is makes is made up of various items that have been uh discussed or which are assumed to be without discussion but any member can pull any one of these and we can have discussion at uh at that member's uh will. So let me just read them. Uh the first one is to approve the minutes of the June 16th uh board of commissioners meeting. Secondly, to approve an extension of a discharge access database system uh service agreement. Third to approve a revocable license agreement with Hindu Samali Temple of Minnesota. Uh next to approve the funding uh and uh funding and treatment uh court cooperative agreement. Next to approve legacy grant uh application for Axible Park playground equipment. And lastly, to approve legacy grant application for Oxville Park bridge replacement. Uh, anyone want to pull any one of those? If not, uh, is there a motion to approve and block? >> Move to approve the agenda. >> Okay. A motion and second to approve and block. All in favor say I. >> I. >> And, uh, they are approved. Next, we go into a discussion item uh, revol involving a Merc utility line improvement project. uh and to approve an agent uh an easement uh for a portion of the project. Who's going to introduce that for us today? Do we have anyone? >> Welcome. Uh County Attorney Cananan. Please introduce yourself. Uh >> good morning, commissioners. Tom Kanan, senior assistant Homestead County attorney. Um, sorry. I believe Matt Miller I thought was going to be taking the lead on this. So, uh, bear with me a moment here. Um, so long story short, uh, what's going on here is that Merc is, uh, Merc is Minnesota Energy Resources Corporation approached the county because they're in the process of upgrading their gas service lines throughout the city of Rochester. And one of those service lines, or I should say a couple of those service lines, they want to place within uh the the boundaries, if you will, of Graham Park. And so the county being the property owner of Graham Park, um facilities and public works and the county attorney's office have all been involved with discussions with Merc on what this should look like. Um, if you look in the packet, I should I should be able again, my my apologies because I didn't know I was going to be presenting today, but it give you a better idea. If you look on page um, it's like 51 of 82 in the numbering of the PDF. Uh it's an attachment to an easement in the in the in the packet. >> Yeah. >> But long story short, there are two lines here. One of them is to be placed on the western side of Third Avenue uh adjacent to Third Avenue Southeast. And just to remind you that Third Avenue Southeast is also County Road 146. So notwithstanding that a lot of people refer to it as Third Avenue, it is a county road that public works is responsible for. So, one of those lines runs along the western side of of Third Avenue Southeast. Then you'll see in the in the page that I alluded to in the packet, there's another part of the line which basically the line will turn 90°. It will go along the north side of 15th Street Southeast, which is one of the interior streets inside of um inside of Graham Park. And then it will turn another 90° and go north and south along Anie Drive Southeast. And so the one in the packet shows that particular service line. Uh we've gone back and forth with Merc because you know uh there's a lot of development that of course the county has in that area. There's a stone wall uh for part of that portion along Third Avenue Southeast. There are some mature trees there that we want of course Merc to be mindful of. Um, so we negotiated back and forth with some language to make sure that if Merc does this project that they're responsible if they damage any of our infrastructure that we need to make make sure that we get repaid for that damage that they create. Um, the wrinkle and the reason that kind of I got involved is um I'll try and break this down because it's kind of an odd legal concept. There's a legal concept called the merger doctrine. What it basically means if you boil it down, um, if you are a property owner and you own what's called fee title, you probably heard us refer to this over the years to the property, you don't have the ability to basically break out. And when they teach it to you in law school, for example, they analogize property rights as a bundle of sticks. I think it's a good analogy because it's not just one thing. It can be different parts of the rights that you have as a property owner that you can potentially give to others or third parties. And one of those rights is an easement. But generally the merger doctrine says that when you have um fee title to a property and you try to give property rights um in the form of an easement to somebody else, the merger doctrine basically says you can't do that. the the ability that you have as a property owner to strip that out and give that easement right to somebody else. You can't hold fee title to a property and an easement on the property. And effectively here, what we were trying to do is give an expanded part of the rightway along County Road 146 to the public works department, which again is just an arm of the county in connection with this project with Merc. And I I'll explain in a moment a little bit about why that is. It's advantageous from the county's perspective if the part that's along Third Avenue Southeast is placed into an expanded part of the County Road 146 right ofway because um there's another legal principle that basically says if Merc is located in that area pursuant to a permit within the right ofway that's issued by the public works department. If Merc ever um if the county ever needs to expand Third Avenue Southeast and it causes the need to for Merc to have to move their gas line down the road in the future, it will be done at Merc's expense rather than the county's expense. And so that's a good reason why there's no immediate plan to expand the 3rd Avenue/county road 146 right ofway to place Merk's north south part of this line within an expanded uh area that's under the control of the public works department so that we have that advantage if the line ever needs to be moved in the future. The lines that are located in 15th Street Southeast and Anie Drive, again, those are a little bit unusual because the streets inside of Graham Park are effectively private streets. Even though the county of course is a public entity, um they've never been dedicated to the use of the public of the city of Rochester like most other streets within the Rochester city limits have been. And so there uh we're not in the same situation. there we've got the ability to grant an easement uh because it's not going to be located within a county right ofway like the part along Third Avenue/county road 146. So long and kind of boring background as to why why we uh needed to do the things that are mentioned in the agenda today. But so with that background, what you see in the agenda is essentially two parts based on that history that I just gave you. One is we asked Merc to essentially break this into two parts. then to have you pass a resolution then to try to avoid the merger doctrine. I'm not going to characterize it as an easement, but basically a reservation of rights that you're giving to the county public works department that effectively gives them more or less the same powers that they would have of an easement, but it's not a formal grant of an easement, which will allow them to control that area. It's between 33 feet out and 50 feet out from the center line of of the right of way. that will allow them to grant a utility permit to Merc to locate that part of the line. That's the first resolution that you see in the packet. And then the second part, because that's just a regular utility easement, uh we're simply asking then that you approve the utility easement for the 15th Street on Drive portion of the project. Um so I guess that's it in a nutshell. Uh again, the building operations part of this I thought Matt was going to be here to address, but [clears throat] again I think probably the most important thing that the board obviously wants to be uh you know assured of is that uh that Merc has to make sure that they, you know, avoid the stone wall and the trees as much as possible. We understand they are going to use tunneling equipment to try and avoid some of those things and stay underground. So, I'm hopeful that there won't be any damage, but that they will it will be their responsibility if any damage occurs as as a result of this project. So, >> any questions of uh Mr. Cananan? Yes, >> Mr. Chair. >> Yeah. Um, do we have uh natural gas service to the Graham Park to begin with or is this all new? >> It's another building operations question. I believe that we do. Um, but as to where those lines run right now, that's more of a a Matt Miller question, unfortunately. >> Okay. I was just curious if this is just an upgrade or if this is, uh, just putting in new lines. Um, >> I know Matt did also tell me that >> they also worked on the placement within 15th Street uh, Southeast because they believe that we might end up with some Grand Park improvements on the south side there where that where that small grove of trees is at some point in the future. and they wanted to make sure that they avoided that if they placed a new gas service line in that area. So, >> great. Thank you. >> Anyone else questions? Uh, thank you, Mr. Cananan, for uh an outstanding job of explaining this as well as uh protecting the interest of the county. So, the resolution uh uh the action request is I think may just read this into the record to approve a res resolution reserving additional area in Graham Park for County Road 146 right away and approve easement to MC for 15th Street Southeast and Oni Drive southeast portion of the project. The resolution's in the packet. Is there a motion to approve? >> I have a question. Point of order, please. >> Yes. >> I have a question. You said it wasn't an easement, but the resolution calls it an easement. So, does that need to be clarified? Or at least it is the way that U. Commissioner Sanjum read. The second part is an easement. The 15th Street and Onie Drive part is an easement, but the >> if the Third Avenue part references an easement, you're right. That wasn't my intention, but I don't didn't think that it did. >> No, I'm sorry. >> There's two There's two documents. There's a resolution and there's an easement. >> All right. So, which one are we on then? We're on the easement. >> Oh, well, resolutions listed first. >> That's what we >> two parts of one hole basically. >> So, in other words, it's all right the way it's written, >> I believe. So, >> okay. >> Okay. Good catch, though. Well, maybe >> in >> case uh any any other questions, comments, thoughts? Uh >> well, no, but I I also wanted to say that I appreciate uh our law professor explaining all this stuff to us. You know, that's really good. I I'm halfway to a degree right now. So, thank you very much. All right. I I I approve a motion to approve the >> Well, we have that. We have a second. So, then all in favor say I. I >> opposen uh and it carries unanimously. So moving on, the uh next item of uh of our agenda is uh is the annual medical examiner presentation. Uh our regular presenter at least since I've been on the board. Uh Dr. Reichart, welcome and uh we look forward to your presentation. >> Thank you, Mr. Chairman, film commissioners. Thanks for having me here today. I'm Dr. Dr. Ross Riker, the medical examiner for Homestead County and the chief medical examiner for the Southern Minnesota Regional Medical Examiner's Office. And I'm joined by my death investigator supervisor, Monica Kindle. So, all right. So, just a reminder. So, these are the the counties that we cover that are in blue. That's part of the the the medical examiner's office, the Southern M Minnesota regional office. Uh the ones that are in the more purple color are counties that we receive consults uh autopsies from. So we're covering a pretty good region of the southeast in Minnesota and a little bit beyond which is good for our understanding of what's going on um in this vicinity. So this is our office. It's uh it's grown over the years and so we're up to five uh forensic pathologists. Uh now um we have uh our death investigators here in Homestead County. Uh we're very fortunate. These are all pathologist assistants. So we have a very high level of expertise for death investigation here and they're an awesome team uh led by um Monica and I can't say how important they are because they're the ones you know fielding to calls responding to scenes year round 247 365. Then just a brief reminder of what's on the death certificate. We have the cause of death, the underlying reason why someone dies, the manner of death, uh circumstances surrounding the death. Then there's a whole bunch of other information that's not on the public or not on the the family facing death certificate, but these are all important public health pieces of information that we're collecting. Um, and this eventually feeds up from uh the local area up to the state and then eventually to the CDC. said when you see the nationwide numbers, they really start at the grassroots level. Obviously, families use this as, you know, for closure and also for documentation, you know, for generations to come. You know, hospitals come and go, bought, sold, but death certificates are things that people hold on to. So, it's very important for families to have that health knowledge. So, starting to get into the the data here. Um, so we had a total of uh 2,126 deaths. We had uh 1848 that were reported to us which reflects 87% of the deaths in the county. So we're in one shape or form involved in uh the vast majority of the deaths. So it gives us some eyes on what's going on and ensures things don't slip through the cracks. I mean it's the medical examiner's worst nightmare for someone to say, you know, what about this person that was buried 3 days ago that, you know, got shot last year kind of thing. That's kind of that's the sort of thing that we're literally trying to avoid. Um so we did uh 231 uh uh deaths that we certified after autopsies. 207 were complete, 19 we did external examinations and then five uh were limited examinations. And so we're seeing a growing category of uh examinations coming in where you have for example somebody who's on hospice, they have a fall because they're on hospice they opt to not have any further evaluation and we're concerned about did the fall contribute to their death. And so we'll bring them in, hook them over, and then do basically postmortem CT imaging from head to toe to see if they have any um underlying injuries as a result. So that would change the manner of death. So seem to see see that growing. Um and then obviously the deaths that we've certified without autopsies um are ones in which the very clearly uh documented uh some uh injuries or something that we put them under our jurisdiction. Um that's again the sort of the person that falls breaks their hip and ends up on hospice a week or two later and declines and passes away. So we're not worried about foul play but it's under our jurisdiction and we have good documentation of what occurred. So this is manner of death by categories and obviously seeing the vast majority as natural deaths is is great. Um you can see that we had uh three um homicides. Two of those occurred in Mstead County and uh where the injury occurred here and one was transferred in. I'll get into the details of that. Uh we had 25 suicides, 231 accidents, uh nine under undetermined uh cases and those are often cases where you know these are often like infant kind of co-sleeping type of of cases or severely decomposed remains or something that we can't figure out from the autopsy what happened to the individual. But we'll get into each of those in a minute. So this is deaths by unnatural. So we've taken out all the natural causes of death. Um so we had five chokings, uh 6.4 injuries, three burns, drowning, 12 firearms, uh the jump and fall category, which we'll go into more detail. Those are the uh typically older individuals that have fallen. We had eight hangings, 25 motor vehicle accidents, 45 drug overdoses. Um we'll get into more of that, and three sharp force injuries, and three in miscellaneous categories. Those are typically are undetermined. So this is the suicide by means. People use what's uh available to them. This fixio was a helium uh related death. Um there was a book out there called the final exit. So you can actually buy online like a suicide kit for helium and so forth. And so uh that's not really sounds unusual, but it's really not that unusual. Um, so people put a balloon over them and their head and basically used the helium to displace the oxygen. Um, so we had one uh jumper fall, we had uh eight uh hangings um and we had five three drug overdoses um and two uh sharp force injuries. And so so no motor vehicle uh suicide fatalities from last year, but we have seen a few of them this year. Not really sure what's happening with that. There was a Netflix uh documentary about a influencer who was uh so I'm told attempted to kill herself and her friends and her friends died. And so there's there is some publicity in the media about suicide by motor vehicle where people you know just basically run into something on a highway or cross over to hit a semi um head on. So suicide uh by age um and so uh that we have two in the younger category, four in the 1825 and then evenly spread across the as we go up beyond the 45 age group. Um so it's uh you know we obviously were keeping particular track on the young age suicides. Often times you can have sort of copycat or influences by people hearing about these things. But um again sort of following in the quote classic suicide of elderly or older individuals multiple comorbidities isolated from family and friends sometimes drug and alcohol issues as well. So this is the suicide rate per capita. Um and so this is where the injuries actually occurred instead county and the deaths occurred instead county. Um, and so you can see for the suicide rate, we're right at the the state average. For [clears throat] some of our counties, they're relatively small numbers. And so, you know, a couple deaths here or there can really dramatically change that per capita rate because this is per 100,000 um individuals. Um, so here are homicide deaths. We had uh two firearms and one blunt force injury. One of the firearms deaths was transferred from outside of homestead county, but they died here. So, it's uh listed as an Mstead County homicide even though the injury did not occur uh within the county. This is the homicide rate uh per capita. Um so for so this is when the injury occurred and death occurred in the county. And so you can see for example Wabasha had two homicides but because it's per capita it like stands up incredibly. So, I will say having four five counties with no homicides like this would make a this would make a lot of medical examiners jealous across the country. That's that's um not knock. It's not common. So, this is slightly colorcoded different than the previous years and so the colors correspond to the the type of means from the homicide. So you can see that and we had uh you know basically the three different ones um in this category for ones that occurred um within the county. So so moving on to accidental deaths by type. Uh so we had choking um and so that's typically someone like choking on a food basis. Uh we had a a house fire. We had a number of falls. Um we had uh the 25 motor vehicle accidents, but three of those were occurred outside of the county, but were transferred here and died here. Um and we had uh 41 uh drug overdoses uh which I won't get into more detail because that is an uptick from last year. Um but six of those were um individuals that were transferred here from outside but passed away within the county. So accidental deaths um so the by vehicle mo vehicle crashes so 13 automobiles uh six motorcycle three pedestrian and three others those are mix of UTV ATV and actually like a mobility um scooter um so uh obviously we're keeping an eye on the motorcycle fatalities this year I mean it seems to be on an uptick but we'll see what it's like uh at the end of the year but the end. You know, there are a lot of factors in that whether it's, you know, inexperience with that particular motorcycle, drugs or alcohol, high rates of speed, and then the biggest killer of motorcycle is our motorcycle drivers in southeastern Minnesota are deer. So, they're, you know, people are like the those windy roads, but you come around those and corners and a deer comes out and and that seems to be a driver of a number of them as well. So this is the uh location by year of where the motor vehicle uh accidents occurred. So it's really um spread out um across the region um across the county. Uh so again, we're trying to look for sort of like quote hotspots or some place that might stand out with multiple fatalities there. And if you dive into it a little bit in more detail here. Um again the [clears throat] you can see the um the dots represent the year. And so we had two fatalities uh basically against uh motor vehicle versus train at that uh railroad tracks on Broadway and civic center drive region. So all right and so this is what it looks like by the by the vehicle type. And so you can see on the key on the side and so this is really reflecting what people are doing in your community. Some counties have just basically motor vehicle accidents and really little else. Others with more snowmobile trails or motorcycle trails will have again that's reflected um in that. So again um uh this continues to grow. I assume soon we'll have like ebikes and scooters and also all all sorts of other categories as people are putting seeming like motors on and everything. So something we're also keeping an eye on. So wear your helmets if nothing else please. Um so sorry this is the one with the train that highlights this by the type. Um so again right there that uh dot in the center um because the dots reflecting the size and so it's slightly bigger because it's two fatalities instead of one. So this is the motor vehicle fatality per capita. So again this is where the injury and death occurred within umstead county. So at 12 which you know again knock on wood is a it's not terrible when you take all of them in into consideration. We're still below the state average which is lower than a lot of other states to begin with. So I think that's relatively good news. So accidents by fall as I've talked about here before you know this is basically as our aging population um you know has a fall and they have comorbid conditions. Um I mean a fracture of a long bone depending on what you read I mean you have increased fatality or death for six months. Uh my brother's an orthopedic surgeon. He tells his patients you're you know you have an increased mortality for up to two years after a broken hip. So it's a it's a big deal. Um it's a big stress on the body and may take someone the amount of death certificates of someone who's going to church and falls and then you know that was sort of it and they're like 90 years old, right? So that those are pretty common sort of examples or one of the cases I had this year of a lady who was in her 90s and was out mowing her yard and then fell on the steps coming in. But so it's it's amazing how fragile we get as we get older with all these sort of of aging. You know, years are hard on us. Let's just I'm feeling it myself. >> Mr. Chair. >> Yes. >> Uh um >> Commissioner >> Dr. Riker, if I could just jump in here about falls in particular. >> Yep. Um I've uh understood over the years that falls among the elderly and the the broken bones that um that are associated with them that it can it can be the case maybe even often the case that the break that the bone breaks uh while the person is standing and that causes the fall. >> Yes. So we do look into that and so what you're talking about is what's referred to as pathologic fractures. And so if someone has a disease that's affecting their bones like multiple myoma or maybe they have metastatic cancer, they can have that fracture and then fall. So we'll go back through their medical records and see um if they have some reason that they would have a particular susceptibility to fracture in that particular location or during the valuation if the clinicians thought that it was due to something other than the trauma of when they fell. So we we do specifically look into that to capture that. >> Thank you. Yeah, absolutely. So, accidental falls uh by injury location. So, we're sort of moving across the screen from sort of like the I don't know what you call it the like least supervised to like the most supervised or different environments. And so, we had 40 that was in the individual's residence. We didn't have others anywhere people fell in someone else's residence. Uh six were people were out in a public setting. Um then we had 28 in assistant living, 13 in care facilities and uh one in a hospital. And so obviously these are huge deals for you know uh healthc care providers whether whatever stage they're in whether it's assisted living or a hospital to manage. But trying to control falls even in a hospital setting is extremely uh complicated and and challenging and continues to be a an issue really across the across the country. people were trying to >> think of innovative ways to you know predict when predict when someone's going to get up and you know do they have sensors in the room and like basically now the person's moving and so it alerts someone to come help them for example do you have video surveillance I mean honestly we the thing that we've seen um more commonly [clears throat] somewhat commonly uh particularly in the deedants's residence is the um the children of like an elderly parent are putting in basically baby cams and so to watch their elderly parents. And so sometimes we even have video documentation of of what happened. So instead of just them being found down, we have actual a video recording of what happened. So >> I know if my kids put one on me, I'm going to ask a few questions. [laughter] >> I'm not there. I'm not there yet. >> Dr. Record, you know, the again, I mean, this is this is repeated every year. The most dangerous place is at home. >> Yep. So that's why I try to get out of the house as much as possible. Uh uh much much safer on the roads. Uh but I think it has to do also with the design of homes. And I would wish that our homebuilders and people who design homes would look at this because a home isn't just built for when you're 20 or 30. Most of the people want to stay in their home as long as they can. >> Yep. But it's not designed necessarily uh for the 80 and 90 year olds. And I think that we could do a lot if we look at the design of those homes of where the bathrooms are, how the bathrooms are constructed, different kinds of things, entrances, exits. So >> and part of that is even remodeling homes so people can stay there. you know, I mean, that is something that could be looked at potentially of, you know, how do you make it affordable or, you know, interesting or motivational for people to say, "Okay, I'm going to change my bathroom. I'm going to put in a ramp. You know, am I going to do these other things that make it, you know, a safer place for myself?" >> So, does a medical examiner get into that uh of suggesting? >> We're not really We're not really in that spa space. We're more of collecting that information and providing it to the likes of you all for for the policy components. We're just informing those decisions. So, and we that's why we send investigators to the scene to see what's going on. Did they is this a cluttered home? You know, did their cat trip them? You know, that kind of thing. >> So, >> so, uh, one last question. You know, obviously you know about this. So, have you done any remodeling of your own home to prepare for the next 20 years? >> I hope I'm not there quite yet, but I'm dealing with parents who are in a home they definitely should not be in. >> Uhhuh. [laughter] >> And it's a h I don't know. I don't want to dis uh say disparaging things about elderly people, but at least my parents in their mid 80s have have really dug in their heels and just it's always a challenge. >> Yeah. you know, it's a really I mean, if you've lived in your home for 50 years, right? >> You know, the idea of like moving out of it and moving to a different location or making some big change is it's a lot of energy and cost and it's a big change. >> So, >> thank you very much. I think I may >> just a followup question. Do you uh do you collect data at all on on falls related that that predisposed to death whether it's stairways or anything else in a house? [snorts] We do collect how it occurred. Yes. And that's actually on the death certificate. Okay. You know, so if we have specifics, um we do if they fall down the stairs, we'll say fell downstairs. Um most of them are fall from standing height to be honest. Sometimes it's fall from seated height. That's probably the majority of them. >> Sure. >> So that is a part under uh non-natural deaths. You have to put how the injury occurred. And so we do have that information on the death certificate. And is is that compiled or it's just available? >> U we don't compile it. I don't know if the health department would, but it's it's definitely available and that that data is available for people to look into and access it through the health department. >> Thank you. >> Absolutely. >> Okay. Accidental deaths related to poisonings or drug overdoses. Poisoning is the public health term. Uh we had one acute alcohol intoxication, 26 illegal drugs, seven mixed, three over-the-counter, and four prescription. Um and so again, these are ones where the death occurred in state county. Not all of them uh were that the injury occur in the county. We had about uh six of them that were transferred in. So uh by age group um so you know from basically 26 to sort of like the 64 is really kind of the peak that we see here. Uh we do have some a few in the younger um and older populations. Um the other counties in southeast Minnesota, it's really skewed towards the older population like in the 40s to 60s which a lot of people find somewhat surprising. A lot of these individuals have been chronic drug users for a long time. Um and maybe you know they thought it was methamphetamine and it was fentanyl or something like that something changed. So this is the per capita rate. So this reflects um all of them where the injury occurred and the death occurred within the county. Um so slightly above the Minnesota average. Again relatively small numbers but can skew it but we're definitely have an uptick in drug overdose fatalities from last year. So if we break it down, uh we had one cocaine, four cocaine and fentanyl, one fentanyl, cocaine and meth, eight just pure fentanyl, two fentanyl and cocaine seems to be a theme here of fentanyl um and meth um and one with methadone as well. Um and then seven with methamphetamine. So methamphetamine has never really gone away. Um it's been in the background since before the that real opioid epidemic. So it consists persists, excuse me. Um it is worth noting that we had uh two scenes where there were multiple fatalities at the scene. In one fatal one of the scenes there was three um individuals that died um in this in the same uh event and another one there were two individuals that died. And so uh in these scenarios they're taking very high uh potent fentanyl and basically are going all of them are going unresponsive essentially immediately and no one's there to call 911 Narcan or what have you. So uh it's kind of crazy but basic I mean it's a big uptick from uh 2024 from 19 to 31 I mean or 16 to 31. Um, and so, uh, again, uh, something we'll obviously continue to keep an eye on. I don't really know why we were optimistic that things were trending down. Um, but still still a nuisance and a problem and a serious danger. I mean, um, yeah, doing elicit drugs has always been dangerous. Now it's really just like Russian roulette essentially every time people take the drugs, I think, personally. Okay. So these are al alcohol related uh deaths uh by um so we started tracking this after the u basically co after the pandemic because we're seeing like as a lagging sort of indicator of the pandemic this increase in alcohol and liver related deaths as people began consuming alcohol heavier um during the pandemic and then it takes years to have that damage occur to the liver. So it's basically sort of a lagging indicator of uh of the pandemic. So chronic alcohol-related ones that were both that occurred in the county and some were transferred. So realize this probably reflects some people being trans potential liver transplants here but 61 is really just a huge number. Uh you had two alcohol acute alcohol. So this is where people have consumed alcohols to basically a lethal uh concentration. So like 0 point4 or higher typically and we had three um from withdrawals. So people are are trying to quit um on their own. So interestingly in relatively recent years there's a particular test that we can do um that will help us uh get a sense of like the chronicity of uh someone's alcohol consumption. It's called a PET test. I'm not going to go through the gigantic name [laughter] of what it what it official name is. Um but so we that's something we've been able to use recently for alcohol-related deaths because a lot of those the withdrawal deaths because you know the family will say you called this chronic alcoholism but they had zero alcohol in their bloodstream and now we can have a test that will say look there's zero alcohol today but there this PET test reflects very heavy alcohol consumption you know prior to death and so it helps us at least document that that's what's happened. So, I mean, it's pretty sad cuz people like, you know, really try to quit on their own and don't realize that like the dangerous dangerousness of alcohol withdrawals. You know, it affects alcohol is affecting parts of your brain stem and your medulla. There's receptors specifically there. And so, it's can be very dangerous because it's affecting your blood pressure and your heart rate and such. So, it's um and I think the general weight public may not realize exactly how dangerous it is to just completely stop alcohol if you've been like a heavy heavy cons you know user of it. So, >> yes. >> What [clears throat] accounts for the significant increase in alcohol related deaths? >> You know, I it's reflecting heavier overall alcohol consumption over a a period of time. And so across our counties, we've seen an uptick in in alcohol liver related deaths and liver related deaths. So again, our theory, it's just a theory because people and other people have reported on this that people just started consuming alcohol in heavier concentrations um and volumes during the pandemic and then that has continued for some individuals and then here you are years later and that you know long-term use of it has basically done that that chronic damage to the liver. I mean, we also see, believe it or not, we'll see people with like endstage cerosis that are 25 years old from alcohol, 27 years old. So, I mean, it's I mean, it's kind of terrifying to be quite honest that you see people with like endstage liver disease from their alcohol consumption, you know, not even 30 years old. So um um natural deaths by causes uh so very similar to what you'd see across the country with cancer and heart disease followed by uh neurologic and then pulmonary diseases. Um you can see the pulmonary ones you know basically stabilized that uptick in 2021 was a result of uh the the pandemic. Um and uh but the other ones look reasonable compared to other data. So again, these are things we're keeping track of. I mean, I think in particularly like the cancer one is one that I'm always kind of looking at because of our farming communities and exposure to chemicals and other sorts of things. You know, we're that there's some exposures that might not be the same as if you were living in like an urban area and someone's, you know, working with those sort of things on a regular basis. So um you know something that I I think about related to that. >> So this is death by age group and so the further it's shifted to the right uh the healthier it people are and the longer people are living uh because you are not dying in an earlier age from non-natural death. So this is reflecting people uh dying of their natural disease primarily. the more of the, you know, the columns that you see in the younger age groups, um, the bigger they are, that's the people dying of non-natural events. So, these are your accidents, suicides, and homicides. And so, I mean, there's some states and counties you could look at and there' be pretty big numbers, you know, in these areas reflecting, you know, their high homicide rate, for example. >> Can I go back to your last one? You you have neurological deaths. Yep. Is is that the Alzheimer's and dementia related included in there? Yes. You didn't break it out, but >> we did not we did not break it out by like stroke versus dementia and that sort of thing. So >> would I that's another one that I've been keeping an eye on because you know for a number of years now you the baby boomer's population you know 8 to 10,000 turns 65 a day and um [clears throat] and it's that's age is the biggest risk factor for developing uh dementia of any sort. Um and so we really anticipated and really like this true epidemic and although across the country the deaths have increased, it hasn't increased at the rate that people would have anticipated. And so that's probably reflective of people being healthier in general. You know, you know, they say what's good for your heart is good for your brain. You know, people know exercise is important, keeps your brain function going, um that sort of thing. So, you know, hopefully that won't be as dramatic as what was anticipated. So basically people should not retire, they should keep working and exercising. Is that what you're saying? >> They need to get out of their house and >> go exercise what you're saying there, you know. [clears throat] >> Yeah. I mean the more engagement and you know other risk factors like so one of the the best predictors if someone's going to get dementia not is how high their education level is. So the idea is like the higher education level you've achieved the more cognitive you reserve you have. So basically you have further to fall so to speak is like one of the thoughts but you know I typically use that for jokes depending on what I meant. >> Right. So and if I could go to your next page there by death. It appears that if I make it to 95 that my chances of dying are reduced according to your chart. [laughter] >> Well this is there's less competition to die when you're 95. >> Less competition. [laughter] In other words, there's less there's less competition to be in that category because we have less number smaller number fewer people in that population. >> It's a goal. It's a goal. >> It's a goal. >> It's very good. [laughter] >> Yeah. Yeah. I mean, eventually we're going to have to do greater than 100. You know, when we had more nuns, it was definitely over 100. I mean, we if I see someone come through and their death certificates, it's like 108. I don't even have to look up where they resided. So, >> yeah. Mhm. >> U question about um the accidental deaths related to poison or drugs. >> Yeah. >> Um is um vaping um a consideration in any of these categories? >> So if it would probably would not be on there because if you vape and you get like the vaping associated lung injury, then that would turn into like a chronic disease and so then that would fall under the pulmonary ones. Uh, knock on wood, we haven't seen that here recently. Our mayopath pulmonary pathologists were some of the ones that actually described that initially, you know, from contaminants, but um, we see we we the royal we our death investigators see and document lots of vaping uh, pens whether for nicotine or for THC on the scenes when they go. It's pretty common to be honest. So, >> I mean, >> um, Mr. Chair, I've got another question about vaping. I've I've heard from uh an emergency room doctor that she has lost patients who have accidentally poisoned themselves by consuming the the raw vape liquid. >> Oh, >> so I've not heard that. I I don't recall having a case like that. Um, but it would be definitely something that we would pick up and they would come in and we would, you know, examine that person. >> Would that be considered vape or poison? >> It would be a um that's a good question. It probably wouldn't be vaping. It would probably be I don't know what the the the the drugs in there that would cause a fatality um are uh but it would be whatever that drug is toxicity um due to consumption of uh you know vaping this and that's would be how it was occurred uh would be consumed liquid from a vaping pin. >> So that would all be documented. So >> what what does it mean excludes cremation approval only? >> Oh um because so uh we approve all the cremation permits and so we don't have the uh cremation approvals captured in this data. So so we're trying to reflect what the the the population is that's coming through our through our office um as the medical examiner. But also that's just like it's sort of a separate thing because you could come through our office and also get a cremation approval or you could not come through our office we would approve your cremation. So so it keeps us from double counting. >> Okay. >> Yeah. >> Mhm. >> So would that would that also then you know somebody dies and I don't care just dies and is buried would that would that be reflected here? Uh >> is it just what things people that go through your >> that would be reflected in our that county's data not in the state county data? >> No, that's is I'm sorry. >> Yeah. >> Mhm. >> So just Okay. An Mstead County person dies. >> Yep. >> Funeral home picks that person up and the burial proceeds and but it never never comes to the >> well it would depend on what would happen. So like if someone dies at home and they're not on hospice, then we would be notified and we would go to that scene and then we decide either to do an autopsy and external examination or decline jurisdiction. So that's an example where we might uh sign the death certificate and you know have just done a medical record review or we might turn it over to the primary care physician. But that would be another one of those that we capture of that 87% that we touched the death somehow in the review process but maybe didn't perform an examination. So if they um are on hospice then that's basically documented in hospice. And so we have they're pre-registered with us. So we have a forms on those individuals and then the hospice nurse um has a form that they fill out that's like did they have a recent fall? could there be a medication error or anything that would flag it basically as a medical examiner case and be reportable to us. So then we're reviewing basically what's coming from the hospice uh nurse um after someone dies on hospice. Then if they get a cremation permit then the funeral home reach out to us and then we our medical exam again the royal we are death investigators they do all the work a lot of work behind the scenes they then will do an investigation look into the individual's medical record and other sorts of things um to see if it's okay to do a cremation because you know you don't want someone to you know try to rush a cremation through and have no oversightes because it's a homicide right you know like oh my wife just died at home uh I'd take her straight to the funeral home and get her cremated ASAP. You know, that's the kind of thing that we're trying to avoid. Uh so that's why we have that that review process. And so depending on the scenario, we may reach out to law enforcement, etc. So there's quite a bit of variability. >> I got one more as long as >> So Dr. Blo used to be known as a coroner. In fact, he was an elected official right under the title of coronor. Uh are are you a coroner or do we have a coroner anymore? >> I'm a medical examiner because I'm a board certified forensic mythologist. So and um needle legal to keep me honest here, but I have statute 390 [laughter] under. Um and so basically we have a county bycounty system. The you're appointed by the county board and if you're a physician then you're a coroner. If you're a forensic pathologist you're a medical examiner. And so that's the distinguishing feature. And so the coroner will oversee their death investigation system. The medical examiner does that but also performs autopsies. So it's probably about I don't know 12 13 14 years ago or something like that. Uh the state statute changed to require the the coroner to actually be a physician. Okay. >> And so and then there was a grandfather clause where those people who were already corners could stay in that position basically to the end of that that allotted time period. >> So >> must have taken the elections provision away as well. So >> yes I mean so >> you would not like to be elected right? >> Huh? I have no interest in being elect. No offense. [laughter] No no offense. It looks like a lot of work amongst other things. Um so in a lot of state I mean since basically the 50s there's been national uh essentially reports and policies and other things that try to eliminate the coroner system across the country with really no avail because in depending on the state or commonwealth it's really deeply embedded um into sort of the whole election process and the government there. It's kind of an entry level position in a lot of places and it can be highly problematic because you know you might have to the requirements can be like literally you're 21 and have a driver's license in Kentucky where I'm from and they may have changed it now but you could never have participated in a duel. So >> so far so good. It's concerning that that was a big enough issue at some point that it had to be written into the state law. But but so so you have people that you know some states require education for the corner system the corners you know a day five days others don't um so there's you know disaster after disaster if you start looking for like what's happened at corners I mean so >> but yeah I'm a medical examiner so >> and Ben I mean he was the coroner for 50 years and so you know I had an opportunity to speak with him and I mean and he was engaged at the national level through the national association of medical examiners and other things. So, I mean, he was really sort of at the forefront of like basically when that organization was started and other sorts of things. So, definitely got things going on the right foot. >> God bless him. He was lights and sirens. I mean, he was >> I'm a little less dramatic. We all are a little less dramatic. [laughter] >> Jeez. Yeah. So, I have a few more questions, but unless you're done or not done, >> this is just the final slide. This is our our overall activities which are basically stable. You know, roughly a thousand investigations, 500 death certificates, 217 scenes, 231 uh autopsies or postm exams, and 1,800 deaths. >> Right. So, one of the things that I noticed is that the natural deaths have decreased. I mean, that's I I think kind of unusual because our population is increasing, but the deaths have decreased. So either they're dying because of other reasons, not natural, or we just had a good year. >> Well, there is going to be some variability, you know, from year to year. Um, and so honestly, some of the things that impact like what we see as far as those kind of categories is like what was the flu season like, >> you know, things like infectious things. So like you know um yeah I mean flu, pneumonia, those sort of things that are really like driving those natural deaths. So if we have a really virilent flu season um it doesn't match the vaccine um you know we'll see an uptick in in deaths um related to that. Um >> so that that's one of the major drivers in the population. >> Okay. And then the other one is I I looked at the causes of death. Um and you don't have marijuana listed. How many people have died of marijuana? >> So uh so THC is not uh directly fatal. It doesn't have receptors in the brain stem for >> so nobody dies of marijuana. >> Not directly. >> Okay. Well, I think it's an important All right. So the other one is is that you reported the incidences of alcohol uh are related to death. Falls are related to death. neurological health is related to death. So, um, if you had advice for public health, where would they put their money to reduce the amount of deaths? >> Well, I think, you know, obviously you've you've hit on it. I mean, obviously, you know, alcohol is a big a big issue. Uh, falls in the elderly population is a big issue. uh you know what we have seen I mean really I mean like uh the zero death you know uh policy across the state has impacted motor vehicle uh deaths you know we've seen decreases in rows like I mean I'm probably the only advocate except for maybe you all for roundabouts in certain certain intersections but I mean these are things that are like like literally lifesavers so >> we do put a lot of money into education I mean I just look at fentan eight deaths and then we have alcohol which is a lot more uh I don't know >> I mean exactly >> it's also a reflection of the volume of people that are participating in the use of different uh drugs I mean there's obviously more alcohol consumption than fentanyl consumption um so >> yes so what your conclusion >> uh well I was an anthropology major so we can talk about about the cultural component components of how that's embedded in different communities and the social acceptances of different drugs and alcohol usage in in different areas. And so I mean it can and I'm not even I'm not I'm not sort of saying it tongue and cheek but not really. Like when I was in New Mexico as a medical examiner there for a number of years there's one town where basically IV heroin use was essentially like generally accepted and grandparents would teach their grandkids how to shoot heroin. It's Rio Riodosa County. You can look it up if you want. um Rioba is one of the towns there and it's like so when you have something that's become become socially normalized you can it can really change that and that community if you you know heepsi was I mean almost everyone had heepsi within a number of weeks you would get heepsi if you started using IV drugs because it's small insular communities sharing needles and so you know there there is that normalization of certain activities in certain communities um even within our own communities you'd be surprised I don't know if the sheriff is still here. But there's definitely things in certain populations within county where people have normalized activities and doing things that we would find probably not particularly normal in our daily activities. >> Thank you. >> Y >> Mr. Chair, >> yes. >> Um do you collect death information from Prairie Island Indian Community which has been recognized congressionally as sovereign um tribal land in northern county? Yes, we do. >> Is that just included in these numbers? >> I didn't I didn't see it um specifically noted on the jurisdictional map that you showed us. >> Um no, we don't have it specifically called out on the map, but we do uh provide a death investigation and work with them and meet with their leaders and such. So, I mean, again, having been in New Mexico before where there's over 20 tri tribes and pueblo in the Navajo Nation, I mean, pretty uncomfortable working with pretty comfortable working with the native population. Um, I mean, I have nothing but great things to say about them and their collegiality and how we work together. Um, you know, they need more time when a deedent passes to do what they need to do for their religious purposes. Um and then they have resources there because of the casino and you know um and they have their own EMS. They have a lot of resources there compared to other uh tribal communities and the the reality is like it's most of the deaths there are little old people with a slot machine with a cigarette hanging out of their mouth to be not too stereotypical but like that really is basically it's the sudden cardiac death in people that have comorbid factors. So um >> God, >> it's us visiting. [laughter] >> You know, I must say that this is a very serious report that you bring us every year, but I do appreciate delivering it with a sense of humor and tongue and cheek often times, but we do all of us realize, you know, the difficulties that families face when this happens. It is serious. Sure. Thank you. >> No, I appreciate that because it is I don't want it to be taken lightly because we take these very seriously. >> Um but it is >> I mean it's a reflection of us and what we do in our lives. Um and so some point probably every one of us will come through one of these statistics including myself. So >> I I got a just a couple. Uh >> yeah, >> if there's such a thing I think they used to call it long long COVID or something like that. Is that more of a morbidity morbidity issue as opposed to a mortality issue? >> Yes. Yes. That's a that's a morbidity issue. And so there's a whole bunch of things that you can get with like the lone covid syndrome. It's probably closer to think about it sort of like a fibromyalgia neurologic component. Some people have persistent pulmonary issues as well depending on it. But yeah, that's it's a it's a long-term morbidity, not so much a mortality that we're seeing. >> Yeah. And then the other one having to do, you know, this this this board deals with tobacco. Just thinking and this is not on your data but uh thinking about you know 50 years worth of anti-tobacco uh legislation and other and and everything else promotion has has tobacco certainly it's it's as toxic it ever was but but is is the rate of tox tobacco related deaths been affected at all that you just percept >> I would I would have I would say yes but I would say it's still a persistent problem depending on the community and again the rate of smoking. I mean I have seen reports of the increase of nicotine use in younger people because there's so many different delivery models. Um those delivery models, you know, are less toxic than this tobacco smoke um is, but it's still still nicotine and that's addictive. And so, you know, does that mean at some point they'll transition to, you know, smoking or chewing tobacco? Um yeah, I can talk about tobacco, too. I'm from Kentucky. So, when I was in medical school, we had 60 I think it was like 60 plus% of the Kentucky population smoked. And I would see people in the clinic in their 20s with like endstage lung disease because they started smoking when they were like 11, 12, that sort of thing. So, I mean, it's a it's an extremely harmful long-term chronic issue. Um, but it's it's still persist. Um >> I I I just don't see it as prevalent in a community. Maybe I'm just not going to the right places or >> you may not be going to the right places, but you might not be hanging out the at the back door of the right places at the right time to see the tobacco users too. So it's also been displaced. I mean, you know, you can't smoke on airplanes, you can't smoke in restaurants. So it's moved to to different locations and so it's a little bit more I don't know say closeted but behind the scenes. So it's not really literally in your face. It's you know around the corner by the the dump truck. It's or the dumpster. It's you know across the street from where people work because the campus doesn't allow it. Um but it's definitely still persistent. So >> thank you so much. Anyone else? Well, Dr. I thank you so much for one more year of great reports and uh again this is serious matter and we we certainly take it that way but this is important data and we really appreciate you stopping by and presenting for us. >> Great. Thank you. Appreciate being medical examiner appreciate your good questions. Makes it more interesting presentation and richer discussion. So thank you. >> Thank you. Thanks. >> Okay. Moving on. Board and committee reports. Uh let me just start to the right. Anything? No report. I >> No report. >> Oh yeah. Uh, Commissioner Sanjim and I had a opportunity to go to Joliet, Illinois to participate in a NACO sponsored uh, forum on energy which really was dealing with land use um, batteries, data centers, and how counties can be involved in that and still protect uh, the citizens from uh, people coming in. uh and making sure that it's done the right way. But I think overall my um assessment of all this stuff is is that the real issue has yet to come and that's that there simply isn't enough energy production in United States to support the growth of the need for electricity in the future. So even though we're doing all these other things, it would appear at this point that the um the need for electricity is outpacing the ability for us to produce it. So that's going to create some issues and of course that's going to create an issue for Minnesota as well as all the other states which is nuclear. Um, and I think that Minnesota will eventually have to face that issue. Thank you. >> No report. >> Uh, yes. I just maybe comment also the the Illinois uh uh experience again part of the rural the rural energy academy and uh this particular county Grundy County is the location of three nuclear power plants. So it's it's kind of the center of the universe as far as nuclear power, but uh and uh but a lot of good discussion uh and and commissioner Wright is correct. Uh we we've got a lot of work to do and and particularly in this state before 2040 uh with the 2040 100% clean energy mandate. So uh where that electricity is going to come from uh needs to be decided today. And as we talked about conservation even this morning, uh uh the need to you need just to conserve and and and think about uh again how to how to meet the needs in 2040 are are here today in 2026. The other one I want to comment about and I'm just so proud of our sheriff week or so ago, a couple of weeks, special Olympics came through Rochester. I suspect in large part due to the work of our sheriff and in in this area and uh I think I remember him saying that even within Homestead County and in large part to his work uh four or five million dollars have been raised to this cause and this uh just just remarkable and uh so thank you Sheriff. is this is a kind of on the route to the Twin Cities where the National Special Olympics uh event was held and I watched several YouTube versions of that and just a glorious experience for all those young people up there that participated. You could just feel the energy, you could feel the excitement and you could feel the emotion of the event. It was just just terrific. And so, Sheriff, thank you for bringing that to town. And uh I think it certainly touched me and I think it touched a lot of people. >> Commissioner, >> um yes, I'll just touch briefly on the Elmstead County Extension Committee. We met last week and um as you can imagine, the the 4 staff are gearing up for county fair, which is the the big um showcase of all the 4ers projects. Along with that, doing lots of day camps and engaging with our schools and continuing to build that 4 program here in Homestead County. Um, our a educator, Mary Nesberg, is very busy fielding everything from how do I prune my apple tree to assisting with farmer education events. And want to just touch on those. Um, the summer is really a um a time when, you know, farmers with crops in the field growing use that chance um to get together for educational opportunities. And Thursday evening, um there's going to be a tour of some oats fields and then we'll conclude at a farmer's um shop in Pine Island to have a meal together and then continue our education journey as we all build the oats program here in Homestead County, which coaleses nicely with our groundwater protection program in encouraging small grains and and changing rotations here in Homestead. Um so if anyone's interested in that, I'd be happy to share that information. It's on the University of Minnesota Extension website. And then um tied to that uh Mary also puts out a monthly newsletter. If you haven't subscribed to that yet, it's called the aggregate. Um just really summarize all of the educational opportunities happening across everything from home gardens uh to everything in the farming community and that those educational opportunities. It's just a great newsletter that brings that all together monthly and you can get in your inbox. So if you have an interest in that, be happy to help you get you signed up for that also. >> Sure. >> Well, my update was also going to be up on the U of M extension. uh as a as a recent appointee to the U of M uh extension committee, I have been so impressed with the uh commitment and very hard work of a small staff that um you know county partners with U of M extension to deliver useful and practical education and research. And this is no surprise to my colleague Commissioner Rossman. Uh I think you've been involved in U of M extension and 4 perhaps your whole life. Uh just uh just at at the highest level they do uh programming and education for agriculture, gardening, master gardener program, master naturalist, health and nutrition, sustainable communities, animals and livestock, crop production, farm management, natural resources, parenting and caregiving. monthly newsletter and I'm sure so much more. Um, just really wanted to lift up this program that has a wealth and depth of programming and education for kids, families, and adults. Uh, we're just so lucky to have it. >> Great. Thank you, Commissioner Hopkins. >> No report. >> Okay. Uh, anything else uh for the good of the order? If not, is there a motion? >> Motion to journ. >> Okay. We have a motion to adjurnn and a second. And all in favor say I. I. And we journ