May 27, 2025 Board of Health Meeting Minutes

OTERO COUNTY BOARD OF HEALTH MEETING
MAY 27th, 2025, 11:00 a.m.
OTERO COUNTY COURTHOUSE, ROOM 107
LA JUNTA, COLORADO

MINUTES

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:

• Richard Ritter, BOH Secretary, OCHD Executive Director

OCHD Attorney:

• Nathan Shultz, J.D.

OCHD Staff:    

• Chris Coffield, RHC
• Chris Menges, SUD Program Director
• Su Korbitz, Environmental Services Program Director
• Dee Leyba, CTC Program Director
• Krissy Phillips, CTC Program Assistant
• Dr. Janell Maier, Disease Prevention & Control/EPR Program Director
• John Miller, Business Manager
• Donna Starck, STEPP Program Director

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 2025 BOH meeting schedule was posted on the BOH website on 1/27/2025, and this agenda was posted in the designated public locations in all OCHD offices and on the BOH website by 5/23/2025.
3. Public Comment: There were no public comments.
4. Consent Agenda (ACTION ITEM)
   1. Approval of Minutes
      1. 3/25/2025, Regular BOH Meeting (Previously sent on 5/20/2025)
   2. Contract Ratification (Pursuant to C.R.S. 25-1-508 (5)(k) & C.R.S. 25-1-511 (3))
      1. North La Junta Sanitation District Loan Agreement
         1. Purpose: At the 7/30/2024 BOH meeting, Rick Ritter shared with the BOH that he was considering offering a no interest loan to the North La Junta Sanitation District (NLJSD) to either repair or replace their malfunctioning mosquito sprayer. The NLJSD applied for and received a grant to pay for a portion of a new sprayer, and OCHD provided a loan to fund the balance. Mr. Nate Shultz drew up the loan agreement, and the NLJSD paid the fee for the agreement.
         2. Status: Fully Executed
         3. Term: 2025-2028 (36 months)
         4. Amount: $7,170
            1. Thirty-five monthly payments of $199.17, and a single payment of $199.05 for the last month.
   3. Approval of Consent Agenda and Approval/Ratification of Items Therein: Lindsey Hart moved to approve the Consent Agenda and ratify the contents therein, Dr. Nelson 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 5/19/2025)
         1. March 2025
            1. Revenues: $155,009.17
            2. Expenditures: $181,894.81
            3. Deficit: $26,885.64
            4. Fund Balance: $3,531,006.02
         2. April 2025
            1. Revenues: $185,027.64
            2. Expenditures: $174,750.42
            3. Surplus: $10,277.22
            4. Fund Balance: $3,541,283.24
      2. Approval of Expenditures (ACTION ITEM): Dr. Nelson moved to approve the March 2025 & April 2025 expenditures in the amounts of $181,894.81 & $174,750.42 respectively, Mark McCuistion seconded, motion carried.
      3. Current Budget Outlook and Response
         1. Outlook: On 5/22/2025, Rick Ritter participated in a local health officials’ NACCHO Zoom meeting that featured Allison Winnike, J.D., as the primary speaker. Ms. Winnike is the Director of the Western Region Network for Public Health Law. Her presentation ran the breadth of federal Executive Orders (EO), cuts to federal, state, and local jurisdictions, current and future litigation including restraining orders and injunctions, federal agency funding restrictions/cuts, etc. Rick Ritter’s one sentence takeaway after participation was, “the only certainty is significant uncertainty.” Without doubt, the federal and state budget landscapes continue to be obscured with uncertainty, confusion, and contention. From a federal funding stream perspective, and relative to this uncertainty, OCHD receives pass through funds (via CDPHE) for Public Health Emergency Preparedness, (PHEP; 100% federal; been receiving this grant since approximately 2001); Epidemiology and Laboratory Capacity (ELC, 100% federal; ELC Round 2.2 term 8/1/24-7/31/25);  Immunization and Vaccines for Children (IZ#3; 100% federal; scheduled to end June 2025); CDC Infrastructure Grant (100% federal, term 7/1/2023-11/30/2027), WIC (100% federal, been receiving for decades), MCH (state/federal match). OCHD, along with the other Colorado grant recipients of ELC and IZ#3 received, from CDPHE, a stop work order effective Friday, 3/28/2025 based on a federal CDC funding rescission (AKA “Clawback”). This has been challenged in court, led by the state Colorado, in the case Colorado et. al. v. HHS et. al.  On Friday, 4/4/2025 Rick Ritter received a notice from CDPHE terminating the previous stop work order via a court Temporary Restraining Order (TRO). And then, on May 16th 2025, the court issued a preliminary injunction regarding the cuts to plaintiffs. As of the time of this writing, OCHD continues to receive FTE support through ELC 2.2 and IZ#3. Federal funding cuts obviously affect state governments, and this has a “trickle-down” effect on local governments, even with non-federal, state-generated dollars.  States are required to have a balanced budget, and when federal funds become unstable/unavailable, state government can cut funding to locals (see “CTC Budget Cuts” below). From a historical perspective, funding to Local Public Health Agencies (LPHA) has been the target of state funding cuts. Rick Ritter refers to this as the “Public Health Funding Rollercoaster”.
         2. OCHD Response: It is incumbent on OCHD, from a fiscal response viewpoint, to be nimble, flexible, adaptable, and ready to change course when the situation dictates.  As has already been established in OCHD’s FY2025 Budget, OCHD’s fund balance will be used as a deficit offset for 2025 and beyond.  Rick Ritter refers to using the fund balance as a deficit offset as “bleeding of the fund balance”. However, a major factor in maintaining fiscal strength during and after periods of lean financial times it to “slow the bleeding” of the fund balance whenever and wherever possible and practical. Without doubt, OCHD is currently in a state of good financial strength and significantly distanced from the trigger point for more extreme measures. OCHD budget trigger point (from BOH Minutes 3/26/2013), to consider significant staff and operational adjustments, is when the fund balance reaches or is approaching 25% of the operating budget at the end of a calendar year without a balanced budget or surplus identified for the subsequent year(s).”
            1. Fund Balance %
               1. 12/31/2023 Fund Bal. $3,066,617
               2. 2024 Approved Expenditures $1,979,314
               3. PERCENTAGE 154.93%
            2. OCHD’s response to the current situation, as detailed above, will be to assume a very cautious fiscal attitude, while continuing our public health practice in this uncertain, unstable fiscal climate.  OCHD will look for and take advantage of cost saving measures, where possible and practical.  Our current fiscal maneuvers protect existing staff now and later.  More specifically:
               1. Consider and use staff attrition through resignations/retirements when possible.  If, after an attrition maneuver, we find that we need to hire staff, then proceed;
               2. Use amplified scrutiny with purchasing, especially for non-subsidized items (i.e., not reimbursable through a program/grant); &
               3. Continue to look for grants and funding streams to support staff and operations.
      4. CTC Budget Cuts:  On 5/5/2025, Rick Ritter received an email from Marc Morgan which read, in part, as follows:  “…the state appropriation for the Community Organizing for Prevention program was reduced by approximately 31% in FY 2025-26. This email serves to notify Otero-Crowley Public Health Department of this funding reduction and provides information regarding the next steps to complete contracts for the upcoming fiscal year. All COFP grantees will see a reduction in the amount of funds in the FY 2025-26 contract. However, grantees will receive the full amount of funding equivalent to the personnel requested during February and March 2025 budget negotiations. In your case, that amount is $135,337. You may determine the best way to implement the amount of funds provided. This approach will enable work to continue throughout Colorado in the last year of the current funding cycle… If we are unable to complete budget revisions by May 29, we will route holdover letters to keep the contracts alive on July 1. This will avoid any break in service.” It is very important to note that, based on the information above, $135,337 (staff salary/fringe) is 39.4% less than the total of $223,325, not the 31% cut referenced above. Rick Ritter will follow-up with Marc Morgan regarding this apparent discrepancy.  Rick Ritter and Dee Leyba, CTC Program Director, met on 5/7/2025 regarding this issue. Based upon the current scenario, Rick Ritter has no intention of laying-off the CTC staff. However, if a 39.4% cut materializes, then the following will most likely be implemented:
         1. Extreme carefulness and scrutiny regarding non-salary/fringe expenses;
         2. Discontinuing occupancy of St. Pat’s Office and related expenses.
      5. 2025 OCHD Financial Risk Management System (FRMS) Assessment: The Financial Risk Management System (FRMS) is a CDPHE program that assesses the financial risk factors of local public health agencies (LPHAs).  On Thursday, 5/22/2025, OCHD received an email CDPHE FRMS which read, in part, as follows: “Thank you for submitting the supporting documentation for your agency’s State Tobacco Education Prevention Partnership (STEPP) award, CT FHLA 2024*0238, for the period of August 2024 in the amount of $60,802.98. The FRMS team assigned a Low risk rating based on the review of supporting documents.” A low-risk rating is the best rating that an LPHA can receive. A BIG CONGRATS to John Miller and Donna Starck for collectively achieving this desirable status!
   2. Personnel
      1. Retirement
         1. Tony Harviston, Environmental Services Program Assistant: Mr. Harviston submitted his retirement letter to R. Ritter on 5/20/2025. His final day of employment will be 6/30/2025. Given the current uncertainty surrounding federal and state budgets and funding streams, Rick Ritter is not yet sure if he will rehire for this position (see above). He has, and will continue, to consult Su Korbitz, Environmental Services Program Director, before a final decision is made.
      2. Resignation
         1. Gypsy Harviston, Community Health Worker:  Ms. Harviston submitted a letter of resignation to R. Ritter on 5/20/2025.  Her last day on the job will be 6/30/2025.  She is going to pursue a course of post-secondary education.  OCHD wishes her all the best in her new endeavors!  OCHD will not be rehiring for this position, and will use attrition as a cautionary cost-saving measure in these uncertain, turbulent financial times (see above).  Gypsy’s Immunization Program duties will be assumed by existing staff (see directly below).
      3. Status Change
         1. Christine Coffield: Ms. Coffield is currently approximately .5 FTE as the RHC Program Director. She will pivot into the Immunization Program to fill the vacancy left by Ms. Harviston with her available .5 FTE.
      4. Positive Vibes
         1. Donna Starck: Mrs. Starck recently completed complaint and compliance regarding the Colorado Clean Indoor Air Act (CCIAA). Following her report to CDPHE, she received 2 email responses that read, in part, as follows: From Raija McIntyre (CDPHE) on 5/21/2025 “Phenomenal response, Donna! Thank you! Would you be comfortable if I kept this response and used it as an example of how a CCIAA response can look from beginning to end? Grantees often wonder what to expect, and I'd love to be able to share what a positive solution could look like. Thank you, and again wonderful job!” & from Eric Brodell (CU Anschutz) on 5/22/2025 “Thank you, Donna! This is exceptional follow through and a model for other grantees just like Raija said.”  Congrats and thanks to Donna on a job very well done!
      5. New Personnel
         1. STEPP Program Support: For Fiscal Year 2026 (7/1/2025-6/30/2026), OCHD requested and has been awarded funds by CDPHE to increase OCHD’s Regional Tobacco Control Program (STEPP) by 1 FTE. Originally, R. Ritter was going to transition .5 FTE of Gypsy Harviston’s time and .5 FTE of Chris Coffield’s time to create this new position without necessitating a new hire. However, with the resignation of Gypsy Harviston, and the transition of Chris Coffield into the Immunization Program to fill that vacancy (see above), there is not sufficient, unsiloed FTE among OCHD staff to appropriately assume this position. This will necessitate hiring a new staff member, which will be fully supported by CDPHE STEPP. The goal is to support and strengthen our regional tobacco prevention efforts. This position will allow us to build capacity, provide training, and ensure continuity within the program.  Currently, OCHD’s Regional Tobacco Control Program serves 9 counties in rural, Southeast Colorado. Additionally, hiring now positions us to be better prepared should we be selected to participate in the potential Chronic Disease Pilot Program, expected in late FY26 or early FY27. If approved, participation in the pilot could bring an additional $100,000 to $150,000 in funding to our region based on the proposed funding model.
   3. 2025 Annual Ride for Recovery Motorcycle Poker Run: On Saturday, 5/17/2025, OCHD hosted the second annual Ride for Recovery Motorcycle Poker Run. The run started at the La Junta City Park, with stops (card draws) at the Frontier Diner in Cheraw, Fort Lyon, John Martin State Park, and back to La Junta. There were 10 motorcycles, 3 cars, and 2 chase trucks/trailers. The poker pot amounted to $505, with $255 going to the winning hand player, and $250 going to the recovery scholarship fund (eventually transferred to SECAHEC for scholarship disbursement). The Frontier Diner had breakfast burritos ready for purchase, residents at Fort Lyon greeted and visited with the motorcycle run participants, and we had a Bent County SO Deputy lead the way (with lights on) over the John Martin Dam and back to Highway Fifty. The purpose of this annual event is to raise awareness/reduce stigma surrounding SUD recovery and raise money for scholarships for those in recovery.
   4. 2025 Safety Jam/A Path Forward Event: On Saturday, June 28th, 2025, at La Junta City Park, the second annual Safety Jam/A Path Forward event will occur. This event is being planned and implemented by OCHD, The Schreiber Research Group (TSRG), and American Medical Response (AMR). The purpose is to raise awareness about safety, and raise awareness/reduce stigma regarding SUD/OUD. The day is packed with events that include a fun walk/run, free SWAG, exhibitor booths, free pizza (until it runs out), a helicopter(s) landing in the park, and Denver Bronco “Orange-Crush” defensive legend Randy Gradishar will be on site. Last year, the event was very well received!
   5. Addendum/Addenda: None
7. Program Reports
   1. CTC, Dee Leyba & Krissy Phillips: General information
   2. DCEP/EPR, Dr. Janell Maier: General information
   3. Environmental Services, Su Korbitz: General information
   4. OUD/SUD, Chris Menges via Rick Ritter: General information
   5. RHC, Chris Coffield: General information
   6. STEPP, Donna Starck: General information
   7. Vital Statistics, John Miller: General information
8. Executive Session: None
9. Adjournment: With no further business, Dr. Yoder adjourned the meeting.

Respectfully Submitted,

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