Consolidated Human Services Board Meeting | January 12, 2026

001Validated human services board meeting. I will be serving as your chair temporarily this evening. Um I'm director of validated human services agency and I would like to begin by having the pledge of allegiance. >> Pledge allegiance >> to the flag of the United States of America and to the republic for which it stands. One nation under God, indivisible, with liberty and justice for all. [Music] >> I'll now offer an invitation. >> Dear God, thank you for the opportunity to gather in service to our community. We ask for wisdom this evening as we consider the needs of all of those we serve in Union County. for clarity as we make decisions and unity as we work together for the common good. Guide the conversations around this room. Strengthen our compassion and help us to lead with

002integrity, humility, and care. May our work this evening and on all of our days reflect justice, hope, and respect for every person. Amen. Amen. The next item on the agenda is the approval of the consolidated human services board minutes for the October 2025 meeting. There is a copy of the minutes in your packet. Y'all can take a moment to review those. And when you're ready, let me know any changes that have been made or there's a motion to approve. >> I'll make a motion to approve. Have a motion to approve by Amy and second by Brandy. All those in favor? Any opposed? Motion passes. >> The next item is the approval of the agenda. >> I'll make the motion to approve. >> Motion to approve from Randy. Second from Amy. All those in favor? >>

003I. >> Excellent. Thank you. The next item is the executive director's report and the first item that we will complete during this portion is the consolidated human services board elections for the 2026 calendar year. The board uh elects a chair and vice chair annually at the first meeting of the calendar year to serve a one-year term. The executive committee shall be composed of a chair, vice chair, and one additional member of the board as voted upon by the board annually at the same time and in the same manner as the vice chair. Nominations will be received and discussed in the order of their nomination and the first nominee to receive a majority of the votes of the members present shall be appointed to the position. Once the chair and vice chair are elected, their terms

004of office shall begin immediately upon election. Last year, Amy Dicki was elected as the chair and Brandy Smith was elected as vice chair and Dr. Craig Kolash was elected to serve in the other person executive committee position. All three of those are eligible because they've only served one year in that role um for reappointment to those positions if you all so elect. and uh anyone else is also eligible to serve in those positions. So at this point I would like to open up the floor for nominations for the chair. >> Yeah. Can I renominate Amy for chair? >> Granny would like to nominate Amy for chair. >> And Dr. Royce seconds that. Excellent. Uh making sure I'm following the process there. I believe. Oh, are there any other nominations for chair? And you may self-nominate

005as well. All right. Hearing none, I would like to uh request a vote on the nomination of Amy Dicki to serve in the role of chair of the consolidated human services board for the 2026 year. All those in favor? >> I. >> Any opposed? Excellent. That nomination passes. And so now, Miss Dicki, congratulations. Uh, and I believe we will go into the vice chair nominations. >> Excellent. Do we have any nominations for vice chair? >> I was going to nominate Brandy for another term if she is so willing. She is. Do we have any other nominations for vice chair? [Music] We have a second for my nomination. All right, we could take a vote on Brandy serving a second term as vice chair. All those in favor say I. I. >> Any opposed? So, it

006passes. Thank you. Uh next we have the um position of um on the executive committee. Previously um uh Dr. Kash have this position. Do we have any nominations? >> I would like to renominate Dr. Kohash second. Dr. Weiss as a second. Do we have any other nominations for the executive committee? With no other nominations, I'd like to put Dr. Kash to nomination to a vote. All those in favor say I. >> I. I. >> Any oppos? Any opposed? It also passes. Congratulations to send it back to you, M. Our next item, there are actually three items that are going to be sort of tied together, at least related to this, but the next item that we would like to have is the dangerous dog, potentially dangerous dog determination uh and appeal process. And this will

007be an update and information on the process as a whole um provided by the sheriff's office. I would ask them to introduce themselves um when when they begin. I believe you have a microphone there. And the intent of this will just be to go over the process as a whole. Uh inform you about the general statute and local code of ordinances that apply and give authorization and authority uh for these activities and then the process that is utilized in making determinations. And then as a followup to this, when we go over the next agenda item, which is the rules of procedure and policies, there will be an addition of uh content and information associated with this just about y'all's process specifically in in association with this. And then uh if you all choose to take

008action to adopt that, there will be a third item which would be selection of potential members on an ad hoc committee should there ever be an appointment. And so at this point, I would like to turn it over to Lieutenant Jamie Grigg and Sheriff's Legal Counsel Brandon Christian. [Music] >> I usually don't talk into a microphone, so I don't know if this is working or not, but um can everybody hear me? Okay. I'm I'm Lieutenant Jamie Grigg, and I am over the animal services division of the sheriff's office. I've been in that role for two years and I' I've worked at the sheriff's office for 24 years in various different ro roles. Um, we wanted to come tonight and just kind of go over what animal services does when we deem a dog uh dangerous,

009potentially dangerous. the um we we we take in over 500 bite reports a year, but in 2025 with those bite reports that we investigate and we receive, only three dogs were deemed as dangerous or potentially dangerous dogs. Um, a lot of investigation goes in to these matters when we get them to determine if we're going to deem the dog dangerous. We uh, of course, we follow the county ordinance and chapter uh, 67 of the general statutes that gives us guidelines for what has the dog done and does it meet that criteria in the statute before we deem the dog dangerous. And as you can expect, we all have something in our mind of what is a dangerous dog? Obviously, one that runs at you in a threatening manner like it's going to bite you and

010you you feel the need to run. You know, that that that could be a potentially dangerous dog. But I'll just go over some of the statute that we that we look at before we deem a dog dangerous, which may end up one day getting it, you know, to the appeal board process to get here to the health department. The uh all bites are reported to the health department and are reported for us for investigation. But under chapter 67 of the general statutes, a dangerous dog means it's a dog without provocation has killed or inflicted severe injury on a person. It is determined by the person or the board designated by the county or municipality authority responsible for animal control to be a potentially dangerous dog because it has engaged in one or more behaviors listed

011below. And this is some of the other factors that we look at when it's reported to us of these different dog bites that happen around the county. Did it inflict a bite on a person that resulted in broken bones? disfiguring lacerations or required cosmetic surgery or hospitalization. A lot of people that get bit end up at the hospital, whether it's for stitches or x-rays to clean that wound out. What's disfiguring disfiguring lacerations is really kind of up to determination. you know, if I if I have a big rip on the side of my face and I have stitches in it, to me that's that's disfiguring my face. Uh, same thing for arms or hands. So, we look at a lot of pictures. The deputies are out there getting photographs of these incidents, doing a uh

012actual police report on the instance, supplement reports, and those pictures are all being attached to this. the deputies that go out to the calls for the bites, they're they're the investigators, the detectives, so to speak, on the dog bites. When they get those, the determining factor of the dangerous dog comes to me. So, I I'm not the person that gets the call and goes out to the scene, but I'm getting all the evidence given to me through the police report, witness statements, camera footage from people's homes, etc., and then I'm looking at all the facts. The dog could also have killed or inflicted serious injury upon another domestic animal when not on the owner's real property. So, if it didn't attack a person, but it just attacks another pet, it's got to leave its property

013to do so to be deemed a potentially dangerous dog. It's not the case for people, but for another dog or cat that it attacks, you know, it's got to leave its property. uh it can actually approach a person when not on its property just in that vicious terrorizing manner. And we get calls for that a lot too where somebody's just taking a stroll in their subdivision and this German shepherd keeps running off of the property and and and chasing them down the street and they have to run from it. And in their opinion, this dog is going to attack me if I don't I don't run. So even a dog just doing that with no bite whatsoever constitutes under general statute as a potentially dangerous dog. You don't have to wait to get bit to

014do something about it. More or less. Like I said earlier, we get a lot of bites throughout the year. They're reported to us from the hospital, urgent care, personal doctors. They can self-report it on our website, our app. They they come in through faxes, 911 calls, and over 500 of those bite reports were recorded with us last year. But only three dogs met the criteria to be a dangerous dog. If those dogs are deemed dangerous, the second I deem that dog dangerous, it is in our kennel at the shelter and it does not leave. The owner of the dog cannot come just pick it up. We serve them with a dangerous dog declaration that they typically meet with me down at the office and we sit in a conference room and we go over that

015declaration to get them to sign it and I sign it and they can choose to get the dog back if they would like, but they have to conform to very strict kennel regulations. The state law does not specify those regulations. That is left up to me. We have a a standard where the the kennel has to be on a concrete pad. The concrete pad's got to be at least 4 in thick. And the the gauge of the kennel's got to be at least an eight gauge wire. That's a wire that you're not going to just shake with your hands. And it's got to have a top on it. And the dog can never leave that kennel for the rest of its life unless it's going to a veterinarian care. It's got to be in that

016kennel 24/7. It can't be in the house. It can't be loved on or slept with or anything like that. That dog lives the rest of its life in this kennel. That's the only way they can get that dog back and or they surrender the dog to us. Once they surrender the dog to us, it becomes the property of the Union County Sheriff's Office Animal Services Division to which point we're going to euthanize that dog because we're not going to put it back out into the public. they they can also appeal my decision. And we tell them that when we serve the declaration, we we tell them that they have three business days under the statute to appeal my decision. And if it gets appealed, then that's when it comes to um the ad hoc board

017or the consolidated human services board for a hearing. And we just want to kind of go over this statute with everybody on on the board to kind of express and let you know what we deal with. You're you're welcome to ask questions to me and let me answer some stuff. But if if you look at the number of bites we take reports for, it could be an Amazon driver, UPS, granddaughter over at the house. I mean, it could be anything you can imagine that someone gets bit by a dog. And and keep in mind we don't we don't do this for any other animals, just dogs. So I mean people get bit by all kinds of things. But if you can imagine any kind of a bite in your mind, it can happen and it

018does and it gets reported to us. But I kind of want to stress the the importance of the dangerous dog declaration. When the sheriff's office gets to the point to actually declare that dog dangerous, it is not because we wanted to. There is an actual statutory reason behind it. And we have to fulfill those requirements to deem that dog dangerous. It may not be dangerous to its owners. It may not be dangerous to the 10-year-old boy that lives in the house, but it has done something to meet this criteria to deem that dog dangerous because we have a lot of children get bit by dogs. And those dogs are not dangerous dogs when they're not deemed. And we just have to make sure at the sheriff's office as a whole and the role that I'm

019in as lieutenant over that shelter to make sure that we I'm not sure where else to really go on this. Um, I'm not sure where else to really go on this. Um, of course, Attorney Brandon Christian's here. He's going to go over a few things as well, but I'll open it up at this time if I may. There may be parts of it that are somewhat vague at times, but as I've learned in my career, some laws are vague and they're vague for a reason. But, uh, and at the end of the day, we just try to follow that statute the best we can to protect everybody. Uh, you know, Union County is growing. Everybody knows that. The subdivisions, the amount of traffic, we're just going to have more and more animals, more and more

020dogs, and we just want to make sure everybody's protected to the best of our abilities and take care of the citizens. >> You you guys made it clear what um what the consequences of a dangerous dog is, like being deemed a dangerous dog. What are the consequences of a dog being deemed potentially dangerous? So the the outcome of a dangerous dog or potentially dangerous dog is the exact same outcome. Um a person I'll give you an example. If a person is severely attacked by a dog to where they're in the hospital for days on end, several reconstructive surgeries, you know, that dog has just really mauled that person up. or you have a dog that has severely attacked their neighbor's dog, maybe two $3,000 in vet bills. And in my eyes, there there's a difference

021because we're dealing with a dog verse human life. But whether that dog is deemed a potentially dangerous because it attacked another dog or it's attacked that person, the outcome of getting that dog back is the same because that dog that has viciously attacked someone's pet could possibly do that to a person as well. Vice versa, we don't always know what's going through an animal's mind. Um I I know a lot of people will argue back and forth all day. I know my dog will never do that. No, you don't. You absolutely don't. And we see that on our end where people say, "I would have never thought." So the outcome to get your dog back after deemed dangerous or potentially dangerous, it's the same. >> Got it. >> So the label is based on what

022they did to get there and then it's the same path. >> Yes, sir. >> Any other questions or anything I can answer? Be more than happy to. Good evening everyone. My name is Brandon Christian. I am legal counsel for the Union County Sheriff's Office. So, just because I am the lawyer in the room, I'm going to be very careful here. Um, I am not a lawyer for Union County. I am not a lawyer for Union County Human Services Agency. I represent solely the Sheriff's Office. So, I'm not here to provide legal advice. I'm only here to uh to kind of explain the way we view this appeal procedure and offer some thoughts on how we go about doing these appeals. Uh >> can we pass this around? >> Yes, if you would. Thank you, Dr.

023Broadway. What Dr. Broadway is passing around right now uh is the we have uh done some refinements to the dangerous dog declaration process. And part of that is is that there has never been a standardized or formal appeal process. It's always been very loose. And I don't think that has done uh a benefit for animal services. I don't think it's done a benefit for the dog owners and I don't think it's been a benefit to this agency. Um, so in order to kind of make things a little bit clearer, the statute says that a person who owns or possesses uh some a dog that has been declared dangerous or potentially dangerous may appeal that decision to the Consolidated Human Services Board because y'all are designated to hear those appeals in our ordinance or what's called

024the ad hoc dangerous dog committee which uh Janet will talk about more in your further action items on the agenda. But essentially, in order to appeal, the statute says that the person must make written objections. If you look at the document that I have had passed out to you, that's exactly what this document is for. It is designed to help somebody trying to appeal to tell you all exactly what it is that they think that Lieutenant Grigg got wrong in the dangerous dog declaration. Uh that should help streamline the appeal process because the whole idea of an appeal was not that you have to retry the whole thing. That's what Lieutenant Griggs already done. He's gone through and reviewed all the evidence. What y'all are called upon to do is to look at his work

025and say, "Did he get it right or did he get it wrong?" And the only thing that y'all are supposed to be looking at based on my reading of the statute, and that's my reading of the statute, is whatever written objections the dog owner presents to you. It's not an independent factf finding mission, which should make y'all's lives and y'all's job easier in the process because you're only having to worry about exactly what the dog owner says was wrong with Lieutenant Grigg's decision. What we are going to do, we are going to start including this notice of appeal uh paperwork in the packet when Lieutenant Grigg declares a dog dangerous or potentially dangerous. and we will go ahead and accept that written appeal on y'all's behalf and transmit that to uh Miss Payne and let

026her coordinate setting up the meetings uh and the appeal meeting and that's kind of how we're going to take this process and then Lieutenant Grigg uh will appear before the ad hoc committee or this board which hears it depends on the exact timing of the declaration uh and from there the decision ision will be put to you and we would ask that you simply consider what has been presented here today uh including the statutory definition. Lieutenant Greg in his declarations are is going to say which of the statutes the dog violated. For example, did the dog severely injure a person or did the dog severely injure or kill another animal off his own property? his declaration is going to say which of the provisions he acted under so that y'all can more clearly uh see

027that and determine whether or not he made the right decision. That's really what I wanted to show y'all tonight. Uh, I'm more than happy to answer any questions about the entire process, about uh what we do, about how it gets to you, or even what can happen after you determine that the dog should be declared dangerous or if you determine the dog was improperly declared dangerous, kind of what would happen after that. I'll be happy to answer any questions, but I don't want to bog you all down in a meeting with a bunch of procedural uh law. So, with that, I'll open the floor to any questions. I have a question. So the the primary changes are going to be that you have they have to submit the written you know um objection and that

028it has to be on the incorrect findings of fact specifically and if anything else comes up in that we direct them back to it wasn't written. >> Cor well not just the incorrect findings of fact. If he said if you they can say okay yes my dog did my dog bit this other dog on the tail but that was incorrectly applied. It does not mean that he severely wounded another animal. So that could be that could be a written objection but the whole idea because the because what was happening is that we would give them the letter and tell them they had the right to appeal and they just write I want an appeal on the letter. That doesn't help anybody. That doesn't help lieuten that doesn't tell Lieutenant Grigg what he potentially did wrong.

029So he walks in here and then has to be prepared to essentially represent everything which is not a streamlined hearing. And that's not the way an appeal in again my opinion. I don't think that's the way an appeal is supposed to work. I think that somebody sitting as an appellet judge for lack of a better term is supposed to decide on the issues. That's what we That's what we in the court system make people do, too. You have to say what your problem with the trial judge's ruling was. You can't just say, "Hey, I want a general review." So, yes, ma'am. That's how that's that's our view. >> So, this year, one of the dangerous dog cases that came up was someone who was um currently incarcerated. Now, I don't know if the individual was

030what their literacy was, but what would that look like? And if we have they have to write out their appeal. >> Well, so I would say the person you know the I now in this case I happen to know the facts and circumstances of the case that you're referring to, but you know, we're not going to I don't think it would be fair for this organization to hold somebody to like a law trained standard, but all they got to do is is get close enough. got to say, "No, my dog didn't bite this other dog or it was not a savage attack." To me, that would be, again, my opinion doesn't control would be enough for y'all to consider, okay, was this a mauling or was this just a simple bite? Does that meet the

031definition? Or maybe, yeah, he was he was cut up, but it wasn't se it wasn't real bad, maybe a way he would put it. And then y'all would say, "Okay, is this severe lacerations or not?" I don't think they have to get the exact perfect wording, but just enough to put everybody on notice. This is my problem. Any other questions? >> I don't do >> Thank y'all for letting us uh present tonight. If you do ever have any questions, Lieutenant Grigg is more than happy to provide information. Certainly, uh, Janet knows how to get in touch with all of us and we're more than happy to help any way we can at any time. Uh, if there's nothing else, I'll turn it back over to her. Thank you very >> Yes. The next item for

032your consideration is the review of the consolidated human services board rules of procedure and policies. There are five human services rules as well as the um excuse me policies as well as the uh rules of procedure. And if you look on page 28 of your packet, uh you will see within the rules of procedure the only changes that we are proposing making and that is underneath article six committees. We are adding a header for section one which previously wasn't needed because we did not have a section two and we are proposing that the addition of a section two uh in alignment with the information that the sheriff's office just presented. I will read that out loud for you. It is section two ad hoc dangerous dog board in accordance with article 1A of chapter 67

033of the North Carolina general statutes and section 6-575 of the Union County Code of Ordinances whenever the chair determines that an appeal of a determination that a dog is a dangerous dog or potentially dangerous dog cannot be heard by a quorum of the human services board within the time period required which is 10 days according to the statute. The chair will notify or request that the director notify the county manager who shall then appoint three persons to serve as a board to hear an owner's appeal. The ad hoc dangerous dog board is the name of that. In order to assist the county manager in appointing persons to the ad hoc dangerous dog board, the human services board shall provide the county manager with a list of individuals from one of the two following sources who

034may be able to serve on the ad hoc dangerous dog board. The first source is you all, the human services board members. And we propose that annually the human services board shall select and endorse by vote a minimum of four members to be available to serve on the ad hoc dangerous dog board. The second group is local veterinarians. Annually, human services agency leadership will work to recruit up to three county residents whose occupation is veterinarian to be available to serve on the ad hoc dangerous dog board. Human services agency leadership will coordinate with the Union County Sheriff's Office, county manager, and the chair to complete all administrative functions related to the ad hoc dangerous dog board. Any questions about that content? >> Just for reference, the reason that it is a minimum of four members.

035So our intent is to have a pool of seven people um ultimately but in case there are veteran so it's it's the human services board responsibility by statute uh to be available to serve again if if we don't have the ability to have a meeting in a quorum within 10 days of the declaration and appeal then we would have the sati board and so we want to make sure that we have at least three people who are able to serve and so our thought about having a minimum of four from you all is that that would give us one extra and then obviously if we have local veterinarians as well then we're covered beyond that. But um starting with this group as a a pool of potential uh participants [Music] and the only other change

036is on page 31 and that will be once you all um vote to approve the rules as amended. If you vote to approve them as amended, however you vote to approve them, we will change that date uh to this evening's date, assuming that we have a majority in favor. [Music] Do we have any questions on the proposed changes that have been presented? [Music] If we have no questions, do we have a proposal? Anyone propose we go ahead and proceed with a vote on the changes? >> I propose we proceed with the vote. >> Do we have a second? >> Second. >> And Lisa Ker second. All right. All those in favor? >> I. >> All opposed? >> And it would be formally. >> Excellent. Thank you all. Now we'll move on to the policies. There

037are five of them. I can go through each of them and and will be happy to do that, but want to give you just an overview of the changes because they are pretty much the same for each of them. Um the first change is to remove references to the division of public health from each of the policies and instead they will be listed solely as under the consolidated human services board. Uh we did engage with the school of government and they verified that there does not need to be any reference to any department because once consolidated excuse me once consolidation occurs it's up to each county as to whether or not they want to reference just the agency as a whole or also maintain any distinct identity or divisions or departments within the agency. But

038that that's not necessary because the departments are no longer standalone entities. They're just part of the services agency. So that is the um initial change at the header of each of these. And then secondarily we updated the approval and review date header descriptions and revision tracking information that is actually at the end under change history of each of the policies. So if you look for instance on page 32 and 33 of your packet, you'll see all of that. Um it previously said approved, reviewed, and revised. And we thought that it would be a little bit more clear to say originally approved since the next date is actually reviewed and approved with any changes. And then the revised is no longer needed or really maybe never was needed because the change history covers revisions and has

039a date and so it's captured underneath the change history. So are there any questions about those changes in general? If not, I think we need to go through each one of them or we could just call all of them out. So, let me let me ask this. That probably would be the easiest thing. So, there are five five policies. The policy development policy, which is literally the framework for how you all develop these um when you want one and and how you uh want one um and and how that is then done. And the second is the rules adoption policy and that is applicable when enacting any regulations that you all do it in accordance with the general statutes that are applicable which is 13A-39 and 138-43. And we actually will have um an update

040in June hopefully. We're going to try to do that with the school of government to go over the authorizations that you all have and and the authority based on the general statutes which some of you have uh received previously and some of you may not have had that update but we're going to try to have an update from the school of government at least once every two years in association with that. The third policy is thee sorry thank you is the appeals policy and that is um also in conjunction with general statute 138-24 and um if you have any questions about that we can talk a little bit more. This is the only one where questions came up in the past, but basically um or as well as any uh administrative penalties enforced by the

041local health director, those appeals would also come to you all for review. And so this just governs that and indicates that that is effectively the process should there ever be an appeal. And the fourth policy is the staff development and staff development, training and education policy. In short, it says that we want to ensure that our staff have the resource to the knowledge and education and skills training uh that will help them perform their jobs effectively. And so that's the intent of that. And the last policy is the public participation for community health improvement policy. And that basically is saying we're going to complete a community health assessment and in conjunct which we are required to do once every three or four years. we do it on a threeyear cycle now. Um, thank you. Sorry,

042>> sorry, >> I triggered myself there. And um, and that we will include the community to have public feedback in that space. If there are questions about any of the specific policies, I think you guys could make a motion to um approve the changes as proposed in all of the policies. >> I just have one question. >> Yes, ma'am. >> Could you on policy three like could you give me I think I understand what it's saying. Could you just give me an examp? >> Yes. Uh we can and actually I'm going to turn it over to Tracy Collie for just a second if she would speak to that because she has a little bit more in-depth knowledge than I do and um maybe it was more openly. So Tracy >> sure we can give you

043an example. So currently >> everybody hear me? Okay. So currently here in Union County, we really only have one uh set of public health rules. The difference between public health rules and county ordinances, public health rules are enforcable across municipal municipal boundaries. And our uh public health rules that we enforce are the irrigation well rules. and that uh those rules basically require irrigation wells to be constructed, sampled, inspected at the same standard as a private drinking water well. Uh and that ensures protection of groundwater supplies, protection of public health. That is the only public health set of public health rules we have now. So if an irrigation well was uh permitted um as part of that process the installation of that irrigation well was in violation of a setback installed in the middle of a

044septic system drain field something like that and we had to take regulatory action. The appeal rights were provided to the property owner or well owner. The appeal would be heard if they did appeal the decision by this board. [Music] So right now this revolves around this one public health rule >> basically. >> Yes, that is the only one we have. I spoke with our county attorney this morning confirmed that there could be some old ones way back in the day but this is the only one and it's been in effect since 2008. Now just for um clarity there are uh county ordinances that environmental health is involved in enforcing those uh those are those appeals are heard by the board of county commissioners. So examples of those which there are two is the Union County

045ordinance for mass gathering and uni county ordinance for solid waste management. So in those situations, the board of county commissioners may look to you all for information, expertise, review, but the overall responsibility and jurisdiction for those uh ordinances lies with the board of county commissioners. >> Any you have any follow-up questions or that explains it. >> Thank you. And those don't go across municipal all municipalities. Correct. >> Right. So the uh the uh irrigation well rules are enforcable across all municipalities throughout Union County for you know obvious reasons for the public health importance. the uh uh mass gathering ordinance and solid waste ordinance are only enforcable in unincorporated Union County and two municipalities that have adopted them and that's uh Mineral Springs and Heavy Bridge. Are there any other questions? [Music] There are no other

046questions. Are there any proposals to move forward with the proposed to adopt the changes? >> Do we have a second to adopt the changes? >> Second. >> A second from Miss Susan. Um, all those in favor. >> I. All opposed. [Music] >> Excellent. Thank you all. Thank you very much and y'all have a good night. Um, the next item is the ad hoc dangerous dog board selection of potential members from the human services board. I won't go back through all of that again since we just read it, but uh at this point, if you all would select nominate four members to be available to serve on the dangerous dog board and then um endorse those that by vote, that would be great. I will uh say that Earl Ward and Wendy Sanders are not here

047this evening, but both of them have confirmed that if necessary, they would be willing to serve on um on this ad hoc dangerous dog board potential member. >> Is this something new that you're doing? Because I know the way we've done it in the before is like anybody on this board, whoever is available >> it is. And so y'all can if everybody says yeah, I'd be happy to serve and that'd be great. We just would like to have at least a minimum of four of you uh to to be the first four that we could call or part of part of the actually the county manager is going to choose whomever he or she at the time would like. Um we will present him with at least seven hopefully uh at least four from from

048you all and then again trying to have at least three other local veterinarians and he can select the members of that ad hoc uh committee at that or ad hoc board at that time. If more than four of you would like to serve and are interested in that by all means we welcome as many of you as possible. Just the goal is so that if and when these come up, which they are rare, but when they do, um they're timesensitive. And so we want to make sure that a everybody's well educated, which was part of the intent of having the sheriff's office here this evening because if it's within 10 days of your regular meeting, then all of you would hear and and it would be the full group. So that's relevant. But uh so

049yes, it's it's just more formalized actually. it to try to make us be assuredly able to have a pool for the county manager to pull from if he so chooses. >> So Janet, I I'm happy to be a part of that. My term is up in June and then I'm happy one of the veterinarians. One of the three veterinarians. >> All right. Great. And so I guess we could well we can count that both both ways then in that regard. Tracy, I think you have something. I was just going to restate what's already been discussed, but remind everyone that this process will be repeated annually at the same time the chair and vice chair are selected. >> And again, you may never be called to do anything. It's just I think hopefully good practice to

050have this in place. >> Could we do a show of hands of those who might be interested in being one of those four to see if we already have the number to proceed? >> That is perfectly good. and we when we have two who are not here if if necessary also. >> So um of everyone here tonight if you would be willing to put your name forward as someone to potentially serve if you could please raise your hand. >> Okay. >> All right. Great. We have four in the room. That means I guess the two who aren't in the room may uh >> well be with Dr. Weiss going >> uh yes. Say again. So they're still part of the pool. >> They can still be part of the pool. That >> I suppose we

051can say with Dr. Weiss going out, can we do a pool of six then? Like that since they said they would be willing to. >> Absolutely. Yes. You you all can can vote on that. And so can we say the names just so that we can have it for the record or Carla? Did you get that? >> I got it all. >> Okay, great. Never mind. >> She's got it. >> Got it. >> Yes, please have a motion. Motion to approve the >> motion to approve >> members of the ad hoc style board. >> Thank you, Dr. White. And do we have a second? >> Thank you, Miss Kerr. All those in favor? >> I I >> So, at this point, you'll be part of the whole pool, but effectively still the human services board.

052And then if you do roll off and and don't um >> and I'll try and recruit some other vetinarians for the board. >> That would be great if you could work with Dr. Broadway. Uh he's going to spearhead that for us on on the county's behalf and um and so if you roll off the board >> I retract my offer then you call me as >> just kidding. I just I have to work with him. I'm not sure I want them. Just kidding. >> That's awesome. >> I do know Janet if she's going to roll off the board in June, she's responsible for finding her own replacement. I like that as an idea as well. At least recommend. >> I didn't sign up for that. >> Encourage some of those people you're recruiting for the

053board. How about that? >> I know a couple people I can ask. >> That's great. Um before I finish with with my portion, I would like to ask I believe all of you saw the roster, but if you didn't have a chance, uh a I'm sure everybody signed in, but specifically to to verify your mailing address and phone number. phone number is not uh going to be posted for public consumption but we just need it internally so that let's say we have an ad hoc dangerous dog board and we need to get in touch with you um that we have that in place and also um we have kicked off the budget season for the FY27 budget which is really hard to believe and so uh we'll be providing an update about that at some

054point but I guess as a starting point. Uh the the good news that I can share is um we have not been requested as we have been in prior years recently to have proposed budget cuts uh at least initially. That does not mean that there won't be any, but it does mean that um we're starting at a neutral point. We do know that it is going to be probably a very tight uh budget year in terms of of revenue and that sort of thing. And so uh we also don't expect many requests to be approved but certainly we will bring forth anything that is necessary for us to sustain uh operations and and provide excellent service to the community. And so I'll provide you guys an update on that as we move through the process.

055That is all that I have. >> Will we go to Miss Morgan next? >> Yes, we will. [Music] Good evening. So, I'm going to present to you tonight our bad debt write off. Um, it's in your packet and I'm not going to read read all of that to you. I'll just do a summary. So to remain in compliance with state guidance, public health is required to make every reasonable attempt to collect patient debt for uninsured patients and patient balances owed after third party insurance determines that balances left are the responsibility of our patients. So the parameters that must be met to meet bad debt write off. It has to be less than $50 owed in the individual account. The balance must be 12 months old or greater. There has to be no patient payment activity

056on the account for 12 months and we determine that by sending out the patient statements monthly in attempt to collect the balances that are owed. Balances are moved into inactive status in our EMR system which is our electronic medical record QRMD and upon approval of the bad debt write off report by the BOCC. We do reactivate these accounts when and if services are rendered to the patient after they are inactivated for bad debt. The current amount that we're um dealing with is $1,46.64 and that's represented in 57 individual client accounts. So the action that we're requesting is a recommendation to the board of county commissioners to authorize the county manager to maintain compliance with the public health bad debt write off process and allow our staff to complete this bad debt write off process in

057the amount of 14664. [Music] >> I just have a question. So, if someone owes money and they don't pay it and it's written off, can they come back in and still be seen and get new services and run up debt again or are they required to pay that balance that they didn't pay? >> So, when they when they come back in for services, the debt would be reactivated and then we would still charge they would still be charged, but we would not refuse service. >> In which case, it goes over 50. It doesn't get written off. >> No, this is bad debt. There is a debt set off process for amounts over 50 and these processes are done annually. We just brought you the bad debt off set off tonight. The write off, excuse me.

058>> Any other questions? >> So, if you write it off and they come in and they happen to pay it, then what happens? >> And they pay what's owed. They just continue to receive services. >> But if we've written it, you're asking if >> So, if it's written off, then is it gone? Do they have to pay it after it's written off? >> No. With a with a write off, it would be reactivated. In other words, this is a client that may have come in and received a service and then we can't get in touch with them. They're not responding. They haven't been back in at all. So, it's not like they're coming in and continuing to receive services and not paying. >> So, there had been no activity for payment on the account for

059a year and they're not responding to the patient statements. >> Okay. But if you write it off, then isn't it gone or is it just I mean >> they're still in the system. It's written off out of the QRMd system, but we have a way to reactivate the day. >> Okay. It's just out of that system. Okay. It just kind of cleans it like a house. Okay, that's fine. I have a problem with that at all. I was just I was just being curious. >> Thank you. >> Any other questions? >> So, is this I'm just curious some more questions. Is this done every January? Because I just don't remember if I was here last January or seeing this. And if it is done every January, how does this compare to previous Januaries? >> It's

060done annually. I don't know that we brought it back consistently in the same month. >> Okay. Just wonder. >> So I can check that for you. Get >> annually. Is it about this amount or is this, you know, how does this compare to previous years? >> Historically, it's not a large amount when you're in the $50 and under because it's a lot of times it's co-pays or I'm just giving an example. It may be a long-term birth control method that's $800. Well, that patient if it's longterm doesn't have to come back in for two or three years. So, we may not see that patient and that device just doesn't get paid off. That would be an example. >> Okay, just so I'm clear, so after a year they have the patient has bad debt. You

061don't see them for a year, gets written off, they come back in for service. Do they and it gets reactivated this bad debt and you tell them you you owe us $25 and they say well do you put them on a payment plan or do you >> they can be on a payment plan. Yes. >> So you do require payment. >> We do require >> to get more service. >> Yes. They also have to have paid as well. >> We don't refuse them service but you still give them service even though we do not refuse service. >> We do not refuse service. So you ask for it, but if they say they can't pay, they still get served. They would still receive services, but we would reactivate the debt. >> We have to clean up

062the cure system, which is our EMR. And if they're not active in the system, so we're cleaning up the debt within the CURMD medical record system, but we can still go back in and reactivate because if they come in, they're going to go back into the patient system. So we would be able to see them again. >> But when their debt goes over 50, it's a different >> it's a different process altogether. >> And this counts toward that >> if it reactivates. >> Yes. >> And the new pushes it over there. >> It goes on to a new. So So there's even a pathway there because of the reactivation. Okay. >> Any other questions? >> Any motions? [Music] I'll move that they write off the bad deck in that system. Second. >> All those in

063favor? >> All opposed. [Music] Thank you, Miss Morgan. Next up, we have Miss Tracy Collie. Okay. So, I have two new public health fees for your consideration this evening. Uh, the first one is a CPT code 900611, Virginia. Uh, this code represents a combined small pox monkey pox vaccine. And then the second one is CPT code fluilvax. Uh, and that is for an uh, influenza virus vaccine. And I have a couple of very smart ladies here. If you have any specific questions about these vaccines, um, sure we can answer any questions you might have. >> Has there been any long-term safety testing done on these vaccines? >> So, Genos has been we've been given the Genios vaccine. Um I can't speak specifically to any specific data to studies but um the reason we are bringing

064this code to the board now is um the lots that we've been given by the state foundation and so now you do with that with with what you will but um the goss have vaccines have been used for small pox not just the imp um but again as As far as specific data here, I can't really speak to safety zones. >> My question would be, do you look at how many because you said their vaccines are expiring, so they're going to be wasted, right? So, do you guys look at how many you've used and how many? So, you're not buying and stocking and loss. >> Yes, we we monitor that inventory weekly. >> In discharge, it's per dose, Virginia, or both doses. that pert the Genios was actually developed back in like 2003 originally for

065smallox. >> Um so it's been around for a long time and then was approved for um EMPOX recently a couple of years ago. We just, you know, we the reason we want to get it approved now um before those lots potentially expire is we would not be able to administer those vaccines without having, you know, the fees approved. >> Do you know how common it is that we administer these vaccines? Um I'll be honest if when we have um you know risk when there's media regardless of I mean regarding outbreaks when we when we have are getting information regarding outbreaks we see um an higher a higher demand and increase in uptake um right now that's not necessarily the case I will say the last dose we administered was last When we're giving those free

066and we didn't previously have a fee and they are they have commercial reimbursement, do we get funding for from the commercial insurance for it? >> We would charge the commercial insurance. >> So, previously it had the potential to >> I don't think so. No. If we get it for free, we don't charge at all. Period. >> Yes. We in order for us to charge a fee regardless of >> you have to have a fee. >> We have to have a fee. >> Private insurance. >> Yes, ma'am. >> Is this a common policy where they give you so many and then say you're on your own, you got to start charging or paying for >> emerging conditions. It is. Yes. >> For what? >> With emerging conditions. So newer conditions like with co initially with co

067the state supplied all of the vaccines and then we kind of transitioned away from that and started billing commercial insuranceances and so monkey pucks would be an emerging condition >> and the demand you know one after that initial amount is provided by the state but really the demand is determined by the you know public health department or the area our demand may be much lower than say the Charlotte metropol the Charlotte area meck county or Durham Guilford County those those types of areas >> can you explain the fee slide just sliding if the vaccine is given in a clinic that the fee has to slide then the fee slides. If it's given in immunization clinic, that's the only clinic that it would not slide. >> And what causes a sliding fee? >> Is that based

068on income? I think this really the question >> based on income like with um [Music] yes with income. So basically if someone could afford the full fee based on their income level then they might pay the full fee right and then there are thresholds and those are established uh specifically in regard to um >> federal poverty >> level. So there's no projections on what the cost might end up being for something that was previously free that we then approved today that could fall to the the sliding fee like what we're looking at the impact financial impact >> the cost to the residents or the total revenue that we would anticipate >> you would anticipate because of if the fee sled is it going to go below what it actually cost you to obtain it >>

069if these slides. Would that go below what it cost us to purchase? >> It could. >> And then there are some that patients that would receive it, it wouldn't slide. There are some patients that would receive it that um they have private insurance or Medicaid that would pay the full fee. >> Do we have any other questions? Yeah. Uh, so do we have a back do we have the vaccine out there available that's that's separate small pack or is this just going to replace that and you have to get this that has both smallpox and monkey because if a child need a monkey pox vaccine [Music] >> if the child is is yeah they could need small pox or they could need impox if they're sexually active or they've been exposed >> like like a

07010-year-old >> potentially Do we have options that they can get the vaccine that's not a combination or is this going to replace that? >> So if they want the small pox vaccine now they have to get a vaccine that has both automatically that has small pox and monkeyox because they just want one cuz we know where monkey pox comes from. >> Genius was first developed for small pox not for >> impox our standing order is that it's an impact. So just it's the same vaccine but now being used for both. Right. >> Okay. That's what I was asking. That's what I was asking. Okay. >> That's fine. >> I was asking if there's like an addition to it, but >> maybe that's what you're explaining. I just didn't hear >> the efficacy is for those

071small. >> That's what I was asking. Right. >> Okay. Thank you. >> Yes. Just to be clear, there's not an additional component for imposs. Yeah, that's a good question. That's exactly what I was trying to do. Thank you. >> Any other questions with regard to the request to approve these two fees? >> I have a motion to approve the two fees. >> We have a motion to approve these two fees. Do we have a second? >> I'll second the motion. >> Have a second. Thank you very Dr. Charles. Sorry, I can't see your name. Um, all those in favor I all opposed. Thank you. They are thank you for the questions. >> I do have a question though now that we have approved them with regard to if someone came in at the age of

07210 that was sexually active um with monkey pox >> with with monkey pox. I mean, you know, I don't want us to go down the rabbit hole on a on a random scenario, but um 10 and sexually active, like are there any protocols in place for that? Like for understanding and making sure that that's not a child welfare situation? >> So, specifically, um there are there's a specific set of criteria for Genos. Um you would be um MSM and men who have sex with other men. Um and for um in contact with men who have sex with other men. Obviously, if there are concerns about um you know, high-risisk behaviors that would warrant a report, that would be um another question. I don't I would not anticipate um you know a 10-year-old coming in to

073request the EMPOX vaccine based on that. Um you know just given the the risk history but obviously if that was a conversation to be had um it would be at a provider's discretion. I mean and and that would be consulted during that visit. Thank you very much for the clarity. Um, Miss Collie, >> do you have another on the communicable dis illness report? So, this is this uh report that we're going to begin doing each month at the board meeting is just to keep you um informed of the current um status of respiratory illnesses and the measles uh case numbers that are expanding um uh in the United States and also you know kind of give you an an update from the national state and bring that all the way down to the uni county

074So just look to receive this report monthly um you know uh during this time where we have influenza, respiratory viruses and measles. So I'm going to let Megan take it away. >> Thank you. I'm Megan Ro. I'm the people supervisor here at Union County Public Health. Um and tonight we just again to reiterate, we want to bring you some updates for respiratory illnesses. um some measles that's an exciting topic and then some vaccine changes that you may have heard in the news regarding the schedules for childhood vaccines. So for um respiratory illnesses and this is more broadly um the epidemiology in the US may be aware but influenza like illness rates are higher than rates previously noted within the last six years. um rates do vary dramatically from state to state, but North Carolina um

075rates are very high and that's based on um percent like percent positivity um the number of illnesses presenting to ERS um and that information is captured um with a statewide database. Um the CDC estimates that there are over 11 million flu-l like illnesses across the US, 120,000 hospitalizations, um and 5,000 um deaths from the flu thus far. Um the main reasons for such dramatic increases include a mutation. So influenza A, specifically um strain H3N2 mutated over the summer. Um and that shifted from a J subclate to a slightly different K subclaid and the subclaves are just like taxonomy. It's kind of tracking the lineage of vac uh viruses. Um and continued decline in vaccination rates. Um mutations are very normal for the flu. Um and those mutations can um cause changes in trends. This year

076we've kind of seen more significant or substantial tren uh trend changes than what we usually see with mutations. And unfortunately this mutation occurred after the flu vaccine formula was finalized in February. So it means that the flu vaccine for this year may only recognize parts of the mutated flu um virus. And although um mismatched, the flu vaccine has seemed to prove some protection against severe illnesses and preliminary data from the UK shows that the flu vaccine may reduce hospitalization by 70 to 75% in children and 30 to 40% in older adults. Um last year was the deadliest non-pandemic flu vaccine for US children on record. Um it also happened to have one of the lowest flu vaccination rates. Um so far nine children have died from flu um from flu or flu complications so far

077this year and we anticipate that it's even higher given that um reporting's typically delayed. Um this you know the higher flu rates and mutations also has impacts on our concerns for pathogenic aven influenza. When you have higher rates of circulating flu um you'd have the higher likelihood that somebody's co-infected. Um so if they're co-infected with HPAI um then it can cause another mutation which leads to um easier transmission from person to person. Luckily RSB activity and COVID transmission are a little bit lower um than what we traditionally see with um this time of year. Um this will be the first year that the winter wave does not peak in the first week of January. [Music] As you can see here um in the purple you do have total respir respiratory rates. Um the flu like

078um is in the influenza like illness is in the green. Um and then the blue and yellow RSV and COVID respectively. Um inatient admissions also appeared to spike that uh the same week which was the week um of ending in the 27th. Um and it showed the highest percentage of ER visits with respiratory like illness with a weight rate of 25.3%. Um of all ER visits having those respiratory symptoms. Um these rates have decreased slightly over the last two weeks which kind of you know locally signals um a peak and now a decline. Any questions about respiratory illness? >> All right. So, measles in the US for the Yes. I'm sorry. >> What's the flu vaccine efficacy? >> Especially since I guess this mutated the flu mutated after the flu was approved. So efficacy varies

079year to year um kind of depending on what flu I mean the the mutations or the strains that are circulating. Um and then it varies depending on the um effectiveness as far as illness severity, hospitalizations um which is why I point that out as well. So, it will vary depending on if the flu vaccine mutates. Um, and when you're talking about efficacy, you think about does it prevent illness? Does it prevent severe illness? Does it prevent hospitalizations? >> Do we do we know? Does anybody need the doctor? >> And you won't until the flu season is over. >> Okay. Or last year, what was it? Do we know? >> Anybody know? I I mean, from what I've heard, it's pretty low. the efficacy is pretty low. That's why it's not even recommended I think now

080by the >> it's recommended like I said it would just depend >> it rarely is actually it's rarely perfect uh you know and and the goal I guess is to minimize or at least decrease hospitalizations. It's not going to prevent >> as much. So just because even you get the flu vaccine doesn't mean you're not going to get the flu. >> The hope is if you get the flu vaccine it won't be as severe. Mhm. But right >> and especially in the im immune compromised folks, the elderly, children, folks taking chemotherapy most at at risk. >> For clarity, was that mutation later in the season and then the spike earlier in the season? So it was a both hit on both ends. The mutation this year, you know, was later than typical. And so the

081vaccine's going to have less empathy probably this year. was finalized in February. The mutation occurred in summer, >> correct? >> And then the spike was earliest. So it's two. >> All right. And so now now on to measles. Um for the full year 2025, there was a total of um 21 2144 cases of measles. Um and this was reported just in the US. Among these um as you can see um all of those were within 45 jurisdictions. Um 25 of the cases were among international visitors to the US. Um there were 49 outbreaks reported in 2025 and 88% of the confirmed cases were outbreak associated. And for comparison, in 2024, there were 16 outbreaks um with 69% of the cases being outbreak associated. 11% of the cases were um hospitalized. So 240 of the 2144

082cases and then um there were three um confirmed deaths as of January 6th. Um there have been we actually know that there are more than three cases, but this is per the CDC resource that I had. um reported in the US all of the cases residing in either North or South Carolina. Um and again we know that there were more cases because within North Carolina we've had more reported cases. So in North Carolina and Union County um we've had five reported cases in North Carolina um within the last 30 days. One was in with um with a child in Pulk County. There were three siblings in Bunkome County and then one partially vaccinated child in Rutherford Rutherford County. Um those five CA cases h all had history of travel to South Carolina to known um

083areas of measles outbreak and three of the four cases were in the same household. um for measles responses including um an international airport terminal, emergency rooms, urgent cares and restaurants. Um in Union County, we have had three measles um rule outs in the last two months. And um so with measal rule out events when we when we have people present to healthcare providers with illness like fever, rash um or measles is on the list of differential diagnosis and testing is done. Um ideally we work with the providers to get guidance regarding testing and control measures before the child leaves because we don't want to test anybody and just say oh go back to child your childare center Monday. We want them to obviously make sure that they stay home until um that test comes back

084negative. Um these events have given our team an opportunity to engage in preparedness exercises and discuss what we should do or what would happen should that event arise. >> Of the three rollouts, were any positive? >> Come again. >> They were all negative. >> All three negative. Yes. Correct. Do you track whether those were vaccinated or partially vaccinated? >> We don't. Um not until we get those results back. Um just we don't want to exhaust those resources. Um now obviously if it is we get a little more information just to be you know on on deck and do go back for any reports um we get with a provider to see if there's kind of any other need to know information um which typically that does include with with that provider report it does include

085vaccination status and I will say two of the three rule out cases we had um were unvaccinated. [Music] >> So for um preparedness for measles in Union County um we can we develop toolkits um for measles response. We continue to pre perfect those toolkits as we get those rule rule outs and respond to reports. Um we continue to work with school health other community partners to bolster measles preparedness. um we've sent out to like childc care centers because it is very common practice for schools to um flag and note those children who are unvaccinated. But um for child care centers just encouraging that practice as well when we do have to um respond to measles. It's going to be very um important to implement those control measures um isolation quarantine for those that are unvaccinated.

086So quickly identifying and notifying those those parents and children will be um very important for response. Um we maintain testing supplies to ensure testing is available when necessary. Um and again as we've kind of went through these um rule outs just discussing responses um so that we can more have more clear and precise communication practices. Any questions about measles? Perfect. Thank you. And so for tuberculosis um in 2025 we had four new active cases. Um two cases were completing their treatment for 2024. So we had a total of six active cases that we followed through 2025. Um of the four new cases three were extra pulmonary clinical cases and one pulmonary case. Um, I'm not the contact investigations I think were was like 28, but I don't want to give you finalized numbers because I

087did not look that up and I apologize. Um, for LTVI cases, we had 156 patients that were evaluated for LTVI and LTVI is latent tuberculosis infections. Um this is compared to 154 evaluations in 2024. So pretty stable. Um we had 48 that declined treatment. 38 were lost to followup. Um treatment was not indicated for 18 of the cases. 20 of them completed treatment. 15 um are still currently receiving LTPI therapy and 17 patients were still pending confirmation and disposition which means our provider reviewed everything and um ordered the the therapy. this far um in 2020 states we have one rule out for active TV >> is 20% lost to followup typical it I mean it is once we just because a lot we get referrals for LTBI also from private providers um so a lot

088of times unless that investigation was initial like init Excuse me. Um, unless that was initiated here, a lot of times we do not we're just unsuccessful in contacting um a lot and most of the time it does happen with outside referrals. Any other questions for Thank you. And then many have seen the um changes in vaccine recommendations. The CDC did formally update the US childhood vaccine schedule. Um I felt like this was a really good demographic to to kind of show um which changed typ before all of them were universally recommended. Um and so that shifted to um high-risk group which means if they fall into those high-risisk categories we would recommend that without the shared clinical decision-m process. And for the others listed on um the shared clinical decision- making just meaning discussing risk

089versus benefits with your provider. Um what we do know as far as how that changes practice for Union County um is the North Carolina law regarding childhood vaccinations has not changed. So that means there's no changes in the required vaccines for school um or even um child care centers because childcare centers also are listed in the law for um childhood vaccination requirements. Um our providers are wellversed in shared clinical decision-making. This is not the first time that's kind of come up in in the world of vaccinations. Um we anticipate more guidance coming from the state regarding potential law changes um that drive those vaccine mandates. Um and we really just don't know what the long-term impacts may have for vaccine. So I have a question couple questions. One like for the recommended for all children

090the HPV virus I know is now recommended one shot is recommended versus two or three. Do we explain that to to a patient to say okay these are the recommended >> right >> but now it's changed from previously it was two or three shots to one shot you know for the HPV virus I mean do we go through that with the with the patient >> not I mean we would give them what's the current recommendation >> like one shot >> yes >> you would say okay now it's one shot okay all right I just And do you do we provide I I think I know the answer because I I know they don't do it in the pediatrician's office or they didn't in the past. Um but the insert that shows the safety and e

091efficacy and the studies that were done for the each of these vaccines. Do we provide information >> information sheets which is required by law? >> Okay. And it shows like how long these vaccines were studied for? No, most information sheets goes through um potential side effects and um >> who needs it, >> how you need it, what side effect, >> what it is, what it's for, >> but it doesn't show you what the um what the studies, you know, how the length of the study was, >> but it does have links to additional information. >> It does. >> Okay. >> Yeah. I just have a quick question. what is um shared clinical decision making like what does that look like in a doctor's office as composed as compared to being just straight recommended? >> So

092it does I mean it looks a little bit different for each patient. We may have some parents that come in with lots of questions and talk about well how would this benefit my child versus what what if I chose not to. Um, so it does look very individualized and I think that's the most important part about shared clinical decision-m because it is very individualized for each patient. So it could be that, hey, I don't really even know what this vaccine's for. Can you tell me a little bit more about it? Um, and why do you, you know, why why would my child be at risk for hepatitis A? >> Um, It does. And to be honest, we've done that all along. >> It's baked into our >> It should be happening at medical visits all

093the time. >> Hopefully it does. >> Aren't all decisions like with your provider shared clinical decision-m? I mean, >> right >> to some extent. I mean, so I guess uh I guess I don't see the difference between >> I think now it's it's very intentional um versus >> okay, here's a list of vaccines that we're going to we're going to recommend for you today. Um whereas, you know, it may warrant, okay, here are all of the vaccines that are available to you today. These are the ones that are universally recommended for everybody. Here are the ones that we can also offer you and this is why. >> Got it. >> And keep in mind that we receive federal funding. So we are held we are held to these standards. We don't know what private physicians

094do in their offices. We can only speak to what we do and what the requirements are and we follow them. >> Yes, ma'am. >> So that's my question. If you're bound by federal funding, are you following the new CDC recommendation or you have to follow the NC law? Because right now, this is ele irrelevant if NC law hasn't changed, right? So, federal funding tied to that, you still have to recommend the old schedule, not the new schedule. >> Right. And I mean, and that's that's the guidance that we've received so far from North Carolina to say hold as soon as we know what this means. Um, and I will preface this to say most everything as far as law refers to ACIP recommendations. ACIP recommendations are currently different than what the CDC recommendations are now.

095And that's because ACIP has not met to review and make a decision on this just yet. And so everything, all of our standing orders refers not necessarily to what CDC schedules are, but ACIP >> and ACIP. Yeah. ACIP is the Yes. immunization practices has made the recommendations. >> You say you anticipate more guidance. What do you are they they're saying they're talking to you? What are they saying? >> And who are they? And it's the North Carolina immunization branch. So they when I say they, it's the immunization branch that kind of guides these vaccine practices. Um the immunization branch is what tells us yes this is, you know, this is a go. >> Okay. I are they saying that the laws may change or the laws going to stay the same? What what are they?

096Um, from what our immunizations coordinator has told me, they do anticipate some changes, but we don't know what that looks like yet. >> Okay. >> Historically, has the NC immunization division? Haven't they always deferred to the CDC? >> ACIP for immunization practices. Yes. And right now ACIP is not what this is >> because they haven't reviewed it yet, but it's what they're it's going to be under review, >> right? >> Yeah, >> it will. >> We have a new ACIP, >> correct? Who's made changes already, >> right? Okay. And remember, we're bound by law, so that's where we fall. You know, as these processes catch up with one another, we'll fall in line. But at this point, have to follow um the legal requirements. >> Yeah. >> So, all that to say more to come.

097>> Thank you. [Music] >> Keep us posted when it comes. >> Absolutely. We'll do. Thank you. [Music] And we have no public comments tonight. >> We have no public comments. >> All right. Do we have a motion? >> Wait. Update. >> Updates. That's right. >> My bad. Go ahead. Um I wanted to share with you since we're at the end of 25 and beginning of 26 just some um dashboard information on human services. So during the calendar year for 25 at the front for navigation, which is who meets our clients at the door, we saw 94,421 429 clients. 28,29 were checked in at the front desk for DSS services. 21,070 calls came through our switchboard and 3,595 interpreting hours were done by human service um interpreters and and the administrative side. So, we had quite

098a lot of folks come through and um look forward to serving a lot more in 26. >> Hey y'all, I'm Karen um division manager for economic services at DSS and I'm sitting in for Ashley who could not be here tonight. Um, so real quick, she wanted me to let you guys know that our behavioral health collaborative will be fully staffed by the end of the month, which is a huge blessing. Um, we now are under the child and family services health plan for all of our foster care children. Basically, the change in that is that all foster care children in the state of North Carolina are now covered by the same health plan instead of having our local LMB. So, they're all under one plan. Um we don't have anything positive or negative to say

099at this point because it's brand new and we're still all trying to get adjusted to it. Um but we do have um our previous worker who did all of our foster care and Medicaid cases. She retired and we do have a new staff person starting um the 24th of January. So that's good. Um and then one of my lead staff are going to be training them. Um, we continue with Medicaid open enrollment, getting all of those applications. We were, and I haven't gotten the newest updates because I've been out on vacation, but um, prior to my vacation, we were getting roughly 700 apps a week, whereas previous um, months we were getting 700 applications. So, my staff are working very, very hard right now. Um, and we are just waiting on pending changes to um

100our the way we do things on research in Medicaid, having to do them every six months and the new um able-bodied adult policies coming down. We're just waiting on definitive guidance from the state, but I will be presenting at your meeting next month. So hopefully I will have more information for you guys. >> Can I have a question? >> Yeah, sure. If I can answer applications per week, is that an unprecedented amount? >> Um, you know, during open enrollment, so what happens is when um when citizens go to the federal marketplace and then make an application, the marketplace system says whether they might be eligible for Medicaid. If they might be eligible for Medicaid, those applications are then sent to us because we have to evaluate them first because you cannot receive the subsidy and

101Medicaid. Um, and so they want us to do those first because it's coming from two different pots of money. So the 700 a week is typical for this um, time of year. Typically from December 1st until usually the end of February or beginning of March, we're getting roughly 700 abs. And my staff are we did get overtime approved. So they are working some overtime and we're cranking them out. But they are um, they are very tired right now and just waiting on those to slow down. All right. Uh so we had our annual Christmas bureau. We um helped about 1,800 individuals um which is actually down a little bit from previous years. We had implemented an online application and did um there were just a couple of changes um and um so we just saw

102a small decrease in our numbers. um we weren't counting individuals, we were counting families before. So I can't tell you apples to apples in terms of numbers, but still we had a huge increase in the number of volunteers who helped us. We had an increase in the number of sponsors. Um and so it it was really really positive this year. Um not that it hasn't been positive before, but I feel like it was it was great. Um, with our senior nutrition program, um, we have taken 91 clients off of our weight list since beginning of July. Um, we have about, uh, 19 more that we had planned to take off. Um, because we were given additional funds to take about 110 people off the weight list. What we did discover is that we also have

103lost some of our clients from um services over this year. So we actually um we had lost between um I guess January and June 27 people had fallen off of our regular services and another 30 since beginning of July. Um so we do have capacity to add even more clients on. um we can only do that as fast as um we have the capacity of our staff to do that. Um so it does take time for us to add people on because we have to do assessments and evaluations. So we can't add them all at one time because if we first of all we don't have the capacity but if we did that then we have to do um evaluations every six months. It would just be really impossible with our staffing to do that.

104So, um, we're doing the best we can to add people. We are down to 301 people on our weight list now, which is which is a lot better than what it has been. And I know we came to the count um to this meeting and talked about that before and at one point we had like almost 700. So, we are down um about 155 of them are for frozen meals. So that means they live in um outside of where any of our meal routes are. Um and of course our frozen meals cost um about I don't know almost not twice but one and a half times what our warm meals do. Um and then we have 146 waiting for warm meals. Uh so we're we're working through that. Uh but we're and we're making progress

105but there's more to be done. Oh, and one more thing. Our lowincome energy assistance program, um we weren't sure what was happening with it when uh the shutdown was in effect, but once that stopped um we were given funding for that. And so that opened up to the whole the entire public uh January 1st. And um we have seen lots and lots of people coming in for assistance. Uh and we are also paying our staff overtime because we usually hire uh two or three additional staff people just for the season, but we had put that on hold because we didn't know what was happening with our funding. So now we have actually trained some of um my other staff and workforce to help out when they can and also um have given them overtime at

106least for a short period of time to communications as well, which is what our staff usually process. So, um it's usually it's a lot of work just like Medicaid, you know, we just see a slew of people coming in. Um with our SIP applications, those have to be processed in 2 days. Um 2 days and um one day for emergency situations and then our lowincome energy assistance program, we have up to 10 days to process um those applications. That's it. Okay, so just a quick additional update for me. One thing I wanted to do was introduce Charlotte Kazaya down there on the end. She is the new environmental health director. Uh been in the role about 10 months or so. Uh so not quite a year. Fantastic job. That is a very busy place as

107you all know. So um I'm glad she was here tonight so I could introduce her. And then just want to thank these ladies for the work that they do. You heard from the report that there's a lot of uh work going on behind the scenes here in Union County Public Health. Uh surveillance work, um followup activities. I mean, it's just uh an extremely important part of what we do to keep the community and our population um safe and healthy. [Music] Hello everyone. Um, I am determined to keep my updates positive and good news only. So, I need you to hold me accountable for that. >> Um, today I want to talk about two claims that we won in December. Both surviving spouse claims. One gave a win of $29,900 back pay and $1,700 a month.

108And that was a claim that was resubmitted which was denied twice by the VA and our veteran service officer Robert Turner resubmitted it with an amended death certificate to win that case. Uh the second one was by James Anderson. um the veteran had a claim in and then he passed away and that gives the um spouse the opportunity to do what's called a substitute claim and claim and she won $85,000 in addition to the 1,600 a month now for the rest of her life. So those were big wins for us for December. Thank you. >> That's great. It's great. >> Hello. Uh we've had a couple of really cool things happen in transportation with the last couple of months. Um we have to do um safety training. We do it quarterly. Um and we're we

109were tired of just sitting in a classroom and doing some of that training. So we got in touch with emergency management and said, "What can we do? We need a drill. We need a real life scenario to engage our staff and have them feel like they're really out there doing it." Um and they ran with that. um or my small vision of it just being transportation evolved into having multiple agencies. Union EMS was there. Um we did it in Waxaw. So we had Waxaw Fire Department, Waxaw Police Department, Lancaster EMS, Charlotte Medics. Um you name it, they were there. Um and it was a scenario where our um trans we had two vehicles that were gifted to us. Um so we really took those vehicles and demolished them. Um, we had it was a pickup

110truck ran into the side of our transportation vehicle and it flipped with 13 passengers inside. Um, we had them mouaged so they all had injuries to them where it really looked like they were having injuries and we never told anyone from any of our departments what was really going on. They had to walk into the scene and be surprised and figure out what they had to do. Um, and I know my team said it was surreal when they actually got out there because they're late to the scene. They're not the first ones out there. So, when they get there, all emergency is there and they have to walk in and just figure out what's going on. So, we had an incident command there. Um, and they had to work through it. And I said, "I'm

111taking vacation that day. You guys are on it." So, I stepped back and let them take care of it. They all did a great job. All the agencies and everyone. We couldn't have asked for a better training. Um and then we also had a uh magazine get in touch with us and ask us to do a feature article on rural transportation and that article hit um at the end of December. So it is called business view if anybody wants to go look at the article. Thank you. >> Thank you all. Any other updates? [Music] Any motions to dismiss? There's a motion to adjurnn. >> A motion. One motion to adjurnn. Do we have a second? >> Second. >> All those in favor? >> Thank you all. >> Good.