 I don't know which one of you wants to start if it should be commissioner shats or. Probably commissioner shats with Woodside because that, that's the first piece that then moves to the other. Does that make sense? Sure, that makes sense to me. Okay. Great. Welcome. This is house corrections and institutions. And we are here this afternoon until approximately three 30. We're going to be hearing at the beginning here an update about the Woodside situation and moving the youth to different placements. And finally now they're at the middle sex secure residential facility. So the patients from the secure. Middle sex, secure residential facility, which was, which is a mental health arena have been moved. To a unit in the state high school. So we've got some questions. We wanted an update and I think first place we'll start is with commissioner shats of DCF. To talk about the move of the youth from Woodside to the other placements. What the thinking is. And also from this committee perspective as well, if Woodside's going to be used for mental health patients, with COVID-19, is there any infrastructure changes that might need to occur in the interim or not. The commissioner shats welcome. And if you could identify yourself for the record and we'll get started. Glad to do so. I'm Ken chats commissioner of the department for children and families. Do appreciate the opportunity to fill you in on what has been going on in the last few months. As you all know, all of us are striving to address this pandemic. It's, it is incredibly challenging. I think all members of our community. Obviously you're impacted. It has in fact also affected our state systems. And so really what this is about was in discussions with the department of mental health. Recognizing that they had a significant need. To have an alternative site for psychiatric patients with COVID-19 symptoms. They had identified working with other hospitals and Sarah squirrel can fill you in more detail. That Woodside. Might be a facility that would meet their needs. As we continue to only have three or four kids. It may be a facility that would meet their needs. As we continue to only have three or four kids. It made perfect sense to us that we would vacate that facility for the greater good. And so we move very quickly to identify along getting support from the human services as a whole. And frankly community providers. We found a place in St. Alvin's. That was available. That seemed like a good spot. We moved very quickly on March 24th. To set up a program at sweet 12. This was. Set up to be a staff secure program. We had four kids there. We the. It had flexibility to be used for a variety of youth. We had thought we would be able to put. We had a lot of. Locks and alarms on the doors and windows to provide an appropriate level of security. And frankly need. I need to own that we move perhaps too quickly and didn't nail that down. And it turned out we could not do that to the facility. As we could not have that level of security. We did have a couple of escapes. That made it abundantly clear that even though again, we were not going to be able to do that, we were not going to be able to do that. And we realized as the youth that the nature of the situation just wasn't working. Along that period of time. Again, in consultation with the department of mental health, we discovered that the department had made plans to temporarily move. The patients. In middle sex to the Vermont psychiatric care hospital. And so. I think it was a Tuesday of last week. And so again, working quickly and our staff move very quickly. To recognize that we viewed the site. We worked with BGS and the department of mental health. To basically transition into that facility. So that that is in fact a facility with. Lock doors with a perimeter fence. Candidly. Although I haven't been here myself. I'm told that it has actually. A lot of the facilities. We have a lot of facilities. So we moved to a nicer facilities than Woodside with respect to the care and treatment of youth. And so we quickly moved there as of Monday, April 6th. We moved kids into that program. They, there, I believe today there's three kids there. The. It's a five bed facility for us in terms of how we'll set it up. It is locked. We'll be following the same policy. And so we'll be following the same policy. And so we will be following the same policy. And so we will be following the same policy. Who are involved in the delinquency system or youth? Who are under the custody of the commissioner of corrections. We will follow the same legal and protocol procedural safeguards. With respect to secure facility. Following also the. Relatively new policies that have been implemented to. And so all of that is in place. We do see this as a temporary program. We know that Department of Mental Health plans are to move back to that facility after the situation if hopefully will calm down relatively soon in terms of the pandemic. So we are continuing to move forward with our plans as described in our proposed budget for 21 to no longer use Woodside for Youth as of July and to have alternative sites available for the care and supervision of youth in residential programs as needed. We're continuing that effort, by the way, in terms of talking to various community providers and continuing to look at the alternatives available to us. So I'll sort of stop there and glad to answer your questions. Any questions of the committee? Oops, anyone? Kurt and then Sarah. Has there been, I realize that there's pressure, but has there been any long-term thoughts of where the youth from Woodside would end up after all this is over? Yes, we did, as you may recall, do request for proposals. We did receive responses to that. We did get one that is promising. We're discussing with them the possibility of creating a residential program that would be available to meet the needs of youth with behavioral issues, including mental health and maybe even autistic challenges. That's not a short-term solution. That would be something that if our negotiations are successful, wouldn't come online for a while. So in the meantime, we are talking to a variety of designated agencies and other community providers with respect to what we still perceive as our need for three to five secure beds. OK, thanks. Sarah. Kurt actually asked my question. So for those three youth that are currently at the middle sex facility, would they qualify for that new proposal that was just submitted to you in the community? Actually, because I don't know exactly what the negotiations would result in, the short answer is maybe. So we would still need possibly a placement for three to five youth that a community setting might not be able to take, depending on negotiations with the community system. Well, we know we need to have a need for the three to five secure beds. If this new program is able to meet that need, of course, that is available. But also to be straightforward about it, my thinking is I'd like to have the secure beds dispersed around the state, not just in one location, so that we don't have the extended transportation issues from one end of the state or the other if there's a need for placement. So from my perspective as a system, I think there's value to having some secure beds in different parts of the state, albeit a small number. So Commissioner, should those secure beds be physically secure or staff secure? I think we need some level of physical security. Again, because the numbers are so small, there's some advantages to having flexibility, depending on the size of the program. That is when there really is a need to have locked doors, and we want to have locked doors. But frankly, if we don't have to, I'd like a program to enable the youth there to have a little bit more access to the community as safe and appropriate for them. OK. Any other questions? Butch? Oh, Butch and then Kirk. Good afternoon, Commissioner. So of the three youths that you have now in middle sex to date, did those youths come to you via the courts and DOC? One of them is a child in the custody of the Department of Corrections. The other two came through DCF and the youth justice system. OK. So just trying to figure out your census. And I'm assuming the youth that came to you through DOC is required to have a secure place to be. We're still working through some of those details with DOC because, in fact, DOC, it's their responsibility to supervise a youth in their custody. They actually have some flexibility on a case by case basis as to whether or not the youth is in a locked facility or not. But to be clear, when we look to the future and when I talk about the three to five secure beds, I'm including the needs of those youth in the custody of the Department of Corrections. My view is even though legally they can be held in an adult facility, as long as they're sight and sound separation, that's not a good environment. And so we are trying to meet that need within our youth system. OK. Thank you. All right. Yeah, two questions. What's the age, roughly, of the ones that we have now in custody there? I don't have that right at my fingertips. But typically, it's primarily 15 to 17-year-olds. OK. And I assume that because all these are actually coming through the judiciary in one way or another, that we still have the same Medicaid funding issues where they would not be, regardless of where they're held, they still would not qualify for Medicaid funding. In terms of our prison program in Middlesex, that's absolutely correct. And if they were like a suite 12 or something like that? That would still be the same challenges regarding receiving Medicaid funding. The thing that might be different to put it out there is if we are able to work with a community-based program, particularly if it's managed and operated by a community-based nonprofit, and it's open to youth other than just youth coming through the justice system, then we have the possibility of receiving Medicaid funding. OK, thanks. OK. Anything else, Commissioner Schatz, before we move on to Commissioner Squirrel and Morning Fox? OK. Commissioner Squirrel, welcome. I don't envy you either. Well, thank you. We certainly appreciate the support and understanding of the legislature. I'm sure Commissioner Schatz, Deputy Commissioner Fox, would agree it's been an intense time for us as we are trying to manage a pandemic and keep Vermont safe. Also, I think just as a preamble to some of the thinking and strategic planning that we've done that when you're dealing with an infectious disease outbreak, you're always behind where you think you are. So a lot of the decision-making that we've been doing is really trying to be thoughtful about not just tomorrow, but two weeks from now, where could we be as a system of care, and how do we absolutely ensure that we have adequate capacity for vulnerable Vermonters across the state? So to that end, on Friday, I think it was March 20th, which seems like years ago, we convened all of the hospital leadership from across the state, all inpatient hospital directors, knowing that what we were looking at as a state system based on the trending models was that we could hit a point in time within our overall medical system where all of our beds would be full across the state from a med surge capacity. So of course, immediately, we were worried about individuals who would or could be presenting in an emergency department with significant psychiatric needs, meaning that they needed to be hospitalized for their psychiatric needs, possibly COVID positive, but their COVID positive symptoms might be mild. So absent their psychiatric symptoms, these would be individuals who would be told to go home, convalesce at home, and take care of yourself. Obviously, for someone who has significant psychiatric needs that would require a hospital level of care, that was not an option for them. So the outcome of those meetings, and we meet with our network of hospital partners on a weekly basis, was a recommendation that we move quickly to immediately stand up an alternative inpatient facility that could serve those who needed hospital level of care for their psychiatric needs, were positive for their COVID, but had mild COVID symptoms. And when we looked across the system, and where would we have capacity, Woodside emerged as a potential location. And certainly that recommendation, I guess, achieved three goals from our perspective, which is why we made it, that we would have capacity to treat those who were COVID positive, who had mild symptoms, but significant psychiatric needs, that we would mitigate the spread of COVID in our inpatient facilities. We did worry a lot about if we had an outbreak in one of our inpatient psychiatric facilities, what that could do to our system very quickly, which would certainly limit access to those who may need it. And we wanted to try to preserve the resources and capacity within our medical system as well. Certainly no one wants to be making these kinds of decisions. And as the commissioner of mental health, I would never be coming to you making a recommendation that any psychiatric treatment should occur at Woodside. However, when we're staring down a pandemic and trying to make decisions to ensure that we have some capacity for individuals that made sense. And from a parity perspective, across our health care system, we're preparing for surge with field hospitals being erected, alternative sites being located, et cetera. So that was some of the thinking. We also know that this is an evolving situation, and we will continue to make changes as we see necessary. I would also note that the Woodside space, if you will, is being loaned to DMH for contingency emergency use, that the future of Woodside will remain a discussion and decision for the legislature. So I just think that's also important to note that this really is a short-term emergency effort on our behalf. In terms of what we've actually done so far, you might have questions about just the facility itself, what we had to do or have done so far to make it safe. I mean, certainly when we look at ligature risk, et cetera, that is where the Woodside facility presents with more safety options and other options, like a dorm, a college dorm, for example, which would have so many significant safety risks, particularly for those who might be suicidal or a danger to themselves. That doesn't mean we didn't have our work cut out for us just in terms of trying to make the space as therapeutic as possible, some investments in the facility itself to create that what's closer to hospital level of care. And then at the same time, we feel a strong sense of responsibility to ensure that we would have the adequate medical personnel and medical equipment knowing what we know about the progression of COVID, that knowing that our psychiatric patients have high comorbidity with other kind of respiratory risks and that they may not be able to fully articulate their symptoms, as well as we might hope. So we really have been working to ensure that the facility is appropriate. We have the right equipment, and we have the appropriate medical personnel. I can tell you today that we have not adequately identified enough medical personnel to staff the facility in the way that we think we would need to. So we are waiting. We are kind of in a little bit of a holding pattern right now while we're waiting to see if we can recruit and retain the adequate medical personnel to provide that level of care. We also need to have conversations with other inpatient partners about other options. Should we not be able to, I guess, acquire or retain the appropriate medical personnel that we think we need for the facility? So that's just kind of a quick snapshot of what we've done so far. We have not made significant changes to the facility itself. I think there have been some equipment that's been ordered, some painting that's been done, some cleaning that's been done, but very minimal, I guess, from a real investment of dollars at this point. So just so folks are aware of that, I would also just underscore that this is intended to be kind of a worst case scenario option for us. So if we are able to, and I think we're going to see some new modeling over the next couple of days in terms of the trajectory of COVID in Vermont, if we can maintain adequate capacity within our broader medical system, obviously, we want any individual regardless of having psychiatric symptoms or not be served in the medical setting. And that is our priority, that if an individual who presents the psychiatric needs and is COVID positive, if there's capacity within our broader medical system, that is where they will be admitted, and that is the priority. Woodside is intended to be kind of a worst case scenario med surge option for us as a system of care. We did ensure that as we were thinking about this idea, we communicated clearly with the appropriate stakeholders, disability rights, Vermont, legal aid, NAMI, Vermont, some of those groups worked in consultation with them to make sure that they were aware of what we were thinking and planning. So I can pause there or I can just pivot right into kind of giving you a sense of the middle sex move and give you that information and then maybe take questions, whatever the chair prefers. Why don't we stop right there and let me just open it up for questions. Any questions from the committee? Carl? Thanks, Commissioner. I just had to unmute myself there. And my internet connection here has been a little bit unstable, so if for some reason I'd get cut off, just let me know. Can you just give us a sense of what sort of numbers you've designed, the sort of surge facility there at Woodside 4? And am I correct in understanding you don't have any patients there now? That's correct. We do not have any patients there now. We still have adequate capacity in our inpatient psychiatric system and within our medical system. The overall capacity of Woodside, I believe, is 30, 25 to 30. I think we were thinking a maximum of 1 to 10. Just given the guidance that we have from the CDC and VDH about viral load, trying to maintain adequate distancing between patients, et cetera. And the limitation of access to medical personnel also drives a lot of that capacity as well. Thanks. So we have a couple more questions. Sarah and then Butch. Thank you. Thank you, Commissioner. So I have a couple of questions. You know, I'm from Southern Vermont. So we've been hearing a little bit about what's going on our local hospital and the Brattle Bar Retreat. And so I'm curious to know how that's been going from your perspective. The Brattle Bar Retreat is preparing to have COVID beds because Woodside is not staffed and open yet. And I'm just curious if there's a role for them, if you're anticipating that they'll be playing a statewide role there. Yeah, that's a good question. And we did speak yesterday with folks from Brattle Bar Memorial Hospital. That's part of the collaboration that's happening. I think what you're seeing is, and even when we were having initial conversations about a statewide approach to this, was there a capacity that was needed in the southern part of the state? And if things were unfolding quickly, knowing it was going to take us some time to get Woodside up and running, I think Brattle Bar Memorial has also been concerned. They're a very small hospital. What did they feel that they would have the capacity to really do if there was kind of an influx of COVID positive patients at the Brattle Bar Retreat? So I think they have worked collaboratively together to come up with a solution for kind of that worst case scenario. I don't think any of our solutions across the state are perfect right now, because essentially the retreat is trying to create a negative pressure environment, which is always challenging. I'm sure they're thinking about the same things that we are having adequate medical personnel. It does sound like Brattle Bar Memorial and the retreat are working very collaboratively together around that. And at the same time, we would also underscore and advocate that from a parody perspective, we would hope that individuals who have psychiatric challenges and COVID positive symptoms that would require hospitalization would, of course, be admitted in a hospital setting. So I think that's kind of a quick summary of what I understand that they're planning. And thank you. I've also heard anecdotally that the number of folks coming into the emergency room with mental acute mental health is really much, much dramatically lower. Is that true statewide? Yes, across the system of care right now, we have seen a general slowdown, if you will, that we are seeing part of the strategy when you're a folk, I guess, staring down an infectious disease outbreak and you're managing a medical facility, you try to decompress your units as appropriate, because we don't want people in these closed settings if that's not necessary. So I think there was our teams across the state discharged where appropriate. So overall, we're seeing lower census across our inpatient system. And then I think because people are self-isolating, they're not out in the community as much, that we have seen a general slowdown in individuals coming to the emergency departments. For example, today we had no people waiting in the EDs, which certainly, given what we're facing as a state, one might say is a good thing. At the same time that also worries me as the commissioner of mental health, that we may have individuals who are experiencing significant psychiatric distress are afraid, not going out in public, afraid to go to the ED and are maybe not getting access to the kind of care that they need. So that's something that we're keeping an eye on. Certainly our community mental health agencies are working very hard to ensure that the folks that they are connected to, CRT clients, et cetera, we're doing a lot of targeted outreach. But yes, generally we're seeing a slowdown. I would also, my thinking is that we may at some point see more of a surge of need on the mental health side broadly across the state, as maybe we move into more recovery mode as a state. So thank you. But... Good afternoon, commissioner. I'm sure you're gonna mention this, but I don't wanna miss it when you get into the next piece about moving folks around. We're very interested in seeing how you opened up beds at VPH, whether you had that capacity there or if you had to create the capacity and how the folks took to the move and what's the environment they're in and is that current environment beneficial to them, to the folks that you had in middle sex? And then was, lastly, I guess, was all this move that you made, which I'm sure some monumental decisions, was that in preparation for freeing up middle sex for maybe the folks from DCF or was it just the best move to make at the time? Yeah, all great questions. So I'll just share with the committee kind of how we got to that decision-making around middle sex, if that's okay. That's a good transition. Great, yeah, thank you. So we, like other medical providers across the state, immediately started experiencing significant staffing shortages at VPCH. So we have some, there are some waivers that have been afforded to hospitals in terms of flexibility and staffing grids, et cetera, but we started seeing significant staffing shortages in our critical staff, such as nursing staff. We share staffing with Vermont Psychiatric Care Hospital and MTCR, and we kind of hit a tipping point where we did not have adequate nursing coverage and care for middle sex to be able to cover both locations. We had also appropriately had consolidated folks at VPCH onto our AMV units. Again, that's overall slowing in the system, so we had some capacity at VPCH, the team. Commissioner, can I just interrupt? A and B, are they H8 bed units? Yes, that's correct. I think so. Deputy Commissioner Morning Fox, are they each eight bed units, A and B? Yes, they are. Okay, thank you. Okay, just so visual, because we've taken a tour of the facilities, so. Yes, yes. Yeah, they're the two larger units. Okay. So we did, our team, our leadership team at VPCH, did make the decision that, in order to ensure adequate staffing for the individuals at middle sex, we needed to consolidate those groups together. We had C unit on at the hospital that was open. So we did decide to move those residents so that we can maintain appropriate staffing. Those residents are occupying a separate unit from A and B. They are not admitted to the hospital. So middle sex is a therapeutic community residence. It is licensed as a residential facility. So while they are currently residing at the hospital, they're not admitted to hospital level of care. They're also still receiving their kind of daily residential programming, access to the library, the activity rooms, the outdoor space, and certainly now have more adequate access to staff and critical resources. The move itself went well. I can't say that it wasn't without its bumps. Certainly when you're moving folks who are used to their current residents who are there because of significant psychiatric needs, that was a transition for them. I think the staff at BPCH and MPCR did a commendable job of trying to make that as thoughtful and safe a process as possible. From a safety perspective, there weren't any significant safety concerns at all. It was more of just the transition of being in a new space and as I speak with the CEO of BPCH on a daily basis and the nursing team and social work team there, the residents do seem to be settling in. So to representative Shaw's question, we made that decision long before it was determined that the alternative site, Suite 12 for DCF, was not going to work. And then of course we said, well, Al Middlesex is open. So DMH essentially offered that to DCF to say, this might be an appropriate interim place for the youth that were moved to Suite 12 to reside. So, and this is a question and this may be too early to tell, but for both Commissioner Squirrel and Commissioner Schatz, do you think once everyone settles in to this new environment where we know the state hospital, it's a much, when we toured it, we said, boy, this is where the secure residential really needs to be. It's a much more therapeutic facility that that population could avail themselves of. And with the Middlesex secure residential, which we've been trying to replace, that environment is very different for those youths than Woodside. So the folks have been there now for a few days, not quite a week. Are either one of you seeing any tempering down of behavior issues or mental health issues or anything based on their environment that's a softer environment respectively? I can't speak to anything that I specifically related to the folks at MTCR or whoever who are now up at BPCH. I don't know, Kenneth, I can't comment on the youth who are now in the Middlesex facility. One thing that I will say, I don't have anything definitive, but I have to say that even when we made the move to Suite 12, one of the things that was good was having more access to the community, which is generally speaking, a good thing so long as we can appropriately supervise those youth and they adjust appropriately. So that, from my perspective, was a bit of a positive. The move to Middlesex, and by the way, we're calling it the Middlesex Adolescent Program now, is too recent to really make any determinations. It'll be interesting to see as the days go forward. Yeah, one thing I also wanna make sure we're all clear about is that the reason we're able to make this move to utilize BPCH, which under normal circumstances is hospital level of care, is because of the flexibility that we have under our current 1135 waiver, which is because of the pandemic. So that's not something we would be able to continue to do beyond this current crisis. So I just wanna make sure that we're clear on that. CMS has created flexibility for us because they agreed with our decision-making from a safety standpoint. It's not something that we could continue to do beyond the crisis. Okay, good, that's good to know. Thank you. We have a question, Kirk. I'm not sure whether you may have just answered it, but also when you talked about a potential surge in the emergency rooms as we begin to move out of this, out of COVID-19. And I have concerns about that too, because I know, or I believe that, a lot of elective surgeries and things are being held, are being put on hold, that the hospitals are not all that busy now, but when we start leaving, they're going to get, it seems to me, very busy. And last year, several years ago, our big concern was the backup in emergency rooms. And that's why we were talking about expanding the VPCH and finding alternatives for those people. What's gonna happen when this begins to hit again? Is there a plan yet for covering these people when that happens? Yeah, I think one of the things that we look at now, as I mentioned earlier, is across our inpatient system of care, we're probably running on average between 50 and 60%, taking off the level one, our level one beds remain very, very high occupancy. So we have some capacity in the system now, it's just not, we aren't seeing the folks in the emergency department. So as we ideally, hopefully move towards a path of recovery as a state, as we start to see more individuals who do have acute psychiatric needs that will require a hospital level of care, we have the capacity in the system. I think the bigger question will be, do we have all the staff back that we need to maintain that capacity? Because one of the reasons that we're having to consolidate units, close down units is because we simply don't have the staffing. So as long as the staffing come back, as we recover as a state, we should be able to rebound in terms of our capacity in our inpatient system. Okay, well, one more question or concern. My understanding is that the middle sex is kind of a step down from the VPCH. And now we've kind of stepped them back up. Is there a difference between the kind of environment or the programming that they're in at VPCH now that makes it qualitatively different from being in the way that otherwise in VPCH? Do you see what I mean? That's a great question. Yeah, I mean, certainly, and I'll probably defer to Deputy Commissioner Fox on this as well, but therapeutic. So when we think about acute inpatient hospitalization, you're kind of immediately assessing, treating and trying to work towards a lower level of care. These individuals have stepped down essentially from that acute hospital level of care and are now receiving more therapeutic treatment in terms of daily living skills, counseling, so that then they can make that next step the lower level of care. So the programming that they're continuing to receive as part of their kind of, which we call as EDLs, daily living skills, is different maybe than the kind of programming that you might be receiving in inpatient care, but I'll just defer to Deputy Commissioner Fox who likely has more to add to that. Their programming will be the primary piece that's different than the other patients at the Vermont Psychiatric Care Hospital. So the goal is that the type of programming and treatment orientation that they were receiving at middle sex, they're going to continue to receive. The only main difference really should be that the physical location is different. Both sites, because of COVID and the pandemic, we have stopped doing community visits and having visitors coming in to try to prevent infections because the folks who live at middle sex and now the C unit at VPCH, there's some of our more medically compromised folks, a number of very elderly, COPD chronic health conditions for folks there. So we had to be very conscious and cognizant of that. And so we had already stopped that type of community outings. So that's not a change by coming up to the hospital. And it'll be the goal similar to moving back to OTCR as soon as we're on that other side of the curve, if you will, that we're able to move back to middle sex. And at that same time, it'll be also moving back into community outings and those types of things. But as far as the internal treatment, their programming will remain essentially the same, which is different than the type of programming and such for the other patients in the hospital. They will not be subject to any kind of emergency procedure. They would not be secluded or restrained, none of those types of things. And that's based on what Commissioner Squirrel was mentioning is that they're not admitted to the hospital. We just basically kind of are using the physical location as a place for them to be living at for the time being. So we have a couple more questions. Are you done, Kurt? Okay, Sarah and then Butch. So it's kind of a follow-up question. I'm curious when we're talking, you're talking about staffing. I know at Woodside, there were roughly 50 staff members. Where have they gone? And maybe that's a question for Commissioner Schatz. Got it. So that was the total number. Frankly, that has been reduced somewhat over time as the population has decreased and we've made our proposal subject to legislative approval to close Woodside. Some staff have moved on to other positions. Moreover, some staff are also impacted by COVID-19 in terms of their concern in terms of their own health with sometimes it's their childcare situations that have resulted in a decrease. So I think we have approximately, I'll say 25 active staff members now, which is the number that we need because of course we need to do several shifts to provide 24 seven coverage. Okay. And the other question, I don't, I'm not sure if you address the story. Have there been any confirmed cases among the staff or the patients at any of the facilities? Have you been? I'm knocking some plastic. The reality is, as I sit here right now, I'm not aware of any confirmed cases of either youth in DCF custody or DCF staff. That's great. And how about it the hospital, the state hospital? Yeah, we've had a few staff who are been tested, persons under investigation, I think is the current acronym. I don't believe that we have had any positive tests for staff or patients at this time. Well, that's great. Keep it that way. Butch, you gotta unmute butch. Something happened. You gotta unmute. So a dropdown came just as I went to hit the mute button. So anyway, sorry about that. No, that's fine. Too many emails coming in. Yeah. So for the deputy commissioner, talk a little bit about up at VPH with the folks there from middle sex. Are there challenges or whatever for separation and security and the folks there from middle sex being able to get outside similar to what they had down in middle sex? And I'm thinking outside the box a little bit now. So. No, we have two separate yards at VPCH. And so we ensure that the folks on C unit, the middle sex folks have access to a separate yard depending on what's available or what's free and the needs at the time, but that they always have the access to a separate yard from those that would be occupied by the patients. And we've got other kind of different things that are in place to make sure that folks are understanding and know who the residents are versus who the quote unquote patients are who are in the hospital, separate dining, separate yard, all those kinds of things. The staff is as commissioner squirrel mentioned, the staff, we share the staff between the two facilities. However, there are certain staff that have a primary placement. So there are some staff whose primary placement is the hospital and others, their primary placement is middle sex. And that's gonna remain the same that those primary staff will remain the primary staff for middle sex. The extra supports would come from other staff that work in the hospital. But if there was a an emergency or something of that sort on the middle sex unit, they really put in place the protocol so that that emergency response would be the same as if it were happening actually at the middle sex facility where we'd be working with Washington County screeners if there was a need for an EE, things of that sort and only, and then to avoid the need of going say to an emergency room for an emergency exam, we would have screeners come in our doctors can do their portion and we would just move someone from the middle sex unit to an inpatient unit and that's also avoiding having to go to the emergency room and all of those complications with that. So I think you're pretty sure I heard you say that the separation's okay, working well, the security's okay, they have activities, they're programming similar to the programming they had at middle sex. However, my question was, my next question was at middle sex, were they allowed to prepare their own meals? Not really, the kitchens in middle sex are not made for doing large meals. We have the capacity from fire marshal concerns and remember the stoves don't have any kind of venting hoods so they'd be able to do some smaller baking type things to work on that kind of skill base and that's a bit trickier, to be honest right now. So just as I asked the question, I suddenly realized that they're shipping meals down there from CH on a daily basis. So not having a place to prepare food does not affect their programming. It's, to be honest, that is a piece that is impacted. That is probably the one area that we're still working on trying to figure out if we can find some other alternative means, but we have a large industrial kitchen that there's no way we can make that safe to try and do that. I believe that we do have microwaves and things of that sort so that they are still using those types of things and that's generally what a lot of the residents at middle sex would use, microwaves to heat up tea, make oatmeal, things of that sort. Thank you. Yep. So anything else? We're bumping up against the two other folks who are waiting to testify on S338 and I don't wanna take up the commissioners and deputy commissioner time anymore and we absolutely have to. Is there any other questions? Okay. If not, thank you both commissioners and deputy commissioner. I know you're doing Yeoman's work. I wanna thank you on behalf of the committee for all that you're doing. Thank you for taking some time here to give us this update. It really does help us in our work going forward in one way or another. It is all not for naught. We're very welcome. Thank you. Thank you very much. Thank you for your support. No problem. Take care everyone. Keep your chin up. Thank you. Thank you. Okay. Okay folks, time to transition.