[0:50] We ready? Yep. All right. So, we'll call
[0:56] this meeting to order. So, I mean, it's
[1:01] early. What time did you say? 09:01. Oh
[1:04] 09:01 okay. All right so the obvious turning
[1:11] off our cell phones. Do any committee members
[1:15] have any disclosures or conflicts of interest? Okay.
[1:23] Any adjustments to the agenda? No? Okay. Move
[1:31] to approve the agenda. I would make the
[1:35] motion. Okay. All right. I did not add
[1:44] on here public comment but that would be
[1:47] right now. Yes. Okay, so we'll open it
[1:52] up for public comment. Have two. Start with
[1:59] Candace Jones. Candace if you could just name
[2:05] give your name and address for the record.
[2:08] Sure Candace Jones PFOS three thousand one hundred
[2:11] twelve Pagosa Springs. Thank you advisory committee members
[2:15] for your service Your careful attention to the
[2:19] details and vision for public health provide an
[2:22] essential framework for this transition. Many residents rely
[2:25] on services now provided through the San Juan
[2:28] State of the Public Health. And I know
[2:30] you folks have them in mind when you're
[2:32] doing this work. So for the sake of
[2:35] Archuleta County residents and visitors, I hope everyone
[2:38] prosecuting the elements of the transition will be
[2:40] equally committed to maintaining service levels. So thank
[2:44] you. On the question of the health board
[2:47] composition, the commissioner should embrace the board of
[2:50] health as an opportunity to engage people in
[2:53] the community who have relevant expertise and experience
[2:56] to perform the practice of public health in
[2:59] Archuleta County. Public health connects dots between community
[3:03] and environmental conditions and individual health. The more
[3:07] points of contact the county has to engage
[3:10] with the community, the better informed public health
[3:12] priorities and practices will be now and over
[3:16] time. Commissioners will not be closed out of
[3:18] public health by appointing others to the Board
[3:21] of Health. They could for example designate one
[3:23] seat to be filled by a commissioner. In
[3:25] any event the commissioners will have a vital
[3:28] role in funding and overseeing the administration of
[3:30] the health department as it does with other
[3:33] departments of the county government. As a practical
[3:36] matter, the commissioners are stretched with their current
[3:39] duties. I hear the commissioners lament demands on
[3:42] their calendars frequently when I attend their meetings.
[3:46] The county administrator and county attorney are also
[3:49] no doubt stretched. The advisory committee members have
[3:52] divided amongst themselves reviewing San Juan Basin Health's
[3:55] files to understand linkages between programs funding and
[3:59] staff. You the committee have asked basic questions
[4:04] about the grant contracts, continuation of grant funding,
[4:09] and the application process for grants. San Juan
[4:12] Basin Health also has agreements with partners to
[4:14] provide services and undertakings to provide services that
[4:18] extend outside the health district to other counties.
[4:22] Why has this log through those contracts not
[4:25] already been done by county staff? We are
[4:28] coming up on a year since the San
[4:30] Juan Basin Health Board voted recommended provision and
[4:33] four months since Archuleta and Lymphatic Missions were
[4:36] made official. Had the foundational work understanding contacts
[4:40] and assets which already been done by county
[4:42] staff, the advisory committee could have jumped directly
[4:45] into questions about service priorities and similar questions
[4:49] that could shape what the Archuleta Health Department
[4:51] will be. Board of Health and the Board
[4:54] of County Commissioners should work in tandem. Each
[4:57] can bring something different and valuable to the
[4:59] public health administration. At least some of the
[5:02] current commissioners acknowledged last year their minimal awareness
[5:06] of San Juan Basin health services and understanding
[5:09] of public health generally. Now is not the
[5:12] time for commissioners to reject the aid of
[5:14] competent, caring, and interested citizens to contribute to
[5:18] the public health of our community. Thank you.
[5:21] Thank you. So next we have Leigh Stoeffer.
[5:39] My name is Leigh Stoeffer, I live at
[5:40] 99 Perry Winkle Drive In Drive. And I
[5:45] too would like to thank the volunteers for
[5:47] their service to the community. I really appreciate
[5:49] your efforts and I know that you have
[5:51] a big task ahead of you. I attended
[5:53] your last meeting and I also attended the
[5:55] oversight meeting last week and first of all
[5:58] I would like to take a moment to
[6:00] enter the public record that the Asthma and
[6:03] Allergy Foundation of America has a very strong
[6:05] online recommendation against the use of hydrogen peroxide
[6:08] nebulizers. This practice is not considered safe and
[6:13] will not be administered by healthcare personnel with
[6:16] practiced evidence based medicine. This intervention was mentioned
[6:19] several times last week in your meeting. This
[6:22] is a good segue to express my deeply
[6:24] felt hopes that we'll be hiring a director
[6:28] who is a believer and practitioner of evidence
[6:31] based medicine and not quackery. I am very
[6:35] interested in the answer to the question posed
[6:37] here last week and that is who will
[6:39] be interviewing the Chiefs Director? In our search
[6:43] for a well qualified individual I think we
[6:46] should consider this person will be interested in
[6:49] just who they will be reporting to. A
[6:51] board of expertise in areas related to public
[6:54] health or a county board of commissioners who
[6:57] oversaw the dissolution of the public health partnership
[7:00] because of what some consider to be political
[7:03] differences. I believe that the composition of the
[7:06] County Board of Health may greatly influence the
[7:08] quality of individual we will be able to
[7:11] attract for the director position. The report by
[7:15] the Otero Group for Laplata County clearly states
[7:18] that County Boards of Health composed of members
[7:21] of differing expertise relevant to public health have
[7:25] better health outcomes than most composed of County
[7:28] Boards of Commissioners. At last week's oversight meeting
[7:31] Mr. Woodman expressed his support for the Board
[7:34] of County Commissioners as Board of Health at
[7:36] least in the beginning. I understand the desire
[7:40] to make this transition a little faster and
[7:42] easier, but I submit that the beginning is
[7:45] probably the most important time to have a
[7:47] board that is composed of people with expertise.
[7:52] The Board of Health actual expertise could be
[7:54] very helpful in getting this department off to
[7:57] a good start and it would avert the
[7:59] impression that this is indeed a political process
[8:03] and might also help recruiting qualified director and
[8:06] staff. Thank you. Okay. Consent agenda there's one
[8:22] just the approval of the meeting minutes from
[8:25] last week. Does anyone have any make a
[8:30] motion for accepting that? A motion. I'll second.
[8:39] Excuse me, this is Suzanne. Yes. In the
[8:47] minutes from last week, I had a question
[8:51] about them. There was for the approval of
[9:00] the interim director and the director, the way
[9:06] it read, it reads Suzanne and I can't,
[9:11] I don't have the minutes in front of
[9:13] me. Suzanne and another person, I can't remember
[9:17] who it was, approved or seconded the motion.
[9:22] I think it should be seconded the motions
[9:25] because there were two motions or else it
[9:28] needs to be clearly shown that there was
[9:32] one motion for accepting the interim and there
[9:36] was another motion for accepting the permanent director.
[9:43] And I seconded one and the other person
[9:47] seconded the other. Also in that part of
[9:51] the minutes, Suzanne is spelled wrong, it should
[9:53] be s u s instead of s u
[9:59] So were there two motions one for the
[10:04] director one for the transitional? Okay so that
[10:07] needs to be broken out. I thought somebody
[10:13] could buy them at the end. You guys
[10:18] tell me. They were two separate. No there
[10:22] were two separate motions. And does anybody recall
[10:29] who did the I made the motion for
[10:33] the transitional one. I might have made the
[10:40] motion for the permanent one as well. I
[10:43] think you did too. I think he made
[10:46] the motion for both. I think I seconded
[10:53] the transitional and I think the other person
[10:57] seconded the permanent. Okay. Do we know who
[11:04] seconded for the permanent? Okay. I'm just gonna
[11:12] write a note and be done with that.
[11:15] It wait. Wait. It was hold on. Kathy
[11:33] seconded the permanent. That's what's on. Okay. All
[11:39] right. I'll make those changes. And so can
[11:43] we get a motion to approve the minutes
[11:48] as amended? So moved. Second. Okay. Thank you,
[12:00] Suzanne. I'll make those changes. All right. Discussion
[12:06] items. Structure of Board of Health. So I
[12:16] passed out the local Board of Health that
[12:19] I got this I got from I believe
[12:25] I got this from San Juan Basin Public
[12:27] Health this was in their little snippet of
[12:34] all sorts of things that have to do
[12:35] with Port of Health. And then I also
[12:40] gave you the local public health agency structure
[12:44] that doing a survey of all the county
[12:46] Colorado counties that I was about three quarters
[12:50] of the way done with. We were we
[12:53] probably should focus at category two and three
[12:58] specifically three. The categories are broken out by
[13:02] the state and we are a category three
[13:06] currently category 3B but about to be or
[13:10] I don't know if it passed to go
[13:12] to a 3A but that's pretty much just
[13:15] for salaries for the county. Is it elected
[13:17] officials? It's population based, is that how they're
[13:20] divided up? That's part of it, but it's
[13:26] a rather complicated matrix to include miles of
[13:31] road then. And then when it says self,
[13:34] what's that? That they are not part of
[13:37] a group, like a district. There's only, most
[13:41] of them are self other than And their
[13:43] boards are independent of a district. Well, like
[13:46] we were part with La Plata County with
[13:48] San Juan Basin. There are like Los Animas
[13:51] shares with I don't how to say that.
[13:56] It's its own it's own standalone health department.
[14:01] Thank you. Right. Mary thank you for doing
[14:04] this first of all from the investigation committee
[14:07] notes there were a couple I left my
[14:09] pizza at home but I think it was
[14:12] Alamosa, Rand and Gilpin but I think one
[14:19] more of those has just the three commissioners
[14:21] but in the minutes from one of the
[14:23] counties interviewed they talked about wanting to add
[14:27] healthcare professionals to their boards and every report
[14:32] that Doctor. Bruce made she said that many
[14:35] counties felt that way that the board of
[14:38] commissioners needed some help from healthcare professionals. Okay.
[14:45] What we can do as a group is
[14:48] come up with a consensus of how we
[14:50] think we should be and either just give
[14:54] a verbal thing to the oversight committee or
[14:57] we can direct a memo from us to
[14:59] submit to the oversight committee and to the
[15:01] commissioners. That would be my vote to give
[15:05] them a formal recommendation on what we believe
[15:10] would be the best way to do the
[15:11] structure. Can we talk about this in just
[15:14] terms of what the pros and cons are
[15:16] for the different structure and pardon my ignorance
[15:18] on this like I'm sorry I didn't get
[15:20] a chance to look at this or really
[15:22] kind of delve into it but what are
[15:24] the pros and cons? I mean, the two
[15:25] ladies who spoke bringing some really good points
[15:28] about having expertise in the area of public
[15:30] health to add to the county commissioners in
[15:38] terms of having that structure, it's obviously expertise
[15:41] ties to the community from different, guess some
[15:46] of the points of contact which I guess
[15:48] I hadn't thought about it that way but
[15:49] it makes sense. What are some of the
[15:51] other I guess pros and cons of having
[15:54] people on there beyond just County commissioners? I
[15:58] think, sorry, I think part of the whether
[16:03] we want to admit it or not perception
[16:05] in the community I think is a bit
[16:09] tainted politically and I believe that the community
[16:16] would view and respect Lord of Health at
[16:20] a greater level if we had real healthcare
[16:24] people on And it's not about control. Think
[16:31] it's perfectly fine to have County Commissioners on
[16:36] the board that makes sense for them to
[16:39] be involved and have a level of control
[16:42] But I think that the community itself, I
[16:45] think would look very favorably on our board
[16:50] if we had some outside folks on And
[16:53] it has to be a minimum if it's
[16:55] okay, so it could be a minimum of
[16:57] five if it's not just the three commissioners,
[17:00] right? But it could be up to nine
[17:01] or so. Our county, it's a minimum of
[17:05] three. Right. And I don't even know if
[17:09] it has a maximum. I thought it was
[17:11] seven. So you could have, like I'm just
[17:17] making this up, you could have four healthcare
[17:20] professionals and three commissioners, or you could have
[17:22] one commissioner and any number of, as long
[17:26] as it's an odd number. Correct. I think
[17:31] the literature is pretty clear about public health
[17:33] areas, anybody speak to this better than I
[17:37] can, that when you have a board of
[17:39] public health, that is not just limited to
[17:43] county commissioners who don't have expertise in public
[17:47] health, that the outcomes have been better. Yeah.
[17:50] So that's what I would remember also and
[17:53] again even if just if you had one
[17:56] commissioner who has a real passion for public
[18:00] health and that would be the contact person
[18:02] I don't think that was a case in
[18:04] the past and quite frankly you know it's
[18:08] time to get away from that and have
[18:11] somebody really to communicate back to the other
[18:13] commissioners what happens. I think that's what I
[18:17] would move for to have a broader board
[18:22] you want all those different talents out there.
[18:25] Well, think the report that you mentioned and
[18:27] the consultants actually read it that was done
[18:28] by the University of Colorado School of Public
[18:31] Health, you know, communities show better health outcomes,
[18:34] they show better financial, not necessarily less financial,
[18:38] but better use of financial resources that they
[18:41] typically get more outside funding from grants and
[18:45] other sources than just county or state funds.
[18:49] Mean their evidence brief was really thorough around
[18:52] you know the fact that there's pretty clear
[18:56] health outcomes when you have additional folks on
[18:59] board of health. Know and I would say
[19:02] like I don't know how we if we
[19:04] can designate, but I think there needs to
[19:06] be at least one person with public health.
[19:09] Because if we don't get a director that
[19:10] has a public health background, primary care or
[19:15] providing medical care and the public health lens
[19:17] are really different in a lot of ways.
[19:21] And so I think that guiding programming and
[19:23] things like that, like having someone with the
[19:26] public health lens is really important, especially in
[19:29] the beginning to get this all off the
[19:31] ground. Once it's rolling and things are kind
[19:33] of established and we have all that stuff
[19:35] out there but I mean it's just there's
[19:37] such a spectrum of things that fall outside
[19:39] of you know the idea of providing care
[19:42] right it's about prevention. Like community prevention, individual
[19:48] prevention, right? So from the public health standpoint,
[19:51] how do we bring in this idea of
[19:54] community based prevention work and education in order
[19:57] to have better health outcomes, right? So less
[20:00] people are having to go for service, hopefully.
[20:05] I think that that you know and I
[20:07] haven't done a lot of research outside of
[20:08] this but there was a ton of things
[20:10] that they cited from the University of Colorado's
[20:13] report It was just a summary but there
[20:17] are definite indications that having other folks in
[20:22] the board of thumb would be really important.
[20:24] But I do think because the financial oversight
[20:28] and management is coming from the county that
[20:30] there needs to be at least one if
[20:31] not two seats for commissioners because you know
[20:35] they have to play together to be able
[20:37] to, right? They're housed and employed by the
[20:40] county but I feel like we need that
[20:42] additional expertise to help direct the programming and
[20:48] the stand up in the community. And I
[20:51] also think that the healthcare profession in general
[20:54] has a whole to crawl out of because
[20:55] of public distrust that's been created over this
[20:58] pandemic and I think it would really help
[21:01] for there to be healthcare people on the
[21:03] board to, you know, reassure that we're on
[21:07] the community side and contact issues. That's a
[21:10] great point that we have a lot of
[21:11] work to do to improve the image of
[21:13] healthcare. How would those non BOCC members be
[21:21] selected? It usually looks like an appointment from
[21:26] what I read. I don't know if we
[21:27] could go outside of the box and do
[21:29] it more like La Plata Electric does. They're
[21:31] like, there's an election, there's like a vote
[21:33] of some kind. I don't know what that
[21:35] would mean if that would make it more
[21:36] political or not. It makes it very expensive.
[21:40] I mean, you know, to run an election.
[21:42] Yeah. We would like for the hospital to
[21:43] have to run an election for our board.
[21:45] Yeah. It was about $40,000 I wonder, could
[21:49] this group just put forward some recommendation? Maybe
[21:52] we do a call. I mean, if if
[21:53] we choose to make this recommendation to the
[21:56] BOCC and they accept it, I wonder if
[21:58] the process could be an open call or
[22:01] something for interested individuals and maybe even some
[22:03] members from this board be interested since there's
[22:06] some good people on this board, But then
[22:10] maybe the recommendations then could come from this
[22:13] group as some vetted members because I think
[22:16] when you say healthcare professional that could mean
[22:19] a whole gamut of people. You want to
[22:22] just kind of make sure it's someone who
[22:24] really feels passionately about public health and uses
[22:28] evidence based practices and all those good things.
[22:32] Do you think that call will be very
[22:34] similar to what they did to convene this
[22:36] committee that there were I guess I wonder
[22:39] if we need to go outside the committee
[22:40] if we can just start with this group
[22:43] and the people that want to participate and
[22:46] then put out a call, people get interested,
[22:49] this job may have been too big for
[22:50] some people but anyway, I would not be
[22:56] opposed personally, you all have to decide about
[22:59] speeding the health board with the commissioners and
[23:02] then breaking up after that. I personally would
[23:07] not be interested in continuing. I mean, I'm
[23:10] happy to be on this, but just because
[23:13] of my day to day with being the
[23:15] town manager, I mean, it's very interesting work
[23:18] and I'm happy to help in this transition,
[23:20] but I don't know that I should be
[23:21] on the board of health moving forward, but
[23:26] be happy to help support the selection process
[23:28] recommendation. The first thing that we would need
[23:31] to do is send recommendation. Yeah. We've oversight
[23:36] committee and their committee. Right. We'd rather spend
[23:42] time today to say I can do because
[23:44] if they say no, right. I'm not sure
[23:51] which one said it, maybe both said it
[23:53] different ways, but I would totally agree with
[23:56] the number one, this group's expertise outside of
[24:02] maybe everybody in the health industry here is
[24:05] extremely talented. I'm going sound like an economist
[24:10] here because I would like to thank the
[24:13] staff and or the BOCC for putting this
[24:15] group together. I mean, they didn't have to
[24:18] do that. I think it was a great
[24:19] move, you know, to move this thing forward.
[24:23] And there has to be a level of
[24:24] trust with whoever comes out of this group
[24:29] or a potential board. But I would, as
[24:33] an ex commissioner, I would totally agree that
[24:36] the number one, the time commitment, you know,
[24:39] we were assigned to sit on the San
[24:41] Juan Basin have one year at a time
[24:43] when I was back when and you guys
[24:47] all know, I'm not an expert in health.
[24:50] Whereas there's people in here that would give
[24:55] really good insight, think, to a board made
[24:58] up of commissioners and outsiders would be my
[25:03] 2¢, and whether it's three commissioners of two
[25:07] health, or you know, majority of health, one
[25:12] or two commissioners, whatever it may be, I
[25:14] do think the public would look at that
[25:16] real favorably right now. And gosh, we've got
[25:21] a clean slate. I think this would be
[25:23] a really good way to keep it clean,
[25:26] keep it as far away from political as
[25:28] possible. It's not, we had that conversation, it's
[25:32] not possible to keep politics out of everything,
[25:34] but this group even board should try our
[25:39] best to, you know, stay out of that.
[25:42] And and I think I would be like
[25:44] you. I I don't I would not have
[25:46] an interest as long as you all felt
[25:47] good financially. I don't bring a whole lot
[25:50] other than that, but I do think it
[25:53] helps people do big time. So, and it
[25:59] is a time commitment. I got these commissioners
[26:02] that do have a full plate. And it's,
[26:05] it doesn't matter when they should have a
[26:09] full plate and I think they do. So
[26:13] it is a five year, the board itself
[26:15] is a five year term and how do
[26:18] you stagger folks when we create a board
[26:21] all at one time? I think that it's
[26:26] a good question. Think that you would start
[26:29] off with by desire, maybe and then, you
[26:37] know if everybody says oh yeah, you know
[26:39] it's not a problem, then maybe do it
[26:41] by library. I mean honestly there's really, you
[26:44] know it's really difficult to begin that process
[26:49] because you don't have, there's nothing established. Yeah.
[26:52] So you're starting from doing it. Yeah, didn't
[26:54] know if there was something that was established
[26:55] that I just didn't know about, create a
[26:57] new board. I mean, I think, you know,
[26:59] you can start with like every, you know
[27:02] two years and one person falls off and
[27:04] he brings one last on. The one nice
[27:05] thing about the five year term is that
[27:07] the commissioners are going to be in and
[27:08] out of that but a five year board
[27:10] right then brings the historical knowledge and expertise
[27:12] of not standing it up. And, know, I
[27:17] mean, I think if we think about composition,
[27:19] because we're making a recommendation, do we need
[27:21] to recommend how many and that? I think
[27:23] we should be as specific as possible. I
[27:26] agree. You know, I mean, I think, and
[27:29] I don't know like an open call again
[27:30] depending on what we think the obligation is
[27:33] going to be. We may get a different
[27:34] group of interested parties if it's not a
[27:37] weekly two hour plus research commitment that we
[27:42] all made sitting here. Know there may be
[27:44] other people who are in the field who
[27:47] are just busy and couldn't commit to this
[27:49] process who may be willing to be on
[27:50] the Board of Health. So I don't know
[27:51] that you know another open call would hurt
[27:55] just to see what the interest is from
[27:57] the community and understand who's available with what
[27:59] expertise. It's certainly you know we're sitting here
[28:04] so that sometimes makes it easy but it
[28:07] doesn't necessarily make it. Since we were all
[28:11] selected by the commissioners to sit on this
[28:13] committee we may need to do something again
[28:15] just to really keep that like a political
[28:18] arm's length of saying we want to know
[28:21] everyone who's potentially interested but that's just This
[28:25] is a very operational committee, right? And so
[28:27] the board of health would not be an
[28:30] operation, you would have people that did the
[28:32] operation reporting to the board of health. So
[28:36] it would be totally different. Yeah, that's a
[28:39] good point. So I think that since the
[28:42] rule, the act states that it should have
[28:45] at least five members, but then it says
[28:47] if you have less than 100,000 people, you
[28:49] can do a three week report and And
[28:51] the board of county commissioners may designate something
[28:53] to county board of health if there was
[28:55] not a separate board of health prior to
[28:56] the effective date of the act. So it's
[29:00] almost like that's having just the county commissioners
[29:03] on it is the least desirable of the
[29:06] options here. Would recommend, and I'd say we
[29:09] all agree with This is the first time
[29:12] seeing this, again, as usual, thanks for the
[29:15] handouts. And Derek, you may know this, the
[29:19] second part of that that was just read,
[29:22] the first part in counties with populations of
[29:25] less than 100,003 member board may be appointed.
[29:29] The Board of County Commissioners may designate itself.
[29:32] If there was not a separate Board of
[29:34] Health prior, is that a legal question? Or
[29:37] do you know the answer? Was there business
[29:41] considered San Juan Basin Health a previous board?
[29:45] We are two separate board of health. So
[29:47] what San Juan Basin has is completely separate
[29:50] from what we're going to have. So we
[29:52] do not have a board of health in
[29:54] effect. Okay, I would make a recommendation of
[29:59] a minimum of five, and we can maybe
[30:04] leave it to the commissioners if they want
[30:06] to have a three and two, or do
[30:09] we wanna recommend a two and three or
[30:11] a one and four? I guess I feel
[30:14] like the majority should probably be non. So
[30:22] either three, two, one and three public health,
[30:26] two commissioners, or four. I agree. I think
[30:34] it should be a majority of non board
[30:39] of commissioners on the health department board, I
[30:43] think that will send a message to the
[30:49] community that it is community based and not
[30:55] politically based. Sally, any comments, Ashley? No. I
[31:07] think if we get bigger than five, we're
[31:11] gonna have a hard time staffing it with
[31:13] people with the writing backgrounds because we have
[31:16] a limited pool of potential folks. I think
[31:19] you're interested in serving those kind of terms.
[31:21] I think five is good. I don't know
[31:23] if I, you know, I think given all
[31:26] the other things that commissioners are on, it
[31:28] probably makes sense to only have one, you
[31:32] know, representing the three on the board only
[31:35] for the sake of time. Does it make
[31:36] sense to have two spending that amount of
[31:38] time in those meetings? Because it is going
[31:41] to be pretty, I mean, it's going to
[31:42] be timely between now and the end of
[31:43] the year. It's going to be timely. Once
[31:46] it's established, it's going to have a different
[31:49] role. And once there's a director on staff,
[31:54] then that director will ease even our burden
[31:58] or whoever's on the board's burden between now
[32:01] and the end of the year because that
[32:03] person should really be a guide to what
[32:07] needs to happen. Suzanne, we're having some technical
[32:11] difficulties. Could you just say something so we
[32:13] can see if we can hear you better?
[32:19] Can you hear me better now? A little
[32:22] bit. Sounds like her internet connection. All right.
[32:28] Thanks for checking, Jamie. Appreciate it. All right,
[32:31] we're doing the best we can. Thank you.
[32:33] Speak louder, Suzanne. All right so process wise
[32:44] you were saying something about a memo but
[32:46] is a motion insufficient that would be reflected
[32:48] in the notes or do we need to
[32:49] put together a memo that explains the reason
[32:54] for this recommendation or do we even need
[32:57] to? Either one would work. The motion would
[33:00] be obviously good today. A memo would need
[33:02] to be created and approved next week. I
[33:05] mean, I'm happy to put together that with
[33:08] some of the data from the two sources
[33:10] that I read as far as supporting our
[33:12] recommendation, if that would be helpful. Thanks, Ashley.
[33:15] But next week we're not meeting. We're not
[33:17] meeting next week. You're right. Do it at
[33:22] the next meeting as far as the formal
[33:24] memo or without That be the twenty seventh
[33:26] or we could Get email. Could we We
[33:29] would approve it via like, I could get
[33:33] each one of your approvals, and then we
[33:36] would actually Cathy could sign it, and then
[33:38] we could actually ratify it at the twenty
[33:40] seventh meeting. Because I do think it's important,
[33:42] right, I think for the process of hiring.
[33:44] I don't know where we're at. Maybe Derek
[33:46] can give us an update on that. But,
[33:48] you know to have some of these things
[33:50] in front of the commissioners so they can
[33:52] make their decisions because I think that will
[33:55] potentially impact who applies and how they choose
[33:58] to then you know make some of these
[34:00] decisions and so the sooner we can make
[34:03] that formal recommendation the better. Yeah, think that
[34:09] the email format would probably be really good
[34:12] and get that voting forward too. It's long
[34:15] way for motion that we send a memo
[34:19] to be written and approved by email with
[34:22] the evidence based in there that we recommend
[34:28] the Board of Health be combined members or
[34:30] if they are not county commissioners and want
[34:33] to take this account. And experts in public
[34:36] health experts public health for this okay. Did
[34:42] you get that? I guess you're taking just
[34:45] thinking about grammar. Want the name of my
[34:49] speaker. Sorry, Sally let it is. Quick question
[34:57] for both. Would this be interim or is
[35:01] this for January 1? I think we're talking
[35:06] about I think we're talking about now. We're
[35:07] talking about setting it up, saying that's a
[35:09] good day situation. Okay. And if that's the
[35:12] case, does this group go away and that
[35:14] group take over? Eventually it will go away.
[35:20] Often to the same thing, it's been a
[35:21] volatile combination. I mean, I think that similar
[35:28] to what La Plata County did, we can
[35:32] appoint a Board of Health, they just would
[35:34] have no authority until January. Okay. You've had
[35:42] a motion was there a second? I'll second.
[35:44] Mary, go ahead. Mean the other thing that
[35:48] we may need to discuss to add to
[35:51] our recommendation Oh I'm sorry I'm not. She's
[35:54] not a voting member. I'll Okay. All All
[36:01] in favor say we should call the vote.
[36:03] Fair aye. Was anyone opposed? Suzanne Poe. Sand?
[36:11] Aye. And you know I don't know if
[36:17] this is something or when this gets decided,
[36:20] but, know, there was some discussion in some
[36:22] of these articles around the Board of Health
[36:23] being an advisory group versus like a policy
[36:26] making group. Right. And so I don't know
[36:28] how that gets designated. I don't know if
[36:30] that gets designated once it's formed and they
[36:33] determine that themselves or if that's something we
[36:36] need to weigh in on as this committee.
[36:37] That may require a little more digging into
[36:41] what's appropriate. I mean, I think based on
[36:45] our discussion, feel like maybe need to be
[36:48] a little bit more of a policy directive
[36:51] group and not just an oversight advisory committee.
[36:55] But I think those are things we need
[36:57] to consider as part of this as well.
[36:59] I do too. As far as the structure.
[37:01] I do too especially between now and go
[37:05] live. Right. January because there is a lot
[37:07] of there are a lot of policies in
[37:09] the past we put in place and again
[37:11] back to the director, you know the director
[37:14] someone who has a lot of experience and
[37:16] should be helping us with that path forward.
[37:22] But those are some differences I saw in
[37:24] some other reading around the Board of Health
[37:27] itself and how it's designated. So I think
[37:30] those are just things we need to be.
[37:32] Especially when we're doing our research too, right,
[37:34] what are there implications for either one of
[37:37] those based on programming and things that are
[37:39] out there in other communities? You know, pros
[37:43] and cons of the setup outside of just
[37:49] the size and Any other comments on that
[37:59] topic? Leanne, come on. Go ahead and not
[38:10] waste her time and break her own. We
[38:13] had asked Leanne Delon to come to because
[38:19] at our first meeting we had so many
[38:21] questions for us, they want basic public company
[38:23] asked her to give us kind of the
[38:27] overall view structure. Yeah. Could I interject real
[38:32] quick? So I have to leave at 10:00.
[38:35] And Leanne's kind of long winded. Should I
[38:40] smack him? Any time get a chance, right?
[38:46] Can I just jump into just a status
[38:49] on the record position? Yeah. So we did
[38:55] advertise last week that that all completed. So
[39:00] it was posted on Tuesday afternoon. We do
[39:05] have a flyer that was created so that
[39:09] it can go out to professional organizations as
[39:11] well, or anybody that has any desire for
[39:14] it. Did get one applicant thus far, an
[39:20] individual that does have some background related to
[39:24] that. I just scanned it this morning, but
[39:28] it appears that probably does meet the minimum
[39:32] requirements. Currently resides in Texas, but that's the
[39:36] only applicant that we have thus far. So,
[39:40] I know that there's another question about this
[39:45] is going to be up to the the
[39:47] commissioners as far as who that person reports
[39:51] to as far as the direct supervision. Yes.
[39:55] I know there has been discussion about it
[39:57] that just for maintenance of county structure that
[40:03] that person would answer me that that's definitive.
[40:08] Is how it's all set is set up
[40:10] here the county that all all director positions
[40:12] report to you? Yep. The only county staff
[40:17] that reports to the board directly is the
[40:19] county manager and the county attorney right everyone
[40:22] else works for Derek. Okay. Is that your
[40:28] preference? Or I mean, are the pros and
[40:33] cons? I mean, I don't know why we
[40:35] would do something different. Yeah, I think it's
[40:37] well, I think yes, that would be, that'd
[40:42] be my preference because it's being set up
[40:44] as a set up. Being set up as
[40:46] a department, it's not being set up as
[40:48] a standard loan Right. You know, I think
[40:53] it could just create some other issues, I
[40:59] guess. What Okay. Is that for the interim,
[41:02] or does that go beyond January 1? It
[41:05] would be for both. Like I said, that
[41:09] that has not been definitively established at this
[41:13] point, but that is in my discussion with
[41:16] them that has been their conversation. Should we
[41:20] make a recommendation from this group or is
[41:23] that if that's a if it's a county
[41:27] policy we don't know that we would need
[41:31] to unless we wanted to change that. I
[41:35] don't know if it's a policy it sounds
[41:37] like it's still up in the air. Well,
[41:39] it's not a policy, it's just, it's a
[41:42] practice for sure. As Mary said, there's only,
[41:47] statutory, there's only two employees of the board
[41:51] and that was the manager and the attorney.
[41:56] What's the wording on the job description I
[41:58] can't remember the very first page they talk
[42:00] about can't remember the firm it's not. Who
[42:04] did it report to? Supervision received? Yes. Okay.
[42:09] So we left it pretty broad. It does
[42:13] say County Commissioners and County Board of Health.
[42:18] Well, said we changed it. Okay. So it's
[42:24] County Commissioners or designee or County Board of
[42:26] So there's an open line with commissioners and
[42:34] having a commissioner on the board of health
[42:36] will keep that open conversation with the commissioners
[42:39] that you know you're I guess I'm wondering
[42:44] if their reporting to you will be different
[42:46] than their responsibility to the board of health
[42:48] this Director Attorney. Yeah, does get a little
[42:55] convoluted because everybody that's going to be in
[43:00] the health department is a county employee. And
[43:05] so the way that it needs to flow,
[43:08] and this is just my opinion, is if
[43:12] it remains the same as all the other
[43:14] county departments, then it maintains consistency in everything.
[43:21] When the employee does not answer through the
[43:28] county manager, and then are they a department
[43:31] head, are they, however they consider. I think
[43:35] it just lends to some confusion. And if
[43:42] that's the case, then I think it also
[43:44] changes the entire pay structure and everything else.
[43:48] But the weird part of it is, so
[43:51] the department or the people that report to
[43:54] you, they don't have separate boards that are
[43:57] gonna be that they're going to be also
[43:59] reporting to you, Planning Commission. It's not unusual.
[44:04] Yeah, planning, you know, and community development. They
[44:08] have, they all have boards. So how do
[44:11] those boards interface with you then? Do they
[44:13] make recommendations to you? Do they make recommendations
[44:16] to the commissioners if something's not going well
[44:18] that they see that you might not? So
[44:23] they don't have any, how do I say,
[44:25] employment decisions, those boards. It's just advisory and
[44:32] their roles and responsibilities. But it's, yeah, it
[44:37] has nothing to do with employment. Of course
[44:40] they can always, they can always come to
[44:44] me, but it's to be the commissioners. I
[44:50] mean, it's not different than the town right
[44:53] so we have employees who report to the
[44:55] tourism board the planning you know things like
[44:58] that outside boards but our employees of the
[45:02] town direction. I think that keeps it clean.
[45:06] It could get messy if you had a
[45:09] department head director who was reporting to this
[45:13] board and then like where are they in
[45:17] the organizational structure of the county? It could
[45:20] create some challenges. I truly believe that. The
[45:29] board of health isn't doing anything related to
[45:32] staffing. We're doing policy procedures, you know, regulations,
[45:38] oversight. So it is kind of two separate
[45:43] responsibilities. It's clarification, it's a lot more clear.
[45:50] And then it's boost you what we have
[45:52] here. I would, as far as interviewing, I
[45:57] mean I would think that, I I would
[45:59] certainly participate but I would create an interview
[46:04] panel of appropriate knowledge, individuals. And I would
[46:13] certainly draw in from outside. And honestly, I
[46:19] would probably be the only one from the
[46:21] county government to participate, the rest I would
[46:24] bring in from outside. So there wouldn't necessarily
[46:27] be standardized questions like? There absolutely would. They
[46:31] would be the same questions, if you will,
[46:35] you know, just for legality. So everybody gets
[46:37] asked the same questions. You can always expand
[46:40] on those questions. Everybody gets asked the same
[46:43] questions. But if you know, can certainly go
[46:47] down a path on an answer that comes
[46:51] out of, know, right. And, but so you're
[46:57] not just held to those exact works. Good.
[47:04] Okay. Cool. Thank you. I'll see you on
[47:12] Zoom tomorrow. As soon as I can get
[47:15] I'll get there. I just don't know how
[47:18] soon I get out of my yeah. Try
[47:22] to figure it out. So Derek's coming. Oh
[47:27] okay, I was gonna say your work session
[47:29] next Okay, I think it would help me
[47:40] if we went around because I don't know
[47:42] everybody. So I'm really happy with Sam one
[47:44] place in the hospital. Andrea Phillips, town manager.
[47:50] Ashley Wilson. I work for Rise Above Violence
[47:52] but have a master's in public health. I'm
[47:56] Sally Kennedy, I'm retired. I'm Kathy Campbell, I'm
[48:00] retired and a glutton for punishment. I'm John
[48:04] Ransom, used to be a commissioner here and
[48:08] now I think I'm retired. And then Suzanne.
[48:15] Yeah, Suzanne Bryant, I'm a registered dietitian. Awesome.
[48:23] Derek, Mary. Thanks having me. I have, I
[48:30] can do some slides maybe just to get
[48:33] the conversation started. I don't really, you know,
[48:35] I think a lot of what we're doing
[48:37] here is kind of Q and A, but
[48:39] what I was going to do, and Derek
[48:40] is absolutely right, am open to it. I
[48:43] have a kind of some, I have a
[48:46] slide deck that we do during our budget
[48:48] presentation that we do for the sets of
[48:51] commissioners every year and we'll do it for
[48:55] the commissioners multiple times at our board of
[48:58] health meeting, which is also a public meeting
[49:01] multiple times when we're adopting our budget so
[49:03] that everybody is kind of playing from the
[49:05] same sheet of music. So what I was
[49:07] thinking just to kick off this conversation is
[49:10] go through those budget intro slides for you
[49:13] all, which will give you just some background
[49:15] on how things were structured in the past.
[49:19] I don't know that it's the most important
[49:21] thing because your job is obviously the future
[49:23] and what you're doing next, but I think
[49:25] just having some basis about where we've been
[49:28] may help in some decision making going forward.
[49:31] So this is our final product for adopting
[49:34] our budget. Janet, thank you so much for
[49:37] reading my mind and getting slides. Janet's sharing
[49:39] the slides from us a long time ago.
[49:42] So we go to the next slide, it
[49:44] describes what San Juan Basin Public Health's mission,
[49:47] vision, and values are. So I'm not gonna
[49:51] read it to you. I'll just give you
[49:52] guys a second to read it. It shouldn't
[49:54] be surprising what the mission and vision of
[49:58] a local public health agency. And then after
[50:02] we go over our mission, which is to
[50:03] protect human and environmental health and inspire well-being,
[50:07] we kind of go through and we do
[50:08] this every year multiple times when we're doing
[50:10] our budget season. So this goes through kind
[50:13] of the legal structure for a multi county
[50:15] health district. So believe that's what's next. Oh,
[50:21] look at that. Okay, so legal structure for
[50:23] a multi county health district is we Post
[50:28] World War II, there was a governor of
[50:30] Colorado that was really, yeah, I'm sure I'll
[50:35] tell the story this way. The governor of
[50:36] Colorado post World War II was very concerned
[50:39] that Colorado had fallen behind in public health
[50:42] across the state. There were high rates of
[50:44] tuberculosis, there was poor sewage, there was environmental
[50:47] runoff, there were some agricultural diseases that were
[50:51] having economic fallout and also having human health
[50:55] fallout. And so there was Florence, Doctor. Florence
[50:58] Sabin moved back to Colorado. She'd grown up
[51:01] here and that she had gone to the
[51:03] East Coast at a very illustrious, very, very
[51:06] ahead of her time career putting together, doing
[51:10] research and public health. And she came back
[51:12] to Colorado and she was tasked to make
[51:15] suggestions to how we would improve health in
[51:18] Colorado. And she visited 60, I don't actually
[51:20] know if there were 64 counties at the
[51:22] time, but she visited every single county and
[51:25] then visited every state rep to work through
[51:28] a suite of laws to catch Colorado up
[51:31] in public health. This happened in '19 She
[51:34] completed her work in 1947. They were signed
[51:37] into law in 1948. There was a package
[51:40] of eight bills, and one of those bills
[51:43] in the state of health laws created the
[51:46] opportunity for counties to go in together to
[51:48] do public health as a multi county district.
[51:52] So that's why when you talk about multi
[51:54] county districts in Colorado, they often were formed
[51:57] in 1948 because of a response to this
[52:01] legislation that was passed. So Archuleta and La
[52:04] Clada Counties were one of the multi county
[52:06] districts that started 1948. We actually had other
[52:09] counties. So it was a larger district starting
[52:11] in 1948. And then the Public Health Act
[52:14] in Colorado was not touched until 02/2008. So
[52:18] we have a habit of really getting ahead
[52:20] and then falling really far behind. So Colorado
[52:24] not updating its law until 02/2008. Once that
[52:27] law was re upped in 02/2008, it required
[52:30] the counties involved. So Arch 11 and Plata
[52:33] County had to redo the agreement, which is
[52:38] done in a resolution by the county commissioners
[52:40] to perform in a multi county district to
[52:44] meet the statutory obligations of local public health.
[52:47] So we were formed in 1948 and then
[52:50] reformed in February '9 actually, because the act
[52:54] was passed into Were you on the commission
[52:56] then? Well, then you should be telling this
[52:59] I'm doing great. I'm just glad you can
[53:01] still remember the So reformed in 02/2009 in
[53:06] response to the public health act of 02/2008.
[53:10] And then that's all described in this slide,
[53:13] which I guess I could have, instead of
[53:14] just relying on that little history lesson, could
[53:16] have just looked at the slide, but this
[53:18] gives the references to what the Colorado statutes
[53:21] are if you want to go look at
[53:22] them. And I imagine you all have started
[53:25] with that. Yes, so that's where we are.
[53:28] So then the next slide, thanks, Janet, just
[53:32] gives you some summaries of what's in these
[53:34] statutory obligations. I won't go through these then
[53:36] if you all have started there. I would
[53:38] also be aware that there are statutory obligations
[53:40] and then there will be subsequent rulemaking by
[53:43] the State Board of Health. There may be
[53:45] other commissions like water quality, air quality, hazardous
[53:49] material commissions at the state, which are separate
[53:52] from the Board of Health, which also may
[53:54] do rule making that would involve obligations of
[53:57] local public health. So while it starts in
[53:59] statute, it then allows other boards and commissions
[54:02] to follow-up with rules and regulations, and that
[54:06] then becomes part of the puzzle of what
[54:09] local public health does. So this is, again,
[54:13] here we just pull out kind of the
[54:15] big pieces of the statutory obligations. You all
[54:18] have reviewed all of those, it sounds like,
[54:20] so I'm not going to go through them.
[54:22] So then I think we have one more
[54:23] slide on statutory obligations. And then let's see
[54:26] what's in our next slide. It's like a
[54:29] Price is Right, What's Behind the Next Door.
[54:31] Okay, so then historically, because I think there
[54:34] has been questions when there was the Health
[54:37] Investigative Committee and lots of discussion around how
[54:40] was this structured, there were some questions to
[54:42] see the contract between San Juan Basin Public
[54:45] Health and the county and how does it
[54:46] all work. And then I think our county
[54:48] commissioners and county administrator with some more history
[54:51] on this would understand why there's not a
[54:52] contract because it's formed by resolution and then
[54:56] the statute actually describes how a multi district
[55:00] operates. And so there isn't a contract back
[55:04] and forth between the counties. The multi county
[55:06] district operates with this proportional allocation of operational
[55:10] costs. So with that, the counties, Lapata and
[55:14] Archuleta County were following the statutory framework rather
[55:18] than creating. And it wouldn't make sense to
[55:20] create a separate contractor MOU because this is
[55:25] already in statute. So So what it talks
[55:27] about is proportion to the county size. And
[55:31] so in this case, we roughly say that
[55:33] La Plata has four times the residence of
[55:36] Archuleta, which is actually shockingly close to accurate.
[55:40] It's like 70,000, so let's say 70,000, but
[55:45] we give you an exact number for the
[55:47] proportional. So when we talked about after their
[55:51] statute, there were rulemakings, so if we go
[55:54] to the next slide, Janet, this one is
[55:56] hard to read, but this is the subsequent
[55:58] rulemaking. I'll walk through this and I don't
[56:00] know if you guys have already seen this
[56:02] one. Okay, everybody has, great. In 2019, the
[56:06] State Board of Health re upped the core
[56:09] services into a new foundational capabilities and foundational
[56:16] services. So prior to that, there were eight
[56:19] core services and seven of them had minimum
[56:21] standards. And that stuck from sometime after 02/2008
[56:25] to 2019. '20 '19, we went with the
[56:28] foundational services and capabilities. This was to create
[56:32] some opportunity for change in the local public
[56:34] health system beginning in 2020. We did experience
[56:38] significant change in the local public health system
[56:41] beginning in 2020, but not based on this
[56:44] new rulemaking, based on other events. But what
[56:50] we did as an agency is we had
[56:54] many years ago decided that we would budget
[56:57] to the court services so that especially our
[57:00] county commissioners could see exactly where the local
[57:04] If organized our org chart and our staffing
[57:08] and our budget to the court services, it
[57:12] would be easier to see what core services
[57:15] are adequately funded, what core services are not
[57:18] adequately funded, and then where the local contribution
[57:22] from the local counties goes. So that had
[57:25] been our habit. So in 2019, when the
[57:29] state board upgraded from seven to 12, we
[57:33] kind of scratched our head and said, all
[57:35] right, this is going to be kind of
[57:36] tricky to redo our org chart and our
[57:38] budget towards these 12 services and capabilities, but
[57:42] it's important to do because it really draws
[57:45] a line for the local community. This is
[57:48] where we can access funding, and this is
[57:50] where it's more difficult to access funding, and
[57:53] this is where the dollars go. So this
[57:56] is the seven core capabilities. And the core
[58:01] capabilities are cross cutting, which means they have
[58:04] to be applied to the five foundational services.
[58:09] And this is now how we budget. So
[58:11] if you've looked at the San Juan Basin
[58:13] public health budget online, I didn't break copies
[58:15] of it, but you will see we are
[58:17] following these. We actually one or two week
[58:20] collapse. So we don't have 12, I think
[58:22] we have 10 areas of budgeting. But I
[58:25] think we tried to do that to make
[58:26] it very clear. It should help you all
[58:29] in your work going forward because we can
[58:31] demonstrate here's where there is access to state
[58:37] funding. The majority of the funding comes from
[58:39] the state of Colorado for foundational service or
[58:41] capability and here's where there's really not and
[58:45] that will figure into your decision making about
[58:47] what services and programs you want to deliver.
[58:51] So then the next slide is how we
[58:55] budget at San Juan Basin, which is a
[58:58] very robust process of building it from the
[59:00] ground up, taking the budget to public, meaning
[59:03] all the special district rules and regulations in
[59:05] the state of Colorado to make that a
[59:07] very public process. So that is just that
[59:10] calendar. I don't think it's really relevant for
[59:12] you all, but it really just demonstrates the
[59:14] transparency and the commitment we have made at
[59:18] San Juan Basin. I'm trying to think if
[59:20] there's anything else in here. Let's get you
[59:23] want to cut we'll just run through down
[59:25] it. Our 2023 budget priorities, I think this
[59:29] is probably important because if we're looking for
[59:33] continuity to ensure that both counties, if moving
[59:38] to single county agencies, really want to build
[59:42] on the success of San Juan Basin. And
[59:44] we do have to say, I mean, Juan
[59:45] Basin is, we offer a robust suite of
[59:50] services. The average health department in The US
[59:53] that serves 50,000 to 100,000 residents has between
[59:57] twenty eight and thirty eight employees and has
[1:00:00] a much smaller offering of programs and services.
[1:00:03] So we have, in addition to our obligations,
[1:00:07] really worked to bring additional programs to give
[1:00:10] families the bright start in life. And we're
[1:00:13] very proud of that work. So in our
[1:00:16] 2023 proposed budget priorities, we really proposed to
[1:00:20] our Board of Health kind of continuing in
[1:00:23] that vein. And so, these were our budget
[1:00:25] priorities in 2023. And actually, I think I
[1:00:31] will go through these. Was obviously retaining and
[1:00:34] recruiting staff. I think everyone's aware that there's
[1:00:36] workforce issues in government and in all kinds
[1:00:38] of sectors right now, especially in places where
[1:00:42] we are seeing the cost of living outpace
[1:00:45] the wages, which I think we're all challenged
[1:00:47] within Colorado. So we are especially in these
[1:00:50] beautiful mountain towns. So we had made that
[1:00:52] a '23 priority. We also worked through some
[1:00:56] of our steady state programs, because many of
[1:00:58] our steady state programs did not get. I
[1:01:01] mean, just going to be perfectly honest, they
[1:01:02] didn't get the attention that they needed over
[1:01:05] the course of pandemic. So it was a
[1:01:07] redoubling of efforts around our steady state programs
[1:01:10] and then working to have an ability to
[1:01:13] scale our communicable disease response efforts. So we
[1:01:16] do like tremendous partnership work with Pagosa Springs
[1:01:20] Medical Center, for example, in disease. But as
[1:01:24] we know, these are unpredictable when we have
[1:01:27] a response demands more resources to when it
[1:01:32] doesn't. So we need the flexibility there. So
[1:01:35] that was part of our 'twenty three budget
[1:01:37] priorities. And then working through some of these
[1:01:40] cross cutting foundational capabilities, which we saw on
[1:01:43] the previous slide, that had been newly introduced
[1:01:47] in 2020. So we also wanted to redouble
[1:01:49] efforts to work through those. And then the
[1:01:53] last bullet is prepare for a successful transition
[1:01:56] from a Mumelzi County local public health to
[1:01:58] single county led departments. So here we are,
[1:02:01] we're tackling the last bullet. So I don't
[1:02:04] know that I need to go into the
[1:02:05] budget in great detail. I just want to
[1:02:07] kind of show you how we've thought about
[1:02:09] the work and then answer any questions you
[1:02:11] all have about kind of how we organize
[1:02:15] and how we could be of service to
[1:02:16] you as you go through this very complex
[1:02:20] set of decisions over the next couple of
[1:02:23] months. And just a verification, we noticed in
[1:02:28] the contracts that we've sent over that June,
[1:02:31] the June, a lot of grant funding, other
[1:02:34] funding expires. Everything. And has the San Juan
[1:02:37] Basin already started requesting funds for the last
[1:02:42] part of the year? So we're not quite
[1:02:46] into the second quarter of the calendar year.
[1:02:48] Okay, so first of all, observation. Things change
[1:02:51] over June 30 to July 1. That is
[1:02:53] because many of the things that we do
[1:02:56] in partnership with the state of Colorado are
[1:02:58] on the state fiscal. This is this tremendous
[1:03:01] wacky problem that the state budgets from July
[1:03:05] to June and counties budget from January to
[1:03:08] December. It makes up It's just another one
[1:03:12] of those things that makes the complexity of
[1:03:15] what we do sometimes off the charts because
[1:03:17] you have to track every one of your
[1:03:19] funding sources, both in the calendar and in
[1:03:24] the state fiscal because you're tracking towards two
[1:03:27] different budgetary allocations. So with that, we often
[1:03:32] start the negotiations for the next, say fiscal,
[1:03:36] the second quarter of the calendar, which is
[1:03:38] the last quarter of the fiscal. So those
[1:03:42] conversations will start in detail April, May, June,
[1:03:46] or July 1 starts. Now that said, we
[1:03:50] have been meeting with CDPHE. We have dozens
[1:03:54] of revenue contracts with CDPHE, and every program
[1:03:58] manager in our organization has been in specific
[1:04:02] contact with their co lead at the CDPHC,
[1:04:07] both on the program side and on the
[1:04:09] fiscal side to determine that San Juan Basins
[1:04:13] contracts will go July 1 to twelvethirty one
[1:04:15] and then January 1 because they won't be
[1:04:18] able to go beyond. They turn into calendar
[1:04:20] year contracts. So they'll go January 1 to
[1:04:23] June 30, that they'll have to work with
[1:04:25] the two counties. So it's likely that some
[1:04:30] of the new funding would bleed into '24
[1:04:32] and then just divide it. San Juan Basin
[1:04:39] won't be able to sign sign into '20
[1:04:41] So when we get the new contracts, they'll
[1:04:44] have to be scopes of work and contracts
[1:04:47] that end twelvethirty But you're absolutely right to
[1:04:52] be thinking about what it looks like in
[1:04:54] '24 because what's also happening in second quarter
[1:05:00] calendar, which is fourth quarter fiscal, is that's
[1:05:03] when the state legislature is making decisions. And
[1:05:06] if they make decisions that look exactly the
[1:05:09] same from the prior year, that there won't
[1:05:11] be enough money for the single county agencies
[1:05:14] to each do their thing. So this conversation
[1:05:17] has been happening at the state level for
[1:05:20] quite some time because they have to adjust
[1:05:23] their budgeting on their side to accommodate the
[1:05:27] changes that we're making here. Bell Ann was
[1:05:33] here last week, which gave me a lot
[1:05:35] of comfort. Oh good. I thought she was
[1:05:37] very good, but to follow-up Kathy's question, it's
[1:05:42] my understanding that, like you just said, this
[1:05:45] will go through twelvethirty one and then the
[1:05:47] next six months, Does Archuleta County need to
[1:05:50] be ready in that September, October timeframe, just
[1:05:54] to follow-up with at least what I understood
[1:05:56] from Bel Air. We have to notify the
[1:06:00] state for the funding of the six months
[1:06:04] in '24. Yes. We'll be going different. Yes.
[1:06:08] Yes. You will all need to both single
[1:06:11] county agencies will need to be in communication
[1:06:14] with CDPG. And quite frankly, I think it's
[1:06:18] preferable to be in communication April, May, and
[1:06:20] June rather than September, October, because this is
[1:06:24] when the decisions are made for the state
[1:06:27] fiscal. State fiscal goes July 1 to June
[1:06:31] '20 '4. Now that may feel to you
[1:06:33] all and I think both counties feel like,
[1:06:36] okay, well then we can negotiate for January
[1:06:39] at the end of this year, but those
[1:06:40] decisions are made. Yeah, because they're made up
[1:06:44] through the state legislative budgeting process. This is
[1:06:54] why Derek left because I am long winded.
[1:06:56] But I try to really think about like
[1:06:59] where the question's coming from. And so if
[1:07:01] I'm giving you more information than you need,
[1:07:03] know, cut me off, but I'm trying to
[1:07:05] really draw the picture of how all the
[1:07:07] pieces fit together because it's not as easy
[1:07:10] as it looks. Thank you. Looks. Does it
[1:07:14] look easy? Okay. Nothing is easy. Have two
[1:07:22] other questions. One is, as a citizen, looking
[1:07:31] back at your public health department that you've
[1:07:33] led for a long time, what gaps do
[1:07:37] you see that affect regards on the county?
[1:07:43] I think it's a great question. We do
[1:07:46] a community health assessment and we work through
[1:07:49] a public health improvement plan and that came
[1:07:52] into feeding in the 02/2008 Public Health Act,
[1:07:55] right? But what didn't come into being, let
[1:07:57] me backtrack for a second. Public health is
[1:08:00] funded, not just in Colorado, but really everywhere
[1:08:04] in very siloed pots of money that don't
[1:08:08] touch each other and don't integrate well. And
[1:08:11] so it leaves it kind of stultified and
[1:08:14] not really nimble to meet community need as
[1:08:17] community need emerges because we are kind of
[1:08:21] stuck with And the other problem is, and
[1:08:23] there's been a lot being written about this
[1:08:24] now post pandemic, is that oftentimes the funding
[1:08:27] is asynchronous to the largest need in a
[1:08:33] community. So if we look at, even if
[1:08:35] we like any type of communicable disease, it's
[1:08:40] gonna have an exponential growth and then there's
[1:08:43] gonna be some work to contain and bring
[1:08:45] it back and then the funding follows because
[1:08:48] then we have congressional decision making, state decision
[1:08:51] making, and then local government. So we end
[1:08:54] up with very siloed pots of money and
[1:08:57] often at the wrong time for the The
[1:09:00] need. That we're having at the time. So
[1:09:02] we have to have that baseline. So then
[1:09:05] in 02/2008, based on the Public Health Act,
[1:09:08] we are asked to do public health needs
[1:09:12] assessments in communities and write public health improvement
[1:09:15] plans. But what's interesting about that legislation is
[1:09:18] that it required that side of it, but
[1:09:20] it didn't free up any non committed, non
[1:09:23] restricted dollars. So if you go into a
[1:09:26] community and determine, you know, the largest need
[1:09:28] in this community is more quality early childhood
[1:09:33] education because that's what sets kids up for
[1:09:36] the healthiest life that we can have, greatest
[1:09:39] potential of health going forward. And we live
[1:09:42] in a childcare desert, and that's something that
[1:09:45] we want to contribute to on the public
[1:09:46] health side, that would be something a community
[1:09:49] may discover into a community health assessment and
[1:09:52] public health improvement plan. No money followed. So
[1:09:56] what was legislated was the assessment and the
[1:09:58] plan, and then you're kind of on your
[1:10:01] own to go seek funding for it. So
[1:10:03] when you say what needs do we see,
[1:10:06] we see needs everywhere. We see room and
[1:10:09] opportunity to do early child, to do family
[1:10:12] formation, to have more resources for substance use,
[1:10:22] children. There's lots of interest right now, I
[1:10:26] think a lot of this is post pandemic,
[1:10:28] is we're having a crisis of school age
[1:10:31] mental health, young adult mental health. So prevention
[1:10:35] programs, that realm, we have had some significant
[1:10:39] suicide clusters in Archuleta and in the Plaquette
[1:10:43] County. But again, with that asynchronous categorized funding,
[1:10:47] identifying it in the community health assessment and
[1:10:51] public health treatment plan does not create a
[1:10:54] straightforward path number addressing it in the community.
[1:10:56] Are block grants available for those types of
[1:11:03] needs? The answer is sometimes, right? I mean,
[1:11:07] is when everything is kind of pieced out,
[1:11:10] then the answer and I mean, pieced out,
[1:11:14] like pieced out that kind of when everything
[1:11:16] is in small funding streams, I can't answer
[1:11:21] that in what, yes. Money becomes available, sometimes
[1:11:25] it doesn't. We're seeing in Southwest Colorado currently,
[1:11:32] we're seeing a resurgence of sexually transmitted infections
[1:11:36] and syphilis, and we're seeing syphilis in pregnant
[1:11:39] women, right? This is such a public health
[1:11:42] story that because we saw such a suppression
[1:11:45] of these infections for decades with good public
[1:11:49] health, then the funding moved on to other
[1:11:53] things that seemed more pressing and the virus
[1:11:56] or the bacterias don't go okay because the
[1:12:00] funding in our eyes have gone other places.
[1:12:03] And so we have providers diagnosing diseases today
[1:12:07] that they haven't seen. They read about it
[1:12:09] in medical school that nobody had actually seen
[1:12:12] and we're seeing this. Southwest Colorado has some
[1:12:15] high rates of pathogens related to sexual transmission
[1:12:21] as well as substance use disorder. We're seeing
[1:12:23] this kind of step up together and we
[1:12:27] aren't prepared for it and this is not,
[1:12:30] we're not unique. This is a kind of
[1:12:32] rural Colorado problem and a rural problem all
[1:12:35] across the country. So the issue that we
[1:12:37] suffer from is when we cut up our
[1:12:40] funding and only give it to what is
[1:12:42] happening now, we lose track of things we've
[1:12:45] been successful with and they come back and
[1:12:48] then they come back more expensively. That is
[1:12:51] the difficulty of what we do with public
[1:12:53] health. So the things we can do are
[1:12:56] huge and endless, but the things we're funded
[1:12:59] for are often very specific. Sorry, Andrea. No,
[1:13:04] was just gonna ask about, so it kind
[1:13:06] of sounds like an iceberg, right? So, you've
[1:13:09] got above the waterline or kind of the
[1:13:11] nice to, I don't wanna say nice to
[1:13:13] have public health programs, but kind of things
[1:13:15] that have discretionary funding attached. Underneath that waterline
[1:13:19] is stuff that we need to figure out
[1:13:21] how to have a base level of funding
[1:13:22] for no matter what. And so that's maybe
[1:13:25] from local dollars. Are there other sources that
[1:13:28] you've seen around the state that people looked
[1:13:31] into some kind of, so if it's not
[1:13:33] state or federal, is there a local like
[1:13:36] for property tax or is there some funding
[1:13:39] source that you're aware of that some communities
[1:13:41] have? So the county contribution that's required by
[1:13:47] law, think presumably if it comes out of
[1:13:49] the county, covers is likely coming from property
[1:13:52] tax. I haven't seen public health have a
[1:13:57] specific public health mill, but there are hospital
[1:14:02] districts and health districts and there are in
[1:14:05] some places, health districts that have relationships with
[1:14:10] community health in addition to supporting hospitals. And
[1:14:15] I don't have, you may have, I don't
[1:14:18] know the whole interplay between, I think there's
[1:14:21] designations, there's a hospital district and a health
[1:14:24] district and there are some different rules or
[1:14:26] there, I actually don't know the special district
[1:14:28] rules on that. Right. Yeah, I mean, are
[1:14:32] a special district health district. We receive, you
[1:14:34] know, funding from our county from the mill
[1:14:38] levy on million dollars a year, which is
[1:14:42] two weeks of operation Which is right. Is
[1:14:45] it because of the spread? But that is
[1:14:47] the fact and yeah. I'm not in any
[1:14:50] way presuming that that's where the answer is.
[1:14:52] Of the communities there have seen some different
[1:14:56] commitments made with health districts if they have
[1:14:59] the broader, but it would depend on one.
[1:15:02] And I think there's, I can only think
[1:15:03] of two in Colorado that have gone that
[1:15:06] route where the health district, but it doesn't
[1:15:09] actually support the local public health agency, it
[1:15:12] supports community health programs outside of the public
[1:15:16] health agency. But there are two that do
[1:15:19] that and they have probably a much higher
[1:15:21] male or a large right. So I hear
[1:15:24] what you're saying it sounds like you're very
[1:15:26] wary of kind of chasing these different funding
[1:15:29] pots because then you kind of take your
[1:15:30] eye off of the basic level of services
[1:15:34] that may reflect the true need in the
[1:15:37] community. It's just really underfunded, correct? Yes, I
[1:15:43] mean, there's some, I was just reading a
[1:15:48] study over the weekend that says 50% of
[1:15:51] the work from '2, after the two thousand
[1:15:56] and eight recession that to where we are
[1:15:58] today is 50% of the workforce we had,
[1:16:01] because that's where things really changed. And the
[1:16:03] reason that they changed is there was this
[1:16:05] idea that if we had more access to
[1:16:11] health insurance, then we would need less safety
[1:16:15] net of care. And so there were cuts,
[1:16:18] there was actually supposed to be part of
[1:16:19] the Affordable Care Act was supposed to have
[1:16:21] a dedicated public health funding stream. That funding
[1:16:24] stream at the federal level has not come
[1:16:27] to fruition. That money has gone other places.
[1:16:31] So without that dedicated funding stream, there has
[1:16:35] just been a real backsliding in what's available
[1:16:39] in most local communities. So, what is the
[1:16:46] likelihood that we could resolve our differences and
[1:16:51] stay in the district? That was a good
[1:16:55] question. And you're directing that question to me.
[1:17:05] Well, I'll answer a different question. I will
[1:17:07] say that San Juan Basin Public Health has
[1:17:09] obviously since 1948 worked to provide services to
[1:17:15] multiple counties in Southwest Colorado. We're very proud
[1:17:19] of the work that we've done. I'm unbelievably
[1:17:23] proud and impressed with the staff that we
[1:17:26] have. We have a staff that just turns
[1:17:29] themselves inside out when there's a call to
[1:17:32] action to create something or get something done
[1:17:35] in a community. And I very much enjoy
[1:17:41] the ability to work with such tremendously committed
[1:17:45] staff and would love to see how we
[1:17:48] can continue that. So I feel like a
[1:17:56] lot of these questions have been budgetary. I
[1:17:58] think more programmatically. Sure. I just have a
[1:18:01] couple you know when it comes to like
[1:18:04] some of our top three sort of mortality
[1:18:06] issues right so like heart disease, diabetes, cancer
[1:18:09] like what are the prevention programming you guys
[1:18:12] are currently sort of involved in? I feel
[1:18:14] like you know some of those things like
[1:18:16] we need to be ready and in place
[1:18:18] to sort of in lieu of reconciling that
[1:18:24] our health department needs to be ready to
[1:18:26] take on in some form. So can you
[1:18:28] describe what some of those are looking like
[1:18:30] currently for you guys or how you're addressing
[1:18:32] some of those things? Yeah, and it depends
[1:18:33] on if you wanna look at that from
[1:18:35] like a primary, secondary or tertiary prevention model.
[1:18:38] And since now that you have said that
[1:18:41] you have an Miles hour, I figured I
[1:18:42] might as well just go with that, right?
[1:18:44] Or we're doing, because a lot of times
[1:18:46] what you see in rural public health is
[1:18:49] you may be doing some of the screening
[1:18:52] and the early diagnosis. And we at some
[1:18:55] point were was doing that work back in
[1:18:58] the day when there was so much less
[1:19:00] healthcare in Archuleta County, right? When I started,
[1:19:04] oh, so actually I was gonna say when
[1:19:06] I started in public health, but it's when
[1:19:08] I started in public health, I was working
[1:19:09] in domestic violence and sexual assault and working
[1:19:11] really closely back with Carmen Hubbs a million
[1:19:15] years ago and the only healthcare in Archuleta
[1:19:18] County was the, I think it was called
[1:19:19] the Mary Fisher Clinic and I never for
[1:19:21] some reason don't know the story of who
[1:19:24] Mary Fisher was and how she had a
[1:19:25] clinic made better but I would love to
[1:19:27] know the story someday. So at that point,
[1:19:32] local public health is doing more of the
[1:19:35] early intervention screening and diagnosis, but we've had
[1:19:38] a tremendous growth and proliferation of healthcare. Know,
[1:19:42] Cagosa Springs Medical Center has a rural health
[1:19:44] clinic, there are some special designations there about
[1:19:47] how rural health clinics serve populations. There's other
[1:19:50] inputs into the healthcare realm. So at that
[1:19:55] point, we shifted our work into care coordination
[1:19:57] and patient navigation because it doesn't make sense
[1:20:01] that we replicate what's available in healthcare. So
[1:20:05] then that gives us the ability, and this
[1:20:07] is where I think the ACA by putting
[1:20:09] the funding towards public health and then having
[1:20:13] it never come to fruition is where things
[1:20:16] went like this, right? We get people health
[1:20:18] insurance, we get more early screenings, diagnosis, more
[1:20:22] early intervention, we should see some improvement. But
[1:20:26] then how do we go further upstream and
[1:20:29] figure out what is making people think, right?
[1:20:32] So, you know, it's the early childhood nutrition
[1:20:35] programs, it's the family formation, the earlier intervention.
[1:20:39] A lot of what becomes your health as
[1:20:42] an adult happens when you're zero to two
[1:20:45] years old in your family environment. So we
[1:20:48] focus on more programs for early family formation.
[1:20:54] And then we should see the benefit of
[1:20:56] that decades out, right? Is that easy to
[1:20:59] measure? Is that easy to talk about? Absolutely,
[1:21:03] positively not. But that's the best we can
[1:21:07] do that for heart disease, different, I mean,
[1:21:12] cancers are tracked to our early childhood, then
[1:21:16] there's environmental inputs, right? So what are we
[1:21:18] doing? One of the things we're working on
[1:21:19] right now is, I'm gonna like knock on
[1:21:22] wood, wildfire events, we are learning so much
[1:21:26] more about what the exposure from the PM
[1:21:29] 2.5 and wildfires focus. So we just went
[1:21:32] to a national foundation and got some funding
[1:21:37] for a pilot program for clean air shelters
[1:21:39] because we know that we live in communities
[1:21:41] where people don't have no reason to have
[1:21:44] a sophisticated HVAC when you live in mountain
[1:21:47] communities with mountain reasons, right? Well, then you
[1:21:50] have wildfires and you have no way to
[1:21:51] keep your indoor air clean. So we're looking
[1:21:54] at piloting some programs with clean air shelters
[1:21:57] because we're finding things like the PM 2.5
[1:22:00] in wildfire smoke is that much more damaging
[1:22:04] than the PM 2.5 that we're exposed to
[1:22:06] all the time, right? So we're working through
[1:22:10] piloting things like that because of the communities
[1:22:13] that we live in. There aren't examples in
[1:22:16] Colorado Clean Air Shelters for Wildfire. This is
[1:22:19] an idea that we heard was piloted in
[1:22:22] California. We said we want to bring that
[1:22:24] to Colorado. We're one of only five organizations
[1:22:28] in the country that received this public private
[1:22:32] partnership, high living money from Devotemont Foundation. So
[1:22:36] we'll do those types of things. And we
[1:22:38] say, how do I, if I have an
[1:22:40] idea, how do I get it funded? We
[1:22:42] write it down, we shop it, we try
[1:22:43] to leverage relationships. And if it's got some
[1:22:46] hook that it's new, it's different, then we
[1:22:49] can maybe get it piloted because there's not
[1:22:52] often the bandwidth to pilot things in rural
[1:22:56] communities. The only other thing I was thinking
[1:23:02] and looking through some of your reports I
[1:23:04] don't see and I could have just missed
[1:23:05] it in the piles of documents. I was
[1:23:11] just curious about the breakdown of like the
[1:23:14] services and like the number of people that
[1:23:16] are accessing those in Archuleta versus La Plata.
[1:23:19] I see the big numbers and again it's
[1:23:21] probably similar but I haven't seen it so
[1:23:24] I don't know Mary if you know where
[1:23:25] it is that you can tell me or
[1:23:27] if you know what it might be called
[1:23:28] Leanne. When we talked last week, you mentioned
[1:23:32] an incentive to me, which I did share
[1:23:34] with the board chair. I haven't shared with
[1:23:36] the committee just because I was gonna bring
[1:23:37] it up today, but Archuleta County, the investigative
[1:23:41] study committee received that information in 2021. So
[1:23:46] they received it broken down by it does
[1:23:50] help understand not fully funded requires agency contribution
[1:23:54] not fully funded, not fully post medical funding.
[1:23:57] And it talks about 8% of clients serve
[1:23:59] result in our society for each of the
[1:24:02] pillars. So they range from eight to 36%
[1:24:05] depending on the program. So what so is
[1:24:08] there a total number? I'm just like, how
[1:24:10] many people, right? 8% is all fine and
[1:24:13] great until it's one person or two people.
[1:24:18] As you guys move through this process, we
[1:24:21] can share more detailed information. Most of us,
[1:24:25] so we have, there was a lot of
[1:24:30] question about how much money do you spend
[1:24:33] in one county versus the other county. And
[1:24:35] we were charged with serving a jurisdiction. So
[1:24:39] we didn't have our staff members and all
[1:24:42] of our budgeting track time between how you
[1:24:45] know, like, you know, would I, you know,
[1:24:47] fill out my time with you differently, because
[1:24:49] I came over here, you know, it's just
[1:24:51] like we weren't having on the expense side,
[1:24:55] that type of tracking, because it wasn't required
[1:24:57] because we were funded to serve the jurisdiction.
[1:25:00] On the programmatic side, we of course have
[1:25:03] lots of data around 36% of our WIC
[1:25:07] clients reside in Archuleta County versus 64% residing
[1:25:13] in La Plata County. And the nurse family
[1:25:16] partnership, it's 30% in Archuleta versus 70%. In
[1:25:21] SafeCare, was SafeCare was actually a program that
[1:25:24] we picked up that the Archuleta County Human
[1:25:26] Services Director at the time really asked us,
[1:25:30] can you pick this program up because it's
[1:25:32] going away from our community? So we had
[1:25:34] an over representation there. Then in other programs,
[1:25:37] it's not twentyeighty, it's tenninety, right? So we
[1:25:43] have that information. And as you guys get
[1:25:46] further down this, I think that some of
[1:25:50] that information should be in the contract documents.
[1:25:54] If it's not, we can start giving you
[1:25:56] estimates around that work because I would be
[1:26:00] interested in it prior to 'twenty. Right? Like
[1:26:04] historically, what did it look like? Right. You
[1:26:08] know, I mean, there were also lots of
[1:26:10] programs, and I don't know if there's a
[1:26:11] way to connect around, you know, what was
[1:26:14] offered out of the Eighth Street Building and
[1:26:16] when and how some of those went away.
[1:26:18] I know a lot of it's related to
[1:26:19] like grants go away, right, but I think
[1:26:22] it would be interesting to see like historically
[1:26:25] some of those services and like the funding
[1:26:27] streams and like when they went away because
[1:26:30] I think what I'm hearing from the community
[1:26:32] is they remember some of those things and
[1:26:33] they really want some of those things but
[1:26:35] historically being able to then have an answer
[1:26:38] to say there's no funding streams. That was
[1:26:40] funded by X, X is morphed into Y.
[1:26:43] And a lot of that would be changes
[1:26:45] with the Affordable Care Act, which has allowed
[1:26:48] the program. You can't have the level of
[1:26:51] health care without a pay source community members.
[1:26:57] And now that that got passed, have, but
[1:26:59] then some of the changes to say, what
[1:27:03] did it look like before pandemic and what
[1:27:04] did it look like after? I'll also say
[1:27:06] pandemic sort of distorted everything because there were
[1:27:09] things like, you know, WIC is one of
[1:27:12] our high volumes programs and WIC is a
[1:27:14] great program. Well, we saw WIC numbers, we
[1:27:18] saw some declining WIC numbers before the pandemic,
[1:27:21] we saw some increased WIC numbers during the
[1:27:23] pandemic. Now that the SNAP benefits are being
[1:27:27] wound back with the end of the public
[1:27:28] health emergency, we expect to see more WIC
[1:27:31] enrollment rates. So there's nothing in our building
[1:27:37] that's not touched in some way by the
[1:27:38] pandemic. We can absolutely give the kinds of
[1:27:42] numbers. Yep. Great. Would y'all be interested in
[1:27:47] seeing what the investigative committee was presented to
[1:27:51] them in October 21? Is that in their
[1:27:53] document? It was not in the docus. Yes,
[1:27:57] do not understand the three. Oh, That'd be
[1:28:00] great. It's again, it just it was what
[1:28:03] they heard from them. So I think we
[1:28:06] ought to know what that was. They did
[1:28:10] guide the commissioners. So it says thirty to
[1:28:15] thirty five percent of communicable disease investigations are
[1:28:18] in Archuleta County, then you're gonna say, how
[1:28:20] many do you think so? I have some
[1:28:22] of that information, 20% of sexual health and
[1:28:25] cancer prevention is here, 25% of environmental is
[1:28:31] here, 30% of on-site inspections, and 33% of
[1:28:38] septic permits were Archuleta County. I mean, I
[1:28:41] just think it helps speak to staffing, know,
[1:28:43] if there's a hundred WIC clients but that's
[1:28:45] only 20% because there's so many in La
[1:28:47] Plata, right, that tells us something about how
[1:28:49] many people we need to run a program
[1:28:52] versus the percentage. I understand why the report
[1:28:55] percentages that you guys are looking at dollars.
[1:28:57] Well, if we have the numbers someplace else,
[1:28:59] right? You that's not they're never in some
[1:29:01] place. Right? Right. But you know, you know,
[1:29:04] but I think that it's helpful just because,
[1:29:07] you know, when we're trying to think about
[1:29:08] how how to staff departments, you know, if
[1:29:12] there's five, then how does this one person
[1:29:14] maybe wear three hats versus in, you know,
[1:29:17] La Plata, maybe that person served a whole
[1:29:20] lot because Well, on that April, May and
[1:29:23] June activity that we discussed when we should
[1:29:25] be visiting with the state and I'm saying,
[1:29:28] you know, last quarter of the state fiscal
[1:29:30] or second quarter of the calendar is also
[1:29:32] where that information comes from because the state
[1:29:35] will say, We're funding you at this level
[1:29:39] because our demographic information is that the size
[1:29:45] of the target population is X, the uptake
[1:29:48] of that program is Y, so we expect
[1:29:51] your client load to look like Z, so
[1:29:55] that has to be staffed at this FTE
[1:29:57] level, right? And that's why you want to
[1:29:59] be doing this with the state April, May,
[1:30:02] and June. The other complication, which I'm just
[1:30:04] going to throw out there, I think this
[1:30:06] one's going to be kind of hard to
[1:30:07] hear because none of this is fun, but
[1:30:09] some of the programs at the state, they're
[1:30:12] not going to want to chop it to
[1:30:14] too small program, right? So at the metro
[1:30:19] region where Tri County Tri County made steps
[1:30:22] towards breaking up, and I think that sort
[1:30:24] of emboldened some decision making about other health
[1:30:28] districts breaking up, they are serving millions of
[1:30:31] people at Tri County. So when they break
[1:30:33] up into Douglas Adams and Arapahoe, the state
[1:30:36] contracting side will take one contract and contract
[1:30:39] three times. It triples their administrative burden, but
[1:30:43] it serves millions of people. We have to
[1:30:46] remember for fifty six thousand and 14000 is
[1:30:49] the state realistically going to double its administrative
[1:30:54] burden for that small number of people? And
[1:30:57] again, this is why I highly encourage that
[1:30:59] these conversations cannot wait until third and fourth
[1:31:05] quarter of the calendar, which is at the
[1:31:08] Tri County, a lot of those conversations happen
[1:31:10] third and fourth quarter, but you're dealing with
[1:31:12] larger numbers of people, there's going to be
[1:31:15] more negotiations for smaller numbers of people. So
[1:31:18] based on your work with the state what
[1:31:23] is our best move and ideally who should
[1:31:27] be having those conversations if we haven't hired
[1:31:29] a director yet in order to get us
[1:31:31] into this ballgame and start thinking through those
[1:31:34] things so that especially as we're thinking about
[1:31:36] programming and staffing, know, mean, do we sit
[1:31:40] on those with you guys as you're like,
[1:31:42] right? Are we all in those together because
[1:31:44] you guys are doing the first half of
[1:31:46] the fiscal year? Like it just seems like
[1:31:48] it's convoluted. You may not know but no
[1:31:51] and we introduced your conversation when we're negotiating
[1:31:54] for the second half of this calendar year
[1:31:56] but I think the sooner that, so if
[1:32:00] there's, if I don't know what the timeline
[1:32:03] is for completing that recruitment and search, but
[1:32:08] the sooner that that happens, then there's a
[1:32:11] person who can start having those conversations. And
[1:32:15] it's with direction and input from you all
[1:32:17] about which programs in what order and how
[1:32:19] do we prioritize this. We're trying to get
[1:32:21] you all the information so you can figure
[1:32:23] out how to prioritize it. And I think
[1:32:25] your questions about numbers served is hugely important
[1:32:28] and we'll be happy to work on that,
[1:32:30] but also that's going to come from these
[1:32:33] negotiations by the state. How many people are
[1:32:39] currently in your funding department of San Juan
[1:32:42] based Mill? How many people work on that
[1:32:44] process? We have an assessment and planning that
[1:32:51] has three staff members that support all of
[1:32:55] the program managers. So we have that skill
[1:32:58] set diffused across the programs. So if you,
[1:33:03] what's your favorite thing in public health? Early
[1:33:08] child. Okay, perfect. So if you're working in
[1:33:10] early childhood and you say, I really want
[1:33:13] this early childhood nutrition, this is my dream,
[1:33:17] I want this. So you are more likely
[1:33:20] than our data and our assessment and planning
[1:33:25] team to come across opportunities. When you come
[1:33:27] across an opportunity, you as the subject matter
[1:33:30] expert on our staff can seek support from
[1:33:33] our assessment and planning team, but you are
[1:33:35] the subject matter expert in bringing in funding
[1:33:39] to your department, which is sometimes a little
[1:33:42] bit different than how other organizations are set
[1:33:46] up. But we, because there's such diversity of
[1:33:50] the programming, we have every program manager and
[1:33:53] every division director with expertise in seeking funding
[1:33:57] to sustain their programs. That's so valuable. And
[1:34:00] that's going to be something extremely hard for
[1:34:02] us to do. I've got an Just curious
[1:34:10] there, Kathy asked a tough question reconciling. I
[1:34:14] like that question. Is there a possibility where
[1:34:17] Archuleta could work with La Plata in that
[1:34:21] role? Going forward? The funding? To work together
[1:34:26] on funding? Well, or to contract with La
[1:34:31] Plata to help with that if we can
[1:34:34] pull that together. So I can only speak
[1:34:37] for San Juan Basin, I can't speak for
[1:34:39] any county, but some of the question I
[1:34:42] can put on the table is like, you
[1:34:44] know, kind of the how's, how do we
[1:34:47] start, know, we know what the what's are,
[1:34:48] we want to figure out what our programs
[1:34:50] are, and we want to get them, get
[1:34:55] the funding and the delivery mechanism in place.
[1:34:58] Those hows could happen in a variety of
[1:35:01] ways but I can't speak to how La
[1:35:03] Plata County would have been. So are you
[1:35:08] involved with the I think La Plata County
[1:35:13] has already formed the board itself. Yes. Are
[1:35:16] you involved in that? What is the makeup
[1:35:21] of that board? Are there any county commissioners
[1:35:24] on No. They do not have county commissioner
[1:35:28] representation. It's all public people from the community
[1:35:30] and public health people. Seven? Is it five
[1:35:33] percent? Seven. No, something commissioner. Seven. So they're
[1:35:38] looking to hire director I'm assuming and you
[1:35:41] may not know this but are they going
[1:35:42] to report to the county manager or are
[1:35:45] they going to report to the school or
[1:35:48] do you know? They have not released their
[1:35:52] solicitation so once that is released I think
[1:35:55] that will be clear. Okay interesting yeah we
[1:35:58] were just having that conversation earlier about reporting
[1:36:00] structures and stuff like that. When is the
[1:36:03] assessment due or can we finish the new
[1:36:06] assessment that's in The survey is open through
[1:36:09] the first week in April. Okay. This survey
[1:36:12] data is one component. So what's required in
[1:36:15] statute is public health improvement plan. How to
[1:36:18] get to your plan can be things like
[1:36:22] a community health assessment. It can also be
[1:36:25] a survey or an analysis of secondary data,
[1:36:29] or it can be a combination of the
[1:36:31] two. So there is a community health assessment,
[1:36:34] there are also focus groups with specific target
[1:36:37] populations, and there are key informant interviews. All
[1:36:40] of those together will provide quantitative and qualitative
[1:36:44] primary data sources, but then it will be
[1:36:47] synthesized with secondary data sources, which are not
[1:36:51] always complete for small communities like counties of
[1:36:55] 14,000 people. So there may be some aggregate
[1:36:58] secondary data that is then used together to
[1:37:01] produce the report. We will be able to
[1:37:04] provide preliminary information on the primary data sources,
[1:37:09] but that takes some time to sift through.
[1:37:12] May and June, we do not intend to
[1:37:14] go public with that. It would be more
[1:37:16] in the summertime as some of the secondary,
[1:37:19] as we're benching it to what we can
[1:37:22] validate through secondary data sources. Because in the
[1:37:26] surveys, we have trouble getting a lot of
[1:37:29] people to respond to them, right? And the
[1:37:31] demographic who uses. Yeah, we have like 1,100
[1:37:36] responses now across the two counties. So as
[1:37:39] long as that has an eightytwenty split, then
[1:37:41] in theory, according to the statisticians we're working
[1:37:44] with, that's statistically valid. But if it over
[1:37:48] represents one group and under represents another group
[1:37:50] or, I mean, we have to be honest,
[1:37:52] like our perceptions don't always match. So if
[1:37:57] we ask people about, how do we achieve
[1:38:01] our highest potential of health, most people will
[1:38:03] immediately go to healthcare and say, well, as
[1:38:06] long as I'm getting my blood pressure screened
[1:38:07] at my healthcare provider, then I'm tackling, addressing
[1:38:12] this need without actually saying, but what we
[1:38:15] find is things that we do in other
[1:38:18] socioeconomic decisions have outsized impact on our heart
[1:38:22] health, right? And that's why we don't simply
[1:38:25] rely on the community responses. We bench it
[1:38:29] to secondary data and evidence based programming in
[1:38:34] communities because we want to tie up the
[1:38:36] pieces together more comprehensive. I had a question
[1:38:41] about the emergency prepared response and it's not
[1:38:44] well formulated in my brain so bear with
[1:38:46] me here but I understand you had a
[1:38:50] group of people, employees that actually were assigned
[1:38:53] that role and it may be the same
[1:38:56] answer to Kathy's but I see this emergency
[1:39:00] preparedness preparedness as a thread that every program
[1:39:02] is responsible for So, it the same relationship
[1:39:06] where the program director of each of these
[1:39:09] services It's a both end. So, we have
[1:39:13] just like we have an assessment and planning
[1:39:15] team that can support program managers to get
[1:39:17] their grant applications out the door or do
[1:39:20] the research. We have a, in this case,
[1:39:23] we have a state funded emergency preparedness and
[1:39:27] response team. And then that they work to
[1:39:32] prepare each department. So when we talk about
[1:39:36] emergency response, some emergency response can be your
[1:39:39] continuity of operations if there's a event in
[1:39:43] your community that doesn't allow your agency to
[1:39:46] perform its duties, right? But then some of
[1:39:49] it beyond that then is also serving the
[1:39:52] community. So if we talk about like a
[1:39:55] wildfire event or flooding event or an emergency
[1:39:58] communicable disease event, but what we did with
[1:40:01] the COVID response, because so many other things
[1:40:03] once we started having stay at home orders
[1:40:06] so many other programs were no longer in
[1:40:08] effect so we created a new org chart
[1:40:10] and moved everyone from their steady state role
[1:40:14] into their emergency response role at the early
[1:40:17] part of the pandemic. So I'm wondering how
[1:40:20] that works with contracts. Suppose we contract for
[1:40:23] an agency here to provide immunizations, who's going
[1:40:27] to lead that effort to if another communicable
[1:40:31] disease pandemic came down? Okay, so what you're
[1:40:34] asking is if you parse out pieces in
[1:40:37] the community, but you need to mobilize for
[1:40:39] a public health effort. So I think that
[1:40:44] it's much more seamless if it's within the
[1:40:46] organization, if it is parsed out and you
[1:40:49] would need to mobilize external to the organization,
[1:40:52] it would have to be something that's addressed
[1:40:54] in the contracting at the front side. Okay,
[1:41:00] that helps. I haven't seen a model like
[1:41:03] that but I'm assuming you know that there
[1:41:05] would be a model like that. But you're
[1:41:08] saying how would you step up quickly to
[1:41:10] address a conflict? Well yeah step up and
[1:41:13] also have somebody that's in charge of it
[1:41:15] who's thinking ahead of the game and on
[1:41:18] top of it you know looking at the
[1:41:19] data coming down from CDC and so forth.
[1:41:23] Not waiting to the last oh my gosh
[1:41:25] we need to get people who are going
[1:41:26] to give injections you know. Thank you. No,
[1:41:32] that's a great question. So we kind of
[1:41:37] divvied up our areas of research. And one
[1:41:43] of the areas that Suzanne and I are
[1:41:45] looking at is environmental health. And would it
[1:41:48] be okay if we contacted Brian or maybe
[1:41:52] other members of the staff if we had
[1:41:53] specific questions about staffing levels of programs, things
[1:41:57] like that. We have a single point of
[1:41:59] contact within our agency for transition questions. Oh
[1:42:03] okay. Because it's just we so you know
[1:42:05] with healthy communication with everyone's talking to everybody
[1:42:08] but we're going with hub and spoke here
[1:42:10] because we've addressed a lot of pieces that
[1:42:12] can be duplicated. So the single point of
[1:42:15] contact for whatever you've been assigned to will
[1:42:17] be Sherry Dugdale, who will then get it
[1:42:19] out in the organization and all of the
[1:42:22] questions because what we'll do is we'll put
[1:42:24] the answer probably in the Dropbox and then
[1:42:26] other people will have access to it. So
[1:42:29] I totally understand like I know you know
[1:42:31] Brian, you have a great relationship. You're like,
[1:42:33] hey Brian, how does this work? I'm going
[1:42:34] to ask that you go through Sherry and
[1:42:36] Sherry and an Alex. Okay. I will get
[1:42:38] her. It's just because I feel like the
[1:42:42] volume of work that we might be doing
[1:42:43] together for the next ten months might be
[1:42:46] kind of prohibitive to allow for relaxed. So
[1:42:52] we're just going to go with this very
[1:42:53] stringent got to go through the single credit
[1:42:55] cost. So the independent consultant that you had
[1:42:59] that came in and did the presented you
[1:43:01] with the results, how accurate do you feel
[1:43:04] that is and Which consultant ought to be
[1:43:08] or how do you sit on top of
[1:43:09] I always was in La Plata County. Oh,
[1:43:13] that's La Plata, yes. That's right. Yes. If
[1:43:17] you're asking if it comports with my experience
[1:43:20] as a local public health agency, I would
[1:43:23] say many components of that do comport with
[1:43:28] our experience. There may be some details that
[1:43:31] we would have come to a different conclusion
[1:43:35] because there is such kind of arcane details
[1:43:41] around how we put the money in to
[1:43:43] make it all work. Do you feel that
[1:43:48] you are understaffed, overstaffed at San Juan Basin?
[1:43:55] Because I think the things that we can
[1:43:59] do in public health and the ways that
[1:44:01] we can improve well-being and protect health are
[1:44:04] so vast that I think there's always room
[1:44:08] to go in more direction. And then I
[1:44:11] think to Sally, right, to Sally's point, if
[1:44:15] we had more programs and services, because there
[1:44:18] are so many ways that we can improve
[1:44:19] health for residents of any place in America,
[1:44:23] then when we're faced with the whether it's
[1:44:26] highly pathogenic avian flu or we're faced with
[1:44:31] another, God, let's not think about another coronavirus
[1:44:35] we're faced with, the more programs and services,
[1:44:37] the more nimble you are to then respond.
[1:44:41] And the other ability you have is to
[1:44:44] catch things earlier as they are, you know,
[1:44:47] come roaring back, right? So like, if we
[1:44:50] use the example of syphilis coming back in
[1:44:53] parts of the country where we're starting to
[1:44:55] see, you know, children be born with eyesight
[1:44:59] issues, which we haven't seen in generations, right
[1:45:02] the sooner that you if you have more
[1:45:04] staff programming to move into other things the
[1:45:08] more you can touch up in the most
[1:45:10] space. Did you have there's a program in
[1:45:15] the somewhere that I read your references a
[1:45:18] volunteer medical course did that activate during the
[1:45:22] pandemic did you get volunteers from it? We
[1:45:25] did yes we had tremendous numbers of volunteers.
[1:45:28] Do you happen to know if that happened
[1:45:30] here? Yes yes yep Yep, across the jurisdiction.
[1:45:34] Wow, love it. Heard about that. There was
[1:45:37] a reaction that was bad here. Bruce spoke
[1:45:40] at our last meeting who said that she
[1:45:43] feels that's a need in Archuleta County is
[1:45:47] getting, it's like almost home health, right? Getting
[1:45:49] whether they're volunteer or paid, but people who
[1:45:52] can actually go to people's homes and provide
[1:45:56] services. We can't really be so intimidated about
[1:45:59] that. Very specific. Here are the rules and
[1:46:02] regulations. Very specific. I mean, all that. That
[1:46:07] is not something that we want to do.
[1:46:10] Medications for oxygen and other durable medical equipment.
[1:46:15] Again, that's what they were asking for at
[1:46:17] that last meeting. But that is not within
[1:46:21] the scope of public health. Mean, the home
[1:46:29] health desk services. I think, you know, they
[1:46:32] were referring to oxygen and blah blah blah.
[1:46:36] And I don't, but who provides that in
[1:46:38] our community? Mercy. We have really good response
[1:46:40] from public. Do we? I guess it's a
[1:46:44] whole branch. It's not only are we really
[1:46:47] siloed within public health of what we do,
[1:46:50] but then all of public health and healthcare
[1:46:52] is really siloed. So if we were to
[1:46:55] step into home health, we would have to
[1:46:58] comport with all. And so, and HIBES did
[1:47:00] public health in some rural communities with home
[1:47:03] health, Yes, and they held federal contracts. Over
[1:47:07] time, again, this is going with the evolution
[1:47:10] of once you have more healthcare available in
[1:47:14] a community, including home health, including long term
[1:47:20] care facilities, then what the public health agency
[1:47:23] does is different and starts to be more
[1:47:26] upstream because we don't step on other, But
[1:47:31] if those things don't exist, then there's a
[1:47:33] whole different conversation. They exist now. Sounds like
[1:47:36] that there were community members here who did
[1:47:39] not have access to home health, didn't know
[1:47:42] how to access it or they were they
[1:47:45] homebound or whatever. Yeah, you don't really know,
[1:47:50] from a point of view of who provides
[1:47:52] home health care, it is through Mercy, they
[1:47:55] have an office that they rent from a
[1:47:58] building that we own on our campus. And
[1:48:01] then they come and the response I get
[1:48:04] from my Swenwick Rural Health Center and Hospital
[1:48:07] program is that they are quick to respond
[1:48:10] and very helpful but obviously somehow in our
[1:48:12] community we're missing some people that didn't have
[1:48:16] that access. I mean, and that makes sense.
[1:48:19] And then there's community connections, has the contract
[1:48:22] for options for long term care, which is
[1:48:25] how people that are either on Medicaid or
[1:48:29] Medicare or both have personal care and this
[1:48:34] is different than skilled nursing. It's how they
[1:48:37] have personal care to remain in their health
[1:48:40] but once we're in oxygen then we're in
[1:48:43] skilled nursing. I don't believe that personal care,
[1:48:48] but personal care for folks that want to
[1:48:51] remain at home is through the Community Connection
[1:48:54] Single Entry Point Program. So that's the other
[1:48:57] thing, I mean, and that's the care coordination
[1:48:59] piece is having the map in your brain
[1:49:00] of how to operate because it's sort of
[1:49:03] mind numbing that this is not a design
[1:49:06] system. This is a system that's grown organically
[1:49:09] in a million different ways. And then any
[1:49:12] individual is trying to navigate something that makes
[1:49:15] no sense, because no one would design it.
[1:49:18] That's right. I'm not 100% sure about that.
[1:49:22] So what does it look like for you
[1:49:23] guys with, like, there a reporting structure where
[1:49:27] you're sort of learning these pieces from our
[1:49:30] different partners, So from the hospital and from
[1:49:33] the urgent care and from Archuleta Integrated, like
[1:49:36] how does that look for the health department?
[1:49:39] Is there a way that they report to
[1:49:41] different things? Is it just about you know,
[1:49:44] some of those like diseases that are coming
[1:49:46] forward? Like what is that? Well, I think
[1:49:49] depending on what type of programming we're talking
[1:49:51] about, so if talking about an infectious disease,
[1:49:54] then there's required reporting from healthcare to the
[1:49:58] public health discipline. Some things are, you know,
[1:50:01] in different timelines and when these happen to
[1:50:03] be reported. And does that report to those
[1:50:05] like the local health departments? Is that for
[1:50:06] the state health And then back down by
[1:50:08] law, it's both, which is very confusing. Again,
[1:50:10] it's not the design system. Nobody would design
[1:50:13] a system that way. But healthcare has to
[1:50:15] report local and state, and then has, you
[1:50:19] know, it's best to just do both because
[1:50:21] it's hard to tell where, right. But then
[1:50:23] in environmental issues, if there's a spill, that's
[1:50:26] going to hit surface water, or if there's
[1:50:29] an issue with the discharge permit, then there's
[1:50:32] that has to be reported to the environmental
[1:50:34] side of the state health department, then either
[1:50:37] it gets kicked to us or it's in
[1:50:39] their regulatory framework, but we'll go out and
[1:50:42] do a bursary first look to tell them
[1:50:45] what the level of acuteness is and how
[1:50:47] quickly they should get someone on the ground.
[1:50:50] So there's things like that. Then for like
[1:50:52] kind of longer term things like if there's
[1:50:55] a community mental health or substance use or
[1:50:59] a rise in infections and teens or that
[1:51:03] sort of thing, we'll work with a variety
[1:51:05] of community partners. And it's some of it's
[1:51:08] very formal reporting structures, some of it's very
[1:51:11] informal, based on relationships, where do you see,
[1:51:14] you know, where there's collaborative management project, which
[1:51:18] is a required program at human services, or
[1:51:22] teens who need extra help and support, it's
[1:51:25] required that public health serve on that. So
[1:51:28] that's a way that we formally have our
[1:51:31] finger on the pulp of what's going on
[1:51:33] with teens and young adults, but then we're
[1:51:35] serving on that where we have the formal
[1:51:37] relationship, we're always building the informal relationships to
[1:51:40] keep each other in the same conversations. Another
[1:51:44] formal one would be child fatality. I'm trying
[1:51:46] to like separate out between formal and informal.
[1:51:48] Child fatality review teams, that would be places
[1:51:51] where we would identify needs in community and
[1:51:54] then either make suggestions for state policy or
[1:51:57] look at local policy. For average child fatality
[1:52:00] reviews only happened in Denver for the whole
[1:52:03] state about like maybe five or probably about
[1:52:06] five years ago, there was state legislation that
[1:52:08] said, you know, maybe it's the locals looked
[1:52:10] at the child's fatality, there may be some
[1:52:13] local knowledge because how we think about some
[1:52:16] of these things in Denver is different than
[1:52:18] how we think about them on the ground.
[1:52:20] When I'm kind of giving that talk about
[1:52:23] why the child fatality moved from Denver here,
[1:52:27] there may be a place that you know
[1:52:28] is a swimming hole and drownings are a
[1:52:32] very high, what's the word I'm looking for,
[1:52:38] we have high prevalence of drownings, and drownings
[1:52:40] are totally preventable. So, if someone in Denver
[1:52:43] is reading about a child fatality and drowning,
[1:52:46] they may see it very differently than you
[1:52:48] do on the ground because you cannot picture
[1:52:50] exactly where that drowning occurred. So, that has
[1:52:54] become more localized, but it can also turn
[1:52:57] into a larger policy, you know, over larger
[1:53:00] education. So formal and informal and relationships. Any
[1:53:09] more questions? Have a question. Suzanne. Can you
[1:53:15] hear me? Yes. When I was reviewing the
[1:53:24] information under contracts, especially for environmental health or
[1:53:28] environmental services. I wanted to be sure I
[1:53:32] understood how they're using the word credentialed when
[1:53:36] we're looking at our research and it said
[1:53:41] credentialed yes or no. What I first thought
[1:53:44] credentialed was, then I thought maybe that's not
[1:53:47] the definition. Can you tell me what credentialed
[1:53:53] means in the background information? So as we
[1:53:59] went through our program services and how they're
[1:54:03] paid for, we made an internal exercise to
[1:54:07] list of staff what needed to be credentialed
[1:54:10] so that you all, in taking on this
[1:54:12] very complex Byzantine job that you've taken on,
[1:54:18] can start thinking about, if I'm recruiting staffing
[1:54:21] for this, do I need to recruit staff
[1:54:24] with existing credentials? Or is this on the
[1:54:27] job training? So we put notes in each
[1:54:31] contract about that. Our environmental health staff is
[1:54:37] not externally credentialed. It is on the job
[1:54:40] training, but there are best practices and standards
[1:54:45] that one would like to see those individuals
[1:54:49] obtain to perform best practices in community. So
[1:54:54] does externally credential mean licensing? You're a licensed
[1:54:59] registered dietitian, but then internally, so for environmental,
[1:55:05] there's internal training, obviously, on how you would
[1:55:07] inspect a septic and tons of rules and
[1:55:10] regulations. But then on the restaurant side, there's
[1:55:13] internal on the job training to get FDA
[1:55:18] certified. This is where like the word is
[1:55:21] FDA credentialed. That's a good one. And our
[1:55:29] recommendation would be that as you're planning, you
[1:55:32] plan both to bring in externally credentialed staff,
[1:55:36] but also allow enough lead time If you're
[1:55:39] going to have your own restaurant inspectors, you
[1:55:41] want to hire them before January 1 so
[1:55:45] that they can do the FDA training. Is
[1:55:46] it required? No. Is it best practice? Absolutely.
[1:55:53] So we've let we put some of that
[1:55:55] information. We sprinkled or we put Easter eggs
[1:56:00] in all the contracts. I hope these helps
[1:56:04] were available. These conversations. Thank you. You. Since
[1:56:22] 2020. Yes. Well, sure. Thank you. Thank all
[1:56:25] of you for taking this on. I think
[1:56:26] we we we care deeply that this is
[1:56:29] successful and that all of our residents have
[1:56:32] the same level of health protections and ability
[1:56:36] to reach their highest potential health. So whatever
[1:56:41] we can do. Do you need to grab
[1:56:43] an amputation while you're here? Director job is
[1:56:51] advertised. I thought my guard you only have
[1:56:55] one applicant so that would give you $50.50.
[1:57:01] Thank you very much. When I got my
[1:57:05] one of my first jobs in college back
[1:57:06] then there was no internet right so they
[1:57:08] would put up the flyers yeah and so
[1:57:10] I was like that looks like a good
[1:57:11] job and then I followed the person who
[1:57:13] was putting up the phone. So, me. Thank
[1:57:27] you very much. Thank you so much. You
[1:57:29] guys have a big job. Knowing how long
[1:57:34] we need those, I probably schedule. No. But
[1:57:36] it's best that we can work on each
[1:57:38] one. But they're very took care of the
[1:57:40] discussion related to the public. The director. So
[1:57:47] I guess we're at additional committee member comments.
[1:57:50] Was there an action so we had that
[1:57:53] discussion with Derek about the reporting structure but
[1:57:56] we didn't make any action or a recommendation.
[1:58:01] So do we want to do that or
[1:58:03] do you all want to think about that
[1:58:04] some more? Do you not want to wade
[1:58:07] into that? I'll jump in. Is that something
[1:58:13] that should be decided by the County Board
[1:58:20] of Commissioners? Probably, but I think we should
[1:58:25] make recommendations if we feel strongly in any
[1:58:31] way on that. And I don't know if
[1:58:34] we do, but yeah I wasn't obviously I
[1:58:36] wasn't but knowledgeable at all about the fact
[1:58:39] that he does have departments that you do
[1:58:42] too that have to go on board I
[1:58:45] wonder if we could table this so we
[1:58:46] could have the last two minutes for the
[1:58:47] questions that we could you want to do
[1:58:49] that today? I mean everybody has them so
[1:58:52] we can just kind of review like the
[1:58:53] intent of them. Yeah. So can we table
[1:58:56] the discussion on that and tell them how
[1:58:58] we're talking about it? Sure. Which questions? There
[1:59:04] was a copy in our packet. Either all
[1:59:09] questions that are relevant to this committee that
[1:59:11] are being asked in our community or have
[1:59:14] been asked in the last year. So John,
[1:59:16] I think to your question is now based
[1:59:17] on public health, I think there's a lot
[1:59:18] of capacity in our community for assessment and
[1:59:21] planning. I don't think we need to necessarily
[1:59:23] lean immediately to try to partner with La
[1:59:27] Plata. I think in some instances, that's, you
[1:59:31] know, for funding, particularly if we can come
[1:59:33] together to write grants or state together there's
[1:59:36] potential for that a lot of agencies do
[1:59:38] that they typically are nonprofits but I think
[1:59:41] there's potential for that but I think we
[1:59:43] kind of need to look at what capacity
[1:59:45] do we have in our need to fulfill
[1:59:48] some of these things. I think there's more
[1:59:49] capacity than we may assume or think that
[1:59:53] there is. But so there are several groups
[1:59:57] that put out questions or surveys or have
[2:00:01] done different things to gather information from our
[2:00:04] community in the last year. And so Sally
[2:00:06] and I went through and we reduced the
[2:00:08] document from about, I don't know, 18 pages
[2:00:11] to what it is now with questions that
[2:00:13] were specifically relevant to this group. So there's
[2:00:17] two things I would pose to us all
[2:00:19] since we don't have time to go through
[2:00:20] them today is to go through them and
[2:00:23] say do we want to request the data
[2:00:27] from any of these questions to look at
[2:00:29] as a group that may pertain to either
[2:00:31] our individual buckets of research we're doing or
[2:00:35] inform some other things about our community and
[2:00:39] their needs. And then what questions are missing
[2:00:43] that we would want to know the answer
[2:00:45] to? I don't know about all of you,
[2:00:49] but I feel very strongly in some ways
[2:00:52] that we need community voice in some of
[2:00:54] these things. This is our first stab at
[2:00:56] community voice because these are being asked to
[2:00:58] our community right now or have been recently
[2:01:02] Advised them. So it's all listed. The data
[2:01:06] source, Healthy Archuleta, the nonprofit, who's doing a
[2:01:09] community health assessment, the medical center did a
[2:01:12] outreach survey, Salmon Basin health survey questions are
[2:01:16] also Yeah, if it goes to medical center,
[2:01:19] just to clarify again, it's different than what
[2:01:21] was reported by the investigative committee with the
[2:01:23] Coastal Springs Medical Center. So you've got to
[2:01:26] make sure that they were contacted. I'm assuming
[2:01:28] that you, this came from our hospital transformation
[2:01:32] program, you know? Dan. Okay, yes. Just wanted
[2:01:36] to make sure. We had, I wanna make
[2:01:38] sure it was us. Yes, we got the
[2:01:39] questions directly from Dan. Dan's our director. So
[2:01:44] he does attend Healthy Archuleta. Yes. And so
[2:01:48] we didn't pull in any of the data
[2:01:49] because we didn't know. I didn't want to
[2:01:51] ask for any of that and overwhelm us
[2:01:53] unless they're seeing through interested in. We can
[2:01:56] certainly request that and it's likely that we'll
[2:01:58] get summaries of whatever that data sources for
[2:02:01] those specific questions. But I think the bigger
[2:02:04] thing is we have the option to potentially
[2:02:07] go into the community and ask other questions
[2:02:09] in a variety of ways, either individually because
[2:02:12] we have points of contact with other service
[2:02:15] providers, we might be able to partner with
[2:02:17] agencies who are doing similar things. Healthy Arjuna
[2:02:21] is in the middle of their community health
[2:02:24] assessment, so they're in year one of three.
[2:02:28] The biggest thing for us is the timeline
[2:02:30] how when would we want that data back
[2:02:33] in order to make good decisions based on
[2:02:35] this right and so what do we have
[2:02:38] time for and that may narrow in very
[2:02:42] specifically if we have additional questions we wanted
[2:02:45] to go to the community right we may
[2:02:46] not go with 100 we may go with
[2:02:48] three because then we can potentially have time
[2:02:51] together that data know Healthy Archuleta is looking
[2:02:55] at doing a community wide poll with a
[2:02:58] company that's working right now with Colorado Health
[2:03:05] Foundation and they have done some really great
[2:03:07] polls. We were just looking at the data
[2:03:10] over the last three years of different communities
[2:03:12] around some of the things related to public
[2:03:14] health. But so we have the potential to
[2:03:18] get questions in on some of that data
[2:03:20] collection so that we're not doing that. We
[2:03:23] can go out and do that ourselves. But
[2:03:25] I think we have to know what we're
[2:03:26] interested in knowing more about directly from our
[2:03:29] community. And so I think if we can
[2:03:31] review these and think about gaps or in
[2:03:34] our particular research service area, what do I
[2:03:36] want to know from my community members that
[2:03:39] pertains to that research? And then we may
[2:03:41] be able to find some partnerships or be
[2:03:44] able to utilize other services. I mean, I'm
[2:03:46] doing maternal child health, I would probably go
[2:03:48] to Aspire like hey can you be willing
[2:03:51] to ask your people some of these questions
[2:03:54] or you know I mean I think there's
[2:03:55] ways to do that if we're interested in
[2:03:57] trying to kind of understand a better scope
[2:04:00] of what we want to know and so
[2:04:03] I wanted to kind of let us know
[2:04:04] like there's a lot of information that's been
[2:04:06] collected. I think we don't have time to
[2:04:09] read the bill so I think we need
[2:04:11] to take all of these organizations gather their
[2:04:14] data and use it. But that's just a
[2:04:20] small part of what we have to do.
[2:04:22] Don't know how y'all feel about this but
[2:04:25] I am somewhat overwhelmed with the depth of
[2:04:28] work that has to be performed by the
[2:04:32] end of this year or anybody, not that
[2:04:35] I'm not willing to help work hard on
[2:04:37] this, but the amount of work that San
[2:04:41] Juan Basin Public Health does is incredible. And
[2:04:48] I just don't see how we can mimic
[2:04:51] that in our county. I don't think we
[2:04:53] have to mimic the entire thing. I think
[2:04:55] we have to look at contract versus in
[2:04:57] house service and what funding we can get.
[2:04:59] Like she mentioned, some of the funding sources
[2:05:01] won't even be willing to send us money
[2:05:04] because we are a small population. Take a
[2:05:07] deep breath and think we're gonna scale this
[2:05:09] way down compared to everything that they're That
[2:05:12] we're gonna be decreasing services for Archuleta County.
[2:05:15] That we have to. But that we still
[2:05:18] have ability to contract others. A lot of
[2:05:20] work going on out there, think, that I
[2:05:23] hope so. So can we, I know Healthy
[2:05:27] Archuleta would share this their information with us.
[2:05:31] I can't imagine they wouldn't. So I think
[2:05:33] we just have to be aware that the
[2:05:34] reports are gonna be really long. So we
[2:05:36] need to be really focused in what we
[2:05:37] ask for potentially, which is why we provided
[2:05:39] the questions. The stuff in red other than
[2:05:42] the titles, I think Sally and I potentially
[2:05:44] added. Mhmm. And then there were some questions
[2:05:46] at the end where you can see possible
[2:05:48] information this committee may wanna look into, which
[2:05:50] is just, you know, some things we were
[2:05:53] thinking through when we talked. So this is
[2:05:54] more just for us to kind of say,
[2:05:56] how does any of this pertain to the
[2:05:58] piece I'm working on? What may I wanna
[2:06:01] ask for? I'm happy to go back and
[2:06:03] and ask for that. But I think I
[2:06:06] mean, I'm sure your report that Dan has
[2:06:08] is probably way too many pages for any
[2:06:11] of us to wanna read. Right? So if
[2:06:13] we're specifically interested in the data to certain
[2:06:16] questions, I think we can ask for that.
[2:06:18] But the whole report is gonna be a
[2:06:21] lot considering everything else that we have to
[2:06:25] read. So that's why we did this is
[2:06:26] to see if we can narrow in on
[2:06:29] specific things. Obviously, the San Juan Basin health
[2:06:31] data won't come out until the summer. And
[2:06:35] so that's the other thing. If we wanna
[2:06:36] do any further digging, is it something we
[2:06:38] wanna align with their timelines so we're looking
[2:06:41] at all of that new data potentially together
[2:06:43] or not? And she didn't give us the
[2:06:46] time when those numbers per program would be
[2:06:48] available, did she? She sort of left it
[2:06:50] hanging. I mean, it seemed like during the
[2:06:53] budgeting process, she said they would have them.
[2:06:55] That may be something we have. Derek or
[2:06:57] whoever is gonna be doing some of that
[2:06:58] reach out for specifically around the number of
[2:07:02] people served in each different programs. Those are
[2:07:09] the main things we leave you guys with
[2:07:10] since we're out of time. The next meeting,
[2:07:16] there's none next. We don't have a meeting
[2:07:17] next week. Enjoy your spring break. So our
[2:07:20] next meeting is March 27. Do we want
[2:07:23] to make that an agenda item to go
[2:07:25] over this? We should read. I think we
[2:07:29] need to readdress it. I think we can.
[2:07:31] I think that was also the day we
[2:07:32] were supposed to bring back our research, which
[2:07:34] again won't happen all in two hours. Don't
[2:07:36] think so. I don't know how we want
[2:07:40] to prioritize that. I do know if we
[2:07:41] want to get out into the community, we
[2:07:43] need to do it sooner than later so
[2:07:45] we can get the data back that we're
[2:07:46] interested in if we want to look at
[2:07:48] that. And again, I think there are resources
[2:07:52] out there where it won't necessarily be us
[2:07:54] having to do that work because I know
[2:07:56] we're all busy. Yeah, if we could come
[2:07:59] up with some questions, specific questions we want
[2:08:01] to ask the community, the county could put
[2:08:05] it on our Facebook page to steer them
[2:08:07] to our public health department webpage to have
[2:08:11] a survey on there. And they could either
[2:08:14] fill it out and email it or come
[2:08:16] in and email it to me or whatever.
[2:08:19] That's one form that we could go through.
[2:08:22] I mean, think any of those things are
[2:08:25] great. I think it's going to be hard
[2:08:26] to necessarily get to the demographic of folks
[2:08:29] that we're looking for when you do that.
[2:08:31] You know, the sampling is definitely an issue.
[2:08:33] San Juan Basin Public Health has said that
[2:08:35] with theirs. Like, they're not necessarily getting to
[2:08:37] the group of people who utilize their service.
[2:08:39] So just their own DHS department. So we
[2:08:43] could So I think that's out and leave
[2:08:45] them there, and they could ask them to
[2:08:47] spread it out with all their people, the
[2:08:50] library. It's a good idea. Or Access Health,
[2:08:56] talk to them. They would probably help us
[2:08:59] out with that. So I think that there's
[2:09:01] some things we could consider. Yeah, maybe we
[2:09:05] could maybe a little I don't know. We
[2:09:09] could maybe have people stationed. I think a
[2:09:13] couple of us could be at the library
[2:09:14] with a questionnaire. Mean, I think the biggest
[2:09:17] thing with any of that though is we
[2:09:18] also have to think about the time to
[2:09:20] then input and analyze anything you want. That's
[2:09:23] not a small undertaking. That needs that really
[2:09:26] looking at data that people are already organizations
[2:09:28] are already collecting and then just add to
[2:09:30] I really found this, I think I sent
[2:09:32] it to everybody, the county health rankings and
[2:09:34] roadmaps. It was an attachment that I sent
[2:09:37] to you guys. Found it. Did you just
[2:09:38] send us? The last week. I found it
[2:09:42] fascinating to go through and look at our
[2:09:44] county compared to Colorado, compared to The United
[2:09:47] States. And I mean, there are a lot
[2:09:49] of categories on here and I think this
[2:09:51] is just a good first swab that, here
[2:09:57] are some things we really need to address.
[2:09:59] Kathy, who was the source on that? I
[2:10:02] couldn't find on their group who actually did
[2:10:04] that. It's that group in Wisconsin I was
[2:10:06] talking about. They were the ones, I think,
[2:10:08] that actually did the research. And I wonder,
[2:10:09] I started looking at some data and I
[2:10:12] couldn't duplicate their numbers. Yeah, countyhealthrankings.org. I can
[2:10:16] look into who they are and where they're
[2:10:18] from. They're almost in the country. We're talking
[2:10:21] a lot about health outcomes and housing is
[2:10:25] ginormous on this report. I mean adequate housing.
[2:10:30] Safe and adequate housing. I don't know, Printed
[2:10:33] these, you know, public health framework is right.
[2:10:40] So I think that we sort of get
[2:10:42] lost in but housing is one of those
[2:10:44] upstream things that everyone's looking at. So this
[2:10:46] is from the American Association of Family Practitioners
[2:10:50] or Physicians. Thank you. And how primary care
[2:10:55] and public health intersect and work together. So
[2:10:59] I think that there are a lot of
[2:11:00] issues that the public health department won't necessarily
[2:11:02] be able to address but should have at
[2:11:04] least some input, sit on some committees around
[2:11:07] how do we do it. And unfortunately, that's
[2:11:11] also where some of the dollars are coming
[2:11:12] from. The concern to me is just chasing
[2:11:20] programs, chasing grants, chasing programs, like squirrels, squirrels,
[2:11:24] squirrels. We mean historically how public health is
[2:11:26] fortunate. Yes and I keep thinking about that
[2:11:29] below the waterline. What are the main issues
[2:11:33] we need to try to address here and
[2:11:36] maybe there is some money outside money coming
[2:11:38] from other entities and we just need to
[2:11:41] find those basic things. Like she was talking
[2:11:46] about with STDs and syphilis growing because it
[2:11:50] sounds like public health is focusing on other
[2:11:52] things and then meanwhile this is getting bad.
[2:11:56] So it's those kinds of things that we
[2:11:58] want to Well, lot of things comes to
[2:12:01] the educational piece of the department, right? Like
[2:12:04] doing messaging campaigns around why it's important to
[2:12:08] do certain things or I mean, I don't
[2:12:10] know when I have babies like I was
[2:12:13] like I don't need those things because I
[2:12:15] know I'm healthy but people don't, you know,
[2:12:17] the vitamin K shots or the goop in
[2:12:19] the eyes or whatever for the babies that
[2:12:21] help prevent some of those things. Lot of
[2:12:22] people are refusing those services, not understanding the
[2:12:26] consequence of the potential if they haven't been
[2:12:29] tested for those things. So a lot of
[2:12:31] it's you know how are we it's not
[2:12:33] necessarily the service provision itself because we have
[2:12:36] great medical providers that provide the service and
[2:12:39] potentially the testing. It's how are we then
[2:12:41] coordinating more of the upstream awareness and access
[2:12:47] to care. I mean, when you bring up
[2:12:51] what she brought up, STD work that was
[2:12:55] done, a lot of that is it's all
[2:12:57] about contact tracing, right? I mean, that's the
[2:13:00] whole thing. Because if somebody comes in with
[2:13:01] an STD, we are required to report that.
[2:13:04] And then the department has to public health
[2:13:05] then the health fund goes out and contact
[2:13:09] tracing and tries to prevent it by treating
[2:13:12] other people. And that is not always possible
[2:13:15] because everyone won't take treatment. That's what we're
[2:13:18] seeing. We're just sharing. Resurgent of that, right?
[2:13:21] So it's a small aspect of what they
[2:13:25] did, but it is an important thing because
[2:13:26] I can remember when it went away because
[2:13:29] we saw a lot of it in our,
[2:13:30] we're in Louisiana where I'm from, and then
[2:13:32] we stopped and then now it's back It's
[2:13:35] like a whack a mole. Because there's so
[2:13:41] little funding that comes down for public health
[2:13:45] in the country and so many needs I
[2:13:49] think that's something that I like with highly
[2:13:51] qualified staff though, how if you get highly
[2:13:53] qualified staff, you should only be able to
[2:13:56] pivot on some of those things because you
[2:13:57] have people who are qualified in a broad
[2:14:00] and well that's kind of what she was
[2:14:01] saying. They have a lot of staff who
[2:14:03] can be flexible and nimble as programs change.
[2:14:06] So you might have gotten hired under this
[2:14:08] one grant to do X, then you may
[2:14:11] end up doing Y two years later. So
[2:14:14] you want people with those broad skill sets
[2:14:16] and ability to of We look at those
[2:14:19] people here. So far they said they'd had
[2:14:21] one applicant and it was from somebody that
[2:14:24] lives in Texas, right? This just went out
[2:14:27] like Tuesday, maybe even Wednesday. Okay, I know
[2:14:30] so. I mean, anybody that's run a small
[2:14:33] business, and I have my whole life, I
[2:14:36] mean, you wear all kinds of hats. And
[2:14:39] if we are attempting to pull this off
[2:14:41] in this county, We can't afford to hire
[2:14:45] everybody that we need. Hire people who can
[2:14:48] do multiple things. Yeah. That's a must. Sure.
[2:14:52] We can, to the next meeting, and just
[2:14:55] a discussion of the, I mean, the more
[2:14:58] I sit here, the more I realize La
[2:15:01] Plata may be four to six months ahead
[2:15:03] of us, at least the understanding that I'm
[2:15:06] getting. But then that made me a little
[2:15:09] bit nervous after this and last week, was
[2:15:11] saying, September, October timeframe, we're gonna be okay.
[2:15:14] But if we're talking, what I heard from
[2:15:17] her April to June, we realistically won't even
[2:15:20] have that director on board till maybe May
[2:15:23] 1. Do we just have a discussion who's
[2:15:27] gonna be following up on at least contacting
[2:15:30] the state and making sure we're communicating I'm
[2:15:34] sure the staff's doing stuff that we're not
[2:15:37] aware of. I apologize if I say that,
[2:15:40] but that makes me nervous that we're not
[2:15:42] going to be ready April, May, June. I
[2:15:44] do know the county manager and the county
[2:15:46] attorney have had conversations with I don't know
[2:15:51] specifics. Do know that the ball has started
[2:15:55] rolling on what we need to be doing.
[2:15:57] Yes. So we're not starting from scratch right
[2:16:01] yet. They've already had conversations. Great. So I
[2:16:05] was thinking a question maybe all of us
[2:16:06] want to ask as we're doing our research
[2:16:08] is what does a fully functional health department
[2:16:11] look from that narrow window? What does it
[2:16:13] look like for environmental health? What does it
[2:16:15] look like for community health? The other question
[2:16:17] I have, what is a fully functional health
[2:16:20] department as of January 1 from the commissioners,
[2:16:25] from the county, whatever it is? Is that
[2:16:27] one program from each of those service areas,
[2:16:30] or at least a contract with one program,
[2:16:32] what does it mean? As we're going through
[2:16:34] our programs, we might want to identify what
[2:16:37] sources. The very bottom first thing on the
[2:16:41] agenda the next time we have time is,
[2:16:43] are we really going to separate? Are we
[2:16:45] going to go back to working with Samuel?
[2:16:47] It would be my top recommendation. So we
[2:16:56] don't get to choose them. Yeah. No. That
[2:16:59] is not on the table at all. There
[2:17:03] is a signed resolution between a joint resolution
[2:17:07] between the two counties dissolving San Juan Basin
[2:17:11] at 01/2017. So it's done. However, there are
[2:17:15] conversations that are occurring. There are. With people
[2:17:19] at both counties. I'm Okay. And that there
[2:17:26] are conversations happening about that. That there are
[2:17:29] people that, in both counties, that realize now
[2:17:35] just how much this has been, and that
[2:17:38] there's been a lot of misperceptions. Even with
[2:17:41] La Platas. I said even with La Plata.
[2:17:44] We're not the only ones that are in
[2:17:47] it. La Plata is also somewhat, I would
[2:17:51] think, struggling too. And Mary, if you're sure
[2:17:55] this is a done deal, it's a conversation
[2:17:57] that can happen, then I think we just
[2:17:59] need to know that all the work we're
[2:18:01] doing, this should continue, or we should just
[2:18:03] drop back even though I think clearly it's
[2:18:07] been done, no doubt about it. All I'm
[2:18:09] saying is that nothing is forever. I mean,
[2:18:14] you could re stand it up. I mean,
[2:18:20] there are things we can do to protect
[2:18:22] the people in our community. But again, I've
[2:18:27] been told that there are people interested in
[2:18:30] trying to have some conversations about that again.
[2:18:34] I think the document that you're gonna have
[2:18:37] Mary share with us that came from San
[2:18:39] Juan Basin about the different That is what
[2:18:42] San Juan Basin Health presented to the investigative
[2:18:45] committee in October of twenty twenty. And that's
[2:18:50] why I thought you might be interested in
[2:18:52] that, because that's what they That was again
[2:18:54] after the pandemic, so it was different, but
[2:18:56] it just Right. For more information. I think
[2:19:01] it'll help in the research that are each
[2:19:03] individual assigned because most have what they do
[2:19:08] before 2020, it wasn't about pandemic. It's not
[2:19:12] scary. I have a question on our research
[2:19:22] under assets. When I looked at the information
[2:19:28] it talked about what assets are owned by
[2:19:31] another entity. Are we going to only look
[2:19:36] into what assets are owned by other entities?
[2:19:39] Or are we going to also see if
[2:19:42] that county owns certain assets themselves? Well, I
[2:19:46] think that the receiver is in the process
[2:19:51] of working with San Juan Basin Health and
[2:19:55] working with the two counties in dividing up
[2:19:57] all the assets. So I don't think that
[2:19:59] that's anything we need to spend time on
[2:20:00] right now. The assets in the report, for
[2:20:03] example Just find out what assets are owned
[2:20:06] by another entity outside the health department. I
[2:20:10] think what that's referring to is like a
[2:20:12] database that's run by the state that we
[2:20:14] contribute information to as a part of our
[2:20:16] reporting system. I don't think it's anything tangible.
[2:20:20] I think it's something that's going on. We
[2:20:22] are required to report to you. Yeah, we'll
[2:20:25] have, I mean, lot of data gets reported
[2:20:27] to the student. Right, so I don't think
[2:20:29] it's anything we need to worry about for
[2:20:30] this at all. Okay. Anything else before we
[2:20:38] adjourn? I move to adjourn the meeting at
[2:20:43] 11:15? Eleven twenty? I know I was like,
[2:21:04] oh my god, it's not really tough to
[2:21:06] read. Right.