 and we will jump right into the first item on our agenda for committee discussion. I had the opportunity to meet to Miss Angela Jenkins, the vice president of the office of community and social health at Prisma Health a couple of weeks ago and we were immediately able to talk about different potential opportunities and intersecting ideas of interest. And so I thought it would be nice to have her come and talk a little bit more in depth about the work that she is leading as well as some potential ideas for collaboration as we continue to think about ways in which we are going to engage in the health space. So with that, I will pass it over to Miss Angela Jenkins from Prisma Health to provide us an update on the hospital's different community health initiatives. Put this here. Good afternoon, everyone. Good afternoon. Just a little bit, I'm a little discombobulated. I flew in last night from Monterey, California and got in at like 2 a.m. I was at the Monterey County Jazz Festival. It was a very cool experience. I had a little private baller party with Herbie Hancock and Christian McBride and Diana Reeves. It was a wonderful experience for those of you who are in the jazz world. Amazing, so I'm exhausted, but happy to be here today. Thank you, you're still being here. Two percent. And you drove from Greenville. I drove from Charlotte to Greenville here, so. But happy to be here to talk about the work that we're doing at Prisma Health. And I'm just gonna start big picture in terms of who we are as an organization, given that we're still fairly new, I think as a newly formed healthcare system within South Carolina. So to give that big picture overview, but I'm gonna delve a little bit into what we're doing around community health, what my office is accountable for, but also how since I came to Prisma Health a couple of years ago, my interest in really doing more about integrating community health into the operational fabric of Prisma Health. I think in the Midlands, there was a lot of good community health work that was led by the office for many, many years. Community facing some investments, some innovative projects, and some of that was different in the upstate. And we were sort of two different entities, as you know, but since I got here a couple of years ago, our goal has been to figure out how we can actually spread the work as a system and make sure it's more integrated and have more of a what we call a one Prisma Health approach to the work that we do. And so just a little bit about me is I moved here from California, that's why I have some roots there. I worked for Kaiser Permanente for 20 years, I led many of their community health initiatives for that system in Northern California, a broad range of activity that I was able to oversee and was recruited here a couple of years ago to help work on the community health initiatives for Prisma Health. And so just, I can share more about my background, but I go everywhere from working with elected officials to working with incarcerated individuals, homelessness individuals, youth on probation and parole, adolescent parents, the whole gamut. And so I have a depth of experience around community health and social health needs. But just to begin, just to talk a little bit about, I should have got this right. I wanna make sure I'm moving this forward correctly. Oh, no, thank you. So Prisma Health at a glance in terms of who we are, and I think I might add some links to the deck, so I hope you were able to get some of those reports. But just, we are now the largest not-for-profit healthcare system in South Carolina. We have over 30,000 team members, 18 acute specialty hospitals, over 2,800 licensed beds, 305 practice sites, more than 5,200 employed in network physicians within our physician network. And we serve over 1.5 million unique patients in the 21 county market area that covers 50% of South Carolina. And then the report I gave you a bigger document that goes over more statistics around who we are now as a new healthcare system. And the reason why I start there is just because of our size and the breadth of what we do, we have a tremendous opportunity to influence health in the state of South Carolina. That's why we came to be as a healthcare system, as you know, and that's the opportunity that I have to work within the organization to be able to make that work happen as a healthcare system. We do have, this is our strategy, high-level framework, just so you can see that community health and health equity are a core pillar of what we are standing to do as a healthcare system. We'll talk about some core examples of how we're doing that, not only at a community level, but operationally. And much of our work is really around putting the patient at a center. I say putting the community at the center too, because that's my work, but really making sure that we're covering a million lives in some of our value-based care contracts and through some of our health plan, becoming one prisma, having a more integrated approach to what we do, leveraging technology, making sure care is affordable and convenient, and really drilling down on some subspecialty and prismetism medicine, which our physicians could talk about more fully if they were here presenting before you. So this is, we all know this, right, where we rank as a healthcare, as a state. We've improved over the last couple of years, but I always like to throw this in here just as a reminder, a stark reminder of the opportunity that we have to improve health as we come together as a collective and how much we spend per year on healthcare, yet our health outcomes, we rank number 41 out of the country in terms of our health status overall, and some key areas around social economic factors, which I'll talk about for birth weight and diabetes, which we know is a difficult challenge here, particularly in the midlands, and just our behaviors, our health behaviors could be better as a system, as a state, as a country. Ms. Jenkins. Yes. Looking at that map, do you know how many states that are shown on that map have not accepted, expanded Medicare, Medicaid? So like 12 or 13 states that might not have had a Medicaid? A smaller number than that. Maybe it's smaller, it might be smaller, I think. And the last one here, it was eight. Yeah, that says it was eight. It was eight states. Has Prisma done any study about what that would do for the financial health of your system? I would improve that health quite a bit, and it would actually improve quite a few health disparities. It would save us a ton of money, and we'd probably have, I don't know how many thousands, a couple hundred thousands of individuals would, I don't know the exact number, would actually have health care coverage, would actually would be a benefit to the system and the state overall from a financial perspective, but also an access issue. So I could get more information back to you, but I haven't done a deep study on that, but I think just generally we, I think we all intuitively know what the positive impact would be of that. Thank you. So this is just another reminder, and I like to put this in here too, because I think most of us who are in the public health field know that only 20% of health care actually happens within the health care system. The rest of it is happening in the community just as a nice reminder, but the social economic factors, which is really where we need to focus our work to do the preventative work to prevent these poor health outcomes happening in the first place. It's really not intuitively linked to health care, but it influences health outcomes when you think of access to education, educational attainment, job status, which gives you health, affordable housing, or housing that you can afford, puts you in different neighborhoods as we know place matters when it comes to health, family support, and income. And so this is just always a nice visual reminder of where health actually happens, not necessarily in the health care system or hospital system, but in the community. And so I always say this is our collective impact, and that's why I'm glad I'm here talking with you today in terms of how we all have to come together to really influence the upstream and downstream focus on illness. And as the healthcare economy and the health systems are moving more towards what we're calling a value-based care system around how we deliver the care, it's really driven to improve healthcare outcomes, to reduce costs, and to improve value and equity and health equity. And this is really going from a fee-for-service model more to a value-based care model, which is the model that I grew up in at Kaiser Permanente, where you have a fully integrated healthcare system, you can focus on prevention, you can focus on health outcomes, and you overall have better health outcomes at the end of the day. But to achieve this, we have to really focus on those upstream factors, which are lower cost than those downstream. And I think this is really nice visual of what that means when you're looking at focusing on prevention. And Prisma Health is on a journey to move toward value-based care. It's gonna be a tough journey, a long journey, but we do have a value-based care unit, which I'm involved in, where we have some value-based care contracts which are focused on health equity. We actually are starting one right now. It's a partnership with a large pharmaceutical, well, large, with CVS, frankly, in the community, to talk about how we can look at, it's the ACO Reach project where we're focusing on health equity, and we've just launched that. And so this is my department really, just as this is a nice framework of what I work on in my department, looking at population and community health, community health and prevention, looking at rural health and access across the state, and drilling down on the analytics and evaluation of the current programs that we have. And so my team oversees a number of services in the community. Many of you are familiar with those that were happening in the Midlands, but it's really around improving access to care. We have our mobile clinics. We do community outreach, we do community events. We haven't done as much since COVID. I recognize that. But as we're ramping back up as a healthcare system, we're pulling together the team to do more of that work in the community. We also have our Healthy Start program, which I'll talk about. We have a community paramedicine program, community health workers. We have a diabetes prevention program. We are still doing some of our legacy investments in the community through the COPA. And we have school health services in the upstate and in the Midlands. And so this is just a nice list of some of the programs that I oversee in my department that are focusing on prevention, but also I'm doing some later intervention with those who are uninsured and don't have good access to healthcare. Let me ask a question. Yes, sir. What is the data as it relates to each one of these areas? How is that related in terms of interaction with the community issues? As you know, Midlands has, 292.03 has a tremendous issue with diabetes, heart, hypertension and that sort of thing. What does the data say in terms of the interaction of your group, your team with persons who are in particularly an unhealthy environment? Right. Two page on the actions of our Diabetes Prevention Program in the upstate and Midlands that shows some of the outcomes. It's the one on the bottom. The next page. So that shows what some of the outcomes in terms of A1C reduction, weight reduction, access to care, because that the Diabetes Prevention Program I'll talk about, but I can talk about it now is a 12 week fully certified CDC national program that we offer in the upstate and Midlands. And it's just a really good example of some of the program outcomes that we've had from that for those who have moved through the entire cohort. And so it just show that there's been improved outcomes. These are individuals that are at risk of diabetes and we've done an intervention with them and those are some of the outcomes related to it. So it really depends on the program that we have. So when you're looking at the Healthy Start program we have a federal grant that has 20 measures that we need to meet to get that grant renewed. And we've been successfully renewing that grant since 1997. It's a five and a half million dollar grant that we have in the Midlands to do interventions with pretty much African American mothers to improve birth outcomes and improve maternal mortality and morbidity in the state. We have a Duke Endowment grant that I was gonna talk about which is around getting uninsured individuals access to care and coverage. And the Duke Endowment has asked us to look at A1C reduction in the patients that we serve when we're starting to measure that. So it really depends on the program, the funding source and the data that they're requesting. But we are doing quite a bit of work within Prisma Health around data capture and collecting data so we can do a better job of telling that story. And so that's part of some of the work we're doing as a healthcare system. And that's great and I'm glad I was able to see this because I guess my concern is we understand some of the data. We understand that data is constantly being gathered. How do we make simplistically an approach to that person wheelchair bound? Yes. How do we market, and I shouldn't say market, but how do we allow the story of Prisma to permeate persons who are in critical situations? How do we do that? How do we market that concern? Now, when it was COVID, we understood what we needed to do and did it. Yes, we did. Does that same marketing scheme or that same marketing model, we see that with Prisma because overall we want our community to be healthy. Right. And if they aren't healthy then two things happen. Our cities aren't safe anymore. And of course, health becomes a detriment to every person in the city. So I want to make sure that the story is being told not only around the table. Right. But that story metastasizes itself in communities where they are hurting. And I'll share this with you. I had a good friend who worked with Prisma. And of course he died. Yes, he did. And a very important part of Prisma community. And he was able to share some of that information to communities and it was helpful. Yes. Not only for the COVID concern, but for another hospital. It was also a hospital. A hospital that can't be named in this room. You're all partners when it comes to health. I'm not making any names. But I want to make sure that the story is told simplistically to that person who is perhaps a stroke victim. That person who is confined in a home in a wheelchair. That amputee person who has and won'ts a prosthetic limb for some reason. So resources become a very, an integral part. So I'm just concerned that around the table it looks good, sounds good. How do we incrementally and specifically look at areas that we're really gonna make a difference in? I completely agree with you. And I think we learned a ton from COVID. And I think we all went away from that. What we recognized during COVID was the power of the trusted messenger, correct? The one that's reflected in the community. I did a whole campaign on COVID when I was working at Kaiser and it was national and actually we worked with Congressman Clyburn on it and we did some investment in the community to actually fund organizations and individuals who are on the ground, who are interacting with these, with community members to tell the story of the importance of protecting themselves and getting the vaccine. And I think after COVID, like a lot of the equity work that we were doing nationally, we've kind of pulled away from that. And I completely agree with you. We need to get back to that. We need to take it from the thousand foot and get into the ground. And I think the importance, the way, I mean, from an advertising perspective it's more challenging because of, and how you do the remarketing. But I do think that there's ways of leveraging community members through community health workers, your workforce that making sure they're reflective of the community and can speak to community members in a trusted way. I think that's the beauty of the team that I oversee is that many of them, my team reflects the community that we serve. When you look at my team, very diverse community staff that I have, getting out in the community and delivering those messages, but we do need to do more of that. And internal to Prisma, we talk a lot about that. What is our story that we wanna tell? And I think that's part of the work that I need to do as a leader of this department, working with our marketing team to figure out how do we tell our story in a better way that can be received and can rebuild, I would say rebuild the trust in the community about who we are as a healthcare system. Yeah, Madam Chair, this is a favorite subject. I know. And simply because I think our city need and desire a health challenge that's going to really push us forward. And it's all about feeding the lambs and not the giraffes, if that makes any sense. And I don't want us to be in a position where I want us to be in a position where we are feeding lambs and not giraffes. Yes. Giraffes doesn't internalize everything that this brings us and I'm very appreciative for this. But what about the lambs? Yes. How are they fed? What resources can we bring to the table that will speak admirably to their specific needs? Now, we can't solve every problem, but our toolbox is large and we are able to clearly define what it is we want to do and what we need to do. So I appreciate this and I promise I won't say anything yesterday. You're welcome to. I got that sense. I'm not worried about it. I wouldn't say that, but yes, I guess. Probably a tale, too. My carry on to you is simply this. I think it's about feeding the lambs and not the giraffes. And if we could simplify that message and make that message clearer and simpler, folk who find themselves in credulous situations are moved into a posture where they can receive something that's going to benefit them health-wise. Thank you so much. Absolutely. And if you hear me in my meetings, whenever they're pushing something forward or want to push technology forward, I'm saying, have you talked to the people who are going to receive this? Absolutely. We're going to experience it. Is it in the language that they can hear and receive? Are we talking to, we have patient advisory groups that are standing up and trying to influence my colleagues to make sure that we're making sure that they're fully representative of the community that we serve, because you are absolutely right. People won't receive it if they're not hearing it from someone that they don't trust that doesn't link with them or is not in the language or in the lexicon that they would be able to receive. So I completely understand. So that's my internal work. When you say you got to go into a system to change the system, that's what I try to do when I'm within the system. We just trying to take care of grandma and grandpa. Yes. Those who find themselves in real critical situation. Thank you. Absolutely. Thank you. For the mobile health services, is that something that you can request for events or how does that work? Because I could see some potential opportunities for us to have our maybe health services go out with some of the other services that the city provides. Yeah, absolutely. We've done that before. We've scaled back a little bit as I mentioned, but definitely we do have a schedule of events that we go to already. And then we have events that people request when we can get out there, we can. And we had a grant for a rural health with the mobile health clinic that we just received another allocation for. So in our rural communities, we can get out there in the community as well. Moving forward, that will be another annual grant that we'll receive to do some of that work. There you go. And that mobile, I'm sorry. That mobile health clinic is critical. Yes. Particularly, I've had a conversation with another hospital. And they are looking at the possibility of doing something because there is a lot of construction, close proximity to the hospital. There's gonna be a senior wing of this. And we're talking particularly about the Oaks there on Forest Drive because there's a senior place where persons will live. So we've had a conversation with them about that possibility of making sure that all seniors are taken care of health wise. It's a difference when you're taking a whole peel and you gotta take a whole peel and cut it in half. And they're getting 50% of what they need to get. So that conversation, it would certainly be good that we elongate this conversation as it relates to mobile medical services because partnering together, of course, brings about a tremendous change. I completely agree. And I'm through. Okay, for this page. Thank you. For this time. So just real quick, I'll get through it real quick. I'm sorry. No, it's all good. It's all good. It's, you know, the interaction is good. It kind of keeps it lively. So my team also does a community health needs assessment. As you know, so we do this every three years. This is just a quick reminder of the priorities that we landed on this last go-around. Well, this will be the next couple of years and I want to just, we did a great job of partnering with community and surveyed over 7,000 people, 14 focus groups, 52 stakeholder interviews to come up with these priorities. There's an action plan that I think I also sent to you so you can see where we're prioritizing our work. And the team overseas, some of that work for the system. This is the diabetes work that I was telling you about, the information that we have in front of you. So we're almost 400 participants, over 1,500 pounds lost, a 6.1% total weight loss with 31 cohorts. And this is system-wide. So just kind of a high-level overview of that. How are you using the word cohorts there, 31 partners? It's 31 classes. So there's like, yeah, I think there's like 12 people, 12 to 15 people in a class. So that would be a cohort when it comes. And so again, we have a lot of it's done online. Some of it's done in person. We moved to online during COVID, slowly moving back to in-person events. Cause you know, once people went home and started work and they didn't want to come back into the office, right? So it's slowly getting people back out in the community. Cause I think that's where you're gonna have the biggest impact. So we're doing some work within Prisma Health to assess all of our diabetes programs system-wide, particularly the prevention programs. This comes up quite a bit in some of our primary care conversations. I work closely with our chief medical officer for primary care where we're talking about how do we do better job by our patients for hypertension, for diabetes, for behavioral health. What do that look like to kind of try to address those services within the primary care environment? What are we doing to look at some of the community health interventions that could help these patients, particularly those who are underserved and need a different kind of communication. So a lot is happening in this place around the diabetes and chronic conditions. We have the Prisma Health Healthy Start program which I talked about, which is in Midlands and Richland and Sumter counties, over 430 newly enrolled pregnant women this year, incredible outcomes. You have a flyer on the outcomes that we have from that program. We just received another $5.5 million grant to extend this program into the upstate and we'll be renewing the Midlands grant as well. So we were one of 10 communities to get that grant nationally. So good kudos to this program and Kim Alston, the program manager who oversees that program. And this is just, I'd like to throw some pictures in here. This is one of the graduations of the Healthy Start program. We do quite a bit around fatherhood engagement which is really important to our moms. And so these are just some cute photos from the recent graduation that we had and I'd love to highlight the families coming together to support their children. And this was just a recent event. Maternal Mortality Month was like last month and so we had this event at the flagpole at one of our hospitals. I wasn't able to come, but that's my funding who oversees some of our hospitals here. Our staff who oversee the program and again some of the male staff that support our program. So just wanted to show those photos because I love them. Again, Access Health I talked a little bit about. This is the Duke Endowment funded initiative, the Richland Midlands program was the very first one funded in the state. We've served almost 40,000 people since its inception. In 2023 we had served 443 new patients that would get them access to specialty care, decreasing our ED utilization by 21%, looking at A1C outcomes as I mentioned. And in this one we uniquely partnered with the Manning Correctional Facility existing 50 patients to get access to care. So this is again, we have three cohort, three programs funded throughout all of Prisma Health. And I just hired a new director of health access for the system, Johnny Williams. He came from that other hospital I think. And so he started on Monday and he will be working with me. He's located in Columbia. He will be working with me to look at this program and just access issues throughout the system and doing analysis and sort of reimagining how we're leveraging these resources and what we could do to improve access to care, particularly for our unfunded and uninsured patient populations. And how is it determined which directional facilities are assisted or the partnerships? I don't know how this one got started. I can ask and find out for you how this was legacy before I got here. So I'm not sure what the selection process was. But I'll definitely find out. Do you have suggestions on other ways to think about that? Well, you know, the Midlands area, yes. But I'm sure there's some methodology. Okay, but yeah, welcome to Take Suggestions. Again, I'm new to all of this. And that's part of the reimagining, correct? So if you have thoughts about how we're implementing some of these programs, I'm open to hear them. And we'd love to learn more about how we can be better partners in the community for not meeting the needs that we need to meet. Then recently we just got the Healthy People, Healthy Carolina grant, another Duke Endowment funded initiative. This is gonna be over 650K over five years. This is what we call a collective impact initiative where Prisma Health will be the main organization leading this effort. And this goes to a little bit of what was talked about earlier, the power of collaboration. So this will be a collaborative effort focusing on 29203 zip code in the Midlands around getting people access to healthy food, exercise, focusing on diabetes prevention. The full work plan has not yet been developed, but we will be hiring a program manager to oversee this program and pulling a cohort of agencies together to help us implement this initiative. So this could be a potential opportunity for us to, since it is in Richland County, for us to engage with you all in what makes sense, especially in the part of the collective impact process where you have different kind of stakeholders come together and talk about, you know, the shared mutual goals for that region. So I would agree, yeah. Love to stay engaged there and plug in where it makes sense. Absolutely, yes, it's a great opportunity because we just started where we just posted the, we're getting the position posted. So if you know of anyone that would wanna lead this initiative, please let us know. So we have a one year planning grant. We'll submit the plan and then the Duke Endowment will review it and then we'll invest in the next five years. And hopefully we might be able to find ways to leverage other resources to enhance this investment. And that's the genius, excuse me, but that's the genius of it, I think, collaboration. And I think when we collaborate, of course, significant things come out of the process. And I hate for it to sound technical, but it becomes human dynamics takes place. Absolutely. And of course, collaboratively coming together with a methodology that is going to be creative and yet productive in the city and in community. I think that's a plus. Now, we haven't done that in the past. And of course, that collective collaboration becomes essential, I think, when we start talking about these various issues. I completely agree. And that's how you build trust. Yes, ma'am. Yes. Yes, ma'am. And have healthy struggle and healthy as you come to decisions about improving community. So quickly go through this. The other part of my work is advancing health equity. I've done collaborative work for a long time. Part of my work is advancing health equity. And so I just wanted to share this, and this is too wordy, but just really talking about how a CMS center is now requesting that hospitals address health equity and really entering, this is where the integration of community health and social health comes with critical to how we deliver care. And so there's a lot of external drivers that are driving much of this. The Joint Commission is a regulatory body that oversees our systems. They've put some provisions in place that we're now implementing. Each hospital has to have a health equity and inclusion plan, which we've created for each of our hospitals. Our boards are approving them now. We're focusing on congested readmissions due to concessional heart failure and maternal mortality and morbidity for our birthing hospitals. And we also have the external drivers, the data that's showing what we need to do so that the disparities and health outcomes in our community when we know what's happening in 2009, 2003. So my work at Prisma Health is to bring the two of that together. So how do we bring the community health in and how do we look at what we're doing at a system level around regulatory requirements and our operating system, which I'll talk about. And so this is what our Pulse program is is called our operating model within Prisma Health. And this is really around improving quality and safety and patient experience. We've added a couple of questions on our patient experience survey that focuses on health equity and despair, in how people feel they've been treated within our healthcare system. We're assessing that data. It's very basic, but just kind of starting to ask those questions. And so again, community health and health equity are integral parts of what we're calling our operating system. So people are looking at, we're looking at how we're screening for social health. Are we capturing all that information? What are we doing with it? How are we referring patients? All of that is happening within what we're calling our clinical advancement program. The next piece of it is Mr. Ohalo is signed onto the equity of care pledge for the American Hospital Association. And so while it's sort of can be performative, where you sign onto this and say we're actually gonna do this, here are the elements related to that in terms of increasing the collection of stratification of data, particularly race, ethnicity and language, cultural competency, a response of care, diversity and leadership, and strengthening community partnerships. We've required every hospital to address at least one of these pledge elements in their health equity and inclusion plan. We've actually required hospitals to address one of the community health needs assessment priorities that we've identified. And it's, again, it's a basic because they're learning how to do this. So we're actually trying to figure out how do we change the system within Prism Health. This is all part of our operating system. It's part of those inclusion plans. We have a phenomenal curriculum of learning opportunities that are Linda Gillespie who oversees our diversity team has put together. We're actually asking them to ask their team members to take some of those basic courses and as a beginning starting point for implementing some of those equity and inclusion plans at the hospital level. And I'm involved in all of the survey conversations and working with them on how to implement those plans. And so we've actually created a health equity framework and you can see here where it talks about clinical advancement and what we're doing around reducing clinical variation and looking at clinical best practices. The community health programs that I oversee are an integral part of that and data to drive decision making. So because we've learned that we needed all healthcare generally nationally needs to do a better job of collecting data. We're actually making it a performance improvement initiative where we have two scheduled events this fall looking at how we're collecting demographic data and how we're collecting social health data at registration. How are we asking the questions? Is there consistency within the system and how we're doing it? Do the clinical practices have the tools that they need to collect this data? And if they don't, we're gonna report that back and say, this is what we found and what can we do to move forward? We know this is going to take a long time to address but we're trying to get some foundational practices in place for collecting this data at registration. So we have some baseline information on the patients that we're serving, what their needs are and how we might be able to address them. And so I just wanted to end here because this is why we're here. This is a capital right here to be and I love this quote because it's really about the work that you're doing in this committee and what we're trying to do at Prisma Health because we know that there's a lot of need in this community and to the point earlier made earlier, working together will make a difference. And I think the biggest difference will be with policy solutions and how you can drive policy in the city and in the county and in the state to help improve health outcomes. And I think we started with that around Medicaid expansion, correct? So I'll end on that note too. Thank you very much. Any other questions? I would hope that at some point in time that there be perhaps some individualized conversation. I know Dr. Bussells has had that conversation. I want to make sure and ensure that collaboratively we are working with other entities, healthcare entities that's going to assume and be a part of this whole, the whole issue of maladies within our city. And I would hope that we could have further conversation as it relates to some of the things. As I look at the equity framework, one of the things of course is positioning Prisma in a way that the story is told. I agree. Yes ma'am. Thank you, Ms. Anderson. And however you can help us do that, we'd love to learn from you on how to translate. Yeah, I think that this is the beginning of several conversations and hopefully with some of the grants that you all are working on, we can plug in where necessary and perhaps we could have some of your team members come and give us an update when appropriate so that the right person or staff member can engage with some of the work that you all are doing. I love to do that. I always love having my team come and talk about their work. I can't do them. So I just really appreciate the opportunity available for whatever you need. So thank you so much. We really appreciate it. Well, thanks very much. Thank you. Thank you. Good to meet you. Thank you. Thank you. All right, we will now shift to our next agenda item looking at differential licensing. Ms. Victoria Riles with our Animal Services. Give me a test. Good morning. Not coming. What are you listening to? What is he doing? Thank you. Thank you. I think the sound's working. Good morning. So today we will be revisiting the change in Animal Services Ordinance Section 462 license for dogs and cats rabies vaccination. We're just checking the sound. Sorry, Victoria. Oh, no, you're fine. Are you guys ready to talk about cats and dogs? Okay. Good. So you'll see here the legal draft in front of you which does highlight the changes. What we are proposing is that we now offer a one-time lifetime pet license for $25 if your pet is spayed, neutered, vaccinated for rabies and microchipped. This is going to be a little different from what's already in place, which is an annual $5 fee if your animal's spayed, neutered. That does not require a microchip. It does require rabies vaccination. Currently, if your animal is not spayed or neutered, it's a $25 annual fee. So we're hoping by implementing the one-time lifetime fee of 25, it will encourage citizens within the community to spay or neuter. We are also still in the brainstorming stages of looking at programs we can implement to help folks within the community get spay, neuter complete. For example, if we have an owner in the community who is facing hardship or has limited resources, we are looking at programs that we could implement with their consent that we would actually pick the animal up and spay, neutered ourselves and then return it. It's sort of a pet fix and return program. But again, those are still brainstorming stages, but just extra programs that we can do from our standpoint to help folks come into compliance with this ordinance of the one-time lifetime fee. How much does a microchip cost them to have a pet microchip? Currently, we only do it for shelter pets. That's not a service that we offer for the public. So we're looking at low-cost chipping, but there are resources within the community through the Humane Society or other animal agencies that offer low chipping, and they may average anywhere from $20 to $30 depending on where you go. The other part of this ordinance would highlight that if your animal is not spayed or neutered or microchipped, you would be facing a $100 annual fee. So again, we are hoping by the alternative of the 25 one-time lifetime fee that would again encourage folks to come into compliance with spay, neuter preferences. So we enforce it. Yeah, that's the big enforcement. Yeah, I was wondering the questions that I wanna raise with that in regard to that, how does that enforce? Typically, we receive rabies certificates on a monthly basis from local vet clinics. That's how we know who has a pet within the city. Many folks just don't know that there is a licensing requirement. So we send out licensing notifications to them to let them know what the requirements are. If they fail to comply and get their pet licensed, the animal control will visit them and then give them a timeframe. Sometimes that visit can be followed with a citation that will be dropped if they come into compliance. And if they don't, then the citation will stand. So is that on a recur... Somebody, that happens to someone and they don't do that. Is there a recurring balance? They would have a fine to pay if they don't. But typically that fine averages, I believe, $152 and some change. So typically people usually will go ahead and get their animal license once they know that that is a requirement. This would probably mostly be complaint driven in addition to the notifications that go out via mail. But again, we are wanting to work with the community to get them tend to compliance. We're not wanting to take punitive measures to reinforce this. And again, if it's somebody who's in the field and just has hardship or lack of transportation, animal control will look at efforts that they can exercise to help those folks get their animals altered so that they can go the one-time lifetime route. Sure, let me ask this. For an example, there's a community, of course, that I serve. There are vicious dogs in this particular community. They've inquired from animal services to either come pick up the dogs. They are in offense. And they seem to be pretty large dogs. I don't want to say they are pit bulls, but they are large dogs that's causing some real disruption within the community. They've called animal services and they have not picked up the dogs. And I know I would think that it's probably their owner's consent would have to be given for that dog to be picked up. But you've got those kind of instances where they are in offense, probably unlicensed, and they are disturbing other members next door. Is there a resolve in any of that? Because I would think that it's probably their owner's responsibility to give or to gain access to that property. What can we do about something like that? There are several routes that can be taken in a situation as such. Of course, we would look at where the owners are out of compliance and work to get them within compliance. If they are licensed, what that sounds like is maybe more so of a nuisance situation. If an incident has not occurred that caused harm into a community member, we would not take actions to confiscate or impound. Really, that is something that we try to avoid. But of course we still take public safety into concern and it is top priority. We would work with the owner to get them into compliance. However, if there were folks in the community that felt those dogs were unsafe to their community, we could pursue a nuisance and it would require the cooperation of the folks who felt that they were in danger to move forward in court with us. Okay, thank you. Victoria, so looking at the ordinance, it says at the end of each month, all licensed veterinarians, shall transmit complete and legible copies of all rabies vaccination. This sounds great. I just am more concerned about, again, moving from losing money on the program to it actually being fruitful. So is it through this potential policy change that you would enforce this on veterinarians that operate in the city? How are we going to require them and ensure that we're getting the information we need so that we actually have an accurate count of the number of animals in the city? Two efforts that we're working on right now to make licensing more accessible and easy for members of the community are trying to get vet clinics on board with licensing within the clinic at the time of the pet owner's annual visit to their vet. They are already required to give us their rabies certificates and of course that goes through a manual process of inputting those certificates and then notifying the owner. Of course that runs into manpower and time constraints with a small animal shelter team. So we're also expanding that to online services. That is something that we do not have and we feel that will create a rather large jump in the licensing community as in the world today it is the most convenient to go online. So folks will have the opportunity to register online without having to gum in person or send a check via mail. Okay, and do we know when the rollout timeline for that is? We're currently working with the IT department as far as payments to get that established. I do not have a date at this time. Okay. Yeah, so I think the fact that we're not online yet I think is probably one of the biggest deterrents but I think making it easy for veterinarians to be able to do that on the spot and have them pay on the spot either online or I guess I'm trying to understand like would they pay the veterinarian and they would then pay us or is it that they could just register while on site at the veterinarian's office? Right now on the brainstorming stage it seems the most convenient that the vet's office would go online for the client and register at that time. Okay. Of course there would be a log or a shipment there for those charges. But yes, I think that would be the simplest to eliminate the paper manual process for both ends or any sort of collections. Okay. Did you have a question? You said, Victoria, you said that the $100 annual fee if the pet is not spayed or neutered and you added or microchipped. Or microchipped. So we need to add that to the, you just say spayed or neutered on proposed changes. Correct. We need to read spayed, neutered and microchipped in order to qualify for the one-time lifetime. Any dog or cat that a sterilized microchipped and vaccinated for rabies may receive a one-time lifetime license for $25 in lieu of the annual $5 license. But then we... But they have to be microchipped. They must be microchipped. And that of course is in an effort to... There's not an annual fee for that. It just has to do with this. Okay. To be eligible for the one-time lifetime. Okay. You have to, yeah. Got it. And we'll just help ensure that we have a higher capabilities of returning animals to the owner in the field so we can skip the impoundment process. Was the discussion in this committee about further studying the relationship between the county program and the city program? Is that something that we took up in this committee? I know we've had a discussion. We can take it up. I don't think we talked about it very, very briefly but not something in depth. I do believe that Richland County is looking at modifications to their licensing as well. I do not know the details of that. I feel confident that they would likely follow suits something similar to ours. They would have to be identical for this to work. Yeah, yeah. I've been shared with their assistant county administrator. He inquired about mandatory spay neuter ordinance and he said, or he always retained that. I said, well, the committee has discussed that what we're moving toward, looks like we're moving toward the differential licensing program and I offered to share details after today's meeting of just depending on how the conversation went. So I know they're discussing that. There's also, yeah, there's interest on county council to do a spay and neuter requirement for all dogs. And it should they do that and it passes, I think it would make sense then for us to revisit but I don't think it should be that we try and do it and then the county doesn't do it since most of the dogs come from the county that might be something we wanna revisit. But yeah. The conversation that I'm recalling is that the figure of the number of pets that are in our facility that are county generated was something like 78%. 65% was last fiscal year. I believe it may have gone to 67% when we last looked at those numbers. And it was that number that pushed us to do the euthanasia of the dogs more often because we didn't have enough room to take the county dogs in without eliminating some of the ones that had already been in the pound. Space is a contributor to euthanasia decisions. Yeah. But maybe we don't need to get into that today but that's something I think we need to look at the relationship between the county and the city as related to pet control. I agree. If they're generating 65% of our impoundment we need to either have a larger facility that they help provide or let them get their own facility. And I think we have asked that we would be periodically having the animal services team come and provide updates as we're working through some of these pieces. So yeah, we've talked about space and I think again, the biggest thing is enforcement and consistency across county and city for this tour. Absolutely. Madam Chair, I'm fine with the proposed changes. We are looking for the rollout of this to be effective January 1st of 2024. Is this something we can also see if county can do January 1st? Sure, absolutely. Because that's, I mean, I know there's appetite there. It's just they may need to be pushed knowing that. Excuse me, Madam. I can't, let me ask you this, if that's the case and we're gonna roll it out January 1st we're talking about from now until January having some, December, brother, having some conversation as to the similarities of what might take place. Yes, sir, what I will do. Is that possible and is it reasonable? And if that, I'm sorry, if that doesn't happen we still proceed with the January 1st rollout. Yes, sir, and I think to Dr. Bussell's point consistency between is really important. It may take the city taking a little bit of a leading role to make that happen, but communication. So, I mean, if whatever y'all unofficially bless I will share with their assistant county administrator tomorrow and say, hey, it looks like we're going to be trying to advance this. Would you like to get together and talk about this? Would you like to get together and talk about mandatory spay and neuter? Where are your elected officials on that? And then it's incumbent upon each body to do the approvals. I think we've got time to have those conversations and have the approvals and work through those details. I think they may have comments on our ordinance that we may want to consider again. Yeah, and I think first priority would be to update the second priority would be to see where they are with the spay and neuter. And we can bring that back to committee. But this sounds good. We will move this forward to greater council. Thank you. To the additional four members of council to take a look. Clint, if we could just have preliminary conversations with the county before this comes to four council, that would be okay. Yes, ma'am. Thank you very much. Thank you. Last but not least, Howard, your favorite topic. Boundary trees. We are ready for you, Brian. Is everybody there? No, Brian. You're going to meet Brian? I just met him today. Okay. Hi. I'm Brian Niagara. I'm now with the forestry and beautification. Where were you before? I actually worked for Alpha Tree Service for going on seven years. I was their operations manager over there. Very cool. You were tall and old. We totally was. Good to know. And we're delighted to have Brian on the team. He's done a really good job. And it's great to have you. Thank you for coming. I have you. Thank you for coming today. Thank you. Thank you. And I do want to thank all of you for giving me the opportunity to talk about my favorite subject, which is trees. It's a huge reason why I work with trees. I did want to point out here at the start, trees do grow symmetrically from the center. That is a large reason and a large driver in how we determine ownership of trees. I just want to jump right into our current practices. To start, we do have a responsibility to mitigate any hazards over the right of way, be it a public tree, private tree, or boundary tree. So whenever we receive a request about a issue in the right of way, we'll send one of our qualified crews to go out. They'll clean up the debris and then we will follow that up with an arborist to look at that tree to determine whether or not we need to do additional work with that tree. And moving from there, we try to determine the ownership of that tree first and foremost. We have several ways that we try to determine the ownership first with the tree records that we have on file. If we can't find it with that, we'll go look at the apron, driveway aprons, water meters, or the corner posts if we could find them. If none of those methods tell us who owns that tree, we're gonna go ahead and call engineering department and get them to actually stake the property for us. We also, once they've staked that, we'll go back and we'll look in, try to determine the ownership of that tree based off of the diameter at breast height. And Robert asked me to mention that. It's an industry standard for determining the caliper of the tree. You measured about four feet up and that's how you determine the caliper of the tree. So we'll try to do it off of that. We do not consider root flares and that is because root flares can grow outside of that and are not necessarily part of the stem of the trunk. If the tree is determined to be a boundary tree, we will, if the tree needs to be pruned, we will prune everything on the right-of-way side of the line and we will inform the homeowner of their responsibility to prune everything on the homeowner's side of the line in shared cooperation and ownership of that tree. If the tree does need to be removed, we're gonna go ahead and remove that tree all the way to the ground because you can't cut down half of the tree and leave it standing. So we're gonna just cut the whole thing down to the ground and in shared cooperation of ownership, we're gonna have the homeowner grind that stem. Throughout this whole process, we are communicating with the CIS and everything that we're doing from start to finish. We're communicating the ownership requirements on both sides and we're trying to keep them well in the loop of what's going on. And if we do replant, which we have had requests to do so, we ensure that that tree coming back is 100% in the right-of-way so that we don't have a boundary tree issue moving forward. Right, let's go back to square one on it. We're talking about boundary trees and a boundary tree is a, the boundary would be the private property versus the right-of-way. So these are trees that have either been planted or have grown into the boundary. Do you know how many of those trees were planted by the city and how many of them were planted by the landowners? So our records go back at least 20 years. Before that, it gets very spotty. So a lot of these trees that we're talking about were planted 50, 60, 70 years ago where there's not a whole lot of records on file on that. And that's why we use the property stakes to try to determine ownership of the tree while trying to determine where that stem originated from. In the examples you put in our packet, some of these boundary trees are 75% in the right-of-way and 25% in the private property. Do y'all split the tree that way too? So you would do three-quarter of the tree would be your responsibility and the other quarter would be the tree. So typically in that case, and I can actually jump forward to that real quick. So this is kind of what you're talking about, I believe. We would typically, in trying to determine where the tree trunk starts, we also recognize that there are no true straight lines or true circles in nature. So what we'll do is if that tree sits at least 25% over the line, we will treat it as a boundary tree. If it's less than that, then it would belong to one or the other. What if that line was on the other side? What if the blue was 75, yeah, there you go. That was quick. What would you do in that? So we would treat that as a boundary tree as well because we're trying to, this goes back to that first statement. We're trying to determine ownership based off of where the stem originated from and we give it that much of a leeway, about 50% of the total diameter of the tree to allow us a little bit of airing on the side of caution on that, that way we're not taking over a tree that's not ours and we're not giving away a tree that is ours. Would you take that as a city tree or would you say you got 75% of that tree? That tree would be considered a boundary tree and we would trim everything over the right away and the homeowner would trim everything on the private property. It seems to me that if the city has got 75% of the tree growing on the street side, that there ought to be some responsibility for the city to take the whole tree. And with that, we did reach out to legal and they said that our current practices is the most defensible practices. Did you see that look? So Brian, I think if you go back and run through some of the other presentations, you'll get to work. Brian, just before you go back to where you started, where you started, let me just ask this question because I think it's essential because I think Robert and Sarah, you all know that I've had some issues with trees and how we deal with that. And I think the mayor has already indicated that he has been in conversation or will be in conversation with Dominion as it relates to tree trimming. Yes, sir. How has that been any interaction, collaboration with city as it relates to Dominion and their trimming and cutting of trees? Yes, sir. So every year, since at least what, 2012, 2011, the city has put together a collaboration meeting. Usually it's held at the Busby Center or I believe last time it was at the print shop where we will go over what trees are being done. We'll have Dominion there to talk about how they do their trimming and also describe the utility trimming practices as it pertains the industry standards. And then throughout the entire year, we're going back and ensuring that they are doing their cuts to the industry standards and making sure that if they are not doing that, we hold them to going back and fixing whatever issues that they have caused. Now, if you've got a place or if you've got a community that is having some real issues with tree trimming and branches leaning, I mean, it's almost like some folks in one person's words is not tree trimming, it's butchering the trees. And they feel as if trees that are limb that should have come off, did not facilitate itself. So it's hanging over the road. I just want to ensure and make sure that as we look at boundary trees, our responsibility not only to the city and the community that we serve, but also Dominion, making sure that that protocol is taken in both lines, both city and Dominion. Yes, sir. And we had a couple of those issues come up earlier this year, most recently we had one over there off Millwood where they had gone through and cut what they just needed to cut and left a big old dead limb hanging over the property. I went in conversation with the Dominion Arborist, he agreed to go back and retrim that to remove that dead limb, since they were already up there in the tree and they went ahead and cleared that out and we were able to cooperate really well with that. Sometimes the communication does not make it from the Dominion Arborist to their contractor, but I talk directly to the Dominion Arborist and he makes sure that that does happen. Well, I want to make sure because these two folk have been very instrumental and very helpful. And the epimir is some of the issues as it relates to tree trimming and tree cutting down. Yes, sir. So if we could sort of continue that and perhaps I don't want to say perfect it, but at least making sure the standard for both city and Dominion are the same. And if there are instances where there's something hanging off the road or dead limb hanging over a tree, over a street, we need to ensure that that's taken care of. Yes, sir. And that goes back to our responsibility to make sure that that's not happening. Yeah, I'm sorry. So going back to the ownership thing, you were about to go over the Google definition. I believe I was up for a shrieks definition, but I can go back to the Google. Okay, I think the only concern I have, Howard, is we can't assume that all owners would want our help in fixing the tree. There may be some that expect the city to help, but not all. And I think you're opening up a can of worms. I'm not a legal expert, but opening up a can of worms when you're... That's what a legal expert says, too. That's right, that's right. Is that what you say? No. I understand that, but what you mean opening up a can of worms? I'm saying that if, so the discussion going on right now is that even if there's, you know, if the majority is on the side of the city, Howard is arguing essentially that even the small part that may be on the owner's side, we have some responsibility. And I'm saying that not all owners may want for us to be on their property, even if the majority of the tree is on our side. I think you and legal are second to second. Oh, okay. Well, there you go. I didn't hear you. What did you say, Ms. Wilson? I think legal is the only second thing about a can of worms. Yeah. But I think the question then to Howard's point though, is with the example of, for example, Millwood and that tree that was left, are there, you know, exceptions where we could have a conversation and work something out? Well, I have faith with the Forestry Division to be fair with the public. But I think you need to, when you're looking down that tree and it's only 25% on the owner's side, be generous in your alignment of the line cutting that tree. Understood. Yeah, so. Make it look good. Yeah, make it look good. Yeah, don't just say, oh, I'm only gonna cut some. Yeah, yeah. That's the bottom line, making it look good. That's right. I think you're right. I don't want to speak for you, but if we get in a situation where pruning was over the right away, creates an imbalance on the tree and it's gonna damage the property owner, we work with the property owner and we'll go ahead and prune the entire tree or take the tree. I mean, we wouldn't create a situation that is detrimental to the homeowner in the pruning process. Absolutely. If you were to trim a tree and leave it unbalanced or leave it like that, then especially in the situation you're describing, we don't want to create any more hazards than we're mitigating. So we're trying to do our best to not only take care of the right away, but also communicate with the homeowner and work in cooperation with them to make sure that that tree is gonna be healthy for a long time. And most of the trees that are really called boundary trees now are older trees because we don't do it anymore. So if we plant a tree now, we get into the right away. Absolutely. It leaves room to grow. Yes, sir. The situation will take care of itself over time. And unbalanced nature of a tree, of course, causes numerous problems on the other side of that tree. You talk about sidewalks, root, I mean water damage, the whole nine yards. So it's extremely important, I think that when we do that, that that tree is in some semblance of being balanced. Yes, sir. And we've got some examples of where we worked in cooperation with the homeowners on various trees. And the vast majority of the people we work with, the tree stands there for years and years afterwards because they like that tree just as much as we like the tree. Madam Chair, I will bow to City Hall and we can table this motion with that tree. But I don't know. Any other questions about boundary trees? Nope, all right. Thank you, Brian. Appreciate it. Thank you guys for letting me talk about trees. And I think it's worth saying, I think it's worth noting, Brian, I appreciate what you're doing for what you're going to do. But I also appreciate these two persons I do. And I'm not saying anything that you all probably have not heard, but when a tree issue is brought to my attention or anybody else's attention, you all are joining on the spot. And I'm appreciative for that. And I hope that we continue this conversation as it relates to trees. Thank you. Thank you. Thank you, Robert. Thank you, Sarah. With that, any other items for discussion? So we'll do it. All right, we will go ahead and adjourn today's meeting and look forward to talking. We have no meeting in October, but in November. Thank you all. We will meet in October. Thank you.