Geauga Public Health Discusses Childbirth Services in the Amish Community
Geauga Public Health (GPH) - October 30, 2024
Meeting Details: The GPH Board met in Regular Session at the Geauga County Administration Building, 12611 Ravenwood Drive, Suite B167-168, Chardon, OH, on October 30, 2024 at 5 pm. This meeting was live-streamed by Geauga County ADP. The Agenda is posted on their Facebook page a few days prior to the meeting and then on their website. The video is available here. This observer did not attend the meeting in person, but viewed the video.
Public Comment Policy: There is no separate written policy, but in practice “Citizens’ Remarks” are listed on the agenda and are permitted as detailed there.
Board Attendance: (as seated, from L to R).
Absent: Dr. Mark Hendrickson
Staff Attendance:
-
Adam Litke - Administrator (end of table left)
-
Ron Graham, Health Commissioner for both Geauga and Lake Counties (end of table right)
-
Dan Lark, Director of Environmental Health (second from right)
Others Present: Dr. Andrea Ward (OB/Gyn at UH Geauga), Christine Sutter (Mother and Infant Nurse Manager UH) and citizens Ed and Kristi Filippi.
1:49 minutes
1.0 Call to Order
Called to order at 5:00 pm.
2.0 Opening of Meeting
The Pledge of Allegiance was recited. A quorum was declared. Dr. Rood certified the delivery of official notices of meeting.
3.0 Board of Health:
3.01 The Board approved Minutes of the Regular Meeting held on September 25, 2024.
Observer Note: Board of Health Published Minutes have previously been up-to-date; however, the most recent minutes published are for the August 28, 2024 Regular Meeting. Use the down arrow under “Select Category” at the top to search for the correct year at the link provided.
3:10 minutes
4.0 Health District Staff Reports
Observer Note: These reports are available with the Agenda on the Geauga Public Health (GPH) website here.
4.01 Population Health Report
No update beyond what is in the report was included with the agenda. Highlights of the report were the Ohio Buckles Buckeyes Program (Car Seat Program) distribution of a car seat and education to parents, and the Health Educator distributed 84 Project DAWN Naloxone kits to the community.
4.02 Environmental Health Report
Beyond what is in the report, Mr. Lark stated there was a public hearing on Monday regarding lowering fees for registration for septic system haulers. One person attended and one email comment was received.
GPH will use almost all the Water Pollution Control Loan Fund (WPCLF) funds for this year. GPH will have $3,000 - $5,000 roll over for next year. Next year GPH will receive $150,000 for WPCLF from the Ohio EPA.
After routine inspections, GPH staff had discussions with some restaurants about cleanliness issues. Mr. Lark was happy to report that all these restaurants have complied and issues were addressed.
Inspections and other environmental tasks are ongoing. Mr. Lark mentioned that GPH employees are busy, do a good job and often encounter frustrations. For example, they were hoping to inspect 10 septic systems on Monday, but only 5 were able to be inspected. The other waste water systems had been turned off. There was some discussion about this and why homeowners would shut off their systems.
GPH is looking at updating software. The new system would have a portal, and the public will be able to access findings regarding restaurant health inspections, septic inspections, fees and pay bills online. There appears to be a more affordable option than what was considered in the past years. The software is called Health Space. Costs would run about $70,000 the first year, with half of that for transferring old data to Health Space. Then costs would drop to $35,000/year. Other counties have used this system as have some of the GPH staff and the feedback has been positive.
9:18 minutes
7.0 Citizen’s Remarks
The agenda was rearranged to allow the comments of Dr. Andrea Ward, who is an OB/GYN with University Hospital/Geauga. There was a lengthy discussion (some of which was inaudible) regarding midwives assisting Amish women in childbirth. Mr. Litke inquired at the State level and with other sources and learned that there are no regulations around what is required to be a midwife. Reviewer Note: See this article for information about the two different kinds of midwives: Certified Nurse Midwives, which are regulated currently under Ohio Revised Code 4723.41, and Certified Professional Midwives, which are not regulated. Several bills have been introduced regarding the latter category. Dr. Ward and others shared that midwife services have been provided in a rental house and that the group of midwives is in the process of moving to another location. Questions were raised as to how to reach out to this community, how best to offer support, how to improve outcomes, and how to help the community differentiate between a physician, a nurse midwife and a midwife. Mr. Litke said he would consult with various boards at the State level (Medical Board, Board of Health and others) for guidance. Also discussed was how to reach out to various leaders in the Amish community and initiate a discussion. The goal is to assure that mothers and their infants are receiving appropriate care. Mr. Graham will also be following up with Dr. Ward.
30:06 minutes
4.03 Administrator’s Report
Rent - Mr. Litke said that someone from the Prosecutor's Office has been assigned to be GPH’s representative for the rent issue in the new County office Building. Reviewer Note: Numerous meetings have discussed how much GPH should pay to the County GPH’s space in the new County Office Building and how much of the GPH space should be allocated to Automatic Data Processing (APD).
Mr. Litke noted that noncompliance cases related to the Operations and Management (O&M) program involving the inspection of septic systems in the county are going to have to be handled in-house. This will require 3-5 new positions over the next 3-4 years. Noncompliance fees for the O&M program will have to cover the costs of instituting this program. Mr. Litke said they are working with legal right now. Any fees collected in excess of the costs will go into a Geauga-specific fund to help low income residents comply. This will be a Geauga Specific WCTLF (Water Pollution Control Loan Fund).
The amended 2025 Budget will be ready to present next month. Mr. Litke is also working on the 2026 Budget which has to be presented to the Budget Commission in March of 2025. Mr. Litke said that the cross-jurisdictional contract (between Lake and Geauga County) has to be amended to account for the additional positions. Currently the Auditor will not permit these costs to be paid until they are approved. Mr. Litke said he would have this information for the next Board meeting. Mr. Litke also noted that they need new vehicles for new staff that will have to be hired for the O&M (Operation and Maintenance) program and vehicles to replace two food service vehicles that are getting older. He estimated they will need two new trucks and three Jeeps. Computers and desks will also be needed as new staff is added.
Mr. Litke said that the accounting demands of the O&M program and the WCPLF will increase and GPH will need a full-time Finance employee. Observer Note: Currently Mr. Litke is serving in that role as well as the role of Administrator. Also, there would be an increased need for someone to fulfill additional administrative requirements so a full-time Finance employee could assist in this area as well.
Observer Note: For over six months, GPH and the Geauga County Board of County Commissioners (BOCC) have been engaged in discussions around GPH paying rent to BOCC for their office space. Simultaneously there have been discussions about ADP assuming some of GPH’s office space. Specifically, the lunch room has been considered for use by ADP.
Mr. Litke said that with the addition of O&M noncompliance employees, the lunch room may be impacted. They are exploring desk sharing, but even with that, additional space will be needed. Ms. Brakey said that it seems shortsighted to rent the lunch room space to ADP as had been previously discussed. Mr. Litke agreed and said that he had told Assistant County Administrator Linda Burhenne that the lunchroom space is not being considered for use by ADP.
Mr. Litke also said that GPH is dipping into some money that had been set aside as cash reserves. He said it will be 4-5 years until the money flows from the new revenue associated with the O&M program.
Mr. Litke said that when GPH last met with the Budget Commission, the Commission thought GPH cash reserves were too high. Mr. Litke said that they (GPH) need to let the Budget Commission know the situation has changed. He also noted that the Health Education person, Emily Landis, is leaving at the end of the week and that she has been a great asset. He said that a new person has been hired.
Ms. Brakey said that she would like to see the rent issue wrapped up. Mr. Litke agreed and said that they might need a Special Meeting to get this done.
40:26 minutes
Health Commissioner’s Report - Mr. Graham said that they are getting ready for the Community Health Assessment, which will happen in 2025. He noted that UH has agreed to cover all the costs this time, about $60,000. For the previous assessment in 2022, GPH and partners contributed about $30.000.
Mr. Graham shared some data gathered at the Fair, some of which points to increased depression, alcohol use, and stress. GPH and UH will be doing focus groups as part of the accreditation process. Mr. Graham said that GPH is accredited for the next two years however the future of accreditation for GPH is less certain. Looking ahead, Mr. Graham discussed two options: Pathways to Recognition and Pathway to Accreditation. He felt that future full Accreditation is financially out of reach right now. To achieve Accreditation they would need a full-time person to work on accreditation, a half-time health educator, and a prime disease program. The Pathways to Recognition would indicate where GPH intends to go but would recognize that it isn’t there yet. Reviewer Note: Accreditation has been a topic of discussion for many months. A good explanation of this process can be found here. The Public Health
Accreditation Board (PHAB) is a non-profit that conducts these accreditations that are required by the
State of Ohio.
Mr. Graham also reported that GPH has been working on some cross training with UH staff and others to provide a back up plan should GPH need coverage for staff who are crucial to the delivery of services. For example, Melissa Kimbro is a fantastic nurse responsible for Vaccines for Children (VAC), weekend on-call for Vaccine monitoring, and many other duties. There is a need to develop a plan for staff to be able to take time off without critical services being interrupted. Mr. Graham is working on this with a sense of urgency.
47:16 minutes
5.0 Old Business
5.01 Resolution to Increase/Decrease Certain Fees, Household Sewage Treatment Systems Program, Second Reading
Motion to do Second Reading: Roll Call- Aye: Rood, Brakey, Bowdren; Abstain: Jones
48:10 minutes
6.0 New Business
6.01 Resolutions
6.01.01 Financial Reports, Resolution 24–10-06-01-01 Several minor questions were asked about entries in the financial reports. Mr. Litke answered them.
Resolution to approve Financial Reports passed unanimously by voice vote.
6.01.02 Permission to Approve Appropriations for Increase/Decrease
These are normal year-end housekeeping transfers moving dollars from the Current fund to General funds in order to pay obligations.
Passed unanimously by voice vote.
7.0. Public Comment - (see above 9:18 minutes)
52:02 minutes
Executive Session:
The Board then went into Executive Session to discuss next year's payroll. Mr. Litke stated the session should last 15-20 minutes. He stated that no action will be taken after the executive session.
Motion to enter Executive Session: Roll Call- Aye: Rood, Brakey, Bowden, Jones
Next Regular Meeting: November 20, 2024 at 5:00 pm. All meetings are held at the Geauga County Administration Building, 12611 Ravenwood Drive, Suite B167-168, Chardon, OH.
More Information: Geauga Public Health
Observer: Kathy Franz
Editor: Gail Roussey
Reviewer: Carol Benton
Submission Date: 11/7/24
The League of Women Voters of Geauga is a 501(c)(3) nonpartisan political organization that encourages informed and active participation in government, works to increase understanding of major public policy issues, and influences public policy through education and advocacy. They do not support or oppose individual candidates or parties. Learn more about the LWVG at www.lwvgeauga.org.