January 28, 2025 Otero County Board of Health Meeting Minutes

January 28th, 2025 Otero County Board of Health Meeting Minutes
Otero County Courthouse, Room 107, 11 am
La Junta, Colorado

Members Present: 

• Dr. Paul Yoder, President and Medical Officer
• Dr. R.J. Nelson, Vice President
• Lindsey Hart
• Mark McCuistion

Member(s) Absent:

• Dr. David Trujillo
• Ex Officio: Jim Baldwin, Otero County Commissioner
• Richard Ritter, BOH Secretary, OCHD Executive Director
• Amy White-Tanabe, Otero County Administrator

Commissioners:

• Tim Knabenshue, Otero County
• Vicky Powell, Crowley County
• Terry McMillian, Crowley County

OCHD Staff:

• Marie Mora-Menges, Nursing/WIC Program Director
• Chris Coffield, RHC
• Chris Menges, SUD Program Director
• Jeff Richardson, PRSS Trainee
• Dee Leyba, CTC Program Director
• Dr. Janell Maier, Disease Prevention & Control/EPR Program Director
• John Miller, Business Manager
• Donna Starck, STEPP Program Director

MINUTES

1. Call to Order:  A quorum being present, the meeting was called to order by Dr. Yoder.
2. Public Notice Posting (Pursuant to C.R.S. 25-1-509(2)(f), C.R.S. 24-6-402 (2)(c)(I), & C.R.S. 24-6-402(2)(c)(III)):  The agenda was posted in the designated public locations in all OCHD offices and on the BOH website by 1/27/2025.
3. Public Comments:  Citizens may address the Board of Health (BOH) on items that are on the agenda or not on the agenda. Items of a personal nature may not be discussed.  Personnel-related matters shall be directed through the appropriate chain-of-command.  You will be asked to state your name prior to your comment.  Neither BOH members or health department staff should be expected to engage in discussions or debate with any speaker. The BOH may direct staff to follow-up with certain matters.  Out of respect for the BOH and others in attendance, please limit your comments to three (3) minutes or less.  The total time allotted shall not exceed 30 minutes per BOH meeting, unless prior arrangements are made.
4. Consent Agenda (ACTION ITEM)
   1. Approval of Minutes (previously sent on 9/26/2024, 11/20/2024, & 1/24/2025)
      1. September 24th, 2024 Regular BOH Meeting
   2. Contract Ratification (Pursuant to C.R.S. 25-1-508 (5)(k) & C.R.S. 25-1-511 (3))
      1. 2025 CDPHE STEPP Option Letter #2
         1. Option Letter Contract Number:  2024*0238 Option Letter #2
         2. Purpose:  CDPHE support for OCHD’s Tobacco Control Program.
         3. Status:  Fully Executed
         4. Term:  1/1/2025-6/30/2025 (6 months)
         5. Amount:  $142,880.00
      2. 2024-2025 CDPHE WIC Task Order
         1. Task Order Number #:  2025*0256
         2. Purpose: CDPHE support for OCHD’s WIC Program
         3. Status: Fully Executed
         4. Term:  10-1-2024-9/30/2025
         5. Amount: $181,922.00
            1. Decrease of $6,421 over the previous contract amount of $188,343.00 (not including $7,500 of computer replacement funds).
      3. 2024-2025 LJPS.CSU PRC.SECOR MOU
         1. Purpose: SECOR support (through OCHD) for the school district’s AV-SAPIP participation and activities.
         2. Status: Partially Executed
         3. Term: 2024-2025
         4. Amount: $10,045.00
         5. Note:  At the 9/24/2024 BOH meeting, it was explained that the CTC/CSU SECOR grant is a one-time payment in full, and not on a monthly cost-reimbursement structure.  The entire $588,311.60 has already been deposited, and will be drawn down to support grant deliverables such as school district participation and the CSU PRC’s work and support.
      4. 2024-2025 LAPS.CSU PRC.SECOR MOU
         1. Purpose: SECOR support (through OCHD) for the school district’s AV-SAPIP participation and activities.
         2. Status: Partially Executed
         3. Term: 2024-2025
         4. Amount: $10,045.00
         5. Note:  At the 9/24/2024 BOH meeting, it was explained that the CTC/CSU SECOR grant is a one-time payment in full, and not on a monthly cost-reimbursement structure.  The entire $588,311.60 has already been deposited, and will be drawn down to support grant deliverables such as school district participation and the CSU PRC’s work and support.
      5. 2024-2025 ManzyPS.CSU PRC.SECOR MOU
         1. Purpose: SECOR support (through OCHD) for the school district’s AV-SAPIP participation and activities.
         2. Status: Partially Executed
         3. Term: 2024-2025
         4. Amount: $10,045.00
         5. Note:  At the 9/24/2024 BOH meeting, it was explained that the CTC/CSU SECOR grant is a one-time payment in full, and not on a monthly cost-reimbursement structure.  The entire $588,311.60 has already been deposited, and will be drawn down to support grant deliverables such as school district participation and the CSU PRC’s work and support.
   3. Approval of Consent Agenda and Approval/Ratification of Items Therein: Dr. Nelson moved to approve the consent agenda and ratify the contents therein, Mark McCuistion seconded, motion carried.
5. Old Business: None
6. New Business
   1. Budget (Pursuant to C.R.S. 25-1-508 (5)(k) & C.R.S. 25-1-511 (3))
      1. Financial Summary Report (Based upon Tyler Financial Systems reports dated 1/24/2025)
         1. September 2024
            1. Revenues: $664,067.96
            2. Expenditures: $171,976.92
            3. Surplus: $492,091.04
            4. Fund Balance: $3,454,513.15
            5. Note:  The atypically high revenue and corresponding surplus is reflective of the SECOR grant deposit in the amount of $588,311.60 (detailed previously at the 9/24/2024 BOH meeting).
         2. October 2024
            1. Revenues: $212,435.22
            2. Expenditures: $189,633.66
            3. Surplus: $22,801.56
            4. Fund Balance: $3,477,314.71
         3. November 2024
            1. Revenues: $232,183.88
            2. Expenditures: $146,470.54
            3. Surplus: $85,713.34
            4. Fund Balance: $3,563,028.05
         4. December 2024
            1. Revenues: $118,820.66
            2. Expenditures: $163,604.32
            3. Deficit: $44,783.66
            4. Fund Balance: $3,518,244.39
   2. Approval of Expenditures (ACTION ITEM):  Lindsey Hart moved to approve the September 2024, October 2024, November 2024, & December 2024 expenditures in the amounts of $171,976.92, $189,633.66, $146,470.54, & $163,604.32, Dr. Nelson seconded, motion carried.
   3. 2024/2025 OCHD Budget Version 3.0 Approval and Adoption (ACTION ITEM)
      1. Version 2024.2025.3
         1. Overview
            1. 2025 BUDGET REQUEST
               1. REVENUE ESTIMATE:  $2,064,419
               2. EXPENDITURE ESTIMATE:  $2,530,786
               3. DEFICIT ESTIMATE:  $466,367
         2. Notes
            1. Version 3.0 was sent to the Otero BOCC and BOH on 11/22/2024.
            2. The BOH meeting at which this budget was scheduled to be approved/adopted, which was scheduled for 11/26/2024, was cancelled due to the inability to achieve a quorum.  Thus, the BOH was unable to approve/adopt this 2025 budget prior to Otero County’s approval/adoption of the overall county 2025 budget on 12/12/2024.
            3. On 12/11/2024, Rick Ritter sent an email to the BOH which read, in part, as follows: “Hello to all.  Due to a lack of a quorum, we had to cancel the 11/26/2024 BOH Meeting.  That meeting’s agenda had the approval/adoption of OCHD’s 2024/2025 Budget Version 3.  At this point, it looks very unlikely that we will be unable to convene a BOH meeting in December… I had previously sent OCHD’s 2024/2025 Budget Version 3 to you for your review on 11/22/2024, and I received no questions/concerns regarding the budget.  I have attached that email for your reference, which also includes Budget Version 3.  Given the current situation, I would respectfully recommend the following course of action:  I can submit OCHD’s 2024/2025 Budget Version 3 to Otero County for inclusion in Otero County’s 2025 Budget.  I will then request that the BOH ratify this budget at the 1/28/2025 BOH meeting.  There is nothing in statute that prohibits this of which I am aware, and this method is somewhat akin to our consent agendas where you ratify contracts after I sign them.”
            4. Based upon the previously disseminated information, Rick Ritter respectfully requested that the BOH retroactively approve/adopt the finalized 2025 budget figures.  Mark McCuistion moved to approve/adopt the 2025 budget as detailed above, Lindsey Hart seconded, motion carried.
      2. Personnel
         1. Vicki Powell, Crowley County Commissioner: Vicki Powell has been elected as the Crowley County Commissioner for District Two.  Congratulations and welcome, Commissioner Powell!
         2. New Personnel
            1. Jeff Richardson, PRSS Trainee: Mr. Richardson has joined OCHD as a PRSS trainee. He has been assigned to Ft. Lyon.  His position is fully subsidized by the TSRG HRSA PRSS grant. At the conclusion of his training, it is anticipated that he will receive COPA certification as a PRSS. Welcome Jeff!
         3. Positive Vibes
            1. Debra Jaramillo: Debra Jaramillo serves as a Deputy Registrar in OCHD’s La Junta Office.  On 11/19/2024, Mrs. Jaramillo received a bouquet of flowers accompanied by a note which read as follows: “Debbie, thank you so much for taking such care and attention to our need to get Mary Valadez’s name changed!!!  We are so grateful!!  You’re a gem!  Cindy and Mary”.  Thanks for the great customer service, Deb, and congratulations on the positive vibes!
      3. 2025-2029 Community Health Assessment (CHA)/Public Health Improvement Plan (PHIP) Review and Approval (ACTION ITEM):  Colorado Revised Statutes (CRS) 25-1-505 requires LPHA’s to prepare a local PHIP that must be consistent with the statewide public health improvement plan required under CRS 25-1-504.  At a minimum, the local plan must address the following:
         1. Examine data about local health status and risk factors;
         2. Assess the capacity and performance of the local public health system;
         3. Identify goals and strategies for improving the health of the local community;
         4. Description of development and implementation of the local plan;
         5. Description of coordination necessary to accomplish the goals and priorities identified in the plan; &
         6. Identification of available financial resources that are necessary to meet the identified public health needs and to implement core public health services.

The BOH reviewed and approved the previous 2020-2024 CHA/PHIP plan at its 1/28/2020 regular BOH meeting.  

The process to complete the local plan is known as CHAPS, which is an acronym that stands for Community Health Assessment and Planning System. Dr. Maier and Marie Menges completed the vast majority of the work, and R. Ritter sincerely appreciates their hard work and dedication to this required and important project! Gypsy Harviston provided the graphic design work, and she did a fantastic job!  In addition to Crowley and Otero, the plan also includes the counties of Baca and Bent. Dr. Maier and R. Ritter met and reviewed the plan on 11/21/2024.  

For Crowley and Otero Counties, screening and prevention, mental health and suicide prevention, substance abuse, physical activity, and food insecurity were chosen as priorities.  These health concerns were selected based on:

1. Local data;
2. Feasibility/practicality to address issues; &
3. Capacity assessment indicating community readiness and availability of strategies/ best practices to address the issues.

Dr. Maier then proceeded to give a more in-depth, detailed overview of the CHA/PHIP.  

The local plan was e-mailed to the BOH and the Crowley/Otero BOCCs on 11/22/2024 and 1/24/2025.  The local BOH, pursuant to CRS 25-1-508 (5)(b), is to approve the local plan and submit it to the state BOH for review.  Dr. Nelson moved to approve the 2025-2029 CHA/PHIP, Mark McCuistion seconded, motion carried.

1. 2023-2024 OCHD WIC Annual Contractor Performance Evaluation:  On 11/18/2024, OCHD received an annual contractor performance evaluation for our WIC Program.  The period of evaluation was 10/1/2023-9/30/2024.  There are 3 possible ratings, “Below Standard”, “Standard”, and “Above Standard”.  OCHD’s WIC Program received the standard rating for all 7 performance categories.  Additionally, it was noted that OCHD was “in compliance with the terms of the contract”.  This evaluation is very significant and welcome, as OCHD has been “conditionally approved” for funding for the 2024-2025 contract year (previously detailed at the 7/30/2024 BOH meeting).  Congratulations to the WIC Team on a job very well done!
2. November 2024 Blizzard Emergency Shelter:  OCHD implemented an emergency blizzard shelter at the Rocky Ford United Methodist Church (RFUMC) on Thursday, 11/14/2024 through Saturday, 11/16/2024. OCHD staff responding were Chris Menges, Jeff Richardson, and Rick Ritter.  Pastor Marty Lee graciously opened the RFUMC as an emergency shelter. In addition to the church, Pastor Lee and his wife, Sandy, provided food and cooking.  Rick Ritter served as Incident Commander (IC) and Chris Menges served as Deputy IC while on-site, and Larry Chatman served as IC during Menges’ and Ritter’s absence. Volunteers included Val Clark, Deloras Demmer, Kristin Carpenter, Larry Chatman, M.J. Guzman, Cheryl Lindner, Melissa Root, and Jane Wheeler.  A total of 6 guests were served, 4 homeless, 1 abandoned, and 1 stranded.  At approximately 1:30am on Friday morning, AVRMC called regarding placement of the wheelchair-bound double amputee that had apparently been abandoned.  This individual was transported by OCHD from AVRMC to the shelter.  Then, at approximately 3:00am, AVRMC called again regarding placement of the stranded individual at the shelter.  An Otero Sheriff’s Office deputy provided that transport. OCHD purchased food for the shelter, and well as sleeping bags for those experiencing homelessness.  On Friday, the volunteers of the day-shift were tasked with finding appropriate destinations for all guests. They did an excellent job, as at the closure of the shelter on Saturday no guests were simply turned out into the street.  Otero DHS took over management of the double amputee on Saturday, and provided accommodation for her until she was able to fly back to her family out of state.  Otero DHS also purchased the plane ticket!  Thanks to Tommy Chambers and Donna Rohde for assisting this individual! OCHD has since participated in 2 additional sheltering events.
3. OCHD’s 100th Anniversary in 2025:  Being formed in the year 1924 or 1925, the Otero County Health Department (OCHD) has the distinction of being one of the oldest (if not the oldest) Local Public Health Agency (LPHA) in Colorado. It is believed that during our first year, OCHD employed a doctor and 3 nurses, and had an estimated budget of $11,000. At OCHD’s inception, the Rockefeller Foundation agreed to furnish $2,500/year for the newly formed LPHA (The foregoing information taken from the newspaper The Daily Democrat dated 3/11/2024). R. Ritter is planning on hosting an OCHD anniversary open house sometime in 2025. The open house will feature historical information and items, as well as food/snacks.  Invitations will go to the BOH, OCHD staff, and our private and public sector partners.
4. 2025 Regular BOH Meeting Dates, Times, and Location (ATION ITEM):  Dr. Nelson moved to keep the BOH meeting schedule the same, L. Hart seconded, motion carried. The 2025 schedule for regular BOH meetings will be as follows:
   1. Dates: Last Tuesday of every other month, beginning in January;
   2. Time: 11:00 a.m.; &
   3. Location: Otero County Courthouse, Room 107
5. Reappointment of Dr. Yoder to BOH: The Otero County Commissioners have re-appointed Dr. Yoder to the BOH for a 5-year term that began on 1/1/2025 and will continue through and including 12/31/2029.  Thanks to the Commissioners for this important reappointment, and to Dr. Yoder for his willingness to continue to serve!
6. 2025 OCHD Medical Officer Approval/Renewal (ACTION ITEM):  On 10/10/2024, Dr. Yoder indicated to R. Ritter that he was willing to serve another term as OCHD’s Medical Officer.  R. Nelson moved to approve Dr. Yoder as OCHD’s 2024 Medical Officer, Mark McCuistion seconded, motion carried.  The BOH expressed its gratitude to Dr. Yoder for his continued service in this necessary and important capacity.
7. 2025 BOH Officers’ Election (ACTION ITEM):  R. Nelson moved to keep Dr. Yoder as President for 2025, Lindsey Hart seconded, motion carried.  Mark McCuistion moved to keep Dr. Nelson as Vice-President for 2025, Lindsey Hart seconded, motion carried.  The group expressed their gratitude for Dr. Yoder’s and Dr. Nelson’s continued service as BOH officers.
8. 2025 Required BOH Training:  Rick Ritter will work with CDPHE’s OPHP to arrange an in-person training following an upcoming 2025 BOH meeting.  This is the manner in which the BOH completed the required 2024 training.
9. 2025 Executive Director Succession Plan (ACTION ITEM):  In the event of Rick Ritter’s unexpected/sudden death or sufficient incapacitation, a succession plan will need to be implemented until the BOH can formerly appoint a new administrator or Rick Ritter recovers from said incapacitation.  Rick Ritter respectfully recommends the appointment of Dr. J. Maier to fill the position of Interim Executive Director.  This general guidance on succession planning is a living, modifiable plan that cannot address all conceivable scenarios, and the BOH has the latitude to modify or alter this plan as it deems necessary.  This arrangement supersedes any previously approved plans.  It is Rick Ritter’s intent to have this plan reviewed and approved annually at the November BOH Meetings.  Below is a current list of the Executive Director’s duties, which will come within the purview of the Interim Executive Director.  Rick Ritter reviewed this proposed succession plan with Dr. Maier on 11/21/2024.
   1. Emergency Preparedness and Response
      1. Incident Commander (IC)
      2. Emergency Support Function 8 Lead for both Crowley and Otero County
      3. South East Region’s Regional Transfer Point (RTP) Lead
      4. Health Alert Network (HAN) Coordinator
   2. Public Information Officer (PIO)
   3. Otero County Registrar of Vital Statistics
   4. Colorado Association of Local Public Health Officials (CALPHO) Representative
   5. OCHD administration & governance
      1. Staff
         1. Program Director supervision
         2. Conflict resolution
         3. Staff meeting preparation and facilitation
         4. Hiring/dismissing (Include Nichole Rallis, Otero County Human Resources)
         5. Board of Health Secretary
         6. Liaison between BOH and BOCC
         7. Contract management
         8. Budget/Funding
         9. Risk management
         10. Staff security/safety
         11. Strategic planning
         12. Law/Legal (Include Nate Shultz, OCHD Legal Counsel)
             1. Enforcement
             2. Meet duties/obligations of Colorado Revised Statutes, Code of Colorado Regulations and applicable CDPHE policies and contractual requirements
         13. Partner relationships
         14. Signatory authority

Dr. Nelson moved to approve the succession plan as detailed above, Mark McCuistion seconded, motion carried.

6. Addendum/Addenda
   1. 2025 Public Notice Posting Placements (Pursuant to C.R.S. 24-6-402(2)(c) (ACTION ITEM):  Colorado Revised Statutes (C.R.S.) 24-6-402(2)(c)(III) states “…a local public body shall be deemed to have given full and timely notice of a public meeting if the local public body posts the notice, with specific agenda information if available, no less than twenty-four hours prior to the holding of the meeting on a public website of the local public body… A local public body that posts a notice of a public meeting on a public website pursuant to this subsection (2)(c)(III) may in its discretion also post a notice by any other means including in a designated public place pursuant to subsection (2)(c)(I) of this section; except that nothing in this section shall be construed to require such other posting. A local public body that posts notices of public meetings on a public website pursuant to this subsection (2)(c)(III) shall designate a public place within the boundaries of the local public body at which it may post a notice no less than twenty-four hours prior to a meeting if it is unable to post a notice online in exigent or emergency circumstances such as a power outage or an interruption in internet service that prevents the public from accessing the notice online.”  C.R.S. 25-4-402(2)(c)(I) states “…In addition to any other means of full and timely notice, a local public body shall be deemed to have given full and timely notice if the notice of the meeting is posted in a designated public place within the boundaries of the local public body no less than twenty-four hours prior to the holding of the meeting. The public place or places for posting such notice shall be designated annually at the local public body’s first regular meeting of each calendar year…” 
      1. The essence of these statutes are as follows:
         1. With online posting, you do not have to post notices physically unless digital posting is temporarily not available due to technology/emergency issues.  OCHD posts digital notices.
            1. The BOH must designate a location(s) to post physical notices if the situation warrants.
         2. In addition to digital posting, the BOH may continue to post physical notices. If this choice is made, then the BOH must designate the physical locations on an annual basis at their first meeting of the calendar year.
      2. R. Ritter respectfully recommended the following to the BOH:
         1. Continue with regular physical postings. This will then serve to meet the physical posting requirements for technology/emergency issues that interfere with digital posting.
         2. Previously, the BOH has approved the lobby area for the La Junta and Rocky Ford offices and outside the door to the Ordway office. These locations are conspicuous to the public, and R. Ritter recommended these same locations to the BOH for 2025. Dr. Nelson moved to approve the recommendations as detailed above, Mark McCuistion seconded, motion carried.
7. Program Reports
   1. CTC, Dee Leyba: General information
   2. DCEP/EPR, Dr. Janell Maier: General information
   3. Nursing/WIC, Marie Mora-Menges: General information
   4. SUD, Arlene Cooke: General information
   5. RHC, Chris Coffield: General information
   6. STEPP, Donna Starck:  General information
8. Adjournment:  With no further business, P. Yoder adjourned the meeting.

Respectfully Submitted,

Richard Ritter

Richard Ritter
Secretary, Otero County Board of Health
Executive Director, Otero County Health Department