Clark County Board of Health

0:00 (upbeat music) - Good morning. Wednesday, July 22nd, 2026. We'll start with the Pledge of Allegiance if you'll join me in standing. - I 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. - Thank you. Let's go with the roll call. - Councilor Belcott. - Present. - Councilor Fuentes. - Here. - Councilor Little.

0:59 - Here. - Chair Marshall. - Here. - And I think Councilor Young is out. - He's out. I think he's listening in, though, but he wasn't able to be here. Okay, are there any amendments to the agenda? - No. - No amendments? Okay, then let's open it up for public comment. Just a reminder, you're limited to three minutes, and this is the Board of Health.

1:27 - Thank you. - Okay, there's two online. We'll hear from them. - Caller, you've been sent a request to unmute yourself. Please do so, state your name for the record, and go ahead with your comments. - Good morning, Kimberly Goheen-Elbon. So I did put a written comment there on today's agenda. I'd ask the public to read that and share. A little bit on the language thing here. I'm looking on the agenda, your language access line. God made all people, but we are a sovereign nation. We are harboring illegal immigrants.

2:27 And for me, that takes away from the American people that are working hard to keep their jobs and food on their table and their children educated, yet we're gonna have to spend a lot of hard-earned tax dollars on this language barrier. These people need to learn the American English language. And frankly, I'm all for trying to get them out. It's a deep subject, but I'm against hard-earned tax dollars being used for this. We're talking a lot of money. I know that when I get a medical thing, there's two and a half pages worth of my money is going to translations and all that. So I wanna mention a little bit about the jail as far as public health. And I'm gonna speak particularly

3:25 about my son, Cleve Goheen-Rengo. He has been in there. There's no good nutrition, no good proteins. It's all processed, which means chemicals are added to all the foods that are grown there. And then they use them there to feed the people there. He has lost all of his body mass. He doesn't even have butt muscles anymore. So I'm really concerned about that. Hopefully his case will become what's called a case law where the court system will listen to what he has to say in his case law. We need a new jail system. There's a lot of areas in the jail, the visiting room, we can't go in and visit anymore in person through the glass. So the whole thing needs to be rebuilt. I mentioned in my written comment about chemtrails.

4:23 You guys need to stop all the chemtrails going above Clark County. And I hope you've been doing something and not just satisfying the law that you have an open public comment meeting and then just ignore what we have to say. I'm very concerned about those chemtrails. I can't even breathe. My nose is plugged up from it and all that 'cause I get outside. I consider overpopulation pollution a health hazard to those of us- - Okay, thank you. Your time is up. One more? - One more. - Okay. - Caller, you've been sent a request to unmute yourself. Please do so, state your name for the record and go ahead with your comments. - Hello? Hello, we can hear you. - Right on. Okay, so this is Melo Carmen de León.

5:19 And I did see this on the agenda about the languages. And I'm talking to you from experience. When I was in Romania, they took a week to find me somebody only because I was hysterical. Otherwise, they pretty much hung up on me and laughed. When I was in Guatemala, as a teenager, go figure, I was a teenager in Guatemala, got arrested. They dragged me by my hair, threw me into the police car. I spoke only English because I knew that they were gonna, you know, probably (speaks in foreign language) which is disappear you in Guatemala when I was about 15. So I spoke only English. They laughed at me. They laughed. Why'd you come to this country not speaking the language? It's on you. Luckily, my uncle showed up in full military regalia. And of course, they threw me at him and I was free to walk away.

6:17 But what I'm saying is in this country, we put out a red carpet for people from other country and they laugh at us. You go to Bulgaria, you go to any other country and ask for translation or free medical and free housing and free food stamps, they gonna laugh at you. I know from experience, I've been to Europe, it's a joke. They don't give a damn about you. And they do call us lazy, stupid Americans 'cause guess what? They're almost right because we are the most obese nation in the world. So yeah, we have a health crisis and it's sad that you can OD on the street and the cops ain't gonna care anymore because as you can see, the cops have just been told to leave drug users alone. So yeah, go ahead, free meth on the street, everybody. Come from all over the nation to this state because drug use is still endorsed and giving you free needles and stuff like that which I think is perpetuating the problem and I know people coming from other states to come here because homelessness and drug use is just a welcome match.

7:16 So anyway, we do have a health crisis and it is drugs and we need to prosecute the drug dealers and that includes people letting the drugs into the country. So, and people who'd come here and don't speak the language, that's on them. My parents put me in a private lessons to make sure I spoke Spanish. My daughter's not gonna be stupid. She's gonna learn a language. All four of us, private lessons. We read and speak Spanish fluently. Little bit of an accent, but hey, they educated us 'cause they knew where we were going and they prepared us 'cause they loved us. If all these people come here unprepared, that's on them. Why should we pay their way if it's on them? They come here, they should speak the language. Thank you very much. I don't know how much time I have. Do I have any more time? - You have 15 seconds. - Okay, well, I'm just saying, God bless everybody. Enjoy the sunshine. Thank you for your attention. And yeah, no more free translation.

8:14 You can get a free translation online on your phone now. - Okay, is there anyone else? That's it. Okay, that closes public comment. The consent agenda is next. It's the approval of the minutes. Are there any corrections to the minutes? Hearing none, I'll entertain a motion to approve. - So moved. - Thank you. Is there a second? - Second. - Thank you. Moved and seconded. All in favor, say aye. - Aye. - Aye. - Motion carries, thank you. Then Public Health in Action Language Access Line. Good morning. - Good morning. This is for the record, Dr. Ellen Melnick, Public Health Director and Health Officer. Delighted to introduce Marissa Armstrong, who is our communications manager, who's going to give this presentation.

9:12 - Good morning. Again, Marissa Armstrong. I'm the communications manager for Public Health. And I'm gonna talk to you today about our Language Access voicemail system. Just a quick overview of what we're gonna cover today. Consider some of the barriers that are experienced by people who speak languages other than English when they call Public Health by phone. Gonna go over our voicemail access system and then review some of the data from the first 18 months of the system. Next slide. Just to give you a little bit of background, the Public Health Communications Program is a small three-person team that provides support for all of our department programs in their communication-related work. So handouts and letters, postcards, any kind of outreach materials. But we also are responsible for developing and managing all the content on our social media, working with our local news media,

10:10 managing and reviewing content that goes on our website, and then overseeing some of our department-wide communications, policies, and contracts, which includes this language access system that we're gonna talk about today. Communication is also a foundational Public Health Services, or FPHS, capability. So we've been able to use FPHS funding to increase our communication support for programs. I would know we had categorical funding, FPHS funding for communications, but that was among some of the funding that was cut for 2027. So for next year, that's gonna be back-filled by Fund Balance. Communications is also part of our indirect services, they're our overhead programs, so other programs in the department contribute funding towards the communication support for their teams. Next slide, please. Oh, you're there. So Public Health has a phone tree system.

11:08 When people call us, they hear prompts, instructing them to select an option and go through those prompts to get to the program or service that they need. Those prompts and the messages they hear are entirely in English. So people who speak languages other than English were facing considerable barriers when trying to get through to us. With this in mind, we started talking to some staff to find out what they do when they get a phone call from someone speaking a language other than English. And we found largely they didn't get those calls. If there was someone who called and did not speak English, they usually had a family member or a friend on the call with them and had them serve as their interpreter. But again, that still required navigating the phone tree system, too, in English. So we were inadvertently really placing that burden of access on the community member trying to reach us. That made it clear to us that we needed some sort of department-wide process and system in place

12:07 to make sure that the services we provide and our information is accessible to residents who speak English as well as other languages. Next slide. So we started reaching out to other county departments and health departments to see how they handled calls like this. Some have a central switchboard or a receptionist, like a main phone number that people can call and would get triaged from there. And they would use over-the-phone, on-demand interpreters to help that person or get them connected. Others in smaller offices would just go down the hall and grab the person who speaks that language and have them come serve as the interpreter for them. Those weren't really options for us, either of them. We don't have kind of a central receptionist or switchboard for our entire department. And while we do have staff members who speak other languages, it just wasn't really a practical option.

13:04 We're a very large department with multiple program areas. Our staff are primarily working remote or in the field. And it would still, again, require people to use that phone tree to get through to even be connected with someone in the first place. So there wasn't anything we could kind of replicate or work from, so we started brainstorming. We talked to staff who work in different sectors, work with different community members. We worked with our county telecom to understand the phone tree capabilities. We talked with a language access expert to understand best practices. And we talked with our contracted language service providers to see interpretation options that were available through them. And after quite a bit of research and troubleshooting, we finally landed on a system that would work for us and launched it in January of 2025. Next slide, please. So when a community member calls our main number,

14:03 they're first prompted to select a language. If they select English, they're just routed through our normal phone tree and nothing changes in the process for them. If they choose a different language, the options are Spanish, Russian, Vietnamese, or Chuukese. Those were selected because they are among the most commonly spoken languages in Clark County. If they select one of those languages, they are routed to a voicemail box. There is one voicemail box for each of the languages. They call and hear a message in that language, instructing them to leave us a message with the reason for their call, the best time to call them, and letting them know that we're gonna be returning the call with an interpreter on the phone. Then those voicemail files are sent by email to the communications team, and we use an online service, an online program, to translate and transcribe that audio file into a written English transcript so that we can understand what the person needs

15:02 and from there triage it to the appropriate program to give them a call back. We have a, we created a internal tracking system, so we enter the information of that call into this tracking system and send the transcript and all the call details to the appropriate program staff to follow up and get back to the person. So they are asked, staff get that and are asked to use our contracted language service providers and get an interpreter on the phone and return that person's call within three days. They receive automated reminders. If the call isn't closed out within three days and then again at five days, and our team also receives those reminders so we can follow up with staff and make sure they're not running into any issues or into anything else they need to be able to complete that phone call. Next slide, please. We developed a number of internal tools to support the process. As I mentioned, we have a tracking system, so we're tracking the details of all of those calls,

16:01 the date, the language spoken, the program that was assigned to respond, and how the call was ultimately resolved. We developed a department procedure to document the roles and responsibilities for the system, and we developed a number of resources for staff. This document on the screen here is one that we give to staff when they receive one of these messages, and it walks them through the process of how to get an interpreter on the line, how to call the person back. There's a script in case they get the person's voicemail, no to leave them a message, explain that they're calling with an interpreter, they'll return the call and give a specific time or day that they're gonna return the call, so that person will hopefully be available to answer when we call back. It also has instructions for going into the tracking system and updating the status of the call, and then we created a instructional video that kind of walks through that process for them as well. Next slide. So we launched this in January of 2025,

17:01 and since then, we've had 40 calls through the language access voicemail systems. 90% of them have been in Spanish, and then 5% each in Russian and Vietnamese. We haven't had any Chuukese calls yet. Most of the calls have been assigned to four programs for follow-up. Our environmental public health support team, which supports all of our environmental health programs, the communications team, Vital Records, and STI HIV prevention. The remaining five were kind of one-off calls that went to different programs. Some examples of the types of calls to the environmental public health support team were a lot of permit questions, what's needed to get a permit, what's the process for the permits, questions related to food cart requirements, and then some food establishment complaints. The calls coming to communications have been more of the general calls, people looking for information

17:58 about enrolling in health insurance or accessing Medicaid, looking for free or low-cost medical or dental care, calls to Vital Records or people with questions about getting their birth or death certificates or corrections to those documents, and then STI HIV prevention is people looking for testing or treatment services. Next slide. So our goal is for the communications team to get the message, translate it, transcribe it, and assign it to program staff within one business day. We have, to date, done that for every single call, and actually all but one was assigned the same day that we received it so we could get it out to staff right away. Then we aim to have all of the calls closed within three business days. To date, we've had 90% of calls closed within three business days, and 80% have been closed the same day or within one day. Of the four calls that weren't closed within three business days,

18:58 three of those were ones that were kept open for multiple days as our staff made multiple attempts to try and reach the person, so there was several attempts to get in contact with them in that time span. Of the 40 calls we've received, 88% were closed with someone on our staff using an interpreter and getting that call returned and making contact with the individual who called us. Four of them were calls that we were unable to get ahold of them after multiple attempts, and one was just incomplete info. They forgot to leave a phone number so we didn't have a way to get back to them. Next slide. We started this with a soft launch to give us a chance to work through any issues, make sure staff were available. We just made it live on our phone tree and waited to see what happened, and we got our first call within, I think, six days. We had several calls that first month. Then we started doing a little bit of promotion. We created this flyer that explains

19:56 that people can call us and we'll call them back with an interpreter. We gave that to some of our community partners to share, and then we did a little bit of promotion on our social media. We've also added the information on some of our translated documents that are in those languages, letting them know more specifically that they can call and have a place to leave us a message and we'd get back to them. We're continuing to try and promote this, looking for more ways to get the word out, working with community partners to share information, as well as continuing with social media and website promotion. And we've also shared the information about this system with other county departments and health departments who've heard about it and interested and wanted to learn more and potentially implement it in their own department. And with that, I think that is it, but I'm happy to answer any questions that you have. - Okay, thank you very much. Are there any questions? Yes, go ahead. - No questions, but I do have a comment.

20:55 Well, thanks so much for this information. I think there's a lot of value as our city and our county continues to diversify and different languages that are spoken, these services are absolutely needed. And contrary to what some of the callers might have said, these individuals, whether you speak English or Spanish or Chuukese or any other language, they pay taxes. They pay taxes through sales taxes, property taxes, federal taxes and fees, all that we utilize to provide these type of services. And I was going to say, so I'm kind of curious, do you have Chuukese translators onsite or at the contact center? - So we use, we have contracts with several language service provider companies and they provide over-the-phone on-demand interpretation. So when we need to reach someone, we will get an interpreter on the phone using the on-demand system and then return the phone call and have kind of a three-way call basically. - Okay, perfect. So you use a third party language call. - Yep. - Okay, got it.

21:55 Congratulations on the 90% close within three business days. But I am curious, three business days seems to be a long time. Is there any reason why that expectation has been set? - We set it just understanding that if it took a day for just to get the call and process and sent to them, and then depending on the nature of the call, if it was something specific to like a food permit and we needed to have a specific staff member with that expertise to call them back, just giving a little bit of grace period in case it's needing a little more time to get the information or the right person on the call, on the phone to return the call. - Got it. This is great. Well, thank you so much. As I mentioned earlier, I think this is a much needed service for community members and I suspect that we're going to continue to see an increase in calls from different languages asking for support from public health, particularly from food permitting. So thank you. - Thank you. Go ahead. - Yeah.

22:53 Just want to go back to something you said at the beginning. Communications seems to be essential to public health and getting the word out on all sorts of things. And you mentioned that it's considered overhead. Is it considered overhead by us or is that a state law or is there a way to change that? It just seems like an essential service of public health especially. And I wouldn't want it to be considered overhead. - Yep. Jeff is stepping up to the mic. Go ahead. - Is it on? Okay. So overhead in this case is just merely where it lies within our budget and how it's funded. There's not categorical funding to support the work. So we have to find a way to fund the work so we can maintain the services. In this case, it's in our overhead pool. So all programs within public health contribute to it. - Yeah. I mean, I've run two nonprofits and I've been their main fundraiser and the hardest thing to fundraise for

23:51 is the overhead which I think is usually the most essential services, the operations. There's no way to change that. It's just considered overhead by our internal systems or what? - I can speak for public health and say if there was dedicated county general fund to support this work, we would definitely accept it. There's not categorical funding available system-wide for things like this. You know, our finance team, our grants and contracts team, there's a lot of things that are really essential to public health functioning adequately. Same exact situation. There's not categorical funding available for those things. - Okay. I don't know if anyone-- - It is a great question. - Yeah, it seems more programmatic to me than overhead. So if there's any solution to change that or shift it, I'd be supportive. Thanks. - Okay.

24:50 Councilor Belcott, do you have any questions? Okay. And so it's just been those three languages, Spanish, Russian and Vietnamese, no calls from the Chuukese community. And I know you all do outreach to multiple communities, and so building that trust is an important thing. As I'm curious about the third party contract, is this a local provider? I'm just wondering if they're hiring local translators to translate. - We have five or six contracts with different providers. They are, it varies. Some of them are based in Washington. A couple of them are based in Washington. I can't recall where each of them are located, but some of them are in Washington. When we're doing in-person interpretation, then it's certainly they're having local people

25:50 who are the interpreters go out with them. When it's over the phone, they're not necessarily local in Clark County, since it's over the phone. - Right. I have heard, and I don't know if it's still a lingering problem, but with Chuukese in particular, there's, I'm not sure if the state recognizes it as a language, and I know there's multiple Pacific Islander languages, some aren't recognized, and that in some cases, they haven't used like a native Chuukese speaker, and some of the translation wasn't actually accurate. So I just wonder about like quality control. - Yeah, and we do have a contract with a local, a local language service provider for Pacific Islander languages specifically, and when we did our RFP for the language service contracts, we made a point to make sure that they could provide

26:49 Chuukese and a variety of other Pacific Islander languages in the various platforms that we need, over the phone, in person, it was a piece of our criteria when we were reviewing. - Great, that's great to hear. Any other questions? - I was just gonna ask, you're working directly with Sakura 39ers, the translating services? - They are not the ones that we-- - Oh, they're not, okay. - No. - 'Cause I know they do provide translators to BPS and the courts. In addition, I remember, Chair Marshall, there was legislation or a bill that was proposed last year to recognize the Chuukese language, and I don't believe it made it in front of the legislature and fully discussed. - Well, that would be a good one to follow up on. - Absolutely, I think it's something that we need to consider. We have about 6,000 Chuukese community members, not including other Pacific Islanders in Clark County alone, so it'd be worth looking into it this next legislative session. - And I'm curious about other departments in the county being able to utilize this service.

27:49 So it would have to be, they would have to develop their own contracts to do this. - I think the other departments or county, there are other contracts for them to use interpreters, and I've shared, like with Public Works, all of the information that we have, kind of the system that we use, so that they could replicate it and implement it in their department. So it would just be a matter of them, you know, adjusting it to kind of fit their needs and how their programs or their department operates. - Great, I'm just thinking of Law and Justice in particular, and there may be some funding issues along with all of this. Okay, any other questions? Great, thank you very much. This is a wonderful service to be able to provide so everyone can have access. - Yeah, thanks. - Okay, Director's Report. You have some timely things to inform us of. - Yeah, I'm gonna start.

28:46 I think the first part of the report is a little overview of the cyclosporiasis outbreak. So you may have heard on the news that the United States is experiencing a rise in cyclosporiasis cases, including this large multi-state outbreak. And 34 states at this point have reported cases that were acquired in the United States. And so far, the last I checked recently, there have been 1,600 cases linked to the outbreak with, according to the CDC, the last number I saw was about 141 hospitalizations related to that. The FDA and the CDC have been investigating the outbreak, and I think many of us have heard in the news that it was traced to a single supplier of shredded iceberg lettuce, Taylor Farms, to Mexico.

29:46 And then the supplier, Taylor Farms, issued a recall of that source, which includes iceberg lettuce sold to restaurants in retail locations, including Walmart stores. So far, the investigation shows that the recalled products were not distributed in Washington or Oregon, so not in our area. We've not identified in Washington state any cases linked to the outbreak. We've had 38 cases in Washington state since May 1st, which is a bit higher than recent years, but not completely atypical. You see more cyclosporo-cyclosporiasis in the summer. Most of the cases we've seen are related to international travel,

30:45 and you see more of it in tropical types of climates. We don't have any evidence of an outbreak occurring in Washington state or in Clark County at this point. So the good news about cyclos, if there's any good news about it, is it's not transmitted person to person. So if you ingest, so what happens is when you have the infection, in your stool, you excrete immature oocysts, forms of the organism, and they're not infectious, so at least not right away. But they end up in the environment, in a warm, moist environment, they become infectious. They mature and develop and become infectious. And then when you eat that contaminated product with these mature organisms, that's how you get sick. I think the challenge is,

31:42 in terms of identifying the source, is that after you ingest these mature organisms, it can take up to two weeks. The incubation period can range from two days to two weeks. So just like all other kinds of outbreaks, we do case and contact investigations, and we interview folks, and ask what their exposures might have been, and remembering what you've eaten two weeks before becomes very difficult. So it's challenging to really identify the source. You might have heard that there was one lettuce specimen, one specimen that ended up being a false positive, and people were questioning whether, well, could you really tie it to the source.

32:39 And just like other outbreak investigations, the epidemiology, the interviews with folks, and looking at cases versus people who are not sick, and seeing what the cases had in common really helps confirm that this was indeed the source of the outbreak. I don't know if folks have any questions. One thing I do wanna recommend is, because food can be contaminated with this, particularly fresh fruits and vegetables, for example, washing them thoroughly before eating them, is really recommended. - Great, thank you. I think I just have a comment. I think it speaks to the challenges when we have a very centralized food system that one provider can have a product that goes out so widely. So I think buying locally can be helpful,

33:38 in addition to washing your fruits and vegetables. Thank you for that update. And then I did have a question about raspberries, 'cause I think raspberries have been, I don't know if it was, people were alarmed that raspberries might be infected. - Well, I mean, I'm not aware of it here, but it's possible, and again, wash your berries. - Great, all right, thank you. - That goes for blueberries too, all of 'em. - I wash 'em all. Okay, thank you for that update. And now bats and rabies. - Yeah, so we have some information available on our website. So one of my favorite times of year is the late spring and summer into the early fall bat season. So they hibernate during the winter. So this is when we see when it's more likely for people to encounter bats, because they're out in a bat.

34:35 Less than 1%, so bats are the only reservoir for rabies in Washington state. It's found in other animals. For example, in Oregon and Idaho. But in Washington state, it's basically bats are the reservoir. Of course there are reservoirs in Oregon and Idaho as well. In the wild, about 1% of bats carry rabies. But bats that people encounter, because they're not exhibiting, when we have an encounter with a bat, the bat is generally not, we're having an encounter with them because they may not be displaying typical bat behavior. 3% of, three to 10% of the bats that are involved in human encounters when we've had exposures, when they're tested, they're found to be, when we're able to test them, they're found to carry rabies. So you can be, are you gonna ask a question, or?

35:34 - Yeah, I'm curious, 'cause you mentioned that when you encounter a bat with rabies, it's not displaying normal bat behavior. Now I've never encountered either a bat with rabies or without rabies. So how can you tell? - You can't tell. So I probably should have phrased that a little bit differently. Bats show up in unusual places. You may find them under a log or something, not where they might usually be, but you can't differentiate whether a bat is rabid just by looking at them and seeing them flying around. You need to assume that all bats are potentially rabid. And I probably shouldn't even mention that. The point I wanna make is that more, three to 10% of bats that are associated with human encounters, where we actually submit specimens for testing, have been found to be rabid.

36:33 Yeah. - No, thanks, that clears things up so in the event that I do run into a bat, I'll be much more cautious. - Yes, assume all of them. So when a dog gets rabies, obviously, they exhibit very abnormal behavior and once they're symptomatic, they die within about 10 days. So that's why we have that observation period for animals that are dogs and cats that might be rabid. But bats, you can't tell by looking at them whether they're rabid or not. - And it is these long, long days where you're more likely to see bats at that kind of late desk, you'll see them flying around. - Yeah, so yeah, so I wanted to give you that three to 10%. That's pretty significant, especially given that rabies is, once you develop symptoms, it's 100% fatal.

37:32 So basically 100%. I mean, it may be as close to 100% as you can get. You can get exposed if you're bitten or scratched by a bat. If you have bare skin contact with an infected bat or saliva, it's possible to get infected. If you're unsure if you've been exposed to a bat, certainly need to call us and we can help determine, our staff can determine whether the bat needs to be, whether the bat needs to be tested. We can also help determine whether, along with the bat testing and depending on whether the bat is found or not, whether you might need post-exposure prophylaxis vaccination.

38:28 So, so far this year, three bats in Washington have tested positive for rabies, none in Clark County. Four bats have tested positive in Clark County in Oregon. So this is basically, I'm sharing this information, basically remind people, especially remind children, never to touch or handle bats, even dead ones. 'Cause even dead ones can be exposed that way as well. We have information on our website, including a video that... No, the video is not available on our website. Is that correct, Marissa? It's on our YouTube, thank you. Okay, it's on the council page now. - Great, okay, thank you for that update. Anything else? - That's about it. - All right, then moving on to

39:28 the Public Health Advisory Council report out.

39:36 (faintly speaking) We're not done with our agenda. No problem. Okay, welcome. - I don't have very much to say because FAC has actually not met since we last saw you. - Could you just state your name for the record? - Oh, sorry, Emily Estes, I'm the Vice Chair of the Public Health Advisory Council. We have a little bit of a scheduling quirk, so you have two meetings and then we'll have two meetings. And we last discussed the YWCA funding, but we didn't get the opportunity to report out on any of the rest of our discussion. So I also just wanted to mention that the membership had very positive responses to Clark County's place-based work, which we also heard about. And I also wanted to share that the FAC has been having ongoing conversations about how to bring community priorities before the Board of Health.

40:35 For example, at the last and previous meeting and several before it, the FAC membership have stated their highest concerns being things like emergency preparedness among adult family homes and how those plans are potentially insufficient. And we've been discussing how we want to set priorities and bring them forward. So that's on the agenda of our next FAC meeting. And we will be reviewing a decision-making tool for how to do that well as a group and developing those priorities. And since we're meeting in person twice before we see you next, I think we'll have a lot of good things to share and more to say then. - Thank you, we'll look forward to that. And I do recall some time ago there was a presentation related to training for adult family care providers.

41:30 So I think there was some things that have been done to recognize some of the needs, but we'll look forward to that. So thank you, thank you very much. Okay, any comments from the board? No comments from the board. Okay, that brings us to the end of the agenda and without objection, we are adjourned.

41:59 (faintly speaking)