September 26, 2023 Board of Health Meeting Minutes

Otero County Board of Health Meeting

September 26, 2023, 11:00 am
Otero County Courthouse, Rm. 107
La Junta, Colorado

Members Present:
Dr. R.J. Nelson, Vice President
Mark McCuistion
Dr. David Trujillo

Member(s) Absent:
Dr. Paul Yoder, President and Medical Officer
Lindsey Hart

Ex Officio:
Amy White-Tanabe, Otero County Administrator
Richard Ritter, BOH Secretary, OCHD Executive Director

Commissioners:
Terry McMillian, Crowley County Commissioner
Tim Knabenshue, Otero County Commissioner

Legal Counsel:
Nathan Shultz, J.D.

OCHD Staff:
Chris Coffield, RHC
Tony Harviston, Environmental Services Program Assistant
Dee Leyba, CTC Program Director
Kristine Phillips, CTC Program Assistant
Dr. Janell Maier, Disease Prevention/Control/EPR Program Director
John Miller, Business Manager
Marie Mora-Menges, Nursing Program Director

Minutes

Call to Order: A quorum being present, the meeting was called to order by R. Nelson.
Public Notice Posting (Pursuant to C.R.S. 25-1-509(2)(±), C.R.S. 24-6-402 (2)( c )(I), & C.R.S. 24-6-402(2)(c)(III)): The 2023 BOH meeting schedule was posted on the BOH website on 12/15/2022, and this agenda was posted in the designated public locations in all OCHD offices and on the BOH website on 9/22/2023.
Public Comment: There were no public comments for items not on the agenda.
Consent Agenda (ACTION ITEM)
1. Approval of Minutes (previously sent on 9/22/2023)
  a. July 25th, 2023 Regular BOH Meeting
2. Contract Ratification (Pursuant to C.R.S. 25-1-508 (5)(k) & C.R.S. 25-1-511 (3))
  1. 2022-2023 CDPHE WIC Option Letter
    - Purpose: Increased CDPHE financial support for OCHD's WIC Program.
    - Status: Fully Executed
    - Term: 10/1/2022-9/30/2023
    - Amount: $194,650.00
      - Increase of$10,000 over the current contract amount of$ 184,650.
  2. 2023 Crowley County Public Health Services Contract
    - Purpose: Crowley County support for OCHD's public health services in Crowley County.
    - Status: Fully Executed
    - Term: 1/1/2023-12/31/2023
    - Amount: $16,197.00
3. Approval of Consent Agenda and Approval/Ratification of Items Therein: D. Trujillo moved to approve the Consent Agenda and ratify the items therein, M. McCuistion seconded, motion carried.
Old Business
1. None
2. Addendum/Addenda: None
New Business
1. Budget (Pursuant to C.R.S. 25-1-508 (5)(k) & C.R.S. 25-1-511 (3))
  1. Financial Summary Reportt (Based upon Tyler Financial Systems reports dated 9/20/2023)
    - July 2023
      - Revenues: $372,592.87
      - Expenditures: $162,051.03
      - Surplus: $210,541.84
      - Fund Balance: $2,546,112.43
    - August 2023
      - Revenues: $123,289.64
      - Expenditures: $166,758.03
      - Deficit: $43,468.39
      - Fund Balance: $2,502,644.04
  2. Approval of Expenditures (ACTION ITEM): M. McCuistion moved to approve the July 2023 and August 2023 expenditures in the amounts of$162,051.03 and $166,758.03 respectively, D. Trujillo seconded, motion carried.
  3. 2022 OCHD Fiscal Performance (based upon Tyler Financial Reports dated 9/20/2023): At the end of 2022, OCHD's fund balance was $2,599,553.50, which represents an increase of $464,578.81 over the 2021 year-end fund balance of 2,134,974.69. Revenues for 2022 amounted to $2,016,491.99, and 2022 expenditures were $1,551,913.18. OCHD received 105.50% of its budgeted revenues, and only expended 81.19% of its budgeted expenditures. This large surplus follows a nation-wide trend. In a Pewtrusts.org article dated 5/10/2022 and entitled Budget Surpluses Push States ' Financial Reserves to All-Time Highs (Budget Surpluses Push States' Financial Reserves to All-Time Highs IThe Pew Charitable Trusts (pewtrusts.org)) the following statement appears "During fiscal 2021 alone, states grew their collective rainy day funds by $3 7.7 billion, or an increase of roughly 50% from a year earlier-driving the total held among all states to a record high of $114.6 billion. Moreover, amid widespread budget surpluses, states reported the largest annual increase in leftover general fund budget dollars (known as ending balances) in at least the past 21 years."
  4. Fund Balance Importance: The fiscal reserves of the fund balance are critical funds that are used in times of necessity and after use should eventually be replenished to a sufficient level dictated by generally accepted financial/accounting principles. They serve as a protection by covering deficits caused by lost funding, unexpected expense, leadership transition, etc. Fund balances are required by C.R.S. 29-1-103 (2) if an adopted budget shows expenditures exceeding revenues. Regarding reserves in a fund balance, three important questions should be considered:
    - Liquidity: Does the organization have adequate cash to meet its month-to-month operating needs?
    - Adaptability: Does the organization have flexible funds that allow for adjustments, growth, and change?
    - Durability: Does the organization have access to funds to address a variety of future needs to deliver its mission over the long-term?
    - Regarding its ability to respond to the projected deficits, OCHD is in good financial shape. During the last 23 years OCHD has been deliberately building its fund balance to withstand financial tempests. In July 2000 (the month before R. Ritter was employed as executive director) OCHD reserves amounted to $104,699. The approved budget for that year was $837,237. The reserves at that time amounted to 12.5%. In fact, for one month during these fiscally troublesome times OCHD literally went bankrupt, with an approximate -$6,000 fund balance. At the September 2000 staff meeting, R. Ritter devoted most of the meeting to the budget and the dire necessity for staff to work together to build the fund balance. Subsequent staff meetings always had (and continue to have) a budget component. OCHD staff answered the call, and today the department is well positioned financially.
    - "Trigger Point": From the 3/26/2013 BOH Meeting, "R. Ritter has identified the "trigger point" to consider staff and operational adjustments, and that point 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)."
  5. Fund Balance Multi-Year Perspective 2001-2022: At the beginning of 2001, the fund balance was $181,723.74. At the end of 2022, the fund balance was $2,599,553.50, which is 14.3050 times the beginning amount in 2001.
  6. Fund Balance Recommended Amounts: Good financial principals dictate having between 3 to 6 months (25%-50%) of the operating budget in the fund balance. OCHD's operating budget for 2023 is $1,999,798.00 (Tyler Final Report dated 9/20/2023). 25% of this amount is $499,949.50, and 50% is $999,899. OCHD's fund balance beginning 1/1/2023 was $2,599,553.50, which is approximately 129.9908% (or 15.5989 months) of the proposed 2023 operating budget.
  7. 2023/2024 OCHD Budget Version 2.1 Approval and Adoption (ACTION ITEM)
    - Version 2023.2024.2.1
      - Overview
        2023 Budget Estimate
        Revenue Estimate: $2,108,322
        Expenditure Esimate: $1,708,076
        Surplus Estimate: $400,246
        2024 Budget Request
        Revenue Request: $1,976,858
        Expenditure Request: $1,976,858
        Contingency Estimate: $94,129
      - Notes
        This budget was sent to the Otero BOCC and BOH on 9/14/2023.
        R. Ritter received an email from Mrs. Amy White-Tanabe on 9/19/2023 saying that the Commissioners and Amy had reviewed the budget material and had no questions.
        The majority ofCOVID-19 funds received by OCHD (ARPA, CARES, OPPI Rural CARES, IZ CARES, ELC Round 1, ELC Round 2, ELC 2.1, and multiple rounds of COVID IZ) have been used to support non-siloed staff salary and fringe (staff that does not have a dedicated funding stream attached to them). This fiscal strategy allows the non-dedicated, nonsiloed funds that formerly supported these non-siloed staff to augment the fund balance. When the federal COVID funds began channeling through CDPHE and out to LPHAs, it was the expressed intent of CDPHE to keep the administrative burden as minimal as possible. ~hile it may have started in this manner, the administrative burden has grown considerably.
        Future Deficit Offsets: It is R. Ritter's intention to use the fund balance to support staff and operations during times of deficit, which will happen, OCHD will have years when expenditures exceed revenues. C.R.S. 29-1-103(2) states "No budget adopted pursuant to this section shall provide for expenditures in excess of available revenues and beginning fund balances." The foregoing applies to local government budgets, including OCHD's. Thus, deficits are allowed if there are reserves sufficient to cover them in addition to projected revenues.
      - Approval/ Adoption: D. Trujillo moved to approve/adopt the 2023/2024 OCHD Budget Version 2.1 as described above, M. McCuistion seconded, motion carried.
2. Personnel
  1. New Personnel
    - Peer Recovery Support Specialists (PRSS): On 9/18/2023, R. Ritter sent an email to detailing OCHD's plans to hire 3 new PRSS for the recently awarded HRSA grant to The Schreiber Research Group (TSRG). Specifics regarding the position (as detailed in the aforementioned email) are as follows:
      - This is a new position being created in response to the successful Health Resources Services Administration (HRSA) grant award.
      - These positions will be 100% subsidized by the new HRSA grant.
      - This is a grant-dependent position, the grant term is currently anticipated to be one year.
      - This is a training position. The successful applicants will receive necessary training through OCHD/TSRG to ready them for the mental/behavioral health workplace.
      - These positions will help support the workforce needs around mental/behavioral health.
      - The Grade will be 104, with a starting annual base of $32,202 (based upon the 8/2023 New Hire Worksheet). This equates to $15.48/hour, which approximates the local starting hourly rate of a PRSS in our area.
      - This will be a non-exempt position under the Fair Labor Standards Act (FLSA).
      - The goal is that when OCHD's PRSS's complete their term at OCHD, they will be ready to enter and support the local mental/behavioral workforce, and they will be hired locally/regionally by our mental/behavioral health providers, such as Valley-Wide Health Systems (Southeast Health Group).
3. 2023 BOH Training: Colorado Revised Statutes (CRS) 25-1-508(7) requires members of a local BOH to take part in annual training. CDPHE's Office of Public Health Practice, Planning, and Local Partnerships (OPHP) maintains a website to facilitate this ,1 training, and it is located here: Boards ofHealth IColorado Local Public Health and Environment Resources
  
  Additionally, R. Ritter will email the above link to BOH members after this meeting. R. Ritter will also be taking this training. BOH Members, please complete the training by 12/31/2023. If you need any assistance at all, please contact R. Ritter at 719-469-4045.
4. A Path Forward Fundraiser Rescheduled: The A Path Forward Fundraiser, detailed at the 7/25/2023 BOH meeting, was postponed. It is anticipated that the event will be rescheduled during the second quarter of 2024.
5. Needle Disposal Kiosk, Dr. J. Maier: OCHD is working with CDPHE's Colorado Household Medication and Sharps Takeback Program to potentially offer sharps kiosks in both Otero and Crowley Counties. Possible locations for kiosk placement could be in La Junta and Ordway. There is no cost to Otero and Crowley counties, CDPHE will be providing the kiosks and will contract with a sharps disposal company that will come down for monthly pickups. Next steps include the following:
  1. Contact smaller, rural areas that have implemented kiosk programs to gain an understanding of their experiences and get their insights, generate a "pros and cons" list.
  2. Discuss the kiosk program with the cites of La Junta and Ordway.
  3. Discuss possible kiosk placement locations with city and county officials, law enforcement, and fire/EMS departments.
  4. Research kiosk outreach/educational materials.
  5. Report back to the BOH, city/county officials on the products of the above activities.
6. 2023 WIC Fiscal Monitoring Desk Audit: OCHD recently underwent a standard WIC desk audit. There were no findings. An excerpt from the audit outcome letter included the following: "Your accountability system reliably documented the expenses allocated to WIC. Adequate documentation was provided and additional information requested was readily available. You are timely in the submission of your invoices. You do a good job of preparing Reimbursement Invoice Forms." Congratulations to Jo Jancar and John Miller on a job well done! Addendum/Addenda
7. Addendum/ Addenda: None
Program Reports
1. CTC, Dee Leyba: General information
2. DCEP/EPR, Dr. Janell Maier: General information
3. RHC, Chris Coffield: General information
4. Vital Statistics, John Miller: General information
5. Executive Session: The Executive Session was tabled for a subsequent BOH meeting to allow for attendance of additional BOH members.
6. Adjournment: With no further business, R. Nelson adjourned the meeting.

Respectfully Submitted,

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

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