[Music] Scott County providing safe healthy and livable [Music] communities introductions good morning Mr Vice chair good morning Commissioners um this morning uh we are joined by a collection of people who we're going to talk to you about a part of Public Health that we all like heard a little bit about during the pandemic um but who do this work day in and day out on infectious diseases and the work that we're going to talk about today um focuses on um the health of individual people but also um potential safety concerns for our community and so I think we have a really good panel pulled together of people who can talk to you about a piece of their work we don't often talk about what I'd like to do today is um ask the people the facilitators to introduce themselves and then we'll move on to the panel and ask you to introduce yourself and then we'll get going with questions good morning I'm Lisa F and I'm the transportation services director Tony wi County Highway engineer Paul augustson Business relationship manager in the transformation and Enterprise services division my name is Ben troop I work with the Environmental Services I uh kind of coordinate uh well water testing the county Marie M's Public Health Lisa bronsky Public Health director Cynthia smithr city of bplan community development director uh Stacy Ward I'm a public health nurse Jody Lis I'm the supervisor of the public health um disease prevention and control and then Michael will be joining us he's has to do our video dos this morning so all right um I'm going to start with the first question um I wonder um Lisa if you could just take a brief moment moment and just talk about um tuberculosis and the protocol for tuberculosis um treatment uh that would be in reference to page eight just to sort of set the stage for for what that [Music] requires um certainly so uh and actually jod could probably speak a little bit uh more to this um but uh every um uh TB client that has active TB uh requires a personal visit it's called direct observe therapy and um we see each client daily um it is a requirement uh we have to watch them take their medication um we interview them to see if they're any if they're having any uh reactions to the medication we make sure that they're seeking their treatment and we coordinate that treatment as well um previously uh about 5 years ago most of those were being done in person so we would drive all over the county and we would do inperson visits um we have shifted our model uh to where we have to see them uh at least once a week in person and the rest are done video if they have those capabilities in some cases we can't but for the most part about 90ish per of our visits are done virtually uh which um increases our efficiency and saves the county money great thank you for that so if someone could just speak to on page8 WE you have a a chart that shows the percent of current um patients with TV who are compliant with treatment so what does it mean to be compliant with treatment so to be complying with treatment means that they're taking their medicine every day like they're supposed to as as it's been prescribed um I just want to make comment that you can cross off the seven and turn it to eight and likely nine um we just had one come in yesterday uh with active TB and has a a one-year-old in the household so that means there's likely to be um treatment for the one-year-old um as they're going through the the determination if the baby is infected or not so can I just just to just be really clear so this is a highly infectious disease so being in compliance with treatment is that like they miss one treatment and there or or how does that work yeah no no um to be non-compliant would mean to be refusing their meds consistently okay um and and truthfully it's not something you can refuse um if someone were to say nope I'm not going to do that um we can then invoke the public health threat law um and we can hospitalize them and treat them so it's not something that really you can refuse treatment so if someone does refuse treatment they can be involuntarily placed in a hospital yep thank you and we haven't had to do that no yet ever ever we we have come close but um we haven't had to do that and the Commissioner of Health would be the person that would declare um and put them uh in uh I olation okay thank you and you know I want to speak a little bit when you asked about the treatment of so the the dot the direct observe therapy is certainly a big part of the treatment um but and we're involved with the whole case management part of you know we get the information from the Department of Health that there's someone that um has TB so you know that starts us with okay you know are they home are they you know do we need to get them um into a clinic we may have to schedule them an appointment um at their own well typically an infectious disease clinic sometimes um we can get them in at uh hen County Public Health Clinic um for their TB workup and then prescribe um meds um treatment is a very um well planned out um plan of for different drugs that we start them on um typically they take those four drugs until we find out if the um TB bacteria is sensitive to them and if they are then we can eliminate one and then after 60 days we eliminate a second one um we get sputum if they're smear positive then we're collecting sputum and getting them down to the clinic to get those tested um they have to do a sputum sample once a week um until the first one until it comes back negative then we collect two more that week um in order for them to come off isolation um so there's a lot of behind the scene things that is involved with um the treatment of someone with TB beyond the um drugly observe therapy sure thank you they are usually with us also this isn't a short thing it's six to n months and it could go up to a year or two but typically it's six to nine months where they see us or communicate with us daily all right thank you next question um I would like to ask some questions around the public nuisance uh ordinance I know that we um passed the ordinance here in scat County in 2020 and um it looks like there's been a significant increase on page 13 in the data since then and um maybe talk about how this has been a positive tool what enabled you to do that maybe previously in the past you were not able to do certainly um I can start that one um so prior to act us actually having an ordinance um we were still mandated by the Minnesota statute 145a to respond however we did not have the tools in place um in order to effectively respond or even work with the cities so the cities were on their own the county was on their own um the nuisance ordinance did enable us it put some very specific things in place we worked with Genie Anderson we created some um some very good um language in our ordinance that allows us to go into the home declare Public Health nuisance they and and tell them that they have 10 days to clean up um this also enabled us to work closely with the city we do have a city partner here um from bail plane and we've worked on um several nuisances uh since uh since we have the ordinance in place and and maybe um since you um can speak to um how well that's going but one of the things that you know at that time we only had three four nuisances per year um we have seen a dramatic increases in public health nuisances and I believe that covid um probably brought a lot of those to light as well as some education and plus now the cities have the ability to reach out to us and we have been able to work together to clean up several nuisances that either were um that we knew about that we couldn't do anything about or um that have been now brought to our attention because the city now has this tool and I'm going to turn it over to you to maybe talk a little yes uh Cynthia city of bplan met Jody and Lisa when we were working on the Nuance ordinance which was welcomed by our community uh our entry to public nuisance is usually via code enforcement city of bplan is a reactive not a proactive approach to code enforcement so we need a complaint to actually investigate whether or not there is a code violation in this case a nuisance violation typically the entry point for these types of uh nuisances are either a neighbor a concerned family member a person who is a first responder or it's we're on a rental inspection and we find an apartment most of the time it's related to hoarding and garbage hoses so it is a concern obviously for the person who lives there it's also a concern for our building official because sometimes we have a lot of items that are piled up and it interferes with the structural Integrity of the building so that's a concern also our First Responders especially our fire fighters if there's a lot of of uh narrow passageways or flammable material or combustible material fires don't act like they typically do so we have fires that burn faster and we have no way of knowing you know how to navigate the interior of the building so that is a direct impact on the neighbors as well so for us it's really important we find that we are most successful when we have a team approach when we can work with the individual when we can work with the family when we can provide resources when we can't deal with this locally we're going to reach out to either jod or Lisa and we're going to ask for assistance because you bring a total new set of tools to help us try to help remedy this situation this is a real issue I would say we deal with probably 10 situations a year and they don't always turn out successful unfortunately we had one individual that we were unable to help so it is real I certainly appreciate the teamwork and I appreciate the resource and we are doing good work here thank you Cynthia um and I'll follow up um typically um it's been very Cooperative um when we've gone in we've offered resources it's gotten cleaned up we have had in two occasions uh not in bplan we've had to order a cleanup where we had to step in but that is not the norm um we have been doing very well on the cleanup piece and remediating the nuisances I think we're we're falling short still um well one of the things is we don't have any staff to do nuisances so you have your public health director and a supervisor going out and you know checking how many different types of cockroaches there are in homes I mean these are it's it's part of the job but um we're doing well on getting it cleaned up um however in most of the cases and and when we go we go on a team I'm kind of the enforcer and Jody's the public health nurse bringing resources um cleanup resources have been well accepted it's that mental health component for hoarding that we really haven't had anybody going yes I have a mental health issue I need I need help so we continue to monitor some of those houses it's chances are um we're going to have to go back uh because typically there's an underlying mental health condition that um is causing the hoarding issue um and uh they're just not ready for help yet um they've cleaned up because they've had to or we've cleaned it up for them unfortunately in some cases we may cause further trauma but if it's impacting the neighborhood there really is no give and take there there um especially if there's other sanitation issues that are causing additional problems on top of the hoarding um but there was a suggestion and I think uh for future steps um we may look at maybe doing a coordinated response kind of model bringing mental health with us and hopefully we can remediate a little bit better on the mental health component awes what isn't reflected here these are just cases that we have responded to um that we take many any phone calls throughout the year and just provide uh instructions or information and connect them with resources on the phone so these are just the cases that we've actually go out and actually physically have to do something uh Cynthia I was just kind of wondering uh since you mentioned you have approximately 10 cases a year that are nuisance related do you always escalate them up to Public Health or is there a threshold that you work with where it gets escalated and maybe you could speak to that a little bit more yeah that's a great question Lisa and I think the answer is our process is likely evolving it really is uh we work as a team in code enforcement and with our Police Department to try to identify who may be able to best reason with the individuals involved sometimes if they're Apartments it's relatively easy because you have an apartment manager or property owner that has an interest in in uh having the apartment cleaned up as well um we probably spend at least 60 days locally trying to remedy situations if we get absolutely no cooperation our goal is always progress not perfe Perfection if we get absolutely no cooperation or we feel that the life of the individual who is in the garbage house is an imminent danger we are reaching out to Lisa and jod immediately what's up crossover on these cases with adult protection and with child protection um some many some you know it it's hard to say um I think the one cockroach one that that you had Lisa there was a there were children somewhere in there involved um adult protection it's a little harder because you know they have to meet the criteria of a vulnerable adult um to be considered in adult protection um so we oftentimes have gone out with adult protection um maybe they get the report first or maybe we get the report first but we go out together um to talk with them they can then assess is this a vulnerable adult situation um and we can assess what's going on and you know is it a public health um thread and so we are able to work together in in that way okay um so yeah there's there's some vulnerable adults some not and I I would say most of the hoarding case like it in the grand picture I would say about 25 to 35% of our cases involve APS or CPS most of the hoarding like we're seeing them most with the hoarding cases especially the extreme hoarding thank you all right let's bring Ben into the fold here um so on page 12 the water test totals per year can you talk a little bit about what this figure is showing us are there any Trends and levels are high what uh what do we do to help out for any sort of uh mitigation so the graph is just kind of depicting um every test that we sell um per year um you'll see that on in 2019 in 2023 we have a lot more um that is probably due to we send out a flyer to all the private well users in the county and uh just a reminder that something that was probably in your best interest um it's not a requirement but as you can see we get a pretty good turnout people that want to know um what's in there drinking water um I guess uh Tony can I can I ask a followup to that yeah so Ben how worried should people be about the quality of water as it relates to lead well as it relates to lead um not not too much um the Department of Health we work with them a lot um trying to like just investigate why there's highed in some houses and some not a lot of the time it's uh older homes it's the Plumbing inside the pipes um it almost it very rare that there's lead coming out of the groundwater okay it's almost always um either public utility there it's like kind of an ongoing investigation on why there's okay High Le but um I guess this 2023 compared to 2022 there's more we we found more houses with high well High Le um High Le is I don't know if that's the right way to say it just because any lead is above the standard the standard is zero okay so um we had more just because the volume of tests was so much more okay so all right thank you can I just also clarify um prior to 2011 uh we would I mean we respond to lead cases and prior to 2011 that threshold wasn't zero it was uh 10 micrograms of lead per deciliter and in 2011 they changed that re and that's for children under six um because we know that lead impacts uh brain development and it impacts children's ability to learn so the cut off used to be 10 so we would have an actionable item at 10 in 2011 they cut that in half to five uh micrograms per deciliter and I believe it was last year mdh uh changed it once again to match what the cdc's recommendation was of 3.5 so it's it's not again zero but if you can look on page 11 you can see the impact of that for us is it's every time they' changed it it's increased the number of cases it doubled our number of cases more than doubled our number of cases we usually had four to about four a year three a year last year we had 11 cases um and I believe this is attributed to the reducing of the actionable leads so right now we're responding to anything about 3.5 none of our most of our lead cases or none of our lead cases actually have been connected to water it's been uh mostly lead paint um we've had some related to some spices that have been brought overseas that contain lead um and some most we don't ever find out what the true source is you know mdh will go out with us if it's a higher level um and and do testing um on the at the home and you know they don't always find something test positive for lead so then it could be you know the parents um bringing things in I remember the last County that I worked at we had a dad that worked at a battery Factory and he was he actually was the source it was on his clothes when he would come home from work and the kids would hug him um and so that was where they were getting the lead so um it it's unfortunate we don't usually find a definitive um thing but we did find the lead in some spices that had been brought over um and apparently it makes the color more brilliant of the spices and it makes it heavier so they costs more so but yeah that's what we have found um Michael any other any other ones that we were definitive on not that I remember a lot of them were just kind of yeah couldn't figure out where the source was but then as we do testing they do Venus draws it gets lower yeah yes um can I ask a question um recently there's been a lot of conversations regarding pofs and pofs testing in water is that something that we're doing at the are we doing well we don't offer any posos testing all that's been done would be through the Department of Health good morning um I'm going to walk back to your narrative a little bit because there's a lot of conversations in here that support the data that we're seeing in the graphs and um I did on page two and on page four I just want to reference that um you talk about a framework that leavs out your minimum set of disease prevention um and that that framework is being edited or revised as we speak um and then also on page four apologize for the page wrestling here um because of current case loads and vacancies we're unable to focus on prevention work and developed and implemented a continuity of operations plan to focus on the most critical tasks can you talk talk about if you if you could influence the the draft of the minimum requirements for prevention and also the increased case loads that you've been seeing how would you like to influence what you've been experiencing in terms of Public Health in terms of the activities that you need to provide and the the case loads continuing to go up and how you can predict and manage those case loads a lot of questions in sorry so so our our framework really is looking at you know what is dividing up because we were very closely with the Department of Health um and local public health and what's everybody's responsibilities um it'd be great to be able to say well you know mdh we really can't do this you just do it and that's not the way it works I mean it's a local public health responsibility and so um mdh has their responsibilities we have our responsibilities um we help you know like right now um because of our our staffing situation uh mdh is like okay you know we know that this is going to be another contact investigation just let us know what we can do for you to support you but they can't do the work and that's our that's our job especially in TB that's the one that's very specific that's local public health responsibility they're doing our pressus they're doing our um measles if we would have one um but and and vericella um but TB that's local and that's a good thing because really we're the ones that are dealing with the family we're the ones that are establishing the trust um with the family and it it takes a lot of trust um to be able to go to someone and say who all have you been talking to lately who's been in your home where have you been traveling to what you know um and it's a struggle sometimes because some of our families are very um concerned about their privacy and don't like to share that so the the thought process and some of this um whose responsibilities is who is looking at who's going to have the relationship with the family um to be able to to do um the best job at the case investigation and typically it's local public health because we're here um so that's kind of the framework part of that question uh what else well and we did have input in the framework so when it came out in draft form and I also sit on the environmental health uh Community Improvement board so there was some opportunities for us to weigh in the bottom line is that these our local public health responsibilities mdh is currently helping us with our pertusus um investigations until they can't and right now there's measles in Minnesota and a pressus outbreak so at some point they may say I'm sorry it has exceeded our ability and it's back to you local public health that's part of the problem I mean how do you we can't in a year or in a day I mean on Friday I mean this the numbers on here were obsolete as of Friday because we got two more protest protestas cases we have to respond whether we have 10 protest or TB cases 10 TB cases or 100 TB cases it's like the refugees normally we get four to s a year we had almost 87 last year 100 the year before and we haven't changed our staffing model so what do we need to do in order again we can't predict it so what what happens when all of a sudden like in May and June we got 51 new refugees that's like an A number that is astronomical for us and actually for Scott County per capita we've had the Lion Share of refugees um if you look at the state map of where're like in the darker color we've gotten a lot of the refugees in Scott County for various reasons we have a lot of refugees coming from the Ukraine they're coming here because their fam's here or the Baptist Church is here and the refugee settlement is matching them to where they want to go um this causes a huge surge in our cases um so we have implemented um some things uh in order to uh meet that need um what has helped is VD going uh 90% virtual so that is increased deficiency freeing up our staff we have used an intervention staff person to do a lot of our Refugee Health assessments we found her during covid and we've kept her because she was fantastic and we would not be able to do that work um without without Marie and I'll let you speak to some of the work that you've been doing in a minute the other pieces we've been doing more recently is um we have implemented a partial continuity of operations we are pulling back on some of our non-essential Services because always life safety and health of the community comes first prevention activities is later so we have um we're only going to the jackon person once a week uh we are not currently completing full Early Childhood screenings because that takes a nurse um we MGH is doing our pusas as we've mentioned and we are going to start having conversations if we should start canceling our health matters Clinic our in person and just going to our model that we were using during Co where we're just doing essential prescription res fills um we're also pulling our chinging checkup coordinator because that's prevention work and we're moving her over to do some of the TB work again prevention will fall behind we're still going to do our vaccinations because that's one of the problems that we're seeing right now that's causing the protestas outbreak and we talked a little bit about this during our community health board meeting is our vaccination rate has dropped below 90% um MMR is at 85 86.5% or 86.4% it's the lest we've seen in a long long time these specific things are leading directly to these outbreaks protesis and and we also have a measles outbreak so focusing on Life Safety health and moving staff where we need to move them unfortunately we have you know BD this morning and that would take a little bit of presence over this unfortunately and Michael was a little bit late but it was because he was conducting an essential service did that answer all parts that question okay that was the theme yeah very good so I'll follow up on that and I see on the screen I popped uh page six so I it ties into that again and this is the percentage of children immunized by entrance in kindergarten so I think you're hitting on that so you know how do what are the steps to get this back to those those Target goals is the the decrease last few years from Co education refugees you hit on you know what are some fact factors and what are the next what are steps moving forward to get back to Trend to those Target goals you know I think it's a very um uh complicated thing all of those things are part of it I think um covid didn't help us with the whole vaccine thing um so people have then moved I'm not going to get the covid vaccine to I'm not going to get my kids vaccinated so I think we've had to deal with some of that so really working with um Outreach um clinics are very involved you know um talking with their their own patients and because again you want you want the trusted relationship to be the one that's providing the information so um providers in the clinics are talking with with their families about immunization and trying to give good sound immunization information um you know we certainly work with our um our Families Our Refugee families um uh all of the families that we come in contact with about immunizations Wick talks about immunizations CTC talks about immunizations so um we're covering all of that um we do uh our immunization clinic so we have two funding sources for immunizations um so we have the Minnesota vaccine for children um and that allows us to vaccinate any child um that is uninsured underinsured meaning that for whatever reason their insurance doesn't cover a certain vaccine or some set of vaccines um and then if they have medical assistance they can come to us and we can vaccinate them um we also have the um un and underinsured adult vaccine program um and that program is where we can um immunize any under underinsured adult um with the adult vaccines um that program this year for the first time we were allotted a certain amount of money as was every county in the state was allotted a certain amount because they're so um short of money in that program and so you know we've already spent our allocation for the year and the year doesn't start again until October 1st so um right now we can't get any more adult vaccine except um they are going to continue to provide us with um verella MMR Co and um taap so those are the only vaccines now that we can offer to adults um because we're out of money uh and I don't think it's going to be any better next year so we've also added a vaccination clinic time to accommodate the increase in need if you look on page seven you can see also our number of vaccinations that we've been given has also Al dramatically increased we did 924 in 2023 and we're on target to exceed probably about a, if it stays consistent between now and then um and in order to I mean obviously we need more time if we're giving out more vaccines so we've added a clinic um okay can we go to page 10 please um so this data looks at referrals of refugees for health assessments and is it correct that public health is required to help link them to a clinic in 90 days is that the requirement the requirement is that they have their health assessment completed within 90 days of arrival okay thank you and so I wonder um um Lisa maybe from like a a director level if you could just very quickly explain the difference between a refugee and an immigrant and then Mar I got a follow-up question for you I'm going to so um you have to apply refugees typically are people that are displaced from their um country of origin due to Civil distrest War things like that um then they can apply to come to the states as a refugee now that's all run by the federal government the federal government determines at the beginning of the fiscal year for which refugees I believe is September 1st um they look and project and say that this is how many refugees we're going to have this year um and they you know they stick to that number and then um so then the the refugees are are done I don't know how they choose which ones from where but that that's how the refugees come to us we know that they're coming ahead of time or this the state does um and then they let us know um uh and all of the refugees um qualify for a set of benefits called um the um Refugee health benefits um those benefits include um medical assistance um it used to be six months I think they have it now for a year and then they work with a resettlement agent gency um that helps them with housing Furnishing their house helping them find jobs Transportation things like that they help them get settled um so that's a refugee um the Department of Health sends us like I said those refugees um so that we have those names and we know you know a lot about them because they all have a refugee Health exam prior to coming um and then once they come then we do their Refugee Health um assessment um or help sorry help schedule them for a refugee Health assessment with a clinic okay the immigrants um they apply through immigration um to resettle in the United States um immigrants are not eligible for those Refugee health benefits so um in fact they are not eligible to apply for medical assistance they can apply for um Minnesota care but they can't apply for medical assistance they're not eligible for that there's a time frame that they have to be here and things like that before they can apply um and be eligible for medical assistance so um immigrants there's um they do have some health um things that they have to do prior to coming over here and where we get involved with immigrants is only if they come over here with a Class B meaning there's something from their overseas um um exam that is a little funky for TB so they maybe had an abnormal chest x-ray they maybe had um uh some TB symptoms and so before they can come over then they have to do some further testing um and then when they come to us we get them because we then uh get them connected with a clinic that can um complete the um U the exam for to rule out active TB and then if they're latent then we um help them with treatment okay and our goal is to make sure that they get um their assessment done within the 90 days and also connect them to like help them find a medical home so we don't continue their care sure so then Marie is there are there like looking at this class B refugees so these are people that have TB or have some high risk for TB is there some prioritization as you are working in Refugee communities for those Class B individuals yes those are people that when I see them uh refer to us we immediately take a look at them contact those clients and prioritize those in getting them into the clinic uh for their assessment their blood test their test x-ray that kind of thing and then typically we're talking to the whole family because a lot of our refugees and and class BS are coming as part of a family just to ensure the safety and health of the family people around them okay thanks one of the complications that we found being having so many of um Refuge Health assessments needed we ran out of we ran out of clinics that had space to take them and jod has worked with a new Clinic arise I think it is um we had to find another location because it was taking more than 90 days to get them in and we just didn't have enough providers in Scott County uh to see these folks so um now we've been really lucky to have a new uh find a new partnership uh versus us trying to do that on our [Applause] own so going back to the water testing a little bit um had some questions about um as I understand the the well tests here that you're talking about are private Wells M um and if they do test positive for some of these resources or some of these um particular um problems uh what kinds of things do we do to help uh the residents with that if they get a test do we get actively involved in this or is this just information that they have then have to kind of work through the system to figure out what to do to improve their water quality y so uh um it's we don't really offer any like mitigation we've applied for Grants and stuff like that to try and well have the ability to do something but um as of right now um we just we're just the messenger we're just letting the them know that they're high and then we can kind of give them steer them in the right direction whe whether it's the department of health or just like regular things like a reverse osmosis machine or filters or anything like that that can mitigate the that specific contaminant that they that they tested positive for um Lisa could or someone I'm not sure um earlier someone spoke to the fact uh that um Early Childhood screenings were no longer being completed and you know that's uh been a priority for this board um so like in the alternative what is happening with that um well just to clarify we're not completing full Early Childhood screenings on site right now uh because we don't have nursing available however um in July and I think a couple days in August um our child and teen checkup coordinator we're partnering with uh shaby school district and they'll be uh going over to the school district to do the screenings there because they were short a nurse and this is also enabling them to add some Early Childhood screening days for the kids that already had appointment and and were able to make appointments we are doing because we have prevention staff we are um doing a big push uh to do a lot of Outreach we've been connecting a lot of kids to Early Childhood screens the data is showing that a bulk of the kids that are um being Mak are making appointments are hearing about it from public health um so we are still doing uh the Outreach and the connection with the school district and getting kids to where they need to be um and getting them um in for their Early Childhood screening so that work is still happening the only thing that we're not able to do right now because of lack of Staff um is the actual full Early Childhood screening okay thank you for that clarifier all right um is there one additional question from the facilitators I was just going to ask a question regarding your next steps that you have documented in your summary um you've talked a little bit about what you've been doing with the refugee Health assessments and partnering but you also mentioned some collaboration with River Valley and some collaboration potentially with coordinated response you want to speak to what you're thinking of in terms of the future dis to um as far as River Valley um for those of you don't know River Valley um Health Center um is now part of the cap agency they're less than they're about a mile away they now have Physicians there as well if we do pull back on some of our health matters clinics it's likely that we'll refer some of our clients uh over there um and we'll see we'll see if that is a possibility of um because we really want to ensure that our clients have a place to go um and have a health care home um and these are typically ones that are have like absolutely no insurance 99% of the thing I think our clients are are uninsured and a couple are un underinsured so if River Valley can pick up that um we may take a look at some future discussion on um if they can maybe fill that gap on a on a a long-term basis we also have the opportunity to partner with open door they have been coming uh whether they're supposed to be here twice a month um and provide uh medical services so taking a look at through Partnerships how can we fill this Gap and do we need to continue even continuing with the health matters Clinic um the other piece um the cordinated response team would kind of want to take a look at if this is a possibility to improve the service that we're already delivering um taking a look at how can we uh help some of our particularly the hoarding cases um with their mental health issues so we don't have I mean it's it's it's for us so we can not come back um month after month I still have cases from three or four years ago that are unresolved on the inside but it doesn't rise to a public health nuisance but in one in for example in one situation they aren't able to live in the home they're living in a hotel because their home is uninhabitable and how can I maybe tie in some Mental Health Resources for that family um because it's technically not a public health nuisance anymore because it's only impacting that family so looking at different ways of doing things um and um and basically improving our service so they will rely Less on public health is there anything else you wanted to add to that anybody no all right um Mr chair Vice chair um these folks are on their way out to deal with the new TB cases so I told them we would keep this briefer this morning so I'd like to stop at this point um and give it back to the board thank you very much yes colleagues any questions on the topic I was just going to ask about the water testing you know there's that water plant going out there in Aluna Market M youve heard about that okay yes um anyhow there was a lot of testing that was done around that could that explain some of the numbers or what kind of testing wasn't there okay was there a lot of testing out there for wasn't there some well clinics or something oh thank you Tracy uh so as part of the um request for the no still can't hear me no maybe come up to the uh somewhere there we go got so as part of the request for that water supply well for the city and for the possible um B water Bottling Company the DNR required a a pump out test which is a a test on the aquafer capability to provide that water um and then some of I saw start to be an article I didn't hear this myself but I saw the article that um some homes had some problems and that was more sediment uh that they were were finding in their home and a few other things that were changing the color of the water um so none of those uh homeowners that were having trouble requested a kit from the county they were working directly with the city and the DNR I see okay and that sediment in the water is that even I have I'm on a well I I have that from time to time is that common yes from time to time you might get sediment in your well an older pump might be causing the problem um so the best uh thing to do is to call your pumper or I'm sorry not your pum uh your well driller your well driller and see what's causing the sediment in your in your water okay also we also have a um a lot of mineral in our water so it could be sediment or you could be getting you you have hard water here in Scott County so you could be seeing some of that too okay any other questions or comments I I've got one um and I thank you for that definition of the whole Asylum seeker and Refugee because I feel like we had a workshop about 3 four five six years ago so all refugees start out as Asylum Seekers if that's the right term but they don't not all Asylum Seekers make it to that Refugee status is that and we're not in charge of that status no we're not in charge of that I'm not really sure if they start off as Asylum Seekers well they're they're however they're entering the system they're theyve they've been displaced and have moved to What's called the refugee camp but yeah a refugee that's just that's the term the federal government gives them and this is what it means um you know they get this uh for the first six months or a year that they come here and so that's cuz I'm trying to remember back in the day um which wasn't that long ago but the the Border crisis whatever is it a direct correlation of that or not necessarily because it's a completely different it's yeah I mean with with Mexico or just in general well that's the one specifically yes I mean since we're so close to the northern border but um so those are those are Asylum Seekers they're not refugees um and there's they won't be you know labeled as refugees they don't fit the criteria as as refugees um they are Asylum Seekers which has some very similar you know their concern of their safety um so they're seeking asylum in the United States um or in another country um and and they have different criteria so most Asylum Seekers um are not eligible for Refugee benefits um although they have designated some countries that they can get Refugee benefits like Haiti we've had a couple ases from Haiti that um received they can get Refugee health benefits um they're not refugees but they can get those benefits so it's it's gotten so complicated I have to refer back to the table constantly to see okay does this one get does this one not it so it's really gotten convoluted um and and hard because then of course you throw in the humanitarian Parolees too because that's the other like all of our ukrainians are humanitarian pares they're not refugees they're not Ayes they're paroles so that's a workshop maybe for another day but the TB tends to kind of correlate to as the refugee status or not necessarily not I mean not necessarily so the majority um of TB uh is forborn however um since I've been here I know we had one um gentleman that was not foreign born um some of our current um cases are not foreign born um there's some tie to travel but they're not they were born in the US so um so yeah it it's not a direct correlation like I said the refugees are all tested before they come um they're tested when they get here we hopefully um can convince them um and with good um education that they should if they do come up as a positive um igra the blood test for TB that they get treated for U latent tuberculosis to prevent um um futuristically developing TB and that is incredibly labor intensive and the video portion seems to be working well we just talked about that not that long ago but the number of visits that's cut down I mean virtual visits seems to be working it it certainly helps with the timing now it does concern me sometimes that we're you know that for some of you know like I think of a couple of them that we have right now that are elderly you know their liver function studies are elevated you know are we are we having to see them on video too much should we be in the home and looking in them in the eyeballs because we want to see if there's any yellowing going on and that can be harder to see over a video so that does concern me you know that maybe we are relying too heavily on video DS but um at this point in time we seem to be doing okay good to know well with no other questions and we want to keep uh um to seven not eight or nine or so we want to get you out in the field okay I was trying be hopeful and Wishful and all those things thank you very much appreciate good work