the restaurant side, there's

[1:55:13] internal on the job training to get FDA

[1:55:18] certified. This is where like the word is

[1:55:21] FDA credentialed. That's a good one. And our

[1:55:29] recommendation would be that as you're planning, you

[1:55:32] plan both to bring in externally credentialed staff,

[1:55:36] but also allow enough lead time If you're

[1:55:39] going to have your own restaurant inspectors, you

[1:55:41] want to hire them before January 1 so

[1:55:45] that they can do the FDA training. Is

[1:55:46] it required? No. Is it best practice? Absolutely.

[1:55:53] So we've let we put some of that

[1:55:55] information. We sprinkled or we put Easter eggs

[1:56:00] in all the contracts. I hope these helps

[1:56:04] were available. These conversations. Thank you. You. Since

[1:56:22] 2020. Yes. Well, sure. Thank you. Thank all

[1:56:25] of you for taking this on. I think

[1:56:26] we we we care deeply that this is

[1:56:29] successful and that all of our residents have

[1:56:32] the same level of health protections and ability

[1:56:36] to reach their highest potential health. So whatever

[1:56:41] we can do. Do you need to grab

[1:56:43] an amputation while you're here? Director job is

[1:56:51] advertised. I thought my guard you only have

[1:56:55] one applicant so that would give you $50.50.

[1:57:01] Thank you very much. When I got my

[1:57:05] one of my first jobs in college back

[1:57:06] then there was no internet right so they

[1:57:08] would put up the flyers yeah and so

[1:57:10] I was like that looks like a good

[1:57:11] job and then I followed the person who

[1:57:13] was putting up the phone. So, me. Thank

[1:57:27] you very much. Thank you so much. You

[1:57:29] guys have a big job. Knowing how long

[1:57:34] we need those, I probably schedule. No. But

[1:57:36] it's best that we can work on each

[1:57:38] one. But they're very took care of the

[1:57:40] discussion related to the public. The director. So

[1:57:47] I guess we're at additional committee member comments.

[1:57:50] Was there an action so we had that

[1:57:53] discussion with Derek about the reporting structure but

[1:57:56] we didn't make any action or a recommendation.

[1:58:01] So do we want to do that or

[1:58:03] do you all want to think about that

[1:58:04] some more? Do you not want to wade

[1:58:07] into that? I'll jump in. Is that something

[1:58:13] that should be decided by the County Board

[1:58:20] of Commissioners? Probably, but I think we should

[1:58:25] make recommendations if we feel strongly in any

[1:58:31] way on that. And I don't know if

[1:58:34] we do, but yeah I wasn't obviously I

[1:58:36] wasn't but knowledgeable at all about the fact

[1:58:39] that he does have departments that you do

[1:58:42] too that have to go on board I

[1:58:45] wonder if we could table this so we

[1:58:46] could have the last two minutes for the

[1:58:47] questions that we could you want to do

[1:58:49] that today? I mean everybody has them so

[1:58:52] we can just kind of review like the

[1:58:53] intent of them. Yeah. So can we table

[1:58:56] the discussion on that and tell them how

[1:58:58] we're talking about it? Sure. Which questions? There

[1:59:04] was a copy in our packet. Either all

[1:59:09] questions that are relevant to this committee that

[1:59:11] are being asked in our community or have

[1:59:14] been asked in the last year. So John,

[1:59:16] I think to your question is now based

[1:59:17] on public health, I think there's a lot

[1:59:18] of capacity in our community for assessment and

[1:59:21] planning. I don't think we need to necessarily

[1:59:23] lean immediately to try to partner with La

[1:59:27] Plata. I think in some instances, that's, you

[1:59:31] know, for funding, particularly if we can come

[1:59:33] together to write grants or state together there's

[1:59:36] potential for that a lot of agencies do

[1:59:38] that they typically are nonprofits but I think

[1:59:41] there's potential for that but I think we

[1:59:43] kind of need to look at what capacity

[1:59:45] do we have in our need to fulfill

[1:59:48] some of these things. I think there's more

[1:59:49] capacity than we may assume or think that

[1:59:53] there is. But so there are several groups

[1:59:57] that put out questions or surveys or have

[2:00:01] done different things to gather information from our

[2:00:04] community in the last year. And so Sally

[2:00:06] and I went through and we reduced the

[2:00:08] document from about, I don't know, 18 pages

[2:00:11] to what it is now with questions that

[2:00:13] were specifically relevant to this group. So there's

[2:00:17] two things I would pose to us all

[2:00:19] since we don't have time to go through

[2:00:20] them today is to go through them and

[2:00:23] say do we want to request the data

[2:00:27] from any of these questions to look at

[2:00:29] as a group that may pertain to either

[2:00:31] our individual buckets of research we're doing or

[2:00:35] inform some other things about our community and

[2:00:39] their needs. And then what questions are missing

[2:00:43] that we would want to know the answer

[2:00:45] to? I don't know about all of you,

[2:00:49] but I feel very strongly in some ways

[2:00:52] that we need community voice in some of

[2:00:54] these things. This is our first stab at

[2:00:56] community voice because these are being asked to

[2:00:58] our community right now or have been recently

[2:01:02] Advised them. So it's all listed. The data

[2:01:06] source, Healthy Archuleta, the nonprofit, who's doing a

[2:01:09] community health assessment, the medical center did a

[2:01:12] outreach survey, Salmon Basin health survey questions are

[2:01:16] also Yeah, if it goes to medical center,

[2:01:19] just to clarify again, it's different than what

[2:01:21] was reported by the investigative committee with the

[2:01:23] Coastal Springs Medical Center. So you've got to

[2:01:26] make sure that they were contacted. I'm assuming

[2:01:28] that you, this came from our hospital transformation

[2:01:32] program, you know? Dan. Okay, yes. Just wanted

[2:01:36] to make sure. We had, I wanna make

[2:01:38] sure it was us. Yes, we got the

[2:01:39] questions directly from Dan. Dan's our director. So

[2:01:44] he does attend Healthy Archuleta. Yes. And so

[2:01:48] we didn't pull in any of the data

[2:01:49] because we didn't know. I didn't want to

[2:01:51] ask for any of that and overwhelm us

[2:01:53] unless they're seeing through interested in. We can

[2:01:56] certainly request that and it's likely that we'll

[2:01:58] get summaries of whatever that data sources for

[2:02:01] those specific questions. But I think the bigger

[2:02:04] thing is we have the option to potentially

[2:02:07] go into the community and ask other questions

[2:02:09] in a variety of ways, either individually because

[2:02:12] we have points of contact with other service

[2:02:15] providers, we might be able to partner with

[2:02:17] agencies who are doing similar things. Healthy Arjuna

[2:02:21] is in the middle of their community health

[2:02:24] assessment, so they're in year one of three.

[2:02:28] The biggest thing for us is the timeline

[2:02:30] how when would we want that data back

[2:02:33] in order to make good decisions based on

[2:02:35] this right and so what do we have

[2:02:38] time for and that may narrow in very

[2:02:42] specifically if we have additional questions we wanted

[2:02:45] to go to the community right we may

[2:02:46] not go with 100 we may go with

[2:02:48] three because then we can potentially have time

[2:02:51] together that data know Healthy Archuleta is looking

[2:02:55] at doing a community wide poll with a

[2:02:58] company that's working right now with Colorado Health

[2:03:05] Foundation and they have done some really great

[2:03:07] polls. We were just looking at the data

[2:03:10] over the last three years of different communities

[2:03:12] around some of the things related to public

[2:03:14] health. But so we have the potential to

[2:03:18] get questions in on some of that data

[2:03:20] collection so that we're not doing that. We

[2:03:23] can go out and do that ourselves. But

[2:03:25] I think we have to know what we're

[2:03:26] interested in knowing more about directly from our

[2:03:29] community. And so I think if we can

[2:03:31] review these and think about gaps or in

[2:03:34] our particular research service area, what do I

[2:03:36] want to know from my community members that

[2:03:39] pertains to that research? And then we may

[2:03:41] be able to find some partnerships or be

[2:03:44] able to utilize other services. I mean, I'm

[2:03:46] doing maternal child health, I would probably go

[2:03:48] to Aspire like hey can you be willing

[2:03:51] to ask your people some of these questions

[2:03:54] or you know I mean I think there's

[2:03:55] ways to do that if we're interested in

[2:03:57] trying to kind of understand a better scope

[2:04:00] of what we want to know and so

[2:04:03] I wanted to kind of let us know

[2:04:04] like there's a lot of information that's been

[2:04:06] collected. I think we don't have time to

[2:04:09] read the bill so I think we need

[2:04:11] to take all of these organizations gather their

[2:04:14] data and use it. But that's just a

[2:04:20] small part of what we have to do.

[2:04:22] Don't know how y'all feel about this but

[2:04:25] I am somewhat overwhelmed with the depth of

[2:04:28] work that has to be performed by the

[2:04:32] end of this year or anybody, not that

[2:04:35] I'm not willing to help work hard on

[2:04:37] this, but the amount of work that San

[2:04:41] Juan Basin Public Health does is incredible. And

[2:04:48] I just don't see how we can mimic

[2:04:51] that in our county. I don't think we

[2:04:53] have to mimic the entire thing. I think

[2:04:55] we have to look at contract versus in

[2:04:57] house service and what funding we can get.

[2:04:59] Like she mentioned, some of the funding sources

[2:05:01] won't even be willing to send us money

[2:05:04] because we are a small population. Take a

[2:05:07] deep breath and think we're gonna scale this

[2:05:09] way down compared to everything that they're That

[2:05:12] we're gonna be decreasing services for Archuleta County.

[2:05:15] That we have to. But that we still

[2:05:18] have ability to contract others. A lot of

[2:05:20] work going on out there, think, that I

[2:05:23] hope so. So can we, I know Healthy

[2:05:27] Archuleta would share this their information with us.

[2:05:31] I can't imagine they wouldn't. So I think

[2:05:33] we just have to be aware that the

[2:05:34] reports are gonna be really long. So we

[2:05:36] need to be really focused in what we

[2:05:37] ask for potentially, which is why we provided

[2:05:39] the questions. The stuff in red other than

[2:05:42] the titles, I think Sally and I potentially

[2:05:44] added. Mhmm. And then there were some questions

[2:05:46] at the end where you can see possible

[2:05:48] information this committee may wanna look into, which

[2:05:50] is just, you know, some things we were

[2:05:53] thinking through when we talked. So this is

[2:05:54] more just for us to kind of say,

[2:05:56] how does any of this pertain to the

[2:05:58] piece I'm working on? What may I wanna

[2:06:01] ask for? I'm happy to go back and

[2:06:03] and ask for that. But I think I

[2:06:06] mean, I'm sure your report that Dan has

[2:06:08] is probably way too many pages for any

[2:06:11] of us to wanna read. Right? So if

[2:06:13] we're specifically interested in the data to certain

[2:06:16] questions, I think we can ask for that.

[2:06:18] But the whole report is gonna be a

[2:06:21] lot considering everything else that we have to

[2:06:25] read. So that's why we did this is

[2:06:26] to see if we can narrow in on

[2:06:29] specific things. Obviously, the San Juan Basin health

[2:06:31] data won't come out until the summer. And

[2:06:35] so that's the other thing. If we wanna

[2:06:36] do any further digging, is it something we

[2:06:38] wanna align with their timelines so we're looking

[2:06:41] at all of that new data potentially together

[2:06:43] or not? And she didn't give us the

[2:06:46] time when those numbers per program would be

[2:06:48] available, did she? She sort of left it

[2:06:50] hanging. I mean, it seemed like during the

[2:06:53] budgeting process, she said they would have them.

[2:06:55] That may be something we have. Derek or

[2:06:57] whoever is gonna be doing some of that

[2:06:58] reach out for specifically around the number of

[2:07:02] people served in each different programs. Those are

[2:07:09] the main things we leave you guys with

[2:07:10] since we're out of time. The next meeting,

[2:07:16] there's none next. We don't have a meeting

[2:07:17] next week. Enjoy your spring break. So our

[2:07:20] next meeting is March 27. Do we want

[2:07:23] to make that an agenda item to go

[2:07:25] over this? We should read. I think we

[2:07:29] need to readdress it. I think we can.

[2:07:31] I think that was also the day we

[2:07:32] were supposed to bring back our research, which

[2:07:34] again won't happen all in two hours. Don't

[2:07:36] think so. I don't know how we want

[2:07:40] to prioritize that. I do know if we

[2:07:41] want to get out into the community, we

[2:07:43] need to do it sooner than later so

[2:07:45] we can get the data back that we're

[2:07:46] interested in if we want to look at

[2:07:48] that. And again, I think there are resources

[2:07:52] out there where it won't necessarily be us

[2:07:54] having to do that work because I know

[2:07:56] we're all busy. Yeah, if we could come

[2:07:59] up with some questions, specific questions we want

[2:08:01] to ask the community, the county could put

[2:08:05] it on our Facebook page to steer them

[2:08:07] to our public health department webpage to have

[2:08:11] a survey on there. And they could either

[2:08:14] fill it out and email it or come

[2:08:16] in and email it to me or whatever.

[2:08:19] That's one form that we could go through.

[2:08:22] I mean, think any of those things are

[2:08:25] great. I think it's going to be hard

[2:08:26] to necessarily get to the demographic of folks

[2:08:29] that we're looking for when you do that.

[2:08:31] You know, the sampling is definitely an issue.

[2:08:33] San Juan Basin Public Health has said that

[2:08:35] with theirs. Like, they're not necessarily getting to

[2:08:37] the group of people who utilize their service.

[2:08:39] So just their own DHS department. So we

[2:08:43] could So I think that's out and leave

[2:08:45] them there, and they could ask them to

[2:08:47] spread it out with all their people, the

[2:08:50] library. It's a good idea. Or Access Health,

[2:08:56] talk to them. They would probably help us

[2:08:59] out with that. So I think that there's

[2:09:01] some things we could consider. Yeah, maybe we

[2:09:05] could maybe a little I don't know. We

[2:09:09] could maybe have people stationed. I think a

[2:09:13] couple of us could be at the library

[2:09:14] with a questionnaire. Mean, I think the biggest

[2:09:17] thing with any of that though is we

[2:09:18] also have to think about the time to

[2:09:20] then input and analyze anything you want. That's

[2:09:23] not a small undertaking. That needs that really

[2:09:26] looking at data that people are already organizations

[2:09:28] are already collecting and then just add to

[2:09:30] I really found this, I think I sent

[2:09:32] it to everybody, the county health rankings and

[2:09:34] roadmaps. It was an attachment that I sent

[2:09:37] to you guys. Found it. Did you just

[2:09:38] send us? The last week. I found it

[2:09:42] fascinating to go through and look at our

[2:09:44] county compared to Colorado, compared to The United

[2:09:47] States. And I mean, there are a lot

[2:09:49] of categories on here and I think this

[2:09:51] is just a good first swab that, here

[2:09:57] are some things we really need to address.

[2:09:59] Kathy, who was the source on that? I

[2:10:02] couldn't find on their group who actually did

[2:10:04] that. It's that group in Wisconsin I was

[2:10:06] talking about. They were the ones, I think,

[2:10:08] that actually did the research. And I wonder,

[2:10:09] I started looking at some data and I

[2:10:12] couldn't duplicate their numbers. Yeah, countyhealthrankings.org. I can

[2:10:16] look into who they are and where they're

[2:10:18] from. They're almost in the country. We're talking

[2:10:21] a lot about health outcomes and housing is

[2:10:25] ginormous on this report. I mean adequate housing.

[2:10:30] Safe and adequate housing. I don't know, Printed

[2:10:33] these, you know, public health framework is right.

[2:10:40] So I think that we sort of get

[2:10:42] lost in but housing is one of those

[2:10:44] upstream things that everyone's looking at. So this

[2:10:46] is from the American Association of Family Practitioners

[2:10:50] or Physicians. Thank you. And how primary care

[2:10:55] and public health intersect and work together. So

[2:10:59] I think that there are a lot of

[2:11:00] issues that the public health department won't necessarily

[2:11:02] be able to address but should have at

[2:11:04] least some input, sit on some committees around

[2:11:07] how do we do it. And unfortunately, that's

[2:11:11] also where some of the dollars are coming

[2:11:12] from. The concern to me is just chasing

[2:11:20] programs, chasing grants, chasing programs, like squirrels, squirrels,

[2:11:24] squirrels. We mean historically how public health is

[2:11:26] fortunate. Yes and I keep thinking about that

[2:11:29] below the waterline. What are the main issues

[2:11:33] we need to try to address here and

[2:11:36] maybe there is some money outside money coming

[2:11:38] from other entities and we just need to

[2:11:41] find those basic things. Like she was talking

[2:11:46] about with STDs and syphilis growing because it

[2:11:50] sounds like public health is focusing on other

[2:11:52] things and then meanwhile this is getting bad.

[2:11:56] So it's those kinds of things that we

[2:11:58] want to Well, lot of things comes to

[2:12:01] the educational piece of the department, right? Like

[2:12:04] doing messaging campaigns around why it's important to

[2:12:08] do certain things or I mean, I don't

[2:12:10] know when I have babies like I was

[2:12:13] like I don't need those things because I

[2:12:15] know I'm healthy but people don't, you know,

[2:12:17] the vitamin K shots or the goop in

[2:12:19] the eyes or whatever for the babies that

[2:12:21] help prevent some of those things. Lot of

[2:12:22] people are refusing those services, not understanding the

[2:12:26] consequence of the potential if they haven't been

[2:12:29] tested for those things. So a lot of

[2:12:31] it's you know how are we it's not

[2:12:33] necessarily the service provision itself because we have

[2:12:36] great medical providers that provide the service and

[2:12:39] potentially the testing. It's how are we then

[2:12:41] coordinating more of the upstream awareness and access

[2:12:47] to care. I mean, when you bring up

[2:12:51] what she brought up, STD work that was

[2:12:55] done, a lot of that is it's all

[2:12:57] about contact tracing, right? I mean, that's the

[2:13:00] whole thing. Because if somebody comes in with

[2:13:01] an STD, we are required to report that.

[2:13:04] And then the department has to public health

[2:13:05] then the health fund goes out and contact

[2:13:09] tracing and tries to prevent it by treating

[2:13:12] other people. And that is not always possible

[2:13:15] because everyone won't take treatment. That's what we're

[2:13:18] seeing. We're just sharing. Resurgent of that, right?

[2:13:21] So it's a small aspect of what they

[2:13:25] did, but it is an important thing because

[2:13:26] I can remember when it went away because

[2:13:29] we saw a lot of it in our,

[2:13:30] we're in Louisiana where I'm from, and then

[2:13:32] we stopped and then now it's back It's

[2:13:35] like a whack a mole. Because there's so

[2:13:41] little funding that comes down for public health

[2:13:45] in the country and so many needs I

[2:13:49] think that's something that I like with highly

[2:13:51] qualified staff though, how if you get highly

[2:13:53] qualified staff, you should only be able to

[2:13:56] pivot on some of those things because you

[2:13:57] have people who are qualified in a broad

[2:14:00] and well that's kind of what she was

[2:14:01] saying. They have a lot of staff who

[2:14:03] can be flexible and nimble as programs change.

[2:14:06] So you might have gotten hired under this

[2:14:08] one grant to do X, then you may

[2:14:11] end up doing Y two years later. So

[2:14:14] you want people with those broad skill sets

[2:14:16] and ability to of We look at those

[2:14:19] people here. So far they said they'd had

[2:14:21] one applicant and it was from somebody that

[2:14:24] lives in Texas, right? This just went out

[2:14:27] like Tuesday, maybe even Wednesday. Okay, I know

[2:14:30] so. I mean, anybody that's run a small

[2:14:33] business, and I have my whole life, I

[2:14:36] mean, you wear all kinds of hats. And

[2:14:39] if we are attempting to pull this off

[2:14:41] in this county, We can't afford to hire

[2:14:45] everybody that we need. Hire people who can

[2:14:48] do multiple things. Yeah. That's a must. Sure.

[2:14:52] We can, to the next meeting, and just

[2:14:55] a discussion of the, I mean, the more

[2:14:58] I sit here, the more I realize La

[2:15:01] Plata may be four to six months ahead

[2:15:03] of us, at least the understanding that I'm

[2:15:06] getting. But then that made me a little

[2:15:09] bit nervous after this and last week, was

[2:15:11] saying, September, October timeframe, we're gonna be okay.

[2:15:14] But if we're talking, what I heard from

[2:15:17] her April to June, we realistically won't even

[2:15:20] have that director on board till maybe May

[2:15:23] 1. Do we just have a discussion who's

[2:15:27] gonna be following up on at least contacting

[2:15:30] the state and making sure we're communicating I'm

[2:15:34] sure the staff's doing stuff that we're not

[2:15:37] aware of. I apologize if I say that,

[2:15:40] but that makes me nervous that we're not

[2:15:42] going to be ready April, May, June. I

[2:15:44] do know the county manager and the county

[2:15:46] attorney have had conversations with I don't know

[2:15:51] specifics. Do know that the ball has started

[2:15:55] rolling on what we need to be doing.

[2:15:57] Yes. So we're not starting from scratch right

[2:16:01] yet. They've already had conversations. Great. So I

[2:16:05] was thinking a question maybe all of us

[2:16:06] want to ask as we're doing our research

[2:16:08] is what does a fully functional health department

[2:16:11] look from that narrow window? What does it

[2:16:13] look like for environmental health? What does it

[2:16:15] look like for community health? The other question

[2:16:17] I have, what is a fully functional health

[2:16:20] department as of January 1 from the commissioners,

[2:16:25] from the county, whatever it is? Is that

[2:16:27] one program from each of those service areas,

[2:16:30] or at least a contract with one program,

[2:16:32] what does it mean? As we're going through

[2:16:34] our programs, we might want to identify what

[2:16:37] sources. The very bottom first thing on the

[2:16:41] agenda the next time we have time is,

[2:16:43] are we really going to separate? Are we

[2:16:45] going to go back to working with Samuel?

[2:16:47] It would be my top recommendation. So we

[2:16:56] don't get to choose them. Yeah. No. That

[2:16:59] is not on the table at all. There

[2:17:03] is a signed resolution between a joint resolution

[2:17:07] between the two counties dissolving San Juan Basin

[2:17:11] at 01/2017. So it's done. However, there are

[2:17:15] conversations that are occurring. There are. With people

[2:17:19] at both counties. I'm Okay. And that there

[2:17:26] are conversations happening about that. That there are

[2:17:29] people that, in both counties, that realize now

[2:17:35] just how much this has been, and that

[2:17:38] there's been a lot of misperceptions. Even with

[2:17:41] La Platas. I said even with La Plata.

[2:17:44] We're not the only ones that are in

[2:17:47] it. La Plata is also somewhat, I would

[2:17:51] think, struggling too. And Mary, if you're sure

[2:17:55] this is a done deal, it's a conversation

[2:17:57] that can happen, then I think we just

[2:17:59] need to know that all the work we're

[2:18:01] doing, this should continue, or we should just

[2:18:03] drop back even though I think clearly it's

[2:18:07] been done, no doubt about it. All I'm

[2:18:09] saying is that nothing is forever. I mean,

[2:18:14] you could re stand it up. I mean,

[2:18:20] there are things we can do to protect

[2:18:22] the people in our community. But again, I've

[2:18:27] been told that there are people interested in

[2:18:30] trying to have some conversations about that again.

[2:18:34] I think the document that you're gonna have

[2:18:37] Mary share with us that came from San

[2:18:39] Juan Basin about the different That is what

[2:18:42] San Juan Basin Health presented to the investigative

[2:18:45] committee in October of twenty twenty. And that's

[2:18:50] why I thought you might be interested in

[2:18:52] that, because that's what they That was again

[2:18:54] after the pandemic, so it was different, but

[2:18:56] it just Right. For more information. I think

[2:19:01] it'll help in the research that are each

[2:19:03] individual assigned because most have what they do

[2:19:08] before 2020, it wasn't about pandemic. It's not

[2:19:12] scary. I have a question on our research

[2:19:22] under assets. When I looked at the information

[2:19:28] it talked about what assets are owned by

[2:19:31] another entity. Are we going to only look

[2:19:36] into what assets are owned by other entities?

[2:19:39] Or are we going to also see if

[2:19:42] that county owns certain assets themselves? Well, I

[2:19:46] think that the receiver is in the process

[2:19:51] of working with San Juan Basin Health and

[2:19:55] working with the two counties in dividing up

[2:19:57] all the assets. So I don't think that

[2:19:59] that's anything we need to spend time on

[2:20:00] right now. The assets in the report, for

[2:20:03] example Just find out what assets are owned

[2:20:06] by another entity outside the health department. I

[2:20:10] think what that's referring to is like a

[2:20:12] database that's run by the state that we

[2:20:14] contribute information to as a part of our

[2:20:16] reporting system. I don't think it's anything tangible.

[2:20:20] I think it's something that's going on. We

[2:20:22] are required to report to you. Yeah, we'll

[2:20:25] have, I mean, lot of data gets reported

[2:20:27] to the student. Right, so I don't think

[2:20:29] it's anything we need to worry about for

[2:20:30] this at all. Okay. Anything else before we

[2:20:38] adjourn? I move to adjourn the meeting at

[2:20:43] 11:15? Eleven twenty? I know I was like,

[2:21:04] oh my god, it's not really tough to

[2:21:06] read. Right.

3-13-2023 Health Department Transitional Committee

Transcript