Good afternoon, everyone. Thank
you so much for joining us here
today. On JULY 16th, 2020.
Excuse me. JULY 16th, 2026. The
King County Board of Health
meeting will come to order. I
m
Teresa Mosqueda, chair of the
board. It
s wonderful to see
everyone here. And I understand
that we do have a quorum. Uh,
clerk. Hey, do you mind calling
the roll?
Sure. Thank you. Board member.
Dunn. Board member. Lewis.
Board member. Von Reichbauer.
Board member. Foster. Board
member. Juarez. Board member.
Rinke. Board member. Saca.
Board member. Falcon. Board
member. Garcia.
Board PRESIDENT.
Thank you. Board member. Shroff.
Board member. Blas. Board
member. Core here. Board
member. Packet. Board member.
De Castro present. Board
member. Chiu. Present. Board
member. Gojo. Board member.
Hartfield present. Board
member. Daniels present.
Present.
Board member Mohammad.
PRESIDENT Present.
Board member. Green. Board
member. Archer. Poli.
Present.
Board member. Lu.
Chia.
Board member Milan Garneau.
Board member. Elkins. Board
member Thomas present. Board
member.
Williams present.
Board member. De Los Angeles
board member Bowen board
member. Lucero. Board member.
Gilli. Chair. Mosqueda.
Present.
You have a quorum.
Thank you so much. Did anyone
want to announce themselves
that MAY have come in after
their name was called in the
roll call. Okay, wonderful. And
as always, we welcome
alternates who are here in the
place of our regular board
members. Are there any
alternates serving in the place
of our regular board members
here with us today that would
like to announce themselves?
Okay, excellent. And as we see
new board members join us, if
the clerks could help me with,
um, announcing them, that would
be great. We again, thank you
all for joining us here today.
Um, and I want to say, um, it
s
been very nice to be able to
have an opportunity to connect
with you all via zoom. We
continue to meet via zoom, uh,
because there
s frankly not
enough seats here at the King
County Council. Um, given our
larger size of the board
meeting. That said, I will be
here in person to be present
with our staff and team who are
here with us in chambers. And
while we don
t have enough
chairs, if there are people who
ever do feel like they want to
come in person, of course you
are welcome. And to our
presenters, we do think that
it
s probably easier for folks
to join via zoom, because then
the presentations can be easily
seen by all members on the
zoom. But we are also wanting
to make sure that anybody who
prefers to come in person for a
presentation or serving on the
diocese, welcome to do so. We
continue to see, um, that
communicable diseases are
amongst our community members,
including Covid, which is still
present in addition to other
communicable diseases. So in an
effort to, uh, live our public
health values, we do offer this
hybrid format and encourage
folks to do what is ever most
comfortable to them and to stay
home. If you are sick. Uh, with
that, we do have a full agenda
today. I want to note that we
will have the, chairs. Um,
excuse me. The director
s
report from director Sandra
Valenciano, who will provide an
regular update. You can also
find her written report. Uh, in
the meeting materials,
beginning on page ten. We will
also have Joy Carpine-Cazzanti,
our board administrator, give
us a quick update about board
membership and this summer
s
recruitment efforts for the
upcoming year 2027. We
ll have
a briefing on the pet
businesses and public health,
zoonotic disease code and
rates. These proposed changes
will come before the board at
our SEPTEMBER meeting for an
actual vote. So today is just a
briefing. We will have an
update on the Seattle and King
County Continuum of Care
efforts. Thank you very much to
Board Member Liu for who, uh,
requested this item. And it is
very timely given that the
Continuum of Care application
was just due on JULY 3rd. And
the ongoing conversations that
we
re having across the region
and nation about the importance
of the continuum of care
dollars, we will have a
discussion and panel that will
include the King County
Regional Homelessness
Authority, the Downtown
Emergency Services Center, and
labor partners who provide
direct services to our most
vulnerable from the Office of
Opioid, Office of Professional
Employees, and International
Union protect 17 and Service
Employees International Union
Health Care 1199 northwest.
Finally, we will have a
briefing about the impacts of
the current political
environment on gender affirming
care. Thank you very much to
Board member Tripoli for
requesting this item on our
work plan as well. At the end
of the meeting, if there
s any
updates that board members
would like to share, you will
have an opportunity to do so
under go to the order and
please note that our AUGUST
20th meeting is canceled and
the next meeting will be at our
regularly scheduled third
Thursday time. That would be
SEPTEMBER 17th, beginning at 1
P.M.. So we do take a little
bit of an AUGUST recess for
Board of Health as well. Uh,
with that, we are now on to
approval of the minutes. I
d
like to ask our vice chair,
vice chair, foster or vice
chair Daniels, would you like
to move approval of the minutes
from JUNE 18th, 2026?
This is this is board member
Daniels. I so moved.
Thank you. Vice, uh, vice chair
Daniel. I vice chair Daniels
for moving approval of the JUNE
18th, 2026 meeting minutes. The
meeting minutes are in front of
us. Are there any corrections,
additions, or comments? Hearing
none. All in favor of approving
the JUNE 18th, 2026 meeting
minutes. Please say aye.
Aye. Hi.
Any opposed? Any abstentions?
Okay.
The abstain.
Uh, thank you. Board member.
Williams. So noted. Board
member Williams is abstaining.
All the other votes were in
favor. Thank you very much. Uh,
that brings us to public
comment. I believe we do have
people in person and perhaps
online who would like to
provide public comment. As a
reminder, if you are online,
please push star six. If you
re
on the phone or use the raise
hand feature and zoom to
indicate that you
d like to
provide public comment. Uh,
board member Dunn, I see you
joining us on screen. Thank you
very much for joining at the
Board of Health here today. And
before I move on with any other
public comment, are there any
other board members that are
joining us that would like to
announce their presence? Okay.
Well, thank you. Board member
Dunn. And again, um, if the
team if the clerks can help,
uh, signal if there
s any other
board members joining us, I
m
happy to welcome them. Uh, you
made it just in time for public
comment. Um, board member Don,
I know you were looking forward
to that. So why don
t we go
ahead and get started with
public comment right away?
Again, if you
re on zoom use to
raise hand feature or push star
six, and do we have anybody
online that would like to
provide public comment?
So far?
Not yet. We will continue to
watch for that. Okay. With
that, for folks in person, you
do have two minutes. You
ll see
a yellow light when it
s
indicating your time needs to
wrap up. Please keep your eye
on comments germane to the
agenda and refrain from
impugning any members of the
public, the staff. Excuse me,
any members of the staff, the
electeds and board members? Uh.
With that, please go ahead and
call public comment.
Thank you. Chair Mosqueda.
First person in chambers is
Alex Zimmerman.
Nice. That
s my friend Alex.
You have been called. Please
leave your sign at your seat.
In accordance with our King
County rules. And your time has
started, please start us time.
All right? Don
t come to
microphone. Why will you watch.
For Alex? Your time has started.
What are you doing?
We
re not going to put the
camera on you until you put
your sign down. Thank you so
much.
Hi. My name, Alex Zimmerman. I
wanna speak about something
that is absolutely absurd. You
are real, Bendita. You are a
real killer. So we have today
agenda number ten about
something. What a scare you
have here. I explain to you my
experience. Okay? King County
housing Authority spent $100
million for dozens, thousands
of legal immigrants. People
with documents. We have 20,000
homeless, 20,000 homeless cost
us every year. Approximately $1
billion in 500 dying every year.
Situation. What is here with
this Nazi Gestapo killer? What
is I see here in this screen?
You know what is meant. How is
this possible? You know what
this means. So, King country
Housing Authority, I
investigate this all. We come
to conclusions. So they are
pure criminal because they
violate executive order from
Donald Trump at his one year
old right now. So all
government department posts a
big only to citizens. I cannot
find a low income. A thousand
people cannot find this 20,000
homeless, almost all American
citizens we can provide to them
a room, you know what I mean.
They said, that
s exactly
what
s happened. You don
t do
this because you, burn Jeter
and Killer. That
s exactly who
you are. You
re more dangerous
than Nazi. Viva Trump. Even
your American Revolution stand
up slave and happy cow. Stop
stealing money from me.
Anybody else signed up for
public comment? Anybody else in
chambers that would like to
provide public comment? I
m not
seeing anybody in chambers and
nobody else online going once,
going twice. Okay. Thank you so
much. Let
s go ahead and move
on with the agenda that does
bring us to Director Valenciano
for an update. Thank you very
much, Director Valenciano, for
your written report and for
being here with us again in
person. Great to see you.
Please go ahead.
Thank you. Chair Mesquita. Um,
hello. Board of health members.
Uh, I only have a few minutes
today for updates, so I wanted
to first start off with
thanking all of our public
health staff for their work on
our fifa response. So luckily,
we survived our fifa World Cup
and everything went pretty
smoothly in King County. So
yes, snaps to all of our public
health staff. We spent a whole
lot of time preparing for fifa
World Cup, and really, I think
we got lucky that there were no
major public health issues or
outbreaks or foodborne
outbreaks during this time, but
I
m just super thankful to all
of the staff that were involved
in the response in planning.
Um, on our mcc team and now in
the post, um, debrief period.
So thank you to everybody. Uh,
although I will say I
m
mourning that Colombia, uh, got
eliminated from the World Cup.
Not gonna lie. Um, I very
quickly did want to share an
update, as I
m sure you all
have seen on the news. Uh,
there is an active and ongoing
outbreak of Cyclospora, so I
wanted to go over that. Um,
because I
m sure there MAY be
concerns about what this might
mean here in King County. Uh,
so just so everyone is aware of
Cyclospora, this is a
gastrointestinal illness that
is caused by a parasite.
Cyclospora. Um, people can
become infected when they
consume food or water that is
contaminated with the parasite.
The illness typically does not
spread from person to person.
So this is good. Um, and case
counts typically do rise around
spring and summertime. Um, cdc
typically considers MAY 1st
through AUGUST 31st the annual
Cyclospora season. Previous
outbreaks have been linked to
consuming contaminated fresh
produce. Uh, in terms of
symptoms, they usually begin
about a week after exposure,
but the onset can be anywhere
from two days to 14 days after
being exposed, with the most
common symptoms being watery,
diarrhea, uh, loss of appetite,
weight loss, bloating, nausea
and fatigue. Less commonly, low
grade fever and vomiting. Uh,
without treatment.
Unfortunately, symptoms can be
remitting and relapsing. Um, so
really important to have it
diagnosed and be treated. Um,
but the illness, although it
can be severe in terms of
symptoms, is not usually life
threatening. Um, in terms of
what
s currently happening
since MAY 1st of this year, cdc
has received over 1600
confirmed cases. Domestic cases
of Cyclospora cases, and they
are currently reviewing over
5000 additional cases that MAY
have also been acquired in the
United States. The cdc, the
fda, state and local health
departments are currently
investigating uh, several
multistate outbreaks of
Cyclospora infections to
identify the source of
infection. Um, in Washington
state. Cyclospora. This is a
reportable condition. Cases
identified since MAY 2026 have
primarily been linked here to
international travel, and we do
not have any outbreak related
cases detected in King County.
We do investigate every single
case of Cyclospora, since
that
s reported to us by a lab
or a doctor to determine where
people MAY have been exposed,
given the rise of what
s
happening in other states, we
are very closely monitoring for
any signs that people MAY have
been exposed to the parasite
locally. So far in 2026, we
ve
had a total of 19 cases among
King County residents, only one
of which was exposed to the
parasite locally. And again,
none have been associated with
what
s happening in other
states. The timing distribution
of the cases that we
ve had so
far does match what we have
seen in years past. In general,
about 90% of the cases in King
County residents are diagnosed
between JUNE through AUGUST,
and about 80% of them are
linked to international travel.
Um, currently, there
s no
evidence that the outbreak
that
s ongoing is impacting us
here in King County. So we
re
monitoring, but we
re not
seeing, you know, an unusual
rise in cases. We did send out
a health alert to all of our
health care partners in King
County, advising our health
care partners to consider the
diagnosis and the event that
they
re seeing any patients
with symptoms of Cyclospora.
And to make sure that they
re
specifically testing for the
parasite. Um, and then making
sure that, you know,
individuals are treated
appropriately, should they have
the illness. Um, at this time,
there
s no confirmed source of
infection. And this is why what
we
re seeing is that we
re
seeing, you know, ongoing
numbers of cases rising because
they have not been able to
determine what the source of
infection is. You know, what
has been the contaminant, um,
food source in previous
outbreaks, it has been, uh,
related to fresh produce, but
it could be a variety of
different things. So in the
past, it has been linked to
raspberries, cabbage, basil,
cilantro, parsley, broccoli,
snow peas. Um, so a variety of
different things that could be,
you know, um, uh, impacted by
this parasite. So while we
re
not recommending at this time
that anyone in our community,
uh, avoids any particular
items, just want to note that
for individuals who MAY be
immunocompromised, they could
consider, um, not, you know,
limiting these until unofficial
source of infection is
identified. But again, we don
t
have that. And they are
actively working as quickly as
possible to identify a source
of infection. We will continue
to provide updates as that
source is identified. Another
important thing is, is that
cooking at high temperatures
does kill the parasite. So
heating food to 158
f or higher
is effective at eliminating the
risk of the parasite. Um, so if
any, you know, foods are going
to be ingested of those that
MAY be have linked in the past,
you know, be helpful to cook
those to high temperatures,
washing your hands and any
fresh produce under running
water before eating, cooking,
cutting is also a good best
practice, but unfortunately
washing alone does not
eliminate the risk. It really
is heating to high
temperatures. Um, and then just
lastly, I want to note that,
um, you know, when food
outbreaks happen and especially
when they happen like this with
multiple multiple states being
impacted, a very strong federal
response is needed to manage
this type of complex foodborne
outbreak and multi-state
investigations. And
unfortunately, what we
re
seeing right now is in part due
to a lack of federal public
health leadership, changes to
food surveillance, and the loss
of public health staff at the
centers for Disease Control.
Um, so, you know, really, when
we
re having these kinds of
foodborne outbreaks that can
impact a large number of
people, these investigations
are typically inherently
complex, and it
s always hard
to make sure that, you know,
individuals can recall what
they
ve eaten for the previous
two weeks, right, to try to
identify a source. Um, but it
really requires collaboration
and coordination between local
health departments, state
health departments and federal
public health leaders. Um, so
we
re hopeful that, um, will
they
ll be able to identify a
source of the infection soon.
But again, here, we
re working
closely with our health care
partners and the state
Department of Health to monitor
things very closely and make
sure that we provide updates to
the public. Thank you.
Thank you very much, doctor. We
have, um, another board member
that joined us. I just wanted
to welcome board member Pete
von Reichbauer. Thank you for
being with us as well.
Colleagues, are there any
questions that you have for
Doctor Valenciano on her report
out? Well, you heard it here.
Cook your food. Don
t eat that
raw lettuce for right now. Um,
congratulations to the entire
team. Uh, for all that you did,
especially during the World
Cup. And, uh, very, very
pleased that there was no major
outbreaks, um, either in our
region or across the three
countries during that time
period. Uh, really, thank you
for all that you do. This is in
addition to the daily work that
you provide. Any additional
questions seeing none. Thank
you very much, Doctor
Valenciano. Again, a written
report on page ten in your
materials. Thank you, as
always, for being here with us.
And if we don
t see you before,
we will see you at the
SEPTEMBER meeting. Thanks.
Okay. This moves us on to item
number eight on our agenda. We
have, um, an update on the
board membership and
recruitment efforts for next
year, 2027. Thanks again to Joy
Carpine-Cazzanti, who is here
with us as a board
administrator, to give us an
update. Thanks for your work
annually to get us prepared for
having a full board
representation and all the
preparation that goes into
recruitment. Over to you.
Thank you. Uh, yes, I
m Joy
Carpine-Cazzanti, your board
administrator from Public
Health, and today i
ll provide
a brief update on our 2027
board membership and the
recruitment process that we are
undertaking to fill a vacancy.
As I reported last month, the
board has four positions that
will expire at the end of this
year. Board member Butch de
Castro position. Lisa Chu
s
position, Christopher
Archiopoli position, and
alternate Francoise Milinganyo
position. Board members two are
Chipotle and alternate Melanie
Garneau will seek
reappointment. Board member
Butch de Castro has served on
the board for many years. And
we definitely appreciate that
and all his expertise. But he
will not return to us next
year. Uh, he represents public
health facilities and providers
and, um, if approved by the
board and the King County
Council, his alternate, Karen
Hartfield, will move into his
position next year. This leaves
Karen Hatfield
s alternate
position vacant, and public
Health has advertised the
opportunity to apply. And this
application period will close
next week. On JULY 22nd. At the
end of the day, as required, we
posted vacancy advertisements
in the Seattle Times and local
papers across King County.
Public health has shared
information on our blog,
website and social media and
sent the opportunity to the
Board of Health email listserv
and other community partners. I
encourage board members to
share the opportunity with your
networks as well. I sent an
email yesterday with more
details that you can share. As
of this morning, we have
received six applications. Uh,
we
re hoping to get a few more
if you are able to help us
spread the word. Just a
reminder about the process
state requirements place
responsibility for the
recruitment, selection and
recommendation of membership
with the Board of Health and
the King County Council makes
the official appointments.
Public health staff are doing
an initial review of applicants
now for eligibility, and those
who are eligible will be
reviewed by board members. Our
Polly Mohamed and Alternate
Hartfield, as well as chair
chair, mosquitoes, Team. These
board members will review
applications, conduct
interviews in AUGUST or early
SEPTEMBER, and then at the
SEPTEMBER board meeting, we
ll
make a recommendation to the
full board on who to bring to
the OCTOBER meeting for an
interview. Thanks to all of you
in advance for your work with
me over the next month. In
OCTOBER, the board will
consider four resolutions
recommending reappointment of
the returning members and
appointment of the new
alternate. If approved, these
will be transmitted to the King
County Council for their
consideration, and acting in
OCTOBER will allow us time for
final action by the Council
before the end of the year. So
I
ll continue to provide
updates as we work towards
recommendations for the full
board approval in OCTOBER, and
I
m happy to answer any
questions.
Well, let me say thanks again
for all the work that you and
the team put into the
recruitment, and the board
members who volunteered to be
part of the subcommittee, and
all of our staff. Um, I
m
really pleased that so many
board members are seeking
reappointment. That
s wonderful
and look forward to continuing
to partner with you. I want to
say thank you to board member
de Castro. I think your service
on the Board of Health, MAY
predate me, and I feel like
I
ve been here for eight years
or seven years or so. So, um, I
just wanted to offer you a
second. If you wanted to chime
in and offer any words, I know
we
ll have a chance to chat
with you again, but just want
to say thanks for your ongoing
service, and I you served as
vice chair in addition to
various leadership roles. So
anything else you
d like to
share? Board member de Castro.
Thank you. Very, very nice of
you to give some space. I
ll
just say briefly in the
immediate, just thank you to
all my colleagues here, uh, you
know, including those in the
past to to do this service for
the community of Seattle and
King County at large. It
s been
a privilege, but I can
definitely say more. Um, as we
close the year. But thank you.
Excellent. Thank you. And thank
you again for your leadership,
especially during the Covid
days. I remember you stepping
onto screen and, uh, really
stepping up. So thank you. Uh,
board member Hartfield, thank
you for your interest in
serving as a permanent member
as well. Thanks for serving as
an alternate. And we are
thrilled that you
re interested
in seeking this position in an
ongoing manner. Is there
anything you
d like to add?
Um, no. I
m excited to have the
opportunity to represent, and
I
ve been enjoying my service
so far, so it sounds like a win
win for all of us.
Absolutely. And we
ll have a
chance to hear more from you in
the upcoming meetings as well.
But I really appreciate your
interest in continuing to serve
here and for your work. Um,
already with this board and
colleagues, you heard from our
board administrator that, uh,
we are continuing to push out
the announcement about the
position that
s open as an
alternate. So if you have not
already shared that with your
listservs, community members,
neighbors, put it on your
social media, please do. And
maybe we can send a little
blurb out just as a reminder
for folks so it
s easy to grab.
Um, and again, the deadline,
JULY 22nd, is when we
re
looking to fill that alternate
position. So if people can get
their applications in before
that, that would be great.
Okay. Thanks so much, Joy.
Anything else that you need
from us at this juncture? No.
Okay. Well that moves us on,
folks. Thank you so much. Um,
more to come on that topic and
more to be heard from board
member de Castro and board
member Hartfield. Uh, item
number ten on the agenda is a
briefing about the Seattle and
King County
s efforts around
the continuum of care. Again, I
want to thank board member Liu,
who had suggested this item be
included in our board
discussion here today. And much
of the board has been briefed
in part on the continuum of
care dollars that we are so
desperately in need of from the
Federal Housing and Urban
Development, um, grants that we
regularly rely on to the tune
of over $60 million here in
King County alone, is how much
we continue to invest in these
items. Um, I
m going to hold
for just a second because I
m
so excited to talk about
Continuum of Care. I actually
forgot to go to agenda number
nine. Is that correct? Team?
Um, so sorry for the preemptive
jump in on a continuum of care
items. Um, so if folks could
just, uh, hold tight for that
item. Uh, board member Liu,
apologies for that. I know, uh,
that was something that you
were teed up to speak to. So
we
re going to go back to
agenda number nine. Um, if you
don
t mind. Agenda number nine
is equally important. This is a
preview of an item that will
come before our, um, fall
discussion in the SEPTEMBER
meeting. The board will
continue to have a conversation
and potentially vote on pet
business and public health,
zoonotic diseases, code and
rate updates. Board members who
MAY vote on such a change in
this fall
s a meeting will
include board members who are
elected officials, and that
s
only because of the impact on
fees and rates. The slides for
the briefing, uh, for this
item, item number nine, again,
that those item, those slides
begin on page 15 of your
packet. And you might recall
this topic for board members
who were here with us last
year, we had a presentation
last SEPTEMBER as well. And
those slides have also been
included in your packet on um,
beginning on page 35. This
year, Public Health has been
providing additional
information at the board prep
meetings and through email
communications to board members
about the zoonotic disease
codes and rates. And we would
very much appreciate if you
have any questions today to
jump in and ask those. I have
told our public health team,
sometimes this item gets
confused with other animal
related public policies. And so
we will be clarifying here
today what zoonotic disease
code and rates refers to. Um,
as there are many health issues
that relate to animals in King
County. We want to have a clear
understanding of what this
relates to and what it doesn
t.
I
m very thankful that we have,
again with us from Public
Health, Ryan Kellogg, who
s the
assistant director of public
health, environmental and
Health division doctor. Jocelyn
Mullins, who
s a public health
veterinarian. Leah Helms, who
is the manager of Solid waste
rodent and zoonotic disease
programs. And, um, Michael
Perez, who
s the finance and
administrative service manager,
uh, to provide us an overview
of zoonotic disease codes and
rates. And again, this is a
briefing with subsequent
conversation to come in
SEPTEMBER. I also want to thank
board member Lewis who is here
with us. Thank you, Board
Member Lewis, for dialing in.
And any other board members
who
d like to announce
themselves before we move on
with agenda number nine. Okay.
Take it away, MR. Kellogg, and
sorry for the false start.
There.
Great. Thank you. Chair.
Mosquito. I
m also very excited
about the continuum of care
presentation, and I appreciate
being here with you and other
Board of Health members. Again,
I
m Ryan Kellogg, assistant
mental health director here at
Public Health. We
re pleased to
be back to share an update with
the board following our
briefing last SEPTEMBER on
public health
s role in
zoonotic disease prevention and
the board
s pet business
regulations. In addition to
today
s presentation on our
code update process, your
packets include last year
s
presentation that provides more
context on public health
s role
in zoonotic disease prevention
and the importance of standards
for pet business operations.
Um, as the chair mentioned, I
m
joined today by our public
health veterinarian doctor
Jocelyn Mullins, and Leah
Helms, who manages our pet
business program. Mike Perez,
our finance and administrative
services manager. Environmental
health is on deck to assist
with any questions from the
board on the proposed changes.
Um, next slide please. Sean,
for our time today, we
re
planning to share details on
why we
re updating the codes.
What
s being proposed as
changes, how we
re engaging
businesses in the public, and
next steps. Next slide. Please
join for a little bit of
background. We
re overdue for
an update to the Pet Business
Standards and title eight,
which have not been updated
since their are adopted by the
board initially in 2010, when
Public Health initially
launched the program. The
updates, which will be
presented to the board in
SEPTEMBER, will align with our
current understanding of
zoonotic diseases, risks and
prevention interests and will
also reflect substantial
changes in the industry. Since
the code was initially adopted.
In addition to the code update,
the program fees are also in
need of updating when
Environmental Health Services
presented our most recent rate
study to the board last
OCTOBER. In OCTOBER 2024, we
noted at the time that the pet
program fees have not kept pace
with the changes in the level
of effort and are not aligned
with Environmental Health
s
full cost recovery model for
rate based programs. So we
ll
be providing more information
on that next slide, please.
Troy. Um, so overall, we
re
focusing the proposed code
changes in five areas. The
policy changes or the pet
business standards are in Board
of Health Code section 8.03
related to pet businesses,
including improvements in
animal health and worker
safety, strengthening infection
control and disease prevention,
reducing risks of animals in
public settings, and updating
and streamlining requirements.
And title two, along with other
environmental health fees. This
is the. This is where we
ll be
proposing some changes to
stabilize the program and meet
the board
s policy and
expectations for full cost
recovery. Um, and just to
provide some clarification to
follow up on the chair
s
earlier comments, we
ll note
that title eight has three
sections in it. It has the, um,
pet business regulations,
rodent control and rabies
control, which includes the
board
s requirement that all
animals over four months are
vaccinated. We and our proposal
are focused on the pet business
regulations and section 8.03.
We are aware of a potential
proposal from Regional Animal
Services and King County
Department of Executive
Services to add a rabies
vaccine reporting requirements
in section 8.04, but that is
separate and distinct from what
public Health is proposing to
the board. In SEPTEMBER. I
ll
close my intro comments by
noting that we have more pets
than kids in King County. In
the businesses that serve them
are a critical and growing
industry. In King County. The
health standards that the board
sets in title eight help ensure
standards are consistent across
businesses and, more
importantly, that our pets stay
safe and healthy when in the
care of others outside our
home. So, to get us started on
the policy changes in section
8.03, I
ll turn it over to
Doctor Jocelyn Mullins to
provide an overview of those
changes.
Great. Thank you so much, Ryan,
and thank you for having us
here today. So the proposed
policy changes include updated
standards to improve animal
health and worker safety. And
this includes establishing
clear enclosure size
requirements for animals,
setting expectations for group
housing practices, including
considerations for the
co-housing of groups of dogs or
cats and strengthening
supervision requirements. This
kind of space and compatibility
requirements for animals are
grounded in evidence based
animal care practices that
encourage adequate movement,
ensure proper social
interactions among animals, and
reduce stress among animals so
that a better ability for
animals to have normal
interactions and have lower
stress means that they are less
likely to develop illness or
bite, and the goal of these
requirements are therefore to
reduce the risk of zoonotic
disease spread within
businesses and improve the
safety of staff who are working
with those animals. And we
ve
included a more detailed list
and frequently asked questions
in your packet that walks
through each of those changes
in more depth. Next slide
please. There are changes that
will also strengthen infection
control and disease prevention
requirements for pet
businesses, again, with a goal
of improving animal and human
safety. And these include clear
expectations for infection
control plans and a plan for
staff training on zoonotic
diseases and working with
animals. And it clarifies
procedures for reporting animal
bites that occur within pet
businesses. We
re also adding a
new requirement for an
isolation plan, and this will
include procedures for timely
management of sick or injured
animals within pet businesses.
And these updates are again,
really grounded in our best
public health practices to
reduce disease transmission
risk in pet care settings and
ensure that cleaning and
sanitation requirements are
clear, and that sick and
injured animals are promptly
recognized, isolated and
treated appropriately. Next
slide join. We
re also adding
standards for business models
that have emerged since the
first code was drafted. There
are new business models in our
county, such as cat cafes, that
really change how the public
interacts with animals and pet
businesses. So unlike
supervised one on one
interactions between animals
and potential adopters or
purchasers in shelters or in
pet stores, these new models
allow the public to interact
with groups of animals in
shared spaces, so these new
standards will ensure that
those interactions can occur
safely and prevent disease
transmission to the public.
Next slide. Joy, thanks. And
lastly, we
re making some
changes that don
t change the
core policy direction of
section 8.03, but instead
include improved clarity and
simplify how the code is used,
and align it with best current
practice in state law. So these
changes make it easier for
business owners and the public
to understand and apply the
code. Additional details are
again provided in the packet
provided to board members for
their review. But first, a few
specific things. We focused on
simplifying the code to make it
easier to understand and apply
in practice, which includes
streamlining requirements to
reduce the complexity, removing
outdated or redundant language,
and updating some definitions
so it
s clearer which
businesses are being regulated.
We
re also aligning language
with current state law,
including updates related to
animal sales. And second, we
re
updating permitting
requirements to better reflect
the current risk and
operational realities in pet
businesses. So this includes
removing low risk categories
such as fish only, pet shops.
And we
re also adding clearer
expectations around permit
display. So permits are visible
to customers and strengthening
our ability to deny permits in
cases of outstanding fees or
unresolved noncompliance. So
with that, I
ll turn it back to
Ryan to go over the background
and proposal on pet business
fees in Board of Health title
two.
Thanks, Doctor Mullins. Um, so
starting with the overview of
our proposed fee changes, um,
our objectives, uh, first and
foremost are to stabilize the
program revenue, the fee
structure, as I mentioned
before, has remained largely
unchanged since the program was
established in 2010. Certain
rates for larger pet businesses
were updated by the board in
2024, when Environmental Health
Services presented the
division
s rate study. But we
noted at the time there was an
adequate level of effort data
associated with the different
business categories, and we
committed to the board to
return with a more specific
proposal, which is what we will
be presenting in SEPTEMBER with
an overview today. Um, I
d like
to also note that the pet
business program is very small,
um, funded at full level. Um,
it
s 1.5 FTEs, um, covering
just over 500 permitted
businesses. Um, the proposal
that we
re sharing will
increase the program fees to
reflect the actual service
costs, consistent with the
Board of Health Policy for full
cost recovery, while not
reducing services. And then
looking ahead to maintain
stability, we
ll continue to
review levels of effort. And
we
ll also adjust rates
annually, similar to other
environmental health permits to
account for inflation. Um, I
ll
note that since 2010, we
ve
also seen significant changes
in the industry. As Jocelyn
mentioned, uh, business
business models have become
more complex, including some
dog daycares growing
significantly in scale. And
there
s been increased demand
from the public for oversight
and from businesses for for
technical assistance and
ongoing guidance. So the goal
here is to move towards a
sustainable fee structure that
supports baseline program
capacity and allows us to
continue providing consistent,
reliable service. Next slide.
Please drive. This is a list of
the types of businesses that
have regulatory standards and
title aid and related fees. And
title two fees paid by these
businesses include. Plan review
for new, remodeled and expanded
facilities, annual permits and
inspections, and a limited
amount of general education and
technical assistance that
include, like regular program
newsletters, maintaining
program information and
resources on Environmental
Health
s website, and response
to customer inquiries and
support requests. Next slide. I
just wanted to give a little
bit of a review of how we
arrive at an environmental
health permit fee. It
s
calculated by multiplying the
hourly rate, or the cost per
hour for providing services. By
the time required for that
service. Next slide. And the
the focus of the proposed
changes are on the amount of
time required to administer
individual business permit
permits, including, as I
mentioned before, plan review,
permit issuance, annual
inspections, and some level of
education and technical
assistance. This is based on
review of our current levels of
effort. I
ll also note that as
we
re bringing the title a
proposal forward, we don
t
expect the proposed policy
changes into title eight that
the board will be considering
in SEPTEMBER to significantly
influence or increase the level
of protection and moving
forward. A note about the
timing. Also, that note on the
bottom of this slide, the
proposed fee changes. It
reflects our 2026 fee schedule,
not what businesses will be
paying in 2027 when the new
fees go into effect. That
s
because ea adjusts our rates
annually to account for
inflation. Pursuant to Board of
Health Policy and Title two,
and we don
t know yet the
specific increases for
inflation in 2027 until later
in the year, when we have the
cpi forecast from the King
County
s Office of Economic and
Financial Analysis. Next slide.
So now under the proposed
changes, there are five areas
in the fee structure that we
re
proposing to change to better
align with how the program
operates today. I
ll review
each of these in more detail in
the following slides. We want
to make our plan review fees
clearer and more predictable up
and reduce processing delays.
We
re adjusting the time, as I
mentioned before, with
inspection and permitting, to
reflect the actual level of
effort establishing tiered fees
for daycare and boarding
facilities that have had
significant differences of
growth and scale and
complexity. Establish a one
time double permit fee for
currently operating unpermitted
businesses who are
non-responsive to our outreach,
and then update miscellaneous
service fees that are not
accounted for elsewhere, like
variance request inspections
and return visits. Next slide.
So starting with the first
three, um, the upfront plan
review, will be proposing to do
our fees upfront consistent
with other environmental health
programs. The current pet
Business Plan review fee
assesses a one hour fee,
followed by additional hourly
fees for any additional time.
Um, for for a small group of
less complicated plan reviews
like poultry retail or mobile
groomer, satellite adoption and
pet food retailer will maintain
that at a one hour rate, plus
any additional hours if needed.
Our experience is that for
other plans, they
re more
complex. They take a minimum of
three hours to complete, so the
current practice of charging an
hour upfront, then doing follow
up billing billings doesn
t do
a good job. It
s not efficient,
and it also doesn
t do a good
job of communicating the actual
cost up front. It can also slow
the permitting process, this
final approval is contingent on
all of our fees being paid, so
it
ll be more efficient for us
and applicants to have the full
fee paid upfront. The next is
this new tiered structure for
daycare and boarding permits.
There
s considerable
variability, as I mentioned, in
the scale of complexity that
we
ve seen developed over time
with this industry group. And
to assess that variability and
the level of effort needed,
we
re proposing a tiered fee
structure based on the number
of animals in a business
s
care. Um, smaller operations
would have lower fees, while
larger, more complex operations
would have higher fees. It
s
not inconsistent with how our
food permits, food permits are
structured. So at the time of
the fees were established that
daycare and boarding in
particular were not at the size
and scale that we see today. So
establishing this tiered
structure creates a more
equitable, um, fee system that
reflects the level of impact
and oversight needed. And then
last on this slide, we
re
proposing to update permit fees
to reflect, as I mentioned
before, the actual time and
effort to conduct the
inspections based on data that
we have available to us. Now,
the initial fees were
established based on level of
effort estimates at the time of
the program was first
established, and since that
time, we have a much better
understanding of what
s
actually needed to oversee the
permits permitted businesses.
Next slide. So we we estimate
that we have approximately 100,
100 unpermitted businesses
currently operating in county.
That and have a shared interest
with a permitted
establishments, a set a level
playing field. We become aware
of these facilities through
public complaints and more
recently through research and
available business databases.
One tool we
re proposing is to
incentivize compliance by
establishing a one time double
permit fee. We would only apply
this when a business is
non-responsive to our outreach.
Our objective is compliance,
not letting the additional fee,
you know, so we we we
acknowledge that there are
likely some businesses out
there that just aren
t aware
that they need this permit. And
so we
re confident that this
tool will be helpful to gain
compliance with those
businesses. There
s another
group of businesses that are
more complex, and they
re in
their compliance needs. They
MAY have underlying zoning
issues, maybe actively
resisting, excuse me, getting a
permit. Um, the proposed fees
that we
re putting forward
don
t include assumptions for
managing those more complex
cases. That
s part because of
the kind of the scale of this
program. And we also don
t want
to burden those costs under the
existing permitted
establishments. So to
meaningfully kind of address
that issue, that
s an
outstanding thing that
environmental health would need
to ultimately have additional
revenue and staff resources to
meaningfully address. So last
is this group of updated
service fees, um, that are
activities not captured by the
base permit fee, including
variances, free inspections and
return field visits. And this
helps ensure that the
businesses that are requiring
those additional level of
service are paying for that
service directly, rather than
distributing those costs
broadly across all permits,
fees. Next slide. So I
d like
to give just a couple of
examples of what the changes
will look like for a couple of
business types. An example one
the fees for a pet groomer, the
actual level of effort
reflected in the proposed rates
increases by 45 minutes to 2
hours total, resulting in an
increase from $281 to $450.
Again in $2,026. Um. An example
two where this is an
illustration of the new tiered
system for daycare and boarding
facilities. Um, recognizing the
difference in operational scale
for the smallest group of of
what we call tier one
businesses that accommodate ten
or fewer animals, the actual
effort increases 15 minutes,
increasing the permit cost by
$57. And for larger tier for
businesses that accommodate
more than 60 animals, the
actual effort changes from 2.25
to 4 hours. The kind of the the
larger shift between tier one
and tier four just is to
recognize that we didn
t have a
tiered structure before. So all
of these tiers started at 506.
Um, hence the tier four being a
larger increase because it
s
reflecting a larger level of
effort. So just to put this in
perspective with what customers
are paying for services,
grooming and bathing services,
um, customers are charged 40 to
$200 depending on the breed
level of treatment and boarding
rates range from 50 to $175 per
day at establishments. You
know, that said, I want to
appreciate that fees are only
one part of the cost of running
a business, and that any cost
increase has an impact. And we
feel the proposed level of
effort accurately reflects the
time we need to ensure that
facilities meet Board of Health
standards, and also what
s
needed to demonstrate to the
public and pet owners that
we
re meeting their
expectations to ensure the
safety of their animal family
members. So next, I
ll turn it
over to Leah Helms to provide a
summary of our engagement with
businesses on the proposed
changes. Um, next slide, Sean.
Thanks, Ryan. So engagement has
been a core part of this
process from the beginning.
We
ve used a variety of methods
to reach businesses,
stakeholders in the public,
providing multiple
opportunities to learn about
the proposal, ask questions and
provide feedback. A few
examples include. We
ve hosted
two public industry engagement
sessions. We
ve hosted two
public webinars and two public
open houses. We
ve also
conducted surveys directly with
several regional animal
shelters and individual
businesses. We
ve shared
updates through newsletters,
our websites, and we have also
made the draft rules and
regulations that are in our
available online for public
review. Over the next few
weeks, we will continue this
work with additional targeted
outreach, including a focus
group with the cat cafe
industry. Next week. So how are
we using feedback? Feedback is
directly informing the proposed
code changes. We
ve used
feedback to refine the proposed
code language, identify
implementation considerations,
and improve guidance materials
and how the fees will be
structured. We
ve also taken
equity as an important
consideration through this
process. We
ve been very
intentional about reducing
unnecessary burden where
possible, and making sure that
we
re hearing from small
businesses, which are often the
most affected by regulatory and
changes. Our goal here is to
help is to develop a code and
fee structure that is fair,
clear and practical to
implement and also protective
of public health. Next slide
please. So how will we support
businesses. We recognize that
these updates will require some
adjustments. So a key part of
this work is making sure that
businesses have the support
that they need to understand
and comply with the changes
following adoption of the code,
we will provide a comprehensive
online resource that includes
FAQs and overview of the
changes and information about
what requirements apply to
different business types to
support implementation, we will
develop templates and guidance
documents along with other
tools to help businesses
translate the code into their
day to day operations. We
re
also proposing a grace period
for existing businesses to come
into compliance with a new
updated code. Requirements.
Requirements that are unchanged
would continue to be expected.
Variances will continue to be
available when appropriate to
address the unique situations
on a case by case basis. For
businesses that are needing
additional assistance, we will
offer technical assistance to
answer questions and help them
understand how the
requirements, how the
requirements apply into their
specific settings. I
d also
like to take a moment and
mention the support that will
be providing the pet business
customers. These are the
clients and customers of our
regulated businesses to help
customers make informed choices
about the care for their family
members. We currently post
permit suspensions on our
website. There
s currently only
one and also provide a link for
customers to check if a
facility has a permit, and to
see a list of recent
inspections. Ryan also
mentioned earlier that part of
the code update will also
include that we will ask for
businesses to post their permit
in a public place. We
re also
working to make additional
improvements on our website,
uh, to make sure that the
information is more accessible
and members can always email or
contact us directly with
questions. Our goal is to make
implementation of this code
revision clear and practical as
possible, so businesses have
the resources that they need to
successfully comply with the
updated code. Next slide please.
So what comes next? We began
this process with an
introduction to the board in
SEPTEMBER 2025, followed by
drafting code changes through
the fall and winter of this
past year. In SEPTEMBER 2026,
we will return to the board
with the full proposed code and
changes for consideration and
potential action. And then
looking ahead. Implementation
is anticipated for early 2027,
which will include a transition
period to support businesses.
Next slide please. So this
concludes our presentation
today. We appreciate the
opportunity to share with the
board, and we look forward to
coming back in SEPTEMBER for
the code adoption. Back to you,
Ryan.
Gets back to the chair.
Back to the chair.
Excellent. Thanks so much. So
that was a lot of information.
We wanted to provide you with
this briefing in advance of the
SEPTEMBER potential vote. Are
there any questions folks have?
And feel free to jump in even
if you are not going to be a
voting member at the SEPTEMBER
time frame. We welcome your
questions and dialogue here
amongst the entire board. Uh,
board member Lewis, please go
ahead.
Thank you. Um, thank you, Ryan
and Doctor Mullins and.
MISS Helms for this
presentation and for sharing
this information with us. Um, I
just have a couple of questions
about, uh, some of
The small businesses that will
be, um, seeing these, um, fee
increases. And I was wondering
two things. When were the fees
last increased and if the
department considered phasing
the increase. I know that you
have the one year grace period,
but wondered if you looked at
at all.
Yeah, I appreciate the
question. Councilmember Lewis.
Thanks. Um, so as I mentioned,
we we adjusted the fees for in
addition to the annual cpi
increases. Um, we did adjust
the fees for some of the larger
operations as part of
Environmental Health
s great
study presentation in 2024, but
there
s been no kind of full
review of the fee structure for
the program since the program
was started in 2010. And so,
you know, the interest with
this is kind of rebased lining.
Um, the, the revenue structure
for the program so that it
s
stable. And I really I
appreciate the question also on
kind of being sensitive to the
impacts, um, particularly to
our small businesses and the
phased implementation of the
fees, especially for the larger
increases, is definitely
something that we considered.
But, you know, as I mentioned,
one of our kind of objectives
around stabilization and the
fact that this program is at
1.5 FTEs, we just environmental
health doesn
t have alternate
funding to support basic
program operations, which we
feel is at that 1.5. Um, so,
um, phasing, implementation or
reducing that service level,
um, would be a result or I
m
sorry, reduce, reduce service
levels would be a result of
going through a phased
implementation. And when we
re
considering reduced service
levels, we
d likely need to
prioritize the higher risk of
the larger businesses while
reducing or eliminating routine
inspections for smaller
businesses, even though those
businesses would still be
required to pay for those
services through their fee. So
this would have a
disproportionate impact on
smaller businesses. In addition
to likely longer service hours,
reduced capacity for customer
service, and availability for
technical assistance, and the
potential to create longer
response and turnaround times.
But, you know, there
s a
there
s a there
s a, you know,
significant difference with
this program compared to other
environmental health programs
that have a larger scale with a
1.5 fte or even a small
reduction in that 1.5 fte will
have a very large
disproportional impact on the
ability of us to provide
provide services. I hope that
answered your question.
It did. Thank you.
Thank you. Board member Garcia.
Please go ahead.
Thank you. Chair. Uh, thanks
for the presentation. Really
appreciate it. I. Big takeaway.
We have more pets than kids. I
have three pets. So this is
really informative. I just
wanted to, uh, I guess,
clarify. Uh, the larger tier
four is for 16 and over or six
zero 60 and over.
Six zero and.
Over, six zero. Okay. And then
what
s there? I didn
t see any
tier two or tier three. Is
there any reason.
There weren
t in the examples?
We were trying not to run
through the entire fee
schedule, but just give you a
sense of how the changes were
landing from the smallest
change to the larger change. So
there are there are two, there
are tier two and three.
Okay. I just wanted to confirm
and.
Businesses that have between 10
and 60 animals.
Gotcha. Makes sense. And just
wanted to confirm is what
s the
point during this process that
the uh like I
m in Buren and we
have a non-profit agency that
kind of oversees, uh, our pets.
And I just wonder, was
wondering at what point is
there or maybe there already
has been relaying to them that
this is, uh, in the works and
it
s potentially going to be
voted on just so that, um,
yeah, they are aware locally in
smaller cities of these
potential changes since they
might not directly see it.
Yeah, yeah. Great question. And
we, you know, want to move
forward and not have any
surprises. Um, and what the
board
s going to be voting for
in SEPTEMBER and been doing
active engagement with um, with
both our regulated committees
but also others in the
community that have an interest
in the in the pet business
requirements. So we have a
listserv that we maintain that
we
ve been providing regular
updates throughout the process.
And 2026, I think we
ve been
sending out two notices to the
listserv per month. We
ve also,
as Leo
s noting, hosted a
series of open house webinars
as opportunities to provide
feedback. You know, early on
when we didn
t have the
specific code proposals, those
were more kind of concepts and
getting feedback on what we
could be doing better, what
we
re not doing right. Um,
leading up to more recently,
actually sharing a strikeout
version of the of the code
changes and hosting some
conversations for folks to
provide us feedback on that.
We
ve also done some specific
outreach with individual, uh,
individual, um, industry types.
Um, typically has a session set
up for cat cafes next week. Um,
we also did some specific
outreach to the larger shelter
operators in Seattle and King
County, and got some really
good feedback from them. Um, on
some standards that didn
t
really align with their
practices, that were making
some adjustments in the code to
reflect that important
feedback. Um, so we
ve been
doing in summary, I guess we
ve
been doing fairly extensive
outreach and feedback, and I
ve
been getting some good comments
back and have been making
adjustments based on those.
Thank you.
Thank you. Vice Chair Daniels.
MADAM Chair, I just had a quick
question. During these
listening sessions when you
spoke to the smaller
businesses, because they will
be the most impacted by this
increase in fee. Um, what have
they, what have they expressed
regarding the fees? Have they,
um, how that will affect them
when, um, uh, keeping their
business open? Um, and how, uh,
taxing that would be. Um, to
their, um, uh, to the
livelihood of their business.
What what what has been what
s
what
s been the general
feedback from the smaller pet
businesses?
I might invite you to step in,
but my understanding is that we
haven
t received any kind of
direct feedback specifying
like, this is going to be. And
I
m going to have to close my
businesses business, or this is
going to be significantly
challenging. You know, we you
know, whenever I think any
agency is going through a
process of increasing fees, you
know, nobody wants their fees
increased, right? And so I
think, you know, some
respondents were indicating
that, you know, any increase
was not something that they
were that they were looking
for. But I think that
throughout this process, we
ve
done a really good job
communicating what customers
are getting for that fee. But
Leah, let me let me see if you
have anything to add from what
you
ve been hearing directly
and engagement sessions.
Um, yes. During the engagement
sessions, we
ve been talking
about generally that the fees
will be going up and that we
are looking at restructuring
them. We
ve provided some
information on our website
about the how and why that will
happen. Um, the final fee
schedule has not yet been
posted. Um, most of the fees
are going up, uh, around $10 a
month for some of the permit
categories. Um, I think it
s
the pet daycare and boarding
category that
s splitting into
tears. That is probably the
biggest impact. Um, folks are
definitely concerned about
fees. Um, but we haven
t
received anything specifically
stating that, um, this will
cause them to not be able to
run their business..
Yeah.
Because I know, Ryan, you said
that they that you reached out
to the larger businesses and
they gave you feedback. Um, I
m
just wondering, the smaller
businesses, the their, their
reach out to them and what
feedback that you got from
them.
Yeah.
Good. Good clarification. Board
member Daniels. Thanks. Um, so
these um, so we kind of we we
did multiple different, uh,
outreach methods on more the
kind of one direction through
the newsletters, keeping people
updated with the process. Um,
uh, advertising opportunities
to provide a comment through a
survey. The group of open
houses that we offered were
open houses that were open to
anybody that received our
listserv notice. So that
included a mixture of small and
larger businesses. The focus
sessions that we had were, at
the request of a couple of
different industries that we
knew had greater interest in
the in the proposed, mainly in
the title eight changes, the
policy changes, not the fee
changes. And those were our
larger animal shelter operators
and the and the cat cafes. I
hope that answers your
question.
Thank you.
Thank you, thank you all for
the engaging in this
discussion. Again, we will
bring this back to the
SEPTEMBER meeting. And I do
want to clarify, um, wanted to
let folks know that all board
members actually have the
chance to vote on proposed code
changes. There will be two
separate ordinances, so one
will be proposed code changes
and one piece of legislation in
front of us will be on fees. So
all board members, regardless
if you are an elected official
or not, get to vote on the
proposed code changes. And then
because of the state law, only
those who are elected in their
individual jurisdictions have a
chance to vote on fee
legislation. But there will be
two pieces of legislation, and
everybody gets a chance to vote
on the code changes again, that
will come back to us as rules
and regulations for us to
consider in SEPTEMBER. If you
have any questions in the
meantime, um, please do reach
out. Ryan and the team is
available for any additional
information. And thanks for
preparing this presentation
here for us today. Great
questions on engagement with
small businesses. Uh, we will
be reaching out to some that
are in our district as well,
who have been interested in a
dog cafe and how to engage in
that process. And if there
s
any lessons learned there. Um,
you mentioned cat cafes. That
makes me want to sneeze, even
though I own a cat. And we do
love our furry friends and also
want to make sure that people,
as they
re getting out of the
house and creating social
cohesion opportunities, that
they they have those chances to
meet people and pets in places.
And that
s really good for our
mental health as well, to get
people out of the house and
engaging in small business
opportunities. We want to
support our small businesses as
well. So let
s make sure that
everybody understands what
s
being proposed and how to
navigate these new proposed
rules. All right. With that I
m
going to oh please go ahead.
And Boardmember Louis.
Just a quick question. Um,
Ryan, will you let us know when
we can start putting
information in our newsletters
and our communication with our
constituents?
Oh, we would love that. Board
member Lewis. Um, I
ll follow
up with Joy and get some
information to you that, um, to
the board that you can you can
share right away.
Okay. And board member Garcia.
Uh, I just wanted to echo if
you could maybe share that also
to our sca, uh, representative
for the Small Cities. Uh,
outside of Seattle. It
d be
great. We
d love to do the same
outreach on. And then. Just
wanted to clarify. Did that
hear that? You you say that you
have only five staff members
that deal with the program on
going out to the businesses and
doing this work. 1.50 okay.
Gotcha.
Getting a lot of getting a lot
of value out of this, out of
this program.
Wow.
Wow okay.
Thank you.
Thank you. Boardmember Garcia.
And, um, you mentioned the
Sound Cities Association. I do
want to note, uh, our newest
board member to the Sound City
from the Sound Cities
Association. Alternate, um,
council member Perry Bloss, who
is with the city of Des Moines.
So we
re glad that they
re
participating as well. And, uh,
echo the comments about sharing
that with sca. Thanks for the
request to get a blurb that
people can put on social media.
And, uh, in their newsletters,
Boardmember Louis. And with
that, colleagues, we are going
to move to the continuum of
care topic. Uh, we do have
quite a few people who are
joining us here today for this
topic. Again, I want to thank
board member Lou, who had
requested this item be added in
partnership with other board
members. After we
ve had some
initial conversation about the
continuum of care, federal
dollars, uh, about over 60
million in federal dollars is
how much King County relies on
annually from Federal housing
and Urban Development grant,
um, a grant that we receive
with some of the proposed
changes and conditionalities
tied to the request for
proposals that we saw from the
federal administration, we are
all very nervous about walk
backs that the federal
administration is proposing on
trusted and proven harm
reduction strategies that allow
for people to get placed into
housing. And our team here in
King County, including at the
King County Regional
Homelessness Authority, in
partnership with providers like
the Downtown Emergency um
Services Center, uh desk and
providers, direct workers on
the front line working with our
most vulnerable community
members, folks from seiu
healthcare, 1199 Northwest Pro
Tech, 17 op. You are all union
workers who work directly with
folks who are needing access to
not just shelter, but the
throughput to permanent
supportive housing to keep
people off the streets. So we
are here at the request of
board member Lou, for
additional information on page
52, in your meeting packets,
you will be able to find more
information about what is going
to be presented here. And I
want to start by asking board
member Lou, if you
d like to
have any comments before we
turn it over to our panelists
and appreciate your engagement
on setting this agenda.
Yeah. Thank you so much. Chair.
Mosquito. Again, my name is
board member Victor Liu for
this work context I you see his
pronouns on this board. I
represent community
stakeholders. And then beyond
that, I am also on the Health
and Homelessness workgroup,
also on the King County
Regional Homeless Authority
Continuum of Care Board as
well. And also work with the
Governor
s Office of Equity,
Community Advisory Board. In
addition also in commerce,
Homelessness Assistance Unit,
Living Assistance Committee,
and most recently, I was also
selected as one of nine
national leaders on the
Community Strategic Team on the
National Alliance to End
Homelessness. So you can tell
that I
m deeply engaged in this
homelessness work. For years
and since the pandemic, I have
focused my work on
homelessness. Beyond working as
a principal consultant,
specializing in specializing in
integrated managed care. And I
understand from today that we
have six presenters, and I
think that this is a very
timely time. As chair Mosqueda
has noted that the local
application for the notice of
funding opportunity ended on
JULY 3rd, and we are actually
looking at $67 million in
Seattle and King County as a
significant amount that will
impact Seattle and King County.
The six presenters that we have
today are just chief program
officer from King County
Regional Homeless Authority.
Daniel Daniel, I haven
t seen
you for a long time. Executive
director from dhsc and also
union representation, Corinne
Constantino, Regan McBride, Jim
Hopkins and Lindsey Grant. And
with that, I will pass the
baton to Jeff.
Thank you. Board. Marylou.
Uh, thank you, board member
Lou. And also for your support
on our as a member of our
board, uh, separately, uh,
chair Mosqueda or one member of
the board, could you just
confirm for me that you can see
my title side? Great. It should
be advancing. Now to my first
slide. There we go. Thank you.
Um, as a board member, Lou
already covered a little bit.
I
m here to give you a
background on the Continuum of
Care program, which is the
largest stream of federal
funding for homelessness
services that, uh, that goes
out nationwide and
specifically, um, in King
County, as you can see on the
chart in front of you, we
receive, uh, for program
dollars 66 million, a little
bit more than $66 million. And,
uh, what is broken down on this
slide are the various areas
that those, uh, or program
types, as we call them, that
are supported with those funds,
the largest being permanent
supportive housing. That
s
especially relevant for this
board, uh, because of the
health intersections for the
individuals that utilize those
services. Everyone in a
permanent supportive housing
unit has a disabling condition
and has experienced chronic
homelessness. And so, uh, the
individuals that would be
impacted in any of those kinds
of project types are going to
have, uh, direct implications
for the work that you all
oversee. There
s also some
other, uh, uh, bolded program
types that I wanted to lump
together and note for you.
Those are things that results
in an individual moving into
permanent housing or having
permanent housing in some way,
shape or form. And as you can
see, that
s 92% of our total.
Uh, so things that are
resulting in housing outcomes,
uh, that
s going to be really
important as I get to my next
slide here and talk about the
amounts that we are potentially
seeing at risk in this coming
funding cycle and the policy
changes that the Department of
Housing Urban Development is.
I
m going to just say hud going
forward, uh, are seeking to
impose. So those significant
changes, the most substantial
I
m going to use the term from
here on out, tier one, I want
you all to think of tier one as
being the funds that are
basically our renewals. It
s
not perfectly guaranteed, but
it is highly likely to receive
those funds. And it
s easy to
think about it that way. And
everything else would fall into
some other kind of a tier. So
we
ll call that tier two.
Maybe, um, tier two. Tier one
is actually a technical term,
um, stemming from the funding
announcement, though
historically, and as you saw in
that prior slide, if you think
about our permanent housing
interventions, that
s 92% of
the money we receive. And a
disproportionate amount of that
is permanent housing itself,
permanent supportive housing.
Um, this year, historically
that that amount that is tier
one. What we get renewed is
usually in the 90 to 97% range.
So almost anything that has
been awarded previously is
eligible for a renewal if each
local community, which is also
required to do a competitive
process, has evaluated that
project to be aligned with its
local goals and performing
effectively and really meeting
the overall work towards ending
homelessness. This year, the
Department of Housing and Urban
Development reduced that to
60%, so nearly half of the, uh,
a little bit less than half of
the existing projects
nationwide are not going to be
renewed. And I
m going to talk
a little bit more about some of
those impacts for us locally.
That
s the most significant
action that we
ve seen. But
there
s several other various
serious changes that hud has
also imposed in this recent
funding cycle that we
re going
through. Um, you can see that
some of those are changing the
types of projects that you can
propose for them to receive. So
instead of it being something
or the results of permanent
housing placements, ending
someone
s homelessness, it has
to focus on things that are
shorter term, uh, or supportive
services instead of helping
necessarily, and having as a
result in permanent housing.
There
s also several policy
changes. I won
t read through
all of them on this list. You
can see them on the slide. This
isn
t everything. Um, I
ll note
that there is a protective
order in place preventing King
County and Seattle from having
to comply with some of these
changes. That court case, King
County versus Turner in
particular, uh, the
requirements to I believe the
language is acknowledge the sex
binary of humans requiring
collaboration with federal
immigration enforcement and
executive order compliance.
Those three items in
particular, we are protected
from at this time, from having
to comply with. But you can see
on this list that
s not
everything that we
re looking
at. There
s new items that have
been imposed. There are there
is a a lawsuit has been filed.
And King County is a plaintiff
in that lawsuit seeking to
enjoin some of these other
conditions. That hasn
t
happened yet. But there is that
lawsuit is in process, and it
was requested that by the
AUGUST 10th, the court make a
determination on the on that,
uh, that complaint. So I
m
going to go to our next piece,
which is that local impact
again, talking about we
ve got
a lot of projects that are
facing not getting renewed. Um,
so if you just look at our
total number, that
s 66 to 83
is the same that I had on my
first slide. You can see that
some numbers, some of those
projects adding up to just
under $40 million, would fit
into that realm of funding,
that tier one that we feel
confident that we can see it
renewed. That
s not perfectly
guaranteed, but we feel pretty
confident about that. We also,
given all the many changes that
hud is imposing nationally,
have worked with programs to
identify places that they have
greater efficiencies or could
make a voluntary change to how
their project operates in order
to better align with hud
s
priorities. And so we would not
have to have that project in
tier one, but would be likely
to still see that project
continue, or it just creates a
funding gap for us to be able
to fit more things in our tier
one, uh, opportunities. That
s
still leaves a gap of $22
million in projects that exist
today. They
ve already been
operating many times for many
years that we would not be able
to operate, although locally,
and we have prioritized our
projects that you could
shorthand it as being permanent
supportive housing project,
permanent supportive housing,
but projects that have
leveraged tens of millions of
dollars for either their
capital investment to create
them or the braiding of
numerous funding streams,
including, um, fcs supports or
Medicaid dollars. In some
cases, um, to into their
funding model, along with
Public Housing Authority funds
and even things like the um,
Veterans Administration funds.
So although those kinds of
projects are prioritized, we
don
t yet have my group, my
readers are actually looking at
the applications right now for
renewals and new projects. We
don
t know exactly yet which of
those projects, um, are which
projects are going to be in
that bucket of 22 million that
are facing, not getting
renewed. But that
s the most
important impact that we
re
looking at. And that would have
downstream impacts on numerous
health systems, which is why I
believe board member Lou really
wanted this to be highlighted
for you all today. As I said
though, earlier on some of
this, there are multiple things
underway to hopefully address
or respond to that risk. First,
as I noted already, there
s
litigation not only existing
with an injunctive order put in
place, but also pending
litigation that is seeking to
prevent some of these actions
from being implemented so that
these effects would just be,
uh, stopped by the courts.
We
ve also had excellent
engagement with county
partners. Councilmember
Mosqueda you participated in
that, for example, and some of
our other board members here, I
believe, as well. Um, a
stakeholder group that
encompasses city and county
stakeholders in looking at the,
the the potential impacts of
this and identifying plans,
ideally, identifying steps that
would be taken if some of these
impacts were to occur. You
know, things, things like ways
to shore up those projects
locally. So we don
t disrupt
that braiding of funds, things
like that. Um, and then also
Csra is not only relying on
that legal pathway that has
been taken, but also we
ve been
doing work to make sure that if
we do need to comply with all
of these, uh, new requirements
and priorities, that we
ve set
up a, an application that will
best compete to retain our
federal dollars and also still
aligns with our local
priorities. So leaning into we
actually did a review of the
many degrees of consultant
reports, public engagements and
development of action plans
that have occurred over the
last 5 to 10 years and
aggregated the themes across
that because there was probably
thousands of engagement
sessions with people with a
range of stakeholders that
really inform that, and there
is a lot of consistency in all
of them about what our system
priorities were. And so and
there was overlap between that
and what hud was requiring. So
we were able to focus our local
competition on those. So those
are the steps we
re taking
right now to offset some of
this impact. And then I
ll flag
and then I
ll just run through
where we
re at in timeline,
because I know you have several
other panelists that are also
going to be touching on some of
these topics as well. Um, most
significantly, uh, board Chair
Mosqueda noted earlier than on
JULY 3rd was the date that our
local applications either to be
a new or to renew your project,
we
re all due. Those are all
with objective rating panels
right now, and that
s what
s
going on over the next couple
of weeks, is for that to occur
and for what we call our rating
and ranking process, where we
take everyone
s scores that
they were given by those rating
panels and aggregated into a
list on AUGUST 10th, which is
the next, uh, board meeting.
Well, not actually, there
s
there
s multiple, um, funding
announcements that our board
has to deal with, but for this
big, large funding opportunity
that we call the hud, no foe.
Um, the, our csc board or
Continuum of Care board will be
meeting on AUGUST 10th, and
that is when that ranked list
of applications is first
presented. And authorized by
the board to move forward.
Essentially, that is when it
becomes our final list of what
we
re moving forward. Hud
requires that within actually
within one day of that, um, we
have to have distributed
letters announcing to all of
those applicants that they
received an award. Um, our
final application to hud is due
on it
s technically due on
AUGUST 26th. Um, that, uh, no
one in the country. Well,
actually, I guess no one that
s
wise in the country submits it
on AUGUST 26th. Will be
planning to submit ours on
AUGUST 24th. It
s not uncommon
that with that, many
jurisdictions across the
country submitting the system
can get overwhelmed or
encounter issues. And there is
not an allowance if you
encounter that for any kind of,
um, you know, extension or
anything like that, you
re
outright just not awarded
funds. And so we make sure we
send in our application a
couple days in advance to make
sure that no technical issues
would result in the loss of $67
million. Um, that
s all my
slides for now. I know you have
several other presenters that
are going to be going, and so
I
ll pause and see if there
s
any questions or actually, um,
sorry. Uh, manager, I
m not
sure if you want to meet a
pause for questions or wait
till we get through all of the
presenters.
Um, I think we can go ahead and
roll right over to Daniel
Malone and then over to our
labor partners. I will say the
timeline that you presented and
the update on the application,
it
s just I think another
important reminder, as board
member Liu noted, that we have
so much at stake with this
application and even the, um,
contingency plan of 10 million
at the county and 21 million at
the city of Seattle is not
anywhere near enough to close a
federal funding gap. So we are
very thankful for the joint
partnership with the city of
Seattle, the King County
Executive Office, the Board of
Health here, who has shown
tremendous interest in
maintaining the health of
people in this region by
keeping people housed, there
will be so many more people
falling into homelessness, not
just not serving those who are
currently homeless, but more
people falling into
homelessness. If we lose these
dollars. So that will
absolutely affect the health of
the population as a whole. And
so the timeline, the
litigation, the application,
all of these things all go
together. We have a litigation
strategy and application
strategy, all in an effort to
have a mitigation strategy on
how much this would impact our
community. So with that, to
talk about what the impact
would be, I
ll turn it over to
Daniel Malone from Downtown
Emergency Services Center.
Thank you so much. I really
appreciate the attention you
re
paying to this. Uh, I
ll try to
build on some of, uh, what Jeff
covered in his excellent
presentation there about how
this is likely to affect
services. Uh, on the ground
here in Seattle. Uh, so, a dsc
is, I believe, the single
largest user of continuum of
care funds of, uh, service
provider organizations in the
state of Washington. Um, and
that
s because we do a lot of
permanent supportive housing
work. And, uh, most of the coc
funds are used for permanent
supportive housing, as Jeff
s,
uh, slides had indicated there.
And also as Jeff, uh, clearly
articulated, hud is through
this know fo aiming to move
funds away from permanent
supportive housing. And the
thing I want to emphasize about
that is what that means then is
that is an attack on people
with disabilities because, uh,
permanent supportive housing is
an intervention specifically
aimed to support people living
with disabilities. And
especially people with long
term psychiatric and other
behavioral health disabilities.
Uh, one indication of the
administration
s hostility to
people with behavioral health
disabilities is that they have
said explicitly in public
forums that hud funding for
permanent housing should only
be for people who are elderly
or living with physical
disabilities. Um, another
element of the of the current
no fo that is new, um, didn
t
exist in previous hud practice
is that they have expanded this
category, uh, that they call
risk review. Uh, where even if
a renewal project is included
in the tier one that Jeff
described and, um, and
therefore should be expected to
be highly likely to be renewed,
hud has endowed itself with,
uh, new powers to reach into
any application, any single
project that
s in the tier one
part of the application through
their risk review process, and
reject it for some new kinds of
reasons. And one of those
reasons is related to a vaguely
defined concept of promoting
self-sufficiency for people.
And it appears that what they
mean by that is moving people
off of public benefits,
including off of, uh, housing
support. So when you apply that
type of thinking to people
living with chronic, uh,
disabling conditions,
especially, uh, serious
psychiatric conditions, you can
see that, um, this no folk
presents a very real risk to
the ongoing housing support and
stability for people with, uh,
serious behavioral health
conditions, permanent
supportive housing, uh, has
really become the residential
backbone in our community for
people with complicated and
chronic psychiatric conditions.
And that
s for two main
reasons. Affordability and the
unique services that are
provided. So, you know, this
population of people living
with disabilities, uh, most
often is surviving on extremely
low incomes. And when they have
a disability benefit from the
federal government, usually
it
s ssi that pays less than
$1,000 a month to live on. And
of course, at $1,000 a month
total, it
s mathematically
impossible for somebody to pay
for housing in the community
that isn
t subsidized. So
permanent supportive housing
covers that. By making sure
that the housing cost to the
individual tenant, uh, is based
on their personal income, and
then, uh, people with the most
challenging conditions, uh,
even when they
re participating
in treatment and taking
psychiatric medications, often
need the kind of robust support
that
s provided by permanent
supportive housing to retain
stability in their housing
continuum of care program has
long been a major source of
funding for the operations of
that very kind of specialized
housing at dc alone, about two
thirds of our around 2200
permanent supportive housing
units are supported by
Continuum of Care funds. Um,
the specific numbers are that
um, 1132 units in dc, site
based permanent supportive
housing, and another 257
scattered site units on the
private rental market, where
coc funding, uh is used for
rental assistance. Um, for a
total of almost 1400 of our
about 2200 units are covered by
Continuum of Care funding. So
it
ll be devastating to have
that funding loss. Uh, at dsc,
that
s about $16 million a year
for, uh, that comes to us
through that source. And then
on top of that, another $4
million is covering that rental
assistance that I mentioned in
the private rental market. Um,
so this, this no foe Jeff
mentioned is, uh, is the
subject of brand new litigation
that has been filed, uh, in two
separate actions. One of those,
Jeff mentioned, King County, is
one of the co plaintiffs in
that, uh, uh, the other uh,
litigation, a very similar case
was filed by a consortium of
states. And the state of
Washington is the lead
plaintiff in that case. Uh, uh,
what
s notable here is that
the, uh, the previous attempt
last year by hud to do this
same action of shifting funds
away from permanent supportive
housing into other uses was
also the subject of litigation.
And these same plaintiffs, uh,
were involved in those
lawsuits. And the judge, uh,
issued preliminary rulings
last, uh, earlier this year.
And then, um, very recently at
the end of JUNE, uh, made her
final ruling in that case from
from last year. And, uh, she
really drilled into what hud
s
aims were here. And I want to
read you a quote from the
judge
s ruling, because I it
s
so, uh, important, I think, as
to what she observed in all
this. She wrote, uh, overall,
the actions undertaken by hud
in attempting to hastily
eliminate its housing first
approach serve as the hallmark
of unseasoned decision making.
And hud
s attempt to
retroactively backfill its
impulsive decision making lacks
a rational connection between
any facts it could have found
and the choices that it
ultimately made. In issuing
these no PFOs. Uh, that
s
pretty choice. Uh, comment by
the judge. Now, again, that
applies to last year
s, uh,
attempted change. Uh, with this
funding. But the new novo that
we
re talking about now and
that Jeff was describing the
process for is very similar.
Um, it it has many of the same
kinds of conditions. And, um,
that
s what the plaintiffs,
including King County in the
state of Washington, are suing
over. And so I
ll just end by
expressing my gratitude, uh,
that, um, King County and the
state of Washington are
defending our communities and
people with disabilities by
pursuing this litigation.
Thanks a lot for having me.
Thank you so much. I think
that
s a great transition to
our union community partners.
Uh, 11.99 opioid and pro tag.
Uh, please go ahead and jump on
in. Hello? Reagan McBride
Lindsey grad and, um, anybody
from opi, you please feel free
to jump in. Go ahead. Reagan.
Thanks, chair. Mosqueda. My
name is Reagan McBride. I use
her pronouns. I
m representing
protec 17 here today and protec
17 represents, uh. Most of the
staff at Kcra. So as we
re
talking about continuity of
services, one of the things
that
s really important with
that is continuity of the
expertise that
s been
delivering this funding. Um,
and that
s coming from the Kcra
staff. That
s, uh, developing
and providing the data for
these continuum of care
applications. Um, they are
working with the nonprofit
partners that are largely
represented by seiu and Payu to
deliver these critical
services. Um, and that
continuity of the staff that
s
administering these is also
really important to, uh, the
care of our unhoused neighbors.
Um, we want to keep in mind,
you know, the staff that
administers this funding and
these programs are our local
homeless service and homeless
systems experts. Um, they are
not just budget line items,
although I know that
s most of
what we
re talking about here
today when we
re talking about
funding is budget line items.
Um, but to humanize not just
the clients that are being
served by this funding, but the
staff, uh, that are providing
those critical services and the
critical data systems, um, and
back end systems that allow for
that. And I can kick it either
back to Jeremy
s data or over
to Lindsay, whatever you
prefer.
Over to Lindsay. Sounds great.
Thanks.
So hey, good afternoon
everyone. For those who don
t
know me, I
m Lindsay, grad
legislative director at seiu
healthcare 1199 northwest. We
represent 38,000 healthcare
workers across the state of
Washington, including the front
care folks at Downtown
Emergency Services Center. Uh,
Jeff and Daniel and Reagan
already really spoke to the
issue. But I just want to say
it
s my job to reiterate, this
is a very timely moment for you
all to be taking on this focus.
Um, the hard work that went
into our next, um, Coc
application by dozens and
dozens of people, um, is is
something that everyone should
be proud of and is really
important to be successful on.
And the fact that you all are
putting an eye on that, uh, is
an important part of the
process. We do not know what
s
going to come next. We hope
that we are going to be met.
Um, uh, with like response.
Somebody who is also taking
this work seriously and knows
how important these resources
are. Um, but one way or the
other, it is going to be our
community that
s impacted. And
so your leadership here is
essential. Um, you know, we
also all are aware of the, the
direction that was announced,
the intention from our
executive and our mayor, uh,
with regards to how our ra is
going to look moving forward
and how they are going to be
supported in making sure that
Coc funds are really provided
the oversight that they need to
be successful. And that is a
team effort. It involves
everyone on this call as well.
Um, so this is the moment to be
talking about this and making
sure that we
re on the right
course. Uh, like I said, we
represent the front line
workers at desk. Um, and so the
thing that we, you know,
consider our North Star is that
people can get better. They do
need these supports, and they
need the housing to get better.
Uh, and then it is the
frontline workers and the long
term relationship that those
workers can provide, um, who
are working in all different
roles. They
re working in
outreach. They
re working, um,
on the treatment side of
things. They
re working as
residential counselors, uh, to
help people get back to where
they need to be. They deserve
to be. And this community,
frankly, needs them to be. We
need to be able to get to, uh,
our, our goal of zero. And we
can only do that with
incredibly professional,
dedicated and supported
workforce. Um, and so we
re all
looking at the same future
together. It is our job to
secure every dollar we can. Um,
from hud on, on the coc front
and then to have smart plans in
place. Um, if we find we need
to pivot. So thank you for your
attention and please consider
us a resource and a partner in
this effort. We want to make
sure that we are moving forward
with our best possible foot,
and so want to be here for your
work as well. I
m happy to
answer any questions.
Thank you so much. I will also
note our friends at iu who are
as well, uh, representing
frontline human service
providers. Um, just sent a note
saying that they
re not able to
join us today, but echo the
points that are raised by pro
tech 17 and seiu healthcare.
1199 northwest. Uh, wanted to
let folks, uh, start to raise
their hands for questions and
also see if board member Lu, if
you had any additional comments
that you
d like to make or lift
up as we conclude, this panel
here.
Yeah. Thank you, Chair
Mosqueda, for allowing me to
bring up this, uh, discussion
item as we know that it
s very
timely. I do not have any
additional comments because I
believe my fellow board members
MAY have questions.
Excellent. Thank you so much.
Uh, colleagues, again, thanks
for the conversation that we
had in our previous meeting
where we discussed the
continuum of care, uh, dollars,
the Federal Housing and Urban
development investments that we
rely on, as you saw from Jeff
s
chart and from board member
Lou
s comments. Uh, near $67
million, just in King County
alone, helping to keep people
not only housed, but with the
direct health services that
they need to stay stably
housed. And you heard that
story repeated from Reagan,
from Lindsay, from Daniel, and
from Jeff. Um, this is really a
matter of keeping people
housed. And as we
ve told our
community partners across the
region, if we see these dollars
go away, we will actually
visibly see more people living
in the street and and suffering
the consequences of that. If
these dollars are not enhanced.
So in partnership with the
federal government, who has
long invested in proven
practices of keeping people
housed and frankly, a Housing
First model, that was, um,
required or encouraged of
contractors in the past now
being questioned. It
s really
important for us to lift up how
critical these services are,
how much this is not only
important for the health of the
population, but for the health
of the local economy as well.
And for us to be really
transparent that we are doing
everything we can in
partnership with other
jurisdictions to keep people,
um, in permanent supportive
housing, transitional housing,
emergency housing is going to
be essential. And the workforce
that provides that is key to
making this a success story
going forward. Board members,
any questions that you have?
Okay. Board member Hartfield,
please go ahead.
Um, yeah. This is a question I
think for Dan, if he
s still
on, um, you mentioned that, um,
the new aim is to prioritize
elderly and physically
disabled. Can you say, like,
what percentage of your current
clients are not going to fall
into that category? And also,
is substance use considered a
physical illness or a
behavioral health illness?
Thank you so much for the
question. Um, I let me clarify
something. Um, I don
t think
through this. No faux that hud
is attempting to, uh, shift, uh.
Uh, its permanent housing to
remain permanent housing for
people with physical
disabilities or who are
elderly. Uh, they have said the
they want permanent housing
dollars to only be used for
that population. But what
they
re attempting to do
through this, no faux, is to
move the permanent housing
funding to other purposes,
including transitional housing
and, uh, services, only for
people. And it appears to be
based on a theory that, uh,
people with, say, substance use
disorder or other behavioral
health conditions will be cured
of their conditions by going
through these kinds of, uh,
services programs or, or
transitional housing programs.
Um, uh, our clientele at dsc
include, uh, many people who
meet the definition of elderly,
uh, and many of them also have
co-occurring physical
disabilities. But nearly 100%
of them have, uh, primary
behavioral health conditions,
including serious mental
illness and, uh, chronic
substance use disorder. Um, I,
I believe that substance use
disorder is considered, uh, by
hud to be a, uh, a behavioral
health condition. I don
t know
if they have a specific stance
on whether it qualifies as a
disability or not. Um, I need
to go look deeper into that to
answer that.
Okay. Thanks.
Excellent. Any additional
questions? Okay. Well, I will
just, um. Uh, summarize by
saying, oh, please go ahead.
Boardmember Garcia.
Thanks, chair. Uh, a very
timely presentation. Really
appreciate this information.
It
s worrisome, to say the
least. Um, as and I, I will
just clarify, I am on the
public health board, per rca
representation. So I
m not
speaking for all of our sca
cities, but I do want to share
the beer and des have a desk,
uh, facility. Uh, so this is a
very alarming, uh, I
ve been
following the news and
legislation. What can we do? I
guess, is what we
ll call
action. Can, uh, members from
the board and others do to
support, uh, the ongoing
efforts to, um, not result in
all our cities having more, uh,
experiencing more homelessness.
Can I take a stab at that? Um,
uh, thank you for for that
question. I think there are
several things that, uh, the
board could be doing. Um, that
includes engaging King County
s
legal counsel on their strategy
for the litigation to try to
preserve this funding. Uh, I
think that, uh, strategies to
look for other resources if
this money does go away in
order to, uh, keep people
retained in their housing. Um,
is another essential part of it
all. And then there
s some
advocacy that, uh, is being
organized by some national
organizations with Congress
that could help with this whole
situation. Um, if there would
be congressional action to
essentially mandate hud to
renew permanent housing, uh,
that would be very helpful.
And, uh, the lead organization
on that is the National
Alliance to End Homelessness.
And, uh, they have some
explicit advocacy, uh, guidance
for local communities to
exercise with their members of
Congress that I would point you
to.
Any additional follow up on
that?
Thank you. Nope. Thank you very
much, MR. Moore. Hello.
Excellent. And, um, hello,
board member. Lucero, thank you
for joining us. I forgot to
mention, um, when you joined us
in. Thanks for being here with
us. And congratulations to you
again on the Thunderbird
Treatment center opening the
grand opening this weekend on
Vashon Island. Uh, speaking of
providing care, please go
ahead. Board members. Lucero.
Thank you so much. And I really
appreciated your attendance at
the opening. Um, it
s such a
magical day. Uh, so my question
is regarding federal funding.
So I
ve noticed a trend with
federal funding changes. So,
uh, for example, we
ve seen
like some changes in Snap
benefits. Um, however, we did
see new initiatives arising
through the Maha initiatives.
Right to, to be able it
redirects resources but
essentially provides similar
service. So my question is, is
with this reduction in hud
funding, are you seeing other
funding opportunities pop up
and say SAMHSa, who just
released their phase, um, or
other areas where they MAY be
addressing housing in a
different sort of way? Because
my experience has been that
that
s what we
re seeing is it
just pops up somewhere else.
Yeah, I
m happy to answer that
for you. So the actual the
program that we
ve been talking
about is the Continuum of Care
program. That program actually
is not reduced at the federal
level in terms of the
appropriation. It
s still
staying whole. In fact, it
received an increase which is
necessary to maintain certain
inflationary changes, things
like that. The issue is that
hud is taking that amount and
allocating about a little bit
more than a third of it to only
be new projects and only to
your point, different kinds of
projects that are what, in the
homelessness space we call
transitional housing. So you
can
t stay there for more than
two years. And, uh, to Daniels,
uh, kind of a metaphor earlier
are really intended to take
where you
re at currently and
have you leaving
self-sufficient without receipt
of any rental supports, things
like that. Um, or also focus on
just providing supportive
services, especially, um, the
type of services that the
administration would see as
addressing the conditions that
are causing an individual
s
homelessness. And, uh, like
resolving those and, and moving
them along. So that is the
shift in, um, in programming,
similar to what you
re talking
about in other spaces, but it
s
not actually moving out of this
federal program to a different
federal program. It
s all
happening within it.
Okay, that makes sense. And so
do we have, um, you know,
second and third tier
strategies to maybe align to
not lose resources because
certainly transitional housing
is a is a need. It
s a gap. Um,
within King County. Um, so you
know, to again, just access the
funds as the administration
s
priorities change.
Um, yeah, absolutely. That was,
uh, when I talked about that
two part strategy that we
re
trying to take. One is one is
the litigation space because,
uh, we there
s tremendous
evidence behind, especially
with permanent supportive
housing, the benefits. I think
just a couple of weeks ago,
there was another recent study
talking about the tremendous
savings on the on incarceration
side. Um, that sage provides.
So we know that it
s an
evidence based approach. But if
our litigation to preserve our
existing projects and not have
to comply with certain
conditions isn
t successful.
Our other strategy that I was
talking about is exactly what
you
re saying. Uh, it
s to
align with those. We just, um,
on JULY 3rd was the end of our
local procurement process to
identify transitional housing
projects or support services
projects that would be brand
new would align, like I said,
with both the administration
s
priorities and with our local
county priorities as the goals
for what we want to see, these
types of these funds support.
And that is absolutely a two
part approach. We
re not
putting all of our eggs in one
basket.
Okay. Thanks, Jeff. I
appreciate that.
Any additional comments from
our panelists or board members?
Okay. Uh, more to come. Uh, we
will make sure if there is any
update on a litigation
strategy, a mitigation strategy
and application strategy, that
the board members here get an
update as well. And for anybody
who is wanting to tune in to
the health, Housing and Human
Services Committee meeting of
the King County Council next
Thursday, we will have a very
similar panel presentation. So
we
re going to use every
platform we can to lift up this
issue and how important these
dollars are. Thanks. All. We do
have another item on our agenda
to close this out for today.
Our last item is a briefing on
the impacts of the political
environment on gender affirming
care. And again, I want to
thank board members Archie Poly
and Yoon for their engagement.
Um, with us on this, board
member Archie Pulley was
gracious enough to allow for us
to carry this item over from a
previous meeting. And so we
want to make sure to give this
item its due time here on page
58 of your meeting packet, you
will see a full summary of the
materials that are included
here. And I want to welcome
board member Archie Pulley to
say any comments. And um, also
thank Ro Yoon, who does the
community engagement for Fred
Hutch Vaccine Trials unit for
being here with us. Remember,
thanks for your patience and
allowing for us to include this
in the work plan. Uh, that was
your leadership on display
there and really excited to
have this agenda item here
today.
Thank you, chair Mosqueda. And
thank you, fellow board
members. Um, before I start, I
just want to answer our board
member Hatfield
s question.
Also, um, substance use
disorder and hiv are not
currently diagnoses for medical
frailty. So the Department of
Health has submitted a
recommendation to get those
exemptions though. So more to
come on that. Um, so thank you
very much. Again, I
m
Christopher Archiopoli and I
m
a community stakeholder on the
Board of Health. I identify as
a person in long term recovery
from substance use disorder. A
person living with hiv since
2008 and a member of the queer
community. I
ll make sure that
my friend and colleague, Ryan,
has the majority of our time to
speak, but I wanted to provide
some history and background
beforehand, handing it over to
Ro. Uh, next slide, please show
me. The lgbt community to the
lgbtq plus community is the
subject of political attacks in
our society. There is no group
more targeted and gender non
than our transgender and gender
non-binary community. In 2026
alone, there have been over 800
anti-transgender bills
introduced across 43 states.
While many of these failed,
many of these have failed, 67
have passed and 267 are still
actively working their way
through legislators, throughout
the legislatures, throughout
the country. In Washington
state, Initiative ill. 26638
would ban transgender girls
from participating in k through
12 school sports. This measure
failed during the 2026
legislative session, but
received enough signatures to
appear on the NOVEMBER ballot
this year. Every time we turn
on the tv or open our phones,
we are subjected to news items
like this one. The one on this
slide forcing schools to out
our transgender students. 1% of
our population is receiving a
disproportionate amount of
negative attention. It
s
impossible for that not to
negatively impact the mental
and physical health of our
community. You MAY have heard
the phrase the first pride was
a riot. This is more than just
a tongue in cheek euphemism.
Although the lgbtq plus civil
rights movement got its start
in the early 1900s, modern
pride celebrations found their
inspiration. On JUNE 28th,
1969, when six New York City
police Departments Department
officers raided the Stonewall
Inn, a bar in Greenwich Village
in Manhattan, New York City.
Nearly 200 customers of all
identities were ejected from
the bar, many arrested as law
enforcement began mistreating
the bar customers. The
situation escalated. What
started as a police raid based
around new nypd
s public morals
push, turned into a six day
resistance that included
pivotal figures such as
transgender activists Marsha p
Johnson and Sylvia Rivera. Many
identify this as a seminal
moment in the movement for
lgbtq plus equality, comparing
its importance to Rosa Parks
refusing to sit at the back of
the bus in Montgomery.
Montgomery, Alabama in 1955, in
2016, PRESIDENT Barack Obama
designated a 7.7 acre site,
including the Stonewall Inn,
Christopher Park, and the
surrounding Air Street at the
as the Stonewall National
Monument to commemorate the
area
s contributions to history
and remembrance of the
Stonewall riots, Christopher
Street Liberation Day was
celebrated on JUNE 28th, 1970.
Since that year, we have seen
pride celebrated the last
weekend of JUNE each year.
Although the battles for
equality seem to have made
significant progress, we have
seen that progress stripped
away in recent years is
essential to stand strong in
the face of adversity, to
ensure those rights continue to
be upheld. If it is truly
important, the risk is worth
the reward. Next slide.
Transgender and gender
non-binary individuals have
stood as leaders in both the
lgbtq plus civil rights
movement, as well as leaders
making up the fabric of our
society. Many of the names
Marsha p Johnson, Sylvia Rivera
and Sylvia Sarah McBride. But
they are not the only ones
making an impact on social
justice. Many others, including
the names of the bottom of this
slide, contribute to business,
art, politics and the general
good of our society. Next slide.
It is my great pleasure to
introduce one of those leaders.
Now, Rowan is an activist and
works in community engagement
at the Fred Hutch Vaccine
Trials Unit, focused on finding
a cure for hiv. Thank you and
welcome Row. The next slide.
Thank you friends. My name is
Rose. She her pronouns. Um, I
have less than five minutes, so
I
m just going to jump right
into it. And in a nutshell,
this is all relates to gender
affirming care. And you can.
Make as long as you want. We
re
happy to go a little over. No
problem okay, okay.
The current landscape is
characterized by increasing
divergence between states.
However, Washington state
continues to maintain statutory
protections for access to
medically necessary gender
affirming care. But on a
federal policy initiative. In
recent court, decisions have
increased some legal and
operational complexities. So
for this, esteem, for all the
esteem members of this board,
the primary considerations I
want to speak about is
equitable access to care,
behavioral health outcomes,
provider capacity, and legal
compliance, and then really
monitoring the effects of
rapidly evolving policy change
that will impact patient and
health systems. So this first
slide I have, um, we oftentimes
see a general estimate of less
than a 1% to describing the
population, transgender people.
But I want to utilize ucla
s
Williams Institute, nationally
recognized estimates of like
0.8% of adults 18 and over
identify as transgender, and
3.3% of youth ages 13 to 17
identify as transgender. So
utilizing those estimates from
the Williams Institute and
applying that to King County
s
population, we
re roughly
estimating around 15 to 18,000
transgender adults and also
including 4 to 5000 transgender
youth between the ages of 13 to
17. So, um, it
s a big order,
and I
m hoping that this
provides you some context of
who we
re speaking of as well.
Um, there
s no direct counts
because gender identity is not
comprehensively collected, and
census data, um, but before
even talk about gender
affirming care in this current
climate, um, I just want to
make reference to injustice at
every turn, which was one of
the first reports back in 2021
looking at discrimination
related to trans people,
non-binary people on a national
level. And
Already, you see that 50% of us
are educating our providers of
what transgender health care
looks like. We
re estimating
that up to 20% are denied based
on their gender identity alone.
So already this audience is not
accessing health resource in
the same way because of
discrimination. But on that
note, I want to kind of move
forward and talk about this
national landscape that
effectively. Um, what kind of
influence my conversation. Um,
so the next slide, um, I want
to I just want to briefly go
over this when we think of
gender affirming care, I think
the general public think
immediately about, um,
surgeries or medical
transition. But this also
includes, um, legal processes,
whether it
s the passport which
is still under threat
currently. Um, you know, birth
certificates, any of the, um,
the necessity, um, requirement
for accessing some services
like medical or surgical. And
then we
re also looking at
social services as well. You
know, whether it
s, um,
acculturation, um, being able
to withstand some of the
anxiety that socially you
ll
find amongst transgender
people. Um, there
s a lot of
evidence based data out there,
despite many puppets that claim
that they know a lot about
this, um, population. There
s a
lot of evidence based, and it
s
supported by the world
professional of transgender
health. Um, cool. The next one.
Next slide please. So I want to
make reference to a website
resource called Trans
Legislation. Um, this is an
anti-trans bill tracker. And
what you
ll find in this, um,
everything that, um,
Christopher had mentioned that
in the state of Washington. But
more importantly, you
re
looking at on a national level
and and it
s pretty serious.
Um, over the past several
years, states have, um, um,
have taken very strong
restrictions. Um, some states
expanding protections like
Washington, but we
re
estimating as of 226, the
Kaiser Family Foundation
reports that 27 states have
enacted laws or policies,
limited youth access to gender
affirming care. That
s
approximately half a
transgender youth in states in
the United States. Um, the
visibility of anti-trans
sentiment as it relates to
young people is, um, beyond
words. And my heart breaks
every time. Um, I will mention
one Supreme Court decision in
2025, it was United States
versus Rometty decision. It was
a it
s a major inflection point
for us. Um, that was um, on
JUNE 2025, the Supreme Court
upheld the Tennessee
s law
restricting gender affirming
medical treatment for minors.
Um, although this really did
not prohibit gender affirming
care on a national level, it
did affirm states authority to
regulate such care for minors,
and it has impacted Washington
state, which settled Children
s
Hospital in terms of limiting
the services that they could
provide for young transgender
folks. Um, since early 2025,
federal executive actions have
sought to limit federal support
for gender affirming care for
individuals under the age of
19. Um, with specific direct um
directives aiming at federal
funding, research grants, and
insurance coverage. Um, in
terms of public health, um,
we
re seeing increased requests
for guidance and related to
health equity. Um, we
re
looking at requests about
behavioral health, suicidality,
suicide. Um, ideology is really
high amongst transgender
people. Insurance access
provider workforce issues.
These are things that are now
into conversations with this
conversation with this, um, the
implication of legislation. Um,
next slide please. So this has
now affected a migration of
transgender folks and their
families in order to save their
family or themselves. They have
moved across. And, um, we know
that the lgbt Commission in
Seattle has petitioned, um,
Katie Wilson to declare a state
of emergency to accommodate the
influx of lgbt folks coming to
Washington state, especially
Trans Pacific, a trans folks.
Um, next slide. Um, it has
threatened, um, parental
autonomy and their decisions of
what they can decide for their
children. Um, it has limited
providers that could work with
them. Um, in terms of adults,
you
re seeing no support with
their insurance. Um, on this on
a national level. Not here in
Seattle, Washington. Um, let
s
move into Washington state. Um,
I
m very proud. Um, Washington.
Um, Washington state remains
one of the strongest protective
states for gender affirming
care access. Um, specifically,
um, and back in 2021, um,
Washington state passed the
Gender Affirming Treatment Act,
which basically, um, prohibited
categorical cosmetic exclusions
or our blanket ban bans on
gender affirming care. So, um,
since that was passed in 2021
and 2022, we saw this huge
surge of trans people in
Washington state accessing
medical and surgical um,
services. And it still
continues to be the case. And I
think for many other trans
residents and others, United
States, um, are paying
attention and coming here for
that reason. Um, another thing
is that Washington state
enacted, um, um, a shield law.
Protection. What this means is
that it protects patients,
providers and others from civil
or criminal actions and other
states that restrict or
criminalize, um, lawful gender
affirming care provided here in
Washington state. So if we have
our neighbors coming to
Washington State for these
services, they will not be
criminalized when returning
back to their home state. All
this to say, it
s pretty heavy.
All this to say that, um,
Washington State has been a
great leader. Um, and all this
to say that, um, um, to the
board members here, um, that
you
re just even inviting me
here to speak about this
because volumes about the care
of transgender folks. So thank
you. And on behalf of my
community partners, that
includes Lavender Rights
Project, a Gender Justice
League Utopia, and so forth,
who really provide lifesaving
services. Um, I look to you all
to ensure that these services
remain available. Thank you.
Thank you very much. Um, board
member, Archie. Anything else
to add?
I don
t think I
ll just echo
what Rose said. Thank you so
much for making the time. And
we really appreciate the
opportunity to share this
important topic with the board.
Thank you. And thanks for the
calls for action and some
example. Um, legislation or
actions that are being taken in
other jurisdictions as well. I
see board member Lucero has a
hand up and then we
ll go to
board member Hartfield.
Yes. Thank you. Chair Mosqueda.
First, I just want to say I
m
so grateful for your
participation in our meeting
today and for sharing
information in in the way that
you have. I want to acknowledge
that this administration
s
attack on our, um, lgbtq two
spirit community has been one
of the most blatant acts of
discrimination. That, coupled
with the movement with Ice. Um,
and I do recognize from a
recent city council meeting,
uh, that folks are coming to
King County and coming to the
city of Seattle as kind of
refugees. So what I heard from
that meeting is that we can do
better. When you have an act of
discrimination at the federal
level, that you know, that
spans across every single tier
of government, there
s only one
response, and that
s a
localized response. So I want
you to know that there are
organizations in this community
that are serving, um, our, our
communities well in this way.
And what our government systems
haven
t been successful at is
we haven
t been able to make
sure that the resources that
are available are readily
accessible. Right. We haven
t
communicated that. So something
like a two, one, one, for
example, for um, for these
communities who are coming to
to our environment for help.
And so I think that we can
really do better there. There
are ways that our health care
environment have been able to
get around some of these
discriminatory laws to still
provide effective services. And
I can tell you that from, you
know, local community health
world, we are rapidly building
capacity to be able to even
provide more services. So I
think that what King County
could do and even this Board of
Health could initiate, is
really establishing a community
response to being able to model
what it looks like to really
care for these communities in
the ways that we
re expecting
the federal government to. And
so I just want you to know that
I
m a partner in this work. I
m
a champion in this work with
you all. And I just want you to
know that our clinical teams
are taking action. And, um, you
know, I fully support more
directed approach.
Thank you.
Uh, board member Hartfield.
Um, yeah. Thank you so much for
the presentation. It
s nice to
see you, row. I
ve seen you for
a long time. Um, I really
appreciate, especially your
broadening out the impact of,
uh, gender issues beyond the
medical, because I think what
we read about frequently in the
press is just. It
s all about
medical transition. And I
appreciate your framing the
argument in a way that people
can understand and maybe
empathize with a little bit
more. Um, question that I had
for you. Two questions, and you
MAY or MAY not have the
answers. One is, how are we
able to quantify this sort of
in migration issue, which I
ve
also seen in the newspaper and
heard on podcasts and whatnot,
and I
m not really sure how we
know that. And then the second
question is, what would the
state of emergency provide us
if, um, Mayor Wilson was
actually able to do that?
That
s a great question. Um, I
think that the lgbt Commission,
um, was responding as the the
whole population of lgbt into
spirit community versus just
specifically trans people. Um,
but we definitely know through
a lot of my trans led
organization that there are
people coming from other states
to specifically access care for
themselves or their family. Um,
and we see that with Sale
Children
s Hospital and so
forth. So but in terms of the
magnitude, I don
t know, um,
the commission is collaborating
with several organizations that
i
ve mentioned just now that
will be collating the
information that they can that
are for those who come new to
Seattle, Washington, having
them kind of register that
through, like organizations
that provide the services. So
that will maybe quantify a
little bit, but I think it will
provide more of a narrative
that
s necessary to talk about
where they
re coming from. Um,
as it relates to the services
or what this emergency can
provide. Um, I I don
t know, I
really, um, I feel that
Washington State just I mean,
King County just supported, um,
the gender ending. Um, I
m
sorry, the coalition ending
gender violence, gender based
violence, they just released
the 226 trans Resource and
referral guide. Um, and that
has been the last update was
over ten years ago.
Yeah. So that
s an.
Amazing thing where this money
could do or resources, it could
ensure that those resources
stay available and maybe scale
up a little bit if we have data
to show that we have this
influx of people. But, you
know, having said that, a lot
of the current organizations
are probably not well trained
to talk about this gender
diverse community as well. So I
think that
s part of training
for providers in addition to
resources for providers, is
another way that we can sustain
this support.
Mhm. That
s great. Yeah I mean
I I
m really happy to hear that
about the guide. And I know how
difficult because primarily
this is all a volunteer effort.
It
s all grassroots. And um
perhaps the state of emergency
might release some funding that
is needed.
I agree and it
s hard to dig.
It
s hard to ask this community
to try to defend itself when
it
s small. So having, um,
sanctions by the city or the
state really helps. And
bolstering that visibility.
Yeah.
Thanks.
Thank you so much. And board
member Tripoli. Um, maybe we
can work with you as a liaison
to see if there is a next step
that the board might want to
take on this. I
m also thinking
maybe there
s some advocacy as
we head into the, uh, state
legislative agenda setting time
frame as well. Uh, given, uh, I
think, as you mentioned, Roe,
the influx of the number of
community members coming to
Washington state generally,
this might be an area of
interest for other
jurisdictions, too. Um, so look
forward to that. And anything
else that the board can do to
lift up the, um, health
complications that are created
and also the, uh, just
additional stressors this
provides in the community. What
affects the mind affects the
body, um, and affects our
entire population health. So,
uh, thank you again for the
presentation. And, uh, look
forward to continuing to
engage. Board member. Any
comments in closing and row as
well?
No, I think I think you again.
And, um, just to sort of tack
on to what ro said. Um, you
know, just from my volunteer
work with queer organizations
like Seattle and the Bailey
Bush House, I can definitely
say anecdotally that there are
there has been an influx of
people from other states. Um,
they would rather be a refugee
living unhoused in their car in
Seattle than live in a house in
Kentucky. Um, so it is putting
stress on the services that are
available. Our community is
already underserved, and the
resources are already limited,
and now they
re being stretched
even further, trying to treat
the influx of people that are
coming from other states. So
yeah, thank you again. And I
would love to be a liaison as
we can do more work on this. So
thank you. Chair Mosqueda.
Excellent. Thank you so much.
Okay. Um, so with that, I just
want to see if there
s any
other comments for the good of
the order. Any announcements
folks might have for Board of
Health colleagues? I will note
again that our board meeting
for AUGUST is canceled. So we
will see you at the SEPTEMBER
board meeting. And that is
SEPTEMBER 17th at 1 P.M.. Uh,
next week at County Council, at
our health, Housing and Human
Services Committee. As I
mentioned, we
re going to have
a very similar presentation on
the continuum of care funding.
Um, and maybe of interest to
colleagues. We will also have a
presentation on the 39th
anniversary of the federal
Americans with Disabilities
Act, Disability Pride month,
and, um, and inviting our folks
who work here at King County on
implementing the Ada
requirements to give us an
update on how things are going.
And that update is we need to
do more. Um, so if you are
interested in dialing in to
hear some of that conversation,
and if you think there
s a
cross area of interest to Board
of Health, please let me know.
Um, and if there
s no items to
come before the board, I thank
you for your time today and the
robust discussion. And with