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We ready? Yep. All right. So, we'll call

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this meeting to order. So, I mean, it's

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

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09:01 okay. All right so the obvious turning

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off our cell phones. Do any committee members

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have any disclosures or conflicts of interest? Okay.

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Any adjustments to the agenda? No? Okay. Move

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to approve the agenda. I would make the

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motion. Okay. All right. I did not add

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on here public comment but that would be

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right now. Yes. Okay, so we'll open it

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up for public comment. Have two. Start with

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Candace Jones. Candace if you could just name

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give your name and address for the record.

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Sure Candace Jones PFOS three thousand one hundred

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twelve Pagosa Springs. Thank you advisory committee members

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for your service Your careful attention to the

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details and vision for public health provide an

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essential framework for this transition. Many residents rely

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on services now provided through the San Juan

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State of the Public Health. And I know

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you folks have them in mind when you're

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doing this work. So for the sake of

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Archuleta County residents and visitors, I hope everyone

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prosecuting the elements of the transition will be

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equally committed to maintaining service levels. So thank

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you. On the question of the health board

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composition, the commissioner should embrace the board of

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health as an opportunity to engage people in

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the community who have relevant expertise and experience

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to perform the practice of public health in

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Archuleta County. Public health connects dots between community

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and environmental conditions and individual health. The more

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points of contact the county has to engage

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with the community, the better informed public health

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priorities and practices will be now and over

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time. Commissioners will not be closed out of

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public health by appointing others to the Board

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of Health. They could for example designate one

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seat to be filled by a commissioner. In

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any event the commissioners will have a vital

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role in funding and overseeing the administration of

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the health department as it does with other

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departments of the county government. As a practical

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matter, the commissioners are stretched with their current

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duties. I hear the commissioners lament demands on

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their calendars frequently when I attend their meetings.

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The county administrator and county attorney are also

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no doubt stretched. The advisory committee members have

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divided amongst themselves reviewing San Juan Basin Health's

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files to understand linkages between programs funding and

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staff. You the committee have asked basic questions

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about the grant contracts, continuation of grant funding,

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and the application process for grants. San Juan

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Basin Health also has agreements with partners to

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provide services and undertakings to provide services that

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extend outside the health district to other counties.

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Why has this log through those contracts not

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already been done by county staff? We are

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coming up on a year since the San

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Juan Basin Health Board voted recommended provision and

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four months since Archuleta and Lymphatic Missions were

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made official. Had the foundational work understanding contacts

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and assets which already been done by county

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staff, the advisory committee could have jumped directly

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into questions about service priorities and similar questions

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that could shape what the Archuleta Health Department

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will be. Board of Health and the Board

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of County Commissioners should work in tandem. Each

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can bring something different and valuable to the

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public health administration. At least some of the

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current commissioners acknowledged last year their minimal awareness

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of San Juan Basin health services and understanding

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of public health generally. Now is not the

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time for commissioners to reject the aid of

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competent, caring, and interested citizens to contribute to

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the public health of our community. Thank you.

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Thank you. So next we have Leigh Stoeffer.

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My name is Leigh Stoeffer, I live at

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99 Perry Winkle Drive In Drive. And I

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too would like to thank the volunteers for

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their service to the community. I really appreciate

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your efforts and I know that you have

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a big task ahead of you. I attended

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your last meeting and I also attended the

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oversight meeting last week and first of all

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I would like to take a moment to

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enter the public record that the Asthma and

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Allergy Foundation of America has a very strong

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online recommendation against the use of hydrogen peroxide

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nebulizers. This practice is not considered safe and

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will not be administered by healthcare personnel with

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practiced evidence based medicine. This intervention was mentioned

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several times last week in your meeting. This

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is a good segue to express my deeply

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felt hopes that we'll be hiring a director

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who is a believer and practitioner of evidence

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based medicine and not quackery. I am very

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interested in the answer to the question posed

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here last week and that is who will

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be interviewing the Chiefs Director? In our search

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for a well qualified individual I think we

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should consider this person will be interested in

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just who they will be reporting to. A

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board of expertise in areas related to public

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health or a county board of commissioners who

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oversaw the dissolution of the public health partnership

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because of what some consider to be political

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differences. I believe that the composition of the

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County Board of Health may greatly influence the

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quality of individual we will be able to

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attract for the director position. The report by

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the Otero Group for Laplata County clearly states

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that County Boards of Health composed of members

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of differing expertise relevant to public health have

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better health outcomes than most composed of County

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Boards of Commissioners. At last week's oversight meeting

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Mr. Woodman expressed his support for the Board

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of County Commissioners as Board of Health at

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least in the beginning. I understand the desire

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to make this transition a little faster and

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easier, but I submit that the beginning is

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probably the most important time to have a

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board that is composed of people with expertise.

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The Board of Health actual expertise could be

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very helpful in getting this department off to

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a good start and it would avert the

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impression that this is indeed a political process

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and might also help recruiting qualified director and

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staff. Thank you. Okay. Consent agenda there's one

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just the approval of the meeting minutes from

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last week. Does anyone have any make a

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motion for accepting that? A motion. I'll second.

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Excuse me, this is Suzanne. Yes. In the

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minutes from last week, I had a question

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about them. There was for the approval of

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the interim director and the director, the way

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it read, it reads Suzanne and I can't,

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I don't have the minutes in front of

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me. Suzanne and another person, I can't remember

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who it was, approved or seconded the motion.

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I think it should be seconded the motions

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because there were two motions or else it

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needs to be clearly shown that there was

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one motion for accepting the interim and there

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was another motion for accepting the permanent director.

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And I seconded one and the other person

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seconded the other. Also in that part of

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the minutes, Suzanne is spelled wrong, it should

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be s u s instead of s u

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So were there two motions one for the

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director one for the transitional? Okay so that

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needs to be broken out. I thought somebody

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could buy them at the end. You guys

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tell me. They were two separate. No there

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were two separate motions. And does anybody recall

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who did the I made the motion for

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the transitional one. I might have made the

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motion for the permanent one as well. I

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think you did too. I think he made

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the motion for both. I think I seconded

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the transitional and I think the other person

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seconded the permanent. Okay. Do we know who

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seconded for the permanent? Okay. I'm just gonna

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write a note and be done with that.

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It wait. Wait. It was hold on. Kathy

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seconded the permanent. That's what's on. Okay. All

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right. I'll make those changes. And so can

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we get a motion to approve the minutes

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as amended? So moved. Second. Okay. Thank you,

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Suzanne. I'll make those changes. All right. Discussion

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items. Structure of Board of Health. So I

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passed out the local Board of Health that

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I got this I got from I believe

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I got this from San Juan Basin Public

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Health this was in their little snippet of

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all sorts of things that have to do

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with Port of Health. And then I also

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gave you the local public health agency structure

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that doing a survey of all the county

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Colorado counties that I was about three quarters

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of the way done with. We were we

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probably should focus at category two and three

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specifically three. The categories are broken out by

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the state and we are a category three

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currently category 3B but about to be or

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I don't know if it passed to go

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to a 3A but that's pretty much just

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for salaries for the county. Is it elected

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officials? It's population based, is that how they're

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divided up? That's part of it, but it's

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a rather complicated matrix to include miles of

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road then. And then when it says self,

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what's that? That they are not part of

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a group, like a district. There's only, most

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of them are self other than And their

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boards are independent of a district. Well, like

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we were part with La Plata County with

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San Juan Basin. There are like Los Animas

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shares with I don't how to say that.

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It's its own it's own standalone health department.

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Thank you. Right. Mary thank you for doing

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this first of all from the investigation committee

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notes there were a couple I left my

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pizza at home but I think it was

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Alamosa, Rand and Gilpin but I think one

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more of those has just the three commissioners

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but in the minutes from one of the

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counties interviewed they talked about wanting to add

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healthcare professionals to their boards and every report

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that Doctor. Bruce made she said that many

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counties felt that way that the board of

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commissioners needed some help from healthcare professionals. Okay.

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What we can do as a group is

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come up with a consensus of how we

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think we should be and either just give

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a verbal thing to the oversight committee or

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we can direct a memo from us to

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submit to the oversight committee and to the

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commissioners. That would be my vote to give

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them a formal recommendation on what we believe

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would be the best way to do the

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structure. Can we talk about this in just

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terms of what the pros and cons are

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for the different structure and pardon my ignorance

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on this like I'm sorry I didn't get

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a chance to look at this or really

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kind of delve into it but what are

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the pros and cons? I mean, the two

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ladies who spoke bringing some really good points

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about having expertise in the area of public

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health to add to the county commissioners in

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terms of having that structure, it's obviously expertise

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ties to the community from different, guess some

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of the points of contact which I guess

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I hadn't thought about it that way but

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it makes sense. What are some of the

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other I guess pros and cons of having

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people on there beyond just County commissioners? I

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think, sorry, I think part of the whether

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we want to admit it or not perception

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in the community I think is a bit

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tainted politically and I believe that the community

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would view and respect Lord of Health at

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a greater level if we had real healthcare

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people on And it's not about control. Think

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it's perfectly fine to have County Commissioners on

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the board that makes sense for them to

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be involved and have a level of control

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But I think that the community itself, I

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think would look very favorably on our board

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if we had some outside folks on And

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it has to be a minimum if it's

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okay, so it could be a minimum of

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five if it's not just the three commissioners,

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right? But it could be up to nine

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or so. Our county, it's a minimum of

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three. Right. And I don't even know if

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it has a maximum. I thought it was

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seven. So you could have, like I'm just

261
00:17:17,619 --> 00:17:20,595
making this up, you could have four healthcare

262
00:17:20,595 --> 00:17:22,994
professionals and three commissioners, or you could have

263
00:17:22,994 --> 00:17:26,595
one commissioner and any number of, as long

264
00:17:26,595 --> 00:17:31,075
as it's an odd number. Correct. I think

265
00:17:31,075 --> 00:17:33,955
the literature is pretty clear about public health

266
00:17:33,955 --> 00:17:37,330
areas, anybody speak to this better than I

267
00:17:37,330 --> 00:17:39,890
can, that when you have a board of

268
00:17:39,890 --> 00:17:43,570
public health, that is not just limited to

269
00:17:43,970 --> 00:17:47,330
county commissioners who don't have expertise in public

270
00:17:47,330 --> 00:17:50,130
health, that the outcomes have been better. Yeah.

271
00:17:50,455 --> 00:17:53,095
So that's what I would remember also and

272
00:17:53,095 --> 00:17:56,695
again even if just if you had one

273
00:17:56,695 --> 00:18:00,375
commissioner who has a real passion for public

274
00:18:00,375 --> 00:18:02,855
health and that would be the contact person

275
00:18:02,855 --> 00:18:04,535
I don't think that was a case in

276
00:18:04,535 --> 00:18:08,830
the past and quite frankly you know it's

277
00:18:08,830 --> 00:18:11,070
time to get away from that and have

278
00:18:11,070 --> 00:18:13,550
somebody really to communicate back to the other

279
00:18:13,550 --> 00:18:17,150
commissioners what happens. I think that's what I

280
00:18:17,150 --> 00:18:21,950
would move for to have a broader board

281
00:18:22,015 --> 00:18:24,335
you want all those different talents out there.

282
00:18:25,055 --> 00:18:27,055
Well, think the report that you mentioned and

283
00:18:27,055 --> 00:18:28,975
the consultants actually read it that was done

284
00:18:28,975 --> 00:18:31,135
by the University of Colorado School of Public

285
00:18:31,135 --> 00:18:34,655
Health, you know, communities show better health outcomes,

286
00:18:34,655 --> 00:18:38,370
they show better financial, not necessarily less financial,

287
00:18:38,370 --> 00:18:41,890
but better use of financial resources that they

288
00:18:41,890 --> 00:18:45,649
typically get more outside funding from grants and

289
00:18:45,649 --> 00:18:48,210
other sources than just county or state funds.

290
00:18:49,505 --> 00:18:52,304
Mean their evidence brief was really thorough around

291
00:18:52,465 --> 00:18:56,225
you know the fact that there's pretty clear

292
00:18:56,465 --> 00:18:59,585
health outcomes when you have additional folks on

293
00:18:59,585 --> 00:19:02,785
board of health. Know and I would say

294
00:19:02,785 --> 00:19:04,710
like I don't know how we if we

295
00:19:04,710 --> 00:19:06,550
can designate, but I think there needs to

296
00:19:06,550 --> 00:19:09,110
be at least one person with public health.

297
00:19:09,350 --> 00:19:10,710
Because if we don't get a director that

298
00:19:10,710 --> 00:19:15,190
has a public health background, primary care or

299
00:19:15,190 --> 00:19:17,750
providing medical care and the public health lens

300
00:19:17,750 --> 00:19:21,004
are really different in a lot of ways.

301
00:19:21,325 --> 00:19:23,645
And so I think that guiding programming and

302
00:19:23,645 --> 00:19:26,045
things like that, like having someone with the

303
00:19:26,045 --> 00:19:29,645
public health lens is really important, especially in

304
00:19:29,645 --> 00:19:31,245
the beginning to get this all off the

305
00:19:31,245 --> 00:19:33,165
ground. Once it's rolling and things are kind

306
00:19:33,165 --> 00:19:35,120
of established and we have all that stuff

307
00:19:35,120 --> 00:19:37,919
out there but I mean it's just there's

308
00:19:37,919 --> 00:19:39,919
such a spectrum of things that fall outside

309
00:19:39,919 --> 00:19:42,720
of you know the idea of providing care

310
00:19:42,720 --> 00:19:48,955
right it's about prevention. Like community prevention, individual

311
00:19:48,955 --> 00:19:51,755
prevention, right? So from the public health standpoint,

312
00:19:51,755 --> 00:19:53,835
how do we bring in this idea of

313
00:19:54,235 --> 00:19:57,995
community based prevention work and education in order

314
00:19:57,995 --> 00:20:00,155
to have better health outcomes, right? So less

315
00:20:00,155 --> 00:20:03,059
people are having to go for service, hopefully.

316
00:20:05,780 --> 00:20:07,460
I think that that you know and I

317
00:20:07,460 --> 00:20:08,820
haven't done a lot of research outside of

318
00:20:08,820 --> 00:20:10,340
this but there was a ton of things

319
00:20:10,340 --> 00:20:13,460
that they cited from the University of Colorado's

320
00:20:13,460 --> 00:20:17,655
report It was just a summary but there

321
00:20:17,655 --> 00:20:22,055
are definite indications that having other folks in

322
00:20:22,055 --> 00:20:24,294
the board of thumb would be really important.

323
00:20:24,535 --> 00:20:28,055
But I do think because the financial oversight

324
00:20:28,055 --> 00:20:30,059
and management is coming from the county that

325
00:20:30,059 --> 00:20:31,420
there needs to be at least one if

326
00:20:31,420 --> 00:20:35,500
not two seats for commissioners because you know

327
00:20:35,500 --> 00:20:37,580
they have to play together to be able

328
00:20:37,580 --> 00:20:40,140
to, right? They're housed and employed by the

329
00:20:40,140 --> 00:20:42,860
county but I feel like we need that

330
00:20:42,860 --> 00:20:48,745
additional expertise to help direct the programming and

331
00:20:48,745 --> 00:20:51,865
the stand up in the community. And I

332
00:20:51,865 --> 00:20:54,105
also think that the healthcare profession in general

333
00:20:54,105 --> 00:20:55,865
has a whole to crawl out of because

334
00:20:55,865 --> 00:20:58,425
of public distrust that's been created over this

335
00:20:58,425 --> 00:21:01,080
pandemic and I think it would really help

336
00:21:01,160 --> 00:21:03,240
for there to be healthcare people on the

337
00:21:03,240 --> 00:21:07,240
board to, you know, reassure that we're on

338
00:21:07,240 --> 00:21:10,440
the community side and contact issues. That's a

339
00:21:10,440 --> 00:21:11,800
great point that we have a lot of

340
00:21:11,800 --> 00:21:13,934
work to do to improve the image of

341
00:21:13,934 --> 00:21:21,855
healthcare. How would those non BOCC members be

342
00:21:21,855 --> 00:21:26,175
selected? It usually looks like an appointment from

343
00:21:26,175 --> 00:21:27,940
what I read. I don't know if we

344
00:21:27,940 --> 00:21:29,380
could go outside of the box and do

345
00:21:29,380 --> 00:21:31,380
it more like La Plata Electric does. They're

346
00:21:31,380 --> 00:21:33,700
like, there's an election, there's like a vote

347
00:21:33,700 --> 00:21:35,380
of some kind. I don't know what that

348
00:21:35,380 --> 00:21:36,580
would mean if that would make it more

349
00:21:36,580 --> 00:21:39,780
political or not. It makes it very expensive.

350
00:21:40,875 --> 00:21:42,635
I mean, you know, to run an election.

351
00:21:42,635 --> 00:21:43,995
Yeah. We would like for the hospital to

352
00:21:43,995 --> 00:21:45,835
have to run an election for our board.

353
00:21:45,835 --> 00:21:49,195
Yeah. It was about $40,000 I wonder, could

354
00:21:49,195 --> 00:21:52,075
this group just put forward some recommendation? Maybe

355
00:21:52,075 --> 00:21:53,640
we do a call. I mean, if if

356
00:21:53,640 --> 00:21:56,040
we choose to make this recommendation to the

357
00:21:56,040 --> 00:21:58,680
BOCC and they accept it, I wonder if

358
00:21:58,680 --> 00:22:01,240
the process could be an open call or

359
00:22:01,240 --> 00:22:03,880
something for interested individuals and maybe even some

360
00:22:03,880 --> 00:22:06,760
members from this board be interested since there's

361
00:22:06,760 --> 00:22:10,154
some good people on this board, But then

362
00:22:10,154 --> 00:22:13,674
maybe the recommendations then could come from this

363
00:22:13,674 --> 00:22:16,075
group as some vetted members because I think

364
00:22:16,075 --> 00:22:19,434
when you say healthcare professional that could mean

365
00:22:19,434 --> 00:22:22,955
a whole gamut of people. You want to

366
00:22:22,955 --> 00:22:24,830
just kind of make sure it's someone who

367
00:22:24,830 --> 00:22:28,030
really feels passionately about public health and uses

368
00:22:28,030 --> 00:22:31,790
evidence based practices and all those good things.

369
00:22:32,430 --> 00:22:34,110
Do you think that call will be very

370
00:22:34,110 --> 00:22:36,510
similar to what they did to convene this

371
00:22:36,510 --> 00:22:39,044
committee that there were I guess I wonder

372
00:22:39,044 --> 00:22:40,565
if we need to go outside the committee

373
00:22:40,565 --> 00:22:42,884
if we can just start with this group

374
00:22:43,044 --> 00:22:46,164
and the people that want to participate and

375
00:22:46,164 --> 00:22:49,125
then put out a call, people get interested,

376
00:22:49,125 --> 00:22:50,804
this job may have been too big for

377
00:22:50,804 --> 00:22:56,610
some people but anyway, I would not be

378
00:22:56,610 --> 00:22:59,970
opposed personally, you all have to decide about

379
00:22:59,970 --> 00:23:02,610
speeding the health board with the commissioners and

380
00:23:02,610 --> 00:23:07,805
then breaking up after that. I personally would

381
00:23:07,805 --> 00:23:10,285
not be interested in continuing. I mean, I'm

382
00:23:10,285 --> 00:23:13,005
happy to be on this, but just because

383
00:23:13,005 --> 00:23:15,405
of my day to day with being the

384
00:23:15,405 --> 00:23:18,205
town manager, I mean, it's very interesting work

385
00:23:18,205 --> 00:23:19,885
and I'm happy to help in this transition,

386
00:23:20,580 --> 00:23:21,940
but I don't know that I should be

387
00:23:21,940 --> 00:23:26,019
on the board of health moving forward, but

388
00:23:26,340 --> 00:23:28,980
be happy to help support the selection process

389
00:23:28,980 --> 00:23:31,779
recommendation. The first thing that we would need

390
00:23:31,779 --> 00:23:36,365
to do is send recommendation. Yeah. We've oversight

391
00:23:36,365 --> 00:23:42,525
committee and their committee. Right. We'd rather spend

392
00:23:42,525 --> 00:23:44,365
time today to say I can do because

393
00:23:44,365 --> 00:23:51,800
if they say no, right. I'm not sure

394
00:23:51,800 --> 00:23:53,560
which one said it, maybe both said it

395
00:23:53,560 --> 00:23:56,760
different ways, but I would totally agree with

396
00:23:56,760 --> 00:24:02,434
the number one, this group's expertise outside of

397
00:24:02,434 --> 00:24:05,154
maybe everybody in the health industry here is

398
00:24:05,875 --> 00:24:10,595
extremely talented. I'm going sound like an economist

399
00:24:10,595 --> 00:24:13,315
here because I would like to thank the

400
00:24:13,315 --> 00:24:15,770
staff and or the BOCC for putting this

401
00:24:15,770 --> 00:24:18,090
group together. I mean, they didn't have to

402
00:24:18,090 --> 00:24:19,770
do that. I think it was a great

403
00:24:19,770 --> 00:24:22,570
move, you know, to move this thing forward.

404
00:24:23,050 --> 00:24:24,810
And there has to be a level of

405
00:24:24,810 --> 00:24:29,294
trust with whoever comes out of this group

406
00:24:29,295 --> 00:24:33,135
or a potential board. But I would, as

407
00:24:33,135 --> 00:24:35,615
an ex commissioner, I would totally agree that

408
00:24:36,655 --> 00:24:39,135
the number one, the time commitment, you know,

409
00:24:39,135 --> 00:24:41,799
we were assigned to sit on the San

410
00:24:41,799 --> 00:24:43,480
Juan Basin have one year at a time

411
00:24:43,480 --> 00:24:47,240
when I was back when and you guys

412
00:24:47,240 --> 00:24:50,519
all know, I'm not an expert in health.

413
00:24:50,840 --> 00:24:54,120
Whereas there's people in here that would give

414
00:24:55,055 --> 00:24:58,175
really good insight, think, to a board made

415
00:24:58,175 --> 00:25:02,255
up of commissioners and outsiders would be my

416
00:25:03,775 --> 00:25:07,535
2¢, and whether it's three commissioners of two

417
00:25:07,535 --> 00:25:12,000
health, or you know, majority of health, one

418
00:25:12,000 --> 00:25:14,800
or two commissioners, whatever it may be, I

419
00:25:14,800 --> 00:25:16,640
do think the public would look at that

420
00:25:16,640 --> 00:25:21,200
real favorably right now. And gosh, we've got

421
00:25:21,200 --> 00:25:23,414
a clean slate. I think this would be

422
00:25:23,414 --> 00:25:26,695
a really good way to keep it clean,

423
00:25:26,695 --> 00:25:28,695
keep it as far away from political as

424
00:25:28,695 --> 00:25:32,054
possible. It's not, we had that conversation, it's

425
00:25:32,054 --> 00:25:34,294
not possible to keep politics out of everything,

426
00:25:34,294 --> 00:25:39,810
but this group even board should try our

427
00:25:39,810 --> 00:25:42,770
best to, you know, stay out of that.

428
00:25:42,770 --> 00:25:44,210
And and I think I would be like

429
00:25:44,210 --> 00:25:46,050
you. I I don't I would not have

430
00:25:46,050 --> 00:25:47,810
an interest as long as you all felt

431
00:25:47,810 --> 00:25:50,850
good financially. I don't bring a whole lot

432
00:25:50,850 --> 00:25:53,090
other than that, but I do think it

433
00:25:53,090 --> 00:25:59,705
helps people do big time. So, and it

434
00:25:59,705 --> 00:26:02,745
is a time commitment. I got these commissioners

435
00:26:02,745 --> 00:26:05,225
that do have a full plate. And it's,

436
00:26:05,545 --> 00:26:09,130
it doesn't matter when they should have a

437
00:26:09,130 --> 00:26:13,530
full plate and I think they do. So

438
00:26:13,530 --> 00:26:15,850
it is a five year, the board itself

439
00:26:15,850 --> 00:26:18,890
is a five year term and how do

440
00:26:18,890 --> 00:26:21,370
you stagger folks when we create a board

441
00:26:21,370 --> 00:26:26,645
all at one time? I think that it's

442
00:26:26,645 --> 00:26:29,605
a good question. Think that you would start

443
00:26:29,605 --> 00:26:37,050
off with by desire, maybe and then, you

444
00:26:37,050 --> 00:26:39,210
know if everybody says oh yeah, you know

445
00:26:39,210 --> 00:26:41,370
it's not a problem, then maybe do it

446
00:26:41,370 --> 00:26:44,890
by library. I mean honestly there's really, you

447
00:26:44,890 --> 00:26:48,810
know it's really difficult to begin that process

448
00:26:49,895 --> 00:26:52,615
because you don't have, there's nothing established. Yeah.

449
00:26:52,615 --> 00:26:54,054
So you're starting from doing it. Yeah, didn't

450
00:26:54,054 --> 00:26:55,895
know if there was something that was established

451
00:26:55,895 --> 00:26:57,735
that I just didn't know about, create a

452
00:26:57,735 --> 00:26:59,815
new board. I mean, I think, you know,

453
00:26:59,815 --> 00:27:02,020
you can start with like every, you know

454
00:27:02,020 --> 00:27:04,020
two years and one person falls off and

455
00:27:04,020 --> 00:27:05,860
he brings one last on. The one nice

456
00:27:05,860 --> 00:27:07,460
thing about the five year term is that

457
00:27:07,460 --> 00:27:08,900
the commissioners are going to be in and

458
00:27:08,900 --> 00:27:10,260
out of that but a five year board

459
00:27:10,260 --> 00:27:12,660
right then brings the historical knowledge and expertise

460
00:27:12,660 --> 00:27:17,005
of not standing it up. And, know, I

461
00:27:17,005 --> 00:27:19,645
mean, I think if we think about composition,

462
00:27:19,645 --> 00:27:21,565
because we're making a recommendation, do we need

463
00:27:21,565 --> 00:27:23,885
to recommend how many and that? I think

464
00:27:23,885 --> 00:27:26,205
we should be as specific as possible. I

465
00:27:26,205 --> 00:27:29,110
agree. You know, I mean, I think, and

466
00:27:29,110 --> 00:27:30,789
I don't know like an open call again

467
00:27:30,789 --> 00:27:33,270
depending on what we think the obligation is

468
00:27:33,270 --> 00:27:34,789
going to be. We may get a different

469
00:27:34,789 --> 00:27:37,830
group of interested parties if it's not a

470
00:27:37,830 --> 00:27:42,230
weekly two hour plus research commitment that we

471
00:27:42,230 --> 00:27:44,915
all made sitting here. Know there may be

472
00:27:44,915 --> 00:27:47,075
other people who are in the field who

473
00:27:47,075 --> 00:27:49,235
are just busy and couldn't commit to this

474
00:27:49,235 --> 00:27:50,755
process who may be willing to be on

475
00:27:50,755 --> 00:27:51,955
the Board of Health. So I don't know

476
00:27:51,955 --> 00:27:55,075
that you know another open call would hurt

477
00:27:55,075 --> 00:27:57,075
just to see what the interest is from

478
00:27:57,075 --> 00:27:59,750
the community and understand who's available with what

479
00:27:59,750 --> 00:28:04,470
expertise. It's certainly you know we're sitting here

480
00:28:04,470 --> 00:28:07,110
so that sometimes makes it easy but it

481
00:28:07,110 --> 00:28:11,595
doesn't necessarily make it. Since we were all

482
00:28:11,595 --> 00:28:13,675
selected by the commissioners to sit on this

483
00:28:13,675 --> 00:28:15,835
committee we may need to do something again

484
00:28:15,835 --> 00:28:18,635
just to really keep that like a political

485
00:28:18,635 --> 00:28:21,035
arm's length of saying we want to know

486
00:28:21,035 --> 00:28:25,260
everyone who's potentially interested but that's just This

487
00:28:25,260 --> 00:28:27,980
is a very operational committee, right? And so

488
00:28:27,980 --> 00:28:30,140
the board of health would not be an

489
00:28:30,140 --> 00:28:32,299
operation, you would have people that did the

490
00:28:32,299 --> 00:28:34,859
operation reporting to the board of health. So

491
00:28:36,539 --> 00:28:39,575
it would be totally different. Yeah, that's a

492
00:28:39,575 --> 00:28:42,215
good point. So I think that since the

493
00:28:42,935 --> 00:28:45,495
rule, the act states that it should have

494
00:28:45,495 --> 00:28:47,335
at least five members, but then it says

495
00:28:47,335 --> 00:28:49,335
if you have less than 100,000 people, you

496
00:28:49,335 --> 00:28:51,360
can do a three week report and And

497
00:28:51,360 --> 00:28:53,440
the board of county commissioners may designate something

498
00:28:53,440 --> 00:28:55,120
to county board of health if there was

499
00:28:55,120 --> 00:28:56,880
not a separate board of health prior to

500
00:28:56,880 --> 00:29:00,080
the effective date of the act. So it's

501
00:29:00,080 --> 00:29:03,200
almost like that's having just the county commissioners

502
00:29:03,200 --> 00:29:06,675
on it is the least desirable of the

503
00:29:06,675 --> 00:29:09,875
options here. Would recommend, and I'd say we

504
00:29:09,875 --> 00:29:12,675
all agree with This is the first time

505
00:29:12,675 --> 00:29:15,475
seeing this, again, as usual, thanks for the

506
00:29:15,475 --> 00:29:19,590
handouts. And Derek, you may know this, the

507
00:29:19,590 --> 00:29:22,389
second part of that that was just read,

508
00:29:22,550 --> 00:29:25,429
the first part in counties with populations of

509
00:29:25,429 --> 00:29:28,470
less than 100,003 member board may be appointed.

510
00:29:29,365 --> 00:29:32,484
The Board of County Commissioners may designate itself.

511
00:29:32,965 --> 00:29:34,725
If there was not a separate Board of

512
00:29:34,725 --> 00:29:37,525
Health prior, is that a legal question? Or

513
00:29:37,525 --> 00:29:41,044
do you know the answer? Was there business

514
00:29:41,044 --> 00:29:45,280
considered San Juan Basin Health a previous board?

515
00:29:45,280 --> 00:29:47,600
We are two separate board of health. So

516
00:29:47,600 --> 00:29:50,800
what San Juan Basin has is completely separate

517
00:29:50,800 --> 00:29:52,560
from what we're going to have. So we

518
00:29:52,560 --> 00:29:54,560
do not have a board of health in

519
00:29:54,560 --> 00:29:59,865
effect. Okay, I would make a recommendation of

520
00:29:59,865 --> 00:30:04,745
a minimum of five, and we can maybe

521
00:30:04,745 --> 00:30:06,505
leave it to the commissioners if they want

522
00:30:06,505 --> 00:30:09,865
to have a three and two, or do

523
00:30:09,865 --> 00:30:11,544
we wanna recommend a two and three or

524
00:30:11,544 --> 00:30:14,610
a one and four? I guess I feel

525
00:30:14,610 --> 00:30:21,409
like the majority should probably be non. So

526
00:30:22,610 --> 00:30:26,129
either three, two, one and three public health,

527
00:30:26,375 --> 00:30:34,054
two commissioners, or four. I agree. I think

528
00:30:34,455 --> 00:30:39,495
it should be a majority of non board

529
00:30:39,575 --> 00:30:43,990
of commissioners on the health department board, I

530
00:30:43,990 --> 00:30:49,510
think that will send a message to the

531
00:30:49,510 --> 00:30:55,350
community that it is community based and not

532
00:30:55,830 --> 00:31:07,765
politically based. Sally, any comments, Ashley? No. I

533
00:31:07,765 --> 00:31:11,525
think if we get bigger than five, we're

534
00:31:11,525 --> 00:31:13,230
gonna have a hard time staffing it with

535
00:31:13,230 --> 00:31:16,350
people with the writing backgrounds because we have

536
00:31:16,350 --> 00:31:19,230
a limited pool of potential folks. I think

537
00:31:19,230 --> 00:31:21,390
you're interested in serving those kind of terms.

538
00:31:21,710 --> 00:31:23,790
I think five is good. I don't know

539
00:31:23,790 --> 00:31:26,975
if I, you know, I think given all

540
00:31:26,975 --> 00:31:28,575
the other things that commissioners are on, it

541
00:31:28,575 --> 00:31:32,414
probably makes sense to only have one, you

542
00:31:32,414 --> 00:31:35,054
know, representing the three on the board only

543
00:31:35,054 --> 00:31:36,654
for the sake of time. Does it make

544
00:31:36,654 --> 00:31:38,495
sense to have two spending that amount of

545
00:31:38,495 --> 00:31:41,009
time in those meetings? Because it is going

546
00:31:41,009 --> 00:31:42,210
to be pretty, I mean, it's going to

547
00:31:42,210 --> 00:31:43,970
be timely between now and the end of

548
00:31:43,970 --> 00:31:46,209
the year. It's going to be timely. Once

549
00:31:46,929 --> 00:31:49,970
it's established, it's going to have a different

550
00:31:49,970 --> 00:31:54,130
role. And once there's a director on staff,

551
00:31:54,945 --> 00:31:58,304
then that director will ease even our burden

552
00:31:58,304 --> 00:32:01,745
or whoever's on the board's burden between now

553
00:32:01,745 --> 00:32:03,664
and the end of the year because that

554
00:32:03,664 --> 00:32:07,505
person should really be a guide to what

555
00:32:07,505 --> 00:32:11,890
needs to happen. Suzanne, we're having some technical

556
00:32:11,890 --> 00:32:13,890
difficulties. Could you just say something so we

557
00:32:13,890 --> 00:32:15,489
can see if we can hear you better?

558
00:32:19,010 --> 00:32:22,130
Can you hear me better now? A little

559
00:32:22,130 --> 00:32:28,264
bit. Sounds like her internet connection. All right.

560
00:32:28,265 --> 00:32:31,544
Thanks for checking, Jamie. Appreciate it. All right,

561
00:32:31,544 --> 00:32:33,065
we're doing the best we can. Thank you.

562
00:32:33,065 --> 00:32:44,180
Speak louder, Suzanne. All right so process wise

563
00:32:44,180 --> 00:32:46,020
you were saying something about a memo but

564
00:32:46,020 --> 00:32:48,740
is a motion insufficient that would be reflected

565
00:32:48,740 --> 00:32:49,940
in the notes or do we need to

566
00:32:49,940 --> 00:32:54,155
put together a memo that explains the reason

567
00:32:54,155 --> 00:32:57,434
for this recommendation or do we even need

568
00:32:57,434 --> 00:33:00,554
to? Either one would work. The motion would

569
00:33:00,554 --> 00:33:02,875
be obviously good today. A memo would need

570
00:33:02,875 --> 00:33:05,480
to be created and approved next week. I

571
00:33:05,480 --> 00:33:08,200
mean, I'm happy to put together that with

572
00:33:08,200 --> 00:33:10,600
some of the data from the two sources

573
00:33:10,600 --> 00:33:12,760
that I read as far as supporting our

574
00:33:12,760 --> 00:33:15,960
recommendation, if that would be helpful. Thanks, Ashley.

575
00:33:15,960 --> 00:33:17,640
But next week we're not meeting. We're not

576
00:33:17,640 --> 00:33:21,974
meeting next week. You're right. Do it at

577
00:33:22,695 --> 00:33:24,375
the next meeting as far as the formal

578
00:33:24,375 --> 00:33:26,615
memo or without That be the twenty seventh

579
00:33:26,615 --> 00:33:29,015
or we could Get email. Could we We

580
00:33:29,015 --> 00:33:33,174
would approve it via like, I could get

581
00:33:33,174 --> 00:33:36,040
each one of your approvals, and then we

582
00:33:36,040 --> 00:33:38,280
would actually Cathy could sign it, and then

583
00:33:38,280 --> 00:33:40,200
we could actually ratify it at the twenty

584
00:33:40,200 --> 00:33:42,680
seventh meeting. Because I do think it's important,

585
00:33:42,680 --> 00:33:44,760
right, I think for the process of hiring.

586
00:33:44,840 --> 00:33:46,360
I don't know where we're at. Maybe Derek

587
00:33:46,360 --> 00:33:48,040
can give us an update on that. But,

588
00:33:48,415 --> 00:33:50,175
you know to have some of these things

589
00:33:50,175 --> 00:33:52,575
in front of the commissioners so they can

590
00:33:52,575 --> 00:33:55,215
make their decisions because I think that will

591
00:33:55,215 --> 00:33:58,575
potentially impact who applies and how they choose

592
00:33:58,575 --> 00:34:00,335
to then you know make some of these

593
00:34:00,335 --> 00:34:03,980
decisions and so the sooner we can make

594
00:34:03,980 --> 00:34:09,739
that formal recommendation the better. Yeah, think that

595
00:34:09,739 --> 00:34:12,380
the email format would probably be really good

596
00:34:12,380 --> 00:34:15,695
and get that voting forward too. It's long

597
00:34:15,695 --> 00:34:19,614
way for motion that we send a memo

598
00:34:19,614 --> 00:34:22,255
to be written and approved by email with

599
00:34:22,255 --> 00:34:27,535
the evidence based in there that we recommend

600
00:34:28,175 --> 00:34:30,949
the Board of Health be combined members or

601
00:34:30,949 --> 00:34:33,109
if they are not county commissioners and want

602
00:34:33,109 --> 00:34:36,469
to take this account. And experts in public

603
00:34:36,469 --> 00:34:42,469
health experts public health for this okay. Did

604
00:34:42,469 --> 00:34:45,795
you get that? I guess you're taking just

605
00:34:45,795 --> 00:34:49,635
thinking about grammar. Want the name of my

606
00:34:49,635 --> 00:34:57,990
speaker. Sorry, Sally let it is. Quick question

607
00:34:57,990 --> 00:35:01,750
for both. Would this be interim or is

608
00:35:01,750 --> 00:35:06,070
this for January 1? I think we're talking

609
00:35:06,070 --> 00:35:07,910
about I think we're talking about now. We're

610
00:35:07,910 --> 00:35:09,750
talking about setting it up, saying that's a

611
00:35:09,750 --> 00:35:12,535
good day situation. Okay. And if that's the

612
00:35:12,535 --> 00:35:14,775
case, does this group go away and that

613
00:35:14,775 --> 00:35:18,855
group take over? Eventually it will go away.

614
00:35:20,375 --> 00:35:21,975
Often to the same thing, it's been a

615
00:35:21,975 --> 00:35:28,920
volatile combination. I mean, I think that similar

616
00:35:28,920 --> 00:35:31,560
to what La Plata County did, we can

617
00:35:32,520 --> 00:35:34,520
appoint a Board of Health, they just would

618
00:35:34,520 --> 00:35:42,085
have no authority until January. Okay. You've had

619
00:35:42,085 --> 00:35:44,245
a motion was there a second? I'll second.

620
00:35:44,565 --> 00:35:48,565
Mary, go ahead. Mean the other thing that

621
00:35:48,565 --> 00:35:51,290
we may need to discuss to add to

622
00:35:51,290 --> 00:35:54,010
our recommendation Oh I'm sorry I'm not. She's

623
00:35:54,010 --> 00:36:01,290
not a voting member. I'll Okay. All All

624
00:36:01,290 --> 00:36:03,770
in favor say we should call the vote.

625
00:36:03,770 --> 00:36:10,224
Fair aye. Was anyone opposed? Suzanne Poe. Sand?

626
00:36:11,744 --> 00:36:17,025
Aye. And you know I don't know if

627
00:36:17,025 --> 00:36:20,240
this is something or when this gets decided,

628
00:36:20,240 --> 00:36:22,080
but, know, there was some discussion in some

629
00:36:22,080 --> 00:36:23,920
of these articles around the Board of Health

630
00:36:23,920 --> 00:36:26,400
being an advisory group versus like a policy

631
00:36:26,400 --> 00:36:28,880
making group. Right. And so I don't know

632
00:36:28,880 --> 00:36:30,640
how that gets designated. I don't know if

633
00:36:30,640 --> 00:36:33,355
that gets designated once it's formed and they

634
00:36:33,355 --> 00:36:36,075
determine that themselves or if that's something we

635
00:36:36,075 --> 00:36:37,995
need to weigh in on as this committee.

636
00:36:37,995 --> 00:36:41,675
That may require a little more digging into

637
00:36:41,675 --> 00:36:45,275
what's appropriate. I mean, I think based on

638
00:36:45,275 --> 00:36:48,050
our discussion, feel like maybe need to be

639
00:36:48,050 --> 00:36:51,490
a little bit more of a policy directive

640
00:36:51,490 --> 00:36:54,770
group and not just an oversight advisory committee.

641
00:36:55,970 --> 00:36:57,410
But I think those are things we need

642
00:36:57,410 --> 00:36:59,090
to consider as part of this as well.

643
00:36:59,375 --> 00:37:01,375
I do too. As far as the structure.

644
00:37:01,535 --> 00:37:05,055
I do too especially between now and go

645
00:37:05,055 --> 00:37:07,934
live. Right. January because there is a lot

646
00:37:07,934 --> 00:37:09,615
of there are a lot of policies in

647
00:37:09,615 --> 00:37:11,310
the past we put in place and again

648
00:37:11,310 --> 00:37:14,110
back to the director, you know the director

649
00:37:14,190 --> 00:37:16,430
someone who has a lot of experience and

650
00:37:16,430 --> 00:37:20,110
should be helping us with that path forward.

651
00:37:22,670 --> 00:37:24,750
But those are some differences I saw in

652
00:37:24,750 --> 00:37:27,444
some other reading around the Board of Health

653
00:37:27,444 --> 00:37:30,005
itself and how it's designated. So I think

654
00:37:30,005 --> 00:37:31,605
those are just things we need to be.

655
00:37:32,165 --> 00:37:34,325
Especially when we're doing our research too, right,

656
00:37:34,325 --> 00:37:37,125
what are there implications for either one of

657
00:37:37,125 --> 00:37:39,525
those based on programming and things that are

658
00:37:39,525 --> 00:37:43,690
out there in other communities? You know, pros

659
00:37:43,690 --> 00:37:49,290
and cons of the setup outside of just

660
00:37:49,290 --> 00:37:59,245
the size and Any other comments on that

661
00:37:59,245 --> 00:38:10,445
topic? Leanne, come on. Go ahead and not

662
00:38:10,445 --> 00:38:13,460
waste her time and break her own. We

663
00:38:13,460 --> 00:38:17,540
had asked Leanne Delon to come to because

664
00:38:19,619 --> 00:38:21,619
at our first meeting we had so many

665
00:38:21,619 --> 00:38:23,779
questions for us, they want basic public company

666
00:38:23,779 --> 00:38:27,155
asked her to give us kind of the

667
00:38:27,635 --> 00:38:32,035
overall view structure. Yeah. Could I interject real

668
00:38:32,035 --> 00:38:34,675
quick? So I have to leave at 10:00.

669
00:38:35,715 --> 00:38:40,539
And Leanne's kind of long winded. Should I

670
00:38:40,539 --> 00:38:45,740
smack him? Any time get a chance, right?

671
00:38:46,380 --> 00:38:49,579
Can I just jump into just a status

672
00:38:49,579 --> 00:38:55,995
on the record position? Yeah. So we did

673
00:38:55,995 --> 00:39:00,075
advertise last week that that all completed. So

674
00:39:00,075 --> 00:39:05,400
it was posted on Tuesday afternoon. We do

675
00:39:05,400 --> 00:39:09,240
have a flyer that was created so that

676
00:39:09,240 --> 00:39:11,720
it can go out to professional organizations as

677
00:39:11,720 --> 00:39:14,680
well, or anybody that has any desire for

678
00:39:14,680 --> 00:39:20,855
it. Did get one applicant thus far, an

679
00:39:20,855 --> 00:39:24,295
individual that does have some background related to

680
00:39:24,295 --> 00:39:28,775
that. I just scanned it this morning, but

681
00:39:28,775 --> 00:39:32,055
it appears that probably does meet the minimum

682
00:39:32,055 --> 00:39:36,780
requirements. Currently resides in Texas, but that's the

683
00:39:36,780 --> 00:39:40,859
only applicant that we have thus far. So,

684
00:39:40,859 --> 00:39:45,180
I know that there's another question about this

685
00:39:45,180 --> 00:39:47,595
is going to be up to the the

686
00:39:47,595 --> 00:39:51,275
commissioners as far as who that person reports

687
00:39:51,275 --> 00:39:54,955
to as far as the direct supervision. Yes.

688
00:39:55,675 --> 00:39:57,675
I know there has been discussion about it

689
00:39:57,675 --> 00:40:03,850
that just for maintenance of county structure that

690
00:40:03,850 --> 00:40:07,290
that person would answer me that that's definitive.

691
00:40:08,090 --> 00:40:10,090
Is how it's all set is set up

692
00:40:10,090 --> 00:40:12,730
here the county that all all director positions

693
00:40:12,730 --> 00:40:17,415
report to you? Yep. The only county staff

694
00:40:17,415 --> 00:40:19,655
that reports to the board directly is the

695
00:40:19,655 --> 00:40:22,855
county manager and the county attorney right everyone

696
00:40:22,855 --> 00:40:28,119
else works for Derek. Okay. Is that your

697
00:40:28,119 --> 00:40:33,800
preference? Or I mean, are the pros and

698
00:40:33,800 --> 00:40:35,320
cons? I mean, I don't know why we

699
00:40:35,320 --> 00:40:37,880
would do something different. Yeah, I think it's

700
00:40:37,880 --> 00:40:42,565
well, I think yes, that would be, that'd

701
00:40:42,565 --> 00:40:44,405
be my preference because it's being set up

702
00:40:44,405 --> 00:40:46,405
as a set up. Being set up as

703
00:40:46,405 --> 00:40:48,805
a department, it's not being set up as

704
00:40:48,885 --> 00:40:53,125
a standard loan Right. You know, I think

705
00:40:53,125 --> 00:40:59,150
it could just create some other issues, I

706
00:40:59,150 --> 00:41:02,990
guess. What Okay. Is that for the interim,

707
00:41:02,990 --> 00:41:05,710
or does that go beyond January 1? It

708
00:41:05,710 --> 00:41:09,790
would be for both. Like I said, that

709
00:41:09,790 --> 00:41:13,685
that has not been definitively established at this

710
00:41:13,685 --> 00:41:16,645
point, but that is in my discussion with

711
00:41:16,645 --> 00:41:20,965
them that has been their conversation. Should we

712
00:41:20,965 --> 00:41:23,125
make a recommendation from this group or is

713
00:41:23,125 --> 00:41:26,770
that if that's a if it's a county

714
00:41:27,970 --> 00:41:31,250
policy we don't know that we would need

715
00:41:31,250 --> 00:41:35,490
to unless we wanted to change that. I

716
00:41:35,490 --> 00:41:37,250
don't know if it's a policy it sounds

717
00:41:37,250 --> 00:41:39,204
like it's still up in the air. Well,

718
00:41:39,204 --> 00:41:42,405
it's not a policy, it's just, it's a

719
00:41:42,405 --> 00:41:46,885
practice for sure. As Mary said, there's only,

720
00:41:47,525 --> 00:41:51,685
statutory, there's only two employees of the board

721
00:41:51,765 --> 00:41:55,110
and that was the manager and the attorney.

722
00:41:56,309 --> 00:41:58,309
What's the wording on the job description I

723
00:41:58,309 --> 00:42:00,390
can't remember the very first page they talk

724
00:42:00,390 --> 00:42:04,470
about can't remember the firm it's not. Who

725
00:42:04,470 --> 00:42:09,805
did it report to? Supervision received? Yes. Okay.

726
00:42:09,965 --> 00:42:13,725
So we left it pretty broad. It does

727
00:42:13,725 --> 00:42:18,445
say County Commissioners and County Board of Health.

728
00:42:18,525 --> 00:42:24,460
Well, said we changed it. Okay. So it's

729
00:42:24,460 --> 00:42:26,619
County Commissioners or designee or County Board of

730
00:42:26,619 --> 00:42:34,715
So there's an open line with commissioners and

731
00:42:34,715 --> 00:42:36,555
having a commissioner on the board of health

732
00:42:36,555 --> 00:42:39,195
will keep that open conversation with the commissioners

733
00:42:39,195 --> 00:42:44,235
that you know you're I guess I'm wondering

734
00:42:44,235 --> 00:42:46,395
if their reporting to you will be different

735
00:42:46,395 --> 00:42:48,635
than their responsibility to the board of health

736
00:42:48,635 --> 00:42:55,490
this Director Attorney. Yeah, does get a little

737
00:42:55,490 --> 00:42:58,530
convoluted because everybody that's going to be in

738
00:43:00,690 --> 00:43:05,805
the health department is a county employee. And

739
00:43:05,805 --> 00:43:08,925
so the way that it needs to flow,

740
00:43:08,925 --> 00:43:12,525
and this is just my opinion, is if

741
00:43:12,525 --> 00:43:14,365
it remains the same as all the other

742
00:43:14,365 --> 00:43:21,520
county departments, then it maintains consistency in everything.

743
00:43:21,760 --> 00:43:28,240
When the employee does not answer through the

744
00:43:28,240 --> 00:43:31,535
county manager, and then are they a department

745
00:43:31,535 --> 00:43:35,775
head, are they, however they consider. I think

746
00:43:35,775 --> 00:43:42,255
it just lends to some confusion. And if

747
00:43:42,255 --> 00:43:44,575
that's the case, then I think it also

748
00:43:44,870 --> 00:43:47,990
changes the entire pay structure and everything else.

749
00:43:48,550 --> 00:43:51,910
But the weird part of it is, so

750
00:43:51,910 --> 00:43:54,790
the department or the people that report to

751
00:43:54,790 --> 00:43:57,270
you, they don't have separate boards that are

752
00:43:57,270 --> 00:43:59,665
gonna be that they're going to be also

753
00:43:59,665 --> 00:44:03,105
reporting to you, Planning Commission. It's not unusual.

754
00:44:04,545 --> 00:44:07,585
Yeah, planning, you know, and community development. They

755
00:44:08,545 --> 00:44:11,500
have, they all have boards. So how do

756
00:44:11,500 --> 00:44:13,819
those boards interface with you then? Do they

757
00:44:13,819 --> 00:44:16,220
make recommendations to you? Do they make recommendations

758
00:44:16,220 --> 00:44:18,619
to the commissioners if something's not going well

759
00:44:18,619 --> 00:44:22,539
that they see that you might not? So

760
00:44:23,465 --> 00:44:25,865
they don't have any, how do I say,

761
00:44:25,865 --> 00:44:32,105
employment decisions, those boards. It's just advisory and

762
00:44:32,105 --> 00:44:37,145
their roles and responsibilities. But it's, yeah, it

763
00:44:37,145 --> 00:44:40,770
has nothing to do with employment. Of course

764
00:44:40,770 --> 00:44:44,290
they can always, they can always come to

765
00:44:44,290 --> 00:44:50,610
me, but it's to be the commissioners. I

766
00:44:50,610 --> 00:44:53,035
mean, it's not different than the town right

767
00:44:53,035 --> 00:44:55,915
so we have employees who report to the

768
00:44:55,915 --> 00:44:58,875
tourism board the planning you know things like

769
00:44:58,875 --> 00:45:02,875
that outside boards but our employees of the

770
00:45:02,875 --> 00:45:06,370
town direction. I think that keeps it clean.

771
00:45:06,930 --> 00:45:09,250
It could get messy if you had a

772
00:45:09,250 --> 00:45:13,970
department head director who was reporting to this

773
00:45:13,970 --> 00:45:17,250
board and then like where are they in

774
00:45:17,395 --> 00:45:19,955
the organizational structure of the county? It could

775
00:45:20,115 --> 00:45:24,835
create some challenges. I truly believe that. The

776
00:45:29,635 --> 00:45:32,275
board of health isn't doing anything related to

777
00:45:32,275 --> 00:45:38,330
staffing. We're doing policy procedures, you know, regulations,

778
00:45:38,330 --> 00:45:43,290
oversight. So it is kind of two separate

779
00:45:43,290 --> 00:45:50,785
responsibilities. It's clarification, it's a lot more clear.

780
00:45:50,945 --> 00:45:52,465
And then it's boost you what we have

781
00:45:52,465 --> 00:45:57,345
here. I would, as far as interviewing, I

782
00:45:57,345 --> 00:45:59,825
mean I would think that, I I would

783
00:45:59,825 --> 00:46:04,609
certainly participate but I would create an interview

784
00:46:04,609 --> 00:46:13,250
panel of appropriate knowledge, individuals. And I would

785
00:46:13,250 --> 00:46:19,195
certainly draw in from outside. And honestly, I

786
00:46:19,195 --> 00:46:21,435
would probably be the only one from the

787
00:46:21,435 --> 00:46:24,395
county government to participate, the rest I would

788
00:46:24,395 --> 00:46:27,994
bring in from outside. So there wouldn't necessarily

789
00:46:27,994 --> 00:46:31,760
be standardized questions like? There absolutely would. They

790
00:46:31,760 --> 00:46:34,880
would be the same questions, if you will,

791
00:46:35,040 --> 00:46:37,920
you know, just for legality. So everybody gets

792
00:46:37,920 --> 00:46:40,240
asked the same questions. You can always expand

793
00:46:40,240 --> 00:46:43,760
on those questions. Everybody gets asked the same

794
00:46:43,760 --> 00:46:47,825
questions. But if you know, can certainly go

795
00:46:47,825 --> 00:46:51,025
down a path on an answer that comes

796
00:46:51,025 --> 00:46:57,425
out of, know, right. And, but so you're

797
00:46:57,425 --> 00:47:03,060
not just held to those exact works. Good.

798
00:47:04,740 --> 00:47:12,835
Okay. Cool. Thank you. I'll see you on

799
00:47:12,835 --> 00:47:15,795
Zoom tomorrow. As soon as I can get

800
00:47:15,795 --> 00:47:18,915
I'll get there. I just don't know how

801
00:47:18,915 --> 00:47:22,915
soon I get out of my yeah. Try

802
00:47:22,915 --> 00:47:27,450
to figure it out. So Derek's coming. Oh

803
00:47:27,450 --> 00:47:29,290
okay, I was gonna say your work session

804
00:47:29,290 --> 00:47:40,775
next Okay, I think it would help me

805
00:47:40,775 --> 00:47:42,295
if we went around because I don't know

806
00:47:42,295 --> 00:47:44,775
everybody. So I'm really happy with Sam one

807
00:47:44,775 --> 00:47:50,454
place in the hospital. Andrea Phillips, town manager.

808
00:47:50,454 --> 00:47:52,615
Ashley Wilson. I work for Rise Above Violence

809
00:47:52,615 --> 00:47:56,420
but have a master's in public health. I'm

810
00:47:56,420 --> 00:48:00,579
Sally Kennedy, I'm retired. I'm Kathy Campbell, I'm

811
00:48:00,579 --> 00:48:04,900
retired and a glutton for punishment. I'm John

812
00:48:04,900 --> 00:48:08,180
Ransom, used to be a commissioner here and

813
00:48:08,180 --> 00:48:15,215
now I think I'm retired. And then Suzanne.

814
00:48:15,215 --> 00:48:22,015
Yeah, Suzanne Bryant, I'm a registered dietitian. Awesome.

815
00:48:23,775 --> 00:48:30,369
Derek, Mary. Thanks having me. I have, I

816
00:48:30,369 --> 00:48:33,250
can do some slides maybe just to get

817
00:48:33,250 --> 00:48:35,569
the conversation started. I don't really, you know,

818
00:48:35,569 --> 00:48:37,329
I think a lot of what we're doing

819
00:48:37,329 --> 00:48:39,089
here is kind of Q and A, but

820
00:48:39,089 --> 00:48:40,770
what I was going to do, and Derek

821
00:48:40,770 --> 00:48:43,085
is absolutely right, am open to it. I

822
00:48:43,085 --> 00:48:46,605
have a kind of some, I have a

823
00:48:46,605 --> 00:48:48,605
slide deck that we do during our budget

824
00:48:48,605 --> 00:48:51,885
presentation that we do for the sets of

825
00:48:51,885 --> 00:48:55,480
commissioners every year and we'll do it for

826
00:48:55,480 --> 00:48:58,920
the commissioners multiple times at our board of

827
00:48:58,920 --> 00:49:01,160
health meeting, which is also a public meeting

828
00:49:01,160 --> 00:49:03,559
multiple times when we're adopting our budget so

829
00:49:03,559 --> 00:49:05,559
that everybody is kind of playing from the

830
00:49:05,559 --> 00:49:07,565
same sheet of music. So what I was

831
00:49:07,565 --> 00:49:10,125
thinking just to kick off this conversation is

832
00:49:10,125 --> 00:49:13,565
go through those budget intro slides for you

833
00:49:13,565 --> 00:49:15,805
all, which will give you just some background

834
00:49:15,805 --> 00:49:18,285
on how things were structured in the past.

835
00:49:19,005 --> 00:49:21,590
I don't know that it's the most important

836
00:49:21,590 --> 00:49:23,510
thing because your job is obviously the future

837
00:49:23,510 --> 00:49:25,190
and what you're doing next, but I think

838
00:49:25,190 --> 00:49:27,990
just having some basis about where we've been

839
00:49:28,070 --> 00:49:30,790
may help in some decision making going forward.

840
00:49:31,350 --> 00:49:34,785
So this is our final product for adopting

841
00:49:34,785 --> 00:49:37,105
our budget. Janet, thank you so much for

842
00:49:37,105 --> 00:49:39,585
reading my mind and getting slides. Janet's sharing

843
00:49:39,585 --> 00:49:41,665
the slides from us a long time ago.

844
00:49:42,145 --> 00:49:44,785
So we go to the next slide, it

845
00:49:44,785 --> 00:49:47,265
describes what San Juan Basin Public Health's mission,

846
00:49:47,265 --> 00:49:51,569
vision, and values are. So I'm not gonna

847
00:49:51,569 --> 00:49:52,530
read it to you. I'll just give you

848
00:49:52,530 --> 00:49:54,930
guys a second to read it. It shouldn't

849
00:49:54,930 --> 00:49:58,290
be surprising what the mission and vision of

850
00:49:58,290 --> 00:50:02,265
a local public health agency. And then after

851
00:50:02,265 --> 00:50:03,945
we go over our mission, which is to

852
00:50:03,945 --> 00:50:07,305
protect human and environmental health and inspire well-being,

853
00:50:07,464 --> 00:50:08,905
we kind of go through and we do

854
00:50:08,905 --> 00:50:10,825
this every year multiple times when we're doing

855
00:50:10,825 --> 00:50:13,305
our budget season. So this goes through kind

856
00:50:13,305 --> 00:50:15,464
of the legal structure for a multi county

857
00:50:15,464 --> 00:50:21,010
health district. So believe that's what's next. Oh,

858
00:50:21,010 --> 00:50:23,010
look at that. Okay, so legal structure for

859
00:50:23,010 --> 00:50:28,850
a multi county health district is we Post

860
00:50:28,850 --> 00:50:30,610
World War II, there was a governor of

861
00:50:30,610 --> 00:50:35,365
Colorado that was really, yeah, I'm sure I'll

862
00:50:35,365 --> 00:50:36,645
tell the story this way. The governor of

863
00:50:36,645 --> 00:50:39,045
Colorado post World War II was very concerned

864
00:50:39,045 --> 00:50:42,005
that Colorado had fallen behind in public health

865
00:50:42,005 --> 00:50:44,405
across the state. There were high rates of

866
00:50:44,405 --> 00:50:47,920
tuberculosis, there was poor sewage, there was environmental

867
00:50:47,920 --> 00:50:51,600
runoff, there were some agricultural diseases that were

868
00:50:51,600 --> 00:50:55,200
having economic fallout and also having human health

869
00:50:55,200 --> 00:50:58,655
fallout. And so there was Florence, Doctor. Florence

870
00:50:58,655 --> 00:51:01,455
Sabin moved back to Colorado. She'd grown up

871
00:51:01,455 --> 00:51:03,135
here and that she had gone to the

872
00:51:03,135 --> 00:51:06,175
East Coast at a very illustrious, very, very

873
00:51:06,175 --> 00:51:10,095
ahead of her time career putting together, doing

874
00:51:10,095 --> 00:51:12,780
research and public health. And she came back

875
00:51:12,780 --> 00:51:15,980
to Colorado and she was tasked to make

876
00:51:15,980 --> 00:51:18,140
suggestions to how we would improve health in

877
00:51:18,140 --> 00:51:20,940
Colorado. And she visited 60, I don't actually

878
00:51:20,940 --> 00:51:22,620
know if there were 64 counties at the

879
00:51:22,620 --> 00:51:25,265
time, but she visited every single county and

880
00:51:25,265 --> 00:51:28,625
then visited every state rep to work through

881
00:51:28,625 --> 00:51:31,185
a suite of laws to catch Colorado up

882
00:51:31,185 --> 00:51:34,865
in public health. This happened in '19 She

883
00:51:34,865 --> 00:51:37,585
completed her work in 1947. They were signed

884
00:51:37,585 --> 00:51:40,910
into law in 1948. There was a package

885
00:51:40,910 --> 00:51:43,309
of eight bills, and one of those bills

886
00:51:43,309 --> 00:51:46,190
in the state of health laws created the

887
00:51:46,190 --> 00:51:48,829
opportunity for counties to go in together to

888
00:51:48,829 --> 00:51:52,505
do public health as a multi county district.

889
00:51:52,665 --> 00:51:54,665
So that's why when you talk about multi

890
00:51:54,665 --> 00:51:57,145
county districts in Colorado, they often were formed

891
00:51:57,145 --> 00:52:00,905
in 1948 because of a response to this

892
00:52:01,305 --> 00:52:04,105
legislation that was passed. So Archuleta and La

893
00:52:04,105 --> 00:52:06,585
Clada Counties were one of the multi county

894
00:52:06,585 --> 00:52:09,200
districts that started 1948. We actually had other

895
00:52:09,200 --> 00:52:11,119
counties. So it was a larger district starting

896
00:52:11,119 --> 00:52:14,800
in 1948. And then the Public Health Act

897
00:52:14,800 --> 00:52:18,400
in Colorado was not touched until 02/2008. So

898
00:52:18,400 --> 00:52:20,960
we have a habit of really getting ahead

899
00:52:20,960 --> 00:52:24,204
and then falling really far behind. So Colorado

900
00:52:24,204 --> 00:52:27,645
not updating its law until 02/2008. Once that

901
00:52:27,645 --> 00:52:30,765
law was re upped in 02/2008, it required

902
00:52:30,765 --> 00:52:33,244
the counties involved. So Arch 11 and Plata

903
00:52:33,244 --> 00:52:38,330
County had to redo the agreement, which is

904
00:52:38,330 --> 00:52:40,810
done in a resolution by the county commissioners

905
00:52:40,810 --> 00:52:44,090
to perform in a multi county district to

906
00:52:44,090 --> 00:52:47,370
meet the statutory obligations of local public health.

907
00:52:47,610 --> 00:52:50,410
So we were formed in 1948 and then

908
00:52:50,410 --> 00:52:54,705
reformed in February '9 actually, because the act

909
00:52:54,705 --> 00:52:56,224
was passed into Were you on the commission

910
00:52:56,224 --> 00:52:58,385
then? Well, then you should be telling this

911
00:52:59,425 --> 00:53:01,505
I'm doing great. I'm just glad you can

912
00:53:01,505 --> 00:53:06,464
still remember the So reformed in 02/2009 in

913
00:53:06,464 --> 00:53:10,420
response to the public health act of 02/2008.

914
00:53:10,500 --> 00:53:13,299
And then that's all described in this slide,

915
00:53:13,299 --> 00:53:14,740
which I guess I could have, instead of

916
00:53:14,740 --> 00:53:16,660
just relying on that little history lesson, could

917
00:53:16,660 --> 00:53:18,339
have just looked at the slide, but this

918
00:53:18,339 --> 00:53:21,255
gives the references to what the Colorado statutes

919
00:53:21,255 --> 00:53:22,855
are if you want to go look at

920
00:53:22,855 --> 00:53:25,335
them. And I imagine you all have started

921
00:53:25,335 --> 00:53:28,455
with that. Yes, so that's where we are.

922
00:53:28,455 --> 00:53:32,390
So then the next slide, thanks, Janet, just

923
00:53:32,390 --> 00:53:34,150
gives you some summaries of what's in these

924
00:53:34,150 --> 00:53:36,470
statutory obligations. I won't go through these then

925
00:53:36,470 --> 00:53:38,550
if you all have started there. I would

926
00:53:38,550 --> 00:53:40,870
also be aware that there are statutory obligations

927
00:53:40,870 --> 00:53:43,670
and then there will be subsequent rulemaking by

928
00:53:43,670 --> 00:53:45,430
the State Board of Health. There may be

929
00:53:45,430 --> 00:53:49,325
other commissions like water quality, air quality, hazardous

930
00:53:49,325 --> 00:53:52,365
material commissions at the state, which are separate

931
00:53:52,365 --> 00:53:54,045
from the Board of Health, which also may

932
00:53:54,045 --> 00:53:57,325
do rule making that would involve obligations of

933
00:53:57,325 --> 00:53:59,565
local public health. So while it starts in

934
00:53:59,565 --> 00:54:02,444
statute, it then allows other boards and commissions

935
00:54:02,444 --> 00:54:06,260
to follow-up with rules and regulations, and that

936
00:54:06,260 --> 00:54:09,940
then becomes part of the puzzle of what

937
00:54:09,940 --> 00:54:13,140
local public health does. So this is, again,

938
00:54:13,140 --> 00:54:15,060
here we just pull out kind of the

939
00:54:15,060 --> 00:54:18,725
big pieces of the statutory obligations. You all

940
00:54:18,725 --> 00:54:20,405
have reviewed all of those, it sounds like,

941
00:54:20,405 --> 00:54:22,085
so I'm not going to go through them.

942
00:54:22,165 --> 00:54:23,365
So then I think we have one more

943
00:54:23,365 --> 00:54:26,805
slide on statutory obligations. And then let's see

944
00:54:26,805 --> 00:54:29,765
what's in our next slide. It's like a

945
00:54:29,765 --> 00:54:31,365
Price is Right, What's Behind the Next Door.

946
00:54:31,900 --> 00:54:34,860
Okay, so then historically, because I think there

947
00:54:34,860 --> 00:54:37,740
has been questions when there was the Health

948
00:54:37,740 --> 00:54:40,140
Investigative Committee and lots of discussion around how

949
00:54:40,140 --> 00:54:42,940
was this structured, there were some questions to

950
00:54:42,940 --> 00:54:45,100
see the contract between San Juan Basin Public

951
00:54:45,100 --> 00:54:46,460
Health and the county and how does it

952
00:54:46,460 --> 00:54:48,335
all work. And then I think our county

953
00:54:48,335 --> 00:54:51,214
commissioners and county administrator with some more history

954
00:54:51,214 --> 00:54:52,895
on this would understand why there's not a

955
00:54:52,895 --> 00:54:56,415
contract because it's formed by resolution and then

956
00:54:56,415 --> 00:55:00,680
the statute actually describes how a multi district

957
00:55:00,680 --> 00:55:04,200
operates. And so there isn't a contract back

958
00:55:04,200 --> 00:55:06,839
and forth between the counties. The multi county

959
00:55:06,839 --> 00:55:10,440
district operates with this proportional allocation of operational

960
00:55:10,440 --> 00:55:14,355
costs. So with that, the counties, Lapata and

961
00:55:14,355 --> 00:55:18,515
Archuleta County were following the statutory framework rather

962
00:55:18,515 --> 00:55:20,515
than creating. And it wouldn't make sense to

963
00:55:20,515 --> 00:55:25,315
create a separate contractor MOU because this is

964
00:55:25,315 --> 00:55:27,500
already in statute. So So what it talks

965
00:55:27,500 --> 00:55:31,339
about is proportion to the county size. And

966
00:55:31,339 --> 00:55:33,820
so in this case, we roughly say that

967
00:55:33,900 --> 00:55:36,220
La Plata has four times the residence of

968
00:55:36,220 --> 00:55:40,220
Archuleta, which is actually shockingly close to accurate.

969
00:55:40,220 --> 00:55:45,615
It's like 70,000, so let's say 70,000, but

970
00:55:45,615 --> 00:55:47,775
we give you an exact number for the

971
00:55:47,775 --> 00:55:51,934
proportional. So when we talked about after their

972
00:55:51,934 --> 00:55:54,415
statute, there were rulemakings, so if we go

973
00:55:54,415 --> 00:55:56,970
to the next slide, Janet, this one is

974
00:55:56,970 --> 00:55:58,730
hard to read, but this is the subsequent

975
00:55:58,730 --> 00:56:00,970
rulemaking. I'll walk through this and I don't

976
00:56:00,970 --> 00:56:02,250
know if you guys have already seen this

977
00:56:02,250 --> 00:56:06,970
one. Okay, everybody has, great. In 2019, the

978
00:56:06,970 --> 00:56:09,450
State Board of Health re upped the core

979
00:56:09,450 --> 00:56:16,185
services into a new foundational capabilities and foundational

980
00:56:16,185 --> 00:56:19,465
services. So prior to that, there were eight

981
00:56:19,465 --> 00:56:21,705
core services and seven of them had minimum

982
00:56:21,705 --> 00:56:25,465
standards. And that stuck from sometime after 02/2008

983
00:56:25,465 --> 00:56:28,810
to 2019. '20 '19, we went with the

984
00:56:28,810 --> 00:56:32,490
foundational services and capabilities. This was to create

985
00:56:32,490 --> 00:56:34,810
some opportunity for change in the local public

986
00:56:34,810 --> 00:56:38,970
health system beginning in 2020. We did experience

987
00:56:38,970 --> 00:56:41,130
significant change in the local public health system

988
00:56:41,130 --> 00:56:44,365
beginning in 2020, but not based on this

989
00:56:44,365 --> 00:56:50,924
new rulemaking, based on other events. But what

990
00:56:50,924 --> 00:56:53,885
we did as an agency is we had

991
00:56:54,285 --> 00:56:57,420
many years ago decided that we would budget

992
00:56:57,420 --> 00:57:00,540
to the court services so that especially our

993
00:57:00,540 --> 00:57:04,060
county commissioners could see exactly where the local

994
00:57:04,220 --> 00:57:08,620
If organized our org chart and our staffing

995
00:57:08,620 --> 00:57:12,224
and our budget to the court services, it

996
00:57:12,224 --> 00:57:15,345
would be easier to see what core services

997
00:57:15,345 --> 00:57:18,704
are adequately funded, what core services are not

998
00:57:18,704 --> 00:57:22,385
adequately funded, and then where the local contribution

999
00:57:22,385 --> 00:57:25,500
from the local counties goes. So that had

1000
00:57:25,500 --> 00:57:29,100
been our habit. So in 2019, when the

1001
00:57:29,100 --> 00:57:33,740
state board upgraded from seven to 12, we

1002
00:57:33,740 --> 00:57:35,100
kind of scratched our head and said, all

1003
00:57:35,100 --> 00:57:36,140
right, this is going to be kind of

1004
00:57:36,140 --> 00:57:38,540
tricky to redo our org chart and our

1005
00:57:38,540 --> 00:57:42,914
budget towards these 12 services and capabilities, but

1006
00:57:42,914 --> 00:57:45,315
it's important to do because it really draws

1007
00:57:45,315 --> 00:57:48,434
a line for the local community. This is

1008
00:57:48,434 --> 00:57:50,994
where we can access funding, and this is

1009
00:57:50,994 --> 00:57:53,394
where it's more difficult to access funding, and

1010
00:57:53,394 --> 00:57:56,550
this is where the dollars go. So this

1011
00:57:56,550 --> 00:58:01,830
is the seven core capabilities. And the core

1012
00:58:01,830 --> 00:58:04,230
capabilities are cross cutting, which means they have

1013
00:58:04,230 --> 00:58:08,790
to be applied to the five foundational services.

1014
00:58:09,245 --> 00:58:11,485
And this is now how we budget. So

1015
00:58:11,485 --> 00:58:13,005
if you've looked at the San Juan Basin

1016
00:58:13,005 --> 00:58:15,645
public health budget online, I didn't break copies

1017
00:58:15,645 --> 00:58:17,485
of it, but you will see we are

1018
00:58:17,485 --> 00:58:20,525
following these. We actually one or two week

1019
00:58:20,525 --> 00:58:22,525
collapse. So we don't have 12, I think

1020
00:58:22,525 --> 00:58:25,560
we have 10 areas of budgeting. But I

1021
00:58:25,560 --> 00:58:26,920
think we tried to do that to make

1022
00:58:26,920 --> 00:58:29,480
it very clear. It should help you all

1023
00:58:29,480 --> 00:58:31,720
in your work going forward because we can

1024
00:58:31,720 --> 00:58:37,080
demonstrate here's where there is access to state

1025
00:58:37,160 --> 00:58:39,000
funding. The majority of the funding comes from

1026
00:58:39,000 --> 00:58:41,975
the state of Colorado for foundational service or

1027
00:58:41,975 --> 00:58:45,415
capability and here's where there's really not and

1028
00:58:45,415 --> 00:58:47,735
that will figure into your decision making about

1029
00:58:47,735 --> 00:58:50,775
what services and programs you want to deliver.

1030
00:58:51,415 --> 00:58:55,590
So then the next slide is how we

1031
00:58:55,590 --> 00:58:58,070
budget at San Juan Basin, which is a

1032
00:58:58,070 --> 00:59:00,870
very robust process of building it from the

1033
00:59:00,870 --> 00:59:03,510
ground up, taking the budget to public, meaning

1034
00:59:03,510 --> 00:59:05,750
all the special district rules and regulations in

1035
00:59:05,750 --> 00:59:07,350
the state of Colorado to make that a

1036
00:59:07,350 --> 00:59:10,025
very public process. So that is just that

1037
00:59:10,025 --> 00:59:12,665
calendar. I don't think it's really relevant for

1038
00:59:12,665 --> 00:59:14,825
you all, but it really just demonstrates the

1039
00:59:14,825 --> 00:59:18,185
transparency and the commitment we have made at

1040
00:59:18,185 --> 00:59:20,025
San Juan Basin. I'm trying to think if

1041
00:59:20,025 --> 00:59:23,130
there's anything else in here. Let's get you

1042
00:59:23,130 --> 00:59:25,450
want to cut we'll just run through down

1043
00:59:25,450 --> 00:59:29,930
it. Our 2023 budget priorities, I think this

1044
00:59:29,930 --> 00:59:33,290
is probably important because if we're looking for

1045
00:59:33,290 --> 00:59:38,285
continuity to ensure that both counties, if moving

1046
00:59:38,285 --> 00:59:42,204
to single county agencies, really want to build

1047
00:59:42,204 --> 00:59:44,605
on the success of San Juan Basin. And

1048
00:59:44,605 --> 00:59:45,964
we do have to say, I mean, Juan

1049
00:59:45,964 --> 00:59:50,470
Basin is, we offer a robust suite of

1050
00:59:50,470 --> 00:59:53,910
services. The average health department in The US

1051
00:59:53,910 --> 00:59:57,670
that serves 50,000 to 100,000 residents has between

1052
00:59:57,670 --> 01:00:00,150
twenty eight and thirty eight employees and has

1053
01:00:00,150 --> 01:00:03,270
a much smaller offering of programs and services.

1054
01:00:03,875 --> 01:00:07,555
So we have, in addition to our obligations,

1055
01:00:07,555 --> 01:00:10,434
really worked to bring additional programs to give

1056
01:00:10,434 --> 01:00:13,635
families the bright start in life. And we're

1057
01:00:13,635 --> 01:00:16,740
very proud of that work. So in our

1058
01:00:16,740 --> 01:00:20,340
2023 proposed budget priorities, we really proposed to

1059
01:00:20,340 --> 01:00:23,060
our Board of Health kind of continuing in

1060
01:00:23,060 --> 01:00:25,860
that vein. And so, these were our budget

1061
01:00:25,860 --> 01:00:31,994
priorities in 2023. And actually, I think I

1062
01:00:31,994 --> 01:00:34,474
will go through these. Was obviously retaining and

1063
01:00:34,474 --> 01:00:36,395
recruiting staff. I think everyone's aware that there's

1064
01:00:36,395 --> 01:00:38,795
workforce issues in government and in all kinds

1065
01:00:38,795 --> 01:00:41,755
of sectors right now, especially in places where

1066
01:00:42,234 --> 01:00:45,560
we are seeing the cost of living outpace

1067
01:00:45,560 --> 01:00:47,640
the wages, which I think we're all challenged

1068
01:00:47,640 --> 01:00:50,360
within Colorado. So we are especially in these

1069
01:00:50,360 --> 01:00:52,440
beautiful mountain towns. So we had made that

1070
01:00:52,440 --> 01:00:56,200
a '23 priority. We also worked through some

1071
01:00:56,200 --> 01:00:58,994
of our steady state programs, because many of

1072
01:00:58,994 --> 01:01:01,315
our steady state programs did not get. I

1073
01:01:01,315 --> 01:01:02,835
mean, just going to be perfectly honest, they

1074
01:01:02,835 --> 01:01:05,075
didn't get the attention that they needed over

1075
01:01:05,075 --> 01:01:07,075
the course of pandemic. So it was a

1076
01:01:07,075 --> 01:01:10,115
redoubling of efforts around our steady state programs

1077
01:01:10,700 --> 01:01:13,180
and then working to have an ability to

1078
01:01:13,180 --> 01:01:16,779
scale our communicable disease response efforts. So we

1079
01:01:16,779 --> 01:01:20,539
do like tremendous partnership work with Pagosa Springs

1080
01:01:20,539 --> 01:01:24,065
Medical Center, for example, in disease. But as

1081
01:01:24,065 --> 01:01:27,025
we know, these are unpredictable when we have

1082
01:01:27,025 --> 01:01:32,704
a response demands more resources to when it

1083
01:01:32,704 --> 01:01:35,105
doesn't. So we need the flexibility there. So

1084
01:01:35,105 --> 01:01:37,345
that was part of our 'twenty three budget

1085
01:01:37,345 --> 01:01:40,210
priorities. And then working through some of these

1086
01:01:40,210 --> 01:01:43,329
cross cutting foundational capabilities, which we saw on

1087
01:01:43,329 --> 01:01:47,009
the previous slide, that had been newly introduced

1088
01:01:47,009 --> 01:01:49,890
in 2020. So we also wanted to redouble

1089
01:01:49,890 --> 01:01:53,835
efforts to work through those. And then the

1090
01:01:53,835 --> 01:01:56,075
last bullet is prepare for a successful transition

1091
01:01:56,075 --> 01:01:58,795
from a Mumelzi County local public health to

1092
01:01:58,795 --> 01:02:01,835
single county led departments. So here we are,

1093
01:02:01,835 --> 01:02:04,359
we're tackling the last bullet. So I don't

1094
01:02:04,359 --> 01:02:05,640
know that I need to go into the

1095
01:02:05,640 --> 01:02:07,640
budget in great detail. I just want to

1096
01:02:07,640 --> 01:02:09,400
kind of show you how we've thought about

1097
01:02:09,400 --> 01:02:11,960
the work and then answer any questions you

1098
01:02:11,960 --> 01:02:15,160
all have about kind of how we organize

1099
01:02:15,160 --> 01:02:16,840
and how we could be of service to

1100
01:02:16,840 --> 01:02:20,425
you as you go through this very complex

1101
01:02:20,905 --> 01:02:23,065
set of decisions over the next couple of

1102
01:02:23,065 --> 01:02:28,744
months. And just a verification, we noticed in

1103
01:02:28,744 --> 01:02:31,145
the contracts that we've sent over that June,

1104
01:02:31,145 --> 01:02:34,280
the June, a lot of grant funding, other

1105
01:02:34,280 --> 01:02:37,880
funding expires. Everything. And has the San Juan

1106
01:02:37,880 --> 01:02:42,520
Basin already started requesting funds for the last

1107
01:02:42,520 --> 01:02:46,295
part of the year? So we're not quite

1108
01:02:46,295 --> 01:02:48,375
into the second quarter of the calendar year.

1109
01:02:48,375 --> 01:02:51,255
Okay, so first of all, observation. Things change

1110
01:02:51,255 --> 01:02:53,895
over June 30 to July 1. That is

1111
01:02:53,895 --> 01:02:55,975
because many of the things that we do

1112
01:02:56,135 --> 01:02:58,615
in partnership with the state of Colorado are

1113
01:02:58,615 --> 01:03:01,095
on the state fiscal. This is this tremendous

1114
01:03:01,380 --> 01:03:05,299
wacky problem that the state budgets from July

1115
01:03:05,299 --> 01:03:08,260
to June and counties budget from January to

1116
01:03:08,260 --> 01:03:12,660
December. It makes up It's just another one

1117
01:03:12,660 --> 01:03:15,405
of those things that makes the complexity of

1118
01:03:15,405 --> 01:03:17,725
what we do sometimes off the charts because

1119
01:03:17,725 --> 01:03:19,885
you have to track every one of your

1120
01:03:19,885 --> 01:03:24,845
funding sources, both in the calendar and in

1121
01:03:24,845 --> 01:03:27,565
the state fiscal because you're tracking towards two

1122
01:03:27,565 --> 01:03:32,170
different budgetary allocations. So with that, we often

1123
01:03:32,170 --> 01:03:36,250
start the negotiations for the next, say fiscal,

1124
01:03:36,330 --> 01:03:38,890
the second quarter of the calendar, which is

1125
01:03:38,890 --> 01:03:42,330
the last quarter of the fiscal. So those

1126
01:03:42,330 --> 01:03:46,875
conversations will start in detail April, May, June,

1127
01:03:46,875 --> 01:03:50,635
or July 1 starts. Now that said, we

1128
01:03:50,635 --> 01:03:54,715
have been meeting with CDPHE. We have dozens

1129
01:03:54,715 --> 01:03:58,475
of revenue contracts with CDPHE, and every program

1130
01:03:58,475 --> 01:04:02,750
manager in our organization has been in specific

1131
01:04:02,750 --> 01:04:07,630
contact with their co lead at the CDPHC,

1132
01:04:07,630 --> 01:04:09,630
both on the program side and on the

1133
01:04:09,630 --> 01:04:13,244
fiscal side to determine that San Juan Basins

1134
01:04:13,244 --> 01:04:15,724
contracts will go July 1 to twelvethirty one

1135
01:04:15,724 --> 01:04:18,444
and then January 1 because they won't be

1136
01:04:18,444 --> 01:04:20,684
able to go beyond. They turn into calendar

1137
01:04:20,684 --> 01:04:23,724
year contracts. So they'll go January 1 to

1138
01:04:23,724 --> 01:04:25,805
June 30, that they'll have to work with

1139
01:04:25,805 --> 01:04:30,109
the two counties. So it's likely that some

1140
01:04:30,109 --> 01:04:32,349
of the new funding would bleed into '24

1141
01:04:32,349 --> 01:04:39,150
and then just divide it. San Juan Basin

1142
01:04:39,150 --> 01:04:41,234
won't be able to sign sign into '20

1143
01:04:41,234 --> 01:04:44,674
So when we get the new contracts, they'll

1144
01:04:44,674 --> 01:04:47,234
have to be scopes of work and contracts

1145
01:04:47,234 --> 01:04:52,674
that end twelvethirty But you're absolutely right to

1146
01:04:52,674 --> 01:04:54,434
be thinking about what it looks like in

1147
01:04:54,434 --> 01:04:59,920
'24 because what's also happening in second quarter

1148
01:05:00,480 --> 01:05:03,760
calendar, which is fourth quarter fiscal, is that's

1149
01:05:03,760 --> 01:05:06,160
when the state legislature is making decisions. And

1150
01:05:06,720 --> 01:05:09,119
if they make decisions that look exactly the

1151
01:05:09,119 --> 01:05:11,655
same from the prior year, that there won't

1152
01:05:11,655 --> 01:05:14,215
be enough money for the single county agencies

1153
01:05:14,215 --> 01:05:17,495
to each do their thing. So this conversation

1154
01:05:17,495 --> 01:05:20,135
has been happening at the state level for

1155
01:05:20,135 --> 01:05:22,935
quite some time because they have to adjust

1156
01:05:23,230 --> 01:05:27,470
their budgeting on their side to accommodate the

1157
01:05:27,470 --> 01:05:33,470
changes that we're making here. Bell Ann was

1158
01:05:33,470 --> 01:05:35,885
here last week, which gave me a lot

1159
01:05:35,885 --> 01:05:37,964
of comfort. Oh good. I thought she was

1160
01:05:37,964 --> 01:05:42,365
very good, but to follow-up Kathy's question, it's

1161
01:05:42,365 --> 01:05:45,085
my understanding that, like you just said, this

1162
01:05:45,085 --> 01:05:47,484
will go through twelvethirty one and then the

1163
01:05:47,484 --> 01:05:50,910
next six months, Does Archuleta County need to

1164
01:05:50,910 --> 01:05:54,190
be ready in that September, October timeframe, just

1165
01:05:54,190 --> 01:05:56,910
to follow-up with at least what I understood

1166
01:05:56,910 --> 01:06:00,990
from Bel Air. We have to notify the

1167
01:06:00,990 --> 01:06:04,214
state for the funding of the six months

1168
01:06:04,214 --> 01:06:08,135
in '24. Yes. We'll be going different. Yes.

1169
01:06:08,214 --> 01:06:11,015
Yes. You will all need to both single

1170
01:06:11,015 --> 01:06:14,775
county agencies will need to be in communication

1171
01:06:14,775 --> 01:06:18,110
with CDPG. And quite frankly, I think it's

1172
01:06:18,110 --> 01:06:20,670
preferable to be in communication April, May, and

1173
01:06:20,670 --> 01:06:24,190
June rather than September, October, because this is

1174
01:06:24,190 --> 01:06:27,070
when the decisions are made for the state

1175
01:06:27,070 --> 01:06:31,390
fiscal. State fiscal goes July 1 to June

1176
01:06:31,390 --> 01:06:33,925
'20 '4. Now that may feel to you

1177
01:06:33,925 --> 01:06:36,244
all and I think both counties feel like,

1178
01:06:36,244 --> 01:06:38,805
okay, well then we can negotiate for January

1179
01:06:39,125 --> 01:06:40,964
at the end of this year, but those

1180
01:06:40,964 --> 01:06:44,724
decisions are made. Yeah, because they're made up

1181
01:06:44,724 --> 01:06:54,170
through the state legislative budgeting process. This is

1182
01:06:54,170 --> 01:06:56,329
why Derek left because I am long winded.

1183
01:06:56,569 --> 01:06:59,050
But I try to really think about like

1184
01:06:59,130 --> 01:07:01,450
where the question's coming from. And so if

1185
01:07:01,450 --> 01:07:03,845
I'm giving you more information than you need,

1186
01:07:03,845 --> 01:07:05,365
know, cut me off, but I'm trying to

1187
01:07:05,365 --> 01:07:07,285
really draw the picture of how all the

1188
01:07:07,285 --> 01:07:10,085
pieces fit together because it's not as easy

1189
01:07:10,085 --> 01:07:14,964
as it looks. Thank you. Looks. Does it

1190
01:07:14,964 --> 01:07:22,339
look easy? Okay. Nothing is easy. Have two

1191
01:07:22,339 --> 01:07:31,595
other questions. One is, as a citizen, looking

1192
01:07:31,595 --> 01:07:33,994
back at your public health department that you've

1193
01:07:33,994 --> 01:07:37,674
led for a long time, what gaps do

1194
01:07:37,674 --> 01:07:40,474
you see that affect regards on the county?

1195
01:07:43,210 --> 01:07:46,090
I think it's a great question. We do

1196
01:07:46,090 --> 01:07:49,850
a community health assessment and we work through

1197
01:07:49,850 --> 01:07:52,570
a public health improvement plan and that came

1198
01:07:52,570 --> 01:07:55,370
into feeding in the 02/2008 Public Health Act,

1199
01:07:55,370 --> 01:07:57,855
right? But what didn't come into being, let

1200
01:07:57,855 --> 01:08:00,575
me backtrack for a second. Public health is

1201
01:08:00,575 --> 01:08:04,415
funded, not just in Colorado, but really everywhere

1202
01:08:04,415 --> 01:08:08,640
in very siloed pots of money that don't

1203
01:08:08,640 --> 01:08:11,839
touch each other and don't integrate well. And

1204
01:08:11,839 --> 01:08:14,880
so it leaves it kind of stultified and

1205
01:08:14,880 --> 01:08:17,679
not really nimble to meet community need as

1206
01:08:17,679 --> 01:08:21,055
community need emerges because we are kind of

1207
01:08:21,055 --> 01:08:23,295
stuck with And the other problem is, and

1208
01:08:23,295 --> 01:08:24,895
there's been a lot being written about this

1209
01:08:24,895 --> 01:08:27,774
now post pandemic, is that oftentimes the funding

1210
01:08:27,774 --> 01:08:33,375
is asynchronous to the largest need in a

1211
01:08:33,375 --> 01:08:35,774
community. So if we look at, even if

1212
01:08:35,774 --> 01:08:40,520
we like any type of communicable disease, it's

1213
01:08:40,520 --> 01:08:43,160
gonna have an exponential growth and then there's

1214
01:08:43,160 --> 01:08:45,399
gonna be some work to contain and bring

1215
01:08:45,399 --> 01:08:48,120
it back and then the funding follows because

1216
01:08:48,120 --> 01:08:51,885
then we have congressional decision making, state decision

1217
01:08:51,885 --> 01:08:54,524
making, and then local government. So we end

1218
01:08:54,524 --> 01:08:57,564
up with very siloed pots of money and

1219
01:08:57,564 --> 01:09:00,524
often at the wrong time for the The

1220
01:09:00,524 --> 01:09:02,684
need. That we're having at the time. So

1221
01:09:02,684 --> 01:09:05,040
we have to have that baseline. So then

1222
01:09:05,040 --> 01:09:08,080
in 02/2008, based on the Public Health Act,

1223
01:09:08,080 --> 01:09:12,399
we are asked to do public health needs

1224
01:09:12,399 --> 01:09:15,280
assessments in communities and write public health improvement

1225
01:09:15,280 --> 01:09:18,484
plans. But what's interesting about that legislation is

1226
01:09:18,484 --> 01:09:20,405
that it required that side of it, but

1227
01:09:20,405 --> 01:09:23,765
it didn't free up any non committed, non

1228
01:09:23,765 --> 01:09:26,085
restricted dollars. So if you go into a

1229
01:09:26,085 --> 01:09:28,725
community and determine, you know, the largest need

1230
01:09:28,725 --> 01:09:33,060
in this community is more quality early childhood

1231
01:09:33,060 --> 01:09:36,260
education because that's what sets kids up for

1232
01:09:36,260 --> 01:09:39,380
the healthiest life that we can have, greatest

1233
01:09:39,380 --> 01:09:42,100
potential of health going forward. And we live

1234
01:09:42,100 --> 01:09:45,005
in a childcare desert, and that's something that

1235
01:09:45,005 --> 01:09:46,685
we want to contribute to on the public

1236
01:09:46,685 --> 01:09:49,404
health side, that would be something a community

1237
01:09:49,404 --> 01:09:52,925
may discover into a community health assessment and

1238
01:09:52,925 --> 01:09:56,050
public health improvement plan. No money followed. So

1239
01:09:56,050 --> 01:09:58,929
what was legislated was the assessment and the

1240
01:09:58,929 --> 01:10:01,090
plan, and then you're kind of on your

1241
01:10:01,090 --> 01:10:03,650
own to go seek funding for it. So

1242
01:10:03,650 --> 01:10:06,130
when you say what needs do we see,

1243
01:10:06,370 --> 01:10:09,409
we see needs everywhere. We see room and

1244
01:10:09,409 --> 01:10:12,975
opportunity to do early child, to do family

1245
01:10:12,975 --> 01:10:21,775
formation, to have more resources for substance use,

1246
01:10:22,335 --> 01:10:26,440
children. There's lots of interest right now, I

1247
01:10:26,440 --> 01:10:28,119
think a lot of this is post pandemic,

1248
01:10:28,119 --> 01:10:31,800
is we're having a crisis of school age

1249
01:10:31,800 --> 01:10:35,239
mental health, young adult mental health. So prevention

1250
01:10:35,239 --> 01:10:39,239
programs, that realm, we have had some significant

1251
01:10:39,755 --> 01:10:43,275
suicide clusters in Archuleta and in the Plaquette

1252
01:10:43,275 --> 01:10:47,274
County. But again, with that asynchronous categorized funding,

1253
01:10:47,355 --> 01:10:51,195
identifying it in the community health assessment and

1254
01:10:51,195 --> 01:10:54,130
public health treatment plan does not create a

1255
01:10:54,130 --> 01:10:56,450
straightforward path number addressing it in the community.

1256
01:10:56,450 --> 01:11:03,090
Are block grants available for those types of

1257
01:11:03,170 --> 01:11:07,445
needs? The answer is sometimes, right? I mean,

1258
01:11:07,445 --> 01:11:10,645
is when everything is kind of pieced out,

1259
01:11:10,965 --> 01:11:14,165
then the answer and I mean, pieced out,

1260
01:11:14,165 --> 01:11:16,885
like pieced out that kind of when everything

1261
01:11:16,885 --> 01:11:21,850
is in small funding streams, I can't answer

1262
01:11:21,850 --> 01:11:25,450
that in what, yes. Money becomes available, sometimes

1263
01:11:25,450 --> 01:11:32,489
it doesn't. We're seeing in Southwest Colorado currently,

1264
01:11:32,570 --> 01:11:36,085
we're seeing a resurgence of sexually transmitted infections

1265
01:11:36,085 --> 01:11:39,284
and syphilis, and we're seeing syphilis in pregnant

1266
01:11:39,284 --> 01:11:42,244
women, right? This is such a public health

1267
01:11:42,244 --> 01:11:45,764
story that because we saw such a suppression

1268
01:11:45,764 --> 01:11:49,670
of these infections for decades with good public

1269
01:11:49,670 --> 01:11:52,790
health, then the funding moved on to other

1270
01:11:53,190 --> 01:11:56,470
things that seemed more pressing and the virus

1271
01:11:56,470 --> 01:12:00,790
or the bacterias don't go okay because the

1272
01:12:00,790 --> 01:12:02,710
funding in our eyes have gone other places.

1273
01:12:03,195 --> 01:12:06,954
And so we have providers diagnosing diseases today

1274
01:12:07,114 --> 01:12:09,275
that they haven't seen. They read about it

1275
01:12:09,275 --> 01:12:11,834
in medical school that nobody had actually seen

1276
01:12:12,074 --> 01:12:15,514
and we're seeing this. Southwest Colorado has some

1277
01:12:15,514 --> 01:12:21,080
high rates of pathogens related to sexual transmission

1278
01:12:21,080 --> 01:12:23,960
as well as substance use disorder. We're seeing

1279
01:12:23,960 --> 01:12:26,999
this kind of step up together and we

1280
01:12:27,239 --> 01:12:30,280
aren't prepared for it and this is not,

1281
01:12:30,280 --> 01:12:32,120
we're not unique. This is a kind of

1282
01:12:32,120 --> 01:12:35,315
rural Colorado problem and a rural problem all

1283
01:12:35,315 --> 01:12:37,715
across the country. So the issue that we

1284
01:12:37,715 --> 01:12:40,195
suffer from is when we cut up our

1285
01:12:40,195 --> 01:12:42,835
funding and only give it to what is

1286
01:12:42,835 --> 01:12:45,635
happening now, we lose track of things we've

1287
01:12:45,635 --> 01:12:48,400
been successful with and they come back and

1288
01:12:48,400 --> 01:12:51,440
then they come back more expensively. That is

1289
01:12:51,440 --> 01:12:53,920
the difficulty of what we do with public

1290
01:12:53,920 --> 01:12:56,320
health. So the things we can do are

1291
01:12:56,320 --> 01:12:59,600
huge and endless, but the things we're funded

1292
01:12:59,600 --> 01:13:04,145
for are often very specific. Sorry, Andrea. No,

1293
01:13:04,225 --> 01:13:06,385
was just gonna ask about, so it kind

1294
01:13:06,385 --> 01:13:09,265
of sounds like an iceberg, right? So, you've

1295
01:13:09,265 --> 01:13:11,745
got above the waterline or kind of the

1296
01:13:11,745 --> 01:13:13,520
nice to, I don't wanna say nice to

1297
01:13:13,520 --> 01:13:15,680
have public health programs, but kind of things

1298
01:13:15,680 --> 01:13:19,600
that have discretionary funding attached. Underneath that waterline

1299
01:13:19,600 --> 01:13:21,040
is stuff that we need to figure out

1300
01:13:21,040 --> 01:13:22,800
how to have a base level of funding

1301
01:13:22,800 --> 01:13:25,600
for no matter what. And so that's maybe

1302
01:13:25,600 --> 01:13:28,695
from local dollars. Are there other sources that

1303
01:13:28,695 --> 01:13:31,175
you've seen around the state that people looked

1304
01:13:31,175 --> 01:13:33,495
into some kind of, so if it's not

1305
01:13:33,495 --> 01:13:36,135
state or federal, is there a local like

1306
01:13:36,295 --> 01:13:39,095
for property tax or is there some funding

1307
01:13:39,095 --> 01:13:41,255
source that you're aware of that some communities

1308
01:13:41,255 --> 01:13:47,039
have? So the county contribution that's required by

1309
01:13:47,039 --> 01:13:49,360
law, think presumably if it comes out of

1310
01:13:49,360 --> 01:13:52,400
the county, covers is likely coming from property

1311
01:13:52,400 --> 01:13:57,635
tax. I haven't seen public health have a

1312
01:13:57,635 --> 01:14:02,195
specific public health mill, but there are hospital

1313
01:14:02,195 --> 01:14:05,475
districts and health districts and there are in

1314
01:14:05,475 --> 01:14:10,755
some places, health districts that have relationships with

1315
01:14:10,755 --> 01:14:15,610
community health in addition to supporting hospitals. And

1316
01:14:15,610 --> 01:14:18,650
I don't have, you may have, I don't

1317
01:14:18,650 --> 01:14:21,290
know the whole interplay between, I think there's

1318
01:14:21,290 --> 01:14:24,010
designations, there's a hospital district and a health

1319
01:14:24,010 --> 01:14:26,250
district and there are some different rules or

1320
01:14:26,250 --> 01:14:28,655
there, I actually don't know the special district

1321
01:14:28,655 --> 01:14:32,335
rules on that. Right. Yeah, I mean, are

1322
01:14:32,335 --> 01:14:34,975
a special district health district. We receive, you

1323
01:14:34,975 --> 01:14:38,495
know, funding from our county from the mill

1324
01:14:38,495 --> 01:14:42,000
levy on million dollars a year, which is

1325
01:14:42,000 --> 01:14:45,600
two weeks of operation Which is right. Is

1326
01:14:45,600 --> 01:14:47,120
it because of the spread? But that is

1327
01:14:47,120 --> 01:14:50,160
the fact and yeah. I'm not in any

1328
01:14:50,160 --> 01:14:52,239
way presuming that that's where the answer is.

1329
01:14:52,800 --> 01:14:55,120
Of the communities there have seen some different

1330
01:14:56,935 --> 01:14:59,895
commitments made with health districts if they have

1331
01:14:59,895 --> 01:15:02,055
the broader, but it would depend on one.

1332
01:15:02,055 --> 01:15:03,415
And I think there's, I can only think

1333
01:15:03,415 --> 01:15:06,535
of two in Colorado that have gone that

1334
01:15:06,535 --> 01:15:09,960
route where the health district, but it doesn't

1335
01:15:09,960 --> 01:15:12,840
actually support the local public health agency, it

1336
01:15:12,840 --> 01:15:16,679
supports community health programs outside of the public

1337
01:15:16,680 --> 01:15:19,160
health agency. But there are two that do

1338
01:15:19,160 --> 01:15:21,080
that and they have probably a much higher

1339
01:15:21,335 --> 01:15:24,455
male or a large right. So I hear

1340
01:15:24,455 --> 01:15:26,135
what you're saying it sounds like you're very

1341
01:15:26,135 --> 01:15:29,015
wary of kind of chasing these different funding

1342
01:15:29,015 --> 01:15:30,695
pots because then you kind of take your

1343
01:15:30,695 --> 01:15:34,375
eye off of the basic level of services

1344
01:15:34,455 --> 01:15:37,520
that may reflect the true need in the

1345
01:15:37,520 --> 01:15:43,440
community. It's just really underfunded, correct? Yes, I

1346
01:15:43,440 --> 01:15:48,160
mean, there's some, I was just reading a

1347
01:15:48,160 --> 01:15:51,594
study over the weekend that says 50% of

1348
01:15:51,594 --> 01:15:56,235
the work from '2, after the two thousand

1349
01:15:56,235 --> 01:15:58,635
and eight recession that to where we are

1350
01:15:58,635 --> 01:16:01,355
today is 50% of the workforce we had,

1351
01:16:01,355 --> 01:16:03,755
because that's where things really changed. And the

1352
01:16:03,755 --> 01:16:05,989
reason that they changed is there was this

1353
01:16:05,989 --> 01:16:10,789
idea that if we had more access to

1354
01:16:11,830 --> 01:16:15,190
health insurance, then we would need less safety

1355
01:16:15,190 --> 01:16:18,230
net of care. And so there were cuts,

1356
01:16:18,230 --> 01:16:19,910
there was actually supposed to be part of

1357
01:16:19,910 --> 01:16:21,885
the Affordable Care Act was supposed to have

1358
01:16:21,885 --> 01:16:24,765
a dedicated public health funding stream. That funding

1359
01:16:24,765 --> 01:16:27,965
stream at the federal level has not come

1360
01:16:27,965 --> 01:16:30,925
to fruition. That money has gone other places.

1361
01:16:31,245 --> 01:16:35,179
So without that dedicated funding stream, there has

1362
01:16:35,179 --> 01:16:39,340
just been a real backsliding in what's available

1363
01:16:39,340 --> 01:16:46,380
in most local communities. So, what is the

1364
01:16:46,380 --> 01:16:51,435
likelihood that we could resolve our differences and

1365
01:16:51,915 --> 01:16:55,915
stay in the district? That was a good

1366
01:16:55,915 --> 01:16:58,875
question. And you're directing that question to me.

1367
01:17:05,230 --> 01:17:07,630
Well, I'll answer a different question. I will

1368
01:17:07,630 --> 01:17:09,790
say that San Juan Basin Public Health has

1369
01:17:09,790 --> 01:17:14,830
obviously since 1948 worked to provide services to

1370
01:17:15,150 --> 01:17:19,675
multiple counties in Southwest Colorado. We're very proud

1371
01:17:19,675 --> 01:17:23,355
of the work that we've done. I'm unbelievably

1372
01:17:23,355 --> 01:17:26,395
proud and impressed with the staff that we

1373
01:17:26,395 --> 01:17:29,355
have. We have a staff that just turns

1374
01:17:29,355 --> 01:17:32,640
themselves inside out when there's a call to

1375
01:17:32,640 --> 01:17:35,600
action to create something or get something done

1376
01:17:35,600 --> 01:17:41,040
in a community. And I very much enjoy

1377
01:17:41,360 --> 01:17:45,920
the ability to work with such tremendously committed

1378
01:17:45,920 --> 01:17:48,915
staff and would love to see how we

1379
01:17:48,915 --> 01:17:56,435
can continue that. So I feel like a

1380
01:17:56,435 --> 01:17:58,835
lot of these questions have been budgetary. I

1381
01:17:58,835 --> 01:18:01,555
think more programmatically. Sure. I just have a

1382
01:18:01,555 --> 01:18:04,099
couple you know when it comes to like

1383
01:18:04,099 --> 01:18:06,980
some of our top three sort of mortality

1384
01:18:06,980 --> 01:18:09,540
issues right so like heart disease, diabetes, cancer

1385
01:18:09,540 --> 01:18:12,340
like what are the prevention programming you guys

1386
01:18:12,340 --> 01:18:14,900
are currently sort of involved in? I feel

1387
01:18:14,900 --> 01:18:16,500
like you know some of those things like

1388
01:18:16,500 --> 01:18:18,420
we need to be ready and in place

1389
01:18:18,420 --> 01:18:23,635
to sort of in lieu of reconciling that

1390
01:18:24,755 --> 01:18:26,355
our health department needs to be ready to

1391
01:18:26,355 --> 01:18:28,434
take on in some form. So can you

1392
01:18:28,434 --> 01:18:30,355
describe what some of those are looking like

1393
01:18:30,355 --> 01:18:32,195
currently for you guys or how you're addressing

1394
01:18:32,195 --> 01:18:33,969
some of those things? Yeah, and it depends

1395
01:18:33,969 --> 01:18:35,409
on if you wanna look at that from

1396
01:18:35,409 --> 01:18:38,849
like a primary, secondary or tertiary prevention model.

1397
01:18:38,850 --> 01:18:41,409
And since now that you have said that

1398
01:18:41,409 --> 01:18:42,770
you have an Miles hour, I figured I

1399
01:18:42,770 --> 01:18:44,210
might as well just go with that, right?

1400
01:18:44,210 --> 01:18:46,105
Or we're doing, because a lot of times

1401
01:18:46,105 --> 01:18:48,824
what you see in rural public health is

1402
01:18:49,065 --> 01:18:52,905
you may be doing some of the screening

1403
01:18:52,905 --> 01:18:55,864
and the early diagnosis. And we at some

1404
01:18:55,864 --> 01:18:58,690
point were was doing that work back in

1405
01:18:58,690 --> 01:19:00,610
the day when there was so much less

1406
01:19:00,610 --> 01:19:03,729
healthcare in Archuleta County, right? When I started,

1407
01:19:04,849 --> 01:19:06,210
oh, so actually I was gonna say when

1408
01:19:06,210 --> 01:19:08,050
I started in public health, but it's when

1409
01:19:08,050 --> 01:19:09,489
I started in public health, I was working

1410
01:19:09,489 --> 01:19:11,889
in domestic violence and sexual assault and working

1411
01:19:11,889 --> 01:19:15,105
really closely back with Carmen Hubbs a million

1412
01:19:15,105 --> 01:19:18,385
years ago and the only healthcare in Archuleta

1413
01:19:18,385 --> 01:19:19,745
County was the, I think it was called

1414
01:19:19,745 --> 01:19:21,745
the Mary Fisher Clinic and I never for

1415
01:19:21,745 --> 01:19:24,305
some reason don't know the story of who

1416
01:19:24,305 --> 01:19:25,985
Mary Fisher was and how she had a

1417
01:19:25,985 --> 01:19:27,310
clinic made better but I would love to

1418
01:19:27,310 --> 01:19:32,750
know the story someday. So at that point,

1419
01:19:32,750 --> 01:19:35,150
local public health is doing more of the

1420
01:19:35,150 --> 01:19:38,590
early intervention screening and diagnosis, but we've had

1421
01:19:38,590 --> 01:19:42,735
a tremendous growth and proliferation of healthcare. Know,

1422
01:19:42,735 --> 01:19:44,895
Cagosa Springs Medical Center has a rural health

1423
01:19:44,895 --> 01:19:47,695
clinic, there are some special designations there about

1424
01:19:47,695 --> 01:19:50,975
how rural health clinics serve populations. There's other

1425
01:19:50,975 --> 01:19:55,110
inputs into the healthcare realm. So at that

1426
01:19:55,110 --> 01:19:57,990
point, we shifted our work into care coordination

1427
01:19:57,990 --> 01:20:01,270
and patient navigation because it doesn't make sense

1428
01:20:01,510 --> 01:20:05,430
that we replicate what's available in healthcare. So

1429
01:20:05,430 --> 01:20:07,815
then that gives us the ability, and this

1430
01:20:07,815 --> 01:20:09,895
is where I think the ACA by putting

1431
01:20:09,895 --> 01:20:13,735
the funding towards public health and then having

1432
01:20:13,735 --> 01:20:16,055
it never come to fruition is where things

1433
01:20:16,055 --> 01:20:18,695
went like this, right? We get people health

1434
01:20:18,695 --> 01:20:22,860
insurance, we get more early screenings, diagnosis, more

1435
01:20:22,860 --> 01:20:26,540
early intervention, we should see some improvement. But

1436
01:20:26,540 --> 01:20:29,420
then how do we go further upstream and

1437
01:20:29,420 --> 01:20:32,219
figure out what is making people think, right?

1438
01:20:32,219 --> 01:20:35,685
So, you know, it's the early childhood nutrition

1439
01:20:35,685 --> 01:20:39,925
programs, it's the family formation, the earlier intervention.

1440
01:20:39,925 --> 01:20:42,644
A lot of what becomes your health as

1441
01:20:42,724 --> 01:20:45,445
an adult happens when you're zero to two

1442
01:20:45,445 --> 01:20:48,560
years old in your family environment. So we

1443
01:20:48,560 --> 01:20:54,239
focus on more programs for early family formation.

1444
01:20:54,560 --> 01:20:56,960
And then we should see the benefit of

1445
01:20:56,960 --> 01:20:59,840
that decades out, right? Is that easy to

1446
01:20:59,840 --> 01:21:03,085
measure? Is that easy to talk about? Absolutely,

1447
01:21:03,325 --> 01:21:07,885
positively not. But that's the best we can

1448
01:21:07,885 --> 01:21:12,045
do that for heart disease, different, I mean,

1449
01:21:12,045 --> 01:21:15,869
cancers are tracked to our early childhood, then

1450
01:21:16,110 --> 01:21:18,429
there's environmental inputs, right? So what are we

1451
01:21:18,429 --> 01:21:19,949
doing? One of the things we're working on

1452
01:21:19,949 --> 01:21:22,750
right now is, I'm gonna like knock on

1453
01:21:22,750 --> 01:21:26,989
wood, wildfire events, we are learning so much

1454
01:21:26,989 --> 01:21:29,605
more about what the exposure from the PM

1455
01:21:29,605 --> 01:21:32,965
2.5 and wildfires focus. So we just went

1456
01:21:32,965 --> 01:21:37,285
to a national foundation and got some funding

1457
01:21:37,285 --> 01:21:39,685
for a pilot program for clean air shelters

1458
01:21:39,685 --> 01:21:41,925
because we know that we live in communities

1459
01:21:41,925 --> 01:21:44,860
where people don't have no reason to have

1460
01:21:44,860 --> 01:21:47,740
a sophisticated HVAC when you live in mountain

1461
01:21:47,740 --> 01:21:50,300
communities with mountain reasons, right? Well, then you

1462
01:21:50,300 --> 01:21:51,820
have wildfires and you have no way to

1463
01:21:51,820 --> 01:21:54,380
keep your indoor air clean. So we're looking

1464
01:21:54,380 --> 01:21:57,340
at piloting some programs with clean air shelters

1465
01:21:57,420 --> 01:22:00,835
because we're finding things like the PM 2.5

1466
01:22:00,835 --> 01:22:04,515
in wildfire smoke is that much more damaging

1467
01:22:04,755 --> 01:22:06,995
than the PM 2.5 that we're exposed to

1468
01:22:06,995 --> 01:22:10,435
all the time, right? So we're working through

1469
01:22:10,435 --> 01:22:13,795
piloting things like that because of the communities

1470
01:22:13,795 --> 01:22:16,230
that we live in. There aren't examples in

1471
01:22:16,230 --> 01:22:19,510
Colorado Clean Air Shelters for Wildfire. This is

1472
01:22:19,510 --> 01:22:22,550
an idea that we heard was piloted in

1473
01:22:22,550 --> 01:22:24,469
California. We said we want to bring that

1474
01:22:24,469 --> 01:22:28,389
to Colorado. We're one of only five organizations

1475
01:22:28,389 --> 01:22:32,515
in the country that received this public private

1476
01:22:32,515 --> 01:22:36,515
partnership, high living money from Devotemont Foundation. So

1477
01:22:36,515 --> 01:22:38,595
we'll do those types of things. And we

1478
01:22:38,595 --> 01:22:40,195
say, how do I, if I have an

1479
01:22:40,195 --> 01:22:42,035
idea, how do I get it funded? We

1480
01:22:42,035 --> 01:22:43,715
write it down, we shop it, we try

1481
01:22:43,715 --> 01:22:46,730
to leverage relationships. And if it's got some

1482
01:22:46,730 --> 01:22:49,930
hook that it's new, it's different, then we

1483
01:22:49,930 --> 01:22:52,970
can maybe get it piloted because there's not

1484
01:22:52,970 --> 01:22:56,090
often the bandwidth to pilot things in rural

1485
01:22:56,090 --> 01:23:02,185
communities. The only other thing I was thinking

1486
01:23:02,185 --> 01:23:04,025
and looking through some of your reports I

1487
01:23:04,025 --> 01:23:05,945
don't see and I could have just missed

1488
01:23:05,945 --> 01:23:11,865
it in the piles of documents. I was

1489
01:23:11,865 --> 01:23:14,425
just curious about the breakdown of like the

1490
01:23:14,425 --> 01:23:16,780
services and like the number of people that

1491
01:23:16,780 --> 01:23:19,500
are accessing those in Archuleta versus La Plata.

1492
01:23:19,500 --> 01:23:21,900
I see the big numbers and again it's

1493
01:23:21,900 --> 01:23:24,700
probably similar but I haven't seen it so

1494
01:23:24,700 --> 01:23:25,980
I don't know Mary if you know where

1495
01:23:25,980 --> 01:23:27,500
it is that you can tell me or

1496
01:23:27,500 --> 01:23:28,715
if you know what it might be called

1497
01:23:28,715 --> 01:23:32,875
Leanne. When we talked last week, you mentioned

1498
01:23:32,875 --> 01:23:34,955
an incentive to me, which I did share

1499
01:23:34,955 --> 01:23:36,715
with the board chair. I haven't shared with

1500
01:23:36,715 --> 01:23:37,995
the committee just because I was gonna bring

1501
01:23:37,995 --> 01:23:41,970
it up today, but Archuleta County, the investigative

1502
01:23:41,970 --> 01:23:46,290
study committee received that information in 2021. So

1503
01:23:46,290 --> 01:23:50,130
they received it broken down by it does

1504
01:23:50,130 --> 01:23:54,195
help understand not fully funded requires agency contribution

1505
01:23:54,195 --> 01:23:57,155
not fully funded, not fully post medical funding.

1506
01:23:57,315 --> 01:23:59,795
And it talks about 8% of clients serve

1507
01:23:59,795 --> 01:24:02,514
result in our society for each of the

1508
01:24:02,514 --> 01:24:05,554
pillars. So they range from eight to 36%

1509
01:24:05,554 --> 01:24:08,435
depending on the program. So what so is

1510
01:24:08,435 --> 01:24:10,590
there a total number? I'm just like, how

1511
01:24:10,590 --> 01:24:13,150
many people, right? 8% is all fine and

1512
01:24:13,150 --> 01:24:15,869
great until it's one person or two people.

1513
01:24:18,590 --> 01:24:21,070
As you guys move through this process, we

1514
01:24:21,070 --> 01:24:25,885
can share more detailed information. Most of us,

1515
01:24:25,885 --> 01:24:30,765
so we have, there was a lot of

1516
01:24:30,765 --> 01:24:33,165
question about how much money do you spend

1517
01:24:33,165 --> 01:24:35,900
in one county versus the other county. And

1518
01:24:35,900 --> 01:24:39,820
we were charged with serving a jurisdiction. So

1519
01:24:39,820 --> 01:24:42,380
we didn't have our staff members and all

1520
01:24:42,380 --> 01:24:45,099
of our budgeting track time between how you

1521
01:24:45,099 --> 01:24:47,985
know, like, you know, would I, you know,

1522
01:24:47,985 --> 01:24:49,745
fill out my time with you differently, because

1523
01:24:49,745 --> 01:24:51,425
I came over here, you know, it's just

1524
01:24:51,425 --> 01:24:54,784
like we weren't having on the expense side,

1525
01:24:55,025 --> 01:24:57,665
that type of tracking, because it wasn't required

1526
01:24:57,665 --> 01:25:00,144
because we were funded to serve the jurisdiction.

1527
01:25:00,625 --> 01:25:03,860
On the programmatic side, we of course have

1528
01:25:03,860 --> 01:25:07,940
lots of data around 36% of our WIC

1529
01:25:07,940 --> 01:25:13,460
clients reside in Archuleta County versus 64% residing

1530
01:25:13,460 --> 01:25:16,580
in La Plata County. And the nurse family

1531
01:25:16,580 --> 01:25:21,645
partnership, it's 30% in Archuleta versus 70%. In

1532
01:25:21,645 --> 01:25:24,765
SafeCare, was SafeCare was actually a program that

1533
01:25:24,765 --> 01:25:26,925
we picked up that the Archuleta County Human

1534
01:25:26,925 --> 01:25:30,285
Services Director at the time really asked us,

1535
01:25:30,285 --> 01:25:32,125
can you pick this program up because it's

1536
01:25:32,125 --> 01:25:34,030
going away from our community? So we had

1537
01:25:34,030 --> 01:25:37,949
an over representation there. Then in other programs,

1538
01:25:37,949 --> 01:25:43,150
it's not twentyeighty, it's tenninety, right? So we

1539
01:25:43,150 --> 01:25:46,270
have that information. And as you guys get

1540
01:25:46,270 --> 01:25:50,275
further down this, I think that some of

1541
01:25:50,275 --> 01:25:54,035
that information should be in the contract documents.

1542
01:25:54,115 --> 01:25:56,915
If it's not, we can start giving you

1543
01:25:56,915 --> 01:26:00,355
estimates around that work because I would be

1544
01:26:00,355 --> 01:26:04,840
interested in it prior to 'twenty. Right? Like

1545
01:26:04,840 --> 01:26:08,760
historically, what did it look like? Right. You

1546
01:26:08,760 --> 01:26:10,280
know, I mean, there were also lots of

1547
01:26:10,280 --> 01:26:11,960
programs, and I don't know if there's a

1548
01:26:11,960 --> 01:26:14,440
way to connect around, you know, what was

1549
01:26:14,440 --> 01:26:16,675
offered out of the Eighth Street Building and

1550
01:26:16,675 --> 01:26:18,595
when and how some of those went away.

1551
01:26:18,595 --> 01:26:19,955
I know a lot of it's related to

1552
01:26:19,955 --> 01:26:22,755
like grants go away, right, but I think

1553
01:26:22,755 --> 01:26:25,155
it would be interesting to see like historically

1554
01:26:25,155 --> 01:26:27,155
some of those services and like the funding

1555
01:26:27,155 --> 01:26:30,369
streams and like when they went away because

1556
01:26:30,369 --> 01:26:32,130
I think what I'm hearing from the community

1557
01:26:32,130 --> 01:26:33,969
is they remember some of those things and

1558
01:26:33,969 --> 01:26:35,889
they really want some of those things but

1559
01:26:35,889 --> 01:26:38,210
historically being able to then have an answer

1560
01:26:38,210 --> 01:26:40,849
to say there's no funding streams. That was

1561
01:26:40,849 --> 01:26:43,725
funded by X, X is morphed into Y.

1562
01:26:43,725 --> 01:26:45,245
And a lot of that would be changes

1563
01:26:45,245 --> 01:26:48,045
with the Affordable Care Act, which has allowed

1564
01:26:48,285 --> 01:26:51,485
the program. You can't have the level of

1565
01:26:51,485 --> 01:26:57,150
health care without a pay source community members.

1566
01:26:57,150 --> 01:26:59,949
And now that that got passed, have, but

1567
01:26:59,949 --> 01:27:03,309
then some of the changes to say, what

1568
01:27:03,309 --> 01:27:04,829
did it look like before pandemic and what

1569
01:27:04,829 --> 01:27:06,590
did it look like after? I'll also say

1570
01:27:06,590 --> 01:27:09,469
pandemic sort of distorted everything because there were

1571
01:27:09,469 --> 01:27:12,085
things like, you know, WIC is one of

1572
01:27:12,085 --> 01:27:14,085
our high volumes programs and WIC is a

1573
01:27:14,085 --> 01:27:18,965
great program. Well, we saw WIC numbers, we

1574
01:27:18,965 --> 01:27:21,685
saw some declining WIC numbers before the pandemic,

1575
01:27:21,685 --> 01:27:23,925
we saw some increased WIC numbers during the

1576
01:27:23,925 --> 01:27:27,180
pandemic. Now that the SNAP benefits are being

1577
01:27:27,180 --> 01:27:28,860
wound back with the end of the public

1578
01:27:28,860 --> 01:27:31,260
health emergency, we expect to see more WIC

1579
01:27:31,260 --> 01:27:37,020
enrollment rates. So there's nothing in our building

1580
01:27:37,020 --> 01:27:38,795
that's not touched in some way by the

1581
01:27:38,795 --> 01:27:42,955
pandemic. We can absolutely give the kinds of

1582
01:27:42,955 --> 01:27:47,755
numbers. Yep. Great. Would y'all be interested in

1583
01:27:47,755 --> 01:27:51,240
seeing what the investigative committee was presented to

1584
01:27:51,240 --> 01:27:53,720
them in October 21? Is that in their

1585
01:27:53,720 --> 01:27:56,440
document? It was not in the docus. Yes,

1586
01:27:57,000 --> 01:28:00,200
do not understand the three. Oh, That'd be

1587
01:28:00,200 --> 01:28:03,720
great. It's again, it just it was what

1588
01:28:03,720 --> 01:28:06,244
they heard from them. So I think we

1589
01:28:06,244 --> 01:28:10,644
ought to know what that was. They did

1590
01:28:10,885 --> 01:28:15,685
guide the commissioners. So it says thirty to

1591
01:28:15,685 --> 01:28:18,485
thirty five percent of communicable disease investigations are

1592
01:28:18,485 --> 01:28:20,244
in Archuleta County, then you're gonna say, how

1593
01:28:20,244 --> 01:28:22,920
many do you think so? I have some

1594
01:28:22,920 --> 01:28:25,800
of that information, 20% of sexual health and

1595
01:28:25,800 --> 01:28:31,800
cancer prevention is here, 25% of environmental is

1596
01:28:31,800 --> 01:28:38,095
here, 30% of on-site inspections, and 33% of

1597
01:28:38,095 --> 01:28:41,455
septic permits were Archuleta County. I mean, I

1598
01:28:41,455 --> 01:28:43,615
just think it helps speak to staffing, know,

1599
01:28:43,615 --> 01:28:45,615
if there's a hundred WIC clients but that's

1600
01:28:45,615 --> 01:28:47,855
only 20% because there's so many in La

1601
01:28:47,855 --> 01:28:49,900
Plata, right, that tells us something about how

1602
01:28:49,900 --> 01:28:52,460
many people we need to run a program

1603
01:28:52,700 --> 01:28:55,740
versus the percentage. I understand why the report

1604
01:28:55,740 --> 01:28:57,660
percentages that you guys are looking at dollars.

1605
01:28:57,660 --> 01:28:59,660
Well, if we have the numbers someplace else,

1606
01:28:59,660 --> 01:29:01,980
right? You that's not they're never in some

1607
01:29:01,980 --> 01:29:04,015
place. Right? Right. But you know, you know,

1608
01:29:04,015 --> 01:29:06,494
but I think that it's helpful just because,

1609
01:29:07,295 --> 01:29:08,735
you know, when we're trying to think about

1610
01:29:08,735 --> 01:29:12,335
how how to staff departments, you know, if

1611
01:29:12,335 --> 01:29:14,735
there's five, then how does this one person

1612
01:29:14,735 --> 01:29:17,280
maybe wear three hats versus in, you know,

1613
01:29:17,280 --> 01:29:20,480
La Plata, maybe that person served a whole

1614
01:29:20,480 --> 01:29:23,040
lot because Well, on that April, May and

1615
01:29:23,040 --> 01:29:25,679
June activity that we discussed when we should

1616
01:29:25,679 --> 01:29:28,159
be visiting with the state and I'm saying,

1617
01:29:28,159 --> 01:29:30,079
you know, last quarter of the state fiscal

1618
01:29:30,079 --> 01:29:32,525
or second quarter of the calendar is also

1619
01:29:32,525 --> 01:29:35,325
where that information comes from because the state

1620
01:29:35,325 --> 01:29:39,245
will say, We're funding you at this level

1621
01:29:39,245 --> 01:29:45,005
because our demographic information is that the size

1622
01:29:45,005 --> 01:29:48,500
of the target population is X, the uptake

1623
01:29:48,500 --> 01:29:51,460
of that program is Y, so we expect

1624
01:29:51,460 --> 01:29:55,060
your client load to look like Z, so

1625
01:29:55,060 --> 01:29:57,380
that has to be staffed at this FTE

1626
01:29:57,380 --> 01:29:59,540
level, right? And that's why you want to

1627
01:29:59,540 --> 01:30:02,180
be doing this with the state April, May,

1628
01:30:02,180 --> 01:30:04,465
and June. The other complication, which I'm just

1629
01:30:04,465 --> 01:30:06,065
going to throw out there, I think this

1630
01:30:06,065 --> 01:30:07,185
one's going to be kind of hard to

1631
01:30:07,185 --> 01:30:09,825
hear because none of this is fun, but

1632
01:30:09,825 --> 01:30:12,545
some of the programs at the state, they're

1633
01:30:12,545 --> 01:30:14,705
not going to want to chop it to

1634
01:30:14,705 --> 01:30:19,420
too small program, right? So at the metro

1635
01:30:19,420 --> 01:30:22,700
region where Tri County Tri County made steps

1636
01:30:22,700 --> 01:30:24,620
towards breaking up, and I think that sort

1637
01:30:24,620 --> 01:30:28,220
of emboldened some decision making about other health

1638
01:30:28,220 --> 01:30:31,500
districts breaking up, they are serving millions of

1639
01:30:31,500 --> 01:30:33,500
people at Tri County. So when they break

1640
01:30:33,500 --> 01:30:36,665
up into Douglas Adams and Arapahoe, the state

1641
01:30:36,665 --> 01:30:39,784
contracting side will take one contract and contract

1642
01:30:39,784 --> 01:30:43,465
three times. It triples their administrative burden, but

1643
01:30:43,465 --> 01:30:46,025
it serves millions of people. We have to

1644
01:30:46,025 --> 01:30:49,580
remember for fifty six thousand and 14000 is

1645
01:30:49,580 --> 01:30:54,060
the state realistically going to double its administrative

1646
01:30:54,060 --> 01:30:57,260
burden for that small number of people? And

1647
01:30:57,260 --> 01:30:59,900
again, this is why I highly encourage that

1648
01:30:59,900 --> 01:31:05,034
these conversations cannot wait until third and fourth

1649
01:31:05,034 --> 01:31:08,395
quarter of the calendar, which is at the

1650
01:31:08,395 --> 01:31:10,474
Tri County, a lot of those conversations happen

1651
01:31:10,474 --> 01:31:12,875
third and fourth quarter, but you're dealing with

1652
01:31:12,875 --> 01:31:15,355
larger numbers of people, there's going to be

1653
01:31:15,355 --> 01:31:18,780
more negotiations for smaller numbers of people. So

1654
01:31:18,780 --> 01:31:23,500
based on your work with the state what

1655
01:31:23,500 --> 01:31:27,179
is our best move and ideally who should

1656
01:31:27,179 --> 01:31:29,500
be having those conversations if we haven't hired

1657
01:31:29,500 --> 01:31:31,615
a director yet in order to get us

1658
01:31:31,615 --> 01:31:34,015
into this ballgame and start thinking through those

1659
01:31:34,015 --> 01:31:36,415
things so that especially as we're thinking about

1660
01:31:36,415 --> 01:31:40,255
programming and staffing, know, mean, do we sit

1661
01:31:40,255 --> 01:31:42,255
on those with you guys as you're like,

1662
01:31:42,255 --> 01:31:44,910
right? Are we all in those together because

1663
01:31:44,910 --> 01:31:46,670
you guys are doing the first half of

1664
01:31:46,670 --> 01:31:48,350
the fiscal year? Like it just seems like

1665
01:31:48,350 --> 01:31:51,470
it's convoluted. You may not know but no

1666
01:31:51,470 --> 01:31:54,350
and we introduced your conversation when we're negotiating

1667
01:31:54,350 --> 01:31:56,830
for the second half of this calendar year

1668
01:31:56,830 --> 01:32:00,344
but I think the sooner that, so if

1669
01:32:00,344 --> 01:32:03,145
there's, if I don't know what the timeline

1670
01:32:03,145 --> 01:32:08,505
is for completing that recruitment and search, but

1671
01:32:08,505 --> 01:32:11,864
the sooner that that happens, then there's a

1672
01:32:11,864 --> 01:32:15,340
person who can start having those conversations. And

1673
01:32:15,340 --> 01:32:17,260
it's with direction and input from you all

1674
01:32:17,260 --> 01:32:19,260
about which programs in what order and how

1675
01:32:19,260 --> 01:32:21,340
do we prioritize this. We're trying to get

1676
01:32:21,340 --> 01:32:23,420
you all the information so you can figure

1677
01:32:23,420 --> 01:32:25,420
out how to prioritize it. And I think

1678
01:32:25,420 --> 01:32:28,905
your questions about numbers served is hugely important

1679
01:32:28,905 --> 01:32:30,505
and we'll be happy to work on that,

1680
01:32:30,505 --> 01:32:33,065
but also that's going to come from these

1681
01:32:33,065 --> 01:32:39,465
negotiations by the state. How many people are

1682
01:32:39,465 --> 01:32:42,025
currently in your funding department of San Juan

1683
01:32:42,025 --> 01:32:44,040
based Mill? How many people work on that

1684
01:32:44,040 --> 01:32:51,239
process? We have an assessment and planning that

1685
01:32:51,880 --> 01:32:55,000
has three staff members that support all of

1686
01:32:55,000 --> 01:32:58,224
the program managers. So we have that skill

1687
01:32:58,224 --> 01:33:03,024
set diffused across the programs. So if you,

1688
01:33:03,985 --> 01:33:08,144
what's your favorite thing in public health? Early

1689
01:33:08,144 --> 01:33:10,810
child. Okay, perfect. So if you're working in

1690
01:33:10,810 --> 01:33:13,690
early childhood and you say, I really want

1691
01:33:13,850 --> 01:33:17,690
this early childhood nutrition, this is my dream,

1692
01:33:17,690 --> 01:33:20,730
I want this. So you are more likely

1693
01:33:20,730 --> 01:33:25,014
than our data and our assessment and planning

1694
01:33:25,014 --> 01:33:27,655
team to come across opportunities. When you come

1695
01:33:27,655 --> 01:33:30,295
across an opportunity, you as the subject matter

1696
01:33:30,295 --> 01:33:33,014
expert on our staff can seek support from

1697
01:33:33,014 --> 01:33:35,815
our assessment and planning team, but you are

1698
01:33:35,815 --> 01:33:38,855
the subject matter expert in bringing in funding

1699
01:33:39,320 --> 01:33:42,280
to your department, which is sometimes a little

1700
01:33:42,280 --> 01:33:46,840
bit different than how other organizations are set

1701
01:33:46,840 --> 01:33:50,200
up. But we, because there's such diversity of

1702
01:33:50,200 --> 01:33:53,640
the programming, we have every program manager and

1703
01:33:53,640 --> 01:33:57,525
every division director with expertise in seeking funding

1704
01:33:57,525 --> 01:34:00,405
to sustain their programs. That's so valuable. And

1705
01:34:00,405 --> 01:34:02,405
that's going to be something extremely hard for

1706
01:34:02,405 --> 01:34:10,460
us to do. I've got an Just curious

1707
01:34:10,460 --> 01:34:14,140
there, Kathy asked a tough question reconciling. I

1708
01:34:14,140 --> 01:34:17,659
like that question. Is there a possibility where

1709
01:34:17,659 --> 01:34:21,020
Archuleta could work with La Plata in that

1710
01:34:21,020 --> 01:34:26,695
role? Going forward? The funding? To work together

1711
01:34:26,695 --> 01:34:31,495
on funding? Well, or to contract with La

1712
01:34:31,495 --> 01:34:34,215
Plata to help with that if we can

1713
01:34:34,695 --> 01:34:37,895
pull that together. So I can only speak

1714
01:34:37,895 --> 01:34:39,735
for San Juan Basin, I can't speak for

1715
01:34:39,735 --> 01:34:42,590
any county, but some of the question I

1716
01:34:42,590 --> 01:34:44,349
can put on the table is like, you

1717
01:34:44,349 --> 01:34:47,070
know, kind of the how's, how do we

1718
01:34:47,070 --> 01:34:48,750
start, know, we know what the what's are,

1719
01:34:48,750 --> 01:34:50,590
we want to figure out what our programs

1720
01:34:50,590 --> 01:34:55,495
are, and we want to get them, get

1721
01:34:55,495 --> 01:34:57,975
the funding and the delivery mechanism in place.

1722
01:34:58,215 --> 01:35:01,415
Those hows could happen in a variety of

1723
01:35:01,415 --> 01:35:03,815
ways but I can't speak to how La

1724
01:35:03,815 --> 01:35:07,335
Plata County would have been. So are you

1725
01:35:08,535 --> 01:35:13,660
involved with the I think La Plata County

1726
01:35:13,660 --> 01:35:16,860
has already formed the board itself. Yes. Are

1727
01:35:16,860 --> 01:35:21,980
you involved in that? What is the makeup

1728
01:35:21,980 --> 01:35:24,060
of that board? Are there any county commissioners

1729
01:35:24,060 --> 01:35:28,265
on No. They do not have county commissioner

1730
01:35:28,265 --> 01:35:30,665
representation. It's all public people from the community

1731
01:35:30,665 --> 01:35:33,225
and public health people. Seven? Is it five

1732
01:35:33,225 --> 01:35:38,820
percent? Seven. No, something commissioner. Seven. So they're

1733
01:35:38,820 --> 01:35:41,060
looking to hire director I'm assuming and you

1734
01:35:41,060 --> 01:35:42,340
may not know this but are they going

1735
01:35:42,340 --> 01:35:45,860
to report to the county manager or are

1736
01:35:45,860 --> 01:35:47,699
they going to report to the school or

1737
01:35:48,100 --> 01:35:52,985
do you know? They have not released their

1738
01:35:52,985 --> 01:35:55,625
solicitation so once that is released I think

1739
01:35:55,625 --> 01:35:58,105
that will be clear. Okay interesting yeah we

1740
01:35:58,105 --> 01:36:00,425
were just having that conversation earlier about reporting

1741
01:36:00,425 --> 01:36:03,180
structures and stuff like that. When is the

1742
01:36:03,180 --> 01:36:06,540
assessment due or can we finish the new

1743
01:36:06,700 --> 01:36:09,420
assessment that's in The survey is open through

1744
01:36:09,420 --> 01:36:12,300
the first week in April. Okay. This survey

1745
01:36:12,300 --> 01:36:15,955
data is one component. So what's required in

1746
01:36:15,955 --> 01:36:18,915
statute is public health improvement plan. How to

1747
01:36:18,915 --> 01:36:22,435
get to your plan can be things like

1748
01:36:22,435 --> 01:36:25,315
a community health assessment. It can also be

1749
01:36:25,315 --> 01:36:28,195
a survey or an analysis of secondary data,

1750
01:36:29,380 --> 01:36:31,300
or it can be a combination of the

1751
01:36:31,300 --> 01:36:34,340
two. So there is a community health assessment,

1752
01:36:34,580 --> 01:36:37,460
there are also focus groups with specific target

1753
01:36:37,460 --> 01:36:40,820
populations, and there are key informant interviews. All

1754
01:36:40,820 --> 01:36:43,860
of those together will provide quantitative and qualitative

1755
01:36:44,355 --> 01:36:47,235
primary data sources, but then it will be

1756
01:36:47,235 --> 01:36:51,555
synthesized with secondary data sources, which are not

1757
01:36:51,555 --> 01:36:55,235
always complete for small communities like counties of

1758
01:36:55,235 --> 01:36:58,130
14,000 people. So there may be some aggregate

1759
01:36:58,130 --> 01:37:01,730
secondary data that is then used together to

1760
01:37:01,730 --> 01:37:04,369
produce the report. We will be able to

1761
01:37:04,369 --> 01:37:08,849
provide preliminary information on the primary data sources,

1762
01:37:09,010 --> 01:37:11,010
but that takes some time to sift through.

1763
01:37:12,105 --> 01:37:14,985
May and June, we do not intend to

1764
01:37:14,985 --> 01:37:16,505
go public with that. It would be more

1765
01:37:16,505 --> 01:37:19,625
in the summertime as some of the secondary,

1766
01:37:19,625 --> 01:37:22,184
as we're benching it to what we can

1767
01:37:22,985 --> 01:37:26,530
validate through secondary data sources. Because in the

1768
01:37:26,530 --> 01:37:29,810
surveys, we have trouble getting a lot of

1769
01:37:29,810 --> 01:37:31,730
people to respond to them, right? And the

1770
01:37:31,730 --> 01:37:36,770
demographic who uses. Yeah, we have like 1,100

1771
01:37:36,770 --> 01:37:39,490
responses now across the two counties. So as

1772
01:37:39,490 --> 01:37:41,925
long as that has an eightytwenty split, then

1773
01:37:41,925 --> 01:37:44,405
in theory, according to the statisticians we're working

1774
01:37:44,405 --> 01:37:48,085
with, that's statistically valid. But if it over

1775
01:37:48,085 --> 01:37:50,885
represents one group and under represents another group

1776
01:37:50,885 --> 01:37:52,965
or, I mean, we have to be honest,

1777
01:37:52,965 --> 01:37:57,550
like our perceptions don't always match. So if

1778
01:37:57,550 --> 01:38:01,150
we ask people about, how do we achieve

1779
01:38:01,150 --> 01:38:03,869
our highest potential of health, most people will

1780
01:38:03,869 --> 01:38:06,110
immediately go to healthcare and say, well, as

1781
01:38:06,110 --> 01:38:07,949
long as I'm getting my blood pressure screened

1782
01:38:07,949 --> 01:38:12,405
at my healthcare provider, then I'm tackling, addressing

1783
01:38:12,405 --> 01:38:15,685
this need without actually saying, but what we

1784
01:38:15,685 --> 01:38:18,245
find is things that we do in other

1785
01:38:18,245 --> 01:38:22,245
socioeconomic decisions have outsized impact on our heart

1786
01:38:22,245 --> 01:38:25,310
health, right? And that's why we don't simply

1787
01:38:25,310 --> 01:38:29,310
rely on the community responses. We bench it

1788
01:38:29,310 --> 01:38:34,270
to secondary data and evidence based programming in

1789
01:38:34,270 --> 01:38:36,990
communities because we want to tie up the

1790
01:38:36,990 --> 01:38:41,534
pieces together more comprehensive. I had a question

1791
01:38:41,534 --> 01:38:44,335
about the emergency prepared response and it's not

1792
01:38:44,335 --> 01:38:46,974
well formulated in my brain so bear with

1793
01:38:46,974 --> 01:38:50,094
me here but I understand you had a

1794
01:38:50,094 --> 01:38:53,940
group of people, employees that actually were assigned

1795
01:38:53,940 --> 01:38:56,980
that role and it may be the same

1796
01:38:56,980 --> 01:39:00,340
answer to Kathy's but I see this emergency

1797
01:39:00,340 --> 01:39:02,980
preparedness preparedness as a thread that every program

1798
01:39:02,980 --> 01:39:06,095
is responsible for So, it the same relationship

1799
01:39:06,095 --> 01:39:08,415
where the program director of each of these

1800
01:39:09,695 --> 01:39:13,855
services It's a both end. So, we have

1801
01:39:13,855 --> 01:39:15,535
just like we have an assessment and planning

1802
01:39:15,535 --> 01:39:17,855
team that can support program managers to get

1803
01:39:17,855 --> 01:39:20,300
their grant applications out the door or do

1804
01:39:20,300 --> 01:39:23,340
the research. We have a, in this case,

1805
01:39:23,340 --> 01:39:27,420
we have a state funded emergency preparedness and

1806
01:39:27,420 --> 01:39:32,619
response team. And then that they work to

1807
01:39:32,619 --> 01:39:36,145
prepare each department. So when we talk about

1808
01:39:36,145 --> 01:39:39,745
emergency response, some emergency response can be your

1809
01:39:39,745 --> 01:39:43,825
continuity of operations if there's a event in

1810
01:39:43,825 --> 01:39:46,945
your community that doesn't allow your agency to

1811
01:39:46,945 --> 01:39:49,530
perform its duties, right? But then some of

1812
01:39:49,530 --> 01:39:52,250
it beyond that then is also serving the

1813
01:39:52,250 --> 01:39:54,889
community. So if we talk about like a

1814
01:39:55,050 --> 01:39:58,650
wildfire event or flooding event or an emergency

1815
01:39:58,650 --> 01:40:01,290
communicable disease event, but what we did with

1816
01:40:01,290 --> 01:40:03,849
the COVID response, because so many other things

1817
01:40:03,849 --> 01:40:06,304
once we started having stay at home orders

1818
01:40:06,304 --> 01:40:08,625
so many other programs were no longer in

1819
01:40:08,625 --> 01:40:10,945
effect so we created a new org chart

1820
01:40:10,945 --> 01:40:13,905
and moved everyone from their steady state role

1821
01:40:14,065 --> 01:40:17,505
into their emergency response role at the early

1822
01:40:17,505 --> 01:40:20,400
part of the pandemic. So I'm wondering how

1823
01:40:20,400 --> 01:40:23,520
that works with contracts. Suppose we contract for

1824
01:40:23,520 --> 01:40:27,920
an agency here to provide immunizations, who's going

1825
01:40:27,920 --> 01:40:31,120
to lead that effort to if another communicable

1826
01:40:31,120 --> 01:40:34,255
disease pandemic came down? Okay, so what you're

1827
01:40:34,255 --> 01:40:37,295
asking is if you parse out pieces in

1828
01:40:37,295 --> 01:40:39,535
the community, but you need to mobilize for

1829
01:40:39,535 --> 01:40:44,095
a public health effort. So I think that

1830
01:40:44,335 --> 01:40:46,815
it's much more seamless if it's within the

1831
01:40:46,815 --> 01:40:49,215
organization, if it is parsed out and you

1832
01:40:49,215 --> 01:40:52,010
would need to mobilize external to the organization,

1833
01:40:52,250 --> 01:40:54,170
it would have to be something that's addressed

1834
01:40:54,170 --> 01:41:00,409
in the contracting at the front side. Okay,

1835
01:41:00,409 --> 01:41:03,625
that helps. I haven't seen a model like

1836
01:41:03,625 --> 01:41:05,864
that but I'm assuming you know that there

1837
01:41:05,864 --> 01:41:08,905
would be a model like that. But you're

1838
01:41:08,905 --> 01:41:10,745
saying how would you step up quickly to

1839
01:41:10,745 --> 01:41:13,624
address a conflict? Well yeah step up and

1840
01:41:13,625 --> 01:41:15,465
also have somebody that's in charge of it

1841
01:41:15,465 --> 01:41:18,440
who's thinking ahead of the game and on

1842
01:41:18,440 --> 01:41:19,880
top of it you know looking at the

1843
01:41:19,880 --> 01:41:22,440
data coming down from CDC and so forth.

1844
01:41:23,000 --> 01:41:25,000
Not waiting to the last oh my gosh

1845
01:41:25,000 --> 01:41:26,760
we need to get people who are going

1846
01:41:26,760 --> 01:41:32,535
to give injections you know. Thank you. No,

1847
01:41:32,535 --> 01:41:37,015
that's a great question. So we kind of

1848
01:41:37,015 --> 01:41:43,360
divvied up our areas of research. And one

1849
01:41:43,360 --> 01:41:45,280
of the areas that Suzanne and I are

1850
01:41:45,280 --> 01:41:48,480
looking at is environmental health. And would it

1851
01:41:48,480 --> 01:41:52,240
be okay if we contacted Brian or maybe

1852
01:41:52,240 --> 01:41:53,840
other members of the staff if we had

1853
01:41:53,840 --> 01:41:57,175
specific questions about staffing levels of programs, things

1854
01:41:57,175 --> 01:41:59,975
like that. We have a single point of

1855
01:41:59,975 --> 01:42:03,655
contact within our agency for transition questions. Oh

1856
01:42:03,655 --> 01:42:05,655
okay. Because it's just we so you know

1857
01:42:05,655 --> 01:42:08,295
with healthy communication with everyone's talking to everybody

1858
01:42:08,295 --> 01:42:10,054
but we're going with hub and spoke here

1859
01:42:10,110 --> 01:42:12,429
because we've addressed a lot of pieces that

1860
01:42:12,429 --> 01:42:15,070
can be duplicated. So the single point of

1861
01:42:15,070 --> 01:42:17,070
contact for whatever you've been assigned to will

1862
01:42:17,070 --> 01:42:19,389
be Sherry Dugdale, who will then get it

1863
01:42:19,389 --> 01:42:22,590
out in the organization and all of the

1864
01:42:22,590 --> 01:42:24,285
questions because what we'll do is we'll put

1865
01:42:24,285 --> 01:42:26,605
the answer probably in the Dropbox and then

1866
01:42:26,605 --> 01:42:29,405
other people will have access to it. So

1867
01:42:29,405 --> 01:42:31,725
I totally understand like I know you know

1868
01:42:31,725 --> 01:42:33,245
Brian, you have a great relationship. You're like,

1869
01:42:33,245 --> 01:42:34,925
hey Brian, how does this work? I'm going

1870
01:42:34,925 --> 01:42:36,445
to ask that you go through Sherry and

1871
01:42:36,445 --> 01:42:38,365
Sherry and an Alex. Okay. I will get

1872
01:42:38,365 --> 01:42:42,150
her. It's just because I feel like the

1873
01:42:42,150 --> 01:42:43,829
volume of work that we might be doing

1874
01:42:43,829 --> 01:42:46,070
together for the next ten months might be

1875
01:42:46,630 --> 01:42:52,565
kind of prohibitive to allow for relaxed. So

1876
01:42:52,565 --> 01:42:53,845
we're just going to go with this very

1877
01:42:53,845 --> 01:42:55,685
stringent got to go through the single credit

1878
01:42:55,685 --> 01:42:59,365
cost. So the independent consultant that you had

1879
01:42:59,365 --> 01:43:01,765
that came in and did the presented you

1880
01:43:01,765 --> 01:43:04,645
with the results, how accurate do you feel

1881
01:43:04,645 --> 01:43:08,699
that is and Which consultant ought to be

1882
01:43:08,699 --> 01:43:09,659
or how do you sit on top of

1883
01:43:09,659 --> 01:43:13,340
I always was in La Plata County. Oh,

1884
01:43:13,340 --> 01:43:17,179
that's La Plata, yes. That's right. Yes. If

1885
01:43:17,179 --> 01:43:19,980
you're asking if it comports with my experience

1886
01:43:20,405 --> 01:43:23,045
as a local public health agency, I would

1887
01:43:23,045 --> 01:43:28,245
say many components of that do comport with

1888
01:43:28,245 --> 01:43:31,605
our experience. There may be some details that

1889
01:43:31,605 --> 01:43:34,485
we would have come to a different conclusion

1890
01:43:35,040 --> 01:43:40,880
because there is such kind of arcane details

1891
01:43:41,600 --> 01:43:43,920
around how we put the money in to

1892
01:43:43,920 --> 01:43:48,240
make it all work. Do you feel that

1893
01:43:48,240 --> 01:43:53,885
you are understaffed, overstaffed at San Juan Basin?

1894
01:43:55,965 --> 01:43:59,005
Because I think the things that we can

1895
01:43:59,005 --> 01:44:01,324
do in public health and the ways that

1896
01:44:01,324 --> 01:44:04,940
we can improve well-being and protect health are

1897
01:44:04,940 --> 01:44:08,220
so vast that I think there's always room

1898
01:44:08,220 --> 01:44:11,580
to go in more direction. And then I

1899
01:44:11,580 --> 01:44:15,180
think to Sally, right, to Sally's point, if

1900
01:44:15,180 --> 01:44:18,220
we had more programs and services, because there

1901
01:44:18,220 --> 01:44:19,954
are so many ways that we can improve

1902
01:44:19,954 --> 01:44:23,554
health for residents of any place in America,

1903
01:44:23,875 --> 01:44:26,835
then when we're faced with the whether it's

1904
01:44:26,835 --> 01:44:30,994
highly pathogenic avian flu or we're faced with

1905
01:44:31,155 --> 01:44:35,130
another, God, let's not think about another coronavirus

1906
01:44:35,130 --> 01:44:37,930
we're faced with, the more programs and services,

1907
01:44:37,930 --> 01:44:41,290
the more nimble you are to then respond.

1908
01:44:41,690 --> 01:44:44,010
And the other ability you have is to

1909
01:44:44,170 --> 01:44:47,955
catch things earlier as they are, you know,

1910
01:44:47,955 --> 01:44:50,515
come roaring back, right? So like, if we

1911
01:44:50,515 --> 01:44:53,555
use the example of syphilis coming back in

1912
01:44:53,555 --> 01:44:55,795
parts of the country where we're starting to

1913
01:44:55,795 --> 01:44:59,155
see, you know, children be born with eyesight

1914
01:44:59,155 --> 01:45:02,460
issues, which we haven't seen in generations, right

1915
01:45:02,460 --> 01:45:04,780
the sooner that you if you have more

1916
01:45:04,780 --> 01:45:08,220
staff programming to move into other things the

1917
01:45:08,220 --> 01:45:10,380
more you can touch up in the most

1918
01:45:10,380 --> 01:45:15,420
space. Did you have there's a program in

1919
01:45:15,420 --> 01:45:18,575
the somewhere that I read your references a

1920
01:45:18,575 --> 01:45:22,975
volunteer medical course did that activate during the

1921
01:45:22,975 --> 01:45:25,295
pandemic did you get volunteers from it? We

1922
01:45:25,295 --> 01:45:28,495
did yes we had tremendous numbers of volunteers.

1923
01:45:28,495 --> 01:45:30,095
Do you happen to know if that happened

1924
01:45:30,095 --> 01:45:34,770
here? Yes yes yep Yep, across the jurisdiction.

1925
01:45:34,930 --> 01:45:37,890
Wow, love it. Heard about that. There was

1926
01:45:37,890 --> 01:45:40,050
a reaction that was bad here. Bruce spoke

1927
01:45:40,050 --> 01:45:43,490
at our last meeting who said that she

1928
01:45:43,490 --> 01:45:47,065
feels that's a need in Archuleta County is

1929
01:45:47,065 --> 01:45:49,864
getting, it's like almost home health, right? Getting

1930
01:45:49,864 --> 01:45:52,585
whether they're volunteer or paid, but people who

1931
01:45:52,585 --> 01:45:56,025
can actually go to people's homes and provide

1932
01:45:56,505 --> 01:45:59,225
services. We can't really be so intimidated about

1933
01:45:59,225 --> 01:46:02,480
that. Very specific. Here are the rules and

1934
01:46:02,480 --> 01:46:07,120
regulations. Very specific. I mean, all that. That

1935
01:46:07,120 --> 01:46:09,199
is not something that we want to do.

1936
01:46:10,000 --> 01:46:15,445
Medications for oxygen and other durable medical equipment.

1937
01:46:15,445 --> 01:46:17,365
Again, that's what they were asking for at

1938
01:46:17,365 --> 01:46:21,445
that last meeting. But that is not within

1939
01:46:21,445 --> 01:46:29,620
the scope of public health. Mean, the home

1940
01:46:29,620 --> 01:46:32,659
health desk services. I think, you know, they

1941
01:46:32,659 --> 01:46:36,100
were referring to oxygen and blah blah blah.

1942
01:46:36,100 --> 01:46:38,100
And I don't, but who provides that in

1943
01:46:38,100 --> 01:46:40,985
our community? Mercy. We have really good response

1944
01:46:40,985 --> 01:46:44,585
from public. Do we? I guess it's a

1945
01:46:44,585 --> 01:46:47,625
whole branch. It's not only are we really

1946
01:46:47,625 --> 01:46:49,865
siloed within public health of what we do,

1947
01:46:50,360 --> 01:46:52,840
but then all of public health and healthcare

1948
01:46:52,840 --> 01:46:55,480
is really siloed. So if we were to

1949
01:46:55,480 --> 01:46:58,360
step into home health, we would have to

1950
01:46:58,360 --> 01:47:00,760
comport with all. And so, and HIBES did

1951
01:47:00,760 --> 01:47:03,400
public health in some rural communities with home

1952
01:47:03,400 --> 01:47:07,375
health, Yes, and they held federal contracts. Over

1953
01:47:07,375 --> 01:47:10,494
time, again, this is going with the evolution

1954
01:47:10,495 --> 01:47:14,255
of once you have more healthcare available in

1955
01:47:14,255 --> 01:47:20,130
a community, including home health, including long term

1956
01:47:20,130 --> 01:47:23,730
care facilities, then what the public health agency

1957
01:47:23,730 --> 01:47:26,370
does is different and starts to be more

1958
01:47:26,370 --> 01:47:31,265
upstream because we don't step on other, But

1959
01:47:31,265 --> 01:47:33,265
if those things don't exist, then there's a

1960
01:47:33,265 --> 01:47:36,065
whole different conversation. They exist now. Sounds like

1961
01:47:36,065 --> 01:47:39,265
that there were community members here who did

1962
01:47:39,265 --> 01:47:42,145
not have access to home health, didn't know

1963
01:47:42,145 --> 01:47:45,120
how to access it or they were they

1964
01:47:45,120 --> 01:47:49,040
homebound or whatever. Yeah, you don't really know,

1965
01:47:50,160 --> 01:47:52,640
from a point of view of who provides

1966
01:47:52,640 --> 01:47:55,840
home health care, it is through Mercy, they

1967
01:47:55,840 --> 01:47:58,400
have an office that they rent from a

1968
01:47:58,400 --> 01:48:01,495
building that we own on our campus. And

1969
01:48:01,495 --> 01:48:04,375
then they come and the response I get

1970
01:48:04,375 --> 01:48:07,255
from my Swenwick Rural Health Center and Hospital

1971
01:48:07,255 --> 01:48:10,135
program is that they are quick to respond

1972
01:48:10,135 --> 01:48:12,855
and very helpful but obviously somehow in our

1973
01:48:12,855 --> 01:48:16,969
community we're missing some people that didn't have

1974
01:48:16,969 --> 01:48:19,210
that access. I mean, and that makes sense.

1975
01:48:19,210 --> 01:48:22,330
And then there's community connections, has the contract

1976
01:48:22,330 --> 01:48:25,610
for options for long term care, which is

1977
01:48:25,610 --> 01:48:29,530
how people that are either on Medicaid or

1978
01:48:29,530 --> 01:48:34,195
Medicare or both have personal care and this

1979
01:48:34,195 --> 01:48:37,075
is different than skilled nursing. It's how they

1980
01:48:37,075 --> 01:48:40,355
have personal care to remain in their health

1981
01:48:40,355 --> 01:48:43,155
but once we're in oxygen then we're in

1982
01:48:43,155 --> 01:48:48,030
skilled nursing. I don't believe that personal care,

1983
01:48:48,030 --> 01:48:51,630
but personal care for folks that want to

1984
01:48:51,630 --> 01:48:54,270
remain at home is through the Community Connection

1985
01:48:54,270 --> 01:48:57,310
Single Entry Point Program. So that's the other

1986
01:48:57,310 --> 01:48:59,230
thing, I mean, and that's the care coordination

1987
01:48:59,230 --> 01:49:00,885
piece is having the map in your brain

1988
01:49:00,885 --> 01:49:03,364
of how to operate because it's sort of

1989
01:49:03,765 --> 01:49:06,405
mind numbing that this is not a design

1990
01:49:06,405 --> 01:49:09,525
system. This is a system that's grown organically

1991
01:49:09,525 --> 01:49:12,405
in a million different ways. And then any

1992
01:49:12,405 --> 01:49:15,605
individual is trying to navigate something that makes

1993
01:49:15,605 --> 01:49:18,460
no sense, because no one would design it.

1994
01:49:18,700 --> 01:49:22,140
That's right. I'm not 100% sure about that.

1995
01:49:22,140 --> 01:49:23,900
So what does it look like for you

1996
01:49:23,900 --> 01:49:27,260
guys with, like, there a reporting structure where

1997
01:49:27,260 --> 01:49:30,700
you're sort of learning these pieces from our

1998
01:49:30,700 --> 01:49:33,534
different partners, So from the hospital and from

1999
01:49:33,534 --> 01:49:36,655
the urgent care and from Archuleta Integrated, like

2000
01:49:36,655 --> 01:49:39,374
how does that look for the health department?

2001
01:49:39,775 --> 01:49:41,455
Is there a way that they report to

2002
01:49:41,455 --> 01:49:44,469
different things? Is it just about you know,

2003
01:49:44,469 --> 01:49:46,310
some of those like diseases that are coming

2004
01:49:46,310 --> 01:49:49,030
forward? Like what is that? Well, I think

2005
01:49:49,030 --> 01:49:51,110
depending on what type of programming we're talking

2006
01:49:51,110 --> 01:49:53,349
about, so if talking about an infectious disease,

2007
01:49:54,310 --> 01:49:58,565
then there's required reporting from healthcare to the

2008
01:49:58,565 --> 01:50:01,525
public health discipline. Some things are, you know,

2009
01:50:01,525 --> 01:50:03,605
in different timelines and when these happen to

2010
01:50:03,605 --> 01:50:05,125
be reported. And does that report to those

2011
01:50:05,125 --> 01:50:06,965
like the local health departments? Is that for

2012
01:50:06,965 --> 01:50:08,805
the state health And then back down by

2013
01:50:08,805 --> 01:50:10,885
law, it's both, which is very confusing. Again,

2014
01:50:10,885 --> 01:50:13,310
it's not the design system. Nobody would design

2015
01:50:13,310 --> 01:50:15,550
a system that way. But healthcare has to

2016
01:50:15,550 --> 01:50:19,630
report local and state, and then has, you

2017
01:50:19,630 --> 01:50:21,310
know, it's best to just do both because

2018
01:50:21,310 --> 01:50:23,230
it's hard to tell where, right. But then

2019
01:50:23,230 --> 01:50:26,815
in environmental issues, if there's a spill, that's

2020
01:50:26,815 --> 01:50:29,855
going to hit surface water, or if there's

2021
01:50:29,855 --> 01:50:32,094
an issue with the discharge permit, then there's

2022
01:50:32,094 --> 01:50:34,255
that has to be reported to the environmental

2023
01:50:34,255 --> 01:50:37,614
side of the state health department, then either

2024
01:50:37,614 --> 01:50:39,820
it gets kicked to us or it's in

2025
01:50:39,820 --> 01:50:42,219
their regulatory framework, but we'll go out and

2026
01:50:42,219 --> 01:50:45,340
do a bursary first look to tell them

2027
01:50:45,340 --> 01:50:47,900
what the level of acuteness is and how

2028
01:50:47,900 --> 01:50:50,059
quickly they should get someone on the ground.

2029
01:50:50,219 --> 01:50:52,620
So there's things like that. Then for like

2030
01:50:52,620 --> 01:50:55,179
kind of longer term things like if there's

2031
01:50:55,179 --> 01:50:59,474
a community mental health or substance use or

2032
01:50:59,875 --> 01:51:03,555
a rise in infections and teens or that

2033
01:51:03,555 --> 01:51:05,555
sort of thing, we'll work with a variety

2034
01:51:05,555 --> 01:51:08,970
of community partners. And it's some of it's

2035
01:51:08,970 --> 01:51:11,850
very formal reporting structures, some of it's very

2036
01:51:11,850 --> 01:51:14,890
informal, based on relationships, where do you see,

2037
01:51:14,890 --> 01:51:18,730
you know, where there's collaborative management project, which

2038
01:51:18,730 --> 01:51:22,055
is a required program at human services, or

2039
01:51:22,055 --> 01:51:25,095
teens who need extra help and support, it's

2040
01:51:25,095 --> 01:51:28,375
required that public health serve on that. So

2041
01:51:28,375 --> 01:51:31,175
that's a way that we formally have our

2042
01:51:31,175 --> 01:51:33,015
finger on the pulp of what's going on

2043
01:51:33,015 --> 01:51:35,750
with teens and young adults, but then we're

2044
01:51:35,750 --> 01:51:37,670
serving on that where we have the formal

2045
01:51:37,670 --> 01:51:40,789
relationship, we're always building the informal relationships to

2046
01:51:40,789 --> 01:51:44,469
keep each other in the same conversations. Another

2047
01:51:44,469 --> 01:51:46,469
formal one would be child fatality. I'm trying

2048
01:51:46,469 --> 01:51:48,605
to like separate out between formal and informal.

2049
01:51:48,605 --> 01:51:51,485
Child fatality review teams, that would be places

2050
01:51:51,485 --> 01:51:54,445
where we would identify needs in community and

2051
01:51:54,445 --> 01:51:57,725
then either make suggestions for state policy or

2052
01:51:57,725 --> 01:52:00,660
look at local policy. For average child fatality

2053
01:52:00,660 --> 01:52:03,060
reviews only happened in Denver for the whole

2054
01:52:03,060 --> 01:52:06,660
state about like maybe five or probably about

2055
01:52:06,660 --> 01:52:08,980
five years ago, there was state legislation that

2056
01:52:08,980 --> 01:52:10,740
said, you know, maybe it's the locals looked

2057
01:52:10,740 --> 01:52:13,235
at the child's fatality, there may be some

2058
01:52:13,235 --> 01:52:16,915
local knowledge because how we think about some

2059
01:52:16,915 --> 01:52:18,994
of these things in Denver is different than

2060
01:52:18,994 --> 01:52:20,675
how we think about them on the ground.

2061
01:52:20,675 --> 01:52:23,875
When I'm kind of giving that talk about

2062
01:52:23,875 --> 01:52:26,514
why the child fatality moved from Denver here,

2063
01:52:27,139 --> 01:52:28,820
there may be a place that you know

2064
01:52:28,820 --> 01:52:32,820
is a swimming hole and drownings are a

2065
01:52:32,820 --> 01:52:38,900
very high, what's the word I'm looking for,

2066
01:52:38,900 --> 01:52:40,900
we have high prevalence of drownings, and drownings

2067
01:52:40,900 --> 01:52:43,545
are totally preventable. So, if someone in Denver

2068
01:52:43,545 --> 01:52:46,264
is reading about a child fatality and drowning,

2069
01:52:46,345 --> 01:52:48,505
they may see it very differently than you

2070
01:52:48,505 --> 01:52:50,345
do on the ground because you cannot picture

2071
01:52:50,345 --> 01:52:54,745
exactly where that drowning occurred. So, that has

2072
01:52:54,745 --> 01:52:57,620
become more localized, but it can also turn

2073
01:52:57,620 --> 01:53:00,980
into a larger policy, you know, over larger

2074
01:53:00,980 --> 01:53:09,315
education. So formal and informal and relationships. Any

2075
01:53:09,315 --> 01:53:15,955
more questions? Have a question. Suzanne. Can you

2076
01:53:15,955 --> 01:53:24,120
hear me? Yes. When I was reviewing the

2077
01:53:24,120 --> 01:53:28,680
information under contracts, especially for environmental health or

2078
01:53:28,680 --> 01:53:32,360
environmental services. I wanted to be sure I

2079
01:53:32,360 --> 01:53:36,215
understood how they're using the word credentialed when

2080
01:53:36,215 --> 01:53:41,335
we're looking at our research and it said

2081
01:53:41,335 --> 01:53:44,855
credentialed yes or no. What I first thought

2082
01:53:44,855 --> 01:53:47,974
credentialed was, then I thought maybe that's not

2083
01:53:47,974 --> 01:53:53,020
the definition. Can you tell me what credentialed

2084
01:53:53,020 --> 01:53:59,260
means in the background information? So as we

2085
01:53:59,260 --> 01:54:03,660
went through our program services and how they're

2086
01:54:03,660 --> 01:54:07,595
paid for, we made an internal exercise to

2087
01:54:07,595 --> 01:54:10,475
list of staff what needed to be credentialed

2088
01:54:10,475 --> 01:54:12,955
so that you all, in taking on this

2089
01:54:12,955 --> 01:54:17,835
very complex Byzantine job that you've taken on,

2090
01:54:18,150 --> 01:54:21,830
can start thinking about, if I'm recruiting staffing

2091
01:54:21,830 --> 01:54:24,550
for this, do I need to recruit staff

2092
01:54:24,630 --> 01:54:27,670
with existing credentials? Or is this on the

2093
01:54:27,670 --> 01:54:31,875
job training? So we put notes in each

2094
01:54:31,875 --> 01:54:37,315
contract about that. Our environmental health staff is

2095
01:54:37,315 --> 01:54:40,994
not externally credentialed. It is on the job

2096
01:54:40,994 --> 01:54:44,675
training, but there are best practices and standards

2097
01:54:45,210 --> 01:54:49,450
that one would like to see those individuals

2098
01:54:49,450 --> 01:54:54,810
obtain to perform best practices in community. So

2099
01:54:54,810 --> 01:54:59,805
does externally credential mean licensing? You're a licensed

2100
01:54:59,805 --> 01:55:05,405
registered dietitian, but then internally, so for environmental,

2101
01:55:05,405 --> 01:55:07,725
there's internal training, obviously, on how you would

2102
01:55:07,725 --> 01:55:10,045
inspect a septic and tons of rules and

2103
01:55:10,045 --> 01:55:13,889
regulations. But then on the restaurant side, there's

2104
01:55:13,889 --> 01:55:17,570
internal on the job training to get FDA

2105
01:55:18,849 --> 01:55:21,809
certified. This is where like the word is

2106
01:55:21,809 --> 01:55:29,425
FDA credentialed. That's a good one. And our

2107
01:55:29,425 --> 01:55:32,945
recommendation would be that as you're planning, you

2108
01:55:32,945 --> 01:55:36,465
plan both to bring in externally credentialed staff,

2109
01:55:36,465 --> 01:55:39,170
but also allow enough lead time If you're

2110
01:55:39,170 --> 01:55:41,969
going to have your own restaurant inspectors, you

2111
01:55:41,969 --> 01:55:45,090
want to hire them before January 1 so

2112
01:55:45,090 --> 01:55:46,929
that they can do the FDA training. Is

2113
01:55:46,929 --> 01:55:51,010
it required? No. Is it best practice? Absolutely.

2114
01:55:53,594 --> 01:55:55,994
So we've let we put some of that

2115
01:55:55,994 --> 01:56:00,074
information. We sprinkled or we put Easter eggs

2116
01:56:00,074 --> 01:56:04,554
in all the contracts. I hope these helps

2117
01:56:04,554 --> 01:56:22,744
were available. These conversations. Thank you. You. Since

2118
01:56:22,744 --> 01:56:25,465
2020. Yes. Well, sure. Thank you. Thank all

2119
01:56:25,465 --> 01:56:26,985
of you for taking this on. I think

2120
01:56:26,985 --> 01:56:29,545
we we we care deeply that this is

2121
01:56:29,545 --> 01:56:32,505
successful and that all of our residents have

2122
01:56:32,585 --> 01:56:36,950
the same level of health protections and ability

2123
01:56:36,950 --> 01:56:41,110
to reach their highest potential health. So whatever

2124
01:56:41,110 --> 01:56:43,590
we can do. Do you need to grab

2125
01:56:43,590 --> 01:56:51,594
an amputation while you're here? Director job is

2126
01:56:51,594 --> 01:56:55,435
advertised. I thought my guard you only have

2127
01:56:55,435 --> 01:56:57,355
one applicant so that would give you $50.50.

2128
01:57:01,690 --> 01:57:05,050
Thank you very much. When I got my

2129
01:57:05,050 --> 01:57:06,809
one of my first jobs in college back

2130
01:57:06,809 --> 01:57:08,409
then there was no internet right so they

2131
01:57:08,409 --> 01:57:10,329
would put up the flyers yeah and so

2132
01:57:10,329 --> 01:57:11,610
I was like that looks like a good

2133
01:57:11,610 --> 01:57:13,690
job and then I followed the person who

2134
01:57:13,690 --> 01:57:27,315
was putting up the phone. So, me. Thank

2135
01:57:27,315 --> 01:57:29,235
you very much. Thank you so much. You

2136
01:57:29,235 --> 01:57:34,050
guys have a big job. Knowing how long

2137
01:57:34,050 --> 01:57:36,850
we need those, I probably schedule. No. But

2138
01:57:36,850 --> 01:57:38,450
it's best that we can work on each

2139
01:57:38,450 --> 01:57:40,770
one. But they're very took care of the

2140
01:57:40,770 --> 01:57:47,225
discussion related to the public. The director. So

2141
01:57:47,225 --> 01:57:50,664
I guess we're at additional committee member comments.

2142
01:57:50,985 --> 01:57:53,385
Was there an action so we had that

2143
01:57:53,385 --> 01:57:56,960
discussion with Derek about the reporting structure but

2144
01:57:56,960 --> 01:58:00,320
we didn't make any action or a recommendation.

2145
01:58:01,440 --> 01:58:03,280
So do we want to do that or

2146
01:58:03,280 --> 01:58:04,800
do you all want to think about that

2147
01:58:04,800 --> 01:58:07,600
some more? Do you not want to wade

2148
01:58:07,600 --> 01:58:13,905
into that? I'll jump in. Is that something

2149
01:58:13,905 --> 01:58:20,225
that should be decided by the County Board

2150
01:58:20,225 --> 01:58:25,170
of Commissioners? Probably, but I think we should

2151
01:58:25,170 --> 01:58:31,570
make recommendations if we feel strongly in any

2152
01:58:31,570 --> 01:58:34,370
way on that. And I don't know if

2153
01:58:34,370 --> 01:58:36,985
we do, but yeah I wasn't obviously I

2154
01:58:36,985 --> 01:58:39,625
wasn't but knowledgeable at all about the fact

2155
01:58:39,625 --> 01:58:42,025
that he does have departments that you do

2156
01:58:42,025 --> 01:58:42,984
too that have to go on board I

2157
01:58:45,065 --> 01:58:46,425
wonder if we could table this so we

2158
01:58:46,425 --> 01:58:47,945
could have the last two minutes for the

2159
01:58:47,945 --> 01:58:49,784
questions that we could you want to do

2160
01:58:49,784 --> 01:58:52,190
that today? I mean everybody has them so

2161
01:58:52,190 --> 01:58:53,710
we can just kind of review like the

2162
01:58:53,710 --> 01:58:56,830
intent of them. Yeah. So can we table

2163
01:58:56,830 --> 01:58:58,750
the discussion on that and tell them how

2164
01:58:58,750 --> 01:59:04,605
we're talking about it? Sure. Which questions? There

2165
01:59:04,605 --> 01:59:08,764
was a copy in our packet. Either all

2166
01:59:09,005 --> 01:59:11,965
questions that are relevant to this committee that

2167
01:59:11,965 --> 01:59:14,045
are being asked in our community or have

2168
01:59:14,045 --> 01:59:16,125
been asked in the last year. So John,

2169
01:59:16,125 --> 01:59:17,485
I think to your question is now based

2170
01:59:17,485 --> 01:59:18,925
on public health, I think there's a lot

2171
01:59:18,925 --> 01:59:21,400
of capacity in our community for assessment and

2172
01:59:21,400 --> 01:59:23,640
planning. I don't think we need to necessarily

2173
01:59:23,640 --> 01:59:27,640
lean immediately to try to partner with La

2174
01:59:27,640 --> 01:59:31,160
Plata. I think in some instances, that's, you

2175
01:59:31,160 --> 01:59:33,560
know, for funding, particularly if we can come

2176
01:59:33,560 --> 01:59:36,985
together to write grants or state together there's

2177
01:59:36,985 --> 01:59:38,985
potential for that a lot of agencies do

2178
01:59:38,985 --> 01:59:41,784
that they typically are nonprofits but I think

2179
01:59:41,784 --> 01:59:43,545
there's potential for that but I think we

2180
01:59:43,545 --> 01:59:45,304
kind of need to look at what capacity

2181
01:59:45,304 --> 01:59:48,040
do we have in our need to fulfill

2182
01:59:48,040 --> 01:59:49,640
some of these things. I think there's more

2183
01:59:49,640 --> 01:59:53,400
capacity than we may assume or think that

2184
01:59:53,400 --> 01:59:57,080
there is. But so there are several groups

2185
01:59:57,080 --> 02:00:01,240
that put out questions or surveys or have

2186
02:00:01,240 --> 02:00:04,645
done different things to gather information from our

2187
02:00:04,645 --> 02:00:06,885
community in the last year. And so Sally

2188
02:00:06,885 --> 02:00:08,805
and I went through and we reduced the

2189
02:00:08,805 --> 02:00:11,445
document from about, I don't know, 18 pages

2190
02:00:11,445 --> 02:00:13,605
to what it is now with questions that

2191
02:00:13,605 --> 02:00:17,280
were specifically relevant to this group. So there's

2192
02:00:17,280 --> 02:00:19,200
two things I would pose to us all

2193
02:00:19,200 --> 02:00:20,800
since we don't have time to go through

2194
02:00:20,800 --> 02:00:23,360
them today is to go through them and

2195
02:00:23,360 --> 02:00:26,960
say do we want to request the data

2196
02:00:27,360 --> 02:00:29,360
from any of these questions to look at

2197
02:00:29,360 --> 02:00:31,735
as a group that may pertain to either

2198
02:00:31,735 --> 02:00:35,014
our individual buckets of research we're doing or

2199
02:00:35,014 --> 02:00:39,014
inform some other things about our community and

2200
02:00:39,014 --> 02:00:43,655
their needs. And then what questions are missing

2201
02:00:43,655 --> 02:00:45,414
that we would want to know the answer

2202
02:00:45,414 --> 02:00:49,900
to? I don't know about all of you,

2203
02:00:49,900 --> 02:00:52,060
but I feel very strongly in some ways

2204
02:00:52,060 --> 02:00:54,060
that we need community voice in some of

2205
02:00:54,060 --> 02:00:56,219
these things. This is our first stab at

2206
02:00:56,219 --> 02:00:58,300
community voice because these are being asked to

2207
02:00:58,300 --> 02:01:00,860
our community right now or have been recently

2208
02:01:02,155 --> 02:01:06,395
Advised them. So it's all listed. The data

2209
02:01:06,395 --> 02:01:09,435
source, Healthy Archuleta, the nonprofit, who's doing a

2210
02:01:09,435 --> 02:01:12,795
community health assessment, the medical center did a

2211
02:01:12,875 --> 02:01:16,630
outreach survey, Salmon Basin health survey questions are

2212
02:01:16,630 --> 02:01:19,429
also Yeah, if it goes to medical center,

2213
02:01:19,429 --> 02:01:21,590
just to clarify again, it's different than what

2214
02:01:21,590 --> 02:01:23,670
was reported by the investigative committee with the

2215
02:01:23,670 --> 02:01:26,630
Coastal Springs Medical Center. So you've got to

2216
02:01:26,630 --> 02:01:28,869
make sure that they were contacted. I'm assuming

2217
02:01:28,869 --> 02:01:32,375
that you, this came from our hospital transformation

2218
02:01:32,375 --> 02:01:36,855
program, you know? Dan. Okay, yes. Just wanted

2219
02:01:36,855 --> 02:01:38,375
to make sure. We had, I wanna make

2220
02:01:38,375 --> 02:01:39,895
sure it was us. Yes, we got the

2221
02:01:39,895 --> 02:01:44,295
questions directly from Dan. Dan's our director. So

2222
02:01:44,615 --> 02:01:48,520
he does attend Healthy Archuleta. Yes. And so

2223
02:01:48,520 --> 02:01:49,880
we didn't pull in any of the data

2224
02:01:49,880 --> 02:01:51,800
because we didn't know. I didn't want to

2225
02:01:51,800 --> 02:01:53,400
ask for any of that and overwhelm us

2226
02:01:53,400 --> 02:01:56,440
unless they're seeing through interested in. We can

2227
02:01:56,440 --> 02:01:58,760
certainly request that and it's likely that we'll

2228
02:01:58,760 --> 02:02:01,915
get summaries of whatever that data sources for

2229
02:02:01,915 --> 02:02:04,235
those specific questions. But I think the bigger

2230
02:02:04,235 --> 02:02:07,035
thing is we have the option to potentially

2231
02:02:07,035 --> 02:02:09,755
go into the community and ask other questions

2232
02:02:09,755 --> 02:02:12,715
in a variety of ways, either individually because

2233
02:02:12,715 --> 02:02:15,530
we have points of contact with other service

2234
02:02:15,530 --> 02:02:17,290
providers, we might be able to partner with

2235
02:02:17,290 --> 02:02:21,370
agencies who are doing similar things. Healthy Arjuna

2236
02:02:21,370 --> 02:02:24,170
is in the middle of their community health

2237
02:02:24,170 --> 02:02:26,970
assessment, so they're in year one of three.

2238
02:02:28,864 --> 02:02:30,945
The biggest thing for us is the timeline

2239
02:02:30,945 --> 02:02:33,344
how when would we want that data back

2240
02:02:33,344 --> 02:02:35,344
in order to make good decisions based on

2241
02:02:35,344 --> 02:02:38,465
this right and so what do we have

2242
02:02:38,465 --> 02:02:42,880
time for and that may narrow in very

2243
02:02:42,880 --> 02:02:45,120
specifically if we have additional questions we wanted

2244
02:02:45,120 --> 02:02:46,720
to go to the community right we may

2245
02:02:46,720 --> 02:02:48,160
not go with 100 we may go with

2246
02:02:48,160 --> 02:02:51,200
three because then we can potentially have time

2247
02:02:51,200 --> 02:02:55,805
together that data know Healthy Archuleta is looking

2248
02:02:55,805 --> 02:02:58,845
at doing a community wide poll with a

2249
02:02:58,845 --> 02:03:05,165
company that's working right now with Colorado Health

2250
02:03:05,165 --> 02:03:07,710
Foundation and they have done some really great

2251
02:03:07,710 --> 02:03:09,709
polls. We were just looking at the data

2252
02:03:10,590 --> 02:03:12,750
over the last three years of different communities

2253
02:03:12,750 --> 02:03:14,909
around some of the things related to public

2254
02:03:14,909 --> 02:03:18,429
health. But so we have the potential to

2255
02:03:18,429 --> 02:03:20,315
get questions in on some of that data

2256
02:03:20,315 --> 02:03:23,675
collection so that we're not doing that. We

2257
02:03:23,675 --> 02:03:25,514
can go out and do that ourselves. But

2258
02:03:25,514 --> 02:03:26,955
I think we have to know what we're

2259
02:03:26,955 --> 02:03:29,435
interested in knowing more about directly from our

2260
02:03:29,435 --> 02:03:31,675
community. And so I think if we can

2261
02:03:31,675 --> 02:03:34,190
review these and think about gaps or in

2262
02:03:34,190 --> 02:03:36,830
our particular research service area, what do I

2263
02:03:36,830 --> 02:03:39,470
want to know from my community members that

2264
02:03:39,470 --> 02:03:41,950
pertains to that research? And then we may

2265
02:03:41,950 --> 02:03:44,030
be able to find some partnerships or be

2266
02:03:44,030 --> 02:03:46,350
able to utilize other services. I mean, I'm

2267
02:03:46,350 --> 02:03:48,430
doing maternal child health, I would probably go

2268
02:03:48,430 --> 02:03:51,925
to Aspire like hey can you be willing

2269
02:03:51,925 --> 02:03:54,245
to ask your people some of these questions

2270
02:03:54,245 --> 02:03:55,765
or you know I mean I think there's

2271
02:03:55,765 --> 02:03:57,765
ways to do that if we're interested in

2272
02:03:57,765 --> 02:04:00,805
trying to kind of understand a better scope

2273
02:04:00,805 --> 02:04:03,139
of what we want to know and so

2274
02:04:03,139 --> 02:04:04,500
I wanted to kind of let us know

2275
02:04:04,500 --> 02:04:06,420
like there's a lot of information that's been

2276
02:04:06,420 --> 02:04:09,780
collected. I think we don't have time to

2277
02:04:09,780 --> 02:04:11,860
read the bill so I think we need

2278
02:04:11,860 --> 02:04:14,980
to take all of these organizations gather their

2279
02:04:14,980 --> 02:04:20,075
data and use it. But that's just a

2280
02:04:20,075 --> 02:04:22,795
small part of what we have to do.

2281
02:04:22,795 --> 02:04:25,755
Don't know how y'all feel about this but

2282
02:04:25,755 --> 02:04:28,875
I am somewhat overwhelmed with the depth of

2283
02:04:28,875 --> 02:04:32,155
work that has to be performed by the

2284
02:04:32,155 --> 02:04:35,810
end of this year or anybody, not that

2285
02:04:35,810 --> 02:04:37,730
I'm not willing to help work hard on

2286
02:04:37,730 --> 02:04:41,250
this, but the amount of work that San

2287
02:04:41,250 --> 02:04:46,530
Juan Basin Public Health does is incredible. And

2288
02:04:48,454 --> 02:04:51,094
I just don't see how we can mimic

2289
02:04:51,094 --> 02:04:53,574
that in our county. I don't think we

2290
02:04:53,574 --> 02:04:55,335
have to mimic the entire thing. I think

2291
02:04:55,335 --> 02:04:57,094
we have to look at contract versus in

2292
02:04:57,094 --> 02:04:59,735
house service and what funding we can get.

2293
02:04:59,735 --> 02:05:01,655
Like she mentioned, some of the funding sources

2294
02:05:01,655 --> 02:05:04,290
won't even be willing to send us money

2295
02:05:04,290 --> 02:05:07,170
because we are a small population. Take a

2296
02:05:07,170 --> 02:05:09,329
deep breath and think we're gonna scale this

2297
02:05:09,329 --> 02:05:12,369
way down compared to everything that they're That

2298
02:05:12,369 --> 02:05:15,170
we're gonna be decreasing services for Archuleta County.

2299
02:05:15,170 --> 02:05:18,135
That we have to. But that we still

2300
02:05:18,135 --> 02:05:20,215
have ability to contract others. A lot of

2301
02:05:20,215 --> 02:05:23,255
work going on out there, think, that I

2302
02:05:23,255 --> 02:05:27,095
hope so. So can we, I know Healthy

2303
02:05:27,095 --> 02:05:31,329
Archuleta would share this their information with us.

2304
02:05:31,329 --> 02:05:33,329
I can't imagine they wouldn't. So I think

2305
02:05:33,329 --> 02:05:34,610
we just have to be aware that the

2306
02:05:34,610 --> 02:05:36,289
reports are gonna be really long. So we

2307
02:05:36,289 --> 02:05:37,730
need to be really focused in what we

2308
02:05:37,730 --> 02:05:39,650
ask for potentially, which is why we provided

2309
02:05:39,650 --> 02:05:42,050
the questions. The stuff in red other than

2310
02:05:42,050 --> 02:05:44,145
the titles, I think Sally and I potentially

2311
02:05:44,145 --> 02:05:46,705
added. Mhmm. And then there were some questions

2312
02:05:46,705 --> 02:05:48,385
at the end where you can see possible

2313
02:05:48,385 --> 02:05:50,545
information this committee may wanna look into, which

2314
02:05:50,545 --> 02:05:53,105
is just, you know, some things we were

2315
02:05:53,105 --> 02:05:54,785
thinking through when we talked. So this is

2316
02:05:54,785 --> 02:05:56,225
more just for us to kind of say,

2317
02:05:56,630 --> 02:05:58,230
how does any of this pertain to the

2318
02:05:58,230 --> 02:06:01,190
piece I'm working on? What may I wanna

2319
02:06:01,190 --> 02:06:03,270
ask for? I'm happy to go back and

2320
02:06:03,270 --> 02:06:06,790
and ask for that. But I think I

2321
02:06:06,790 --> 02:06:08,949
mean, I'm sure your report that Dan has

2322
02:06:08,949 --> 02:06:11,255
is probably way too many pages for any

2323
02:06:11,255 --> 02:06:13,095
of us to wanna read. Right? So if

2324
02:06:13,095 --> 02:06:16,615
we're specifically interested in the data to certain

2325
02:06:16,615 --> 02:06:18,775
questions, I think we can ask for that.

2326
02:06:18,775 --> 02:06:21,815
But the whole report is gonna be a

2327
02:06:21,815 --> 02:06:25,010
lot considering everything else that we have to

2328
02:06:25,010 --> 02:06:26,770
read. So that's why we did this is

2329
02:06:26,770 --> 02:06:29,170
to see if we can narrow in on

2330
02:06:29,170 --> 02:06:31,570
specific things. Obviously, the San Juan Basin health

2331
02:06:31,570 --> 02:06:34,130
data won't come out until the summer. And

2332
02:06:35,410 --> 02:06:36,850
so that's the other thing. If we wanna

2333
02:06:36,850 --> 02:06:38,850
do any further digging, is it something we

2334
02:06:38,850 --> 02:06:41,135
wanna align with their timelines so we're looking

2335
02:06:41,135 --> 02:06:43,534
at all of that new data potentially together

2336
02:06:43,695 --> 02:06:46,894
or not? And she didn't give us the

2337
02:06:46,894 --> 02:06:48,815
time when those numbers per program would be

2338
02:06:48,815 --> 02:06:50,735
available, did she? She sort of left it

2339
02:06:50,735 --> 02:06:53,520
hanging. I mean, it seemed like during the

2340
02:06:53,520 --> 02:06:55,440
budgeting process, she said they would have them.

2341
02:06:55,440 --> 02:06:57,280
That may be something we have. Derek or

2342
02:06:57,280 --> 02:06:58,880
whoever is gonna be doing some of that

2343
02:06:58,880 --> 02:07:02,239
reach out for specifically around the number of

2344
02:07:02,239 --> 02:07:09,455
people served in each different programs. Those are

2345
02:07:09,455 --> 02:07:10,495
the main things we leave you guys with

2346
02:07:10,495 --> 02:07:16,175
since we're out of time. The next meeting,

2347
02:07:16,175 --> 02:07:17,615
there's none next. We don't have a meeting

2348
02:07:17,615 --> 02:07:20,470
next week. Enjoy your spring break. So our

2349
02:07:20,470 --> 02:07:23,590
next meeting is March 27. Do we want

2350
02:07:23,590 --> 02:07:25,590
to make that an agenda item to go

2351
02:07:25,590 --> 02:07:29,350
over this? We should read. I think we

2352
02:07:29,350 --> 02:07:31,750
need to readdress it. I think we can.

2353
02:07:31,750 --> 02:07:32,950
I think that was also the day we

2354
02:07:32,950 --> 02:07:34,665
were supposed to bring back our research, which

2355
02:07:34,665 --> 02:07:36,825
again won't happen all in two hours. Don't

2356
02:07:36,825 --> 02:07:40,185
think so. I don't know how we want

2357
02:07:40,185 --> 02:07:41,945
to prioritize that. I do know if we

2358
02:07:41,945 --> 02:07:43,705
want to get out into the community, we

2359
02:07:43,705 --> 02:07:45,145
need to do it sooner than later so

2360
02:07:45,145 --> 02:07:46,985
we can get the data back that we're

2361
02:07:46,985 --> 02:07:48,505
interested in if we want to look at

2362
02:07:48,505 --> 02:07:52,179
that. And again, I think there are resources

2363
02:07:52,179 --> 02:07:54,499
out there where it won't necessarily be us

2364
02:07:54,900 --> 02:07:56,820
having to do that work because I know

2365
02:07:56,820 --> 02:07:59,060
we're all busy. Yeah, if we could come

2366
02:07:59,060 --> 02:08:01,860
up with some questions, specific questions we want

2367
02:08:01,860 --> 02:08:05,685
to ask the community, the county could put

2368
02:08:05,685 --> 02:08:07,925
it on our Facebook page to steer them

2369
02:08:07,925 --> 02:08:11,205
to our public health department webpage to have

2370
02:08:11,205 --> 02:08:13,205
a survey on there. And they could either

2371
02:08:14,405 --> 02:08:16,965
fill it out and email it or come

2372
02:08:16,965 --> 02:08:19,125
in and email it to me or whatever.

2373
02:08:19,410 --> 02:08:22,610
That's one form that we could go through.

2374
02:08:22,610 --> 02:08:25,250
I mean, think any of those things are

2375
02:08:25,250 --> 02:08:26,770
great. I think it's going to be hard

2376
02:08:26,770 --> 02:08:29,490
to necessarily get to the demographic of folks

2377
02:08:29,490 --> 02:08:31,250
that we're looking for when you do that.

2378
02:08:31,250 --> 02:08:33,010
You know, the sampling is definitely an issue.

2379
02:08:33,595 --> 02:08:35,195
San Juan Basin Public Health has said that

2380
02:08:35,195 --> 02:08:37,355
with theirs. Like, they're not necessarily getting to

2381
02:08:37,355 --> 02:08:39,515
the group of people who utilize their service.

2382
02:08:39,515 --> 02:08:43,195
So just their own DHS department. So we

2383
02:08:43,195 --> 02:08:45,275
could So I think that's out and leave

2384
02:08:45,275 --> 02:08:47,835
them there, and they could ask them to

2385
02:08:47,835 --> 02:08:50,800
spread it out with all their people, the

2386
02:08:50,800 --> 02:08:56,800
library. It's a good idea. Or Access Health,

2387
02:08:56,800 --> 02:08:59,200
talk to them. They would probably help us

2388
02:08:59,200 --> 02:09:01,520
out with that. So I think that there's

2389
02:09:01,520 --> 02:09:05,135
some things we could consider. Yeah, maybe we

2390
02:09:05,135 --> 02:09:09,695
could maybe a little I don't know. We

2391
02:09:09,695 --> 02:09:13,375
could maybe have people stationed. I think a

2392
02:09:13,375 --> 02:09:14,975
couple of us could be at the library

2393
02:09:14,975 --> 02:09:17,870
with a questionnaire. Mean, I think the biggest

2394
02:09:17,870 --> 02:09:18,990
thing with any of that though is we

2395
02:09:18,990 --> 02:09:20,270
also have to think about the time to

2396
02:09:20,270 --> 02:09:23,630
then input and analyze anything you want. That's

2397
02:09:23,630 --> 02:09:26,030
not a small undertaking. That needs that really

2398
02:09:26,030 --> 02:09:28,429
looking at data that people are already organizations

2399
02:09:28,910 --> 02:09:30,430
are already collecting and then just add to

2400
02:09:30,430 --> 02:09:32,945
I really found this, I think I sent

2401
02:09:32,945 --> 02:09:34,945
it to everybody, the county health rankings and

2402
02:09:34,945 --> 02:09:37,105
roadmaps. It was an attachment that I sent

2403
02:09:37,105 --> 02:09:38,865
to you guys. Found it. Did you just

2404
02:09:38,865 --> 02:09:42,065
send us? The last week. I found it

2405
02:09:42,065 --> 02:09:44,465
fascinating to go through and look at our

2406
02:09:44,465 --> 02:09:47,105
county compared to Colorado, compared to The United

2407
02:09:47,105 --> 02:09:49,800
States. And I mean, there are a lot

2408
02:09:49,800 --> 02:09:51,400
of categories on here and I think this

2409
02:09:51,400 --> 02:09:57,560
is just a good first swab that, here

2410
02:09:57,560 --> 02:09:59,239
are some things we really need to address.

2411
02:09:59,640 --> 02:10:02,224
Kathy, who was the source on that? I

2412
02:10:02,224 --> 02:10:04,784
couldn't find on their group who actually did

2413
02:10:04,784 --> 02:10:06,864
that. It's that group in Wisconsin I was

2414
02:10:06,864 --> 02:10:08,065
talking about. They were the ones, I think,

2415
02:10:08,065 --> 02:10:09,985
that actually did the research. And I wonder,

2416
02:10:09,985 --> 02:10:12,224
I started looking at some data and I

2417
02:10:12,224 --> 02:10:16,224
couldn't duplicate their numbers. Yeah, countyhealthrankings.org. I can

2418
02:10:16,224 --> 02:10:18,110
look into who they are and where they're

2419
02:10:18,110 --> 02:10:21,949
from. They're almost in the country. We're talking

2420
02:10:21,949 --> 02:10:25,630
a lot about health outcomes and housing is

2421
02:10:25,630 --> 02:10:30,190
ginormous on this report. I mean adequate housing.

2422
02:10:30,190 --> 02:10:33,075
Safe and adequate housing. I don't know, Printed

2423
02:10:33,075 --> 02:10:39,155
these, you know, public health framework is right.

2424
02:10:40,035 --> 02:10:42,035
So I think that we sort of get

2425
02:10:42,035 --> 02:10:44,355
lost in but housing is one of those

2426
02:10:44,355 --> 02:10:46,699
upstream things that everyone's looking at. So this

2427
02:10:46,699 --> 02:10:50,060
is from the American Association of Family Practitioners

2428
02:10:50,060 --> 02:10:55,580
or Physicians. Thank you. And how primary care

2429
02:10:55,580 --> 02:10:59,715
and public health intersect and work together. So

2430
02:10:59,715 --> 02:11:00,755
I think that there are a lot of

2431
02:11:00,755 --> 02:11:02,755
issues that the public health department won't necessarily

2432
02:11:02,755 --> 02:11:04,435
be able to address but should have at

2433
02:11:04,435 --> 02:11:07,475
least some input, sit on some committees around

2434
02:11:07,475 --> 02:11:11,360
how do we do it. And unfortunately, that's

2435
02:11:11,360 --> 02:11:12,960
also where some of the dollars are coming

2436
02:11:12,960 --> 02:11:19,919
from. The concern to me is just chasing

2437
02:11:20,480 --> 02:11:24,320
programs, chasing grants, chasing programs, like squirrels, squirrels,

2438
02:11:24,320 --> 02:11:26,955
squirrels. We mean historically how public health is

2439
02:11:26,955 --> 02:11:29,755
fortunate. Yes and I keep thinking about that

2440
02:11:29,755 --> 02:11:33,675
below the waterline. What are the main issues

2441
02:11:33,675 --> 02:11:36,074
we need to try to address here and

2442
02:11:36,074 --> 02:11:38,715
maybe there is some money outside money coming

2443
02:11:38,715 --> 02:11:41,469
from other entities and we just need to

2444
02:11:41,710 --> 02:11:46,830
find those basic things. Like she was talking

2445
02:11:46,830 --> 02:11:50,429
about with STDs and syphilis growing because it

2446
02:11:50,429 --> 02:11:52,785
sounds like public health is focusing on other

2447
02:11:52,785 --> 02:11:55,745
things and then meanwhile this is getting bad.

2448
02:11:56,065 --> 02:11:58,625
So it's those kinds of things that we

2449
02:11:58,625 --> 02:12:01,265
want to Well, lot of things comes to

2450
02:12:01,265 --> 02:12:04,305
the educational piece of the department, right? Like

2451
02:12:04,739 --> 02:12:08,099
doing messaging campaigns around why it's important to

2452
02:12:08,099 --> 02:12:10,980
do certain things or I mean, I don't

2453
02:12:10,980 --> 02:12:13,380
know when I have babies like I was

2454
02:12:13,380 --> 02:12:15,219
like I don't need those things because I

2455
02:12:15,219 --> 02:12:17,795
know I'm healthy but people don't, you know,

2456
02:12:17,795 --> 02:12:19,635
the vitamin K shots or the goop in

2457
02:12:19,635 --> 02:12:21,235
the eyes or whatever for the babies that

2458
02:12:21,235 --> 02:12:22,594
help prevent some of those things. Lot of

2459
02:12:22,594 --> 02:12:26,515
people are refusing those services, not understanding the

2460
02:12:26,515 --> 02:12:29,315
consequence of the potential if they haven't been

2461
02:12:29,315 --> 02:12:31,390
tested for those things. So a lot of

2462
02:12:31,390 --> 02:12:33,390
it's you know how are we it's not

2463
02:12:33,390 --> 02:12:36,110
necessarily the service provision itself because we have

2464
02:12:36,110 --> 02:12:39,230
great medical providers that provide the service and

2465
02:12:39,230 --> 02:12:41,790
potentially the testing. It's how are we then

2466
02:12:41,790 --> 02:12:47,015
coordinating more of the upstream awareness and access

2467
02:12:47,015 --> 02:12:51,895
to care. I mean, when you bring up

2468
02:12:51,895 --> 02:12:55,094
what she brought up, STD work that was

2469
02:12:55,094 --> 02:12:57,530
done, a lot of that is it's all

2470
02:12:57,530 --> 02:13:00,010
about contact tracing, right? I mean, that's the

2471
02:13:00,010 --> 02:13:01,850
whole thing. Because if somebody comes in with

2472
02:13:01,850 --> 02:13:04,489
an STD, we are required to report that.

2473
02:13:04,489 --> 02:13:05,930
And then the department has to public health

2474
02:13:05,930 --> 02:13:09,555
then the health fund goes out and contact

2475
02:13:09,555 --> 02:13:12,435
tracing and tries to prevent it by treating

2476
02:13:12,435 --> 02:13:15,155
other people. And that is not always possible

2477
02:13:15,155 --> 02:13:18,675
because everyone won't take treatment. That's what we're

2478
02:13:18,675 --> 02:13:21,155
seeing. We're just sharing. Resurgent of that, right?

2479
02:13:21,155 --> 02:13:25,000
So it's a small aspect of what they

2480
02:13:25,000 --> 02:13:26,920
did, but it is an important thing because

2481
02:13:26,920 --> 02:13:29,160
I can remember when it went away because

2482
02:13:29,160 --> 02:13:30,760
we saw a lot of it in our,

2483
02:13:30,760 --> 02:13:32,760
we're in Louisiana where I'm from, and then

2484
02:13:32,760 --> 02:13:35,815
we stopped and then now it's back It's

2485
02:13:35,815 --> 02:13:41,014
like a whack a mole. Because there's so

2486
02:13:41,014 --> 02:13:44,534
little funding that comes down for public health

2487
02:13:45,255 --> 02:13:48,479
in the country and so many needs I

2488
02:13:49,519 --> 02:13:51,119
think that's something that I like with highly

2489
02:13:51,119 --> 02:13:53,920
qualified staff though, how if you get highly

2490
02:13:53,920 --> 02:13:56,320
qualified staff, you should only be able to

2491
02:13:56,320 --> 02:13:57,920
pivot on some of those things because you

2492
02:13:57,920 --> 02:14:00,320
have people who are qualified in a broad

2493
02:14:00,320 --> 02:14:01,760
and well that's kind of what she was

2494
02:14:01,760 --> 02:14:03,280
saying. They have a lot of staff who

2495
02:14:03,280 --> 02:14:06,614
can be flexible and nimble as programs change.

2496
02:14:06,614 --> 02:14:08,534
So you might have gotten hired under this

2497
02:14:08,534 --> 02:14:11,415
one grant to do X, then you may

2498
02:14:11,415 --> 02:14:14,295
end up doing Y two years later. So

2499
02:14:14,295 --> 02:14:16,215
you want people with those broad skill sets

2500
02:14:16,215 --> 02:14:19,415
and ability to of We look at those

2501
02:14:19,440 --> 02:14:21,920
people here. So far they said they'd had

2502
02:14:21,920 --> 02:14:24,560
one applicant and it was from somebody that

2503
02:14:24,560 --> 02:14:27,840
lives in Texas, right? This just went out

2504
02:14:27,840 --> 02:14:30,960
like Tuesday, maybe even Wednesday. Okay, I know

2505
02:14:30,960 --> 02:14:33,515
so. I mean, anybody that's run a small

2506
02:14:33,515 --> 02:14:36,635
business, and I have my whole life, I

2507
02:14:36,635 --> 02:14:39,515
mean, you wear all kinds of hats. And

2508
02:14:39,515 --> 02:14:41,915
if we are attempting to pull this off

2509
02:14:41,915 --> 02:14:45,130
in this county, We can't afford to hire

2510
02:14:45,130 --> 02:14:48,570
everybody that we need. Hire people who can

2511
02:14:48,570 --> 02:14:52,969
do multiple things. Yeah. That's a must. Sure.

2512
02:14:52,969 --> 02:14:55,770
We can, to the next meeting, and just

2513
02:14:55,770 --> 02:14:58,405
a discussion of the, I mean, the more

2514
02:14:58,405 --> 02:15:01,125
I sit here, the more I realize La

2515
02:15:01,125 --> 02:15:03,525
Plata may be four to six months ahead

2516
02:15:03,525 --> 02:15:06,405
of us, at least the understanding that I'm

2517
02:15:06,405 --> 02:15:09,045
getting. But then that made me a little

2518
02:15:09,045 --> 02:15:11,630
bit nervous after this and last week, was

2519
02:15:11,630 --> 02:15:14,510
saying, September, October timeframe, we're gonna be okay.

2520
02:15:14,750 --> 02:15:17,070
But if we're talking, what I heard from

2521
02:15:17,070 --> 02:15:20,350
her April to June, we realistically won't even

2522
02:15:20,350 --> 02:15:23,804
have that director on board till maybe May

2523
02:15:23,804 --> 02:15:27,165
1. Do we just have a discussion who's

2524
02:15:27,165 --> 02:15:30,525
gonna be following up on at least contacting

2525
02:15:30,525 --> 02:15:34,605
the state and making sure we're communicating I'm

2526
02:15:34,605 --> 02:15:37,050
sure the staff's doing stuff that we're not

2527
02:15:37,050 --> 02:15:40,010
aware of. I apologize if I say that,

2528
02:15:40,010 --> 02:15:42,010
but that makes me nervous that we're not

2529
02:15:42,010 --> 02:15:44,090
going to be ready April, May, June. I

2530
02:15:44,090 --> 02:15:46,889
do know the county manager and the county

2531
02:15:46,889 --> 02:15:51,885
attorney have had conversations with I don't know

2532
02:15:51,885 --> 02:15:55,645
specifics. Do know that the ball has started

2533
02:15:55,645 --> 02:15:57,804
rolling on what we need to be doing.

2534
02:15:57,804 --> 02:16:01,085
Yes. So we're not starting from scratch right

2535
02:16:01,085 --> 02:16:05,130
yet. They've already had conversations. Great. So I

2536
02:16:05,130 --> 02:16:06,650
was thinking a question maybe all of us

2537
02:16:06,650 --> 02:16:08,410
want to ask as we're doing our research

2538
02:16:08,410 --> 02:16:11,290
is what does a fully functional health department

2539
02:16:11,290 --> 02:16:13,930
look from that narrow window? What does it

2540
02:16:13,930 --> 02:16:15,850
look like for environmental health? What does it

2541
02:16:15,850 --> 02:16:17,995
look like for community health? The other question

2542
02:16:17,995 --> 02:16:20,635
I have, what is a fully functional health

2543
02:16:20,635 --> 02:16:25,435
department as of January 1 from the commissioners,

2544
02:16:25,435 --> 02:16:27,275
from the county, whatever it is? Is that

2545
02:16:27,275 --> 02:16:29,755
one program from each of those service areas,

2546
02:16:30,460 --> 02:16:32,700
or at least a contract with one program,

2547
02:16:32,700 --> 02:16:34,299
what does it mean? As we're going through

2548
02:16:34,299 --> 02:16:37,660
our programs, we might want to identify what

2549
02:16:37,660 --> 02:16:41,180
sources. The very bottom first thing on the

2550
02:16:41,180 --> 02:16:43,905
agenda the next time we have time is,

2551
02:16:43,905 --> 02:16:45,745
are we really going to separate? Are we

2552
02:16:45,745 --> 02:16:47,905
going to go back to working with Samuel?

2553
02:16:47,984 --> 02:16:56,730
It would be my top recommendation. So we

2554
02:16:56,730 --> 02:16:59,370
don't get to choose them. Yeah. No. That

2555
02:16:59,370 --> 02:17:01,851
is not on the table at all. There

2556
02:17:03,290 --> 02:17:07,209
is a signed resolution between a joint resolution

2557
02:17:07,209 --> 02:17:11,025
between the two counties dissolving San Juan Basin

2558
02:17:11,025 --> 02:17:15,424
at 01/2017. So it's done. However, there are

2559
02:17:15,424 --> 02:17:19,186
conversations that are occurring. There are. With people

2560
02:17:19,186 --> 02:17:26,681
at both counties. I'm Okay. And that there

2561
02:17:26,681 --> 02:17:29,879
are conversations happening about that. That there are

2562
02:17:29,879 --> 02:17:35,080
people that, in both counties, that realize now

2563
02:17:35,080 --> 02:17:38,764
just how much this has been, and that

2564
02:17:38,764 --> 02:17:41,805
there's been a lot of misperceptions. Even with

2565
02:17:41,805 --> 02:17:44,525
La Platas. I said even with La Plata.

2566
02:17:44,525 --> 02:17:47,405
We're not the only ones that are in

2567
02:17:47,405 --> 02:17:51,340
it. La Plata is also somewhat, I would

2568
02:17:51,340 --> 02:17:55,420
think, struggling too. And Mary, if you're sure

2569
02:17:55,420 --> 02:17:57,100
this is a done deal, it's a conversation

2570
02:17:57,100 --> 02:17:59,660
that can happen, then I think we just

2571
02:17:59,660 --> 02:18:01,020
need to know that all the work we're

2572
02:18:01,020 --> 02:18:03,420
doing, this should continue, or we should just

2573
02:18:03,420 --> 02:18:07,415
drop back even though I think clearly it's

2574
02:18:07,415 --> 02:18:09,415
been done, no doubt about it. All I'm

2575
02:18:09,415 --> 02:18:14,535
saying is that nothing is forever. I mean,

2576
02:18:14,535 --> 02:18:19,490
you could re stand it up. I mean,

2577
02:18:20,209 --> 02:18:22,690
there are things we can do to protect

2578
02:18:22,690 --> 02:18:27,891
the people in our community. But again, I've

2579
02:18:27,891 --> 02:18:30,434
been told that there are people interested in

2580
02:18:30,434 --> 02:18:34,354
trying to have some conversations about that again.

2581
02:18:34,754 --> 02:18:37,395
I think the document that you're gonna have

2582
02:18:37,395 --> 02:18:39,715
Mary share with us that came from San

2583
02:18:39,715 --> 02:18:42,754
Juan Basin about the different That is what

2584
02:18:42,754 --> 02:18:45,850
San Juan Basin Health presented to the investigative

2585
02:18:45,850 --> 02:18:50,568
committee in October of twenty twenty. And that's

2586
02:18:50,568 --> 02:18:52,809
why I thought you might be interested in

2587
02:18:52,809 --> 02:18:54,729
that, because that's what they That was again

2588
02:18:54,729 --> 02:18:56,729
after the pandemic, so it was different, but

2589
02:18:56,729 --> 02:19:01,434
it just Right. For more information. I think

2590
02:19:01,434 --> 02:19:03,354
it'll help in the research that are each

2591
02:19:03,354 --> 02:19:08,075
individual assigned because most have what they do

2592
02:19:08,395 --> 02:19:11,995
before 2020, it wasn't about pandemic. It's not

2593
02:19:12,314 --> 02:19:20,931
scary. I have a question on our research

2594
02:19:22,450 --> 02:19:26,851
under assets. When I looked at the information

2595
02:19:28,235 --> 02:19:31,436
it talked about what assets are owned by

2596
02:19:31,674 --> 02:19:36,155
another entity. Are we going to only look

2597
02:19:36,155 --> 02:19:39,436
into what assets are owned by other entities?

2598
02:19:39,516 --> 02:19:42,409
Or are we going to also see if

2599
02:19:42,409 --> 02:19:46,889
that county owns certain assets themselves? Well, I

2600
02:19:46,889 --> 02:19:51,529
think that the receiver is in the process

2601
02:19:51,529 --> 02:19:55,195
of working with San Juan Basin Health and

2602
02:19:55,195 --> 02:19:57,755
working with the two counties in dividing up

2603
02:19:57,755 --> 02:19:59,275
all the assets. So I don't think that

2604
02:19:59,275 --> 02:20:00,875
that's anything we need to spend time on

2605
02:20:00,875 --> 02:20:03,835
right now. The assets in the report, for

2606
02:20:03,835 --> 02:20:06,395
example Just find out what assets are owned

2607
02:20:06,395 --> 02:20:10,610
by another entity outside the health department. I

2608
02:20:10,610 --> 02:20:12,370
think what that's referring to is like a

2609
02:20:12,370 --> 02:20:14,530
database that's run by the state that we

2610
02:20:14,530 --> 02:20:16,530
contribute information to as a part of our

2611
02:20:16,530 --> 02:20:20,530
reporting system. I don't think it's anything tangible.

2612
02:20:20,530 --> 02:20:22,610
I think it's something that's going on. We

2613
02:20:22,815 --> 02:20:25,455
are required to report to you. Yeah, we'll

2614
02:20:25,455 --> 02:20:27,615
have, I mean, lot of data gets reported

2615
02:20:27,615 --> 02:20:29,136
to the student. Right, so I don't think

2616
02:20:29,136 --> 02:20:30,815
it's anything we need to worry about for

2617
02:20:30,815 --> 02:20:38,560
this at all. Okay. Anything else before we

2618
02:20:38,560 --> 02:20:42,000
adjourn? I move to adjourn the meeting at

2619
02:20:43,119 --> 02:21:04,808
11:15? Eleven twenty? I know I was like,

2620
02:21:04,808 --> 02:21:06,407
oh my god, it's not really tough to

2621
02:21:06,407 --> 02:21:06,968
read. Right.