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MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org

CLINTON

Branch Office 1307 E. Townsend Rd.

St. Johns, MI 48879-9036 (989) 224-2195

GRATIOT Branch Office

151 Commerce Drive Ithaca, MI 48847-1627

(989) 875-3681

MONTCALM Branch Office

615 N. State St., Ste. 1 Stanton, MI 48888-9702

(989) 831-5237

ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2

Stanton, MI 48888-9702 (989) 831-5237

MARK W. (MARCUS) CHEATHAM

Health Officer ROBERT GRAHAM, DO, MPH, FAAFP

Medical Director

BOARD OF HEALTH Bruce Delong

Jack A. Enderle Betty Kellenberger

Jane Keon Tom Lindeman

Laura McCollum

Your Public Health Team,

Connecting with our Communities to Achieve Healthier Outcomes.

BOARD OF HEALTH

REGULAR MEETING

At

Mid-Michigan District Health Department

Montcalm County Administrative Offices

Conference Room A, Stanton, Michigan

Wednesday, October 29, 2014

10:00 AM

AGENDA

We take action to assure the health and well being of our community and the environment

by responding to public health needs and providing a broad spectrum

of prevention and educational services.

Pledge of Allegiance

Guests: Susan Moran, Senior Deputy Director, Public Health Administration and Mark Miller, Director, Local Health Services from Michigan Department of Community Health Please remain after the meeting to have a group picture taken for the 2014 Annual Report. Wear your favorite"red carpet" look!

A. AGENDA NOTES, REVIEW, AND REVISIONS:

B. CONSENT ITEMS:

1. Meeting Minutes

a. Michigan Association for Local Public Health (MALPH) Board of Directors Meeting

held July 14, 2014 -Attached.

3

b. Michigan Association for Local Public Health (MALPH) Board of Directors Meeting

held August 11, 2014 - Attached.

6

c. Mid-Michigan District Board of Health Regular Meeting held September 24, 2014 -

Attached.

7

2. Communications

C. PUBLIC COMMENTS:

http://www.mmdhd.org/

D. BRANCH OFFICE EMPLOYEES:

E. COMMITTEE REPORTS:

1. Finance Committee - Tom Lindeman, Chair

a. Mid-Michigan District Health Departments Monthly Balance Sheet, Revenue and

Expenditure Report for September 2014 Delayed due to year-end closing

b. Mid-Michigan District Health Department's Expenses for September 20 through October

17, 2014 - Attached.

14

c. Change of Bank Signatures - Attached. 28

d. Epidemiologist Services - Attached. 29

e. Addendum to Associated Agreement for Physician Services - Attached. 34

2. Personnel Committee - Betty Kellenberger, Chair

3. Program Committee - Bruce Delong, Chair

4. Mid-Central Coordinating Committee - Tom Lindeman, Vice Chair

F. MEDICAL DIRECTOR'S REPORT: Robert Graham, DO, MPH - Attached.

1. Ebola Preparedness 36

G. HEALTH OFFICER'S REPORT: Mark W. (Marcus) Cheatham, Ph.D., Health Officer

1. Quarterly Service Report (July 1 - September 30, 2014) - Attached. 39

2. District-Wide In-Service, Friday, November 7, 2014, Gratiot-Isabella RESD, Ithaca 48

3. Employee Survey Results - Attached. 51

H. OLD BUSINESS:

1. Michigan's Premier Public Health Conference Update (Betty Kellenberger, Laura

McCollum, and Jane Keon)

2. Annual Commissioner Forum Recap - Attached. 59

I. NEW BUSINESS:

1. Emerging Issues

2. Community Health Worker (CHW) Data Presentation - Handout.

3. Amendment and Summary for the Flexible Savings Benefits Carryover for 2014 - Attached. 60

J. LEGISLATIVE ACTION:

1. Total Coliform Rule (rTCL) Update

K. INFORMATIONAL ITEMS: - Attached.

1. Mid-Michigan District Board of Health Action Items, September 2014 64

2. Staffing Report 65

L. RELATED NEWS ARTICLES AND LINKS: - Attached.

1. MMDHD News Articles Available Online at: http://mmdhd.org/boh-news-2014.html

2. EPA and MDEQ Wrap Up 2014 Cleanup in Residential Area, Environmental Protection

Agency, October 2014 - Attached.

66

M. AGENCY NEWSLETTERS: - None.

MICHIGAN ASSOCIATION FOR LOCAL PUBLIC HEALTH

(MALPH)

Board of Directors

Meeting Minutes

July 14, 2014

I. Call to Order The meeting was called to order at 9:00 by Linda VanGills, President.

II. Roll Call

A quorum was present.

Jurisdictions Represented:

Barry-Eaton [Colette Scrimger], Bay [Joel Strasz], Benzie-Leelanau [Dodie Putney], Branch-

Hillsdale-St. Joseph [Steve Todd], Calhoun [Jim Rutherford], Central Michigan [Steve Hall],

Chippewa [Dave Martin], Detroit [Debra Whiting], Dickinson-Iron [Steve Markham], District 10

[Linda VanGills], District 4 [John Bruning], Grand Traverse [Wendy Trute], Huron [Gretchen

Tenbusch], Ionia [Ken Bowen], Jackson [Richard Thoune], Kalamazoo [Lynn Norman], Kent

[Adam London], Lapeer [Stephanie Simmons], Lenawee [Patsy Bourgeois], Livingston [Dianne

McCormick], Luce-Mackinaw-Alger-Schoolcraft [Nick Derusha], Macomb [Bill Ridella],

Marquette [Fred Benzie], Midland [Mike Krecek], Mid-Michigan [Marcus Cheatham, Jack

Enderle], Monroe [Kim Comerzan], Muskegon [Ken Kraus], Northwest Michigan [Linda

Yaroch], Oakland [Kathy Forzley, Tony Drautz], Ottawa [Lisa Stefanovsky], Saginaw [John

McKellar], Shiawassee [George Pichette/Gene Paez], St. Clair [Annette Mercatante]Tuscola

[Gretchen Tenbusch], Washtenaw [Ellen Rabinowitz], Western UP [Guy St. Germain].

Others Present:

[Administrative Officers Forum], Joy Hawkins, [Behavioral Health Sciences Forum], Chelsea

Moxlow, [Environmental Health Forum], Rebecca Burns, [Nurse Administrators Forum], Anne

Young, Becky Bechler, Ed Dore.

Staff: Meghan Swain and Jodie Fulk

III. Approve Agenda Motion by M. Cheatham, support by S. Hall to approve the agenda. Motion carried.

IV. Approve Meeting Minutes Motion by W. Ridella, support by M. Cheatham to approve the May 12, 2014 minutes. Motion

carried.

V. Reports of Officers and Staff

A. President L. VanGills reported meeting with Rob Fowler, CEO of the Small Business Association

of Michigan but also the Chair of the Michigan Health Endowment Fund (MHEF). He

stated he is interested in having local public health engaged and submitting a funding

application to address a public health issue. The MHEF Board is looking to release some

dollars through a grant process in early fall, 2014. L. VanGills, K. Forzley, and M.

Cheatham will work on next steps, and asked for volunteers from the full board. M.

Krecek, L. Yaroch, W. Ridella, and E. Rabinowitz have volunteered. K. Forzley and L.

Stefanovsky were able to connect with the people from Missouri (who also have a similar

fund). They were able to provide insight on how Missouri addressed public health issues.

3

Meetings Minutes

July 14, 2014

Page 2

There is a meeting with DEQ today, and we will continue to address the Revised Total

Coliform Rule. There continues to be concern expressed regarding this program being a

mandated service under Essential Local Public Health Services.

The 2014 NALBOH conference is August 13-15, 2014 in Milwaukee, Wisconsin. Please

consider attending and/or having commissioners/board of health members attend.

The Executive Committee will begin the evaluation of the Executive Director. If board

members would like to provide input, please contact L. VanGills.

B. Secretary/Treasurer (Financial Statements) G. St. Germain reported that MALPHs budget continues to be on target.

C. Lobbyist The legislature will have a few session days throughout the summer. Road funding was

not addressed but is an agenda item for the fall. The medical marijuana provisioning

centers (HB 4271). The Healthy Michigan Plan is on target, hitting their annual target

after four months.

D. Executive Director The 2014 Michigan Premier Public Health Conference is at Shanty Creek. Please register

and make your reservations soon. F. Benzie and M. Cheatham are leading the

Nominations Committee for the FY 2015 Executive Committee. If you have an interest in

serving on the Executive Committee, please let them know. There is a proposal on the

primary ballot in August that has implications for local public health. Proposal 1 will

back fill revenue sharing dollars that were lost under the Personal Property Tax repeal.

However, there is concern that the dollars will come from the General Fund, which is

where Essential Local Public Health Services dollars are from. M. Swain will provide

complete information to board members, as analyzed by the Citizens Research Council.

Next month will be Phase II of strategic planning for MALPH. The previous five (5)

priority areas will be given action items.

VI. John D. Tilden Jr., DVM MPH

Dr. Tilden presented Information Sharing Agreements between local health departments

and the Food and Drug Administration including frequently asked questions.

VII. Accreditation Efficiencies Report

M. Cheatham presented the final recommendations of the Accreditation Efficiencies

Committee. Motion by M. Cheatham, support by W. Ridella to support the

recommendations. Motion carried.

VIII. Karlene Ketola - Michigan Oral Health Coalition

Ms. Ketola presented local, state, and national initiatives in oral health and how to build local

oral health coalitions.

IX. SB 851 Low Risk Foods

Discussed this legislation and members were able to compromise on the language which will be

submitted to Sen. Caspersons office. Motion by M. Krecek, support by A. Mercatante to

accept the language agreed to by committee members and support SB 851, with

amendments. Motion carried.

4

Meetings Minutes

July 14, 2014

Page 3

X. Welcome Sue Moran, Deputy Director of Public Health Administration

The Board of Directors welcomed Sue Moran, the new deputy director of the public health

administration section of MDCH. She discussed the State Innovation Model grant. The

application is due July 21, 2014. She looks forward to working with local health departments

and visiting. L. VanGills iterated the importance of working in tandem on public health

priorities, collectively, to strengthen outcomes.

XI. Reports from State Departments

A. Agriculture and Rural Development

Sandra Walker reported they are working on electronic inspection program. She stated

they are moving forward with Phase I and Phase II with the food section including hiring

field inspectors. The timeline is 20 months and Phase III will include opportunities for

local health departments.

B. Environmental Quality

Dana DeBryun reported that Ric Falardo is retiring at the end of the month. The

department is in the process of interviewing candidates for the campground program.

She reported of training for the non-community water supply for type I systems at the

Wastewater Conference in January.

C. Community Health

Mark Miller reported that they are working on guidance regarding epi-pens. Plan First!

has been extended to existing patients. Rashmi Travis is working on infant mortality, a

hardy agenda with eight (8) strategies. The department is tasked with redoing the metrics

on infant mortality and use metrics on current initiatives. He also discussed

immunizations waivers, legislation pending.

XII. Public Comments/Announcements

Members are seeking guidance on the undocumented children/individuals migrating north. What

state department is responsible for coordinating their health needs? It would be helpful if MDCH

would take the lead and provide guidance. We will need to discuss this at our next meeting.

XIII. Adjournment

The meeting was adjourned at 12:17pm.

5

MICHIGAN ASSOCIATION FOR LOCAL PUBLIC HEALTH

(MALPH)

Board of Directors

Meeting Minutes

August 11, 2014

I. Call to Order The meeting was called to order at 10:05am by Linda VanGills, President.

II. Roll Call

A quorum was present.

Jurisdictions Represented:

Allegan [Angelique Joynes], Barry-Eaton [Colette Scrimger], Benzie-Leelanau [Dodie

Putney], Berrien [Mike Mortimore], Branch-Hillsdale-St. Joseph [Steve Todd],[Theresa

Christner], Chippewa [Dave Martin], District 10 [Linda VanGills], District 2 [Denise

Bryan], Grand Traverse [Wendy Trute], Huron [Gretchen Tenbusch], Ingham [Linda

Vail], Ionia [Ken Bowen], Kalamazoo [Lynn Norman], Lapeer [Stephanie Simmons],

Lenawee [Patsy Bourgeois], Livingston [Dianne McCormick], Macomb [Gary White],

Marquette [Fred Benzie], Midland [Mike Krecek], Mid-Michigan [Marcus Cheatham],

Monroe [Kim Comerzan], Northwest Michigan [Linda Yaroch], Ottawa [Lisa

Stefanovsky], Saginaw [John McKellar], Shiawassee [George Pichette], St. Clair

[Annette Mercatante], Tuscola [Gretchen Tenbusch], Washtenaw [Ellen Rabinowitz].

Others Present:

Staff: Meghan Swain, Executive Director and Jodie Fulk, Membership Services/Event

Coordinator. Jane Powers, Katie VanDorn, Public Sector Consultants.

III. 2015 Executive Committee Ballot The Board reviewed the ballot for the 2015 Executive Committee. L. VanGills asked for

nominations from the floor. There were no nominations from the floor. Motion by M.

Cheatham, seconded by A. Mercatante to accept the ballot for the 2015 MALPH

Executive Committee. Ballots will be mailed to board members. You can fax, email, or

USPS back to the MALPH office.

IV. MALPH September Board Meeting The Board discussed canceling the September meeting due to conflicts with the Green

Health Summit and the MSU Fall Policy Forum. The decision was made to cancel the

September Board meeting. The Board will next meet Tuesday, October 21st at Shanty

Creek, coinciding with the 2014 Michigan Premier Public Health Conference. Any

essential business will be conducted by special meeting on conference call.

V. Public Comments/Announcements

No public comments or announcements were made at this time.

VI. Adjournment

The meeting adjourned at 10:15am.

6


CLINTON


St. Johns, MI 48879-9036 (989) 224-2195



(989) 875-3681



(989) 831-5237


Stanton, MI 48888-9702 (989) 831-5237



Medical Director




Laura McCollum


Connecting with our Communities to Achieve Healthier Outcomes

BOARD OF HEALTH

REGULAR MEETING

at


Gratiot County Branch Office

Ithaca, Michigan

Conference Room A

Wednesday, September 24, 2014, 10:00 a.m.

MINUTES

We take action to assure the health and well being of our community and the environment

by responding to public health needs and providing a broad spectrum

of prevention and educational services.

Members Present: Laura McCollum, Chairperson; Bruce Delong; Jack A. Enderle; Jane Keon; and Tom

Lindeman

Members Absent: Betty Kellenberger

Staff Present: Mark W. (Marcus) Cheatham, Ph.D., Health Officer; Melissa Bowerman, Director of

Administrative Services; Cynthia M. Partlo, Board Secretary; Robert Graham, DO, MPH,

FAAFP, Medical Director; and Bob Gouin, Director of Environmental Services

Staff Absent: None

Guests: None

L. McCollum, Chairperson called the regular meeting of the Mid-Michigan District Board of Health to order at

10:11 a.m., on Wednesday, September 24, 2014, at the Gratiot County Branch Office of the Mid-Michigan

District Health Department, Ithaca, Michigan.

Pledge of Allegiance was led by L. McCollum.

A. AGENDA NOTES, REVIEW, AND REVISIONS:

M. Cheatham requested to add Grant Update under Health Officers Report, item G. 4.

7


of 7

Motion made by J. Enderle and seconded by T. Lindeman to approve the Agenda as revised.

Motion carried.

B. CONSENT ITEMS:

1. Meeting Minutes

a. Mid-Michigan Health Plan Advisory Board Meeting held August 21, 2014

b. Mid-Michigan District Board of Health Regular Meeting held August 27, 2014

c. Mid-Michigan District Board of Health Closed Session held August 27, 2014

d. Mid-Michigan District Board of Health Personnel Committee Closed Session Meeting held September 17, 2014

e. Mid-Michigan District Board of Health Personnel Committee Meeting held September17, 2014

2. Communications None

C. Partlo distributed the Closed Session Meeting Minutes for August 27 and September 17,

2014. After the Board read them, C. Partlo collected them.

Motion made by J. Enderle to accept and place on file meeting minutes B. 1. a. through e.

Motion seconded by J. Keon. Motion carried.

C. PUBLIC COMMENTS: None.

D. BRANCH OFFICE EMPLOYEES: None.

E. COMMITTEE REPORTS:

1. Finance Committee Tom Lindeman, Chair

a. Mid-Michigan District Health Departments Monthly Balance Sheet, Revenue and Expenditure Report for August 2014

Motion made by T. Lindeman to approve and place on file the Mid-Michigan

District Health Departments Monthly Balance Sheet, Revenue and Expenditure

Report for August 2014. Motion seconded by B. Delong. Motion carried.

b. Mid-Michigan District Health Department's Expenses for August 23 September 19, 2014

J. Enderle stated that the agency pays $4,000 per month for a copier lease and expressed

concern over the annual cost. M. Bowerman indicated that the lease would be expiring in

one to two years and stated she would explore other options to see if the expense for

copiers could be reduced.

8

of 7

Motion made by T. Lindeman to pay the Mid-Michigan District Health

Departments Expenses for August 23 September 20, 2014, totaling $310,375.86.

Motion seconded by J. Keon. Motion carried.

c. FY 13/14 Proposed Amended Budget

Motion made by T. Lindeman and seconded by J. Enderle to approve the FY 13/14

Amended Budget as proposed. Motion carried.

d. FY 14/15 Fee Changes

T. Lindeman indicated that the Finance Committee recommended approval of three new

fees: Irrigation Well Permit Applications $333; Paraguard IUD $485; and Mirena

IUS $670.

Motion made by T. Lindeman and seconded by J. Keon to approve the fee changes

as proposed: Irrigation Well Permit Application Fee $333; Paraguard IUD

$485; and Mirena IUS - $670. Motion carried.

e. Epidemiologist Contract

M. Cheatham explained that the Associated Agreement for Epidemiologist Services is a

50% split of services between the CMDHD and the MMDHD. He requested

authorization to have L. McCollum sign the Agreement on behalf of the Board.

Motion made by T. Lindeman and seconded by J. Enderle to authorize L.

McCollum, Chairperson to sign the Associated Agreement for Epidemiology

Services as proposed. Motion carried.

2. Personnel Committee Betty Kellenberger, Chair (B. Delong reported for B. Kellenberger)

1. Consider Acceptance of Teamsters Local 214 Ratified Contract

C. Partlo distributed a memo outlining the changes to the Teamsters Local 214 Contract

and the Ratification Summary. M. Cheatham reviewed the documents and requested

Board acceptance of the Contract.

Motion made by B. Delong and seconded by J. Keon to accept the Teamsters Local

214 ratified Contract as proposed and authorize L. McCollum to sign the completed

Contract once received. Motion carried.

2. Health Officers Contract

M. Cheatham explained two changes to the Health Officers Contract that the Personnel

Committee recommended noting that his wages increased by 2%, consistent with the

Teamsters Local 214 and non-union employees. He explained the second change was to

section 5. h) requiring Board approval for payment of out-of-state travel. Language was

removed requiring Board approval for out-of-state travel. He requested the full Board of

Health to approve the revised contract.

9

of 7

Motion made by B. Delong and seconded by J. Keon to approve the Health Officers

Contract as revised. Motion carried.

3. Program Committee B. Delong, Chair No report.

4. Mid-Central Coordinating Committee T. Lindeman, Vice Chair No report.

F. MEDICAL DIRECTORS REPORT: Robert Graham, DO, MPH, FAAFP

1. Infectious Disease Soup

Dr. Graham stated that a five-year-old child died recently from the CMDHD district during the

time that Enterovirus 68 was announced. He stated that due to the ease of communication

through social media, rumors were being circulated that the child died from Enterovirus, when in

fact, the child died from other causes. He described Enterovirus and its symptoms. Additionally,

he emphasized the importance of relying on factual information rather than sensationalism and

controversy.

Dr. Graham also stated that cases of Pertussis/Whooping Cough have been seen within all of the

19 counties he serves. He emphasized the importance of prevention for all those in the family.

No cases of Middle East Respiratory Syndrome or Ebola Virus have been seen in our district. He

outlined the precautions that have been taken within the district in case these infectious diseases

make their way into Michigan. He added that West Nile Virus (WNV) was still present, although

there were fewer cases this year compared to last years increased number of cases. In summary

Dr. Graham stressed the importance of preventing infectious diseases and preparedness.

Dr. Graham offered the following as the Recommendation of the Board of Health for the month

of October:

Everyone over the age of six months should get a flu shot. Everyone two months of age and older

should begin vaccination against whooping cough or have a completed series against whooping

cough.

J. Enderle asked if anything was being done to change the ability of residents to sign a waiver for

receiving immunizations. Dr. Graham replied that the State was considering a proposal requiring

residents to come to the health department to receive education regarding vaccine-preventable

diseases before obtaining a waiver. He stated that he was aware of two health departments in the

State of Michigan that do not allow waivers for immunizations without first consulting with the

health department staff. The Board discussed the immunization waiver process. M. Cheatham

reported that the State was working on changes to the waiver process.

Motion made by J. Enderle and seconded by J. Keon to adopt the BOH Monthly Healthy

Living Recommendation for October as proposed. Motion carried.

G. HEALTH OFFICER'S REPORT: Mark W. (Marcus) Cheatham, Health Officer, Ph.D.

1. Travel Request

M. Cheatham requested approval from the Board to travel to the Joint Public Health Informatics

Task Force (JPHIT) meeting in Washington, DC, October 29-30, 2014. Although the memo

stated he requested that Melissa Bowerman, Director of Administrative Services be appointed as

10

of 7

Acting Health Officer in his absence, he would not be out of touch and felt it not necessary. No

action was taken by the Board.

M. Cheatham provided an update regarding JPHIT.

2. Health Officer Vacation Request

M. Cheatham stated that he will be on vacation out-of-state September 27 through October 5,

2014. He requested that M. Bowerman be appointed as the Person in Charge during his absence.

Motion made by J. Keon and seconded by T. Lindeman to approve the Health officers

vacation September 27 through October 5, 2014 and appoint M. Bowerman as Person in

Charge during his absence. Motion carried.

3. FY 14/15 MMDHD Organizational Charts

M. Cheatham stated that the agencys Organizational Charts needed to be approved on an annual

basis; and he reviewed the changes with the Board.

Motion made by B. Delong and seconded by T. Lindeman to approve the agencys FY 14/15

Organizational Charts as presented. Motion carried.

4. Grant Update

C. Partlo distributed the Grant Update. M. Cheatham stated that the agency has had success with

recent grant applications. He outlined the grant funds received stating that $21,000 had been

received for the expansion of the Montcalm Area Dental Clinic; $5,000 for the fluoride varnish

program; and $73,669 from the Substance Abuse and Mental Health Services Administration

(SAMHSA) for the first year of a five year grant to support the work of the Clinton Substance

Abuse Coalition. Additionally, M. Cheatham mentioned he forgot to add to the Grant Update the

$5,000 from the Central Montcalm Community Foundation for the expansion of the Montcalm

Area Dental Clinic (although it was included in the amount above). He added that he planned to

partner with the Greenville Area Community Foundation to assist with requesting the remainder

of the funding. The Board expressed concern regarding the growing use of heroin within the

district.

H. OLD BUSINESS:

1. Additional Members to the Board of Health

M. Cheatham explained that any changes to the Intergovernmental Agreement to add at-large

Board members would need to be approved by County Commissioners. The Board members

discussed how the process might be structured and indicated that the details would need to be

worked out, such as: must have two County Commissioners; each county may appoint one

alternate; each county can only have two votes; Commissioners have the vote unless not present,

then alternate votes on behalf of Commissioner; consider per diem/mileage expense because

alternates need to attend every meeting. L. McCollum suggested that the county appointing the

alternate could be responsible for paying the per diem to the alternate. M. Cheatham stated that

he would consider the feedback provided and develop language for consideration.

11

of 7

J. Keon asked M. Cheatham to see examples of what other counties are doing regarding alternate

members and the language in their agreements. M. Cheatham agreed to provide information at a

future meeting.

I. NEW BUSINESS:

1. Board of Health Actions and Outcomes

M. Cheatham explained that the document was created to serve a need for national accreditation.

He reviewed the document and stated that it was very helpful to provide a history of Board of

Health actions. He proposed that this document be reviewed by the Board of Health every

December at the regular Board meeting. He requested the Board accept and place the document

on file.

Motion made by B. Delong and seconded by J. Keon to accept and place the Board of

Health Actions and Outcomes, August 2013 through August 2014 on file. Motion carried.

3. Emerging Issues

1. B. Delong reported that Steve Willis Clinton County Republican Party Chairperson obtained a copy of the Well and Septic Stakeholders Committee final report and

recommendations; sending emails to the community requesting them to attend

tomorrows Commissioner Forum. B. Delong also received a complaint from a

constituent regarding the final report and recommendations, stating that the health

department doesnt have the right to go into a persons home to inspect their water or do

soil borings without just cause, and charging the homeowner for the costs. M. Cheatham

stated that those are not the topics that are being discussed tomorrow. He provided an

overview of the final report and recommendations, stating that the Commissioner Forum

was held to obtain feedback from Commissioners on whether to proceed forward with the

recommendations. B. Gouin explained what he thought was the concerns of the

constituent. After discussion regarding the format of the Commissioner Forum, L.

McCollum stated that she would be willing to moderate the event.

J. LEGISLATIVE ACTION:

1. Legislative Update

M. Cheatham reviewed the Legislative Update stating that the document was prepared to bring

awareness to bills that could become law and how they affect public health. After discussion, the

Board of Health expressed interest in receiving the legislative update periodically.

K. INFORMATIONAL ITEMS:

1. Mid-Michigan District Board of Health Action Items, August 2014

2. Staffing Report

12

of 7

L. RELATED NEWS ARTICLES AND LINKS:

1. "Michigan Hospitals Placed on Alert for Enterovirus", Gannett Michigan, September 9, 2014; http://www.lansingstatejournal.com/story/news/local/michigan/2014/09/08/enteroviru

s-may-already-michigan/15304037/

2. "Air is Still Contaminated 40 Years After the Michigan Chemical Plant Disaster in St. Louis, Michigan", Environmental Science & Technology, September 11, 2014

M. AGENCY NEWSLETTERS:

1. Inside MMDHD, Health Enhancement Committee (HEC), September 2014

There being no further business to come before the Board, the meeting adjourned at 12:05 p.m.

Respectfully Submitted,

Cynthia M. Partlo, Board Secretary

For Laura McCollum, Chairperson

Mid-Michigan District Board of Health

13

http://www.lansingstatejournal.com/story/news/local/michigan/2014/09/08/enterovirus-may-already-michigan/15304037/http://www.lansingstatejournal.com/story/news/local/michigan/2014/09/08/enterovirus-may-already-michigan/15304037/

EV 1776 262,646.19$

EV 1777 154,261.46$

TOTAL 416,907.65$

MONTHLY EXPENSES FOR

September 20, 2014 - October 17, 2014

14

CK# EV 1776 10/3/2014

Payables

101107

thru Quantum Checks & Direct Deposits 93,046.48$

101136

Payroll

AFLAC Employee Deduction 401.31$

MERS Employee Electronic Transfer 3,378.16$

Chemical Bank Payroll-Ameriprise NBS 380.00$

Chemical Bank Payroll-Nationwide 1,725.00$

Chemical Bank Payroll-MERS 457 240.00$

Chemical Bank Payroll Tax Electronic Transfer

Federal 34,081.54$

State -$

MERS Employer Electronic Transfer 14-Sep 25,026.44$

Chemical E-Banking fee 14-Aug -$

Chemical Bank Interest 14-Aug -$

Direct Deposit Payroll 104,367.26$

State of Michigan Unemployment 4Q FY13 -$

TOTAL 262,646.19$


615 North State Street, Suite 2

Stanton MI 48888

(989) 831-5237

15

RUN DATE: OCT 01, 2014 - 13:19 Mid Michigan District Health Department PAGE 0001

ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

55 10/03/14 END012 ENDERLE JACK A SEPTEMBER 2014 09/24/14 11703 49.20$ -$ 49.20$

TRAVEL/PER DIEM

DIRECT DEPOSIT

CHECK TOTALS: 49.20$ -$ 49.20$

56 10/03/14 KEL038 KELLENBERGER BETTY SEPTEMBER 2014 09/24/14 11729 121.76$ -$ 121.76$

TRAVEL/PER DIEM

DIRECT DEPOSIT

CHECK TOTALS: 121.76$ -$ 121.76$

57 10/03/14 LIN033 LINDEMAN TOM SEPTEMBER 2014 09/24/14 11699 108.28$ -$ 108.28$

TRAVEL/PER DIEM

DIRECT DEPOSIT

CHECK TOTALS: 108.28$ -$ 108.28$

101107 10/03/14 BLU008 BLUE CROSS BLUE SHIELD OF MI OCTOBER 2014 0001 10/01/14 11732 2,485.55$ -$ 2,485.55$

HEALTH INSURANCE

COMPUTER CHECK

OCTOBER 2014 0000 09/09/14 11731 24,207.17$ -$ 24,207.17$

HEALTH INSURANCE

CHECK TOTALS: 26,692.72$ -$ 26,692.72$

101108 10/03/14 BLU034 BLUE CARE NETWORK 142550006027 09/12/14 11730 29,787.50$ -$ 29,787.50$

OCTOBER HEALTH INS

COMPUTER CHECK

CHECK TOTALS: 29,787.50$ -$ 29,787.50$

101109 10/03/14 BUS090 BUSINESS MANAGEMENT DAILY REN1R04 08/08/14 11694 147.00$ -$ 147.00$

PAYROLL LEGAL SUBSCRIPTION

COMPUTER CHECK

CHECK TOTALS: 147.00$ -$ 147.00$

101110 10/03/14 CAP095 CAPITAL AREA UNITED WAY 10/3/14 10/01/14 11737 36.00$ -$ 36.00$

41821 EMPLOYEE DONATION

COMPUTER CHECK

CHECK TOTALS: 36.00$ -$ 36.00$

101111 10/03/14 CDW016 CDW GOVERNMENT, INC. PH78153 09/10/14 11677 016014-00 210.66$ -$ 210.66$

JABRA FLEX HEADSET

COMPUTER CHECK

CHECK TOTALS: 210.66$ -$ 210.66$

101112 10/03/14 CEN012 CENTER MEDICAL SUPPLY CO 1258438 09/15/14 11684 016007-00 102.80$ -$ 102.80$

HEMOCUE

COMPUTER CHECK

CHECK TOTALS: 102.80$ -$ 102.80$

101113 10/03/14 CEN149 CENTURYLINK 1313146285 08/31/14 11691 61.11$ -$ 61.11$

CLINTON LONG DISTANCE

COMPUTER CHECK

CHECK TOTALS: 61.11$ -$ 61.11$

16





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

101114 10/03/14 CHA166 CHARTER BUSINESS OCTOBER 2014 09/18/14 11698 122.39$ -$ 122.39$

10/1-10/27/14 CBO INTERNET

COMPUTER CHECK

SEPTEMBER 2014 09/18/14 11697 13.60$ -$ 13.60$

9/28-9/30/14 CBO INTERNET

CHECK TOTALS: 135.99$ -$ 135.99$

101115 10/03/14 CRY023 CASAIR-CRYSTAL AUTO SYSTEM 158576 10/01/14 11733 1,500.00$ -$ 1,500.00$

BUSINESS INTERNET

COMPUTER CHECK

CHECK TOTALS: 1,500.00$ -$ 1,500.00$

101116 10/03/14 DEL007 DELTA DENTAL OF MICHIGAN 624207 09/16/14 11688 4,513.90$ -$ 4,513.90$

OCTOBER 2014 DENTAL

COMPUTER CHECK

CHECK TOTALS: 4,513.90$ -$ 4,513.90$

101117 10/03/14 DEL057 DELONG BRUCE SEPTEMBER 2014 09/24/14 11701 56.40$ -$ 56.40$

TRAVEL/PER DIEM

COMPUTER CHECK

CHECK TOTALS: 56.40$ -$ 56.40$

101118 10/03/14 FRO027 FRONTIER 09/13/14 09/13/14 11696 328.41$ -$ 328.41$

989-224-2195 10/1-10/12/14

COMPUTER CHECK

09/19/14 09/19/14 11706 56.32$ -$ 56.32$

989-875-2952 10/1-10/18/14

9/13/14 09/13/14 11695 492.61$ -$ 492.61$

989-224-2195 9/13-9/30/14

9/19/14 09/19/14 11705 37.55$ -$ 37.55$

989-875-2952 9/19-9/30/14

9/20/14 09/20/14 11710 60.02$ -$ 60.02$

989-875-7707 8/20-9/19/14

CHECK TOTALS: 974.91$ -$ 974.91$

101119 10/03/14 GSK052 GLAXO SMITH KLINE 31914902 08/13/14 11686 015082-00 945.09$ -$ 945.09$

BOOSTRIX

COMPUTER CHECK

CHECK TOTALS: 945.09$ -$ 945.09$

101120 10/03/14 KEN014 KENT COUNTY HEALTH DEPARTMENT EH083114-5637 09/02/14 11707 36.00$ -$ 36.00$

MONTCALM WATER LAB

COMPUTER CHECK

CHECK TOTALS: 36.00$ -$ 36.00$

101121 10/03/14 KEO043 KEON JANE SEPTEMBER 2014 09/24/14 11702 104.20$ -$ 104.20$

TRAVEL/PER DIEM

COMPUTER CHECK

CHECK TOTALS: 104.20$ -$ 104.20$

17





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

101122 10/03/14 MCC164 McCOLLUM LAURA SEPTEMBER 2014 09/24/14 11700 215.40$ -$ 215.40$

TRAVEL/PER DIEM

COMPUTER CHECK

CHECK TOTALS: 215.40$ -$ 215.40$

101123 10/03/14 MDCH59 MICHIGAN DEPT OF COMM HEALTH FOWLER 10/16/14 09/23/14 11728 20.00$ -$ 20.00$

BLOODBORNE PATHOGEN TRAINING

COMPUTER CHECK

PRATT 10/16/14 09/25/14 11727 20.00$ -$ 20.00$

BLOODBORNE PATHOGEN TRAINING

CHECK TOTALS: 40.00$ -$ 40.00$

101124 10/03/14 MID169 MIDMICHIGAN MEDICAL CENTER 2447832 06/17/14 11704 190.20$ -$ 190.20$

MAMMOGRAM/GRATIOT BREAST HEALTH

COMPUTER CHECK

CHECK TOTALS: 190.20$ -$ 190.20$

101125 10/03/14 MIS005 MiSDU/FRIEND OF COURT 10/3/14 10/01/14 11736 234.68$ -$ 234.68$

913105050 DEDUCTION 10/3/14

COMPUTER CHECK

CHECK TOTALS: 234.68$ -$ 234.68$

101126 10/03/14 NEH029 NEHA MEMBERSHIP FY14/15 09/17/14 11690 95.00$ -$ 95.00$

DUES FOR KALNINS

COMPUTER CHECK

CHECK TOTALS: 95.00$ -$ 95.00$

101127 10/03/14 OFF001 OFFICEMAX INCORPORATED 036012 09/10/14 11678 016010-00 11.65$ -$ 11.65$

BATTERIES

COMPUTER CHECK

041786 09/11/14 11680 016010-00 11.65$ -$ 11.65$

BATTERIES

073249 09/10/14 11679 016010-00 95.72$ -$ 95.72$

ENVELOPES,HI LITERS,FRAMES

229412 09/17/14 11685 016016-00 122.04$ -$ 122.04$

LEGAL PADS,ENVELOPES

229417 09/17/14 11683 016017-00 120.80$ -$ 120.80$

FOLDERS,ROLLING CASE

229616 09/17/14 11681 016013-00 239.79$ -$ 239.79$

YEARLY CALENDARS

326629 09/22/14 11744 016019-00 186.08$ -$ 186.08$

POCKET FOLDERS,CLIPS

326630 09/22/14 11723 016020-00 148.90$ -$ 148.90$

COPY PAPER,BATTERIES

326637 09/22/14 11743 016023-00 589.02$ -$ 589.02$

POCKET FOLDERS,HANGING FOLDERS

18





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------


WIRELESS MOUSE

790871 08/27/14 11687 015095-00 383.66$ -$ 383.66$

TONER,COPY PAPER,BATTERIES

CHECK TOTALS: 1,941.10$ -$ 1,941.10$

101128 10/03/14 SAN020 SANOFI PASTEUR INC 901821437 08/20/13 11745 (1,744.82)$ -$ (1,744.82)$

FLUZONE MULTI DOSE

COMPUTER CHECK

903283023 08/20/14 11735 013096-00 3,831.56$ -$ 3,831.56$

514-25 FLUZONE

903541382 09/18/14 11720 013096-00 6,266.94$ -$ 6,266.94$

FLUZONE 395-65

903561376 09/20/14 11719 013096-00 1,803.95$ -$ 1,803.95$

FLUZONE 621-15

903576949 09/22/14 11718 013096-00 5,411.87$ -$ 5,411.87$

621-15 FLUZONE

CHECK TOTALS: 15,569.50$ -$ 15,569.50$

101129 10/03/14 SHR011 SHRED-IT USA LLC 9404234492 09/24/14 11708 117.98$ -$ 117.98$

MONTCALM SHREDDING

COMPUTER CHECK

101129 10/03/14 SHR011 SHRED-IT USA LLC 9404234493 09/24/14 11709 221.76$ -$ 221.76$

FINANCE 02/03 FILES

CHECK TOTALS: 339.74$ -$ 339.74$

101130 10/03/14 STA002 STATE OF MICHIGAN/DEQ 874740 08/28/14 11689 510.00$ -$ 510.00$

CLINTON WATER LABS

COMPUTER CHECK

CHECK TOTALS: 510.00$ -$ 510.00$

101131 10/03/14 STA008 STATE OF MICHIGAN TM14-111731 09/04/14 11693 17.67$ -$ 17.67$

BLOOD LEAD LAB

COMPUTER CHECK

CHECK TOTALS: 17.67$ -$ 17.67$

101132 10/03/14 TOB018 TOBACCO-FREE MICHIGAN FY14/15 09/18/14 11692 30.00$ -$ 30.00$

SARA THELEN MEMBERSHIP

COMPUTER CHECK

CHECK TOTALS: 30.00$ -$ 30.00$

101133 10/03/14 UNI001 UNITED WAY OF MONTCALM CO 10/3/14 10/01/14 11739 63.00$ -$ 63.00$

EMPLOYEE DONATION

COMPUTER CHECK

CHECK TOTALS: 63.00$ -$ 63.00$

19





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

101134 10/03/14 UNI009 UNITED WAY OF GRATIOT CO 10/3/14 10/01/14 11738 64.00$ -$ 64.00$

EMPLOYEE DONATION

COMPUTER CHECK

CHECK TOTALS: 64.00$ -$ 64.00$

101135 10/03/14 VER004 VERIZON 9732488440 OCT 09/21/14 11712 471.36$ -$ 471.36$

10/1-10/21/14 CELL/BROADBAND

COMPUTER CHECK

9732488440 SEPT 09/21/14 11711 262.93$ -$ 262.93$

9/22-9/30/14 CELL/BROADBAND

CHECK TOTALS: 734.29$ -$ 734.29$

101136 10/03/14 WINN73 WINN TELECOM 7019-1639039BB 09/15/14 11713 6,559.91$ -$ 6,559.91$

9/15-9/30/14 MULTILINE ACCESS

COMPUTER CHECK

7019-1639039BB 09/15/14 11714 858.47$ -$ 858.47$

10/1-14 MULTILINE ACCESS

CHECK TOTALS: 7,418.38$ -$ 7,418.38$

BANK CODE TOTALS: 93,046.48$ -$ 93,046.48$

30 COMPUTER CHECKS

0 MANUAL PAYMENT CHECKS

0 VOID CHECKS - TRX

0 VOID CHECKS - STUBS

0 VOID CHECKS - ERROR

0 VOID CHECKS - FORM ALIGNMENT

3 DIRECT DEPOSITS

33 CHECKS TOTAL

COMPANY TOTALS: 93,046.48$ -$ 93,046.48$

20

CK# EV 1777 10/17/2014

Payables

101137

thru Quantum Checks & Direct Deposits 16,242.71$

101170

Payroll

AFLAC Employee Deduction 401.31$

MERS Employee Electronic Transfer 3,422.04$

Chemical Bank Payroll-Ameriprise NBS 380.00$

Chemical Bank Payroll-Nationwide 1,725.00$

Chemical Bank Payroll-MERS 457 240.00$

Chemical Bank Payroll Tax Electronic Transfer

Federal 28,977.94$

State -$

MERS Employer Electronic Transfer - correction 14-Aug (25,026.44)$

MERS Employer Electronic Transfer - actual 14-Aug 18,116.29$

MERS Employer Electronic Transfer 14-Sep 18,975.04$

Chemical E-Banking fee 14-Sep 69.98$

Chemical Bank Interest 14-Sep (2.90)$

Direct Deposit Payroll 90,740.49$

State of Michigan Unemployment 4Q FY13 -$

TOTAL 154,261.46$


615 North State Street, Suite 2

Stanton MI 48888

(989) 831-5237

21





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

101137 10/17/14 APAO62 APOTHECARY SHOPPE 999995214 09/30/14 11751 016034-00 23.95$ -$ 23.95$

FERROUS SULFATE 325MG

COMPUTER CHECK

CHECK TOTALS: 23.95$ -$ 23.95$

101138 10/17/14 BEH044 BEHAVIORAL HLTH SCIENCES 14/15 MEMBERSHIP 10/01/14 11805 50.00$ -$ 50.00$

CHERYL THELEN

COMPUTER CHECK

CHECK TOTALS: 50.00$ -$ 50.00$

101139 10/17/14 CAP095 CAPITAL AREA UNITED WAY 10/17/14 10/01/14 11812 36.00$ -$ 36.00$

EMPLOYEE DONATION

COMPUTER CHECK

CHECK TOTALS: 36.00$ -$ 36.00$

101140 10/17/14 CEN149 CENTURYLINK 1316366015 09/30/14 11808 70.43$ -$ 70.43$

CLINTON LONG DISTANCE

COMPUTER CHECK

CHECK TOTALS: 70.43$ -$ 70.43$

101141 10/17/14 CHE172 CHERRY STREET HEALTH SERVICE OCTOBER 2014 10/01/14 11786 125.00$ -$ 125.00$

WIC CLINICS

COMPUTER CHECK

CHECK TOTALS: 125.00$ -$ 125.00$

101142 10/17/14 CIT143 CITY OF ITHACA 2881 10/01/14 11764 179.18$ -$ 179.18$

CORRIGAN MERS TRAINING

COMPUTER CHECK

CHECK TOTALS: 179.18$ -$ 179.18$

101143 10/17/14 CLI092 CLINTON COUNTY ADMIN/ACCT AC-2014-036 10/01/14 11765 1,675.00$ -$ 1,675.00$

NOVEMBER RENT

COMPUTER CHECK

CHECK TOTALS: 1,675.00$ -$ 1,675.00$

101144 10/17/14 COH003 COHL, STOKER & TOSKEY 44877 10/03/14 11806 482.79$ -$ 482.79$

SEPTEMBER LEGAL

COMPUTER CHECK

CHECK TOTALS: 482.79$ -$ 482.79$

101145 10/17/14 COV178 COVENANT MEDICAL CENTER CBO 22412 SEPT 10/05/14 11799 24.00$ -$ 24.00$

CLINTON LABS

COMPUTER CHECK

SEPTEMBER 2014 09/30/14 11798 43.00$ -$ 43.00$

GRATIOT LABS

CHECK TOTALS: 67.00$ -$ 67.00$

101146 10/17/14 E&S003 E&S GRAPHICS INC 49462 09/30/14 11755 016025-00 238.87$ -$ 238.87$

EH BILLING FORMS

COMPUTER CHECK

CHECK TOTALS: 238.87$ -$ 238.87$

22





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

101147 10/17/14 FIS043 FISH MICHAEL REFUND 10/01/14 11789 21.00$ -$ 21.00$

OVERPAYMENT

COMPUTER CHECK

CHECK TOTALS: 21.00$ -$ 21.00$

101148 10/17/14 FRO027 FRONTIER 10/1-10/27-14 10/01/14 11788 65.20$ -$ 65.20$

989-224-4300

COMPUTER CHECK

9/28/14 09/30/14 11787 7.25$ -$ 7.25$

9-28-9/30/14 989-224-4300

CHECK TOTALS: 72.45$ -$ 72.45$

101149 10/17/14 GSK052 GLAXO SMITH KLINE 32067208 09/29/14 11817 016031-00 945.09$ -$ 945.09$

BOOSTRIX

COMPUTER CHECK

CHECK TOTALS: 945.09$ -$ 945.09$

101150 10/17/14 HOS101 HOSPITAL NETWORK HEALTHCARE 33628 09/30/14 11761 59.00$ -$ 59.00$

MONTCALM WASTE PICKUP

COMPUTER CHECK

CHECK TOTALS: 59.00$ -$ 59.00$

101151 10/17/14 IMP002 IMPREST CASH-MONTCALM 080714 09/30/14 11803 10.00$ -$ 10.00$

G.C.F.F.Y BOOTH (ICE)

COMPUTER CHECK

081114 09/30/14 11804 27.62$ -$ 27.62$

G.C.F.F.Y & BATHROOM SUPPLY

AUGUST 2014 09/30/14 11790 22.94$ -$ 22.94$

KEYS/OUTREACH SUPPLY

INCREASE M/O 10/01/14 11794 60.00$ -$ 60.00$

PER MB INCREASE FOR EMERGENCY

JUNE-SEPT REFUN 09/30/14 11782 36.41$ -$ 36.41$

POSTAGE/EH SUPPLY

CHECK TOTALS: 156.97$ -$ 156.97$

101152 10/17/14 MCK032 MCKESSON MEDICAL 46550406 08/21/14 11757 015091-00 112.79$ -$ 112.79$

EXAM GLOVES

COMPUTER CHECK 46550406 08/21/14 11758 015091-00 (55.60)$ -$ (55.60)$

EXAM GLOVES

INVOICE TOTALS: 57.19$ -$ 57.19$

47172431 09/08/14 11756 015091-00 102.81$ -$ 102.81$

EXAM GLOVES

48161063 10/02/14 11750 016041-00 320.09$ -$ 320.09$

GLOVES,LANCETS,COTTONBALLS

CHECK TOTALS: 480.09$ -$ 480.09$

23





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

101153 10/17/14 MIS005 MiSDU/FRIEND OF COURT 10/17/14 10/01/14 11811 234.68$ -$ 234.68$

913105050 EMPLOYEE DEDUCTION

COMPUTER CHECK

CHECK TOTALS: 234.68$ -$ 234.68$

101154 10/17/14 MNA004 MICHIGAN NURSES ASSOCIATION OCTOBER 2014 10/01/14 11810 595.21$ -$ 595.21$

DUES

COMPUTER CHECK

CHECK TOTALS: 595.21$ -$ 595.21$


COPY PAPER,YELLOW NOTES

COMPUTER CHECK

459877 09/29/14 11747 016030-00 224.40$ -$ 224.40$

MONTHLY/YEARLY CALENDARS

459884 09/29/14 11748 016028-00 493.36$ -$ 493.36$

ENVELOPES,PENS,CLIPS

CHECK TOTALS: 779.61$ -$ 779.61$

101156 10/17/14 OPT016 OPTUMINSIGHT 37472318 10/01/14 11807 103.97$ -$ 103.97$

SEPTEMBER EDI/MAILED CLAIMS

COMPUTER CHECK

CHECK TOTALS: 103.97$ -$ 103.97$

101157 10/17/14 PEO083 9/3/14 09/03/14 11797 5.76$ -$ 5.76$

MIHP TRAVEL

COMPUTER CHECK

SEPT 2014 09/30/14 11796 5.76$ -$ 5.76$

MIHP TRAVEL

CHECK TOTALS: 11.52$ -$ 11.52$

101158 10/17/14 QUI003 QUILL CORPORATION 6376089 09/23/14 11754 016024-00 43.97$ -$ 43.97$

NAMEPLATE,WIRELESS MOUSE

COMPUTER CHECK

6407682 09/24/14 11759 016024-00 14.99$ -$ 14.99$

BALLPOINT PENS

6439151 09/25/14 11760 016024-00 25.98$ -$ 25.98$

NAMEPLATES SHAWN/COURTNEY

6502963 09/26/14 11749 016035-00 26.86$ -$ 26.86$

FILE FOLDERS,FOLDER LABELS

CHECK TOTALS: 111.80$ -$ 111.80$

101159 10/17/14 R&S005 R&S NORTHEAST LLC 59670 09/26/14 11753 016033-00 1,195.80$ -$ 1,195.80$

ORTHO-CYCLEN,ORTHO TRI-CYCLEN

COMPUTER CHECK

CHECK TOTALS: 1,195.80$ -$ 1,195.80$

24





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

101160 10/17/14 STA002 STATE OF MICHIGAN/DEQ 874731 08/28/14 11785 1,002.00$ -$ 1,002.00$

GRATIOT WATER LABS

COMPUTER CHECK

878664 09/30/14 11809 796.00$ -$ 796.00$

MONTCALM WATER LABS

CHECK TOTALS: 1,798.00$ -$ 1,798.00$

101161 10/17/14 STA008 STATE OF MICHIGAN RM14-113404 09/04/14 11792 17.67$ -$ 17.67$

BLOOD LEAD LAB

COMPUTER CHECK

TM14 112899 09/04/14 11791 17.67$ -$ 17.67$

BLOOD LEAD LAB

TM14-112082 09/04/14 11793 17.67$ -$ 17.67$

BLOOD LEAD LAB

CHECK TOTALS: 53.01$ -$ 53.01$

101162 10/17/14 SWM155 SW MEHA 10/17/14 10/01/14 11763 15.00$ -$ 15.00$

BRANDON JONGKIND

COMPUTER CHECK

CHECK TOTALS: 15.00$ -$ 15.00$

101163 10/17/14 TEA001 TEAMSTERS LOCAL 214 OCTOBER 2014 10/01/14 11815 2,139.41$ -$ 2,139.41$

DUES

COMPUTER CHECK

CHECK TOTALS: 2,139.41$ -$ 2,139.41$

101164 10/17/14 TRI049 TRINITY EVANGELICAL FREE MEMORIAL 10/01/14 11766 40.00$ -$ 40.00$

RAYMOND EVANS

COMPUTER CHECK

CHECK TOTALS: 40.00$ -$ 40.00$

101165 10/17/14 UNI001 UNITED WAY OF MONTCALM CO 10/17/14 10/01/14 11814 63.00$ -$ 63.00$

EMPLOYEE DONATION

COMPUTER CHECK

CHECK TOTALS: 63.00$ -$ 63.00$

101166 10/17/14 UNI009 UNITED WAY OF GRATIOT CO 10/17/14 10/01/14 11813 64.00$ -$ 64.00$

EMPLOYEE DONATION

COMPUTER CHECK

CHECK TOTALS: 64.00$ -$ 64.00$

101167 10/17/14 UPS002 UNITED PARCEL SERVICE 304 09/30/14 11802 (16.93)$ -$ (16.93)$

BILLING INCENTIVE FOR 5/24/14

COMPUTER CHECK

354 08/30/14 11801 12.15$ -$ 12.15$

FOOD TESTS

404 10/04/14 11800 11.56$ -$ 11.56$

FOOD TESTS/MERCURY SPILL

CHECK TOTALS: 6.78$ -$ 6.78$

25





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

101168 10/17/14 VER004 VERIZON 9732663594 09/23/14 11783 73.02$ -$ 73.02$

9/24-9/30/14 MIHP BROADBAND

COMPUTER CHECK

SEPT 9732663594 10/01/14 11784 145.77$ -$ 145.77$

10/1-10/23/14 MIHP BROADBAND

CHECK TOTALS: 218.79$ -$ 218.79$

101169 10/17/14 WRI074 AUGUST 2014 08/26/14 11795 10.56$ -$ 10.56$

MIHP TRAVEL

COMPUTER CHECK

CHECK TOTALS: 10.56$ -$ 10.56$

101170 10/17/14 FIR003 FIRST NATIONAL BANK OMAHA 15098 SEPT 2014 09/30/14 11773 015098-00 9.99$ -$ 9.99$

SAFETY HANDBOOK

COMPUTER CHECK

16000 SEPT 2014 10/01/14 11775 016000-00 23.29$ -$ 23.29$

CALENDAR REFILLS

241607426141818 10/02/14 11777 016021-00 601.65$ -$ 601.65$

STAMPED ENVELOPES

241607426241818 10/02/14 11778 016022-00 1,772.65$ -$ 1,772.65$

STAMPED ENVELOPES

244921542538499 10/02/14 11776 016015-00 25.84$ -$ 25.84$

REPLACEMENT PART FOR SERVER

246921642550007 10/02/14 11781 319.21$ -$ 319.21$

STAMP.COM FEE/SUPPLY/LUNCHEON

246921642620006 10/02/14 11779 016018-00 43.54$ -$ 43.54$

CALENDAR REFILLS

246921642730004 10/02/14 11780 016036-00 30.72$ -$ 30.72$

AT A GLANCE CALENDAR

GOUIN SEPT 2014 09/30/14 11770 460.87$ -$ 460.87$

LUNCH/MED WASTE TRAINING

SEPT 2014 8796 09/30/14 11768 775.00$ -$ 775.00$

MALPH TRAININGS

SEPTEMBER 2014 09/30/14 11767 55.99$ -$ 55.99$

LUNCHES

CHECK TOTALS: 4,118.75$ -$ 4,118.75$

26





------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

BANK CODE TOTALS: 16,242.71$ -$ 16,242.71$

34 COMPUTER CHECKS

0 MANUAL PAYMENT CHECKS

0 VOID CHECKS - TRX

0 VOID CHECKS - STUBS

0 VOID CHECKS - ERROR

0 VOID CHECKS - FORM ALIGNMENT

0 DIRECT DEPOSITS

34 CHECKS TOTAL

COMPANY TOTALS: 16,242.71$ -$ 16,242.71$

27


CLINTON


St. Johns, MI 48879-9036 (989) 224-2195



(989) 875-3681



(989) 831-5237


Stanton, MI 48888-9702 (989) 831-5237



Medical Director




Laura McCollum


Connecting with our Communities to Achieve Healthier Outcomes

M E M O R A N D U M

TO: Board of Health

FROM: Melissa Bowerman, Director of Administrative Services

DATE: October 8, 2014

SUBJECT: Bank Signatures on Agency Accounts

With the retirement of Bonnie Havlicek, we are in need of updating our bank signature cards. I am requesting

that the Board of Health approve the following staff be authorized on all Mid-Michigan District Health

Department bank accounts Chemical Bank Montcalm Branch Office/Main Office in Stanton, First Bank

accounts for the Clinton Branch Office in St. Johns, and the Commercial Bank for the Gratiot Branch Office in

Ithaca:

Marcus Cheatham, Health Officer

Melissa Bowerman, Director of Administrative Services

Bob Gouin, Environmental Health Director

28


Epidemiology Associated Agreement 2015-2016 Page 1 of 5

ASSOCIATED AGREEMENT

FOR EPIDEMIOLOGY SERVICES

The MID-MICHIGAN DISTRICT HEALTH DEPARTMENT, hereinafter referred to as

(MMDHD), 615 North State Street, Suite 2, Stanton, Michigan, 48888-9702 and the CENTRAL

MICHIGAN DISTRICT HEALTH DEPARTMENT, hereinafter referred to as (CMDHD), 2012

East Preston, Mt. Pleasant, Michigan, 48858, herein enter into this Associated Agreement for

Epidemiology Services. The Epidemiologist will serve the two District Health Departments:

MMDHD and CMDHD.

NOW THEREFORE, it is agreed as follows:

1. The agreement shall commence October 1, 2014 and shall continue through

September 30, 2017.

2. The Epidemiologist shall receive total compensation of Sixty Three Thousand Seven

Hundred Eighty Six and 00/100 ($63,786.00) Dollars, for the period of October 1, 2014

September 30, 2015 with a 2% increase in both Fiscal Years 15/16 and 16/17. The base

salary includes an estimated annual amount for fringe benefits.

3. The MMDHD and CMDHD shall each be responsible for forty-two percent (42%) the

cost of the Epidemiologists compensation including base salary and fringe benefits.

4. MMDHD and CMDHD agree to permit District Health Department #10 to purchase

sixteen percent (16%) of the Epidemiologists time. If this changes, MMDHD and

CMDHD can change the proportion of the Epidemiologists time for which they are

responsible by a memorandum of understanding if they agree to do so.

5. The Epidemiologist shall dedicate his or her full time to this employment. Except under

extraordinary circumstances, the Epidemiologist shall direct forty-two percent (42%) of

his working efforts to MMDHD and forty-two percent (42%) to CMDHD.

6. The Epidemiologist shall receive all fringe benefits and expense reimbursements as an

employee of MMDHD. All employment records and disbursements shall be

administered from MMDHD.

7. The Epidemiologist shall suffer no loss of seniority, vested rights, or any other benefits

related to his or her length of employment by virtue of this Agreement.

29


8. Typical duties to be performed by the Epidemiologist are set forth in the Job Description

attached as Exhibit A and incorporated herein by reference.

9. This Agreement may be terminated by any party giving sixty (60) days written notice.

All parties agree that should this Associated Agreement be terminated, the

Epidemiologist shall remain an employee of MMDHD only and, in that capacity shall

also be an employee at will.

10. Approval of both MMDHDs and CMDHDs Boards of Health is indicated by the

signature of the respective Chairpersons shown below.

MID-MICHIGAN DISTRICT CENTRAL MICHIGAN DISTRICT

HEALTH DEPARTMENT HEALTH DEPARTMENT

By:__________________________________ By:________________________________

Laura McCollum, Chairperson George Green, Chairperson

Date:_________________________________ Date:______________________________

30


Exhibit A JOB DESCRIPTION

MID-MICHIGAN DISTRICT HEALTH DEPARTMENT

EPIDEMIOLOGIST

Job Description

NATURE OF WORK

This is a professional position in the Community Health and Education Division, under general direction of

the Division Director, responsible for provision of surveillance, monitoring, and planning in the area of

chronic and communicable disease control and prevention. The employee identifies program needs, collects

and analyzes statistical data, prepares reports, recommends program/policy modifications or enhancements,

participates on Communicable Disease Response Team, and interacts with various external agencies as

applicable.

EXAMPLES OF WORK

Serve as a resource for the planning process, development, and evaluation of Public Health Programs.

Develops recommendations for program and policy modifications or enhancements.

Serve as a liaison with other local public health assessment analysts, epidemiologists, MIS personnel and

appropriate MDCH (Michigan Department of Community Health) staff to assure MMDHD is utilizing

evaluation methodology and epidemiological tools consistent with other agencies and MDCH.

Gathers, processes, and analyzes relevant demographic and statistical data specific to the local health

jurisdiction.

Collect, analyze and interpret data, and aid Divisions in their preparation of reports for distribution to local

public health Administration, Board of Health, Community Health Advisory Committees, and interested

public.

Perform research with Divisions and Medical Director on current public health issues identifying areas of

unmet health needs. Prepare and/or aid in preparation of written reports and verbal presentations.

Aid Divisions in developing evaluation measures for agency outcomes and impact indicators.

Develops and maintains various data base systems to determine the prevalence and incidence of infectious

and chronic diseases.

Writes detailed or technical reports of findings, conclusions, and recommendations based on a thorough

analysis and interpretation of data.

31


Designs, coordinates, and conducts communicable disease outbreak investigations; reviews infectious disease

cases; develops questionnaires; reviews and evaluates data.

Oversees tuberculosis control program; advises nursing staff on case management; determines resource

allocations for screening of contacts (may provide direct services to patients and work with non-compliant

patients); develops policies and procedures for tuberculosis control.

Epidemiologist

Job Description

Page 2

In times of a public health emergency, employee may be required to perform specialized assigned duties

as outlined in MMDHD Policy #126 entitled Emergency Preparedness for Chemical, Biological,

Radiological, Nuclear and Explosive Events.

Performs other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES

Principles and practices relating to public health, epidemiology, and communicable diseases.

Biostatistics and research design as related to epidemiology.

Diagnosis and treatment of communicable disease.

Chronic and communicable disease intervention and programming strategies.

Computer applications relating to the area of assignment.

Communicating clearly and effectively, orally and in writing.

Reading, analyzing and interpreting professional periodicals and journals, technical procedures and

government regulations.

Preparing clear and concise reports, correspondence, and other written material.

Organizing work, setting priorities, meeting critical deadlines, and following up assignments with a minimum

of direction.

QUALIFICATIONS

Masters degree in Public Health, Epidemiology, or a related field, or its equivalent in experience.

Public Health background with at least two to three years related work experience.

Other combinations of education, training, and experience which provide the required knowledge, skills, and

abilities to perform the essential functions of this job would be considered.

Substantial micro-computer skills particularly in areas of word processing; database; spreadsheet; and

graphics; including electronic communication via modem.

32


Physical Requirements: Sitting for prolonged periods of time; standing; kneeling; bending; twisting; and able

to lift and carry presentation materials, A/V equipment, and files, etc. to a maximum of fifty pounds.

Required to travel and provide own transportation.

Revised: 3/28/2006

33

Outline of process for dealing with a patient suspected of having Ebola Virus Disease

Phone Call received from a patient or

from a persons home or from a doctors

office describing a patient with fever

and or nausea and vomiting.

Has the person traveled in West Africa in

the last 21 days or had contact with a

known case of Ebola in the last 21 days

NO YES

Routine Care Keep patient in place. Alert EMS

of a possible case of Ebola.

Transport patient to appropriate

facility

Start Strict Isolation procedures

Information about personal contacts should be obtained

Notify Michigan Department of Community Health 517-335-

8165 during business hours 517-335-9030 after hours

Limit invasive procedures

Collect two red top blood samples in plastic tubes for

confirmatory testing

Local Health Department will conduct tracing of Suspected

Ebola case contacts

Implement a contact monitoring system

Request Activation of EOC

36


CLINTON


St. Johns, MI 48879-9036 (989) 224-2195



(989) 875-3681



(989) 831-5237


Stanton, MI 48888-9702 (989) 831-5237



Medical Director


Connecting with our Communities to Achieve Healthier Outcomes.

October 20, 2014

Dear Parent/Guardian:

As you have probably seen in the media, some schools in Ohio closed after two students travelled on a plane with a nurse

who later tested positive for the Ebola virus. The two students went to school after traveling, and when it was discovered

they had been on the plane with the nurse, a decision was made to close the schools. It is natural to wonder if something

like that could happen here, and how our schools would handle it.

First, it is important to understand that it was not necessary from a medical perspective to close the schools. The nurse

was almost certainly not contagious while she was on the plane. Even if she was, it is highly unlikely that she could have

spread the virus to other passengers just by sitting near them, and the two students could not have transmitted the virus to

other students so soon after exposure. Therefore, in a situation like this, the Health Department would not order the

schools to close.

However, whenever concerns for student welfare are high enough, a superintendent may at his or her own discretion

choose to close a school.

We want to stress that those living in the United States are not at-risk of contracting Ebola unless they have traveled to

one of the West African countries suffering from the Ebola outbreak (Guinea, Liberia, Sierra Leone, Nigeria or Senegal),

or had close contact with the body fluids of someone who has Ebola.

We also want you to know that local hospitals, health care providers and public health professionals are preparing for the

unlikely event that a patient who may have Ebola is identified in our area. If this should happen, the person will be

immediately isolated and tested for Ebola.

The Ebola situation in West Africa and here in the United States will continue to evolve. Please visit

www.michigan.gov/ebola for the most up-to-date information. You may also contact one of our Communicable Disease

nurses with questions:

Clinton County: 989-227-3111

Gratiot County: 989-875-1019

Montcalm County: 989-831-3615

Mid-Michigan District Health Department will continue to stay in close contact with school officials, and will notify you

of any important developments.

Sincerely,

Robert Graham, DO, MPH

Medical Director

37

http://www.mmdhd.org/http://www.michigan.gov/ebola

Travel plus fever?

Done

N O THING

Health Care

Local Public Health

EOC

1. Isolate! 2. Contact MDCH

3. Contact LHD

4. EMS: Transport to designated

facility or request help from MDCH

LHD monitors contacts for symptoms

LHD begins contact tracing

5. Testing per BOL Instructions

6. Clean-up by designated firm.

Activate EOC Establish JIC

N O FEVER

Fever?

NO

Regular calls and briefings

Y E S

Flow Chart for Local Ebola Response

www.michigan.gov/ebola MDCH: 517-335-8165 24/7: 517-335-9030

First Day

Ask everyone with fever travel history. Ask all travelers to

West Africa to identify selves. F

irst Hour

38

http://www.michigan.gov/documents/emergingdiseases/NewCDCebola-algorithm_470869_7.pdfhttp://www.michigan.gov/documents/emergingdiseases/NewCDCebola-algorithm_470869_7.pdfhttp://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.htmlhttp://www.michigan.gov/documents/emergingdiseases/ems-checklist-ebola-preparedness_470787_7.pdfhttp://www.michigan.gov/documents/emergingdiseases/ems-checklist-ebola-preparedness_470787_7.pdfhttp://www.michigan.gov/documents/emergingdiseases/ems-checklist-ebola-preparedness_470787_7.pdfhttp://www.michigan.gov/documents/emergingdiseases/ems-checklist-ebola-preparedness_470787_7.pdfhttp://www.michigan.gov/documents/emergingdiseases/contact-tracing_470784_7.pdfhttp://www.michigan.gov/documents/emergingdiseases/contact-tracing_470784_7.pdfhttp://www.michigan.gov/documents/mdch/Ebola_lab_update_2_8-22-14_466115_7.pdfhttp://www.michigan.gov/documents/mdch/Ebola_lab_update_2_8-22-14_466115_7.pdfhttp://www.cdc.gov/vhf/ebola/hcp/medical-waste-management.htmlhttp://www.cdc.gov/vhf/ebola/hcp/medical-waste-management.htmlhttp://www.cdc.gov/vhf/ebola/hcp/medical-waste-management.htmlhttp://www.cdc.gov/vhf/ebola/hcp/medical-waste-management.htmlhttp://www.michigan.gov/ebolahttp://www.michigan.gov/documents/emergingdiseases/hospital-signs-tabloid_470792_7.pdf

MID-MICHIGAN DISTRICT HEALTH DEPARTMENT

QUARTERLY SERVICE REPORT

FY 13/14

Fourth Quarter, July 1, 2014 - September 30, 2014

This report provides information regarding every program operated by the Mid-Michigan District Health Department, on a county-by-county and a district

wide basis. Planned and actual service activities by program are included. Data is also organized in columns to provide comparisons of program data over

two (2) periods: 1) Current Quarter and 2) Year-To-Date/Same Period, Previous Year. For additional information or clarification of the data presented in

this report, please contact the Health Officer at (989) 831-3610.

MATERNAL AND CHILD HEALTH SERVICES PAGE NO.

District Wide ....................................................................................... 1-2

Clinton County ........................................................................................ 6

Gratiot County ................................................................................. 10-11

Montcalm County .................................................................................. 15

COMMUNITY HEALTH AND EDUCATION

District Wide ........................................................................................... 3

Clinton County ........................................................................................ 7

Gratiot County ....................................................................................... 12

Montcalm County .................................................................................. 16

ENVIRONMENTAL HEALTH

District Wide ....................................................................................... 4-5

Clinton County .................................................................................... 8-9

Gratiot County ................................................................................. 13-14

Montcalm County ............................................................................ 17-18

Dated: October 29, 2014 _______________________________

Mark W. (Marcus) Cheatham, Ph.D.

Health Officer

39


Program Listing

Revised: November 2013

Community Health and Education Division Programs

WOMEN, INFANT AND CHILDREN (WIC) NUTRITION PROGRAM: The WIC program is a federally-funded health and nutrition program designed to improve health outcomes for eligible women, infants and children. This is accomplished by providing nutritious food, nutrition education, breastfeeding promotion and support, and referrals to health and other services. FAMILY PLANNING (FP) PROGRAM: FP services help women and men determine if and when they want to have a child. Services include screening for breast and cervical cancer, sexually transmitted infections (STIs) and other health issues, in addition to providing a full range of birth control information and supplies. The program promotes maternal health through client education, counseling and referral to community resources for social and medical issues. Services are strictly confidential and provided on a sliding fee scale. CHILDRENS SPECIAL HEALTH CARE SERVICES (CSHCS): The Mid-Michigan District Health Department (MMDHD) serves as the local representative for the Michigan Department of Community Health CSHCS program. CSHCS are for children and some adults with special health care needs. Family-centered services include case management and care coordination to assist families in accessing and navigating complex medical specialty systems. Clients are assessed and referred to community resources. MATERNAL INFANT HEALTH PROGRAM (MIHP): MIHP is a program for infants and pregnant women with Medicaid health insurance. MIHP provides support to promote healthy pregnancies, good birth outcomes and healthy infants by providing assessments, health education counseling and referrals to community resources. Services are provided by a multi-disciplinary team consisting of a Public Health Nurse, Social Worker and Dietitian, usually in the clients home environment. IMMUNIZATION PROGRAM: The Immunization Program provides vaccinations for preventable diseases for children, teens and adults. The Vaccines for Children (VFC) program provides vaccines at no cost to eligible children, from birth through 18 years of age, who are on Medicaid, have no health insurance, or meet other qualifying conditions. ACUTE COMMUNICABLE DISEASE/TB CONTROL PROGRAM: The Communicable Disease (CD) program provides surveillance, reporting, controlling and preventing infectious diseases in the community. The TB Control program provides diagnosis, treatment and prevention of tuberculosis in cooperation with the family physician and or the MMDHD Medical Director. Medication is provided for treatment and prevention of TB.

40


Program Listing


SEXUALLY TRANSMITTED INFECTIONS (STI)/HIV COUNSELING, TESTING and CONTROL PROGRAM: STI services include diagnosis, treatment, counseling and partner notification for STI exposures. STI prevention education is provided with the goal of decreasing costly complications from infections, and saving substantial public and private healthcare dollars. Services are strictly confidential. Anonymous and confidential HIV counseling and testing is also provided. Clients needing treatment or follow-up are referred to the regional provider of these services. HEARING SCREENING PROGRAM: By law, all children must be screened for hearing at least once between the ages of three and five years old, in kindergarten, second, and fourth grades. Early identification of hearing problems can prevent developmental, social and emotional delays. Children identified with hearing problems are referred to physicians for further evaluation. VISION SCREENING PROGRAM: Vision screening takes place at least once between the ages of three and five years old, first, fifth, and seventh grades. Early identification of vision problems can enhance academic achievement and prevent permanent loss of vision. Children identified with vision problems are referred for follow-up.

Environmental Health Division Programs

FOOD SERVICE SANITATION PROGRAM: Periodic inspections of food service establishments, mobile food units, and vending machines for compliance with public health standards; includes recommendations for licensures, review of plans and specifications for new and remodeled establishments, educational activities, and investigations of reports of foodborne illnesses. PRIVATE AND SEMI-PUBLIC ON-SITE SEWAGE DISPOSAL PROGRAM: Assures the adequate and proper disposal of wastewater in areas not served by public sewage systems; accomplished through proper design, inspection and management of various methods of sewage effluent disposal. PRIVATE, PUBLIC, AND NON-COMMUNITY WATER SUPPLY PROGRAM: Protects sources of drinking water, assures proper plugging of abandoned wells, and assures private/public water supplies are constructed, maintained, and operated in compliance with state and federal safe drinking water supply standards. NUISANCE ABATEMENT PROGRAM: Investigation and management of complaints alleged, including public or private nuisances or unsanitary conditions.

41


Program Listing


WATER AND SEWAGE SYSTEM EVALUATION PROGRAM: Evaluation of operation and construction of existing water supply and sewage disposal systems against State and Local standards. DHS FACILITY INSPECTION PROGRAM: Inspections and consultations made at the request of the Department of Human Services, of child and adult care facilities for compliance with health and social service standards; includes new facility review and approval and investigations relative to specific nuisance complaints.

42

Community Health and Education Division (CHED) Quarterly Division Update

Fourth Quarter (July 1, 2014 September 30, 2014)

Andrea Tabor, CHED Director

October 29, 2014

Oral Health Initiatives During the past quarter, 159 Head Start students were screened by the Oral Health Coordinator and received their first fluoride varnish applications of the school year. Students identified as having dental concerns were referred to local dentists. Head Start works with the childrens families to arrange the follow-up visits with dentists. The Mid-Michigan District Health Department (MMDHD) has expanded the fluoride varnish program into the Women, Infants, and Childrens (WIC) clinics in the past fiscal year. This past quarter, 186 WIC children received fluoride varnish applications. Communicable Disease: In addition to staying up on the latest developments, the Epidemiology (EPI) team (Health Officer, Medical Director, CHED Director, Epidemiologist, CHED Supervisor, Communicable Disease Nurses, Public Information Officer, and Management Information Specialist) held a conference call on October 16th to discuss the latest recommendations regarding the Ebola outbreak. Marcus led the team through a variety of scenarios to talk about how MMDHD would respond. This process helped the group determine our strengths as well as opportunities for improvement (e.g. the type of personal protective equipment that we currently have available). Pathways to Better Health: Pathways to Better Health is the federally-funded community HUB project that strives to improve health outcomes for at-risk individuals and reduce health care costs. Working with the Ingham Health Plan Corporation, the MMDHD hired a Community Health Worker (CHW) for Clinton County to provide peer support services to help individuals navigate the health care system and receive much needed assistance. This past quarter the CHW began serving clients and now has a full caseload, demonstrating the need for such services. Thanks to funding from the Mid-Michigan Health Plan, MMDHD has recently hired two CHWs to provide case management services for at-risk residents in Montcalm and Gratiot Counties. Nursing Students: The fall usually brings students through our doors to spend time with staff learning the great things they do every day. This year has been exceptionally busy with nursing students from the Un

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