County Commissioners Receive Transit Work Program Update After Approving Library, EMS, and Family Support Funding

acknowledgement. As we convene for the Durham County Commissioners meeting, it's crucial to recognize the painful truth of history. We stand on the stolen ancestral lands of the Kataba, Eno, Okanichi, Shakori, and Tuscarora peoples whose deep connection to this land predates our arrival. We acknowledge with humility the unjust displacement and violence that occurred leading to the dispossession of indigenous peoples from their homelands.

Their resilience in the face of such adversity is a testament to their strength and spirit. May we humbly honor the ancestors and elders of these nations, both past and present, by committing ourselves to fostering understanding, healing, and justice for all who inhabit this land. Let us walk forward together with open hearts, acknowledging the past and embracing a future guided by compassion, respect, and unity. >> All right. Thank you, Commissioner

Burton. The next item on our agenda is citizen comments and from what I understand we do not have anyone signed up virtually or in person. So we'll move forward. Next item on our agenda is consent agenda.

Manager Hagar. >> Good morning. I will read the items for on the consent agenda. The first one is 260115.

This is a budget ordinance amendment recognizing $72,878 in grant funding from the State Library of North Carolina's Libraries Strengthening Connections Grant in support of programming laptop purchases. The next item is 26134. 17

and this is additional revenue from the Durham Library Foundation. So we are grateful for those additional dollars. Yes, ma'am. >> Yes.

Thank you to the library foundation. I was just wondering will there be any kind of public recognition of that like when we when we this is on our next regular meeting maybe um some some acknowledgement of them. >> Oh absolutely we can definitely do an acknowledgement um at the meeting. I know there have been times when we've presented a check and so we'll follow up to um see how that um Okay.

Okay. The next item is 260138. This is a budget ordinance amendment um for the public health department to recognize $1,500

from the Delta Dental Foundation grant to the Department of Public Health Dental Division's Community Smiles Initiative. This next one is 2613 5 0139. This is an approval of Sanford Electrical Contractors Inc. contract amendment for electrical services for the utilities division in the amount of $161,3853.

This will bring the contract to 354,000. I'm sorry. Yeah. 50. I'm just having a day this morning. Not to exceed $330,000.

The next one is 260142. This is approve and execution of a design narrative contract with CPL architects and engineers for the Junction Road Fleet Operations Project in the amount of $180,500 with 10% contingency not to exceed $198,550. Yes, ma'am. Um so just wanted to check in about this project because um very exciting that we're moving forward with Junction Road which also impacts >> the plans for the animal shelter. Um when I looked at the study related to this um that was done in 2013 I mean sorry 2023 report um with O'Brien Atkins. It had two

different possible site plans and I was wondering had we've decided on which one. One had the animal shelter right next to the fleet operations maintenance facility. One had them in separate north south locations. I was just wondering if that had been decided.

Okay. >> Uh good morning commissioners. Um I I think the short answer is no. Um we're kind of leaning toward one, but this study is going to help frame that decision.

Um so I don't want to say today uh you know what we're looking at. The the idea is to get this design consultant on board, get them up to speed on um the actual project itself, verify the programming and the um space needs for the Junction Road facility, and then we'll be able to say more definitively which direction we'll go. So, >> okay. Cuz I just want to I mean, I I

looked at the pros and cons that were highlighted in the report. Um, and I guess, you know, I I think it's going to be really important that those decisions are made in conjunction with the animal shelter because if they are located next to each other, it's going to be more cost effective evidently in terms of putting in the infrastructure, but there could be a negative impact to the animal shelter with all the noise and the operations and also could infect impact future future expansion. >> Yes, ma'am. >> of the sites.

So, I just I think I I would like that to be brought back to our board at least to you know for discussion. >> Certainly. >> Yeah. Um and the other issue I wanted to raise was um it's great to see the imp um the emphasis on you know the solar panels on top and um I also saw that in the report and the lead certification

but I'm just wondering I know we have not formally adopted the new proposed building policy that Tobin brought to us and I was wondering how that will then be applied to this since it's not formally adopted yet. >> And uh Perry can also share although we've not adopted the plan over the years, those are standards we've tried to include in the project. So uh the our we're sort of catching up with our policy adoption with our practice. And Perry, can you weigh in further on that to make sure I'm not overstating what we've done?

>> Yeah. So, Commissioner, we are planning to bring that updated policy to the board sometime soon. Uh, but the design features that the manager is referencing, the majority of them are already included in our um building design and construction. Anyway, and um, inherently there have been some recent code updates that uh, are allowing us to

just further uh, enhance uh, sustainable initiatives through design. um kind of inherently. And so um yes, we are considering all of those policy updates in the new design for all of our uh larger capital projects. And so um yes, we will certainly we'll we'll we'll bring more information to you on that as well once we take a deeper dive into the actual scoping of this facility.

So >> thank you. >> Yes, ma'am. Okay, the next item is 260145. 7 million. 26 life pack CR2

38. Questions? The next item is 260154. This is approval of the 500 East Main Street storm water control measure and public pedestrian access easements and plats and to authorize the county manager to execute the second amendment to the master declaration agreement.

Okay. I just had a question. I'm seeing that um basically we're we're part of this is we're doing a sidewalk maintenance agreement with the city. Um so that is

for the linear the sidewalk that's part of the linear park itself. Is that correct? >> Yes, that's correct, Commissioner. Uh the um please remember that that linear park is has been conveyed to ZAM and so I just put this on the agenda for the board's recognition.

And I remember in the past you wanted to make sure that the um linear park uh always continued to have public access and so this is just documenting uh that and so there are some other things tied to this but specifically that is more so related to ZOM but I did wanted to recognize it just to make sure that we're following through on that commitment. >> Thank you. And will Zam be responsible for maintaining the lighting and the public art and the other benches or whatever is there? Is that their responsibility?

>> Yes, ma'am. That is correct. Being that that property has been conveyed to Zam through the master development agreement, they have agreed to uh

maintain that linear park uh in perpetuity. >> Thank you. >> Yes, ma'am. Okay, the next item is 260160.

This is approval of a contract amendment with Boundry Medical in the amount of $75,000 additional in funding to purchase emergency medical services medical supplies for a total contract of $450,000. Okay, the next one is 260165. 83 83 cents for family and consumer science program expenses for the fall fest plant

sale and EMFV program. I know this is a program that everyone looks forward to um having each year. Okay. The next item is 260169.

This is an approval of budget ordinance amendment number BCC075 to recognize additional funding from the drug Durham Alcohol Beverage Control Board in the amount of $5,000 for the Durham Recovery Court. The next item is 260172. This is a budget ordinance amendment um for cooperative extension to recognize a $600,000 grant award from the North Carolina Division of Social

Services for the Welcome Baby Program for Family Support Program Service and establish a 65 FTE position. Fantastic. >> Um yes, thank you so much for this. I was really excited to read about this.

Um, this is really really great. I just wanted to know like in 65 like how many hours is that position? I was just wanting for my clarification. That's all.

>> Good morning, commissioners and um, county manager. 65 is roughly about 25 hours a week. So for clarification, will we have a full-time person and it's 065 is funded from this grant and then the remaining is funded from elsewhere or it's just 65. >> It's 65 to add to the stuff that we

already have because we're establishing um services for um school age children incredible years. We're going to start serving from six to 12 years old. >> Amazing. Thank you so much.

I just want to say congratulations patients and for getting this grant which really is for a 4-year period which is fantastic. I appreciate that this is going to help extend the number of years of the age of children that can be served. So, the incredible years um being ages 6 to 12 and then the um circle of parents, I love that. Um you know, supporting families with kids up to age 17. Um, I was wondering how this fits into um helping parents who were um being uh

given uh orders from a judge related to um DSS um when they're being directed to um you know engage in different programming for reunification. Are you all do you work with DSS? Um is this something that's offered to parents to help support them for with reunification? >> So yeah, we do work with DSS.

I actually wrote a letter of support. Um so we are going to be uh of course uh getting referrals like we always do with all the other services that we offer. We do work with social social workers. will work with DSS and when they have uh parents that are required to take uh the classes uh we we do serve uh and work with them.

>> Great. Thank you so much. >> Any others? Okay.

Okay. This concludes unless I make I did my double check all of our consent items and um I will turn it back over to to the chair. >> Thanks and thank you manager Hagar. Um are there any further discussions on anything for the consent agenda that was presented?

All right. Thank you. We're moving forward. Next item on our agenda is discussion items.

Um, >> okay. Okay. So, a good problem to have. We're moving a little bit ahead of schedule here. Um so the the next item on our agenda was the women NC Ced AW

resolution and student research presentation. It doesn't seem that they have arrived yet. So the item after that is uh our make sure I'm miss am I oh okay I'm at the top of the page. Yeah the draft uh fiscical year 27 Durham annual transit work program presentation.

Uh are your people here? Uh we're missing two. Okay. What about the uh an overview of the medical services and detainee health in the county?

There's two people missing for transit. Yeah. >> Yeah. We're we're a little ahead of schedule here. I had shared with the um individuals with women and C that it may

be closer to 10 um so um but we are trying to get others to come sooner. >> Okay. >> All right. What do we have the people present for the um detainee health and the detention center facility?

No. Okay. Um, yeah, we're we're going to have to Yeah. So, let's take let's take a recess to let's say 9:35 and maybe we could get maybe people will be here for one of one of these, right?

Okay. All right. So, we'll go into recess till 9:35. All right.

Thank you. >> Got one. Yeah, that's okay. We're at

back. It is 9:35 and we do have a winner who uh got here first. So, it was a race. It It was a race.

Okay. So, uh, we're going to go at our on our, uh, with our agenda as planned. We have the draft fiscal year 2027 Durham annual transit work program presentation. Um, we have allotted for 75 minutes.

Um, I'm hoping we can the presentation can be done in 60 maybe and then we have 15 minutes of questions, but let's try to stick to the 75 minutes. Okay. I'll turn it over to you um director paper. >> All right.

Um good morning. Thank you. Um thanks for your patience as we got everyone here. Um so this is our annual uh presentation of the draft work

program. Um so this is the annual budget for the Durham County Transit Plan funds. Um, we have four speakers here. Myself, um, Brandy Miner, uh, transit program administrator for Durham County, uh, Curtis Scarpagnado, the transit planner for Durham County, and Steven Schlashberg, the tax district administrator at Dur at at Go Triangle.

So, um, with that, I will turn it over directly to Brandy, um, to go through the presentation. Okay. Good morning. Thank Thank Good morning. In 2011, Durm County voters approved a halfsent sales tax to fund public transportation improvements that expand the quality of service within Durm

County and provide greater regional connectivity to the rest of the triangle. The Durm County Transit Plan, which was updated and adopted in 2023, determines how transit, excuse me, determines how these public transportation funds within Durham County will be managed and spent as required by state law. The transit plan was approved by the Durham Board of County Commissioners, GO Triangle Board of Trustees, and the Triangle West Transportation Planning Organization in the spring of 2023. The transit governance interlocal agreement, which was also adopted in 2023, establishes the duties and responsibilities of the staff working group.

The staff working group is a technical committee serving in an advisory role to the three governing boards. The staff working group primarily includes staff from Durham County, Go Triangle, City of Durham, and Triangle West. We are tasked with coordinating the planning and implementation of the annual work program and the multi-year vision plan. There are four voting members, one from

each organization who collectively determine which items such as the work program and related amendments should be advanced to the governing boards for approval. Approval of any item before the staff working group requires a minimum of three affirmative votes. While the preferred approach is to achieve consensus before advancing items for board consideration, items may be referred to the boards if consensus cannot be reached. I will now turn the presentation over to Stephen who will provide an update of the FY25 financial results.

>> Would you like for me to click, Steve? >> Um, you can click. Okay. Thank you.

>> Uh, thank you everyone and good morning. Happy holidays everyone. So what we wanted to do is give a real high level uh result from FY25. These are unudedited financials.

So go triangle still going through their process on their AGER. At the last board meeting uh their CFO asked for a um uh the like a extension to the end of this month. So we anticipate the actual ACT for coming out fairly soon. So just wanted to give

that to advise everybody that it is unudedited at this point. 4 million. I would note as you see on the bottom uh we just kind of received and I'm sure you've heard this from director Lane and everything we've received uh the halfsent sales tax for December. There's a couple of month delay uh because by the time it goes to the do department of revenue and comes back down to us it takes around two months or so.

We've uh received actually a very good amount for December. You would expect uh unfortunately things like tariffs hurt us in the pocketbook, but helps on things like uh article 43 on sales tax. We are at 50% of the budget for this year. So, we anticipate the budget of 44 million for FY26. We anticipate meeting that or even exceeding that, but last year there was a drop that was also shown in the county's article 39. Um, in the $7 and the $3, we were pretty much

in spitting distance when it came to how we actualized. That's the easiest thing to budget. The same amount of cars for the most part get, you know, a small increase around one one and a half% comes in uh to the town uh to the county and based on that it's kind of easy to budget. It's the $3 or $7.

Uh we've actually tax district have reached out to DMV. We've asked about why that you know there's not a bigger growth. There's a lot of people coming into the region between Durham, Orange, and Wake. Uh part of it is being a victim of our own success with transit.

We're putting such an awesome product out there that people are less driving. But uh we work again with the DMV on um on that information uh just to kind of always keep it uh hold, you know, just to keep it on the same uh uh path. So we are understanding vehicle rental tax. Uh there was a uh discussion in Wake County. is what's called the conference committee. There's still conversations with go triangle and the transit plans on the retain the retaining of the

vehicle rental tax. Part of the Wake County um conference committee in FY25 was to give a portion or contribute a portion to the transit plan. Go triangle because they did it in Wake wanted to make sure they do it in Durham and Orange County. That's what that 799 was.

Uh investment earnings uh as you see because we do have money sitting in the bank. So, um, you know, it's been great great returns. Obviously, things have gone down, but we have, um, a great, uh, director of treasury, very new. She actually worked in the county at one point.

She, um, used to work in the city of Raleigh. So, we're really kind of reinvesting. 4 4 million of investment earnings. So that's the money sitting in the bank and through investments. That's income that you we don't budget. 7 million

that was a reimbursement from Go Triangle. Go triangle um they um they sold a parcel that was back from the light rail days and based on the share of the percentage. It was in Ellis Road. Uh they repaid the county transit plan back the amount that was taken from that.

So that's a portion of that. But at the end of the day, the revenues are 52 million, which is over the budget, but that's because of those investment incomes and reimbursements from Go Triangle. Um, any question? Yeah. um the parcel that you just mentioned that was sold on Ellis Road, was there any process for evaluating whether that would be of any value to Durham County um itself rather than selling it, especially because that's like a key area where there's um a lot of development going on and there's a lot

of interest in doing transit oriented uh development, affordable housing. >> How how big was that parcel and >> how how was that decision made? >> Yeah, it it was I don't believe I think it's part of a parcel. I don't know maybe you would know a little more Ellen work I'll defer >> I I know a little bit.

Um it it's a relatively large parcel at um Ellis and the railroad. So, it was purchased, I think, as part of the regional rail project. I'm sorry. Way back when.

>> And um a portion, it was like an easement on the road frontage there was sold to NC DOT because NC DOT is going to do a grade separation of Ellis and the railroad. So, they needed some of that frontage of the property. But there there still is a sizable amount uh left. It was really just that >> okay >> just that portion. Okay. >> Um there are some access issues though we should add because the the grade

separation um there would need to be alternative access to the property if that makes sense. >> Okay. I just wanted to especially for our chair who is the our um liaison to the go triangle board. It's really um I remember from when I was on the go triangle board and working on the light rail that a lot of the properties um I would say the properties that I know of that are in Durham County, city of Durham could have still a lot of value um because of their locations in transit corridors um for you know public private partnerships or transit oriented development with affordable housing.

So I I just want to make sure we are very careful about what we the disposition of those properties. Yeah. Um, and I also just wanted to highlight though that looking at the budget, the preliminary budget, it still looks like

we're making up um while we show a a net um gain in revenue, it's really from the investment earnings, not from the sales tax revenue. So, I I also think that's really important for us to be aware of that. Um, >> yeah. >> So, it looks good.

Oh, hey, we've got five million plus dollars in new additional revenue, but actually it's it's from the investment, not from the sales tax. So, it's I we need to be very careful about those trends. Yeah. >> Yeah.

Those are those are great points. And in FY27, we actually have budgeted uh and and Brandy and Ellen will go through this and Curtis, we budgeted very conservative for that reason. Um what was great about that question I appreciate that with the uh parcel the fact that Ellen obviously knew all that. So there is conversations going and as Dr. Lee would know uh before any kind of uh selling of those parcels um go

triangle staff does bring it to the board level just to kind of identify but to your point they definitely go through that thorough process of where else can we use it what else can it be used and things like that. So, you know, thank you. I appreciate the the question and just all that information on that. Um, next slide, Brandy.

>> Oh, yeah. Sorry. >> Yeah. I wanted to I just need to make sure I understand.

And um the $7 vehicle vehicle registration tax that's just paid by Durham County residents through the $3 vehicle registration tax. How's that split up? >> Yeah. So, that's a great question actually.

Um, so the $7 vehicle registration tax, that's actually a tax that the actual county um approved for uh to the actual residents. That's also there is one in Wake and um Orange County, too. That was to help uh the actual transit plans when it started getting launched. The $3 is actually a portion of Go Triangle's regional transportation authority tax. So they actually have the ability for say $10

total. Out of that 10, they keep $7 of it. And part of like the um discussions with the ILA was allocating $3 of that to the transit plans also to kind of contribute to that amount. So it's different.

One's a regional and then one is actually county specific uh voted on >> and reimbursement from go triangle. >> Yeah. >> What tell me a little bit more about that. >> That was the the parcels that we just discussed.

So they sold a piece of real estate and so it it was other parties involved but the actual Durham transit plan or the funding that they got from the transit plan for that project they reimbured at a percentage. So it might have been much lower at the time but they said at the time if it was you know and I should know this percentage I apologize but say it was like 30% they said we will give 30% of the total sale not just what you um not just what we took. So everybody shared in obviously selling it at a higher price. >> Okay. Thank you so much. >> No, that's great.

>> All right. Go ahead. Uh, Commissioner Valentine. Oh, yeah.

Thank you, Chair. >> If we could just go back to the uh investment earnings for just a second. So, I feel a lot of phone calls and people um seem to suggest that that money could be used for sort of yearly operating expenses. It's my understanding that that that uh uh that investment earnings is used um consistent with with our plan and the potential needs that we have.

And so maybe you could sort of clear that up for me. >> Yeah. So what we do is once things are finalized and the act is complete, we will take those funds and we will then put it in our next year's work program. So it gives us the ability to actually add more projects if if need be.

So, we'll take that money. The good thing and the bad thing is the the good thing is that it's a nice amount of money. I won't say bad thing, but by by accumulating these funds in the bank, um, you know, some people might say it's

4 million, but what we do is we put it all into the kind of financial model and say here's an additional $7 million once it's been fully vetted, uh, audited. there's a lot of compliance, a lot of uh review from obviously the LGC um the um the auditors that's Molden and Jenkins. So, we make sure all those uh steps are done before we officially implement it in but it does go right into the model and it gives the ability to spend more money on other projects. >> Thank you for that.

So, just so I'm clear, it's not uh although it appears a surplus, it's it's just not for available draw down immediately. No, no. Yeah. I mean, okay.

The I guess theoretically somebody could, but we it is part of the plan. >> It's part of the model. >> It Yes. Exactly.

>> Okay. Thank you. >> Yep. >> So, this is very high level how how we ended the year. Uh it's based on the way

the ordinances are kind of um kind of formulated. So, obviously everything is on an ordinance. Uh 79% of the budget. This is the operating costs were uh used.

3 was encumbered. So, it went unencumbered actually. So went back to fund balance. Part of the financial policy is any operating expense that's not used.

It's kind of use it or lose it. So it kind of goes back to the the fund balance to be redeployed. Uh at a high level, you know, the majority of stuff TDA was uh savings request of staffing and honestly TDA does a lot of in in-house work. So like we have money for like financial consultants, modelings, things like that.

We do a lot of that in-house to try to save funding. Transit plan, uh you know, same thing. It's staffing savings. uh Go Triangle didn't have to do surveys this year, so that was part of their uh amount. And then the operations, uh the city of Durham, I believe there was like one route that um some of the routes that either didn't get ran or they ran a little delayed. Obviously, there was I believe driver shortages, things like

that. So, at the general part, there was some savings on operating uh but we were able to bring it back into um fund balance so we could redeploy for uh you know, the next years. it just kind of rebuilds up on it. Um the next slide is the capital.

Similarly, capital the thing that you know capital you guys all know but for the public out there capital a lot of it takes time. Capital projects are big takes a couple of years sometimes to just kind of put things out. If you're building like an infrastructure even something as small as a transit amenity takes, you know, a year or two just to kind of like work with, you know, if there's rightway or things like that. 4 million.

3. They actually do a uh bus stop kind of replacement improvement pro they have a whole project that's a bus stop uh improvement project that they do on behalf of the whole county. So it'd

be on go Durham, it'd be for like um bus stops for go triangle. And that's why you see all these like beautiful bus stops coming up uh more recently in the in the county. 2 million. Uh but uh the money gets carried forward from year every year.

5 million in funding that's still been uh encumbered is being you know kind of locked in that uh people could draw down on. So that includes the rest of like gom station, some of their BRT early stuff, things like that. >> Commissioner Jacobs. >> So when I look at this, I see a lot of red flags. um you know when I'm looking at especially when when I'm look when I'm thinking about what is being requested um in for

changes or or in the being requested by our some of our partners for the new work plan and I see that the city of Durham for transit infrastructure they're only spent 15% of their money Um you know same thing with go triangle um only you know the the the rates of spending are are very low uh 26% for transit infrastructure vehicle purchase 21% um I see even with us 9% although the it's the context is um anyway so I I guess I'd like to hear a little bit more about what's going on because when you have people who are asking for more money for things and they haven't spent the money they already have um then I think we need to really be paying attention to what's happening and I don't know if you want to comment on any of that Alan

>> um well okay we for Durm County I do want to note that this is primarily in two um planning projects the bus rapid transit vision plan and the eastm railroad crossing study. Um, both of which are now encumbered and getting started and the BRT vision plan's well underway. So, that that accounts for that difference for Durham County specifically. Um, and then, you know, I do I do want to emphasize that capital projects there typically would be a lag.

Like, we would never be at 100%. You know, they take some time to develop and plan and design. Um, so there there would always be a discrepancy here. Um, but but yes, I mean I do think to your point there is an issue of folks asking for funding um years ahead of when they expect to actually encumber it. Um I would say oh I would say you know we

have a policy thanks to our staff which we've been really implementing with Durham public schools which is things need to be shovel ready. So you know not not allocating money for things unless you are literally ready to to build them. So it seems like we should be using that policy across the board. Commissioner Burton, >> thank you so much.

Yeah. So, when I look at these numbers, because it's a lot of numbers, right? And trying to imagine in my brain, okay, where all this money is going, like we have this pot of money here for in Durham County for our work plan, and then the city of Durham has the same amount of money, the not the same amount, but they have money, right? And we're contributing to the city of Durham to help with their operations. Correct.

>> Yeah. >> Okay. And so then we also give money to Gold Triangle to help with those operations, right? Okay.

So, and the reason I ask this is because I want to make sure when I go out into the public and people ask me questions, I know how to answer them. Okay. So it's I have a I know it in my brain, but I just want to make sure it's, you know, clear. So when I see the 45493198 number on the capital, that's the money that's going in that's staying there for these big projects.

>> Yeah. So it's for a bunch of projects and and what I would say the way the transit plan's kind of built is to help fund expansion. So, anything that's expansion really, the transit plan was kind of built to to help fund that. So, that's why you've seen a lot more like go Raleigh, I'm sorry, go Durham routes, go triangle expansion routes because of that. One other thing um I I would say I I agree 100% um with your comment about

people asking for money early on. It makes it very complicated for modeling, right? because we want cash flow and if we have a project that's early on that you know we we're not spending in the next couple of years you know then the thought process is well do we have to borrow for it so we actually work very closely on what's the reality like BRT study is I think $6 million of that transit infrastructure for the city of Durham but we're in the very early stages of that so the question is is like what's the real cost curve of that uh part of that but um one thing I would keep in mind this is ended 630 2025. So there has been some spent over the last couple of months on some of these amounts, some of these projects.

Uh so you know, so I'm not saying it might not still be the 45 million. I think that this delay is obviously something that we need to be uh cognizant of. We obviously as part of staff working group, um we actually have this information broken down by project. We review it for the partners and say, is this still actually something that needs

to be getting done or or not? But to Ellen's point, things like Go Durham Station, the part of that is with Go Triangle, the mobility hub, these are projects that are are known to take a couple of years to build out where sometimes you need the funding upfront or at least acknowledging the funding to get the um the uh the the the the contractor to to bid on it or to take it. So, um, but yeah. >> So, what I'm concluding just from reading all of this and listening is that we need to be very, very careful about how we spend this money because if we are not careful, we won't have any money to for these big projects.

And that's what I'm concluding. So, um, even though it looks like a lot of money, it's really not a lot of money, especially when you're doing these big projects. Correct. Yeah.

>> Yeah. Yeah. Exactly. Okay, thank you. >> So this was the uh how we ended the year

uh with cash and investment balances. So I will say that says over there February 28th we ended with 210 million in cash. 5 million. So, you know, the cash obviously as we're getting the article 43 as we're getting the $7 and the $3 is helping our uh excess liquidity. Uh but to the point of that 213 that I just mentioned or 195 we had that $49 million that I just showed 50 million that's locked in like theoretically that's encumbered already that we can't spend that and uh the county uh working with uh go triangle and all the staff working group members have a have very robust financial reserve policy. So that's another around uh $45 million that is reserved and that's basically like we have to make sure that it's a 5% of projects plus another 10 million that we worked obviously with county staff to feel comfortable like to basically inoculate from a possible recession or things like

that. So where it says 195 or 213, we really have like 120 million in excess liquidity. And as we just discussed with uh Commissioner Valentine, that funding is kind of mapped out in our MYUP and CIP. So there's a bunch of es and flows where we get down to I think a low point of like $15 million, which we've talked about the last meeting.

So you know, it's nice that we have the money, but it's a lot of it is already spoken for. Um and I think that might be the last slide on 25. There's any questions? >> Any questions?

I think they were asked all the way along, so I think we're good. Thank you. Durham County launched the Durham Transit Tracker last year and the transit tracker tracks the financial data for all Durham County transit plan funded projects and it also tracks project implementation metrics for applicable projects which you can see an

example of here with the Durham station improvements with the timeline for construction and as you know it's currently under construction. And there's a lot of work going on over there. And on the top right, you can see the funding available in FY25 and the funding spent. So, kind of picking back on Steve's slides, not all of it has been spent.

34% was spent in the previous fiscal year. And again, some of that is just due to capital projects being multi-year endeavors that take a while to deliver, but not all of it is due to that. And the tracker also shows locations, which you can see a snippet of in the bottom right corner. Uh, next slide. And we also want to take a moment to highlight some of the accomplishments of the last year or so in terms of transit and the transit plan. And in particular, I want to highlight Go Triangle here has won a number of important federal awards in the last couple years, including 25 million in an FI24 raise grant, 2 million in FY26 they were awarded through community project funding, and

5 million from Triangle West TPO's regional regional flexible funding program towards the Triangle Mobility Hub, which will be a new transit center in the RTP area serving CO triangle routes and connecting uh the greater Durham region with our regional partners in Wake and Orange. They also received 17 million for a bus and bus facilities grant uh to update their maintenance facility at Nelson Road, which is a huge amount of money. And I'll also highlight that the city of Durham secured 6 million in funding to replace some of their baseline fleet service. Um and they also deployed 15 new battery electric buses expanding on their zero emission service.

So just taking a moment to highlight some of the important awards our partners have been securing and we'll go on to the next slide. Thank you. So in terms of other major accomplishments uh through transit plan funded projects, the city of Durham has advanced a number of capital projects

over the last year. This includes the village transit center. And just for some context on the village transit center, you can see it on the map here. It's along Holloway Street sort of near where the Little Caesars is.

and that will be a future stop along the central Durham BRT. So, just highlighting that they have advanced um progress on approval and site acquisition. And the city has also continued on its work with the junction road pair transit maintenance facility scope. They have confirmed the scope for that.

Uh that'll be the maintenance facility for the combined city county access program. And the city has also completed near complete design and approval for the Horton Road project which is a transit access project roughly around the intersection of Horton Road and Guest Road where the food line and Harris ter are to ensure safe access to transit stops in that vicinity for the riders. So they're positioning multiple projects now for bidding and construction in the next year. Next slide. Go Durham Connect Microtransit service

was also launched in the last year. Um and it expanded its service relatively recently to serve the Museum of Life and Science, Treyburn Industrial Park, Welcome Venture Park and Durham Techch North Campus to name just a few of the many locations it serves. There are two zones for the microtransit service in North Durham and East Durham. And the service has provided 8,000 trips since launch um including nearly 700 to DPS locations.

Go Durham access enhanced customer experience through technology. This is a Durham transplant funded project to implement AI powered phone support and a centralized feedback system um improving accessibility, reducing weight times and achieving a 97% customer satisfaction rating with faster complaint resolution and again this is for the combined city county access program. Next slide. Major bus service expansions. So the Durham transit plan over the last several years has dramatically increased funding for service expansion along a

variety of corridors. This is just highlighting some of the more recently launched ones. Go Triangle increased its regional bus service with the first regional route with all day 50-minute service in North Carolina. And Go Triangle routes 400 4005 increased to 50-minute service between Durham station and Chelico/Carbor.

Go triangle also increased its hours and realigned route 700 to serve NCCU and Durham Tech between downtown Durham and the regional transit regional transit center. A new route 705 was introduced with access between downtown Research Triangle Park and the RTC. Go Durham's first 10-minute bus corridor, uh, the first 10-minute bus corridor anywhere in Durham was launched, um, earlier this year along the Holloway Street portion of the Route 3 and Route 16. And I want to highlight that this new 10-minute corridor also overlaps with the future Central Durham BRT. So, we are getting that corridor BRT ready for the eventual delivery of the Central Durham BRT.

And I'll just go into some details here on the route three which now operates 15 minutes providing frequent and reliable service to the Walmart at Gleniew station and the route 16 which replaces the former route 3B and now operates every 30 minutes doubling the previous 60-minut service frequency. Next slide. Bus rapid transit. So the city of Durham has continued work to advance the design of the central Durham BRT.

Uh this will be Durham's first BRT corridor. It will run from the Duke/VA medical center to downtown Durham to the village um near that affforementioned village transit center and at the same time the county has been leading the development of the Durham BR2 vision plan which you can see a little snippet of in the right there some of the corridors we're looking at. I'll caveat that those corridors are subject to further analysis and that's not by any means a final list there. So there'll be more to come.

Keep an eye out. We're going to have more engagement on this too. Uh we expect to start

public engagement on the Durham BRT vision plan in May and we're hoping to develop a list of prioritized corridors for BRT in the future connecting Durham with locations locally and regionally. Next slide. And that concludes for me. I'll pass it over to Brandy.

>> All right. Thank you, Curtis. The work program is the annual budget for the transit plan and its primary goal is to advance the projects in the adopted plan. As the staff working group administrator, I'm tasked with presenting the work program to the governing boards for approval.

Um you have the draft before you now and then we will come back um in a month or so to present the final recommended. The work program must be approved by the county commissioners and the GO triangle board of trustees. The work program is developed with our partners over the course of several months based on the approved development schedule. The updated revenue forecast shows a decrease in our primary revenue source which is the article 43 haveent

sales tax and the staff working group was unable to reach consensus by our original deadline on which projects to advance to the boards for consideration. As such, the draft work program was delayed by two months and the staff working group voted to release the work program for public comment at our March meeting which is required by the ILA. So this is an overview of our schedule. You know, as the schedule has been delayed, the draft is just now being presented to the county commissioners and will be and will be followed by a presentation to the GO triangle audit and finance committee on Wednesday.

At the conclusion of these presentations and the public comment period, I will work with the staff working group to finalize the work program and I'll come back to the governing boards in May and June with a second presentation. If the work program moves forward, we anticipate receiving approvals from both governing boards in June. The work program continues the implementation of the four key themes of

the DURM transit plan which include improve the current system, more projects sooner, connect the region with quick and reliable service, and better experience at stops and stations. This pie chart represents the funding priorities of the transit plan. The draft work program generally maintains the same priorities of the transit plan, but there were a couple of shifts um in the plan. Most notably, the operations and maintenance category increased by 5% and the enhance and extend bus service category increased by 2%.

As with last year's work program, our goal again this year was to maintain transparency and accountability within our project budgets, schedules, and implementation metrics. I am happy to report that one of the process improvements we suggested last year has been implemented in this draft work program. As shown here in this example of the Triangle Mobility Hub, you'll see that every project in the work program now includes a cost share, which helps

improve transparency and consistency in the reimbursement process. Additionally, the project implementation metrics continue to be tracked and displayed in the Durham transit tracker that Curtis just talked about, and that is updated twice a year. I'll now provide a overview of the budget for the draft. So, as mentioned earlier in the presentation, you know, our article 43, which is our largest revenue source, the growth in that has slowed significantly.

4 million less than budget. In FY26 through December 2025, the tax district administration has informed us that we have received approximately 50% or 22 million of the budgeted 44 million in revenues. While we are currently on track to receive all the projected

revenues from the halfsent sales tax in FY26, the draft work program revenue forecast will remain at the same level of 44 million for the budget. Due to the decline in revenues and an overwhelming number of funding requests received from our partners, Durm County staff provided a presentation to the county commissioners and go triangle audit and finance committee in January. Our goal at that time was to seek direction on how to proceed with the draft work program given the revenue forecast. Following these presentations, I advised the staff working group to proceed with a status quo budget for the draft and to develop options for the governing boards to consider with the remaining available funding. The draft work program represents a status quo budget, meaning no new projects have been included with the exception of the Durham County transit plan update, which is required to be updated every four years. The staff working group could not reach consens consensus on which projects to advance and therefore I suggested to create a

supplemental document to highlight the partner priorities for consideration by the boards. An overview of these priorities will be shared later in the presentation. The status quo budget maintains the financial model assumptions including all programmed funding in the multi-year operating and capital improvement program. Fund balance is necessary for us to have the ability to fund future capital and operating projects and our adopted financial policy requires us to maintain at least 10 million in excess liquidity.

In this year's draft work program, the low point in the financial model occurs in FY35 at approximately 15 million, which leaves we only which means we only have about 5 million available to allocate. Now, Steve alluded to this also in his presentation about the fund balance. Um, but as of December 2025, the fund balance was 27 million. 5 now, but it it was 207 million. Um so however 51 million is held as a

restricted reserve per the currently adopted financial policy. This policy will be reviewed during the next transit plan update. Another 45 million which we also saw on the previous slide is already committed to projects that were approved in FY25 and earlier work programs. Because capital projects often span multiple years, the timing of when these funds are appropriated does not always match when they are actually spent.

As a result, these funds are being carried forward until the projects are completed. Of the 111 million remaining, 55 million has been committed to FY26 projects and the rest is already incorporated into the model for for future projects. We also discussed investment income in Steve's slides. 4 million in FY25. And as Steve mentioned as well, you know, these revenues, they're highly unpredictable and they are not included in the financial model. So any investment income we receive is added to the fund balance.

This next slide provides an overview of the projected total revenues for FY27 which are approximately 57 million. 5 million. 4 4 million from the fund balance to maintain a balanced budget. It's also important to reiterate that as compared to prior work programs, the sales tax growth has decreased in recent years.

In FY25 and 26, revenues were up 8% and 6% respectively when compared to the 2023 transit plan. In those years, we were able to add new projects and increase the budgets of existing projects. But now in FY27, we are only showing an increase of 3% as compared to the transit plan and the draft work program only includes one new capital project. This slide provides an overview of our

recommended operating and capital expenditures. 5 million. The recommended expenditures by agency provides an overview of how the funding is distributed amongst the partners. 2 million.

However, it is important to note that some projects such as the Durham bus stop improvement program provide benefits to other agencies and are not exclusive to the project sponsor. The good news is despite the decline in these revenues, we can continue to fulfill all existing work program and future transit plan commitments. 5% annual growth rate and the carryover capital projects. Some of the projects have been updated with new cost

estimates or scopes. And as I mentioned, there is one new capital project in the draft. In FY25, the transit plan share increased from 5 million to 30 million for gom improvements to the F street bon and construction of a new separate paratransit maintenance facility located on junction road. The increase was approved with the understanding that local or federal funding would provide for the remaining costs.

5 million was originally appropriated for construction of the Face Street Bonf in FY26. However, the city has now requested to reallocate this funding between both facilities and use it for design cost in FY27 and construction in FY28. Both projects currently have sufficient funding available for design, but full construction cost full construction funding has not yet been identified. The transit plan funding for GO Triangle's Nelson Road bus maintenance

2 million has been programmed for construction. 7 million federal grant in February. And in this year's work program, they will also receive $728,000 for the purchase of new vehicles. 3 million is programmed for the Durham bus stop improvement program, which is a multi-year improvement plan for bus stops within Durham County.

420,000 is programmed for design and construction of the Triangle Mobility Hub, which again also received 2 million in community project federal funding. 1 million will be programmed for Gold Derm's village mobility hub project, which will be used for design and construction of a quick build improvement. We also have a 500,000 regional connections placeholder in our budget that may be used for planning and or grant matching opportunities. Again, as

Curtis mentioned, the city's BRT project is underway and they will receive a total of $10 million. 6 million of that was appropriated in last year's work program for design, preliminary design of the Central Durham BRT project. While final design is not expected to begin in FY27, the city has requested an early approval of the remaining $4 million for the county's bus rapid transit vision plan. We are not requesting any new funding, but the project is currently underway and is expected to conclude in the fall of 2026.

The one new project that we have in the draft is the Durham transit plan update. The transit governance ILA requires the plan to be updated every four years and will include a review of the ILA. The staff working group reached consensus to move forward with this request and Durham County staff also recommend incorporating related policy developments into the next update. There is a shared interest in in improving the

work program development process, adding reasonable flexibility in project funding, and reducing the conflicts that arise under the current decision-making approach. We are requesting 650,000 for this project which upon approval is expected to begin in early 2027. As mentioned earlier, we are able to fulfill all the commitments in the current transit plan. There are several future capital and operating projects from the 2023 plan that have not yet been initiated.

4 million. 2 million. We also have the quick and reliable regional connections placeholder which we will have a better idea of how to use at the conclusion of the BRT vision plan. Now I'll provide an overview of the partner priorities. After the January 2026 presentation, Durm County staff were directed to

provide recommendations of how to spend the remaining five million available in the financial model. A supplemental document that was included in the agenda packet and released during the public engagement period was created this year to provide the boards and the public with an overview of the partner priorities. There were a total of six priorities submitted by the project sponsors. The city submitted their two maintenance facility projects which include the Face Street Bonf and the Junction Road Parat Transit maintenance facility.

5 million to fund design of these facilities, but construction remains unfunded and was presumed to be covered by local or federal funding. 6 million for Junction Road. This additional funding is requested to be programmed in the CIP in a future year,

not FY27, but updating the CIP with anticipated costs is part of the work program process to ensure that all promise projects can be funded. The third capital project submitted for consideration is the annual work program improvement project. Durham County requested $50,000 to hire a consultant to build a database to develop a more efficient system for submitting and tracking projects. This would be a one-time request, but Durm County staff are currently exploring other options that may not involve transit plan funding.

Go Triangle submitted two service expansion requests for consideration on route DRX. They requested an additional 265,000 in FY27 to fund halfyear 30 minute weekday midday service to improve frequency on this route. 4 million over the life of the current plan. The project is funded

50% from the wake transit plan. However, service expansion on the DRX is not a funded project in the current transit plan. On route 800, they are requesting an additional 217,000 to fund fullyear service improvements and keep the route running on time. This project is funded 50% from Orange County's transit.

5 million over the life of the plan. Two staffing requests were submitted for consideration. The first is approximately 75,000 submitted by Go Triangle to fund a service planning team that will be focused on developing and preparing new transit services funded by the plan. The total impact of this request would be an increase of approximately 1 million over the life of the plan. The second request is from Triangle West and would be an increase of about 28,000 for their existing staff project to help fund their participation in the staff working group. The total impact of this request would be an increase of 462,000

over the life of the plan. It is important to note that a staffing study was recently approved as an FY26 amendment which will assess the staffing needs for current transit activities. This study will take approximately 6 to 8 minutes and is estimated to be completed later this year. Lastly, our public engagement period is now open.

Information about the work program is available on the Durham County Transportation website. We are also advertising on Durham County social media platforms and residents may also take a survey online and attend one of the tableing sessions that we are having at Durham station. The first one was last week. U we have one scheduled for tomorrow and then again next week.

Uh so staff can come on site. They can um take the survey. Uh we can answer questions about the plan. gov. A public engagement report will be prepared and shared with the governing boards at the conclusion of the engagement period.

Any questions? >> Uh, Commissioner Jacobs. >> Brandy, are you all going to discuss your recommendations um that was in the memo um related to policies? I mean, I do have a number of questions, but I was going to wait >> until after that portion.

>> Sure. I'll turn that over to >> Okay. Um, Commissioner Jacobs, um, so I am a member of the staff working group, one of the four members. Um, and I wrote a memo, you know, representing the Durham County staff position.

Um, so I just want to make sure it's clear that that is separate from the staff working group recommendations. Um and um so you know I wanted you all to understand I guess the perspective that I have on some of these projects. Um so that's that's listed there. Um there's a number of kind of recommendations. Um

um you know I I'll just summarize things. You know I think as we've described um this is a the Durham transit plan is a long range plan right? It goes through 20 240 and uh when the funding was approved, it was originally designated to go towards large projects that take a long time to develop, require careful planning. Um there's CIP and a multi-year operating plan that map all this out long term. Um and so, you know, what we've what we've had this year, you know, is kind of a tension, right, between funding things this year and following that long range adopted plan. Um I think as as Brandy described um the work program includes that CIP NY and multi-year operating plan and we are um you know looking at the financial model longterm looking at where that that future um dip is and where where the fund balance is.

Um and so we're trying to maintain that and we we are able to fund everything that was in the plan with this work draft work program. Um you know we we do have an issue of what is reasonable for us to have some flexibility on and of course there should be you know things change but what what what shouldn't we change right because we're looking towards that long-term plan. Um also the long-term plan you know this is a very unique process in the sense that three governing boards have to approve it that is difficult right to get everyone on board and to get everyone have consensus around this um you know that's why we have this transit plan update planned that's going to take a while and um involve a lot of governing board discussions and making sure that we are reaching consensus and can get three boards to approve um this annual budget process isn't really designed to make changes to that

long-term plan. And I think that that's some of the conflict we had this year is a a desire to make changes to the long-term plan and then but also a desire to maintain those promises. Um as such, you know, it's my recommendation that we focus on making sure that we're fully funding projects in the plan first and foremost. Um, you know, we we do need to address some of the capital funding gaps on capital projects.

Um, you know, there are often opportunities to pursue federal grants. Uh, but there are some projects that aren't eligible for those federal grants as well. So, we may we need to we need to develop a coordinated solution um on those projects with the city of Durham. Um there's also, you know, a lot of uncertainty, I think, right now, especially in the last few months about the operating costs. You know, gas prices are going up. Um that could affect what it costs to

run all of these services that we've planned and that are in our budget, you know. So, so I think it's it is wise to be a little um conservative right now on those bus operating costs. Uh, we also want to look closely at that at those bus operating costs to make sure that we're being fair. You know, we get we get requests obviously from Go Triangle.

We get requests from the city of Durham. We want to treat we want to we want to be a good partner and try to fund both entities fairly and equitably. Um, so, you know, as part of the transit plan update, we want to look closely at that operating cost for buses and make sure we're being fair. Um, in terms of the priorities that were requested, um, you know, it is it is my recommendation that we focus on the the maintenance facilities for the city of Durham right now. Um I am I am concerned

that there are significant funding gaps for those um that are potentially needed in the next few years and um there are there are some limited opportunities. You know you can pursue federal grants but the scale of what's being requested is pretty significant. It would be it would be it may be difficult to receive that much in other funding sources. So, um, again, you know, I hope we can, um, get together with the city and come up with a coordinated solution on that.

Um, the staffing request, you know, we're doing a staffing study in part to make sure we're being fair and treating all of our partners equally. So, you know, it's my recommendation that we defer those staffing requests until the outcome of that study. Um and then you know with the bus operating like I said I think we need to um make sure that we are able to fully fund what we already have um in the plan and I do want to note that we have rapidly expanded bus operating in the last few years and we've we expanded it

even faster than what we said in the plan. Uh many of the projects were in future years and we pushed those into last year's budget. Um many of those projects haven't been fully implemented yet though. You know, you saw that there's a operating balance um last year.

Um and and in part it's because some of those projects haven't haven't um been put into service yet. So I I also think it's important to note that even even with the status quo budget, there are expansions that are that were funded in this year's budget that will probably occur next year. So there will still be improvements to the bus system that riders will experience just based on previously approved expansion projects um you know on the um on the um capital funding gap and the investment income. Um, so ju just to be

clear, we receive that like like Steve said, we um receive that and kind of can book it once the audit has been complete and then we program it into next year's uh work program, but we do not make a forecast for what that would be in future years. It's kind of like a bonus that we get one year at a time. Uh so I think that that may be an opportunity to address some of the capital funding gaps. Uh you know as we acrew that we could earmark that to capital funding projects. Um and then you know lastly my last recommendation is that is on the cost share issue and with go triangle you know we I we do want to make sure that we are we are able to contribute to go triangle's funding needs um and that it it is done in a coordinated fair way across the three counties. Um it is very difficult for Go Triangle I think to

coordinate this. um they try and we are supportive of those efforts to try to make sure that we're all on the same page. Um I hope that you know we can make more progress on that. Um you know we do have very different funding uh capacities in the three counties.

You know Wake County sales tax is like three and a half times as much on an annual basis as Durham. So, um, there are some areas where we may not be able to keep up with Wakes's pace of funding. Um, having a equitable kind of cost share may help us better coordinate things with our neighboring counties. Um, so that's in summary, you know, my recommendations there.

Um, be happy to answer any questions. >> Okay. Vice Chair along. >> Yes. Thank you all so much for this presentation. Um, I know that me and Wendy, we talked to Ellen and your team

a lot when it comes to NO stuff. I'm wondering because going back to the questions from Commissioner Valentine and Commissioner Burton earlier about the transit tax dollars and just being good stewards of that funding and what it's for. I'm wondering when we have theUS between Go Triangle, the city of Durham, are there ways that we can implement like stronger guard rails for like funding that the county may give of looking at because I know like with our projects, we like to be shovel ready and having these type of like steps put forward before we move money into things. And this is like all of our capital improvement projects, not just transit. and that if we have stronger guard rails in ourus with the city with Go Triangle to protect those county transit tax dollars that like we can't just move this money without projects actually being ready um or without projects

having any sort of plan for receiving or applying for federal funding uh applying for any other sources because this is not an unlimited pool of money. So, is that something that can be put into theus that we have? Are is it already existing in those? Just so it's not like a every time we're asked for it, we have to revisit this conversation.

Um, I don't think we have that really addressed very well and I think that's some of the issues here, right? Um, we do rely on our partners to know where they're at and to tell us where they're at and anticipate their schedule, you know. Um there's a lot of projects here too, right? It's hard to keep up and know everything about everyone's projects. So there's a lot of uh teamwork and kind of reliance on their information when we when we program this. Um I just like I don't have the answer for that, but I think it's something we

could certainly look at in the new um interlocal agreement and transit plan update. Go ahead. >> No, I was going to share the C um city manager and I have talked about um as well as Deputy Jones can also weigh in the a changed approach in how we are evaluating our efforts and um there's been a reset button that's been hit in a lot of ways due to sort of our current fiscal climate and um that has not been isolated. ated to these projects is across the gamut and I know some of our strategies have changed um because of how um our revenue streams have shifted and so it's harder to predict what's available and costs are rising at unprecedented levels um due to factors that we can't

control whether it is inflation and most recently tariffs and and when you're talking about these large capital projects, um a 10% or 20% shift into millions then becomes a a hard issue for those who have to figure out well how do you cover this gap and so long-term coordination and planning becomes even more essential. So I know um that's in the forefront of all parties and trying to figure out how do we do this different and coordinate seamlessly so that the community can move forward in those most pressing desired transportation goals while also being very tactical and addressing those um sort of shortterm areas as well. So, um I those conversations will happen and I I know that we can give more insight on

this um in future conversations. >> Thank you. >> Uh were you done vice chair? >> Yeah, that was my main thing.

I mean, I appreciate all the work that our Durham County transit team does. I know our projects, we have seen that they have been on time, on budget, and so I want to make sure that as folks come to us, as Commissioner Valentine said, calling us, emailing us, uh, to shift money around, that we are using our taxpayer dollars for the intended purpose that they voted on it for. >> Okay. Um, uh, Commissioner Jacobs.

Yeah. Um, well, thank you everyone. Um, really appreciate all the information. Um, I do want to give a special shout out to our Durham County uh, transit uh, staff for the great work that you do. Um, and I just want to say I really I

support um, what we've heard from our staff. Um I what I'm hearing and what I saw in the memo was really a need to um find you know to to do some of these studies before we move forward with some of these um additional even considering some of these requests um because what I heard is that we are needing to do a staffing study um to really understand you know like what are we paying for what are people doing. Um we also need to um do a bus operations study um to understand the costs around bus operations. And it was really concerning to to know that um we have requested the information about bus operations cost per hour um from both go triangle and the city of Durham, but we have not received that

information in three years from the city of Durham. Is that correct, Ellen? Um we are we will we need to work with them to confirm what their actual cost per hour has been for the last three years. >> Okay, it it is they've been getting reimbured based on the budgeted amount and there is supposed to be a reconciliation with the actual amount each year.

So >> okay, >> we need to we need to make sure that everyone's following the adopted policies on that. >> Yes. >> Yeah. So the point is we need to be receiving the information that we're requesting when we're providing this type of funding. Um also I think it's really critical um around the CIP capital improvement funding. Um, we really need to understand how has the city of Durham planned for the best their best operations and

maintenance facility uh, improvements and the paratransit um, maintenance facility improvements just like we the county have we have our own CIP and we plan and we budget. Um we I would like for our board to receive that information. Um how they have planned for these things because there is absolutely it's inappropriate to expect the Durham County transit plan to pay for these long range um when we can help um but we cannot be expected to pay for these things. And um you rate you also noted in your report that because the city went ahead went and um I think you said that they didn't fund follow federal requirements for site acquisition for the paratransit facility

that that now precludes the city from getting federal funding. Is that correct? Am I reading that? >> Yes.

Yeah, that is correct. >> Okay. So, again, this is a decision that was made that then affects us at the county level. And so this is a concern and we need to I think what we need to know moving forward and how we address it. Similar to what Vice Chair Alam said is I think we need to have a clear policy related to capital projects about what is going to be the transit plan cost share and then what is the plan to get federal and state you know or city funding related to that there there should be a plan around all all the sources of funding. Um so um and then the other you mentioned also in your memo considering a policy

related to the um investment income that we've learned about. Um and so I that would be really interesting. Um, I I support you looking at that and also bringing that back to us. And this could be a possible way to help with some of the um capital needs for these projects that are not way going way beyond what we have capacity for.

And so I appreciate you looking at a creative approach, but it needs a policy that's fair. Um and I I just want to say in general, you know, we came up with we did a governance study. We came up with this plan because of what happened with the light rail project and you know we said to the PE we said to our residents that we are going to be transparent. we're going to be good stewards of this money and that this

money is going to be used for expansion projects and to deliver you know actual you know going back to the goals to deliver projects for the people in our community. So to see that, you know, you showed aside that these are services that were approved in 2023. We haven't done them yet. So, um, you know, we we really need to be holding ourselves accountable.

And I think that it's going to take um to your point, county manager, us really getting together and maybe having some type of separate, you know, group that can work together to uh address these issues of how we can really coordinate and work together so that we can again deliver what we said we were going to do for the people in our community. >> All right. Thank you. We have about five

minutes left on this. I know Commissioner Valentine, you wanted to speak >> and chair, I just have one question. >> Okay. >> Thank you so much.

Uh thank you to the transit team for your continued work. I know it's hard work and go triangle. Um, but my question is during the the brief of um maybe I should have asked it during the time uh time that you were actually briefing it, but you talked about the bus rapid transit project development and the city wanting early approvement early approval, excuse me, of the 4 million in the plan funding. First, is that something that's, you know, um common? And second, for what purpose are they asking for the um the early approval? Um I they did ask uh so I guess uh when we first added this to our our CIP um we added it in two years 6 million in 26

and then an additional 4 million planned for 27. Um, so I know they are moving forward with a contract with a consultant to initiate project development for that 6 million um, in 20 that's already in this year's work program. Um, I don't believe it's been uh, approved yet. I think it's still underway.

So um, they really haven't spent much of any of that $6 million. Um so the four million is in anticipation of completing that project development contract and then the next phase to do final design. Um I don't I have not seen you know the latest schedule on how long it will take to do the project development but um I think that they have acknowledged that it takes a while to spend $6 million and it probably won't be next year. Um but but they did ask for approval of the four million uh that was previously programmed. Um it is

very likely not going to be used though next year. It'll probably be one of those carryover projects this time next year. >> And and so is that common >> in this process? Yes, it is common that folks are asking us to approve funding ahead of when it's needed.

Um I I guess if it's necessary I'm not sure. >> I always have a concern that you know money is being used for its intended purpose. And so when I see things like that my mind wonders you know why are they asking >> in that particular way and so that raises a red flag for me. Thank you. I mean we could uh so the in the work program you know there's sheets for every project that says what is it is intended to be used for you know and we that is the I guess documentation of what it should be used for and then when

submissions are made for reimbursements uh they should be checked and make sure that it is in compliance with what is written on those exhibits. I agree with that, but it will be months, years down the line before uh we we actually know. So, just a red flag for me. Thank you.

>> Okay. And then the I did have one question. So, we're getting quite a few emails about the uh fair free um Durham Go Durham um buses. Where does this land in the uh plan?

>> Um so early in this work program process um additional funding to uh cover cost of fair free service was requested by the city. Um you know back in January we had that list of all the things that had been requested and that was on that list. uh when we asked for

uh priorities for the draft, uh the city identified the maintenance facilities as their priorities. Um so that's why we didn't talk about that at all today because it was in response to what the city told us they wanted us to focus on for the draft work program. >> Um >> so what does that mean to that program? Does that mean we're just not we're not focusing on that for this particular >> um >> work plan?

>> So there's there's a I do want to make sure it's known that we do support I guess uh the city's operating cost um in the work program already. Um really in three ways. First of all is all of the cost of the expansion services. You know we fund those 100% of the cost.

uh we don't deduct any expected fair revenue. So you you could say that we are sponsoring fair free on all of those expansion services first of all. Um and then second of all um there

is a project in the work program that's been in there since the original transit plan called increased cost of existing services. And that's where uh the city receives half of the $7 fee each year to just cover increased operating cost. Um, I actually found in cleaning out my garage the other day. I found my 2005 Go Durham um, map and the city's had to dollar fairs since 2005, probably earlier.

Um, so the city's, you know, used a lot of this um, operating funding to help keep fairs low. you know, historically for years it's been a city policy decision to keep fairs very low. So we we also fund um so just to say you know we're supporting fair free by funding that increased cost of existing service amount. It's about 900,000 a year I believe. And then um

thirdly, there was a project approved uh two years ago called the uh dime program and that is funded at about 392,000. Um and so that was designated to help also supplement the cost of fair free. >> Okay. >> So so there is funding you know for fair free there's no new new funding, right?

But there's all of those those three existing funding sources are still going to help supplement the city's bus operating costs. >> Okay. So, what I'm hearing is we're we're con the status quo again. We're still supporting it in the way we have.

It's just no new funding. >> Yeah. >> Okay. >> And and I the 23 plan did not fund fair free at that time. um all the systems were fair free and they they were still determining whether or not to stay fair free or not. Um

so the transit plan acknowledged that that was the case but did not have a a line item saying we would be funding fair free >> and for what I from what I understand we're the only system that still does that. Correct. >> Um well go Carry is fair free. They went fairree during COVID and have stayed fair free.

Um, and Chapel Hill Transit has been fair free for a long time. Um, they receive a lot of funding from UNCC. They kind of have a merged town and university system and uh that helps I know. >> Okay.

Thank you very much. Oh, we're going to move on. All right. So, thank you for this presentation.

Appreciate all your work. Super important. and we look forward to the continued updates as um we uh as your timeline suggested there. Thank you all very much. The next item on our agenda is an overview of No, no, I think we're I think it's the other

one, right? Oh, yeah. Yeah. Yeah.

It is the Women NC. Uh CE D A W. I'm not sure if you say that word out or not, but said all resolution and student research presentation. Uh we are four minutes uh behind, but we're okay.

Please take your time. Welcome. Wow, look at these pictures. Wow, a nice intro slide there.

All right. Thank you so much. And I'll turn it over. Or did you wanna Okay.

>> Thank you. My name is Beth Dean. I'm the founder and president of Women NC. Women for North Carolina is a nonprofit

statewide organization and we have been working with the local universities and the resident of North Carolina including Durham. We have been partnered with the Dorham based uh universities such as Duke University and NC Central and we have had several students from these universities who have attended our leadership training program. Our mission is to engage young people to become advocates for women's human rights and for social justice. And for the past 16 years, we have trained more than 350 undergraduate students to become advocates locally, nationally and globally. Today, thank you very much for the opportunity. Uh I would like just to give you some

background uh between our women and his relationships and Durham County Commission Commissioners in 2017 when Commissioner Jacob was here. Um we were able to pass a resolution to support women's human rights and to address the areas of concern uh of women in Dorham. Although we praise the progress and the current status comparing with other counties, Dorham has been a very advanced county. But uh in 2017 we passed this resolution called CEDA. CIDA is an international treaty that stands for convention for the eliminations of all forms of discrimination against women and uh it is it has become like a nationwide

campaign that many cities and counties has decided to apply the principles of this international treaty United Nations international treaty. to the local level. So far, I'm happy to report to you that more than 70 cities and counties across the country have joined this campaign and they are working on the grassroot level to pass ordinance or see or resolution uh to address the issues that women are facing locally at the city, county and state level. So I'm going to give most of the time to our student today. We have three students that they are going to discuss their research. Women and C's program involved in engaging uh university student to conduct

research on status of women in different community of North Carolina and most of the time our student have been interested in Durham. If you look at women's website, you see several several researches about status of women in Dorham in regard of health, housing, uh daycarees, wage gap, violence against women and all that. And these are not just the research. These are our student also have the recommendation for policy recommendation that how we can improve the situation as you will see in their presentation today and um we have done this before uh when we pass CAD our student presented here and then the all the county commissioners agreed to pass this resolution. I would like to stop here to give the more time to our

students, but I have a project that I like to discuss it in another time that how this women's effort and Dorham County Commissioner collaboration can benefit women and girls in Dorham better. But at this point, I let our student to introduce themselves and to present their research. Good. Hi everyone.

Um, my name is Noel Smith. I'm a senior psychology major at North Carolina Central University. And today my research is on the unmasking strength, the strong black women archetype on health, coping, and wellness in black women in United States Southern Communities. Um, my motivation for this project is deeply personal. As a black woman navigating the world, there are moments when it feels like I'm carrying an invisible weight while still being expected to show up, perform, and lead without hesitation. That experience is

not just isolated to me. I've noticed a generational pattern of the strong black women archetype within my own family, among women I admire, and in many of my mentors. Strength is modeled, endurance is praised, and self-sacrifice is normalized. And it made me begin to question, how often are black women showing up for everyone else while quietly ignoring their own needs?

And how often is resilience mistaken for invulnerability? This project is grounded in one powerful truth. Just because you carry it well does not mean it isn't heavy. That statement is not just a phrase.

It is the foundation of this work. " Simply put, oh, sorry. I'm sorry. If you have to advance your slides, there's a clicker right there.

>> Oh, okay. There we go. Okay, there we go. Sorry, everyone. Okay, you may be asking, what is the strong

black women archetype? Simply put, it is a culturally embedded expectation that black women must always be strong, self-reliant, and resilient even in the face of chronic stress and structural adversity. That expectation is not small. It is not neutral.

It is powerful. It shapes how black women are perceived. It shapes how black women see themselves. And it shapes how they move throughout the world.

This archetype did not appear out of nowhere. Its historical roots have directly shaped the societal expectations placed on black women today. Expectations that can profoundly impact both physical health and emotional well-being. So, how did this archetype evolve?

Cultural reinforcement happens everywhere within our families, within communities, media representations, workplaces, and even the institutions black women navigate daily. Over time, strength stops becoming a choice and becomes an obligation. We also must discuss medical

mistrust. Medical mistrust is not irrational. It stems from a long history of medical racism and exploitation inflicted on black communities. This history is significant.

This history is a significant reason why many black women delay engagement with health care systems in the United States, often to their own detriment. And historically, the strong black women archetype is deeply connected to harmful stereotypes born during the antibbellum south and the Jim Crow era. These include the mammy, which is the self-sacrificing caregiver, the Jezebel, the hypersexualized woman, and the sapphire, now the angry black woman. These stereotypes were never just narratives.

They were tools of control. and their legacy continues to influence how black women are treated, understood, and expected to perform strength today. When we turn to the literature and the data, the patterns are undeniable. Black

women experience some of the highest health disparities in the United States in comparison to white women and women in many states in and in women in many cases. One of the most alarming examples of is maternal health. Black women have the highest rates of maternal and pregnancy related mortality per 100,000 live births in this country. When we look at mental health research, we see another important pattern.

Qualitative studies show that women who strongly endorse the strong black women archetype fully internalize the expectation of constant strength and are more likely to adopt maladaptive coping strategies. And that is where this archetype shifts from being protective to potentially harmful. Based on the data, the historical context, and the lived experiences I've discussed, I propose three levels of policy intervention. national, regional, and local.

A national recommendation is to implement a respectful maternity care framework that promotes dignity, informed consent, and biasaware care. This should include a mandatory bias awareness training for all health care professionals to reduce medical mistrust and maternal health disparities impacting black women. for a regional me recommendation is to expand Medicaid coverage for doula services across southern communities. Doulas provide continuous emotional,formational, and advocacybased support during pregnancy, child birth, and postpartum.

States like California and Colorado have shown improved birth outcomes through this model. And for a local recommendation is to offer health screenings in community spaces such as campuses, faith institutions, workplaces, and black women focused spaces. Pair these screenings with interactive stress reduction and mental health education to create safe,

responsive environments that support both physical and emotional well-being for black women. Thank you all for listening to me today. I'll be passing it over to Caroline who will present her research on the smile gap. Hello.

Okay. All right. Okay. Uh, good morning.

My name is Caroline J and I'm a senior at Duke University studying sociology and chemistry on the predental track. Um so I'm a woman NC scholar and during the session I want to talk about why um maternal health equity um is being compromised through a lens that we almost always overlook in public policy which is the mouth. Um I call this crisis the smile gap. My research

focuses on a very specific local case study, how Medicaid insufficiency hurts oral health for pregnant women and single mothers in the state of North Carolina. Um, examining these local mechanisms helps us understand the complex on the ground realities that trap our most vulnerable residents. Um, today I want to outline why this is not just a clinical deficiency, but a profound crisis of economic mobility and human dignity. You may be wondering why teeth.

Academically, as a predental student studying sociology and chemistry, this issue sits perfectly at the intersection of biological healing and social equity. But my real motivation is deeply personal. In the sixth grade, I suffered second and third degree burns across my face, neck, and arms. And returning to school um taught me exactly what it's like to navigate the world when something is visibly wrong with your face. Um, I experienced firsthand how a physical difference dictates your actual opportunities. Um, in our society, a

smile is a very powerful social marker. For single mothers living in poverty who are over represented in customer-f facing low-wage jobs, a smile is often a prerequisite just to get hired. Visible dental decay signals marginalization instantly. And studies confirm that women with visible dental disease are judged as less professional and less trustworthy.

Losing her smile becomes an economic trap that actively prevents her ability to get a job and engage in public society. We're talking about whether or not a woman is allowed to exist, work, and participate fully in public life. The barriers, however, extend far beyond social perception. They are deeply biological. Pregnancy is a massive physiological stress test and rising hormone levels make women highly susceptible to pregnancy gingivitis or gum disease which affects 60 to 75% of pregnant women globally. Left untreated,

it triggers systemic inflammation that can mimic the biological signs of labor which leads to severe complications including preeacclampsia, pre-birth and or pre-term birth and low birth weight. Furthermore, this broken system causes disproportionate harm to minority women of already vulnerable populations. In our state, Medicaid finances half of all resident births. when uh of those Medicaid financed births, 67% are to unmarried mothers.

When we look closer, we see that the these births are heavily concentrated among black and Latino mothers. Because the medical risks are so severe, pregnant women in North Carolina are 100% eligible for the Medicaid for pregnant women program. 5%. 5% receive it.

If the coverage exists, why is utilization so low? The state pays private health plans a flat fee to manage all of a woman's general health care, her OB/GYN visits, her blood work, her hospital delivery. But dental care is carved out and is completely excluded from this managed care package. This severs the mouth from the body.

Because of this, mothers are forced to navigate what I call a ghost network or providers that exist to her on paper but not in practice. Um overhead paying for uh building leases, equipment, and staff salaries is approximately 60 to 70% of gross revenue. Yet, North Carolina Medicaid reimbures only about 34 cents on the dollar. Dentists literally lose money on every single Medicaid patient they treat. Even here in Durham, a globally recognized city of medicine, a single mother working hourly shifts without paid leave faces insurmountable logistical barriers to finding a participating doctor.

To close the smile gap, we need actionable systemic shifts. Um, so here are my policy recommendations. First, we must modernize reimbursement. We must advocate at the state level to raise the reimbursement floor to a sustainable rate, bringing it closer to 46 or 50% of usual usual charges.

Second, we must integrate warm handoffs. An OB/GYN might see signs of systemic inflammation, but has no built-in network to seamlessly refer her to a dentist. A pregnant woman should not be handed a confusing list of phone numbers. Her prenatal clinic should directly schedule the dental appointment for her on the spot.

Third, we must invest in logistics. While uh the Durham County Department of Public Health provides a vital safety net in their dental clinic, they cannot bear the entire county's burden. Uh we must fund patient navigator roles, community health workers who can specifically assist single mothers in arranging complex scheduling and finding child

care. We have an unprecedented opportunity right now. The recent 12-month postpartum Medicaid expansion is a critical window of opportunity and we now have a full year to intervene um in a pregnant woman's oral health. Our goal is clear.

We must transform this Medicaid card from a useless piece of plastic into a functioning passport for oral health. Thank you. Um and now I'm going to pass it off to Shelina who's going to talk about um resource access for Latinx survivors of intimate partner violence. >> Thank you, Caroline.

Hello everyone and good morning. My name is Shelina Morgan Lopez and I am a women NC scholar and senior political science major at NC State. My research project surrounds access to resources for Latinx survivors of intimate partner violence in North Carolina. The counties I focused on were Meckllinburgg, Durham, and Dupin counties, which all have

notable Latinx populations, but different rural and urban contexts. Durham's Latinx population is about 17%. So, why did I choose to explore this topic? I come from an Afro Latino family and I myself have seen the impacts of IPV on generations of women in my family.

I've worked for various nonprofits that engage in sexual assault prevention strategies and I've served in Title 9 rules on and off of NC State's campus. As you're probably already aware, Title 9 are protections that prohibit discrimination on the basis of sex in educational spaces that receive federal funding. I wanted to look at a population that has been relatively underststudied. In putting my literature review together, I found that it was not easy finding recent North Carolina specific data related to IPV and Latinx women. I also felt that this project was incredibly timely considering recent immigration laws and ICE presence across our state and nation and right here in Durham.

Okay. So, what's the issue? The CDC defines IPV as physical violence, sexual violence, stalking, or psychological harm by a current or former Sparter partner or spouse. National data shows that Latinx women are disproportionately impacted by IPV, but often do not report it.

I wanted to explore whether or not these trends are reflected here in our state, if there are rural and urban differences, and more specifically, what causes these differences. My project consisted of both of a literature review of existing data and of interviews with mental health practitioners, lawyers, domestic violence crisis responders, and other organizational staff across the three counties that I looked at. So, various concerns came to light, but four main themes stood out. Firstly, there just aren't enough bilingual service providers to help Latinx survivors. Second, people are scared of ICE and are not leaving their homes to seek IPV services.

Third, survivors are facing economic and transportation barriers. Many survivors are also mothers and are or are in situations where their partner is the breadwinner. One provider even described to me how in some cases either the survivor's partner is documented while the survivor is undocumented, or they're both undocumented and their survivor fears the deportation of their partner. And finally, cultural stigma and norms may contribute to survivors staying silent.

You may have heard the term machismo, which describes the toxic masculinity in Latinx communities. But Marianismo and familismo are concepts applied to women. These concepts encourage them to remain pure, docile, and virginal while also placing the family above all else. I think it's also important to note that in this political climate, it's not just survivors that are fearful. Some providers themselves are fearful for their safety, and some refused to meet with me or did not allow me to record our meetings.

Here are the policy recommendations I've developed as a direct response to these interview findings. Firstly, as I discussed before, we need more culturally and linguistically responsive services as many survivors face language barriers and many organizations expressed not having adequate bilingual staff. I also noticed that many organizations do not have a Spanish hotline or a translation feature on their websites, which may deter survivors from seeking those services. Secondly, we need to ensure that protections are in place that allow survivors, especially undocumented survivors, to seek services without fear of ICE or deportation. Finally, we need to stabilize funding for legal and mental health services, especially considering organizations have been hit hard by federal funding cuts. Surviving IPV itself is already traumatic enough and it's important that we ensure that survivors feel comfortable seeking help and that they aren't ret-raumatized by the helpseeking process and that they're supported when

they're pursuing healing, justice, and care. Thank you so much. >> Thank you all. >> May I add something?

Thank you very much uh to our scholars. But I would like to add this that uh the name of Dorham County and Dorham cities who have passed CEDA in 2017 and 2018 has been taken to the national level. you are listed in the cities for seda campaign at the national level and at the United Nation. Doram is like a sort of women's human rights county. So I wanted just to bring this to your attention and I am looking forward to take the next step to with this all these great uh policy recommendation to see how we can collaborate for implementation of these

policies. Thank you. If you have any questions our student the research papers are listed posted in our website in details. They just had a just a very short version today and they also presented at the United Nation.

We came back two weeks ago. They presented the research at the commission on the status of women in New York and it was well received by the global audience. Thank you. If you have any question please.

>> Okay. I'm gonna start with Commissioner Burton. Oh, Vice Chair alone. >> Wow.

just well first of all the these presentations are absolutely amazing and I it's just very clear how much effort and time y'all put into this but also just how knowledgeable y'all are. I don't know if in college I was working on projects this complex. Um want to thank you so much Beth for your leadership and mentorship of uh young

women across North Carolina. I actually met Beth back in 2017 when we passed the first CEDA when I was chair of the Durham Mayor's Council for Women. Um, and so in awe of your work since then, but Noel, Chelina, and Caroline really so impressive and like I've learned so much from all of y'all's presentations and I think it's really important. I would want us to see like if there's ways that I'm not sure I'm sure you've already reached out to the city if the city is receiving these presentations as well.

Um but also I am glad um director Jenkins our public health director is here. Um I would like us to make sure that he has a copy of this cuz I'm going to share especially the dental piece the Medicaid benefits one. We have been working on a benefits access program um that former mayor Steve Schul uh initiated of how do we make sure that residents are utilizing

all of the benefits programs that exist that are out there that I think the study shows there's like $800 million worth of benefits programs that are funded that res people are not using like across the country. Um and so the fact that these programs exist, how do we remove those barriers that exist for people to just whether it's child care, whether it's knowledge that these programs exist, language barriers. Uh I think this will be a really impactful piece for them because I mean as a mother of two, I remember when my second kid, I ended up having five cavities and I never realized how pregnancy impacts your teeth. I remember one of my nurses actually said they're leeches in a loving way, but the the way that they actually just strain all of a mother's nutrients and how it impacts your bodies in ways that you don't anticipate. Um, and also when you have cavities that go untreated, how many ways that can impact your heart uh and other parts of your

body that you just wouldn't see connected. Um, I would just love I'm glad that we have these presentations. I would love to stay in contact with y'all to see how we can work with uh different nonprofits in the Durham community that are working on black maternal health, on domestic violence, uh especially with the Latino community and dental relief to see how we can integrate this research and work that you all have done um to start building because there are a lot of nonprofits and organizations doing some of this work, but this will kind of give a foundation to helping them come together and collaborate more stronger. ly to see how we need to fill these gaps.

So, just grateful for y'all's work and not really any questions, just in awe of the research y'all done. And be on the lookout for emails from me. >> Thank you. >> All right.

They have their LinkedIn >> things on there. Just so you know, there's a couple of them that don't work because I was trying to connect with you all. I couldn't find the well on

LinkedIn. So, okay. Yeah. I'd like that as well.

Commissioner Burton. Yes. Um, thanks, Chair Lee. And I just I don't have any questions per se.

I just have a comment. Uh, like um, Vice Chair Lama, I was very impressed with your presentations. And one of the things that with Noel with your presentation about black women, um, it really spoke to me because as I'm a black woman and many times we are seen as being strong and resilient and we can handle anything and then we so I guess it's the mammy type that you said the arch type. So have that arch type.

But then if we put a boundary or we speak up for ourselves or we say, "Okay, we're not going to tolerate something," we become the sapphire, angry, mad, not friendly, all of those things. So I've experienced those things. So I'm really

glad and how it affects our health as black women's health. Um, so I really am glad that you put that out there. And then it shows up in maternal health because you're carrying so much and how can we give people women, black women, women of color support. Um, so I really appreciate you putting that in the space and then also about the dental health.

Um, I just want to uplift that because I taught in elementary school for many, many years and the number of children that came to school with cavities, teeth pain, things of that nature and so many dentists who do not see um people, children, adults, what have you if they have Medicaid. And I think it's a travesty that it's not fully covered in Medicaid because it is a part of the entire body. And I had read a book many years ago that talked about the same thing you discuss around the um how

people are seen as not f not friendly but um you know lazy or not as intelligent or things like that. we get this um stigma around your teeth not being good and we really need to focus more on that. And also going back to the um Latinx women, I met with um the executive director of El Centro Hispano and when I first got um sworn in talking about how that is a problem with abuse and um women, Latinx women not speaking up. So, this was excellent.

I appreciate you coming to us to speak about this and about, you know, if we can do something as a Durham County government um to help with this and um I'm looking forward to staying in contact with all of you. So, thank you so so much. >> Uh Commissioner Valentine, then I'm going to go to Commissioner Jacobs. >> Yes.

Thank you, Chair. Uh ladies, thank you so much for coming here today. Uh it

takes uh a level of courage um to do the work that you're engaged in. Um here in the 21st century uh it's almost a tragedy uh that your advocacy is even needed because the fact of the matter is is that all of our origins begin with a woman. Whether you're a man or a woman, your origins begin with a woman. Um this isn't quite like appearing before the United Nations.

uh but quite frankly when you you present as though you're presenting to the world and so continue uh in this space and to the extent that the county uh can advance the cause uh I'm sure that my colleagues and I uh will work hand in glove along with you in this effort. Thank you >> Commissioner Jacobs. >> Well, first of all, it's great to see you again, Beth. Um, so it's hard to believe it's been almost 10 years that the county um approved this resolution and participating in this program and

frankly it has been quite a while. Um, Beth shared with me that she took a she retired for five years and then has recently come back to lead this work and as we can see how important this work is. So, thank you uh to our three scholars uh for your outstanding work and how important it is to um the marriage between this scholarship and impacting policy. Um and so the work that you've done is is really important and very powerful and we want to make sure that it does have the policy impact at the end of the day. Um, and I would, so one of my questions is, um, Beth, how are you all working with the Durham Women's Commission? Because I think when I think about how can we how can we integrate your recommendations and your work into Durham County policy and programs,

services. So, one is with the Durham Women's Commission, who we frankly, unfortunately, have not been very connected to. um uh we have in the past but not so much in the last few years and I'm just wondering have you all brought this to the women's commission and just wanted to hear what you had to say about that. >> Sure. uh as a matter of fact the model for cities for CIDA that women has been following is through body of women commissions and then then the local government that's why you know even at the city city level at the city level in Doram we tried two years for create this Dorham mayors women council you know like in 2015. So this is the model that we follow and we have been working with Dorham County Dorham women Dorham County

women commission for years and this year uh one of our mentors we call it fetors uh Noel FTOS is the chair of the Dorham County Women Commission Tiffany and they they they were really planning to be here today but because they are working uh members they were not able to make it but yes we are in a close contact with Doran women commission and as I mentioned this is the model that we follow to have a stronger voice it is better it is better uh to just go through the advisory women advisory board you know at the local level yes and and I think the I I remember that the the doran Government Commission used to provide like annual report and I think now this co you know

put a pause on everything but I think we can resume that and with the resources that our students are providing maybe they can pull together a report for you and then policy recommendations >> that would be great because we we did used to get an annual report really kind of like the state of women in Durham um and certain just looking at certain data points and and we honestly haven't had that and maybe you all your work can can help um spark that again. So I appreciate that um that you are already collaborating with them and that would be great. And so related um Noel to your presentation um and I know Rod Rod you're here right? Oh no was Oh, there you are.

Um, you know, we it would be great for us to get an update. Durham County Public Health, we have a whole initiative around um maternal health. And so I would I don't

know if you've seen these report the report yet, but we'll if we can make sure that Rod gets Noel's report um to get really an update on this. And then the other I just wanted to share with you our two state senators um Senator Murdoch and Senator Chitlook. This is one of their big priorities and I would suggest you um reaching out or if you want an introduction any of us um can help with that connecting to you to them because they some of the things you recommended do require work at the state level uh policywise. Um, and then I also was wondering, Rod, if you and I can help with this as well, because I'm on our Lincoln Community Health Center board, but because our a lot of our services around Black Maternal Health are through Lincoln Community Health Center and public health, so making sure

that Lincoln gets your information as well. Um and then uh Caroline um uh also the connectedness between your two reports and yes I had I had numerous root canals and also two implants when I was pregnant in my three pregnancies. So, yes. Um, but we I I'm curious also, Rod, if we could get an update on what what are Durham County's numbers related to the data that Caroline um shared about the number of pregnant women that are making use of the um Medicaid benefit around dental services and kind of what what do we offer because also Durham Tech has a mobile clinic and just just wondering how are we addressing some of those barriers? And then Chelina um your report I just while

you were speaking I looked up our Durham crisis response center and also our family justice center. We we have a family justice center supposed to serve people who are victims of domestic violence and there's nothing in Spanish on either of those websites. So that that is something I will follow up with the director about. Um, and then I just also want to acknowledge our sheriff who's here. Um because you know thanks to our sheriff who has been very strong in his support for everyone in our community and recently um presented at the Senate Judiciary Panel and spoke very strongly about how ICE activities threatens community safety and specifically I think Sheriff you referred to things like domestic violence Um, so I would hope that in Durham maybe

things are a little better knowing that we have a share, we have law enforcement that is supportive. Um, but the data about one and three Latinas being victims of domestic vi or inter partner violence is un it's really devastating. So um and of course we have El Centu and Alfurro here but um it's a reminder that we we can and we must do better. So thank you.

>> All right. And I'll say you know this uh these presentations were wonderful. I have a a freshman in college and I hope by the time he is, you know, in his later years in college that he can give some coherent type of presentation. I wouldn't even expect him to be at that level. But the way you all have performed is has been

really wonderful. I really look forward and that's why I was looking up you all on LinkedIn because I'm hoping to um keep up with you all and and look at your research and so forth. I'm really really interested in research. Um um I've be become that since since getting my doctorate.

So I'm obviously deeply interested in the data that you all are finding and the um and the u writing that you all eventually do. Um I did have a question uh for Noel. You mentioned kind of towards the end of your presentation you know of the what your recommendations were and it was really about the training for the professionals you know in relation to black women for medical professionals and I think that's that's beneficial. Have you thought about uh how that works on the other side as well? So trust um trust with medical in my opinion now I'm not a black woman right but I obviously

but I um I've seen this in my wife as well you know that that mistrust and I'm curious how the um how the trust is addressed so if we do the training for professionals how do we get you know individuals to trust more on that side Is it is it training as well? Have you thought about that side or how do we address that to try to rebuild the trust as we go into the professionals? >> Um, I think specifically I not training really. I think like the educational programming um and just kind of making black women more aware of what's kind of going on and what's behind the scenes. Um, and then I think when I talk about the training for medical professionals, it's more so like it should be implemented within their curriculum um, when they go throughout um, med school and stuff like that. But specifically

just I think the educational programming for black women to become more aware of what they're experiencing on a daily and then how it's affecting their health and then who are the people that you can go see. So kind of researching who are the clinicians that um we recommend and I think black women a lot of the time we find soulless in people that look like us. So kind of something like that as well is what I'm looking at. >> That's that's excellent.

Thank you so much. I really appreciate that. Now, I know that two of you all go to school here in Durham and one in that other city down there, but I hope that after school we can have you here continuing your research. Durham is a perfect place for you all to be um to continue your research.

I do appreciate this. This is absolutely wonderful. Thank you all for everything that you're doing and everything that you will do um for your perspective topics. Okay. Thank you so very much. Thank you.

>> Eagle Pride. >> I'm in the middle of a job search, too. Looking for policy and public health jobs. Just thought I should should put that out there.

>> Put it out there. Put it out there. This is the place. That's right.

Somebody get her information. All right. Thank you all. Um, looks like the last item, yeah, the last item on our agenda today is an overview of medical services and and detainee health in the Durham County detention facility.

We've allotted 60 minutes for this. Um, so welcome, welcome, >> chair. How we how we doing on time? All right, chair.

How we doing on time? >> We're doing We're doing pretty good on time. We are We're still about five minutes behind. >> That's okay.

Thank you. Thank you. Good morning, commissioners. >> Welcome, >> Chair.

County manager. Um, Sheriff Burkehead here. We appreciate this opportunity to present to you this morning. Uh, this presentation was born out of some questions that you all uh asked us at the March meeting uh as well as the March work session.

And so we said we'd be able to prepare a presentation and have that data for you uh at today's work session. So I have several individuals with me here today. I will start with our guest uh well path and allow them to introduce themselves. Emily >> director sorry I'm Emily we I'm Emily Wilson. I'm the regional vice president of operations for Wellpath. So I oversee

um the South Central area. This is Dr. Dr. Delica Reynolds Barnes.

She is our chief pharmacy officer. And then I also have Dr. Go ahead. You can >> Dr.

Durge Taranth. Uh I'm the chief medical officer of WAT. >> And my staff, Chief Ellerby, Detention Services, >> and Kesha Lovely, uh in-house counsel at the sheriff's office. >> All right.

Hopefully, we have lots of good information for you here today. Uh, as I said a moment ago, this was born out of questions and conversations that we had at our last meeting and some follow-up discussions since then. Uh, so I will dispense with a preamble and I will turn it over to Emily and her team. Uh, and then we'll we also have uh the director of justice services and Dr. Jenkins, director of public health, who are obviously intimately involved in what takes place at the detention center as it relates to uh medical care and

mental health services. So, they too are available to answer any questions that you all may have. So, with that, we will start. Kisha, Miss Love Lace, >> good morning.

Um we're just going to give a quick overview of medical services in the detention facility and then hand it over to Wellpath to um go over the data. Um really dates back to the late 1990s when the current foundation for what we have in the jail um was implemented. In 2000, um, public health contracted, prior to 2000 rather, the county provided all services in the jail, medical and mental health. In 2000, we contracted uh with correctional care solutions for medical services. In around, I believe 2015 is when Wellpath acquired Correctional Care Solutions. So, Wellpath um through is partner or the company they acquire correctional care solutions has been in our facility

for the past 25 26 years. We are NCCHC and ACA accredited. That's the National Commission on Correctional Health Care as well as the American Correctional Association, both of which have numerous standards dealing with medical care um in uh correctional settings. Um and it and we also have our Kalia accreditation which focuses more on law enforcement.

But those three combined um make us a triple crown accredited facility. Less than 1% of the sheriff's offices in the nation have that. It's only I believe 79 out of 5,000. So we're one of three in North Carolina.

And that really sets the standard and level of care that we have in the facility 247 um 24 days a week, seven uh 24 hours, seven days a week. Comprehensive medical, dental, and optometry services in the facility. Um as well as in the

youth home as well. And Wellpath is also provides our pharmacy services. Even though once you see mental health is still provided by the county those prescriptions are filled through well paths um pharmacy division that's what I will say and also for our MAT programming mental health began in our jail in 1998 um through our justice services division um also 247 services they provide the mental health clinic counseling the star program and we employ here in the county county county employees who are the program managers as well as certified counselors who provide those services. JSD has a contract with Dr.

Canal who runs our mental health clinic as well as a contract with recovery innovations for after hours telly health. They receive referrals from the intake screening that Wellpath does as well as detainine sick call requests. Our detention officers when they notice something can also make referrals there and they also JSD

provides services in the youth home. most recent addition to medical services in the jail um is our MAT program which started in September of 2019 that is housed within the sheriff's office. We have a program manager as well as um uh peer support. Our peer support person is here, Miss Caldwell is with us this morning.

We are supported by Wellpath. They provide the dosing clinic and those who al um also are suffering from kind of mental health issues JSD comes in provides that counseling services. With that I am going to turn it over to Emily. >> Thank you.

So first um I wanted to introduce oursel and our company. We've never had the opportunity to come speak in front of the county commission. So thank you for having us. We're we're thrilled to be here and um look forward to your questions.

Uh Wellpath is first and foremost a clinical care company. Patient care is our 100% of our focus. The way we feel like we provide that best is through stability. So when we

have a stable team and stable ta staff and we have significant longevity in our leadership at the site, um we're really able to deliver higher quality care. um further relationships. So, our relationships with the health department, our relationships with custody is extremely valuable. We cannot be successful without um kind of a symbiotic relationship with custody.

Uh and the sheriff and his team have been amazing partners in that regard. And then trust, of course, that's part of the reason we're here. We want to be transparent. We want to be open and make sure that you all have the information that you need.

Um so those are kind of our four core um philosophies. Um and I will hand it over to Dr. Terren to kind of talk through the clinical highle overview of our healthcare delivery process. >> Thanks Emily. Um, so when we look at the care that we're providing, uh, what I'd like to do is kind of give you, uh, an

idea of what the process looks like from when an individual is, uh, taken in on intake and booked through the entire process, um, by the time we they're released. Um, so for the, you know, Yep. Okay. So, um, when an individual is booked, the first thing that we need to do is get a an assessment of, uh, number one, who they are, what their medical conditions are, and, uh, what needs that they're going to have while they're under our care.

And so, uh, first and foremost, their acute medical needs. So, a lot of times they're coming in with certain injuries or certain acute problems. We want to make sure that's properly addressed in a timely manner. They also are going to have a lot of uh chronic conditions. A lot of times we will try to get release of information uh either from any uh providers that they work with in the community or through a health information exchange where we can try to access their medical records and

determine what their chronic conditions are. Um that will include any psychiatric conditions, any somatic medical conditions, any dental conditions. Um once that has been determined, the next step at intake is to make sure everything is stabilized. Uh any issues that are acute are treated immediately and then we get them set up for chronic care visits.

Um the other thing that oftentimes happens as you know uh when people are booked is that there's a number of people going through withdrawal um or having recently uh uh been under the influence of alcohol or any type of uh substance. We need to make sure that we address those immediately because those are the are some of our highest risk patients because uh that the the manifestations of that will come on very quickly. Um once we have them stable, once um we've identified that we uh they're they're going to be in our in custody for a

period of time, we then the next step is to make sure we get an init initial history and physical um within 14 days. And then if they have any chronic care conditions within the first 30 days, we will get that chronic care uh visit set up where we will do labs. We will do um make sure they don't uh if they need to see any specialists or any kind of specialty care, we will get them set up for that. Um and then that gets followed up every 90 days for those conditions where we assess uh how they're progressing and and the goal is to make sure that we are making changes with every visit so that their chronic conditions are improving over time. Um and then through the course of their stay as acute conditions may come up we address those uh very timely because the acute conditions are often times uh the the issues that end up getting them sent to the emergency room or possibly admitted and those are uh we have mechanisms in place to uh try to deal with the emergency room. Uh and I'll go

over that a little bit later in our presentation. And then finally just before uh well starting from the moment they are booked we are starting to plan what it's what their discharge is going to be like when they are released. So we are we have a network of community providers and we would we try to make sure that we keep connected with them so that once they are released we send them home with a short supply of their medications and then also appointments so that way once they leave they are set up for success. uh though you know recidivism can be high and if if that is not taken care of.

So that's the that's the uh the path that our uh patients take as they once they're uh booked through their release >> and I'll go through so for all of that to happen for a patient there's a significant amount of manpower that kind of comes with that. So I wanted to kind of go over uh we call it a matrix but our staffing plan for the Durham facility. These are customized for

Durham County. Um, I'm not going to go through every single position. However, I do have a highle overview in our appendex if you would like to see what all these positions do. Um, but in general, we at each week we have over a thousand hours of nursing.

We have over a 100 provider hours, over 200 mental health hours, which are again not provided by Wellpath, they're provided by the county health department. And then um we have 200 administrative hours. Um and the list goes on. There's a there's a lot of work that goes into seeing these patients.

And no one patient comes in with just one condition. Typically, we see patients enter the facility and they've got untreated diabetes or untreated HIV. They have they are often detoxing and need to be put on a sew protocol um and need immediate assistance. Um, often they'll have all of those things and be dealing with a schizophrenic episode of some kind, which is um, something that we

would want to intervene in as soon as possible. Um, so it's extremely complex and like I said, the only way that we can accomplish this is is with like significant partnership with the custody staff that's currently there. they really they really help us a lot um to work through these issues and to help address all the needs of these patients who come inside the facility. Um, so this is our matrix for the adult facility and then we also have an MAT matrix which is just a little bit more provider hours and then of course that dosing LPN that we talked about and then we have a coordinator who helps us coordinate the um procurement of methadone if needed and then also the patients connection in the community postrelease. Um, and then this is our matrix for the youth home um, which involves 247 RN care for our youth in Durham County. So with that, I wanted to start taking a look at the drivers of

the cost increase. Um, your biggest drivers of cost increase are mainly around pharmacy. Um, so we thought let's take a look at pharmacy first and then we'll look at outpatient care. Here you go, Delica.

>> Thank you, Emily. Again, my name is Delica Reynolds Barnes. I'm the chief pharmacy officer for Will Path. I've been a pharmacist for about 30 years and spent about 22 23 years specifically in correctional health care.

I think the goal today is to just be here to answer questions. My goal is just to be a resource, answer those questions and follow through. If I could say anything, and you'll hear me say this throughout uh my part of the presentation, is that we don't treat these patients in a vacuum. These are your patients, your your your um residents in this county.

And patients in correctional health care is really community health care. It's just an extension. It's not like they just show up at our door and we start diagnosing and doing these things for them. They're living in this community. Either their disease states are being

treated or undertreated. We are trying to put them back to a level playing field. But because recidivism is about 30%, we know that they leave and other things intervene and we try really hard to intervene and we get them back and we try to restabilize them. Um, if we look at the past six months, what are we treating in Durham County?

What are those disease states? I will say that about 30% of the inmates that come into the facility are on medication and of those patients, they're on about three and a half to four prescriptions a piece. And the top disease states that we treat tend to be around a mental illness. Obviously mental health resources being what they are throughout the country.

This isn't a Durham County issue, a lot of these patients become just as involved because of mental health behaviors and mental health crisis. Uh pulmonary asthma, COPD, especially in the in in the south, we see that GI diseases, cardiac um hypertension, heart failure, uh seizure disorders, we see HIV. So everything

that you see in the community, we see them when they come into uh our facility into your facility. One of the questions is so what's going on with um uh total intakes? So we have seen an increase in the overall annual population uh over since 2020. Now 2020 I'll always refer to a unique year for for everyone and remember that was COVID.

And so we always we did have lower intake in the jail system. we had lower intake in health care services throughout the country but since 2020 we have seen us uh kind of a climb and then a stabilization of your population. One of the things I will say post 2020 it's not been a significant increase. So when we start to talk about well what's going on we haven't seen a significant large amount of patients.

One of the things we want to talk about is what's going on with the acuity or the level of illness burden that patients are bringing into these facilities that are driving this cost. So this is a interesting slide. U when I

initially looked at the numbers and slides depending on how you scale them show what they show. So 2019 let me caution is not a full uh year. It's about seven months of data. It was based on the uh change in fiscal year and when well path uh implemented a well path contract with our pharmacy partners.

So we'll start with 2020 and we explained exactly what happened in 2020. We had COVID patients that had significant illnesses were seen to be at higher risk for developing COVID. So, we were able to release those patients a little quicker. People were having less issues.

Uh we just weren't out and so there were less people coming into our facility. So, let's look at 20 uh 21 and we can see what's going on with pharmacy. We're seeing not only the overall um number of uh patients on meds uh increase. So we started out about 1,900. We're about 100 to 200 more patients a year in your facilities on medication. Uh and then the question is is that a proportional

increase in in drug cost? It's not. And the change is the the disease states that we are treating in the county and the medications uh specifically around mental illness that we're using to treat some of those. And we'll talk about that next.

One of the big areas that we are seeing uh in Durham that is a driver of your cost is issues around the treatment of HIV. Um HIV um is a very small percentage of your patients that come into the facility. It's about a half percent of the overall total patients. The average drug cost to treat uh a patient uh with HIV is about $4,000 to $4,500 per patient.

So it's not an inexpensive disease state to treat. Again, uh correctional health is community health. So when we see HIV patients in a correctional facility, uh please know that this is a reflection of what's going on uh in the community. And so one of the things that you will see is in in

2024, we saw a a large climb in the number of patients, absolute patients that were uh uh inside the Durham County Jail. And that is reflected in the increased drug cost. What we do know about HIV is that uh um not being a young pharmacist, I can remember when we had people on four or five meds trying to treat it, you know, the therapies have significantly improved. But with that improvement in therapies, there's been a significant increase in the overall cost.

The benefit of the this treatment though is that the therapies are so powerful now that you can get the virus down to undetectable. Why is that important? Because if you get the virus down to undetectable, they can't spread it in your community. So, I'll go back.

You'll get tired of me saying it. Correctional health is community health. So what we're trying to do inside the correctional facility is get those virus lo virus loads down to undetectable so that when they are released and go back out in the community and interact with

people um despite whether they relate their status or do not you know we want their virus load to be low enough that we don't continue to see this grow in your community because as you can tell it doesn't take a lot of patience to impact this community financially. Um, one of the things that we will say is, um, Durham County, uh, again, when we look at the rate of diagnosis of HIV, uh, Durham County consistently is a higher rate per capita, uh, compared to, uh, Wake County and Orange County. So, we see even within the county, uh, we are seeing a higher rate of diagnosis about, uh, 22 per 100,000. uh and then that's higher than what we see within the state.

Now, that should be expected because in more rural areas, we're going to have less diagnoses. We're gonna have less people. So, it's not an indictment. Uh also within the United States. And one of the things that we watch at Wellpath because we're we are um

sometimes it's a blessing and sometimes it's a curse, but we're lucky enough to be able to track patients around the country because we have contracts in multiple uh counties throughout the country. And when we look at um Atlanta, uh Fulton County, we follow it up through uh Davidson, Shelby, into Marian, Indiana, and even into Durham. We know where the impetus for this starts, and we are starting to see these things climb. And so as you look at your programs within your community for 19 to 25 year old uh uh uh um primarily minority males and females, you know, that effort will be important because that's not a number that just goes down in a vacuum. The treatment works, but there's got to be some effort on pre prevention and that's part of what's driving uh your your jail HIV cost. The other big area that we talked about is Willpath doesn't provide uh mental health psychiatric services to the county, but the pharmacy cost we

continue to monitor and look for opportunities within that pharmacy cost uh in Durham County uh represent about 40 uh% of your um overall cost um of the psychotropic cost. We typically within our other counties we'll see pharmacy costs being divided into um depending on the county a third would be HIV third would be mental health and a third would be everything else. So we are seeing a little bit higher push on the psychotropic cost uh within Durham County and that when I say psychotropic those are the all the things that we do to treat uh mental illness. So, not only is it the anticycchotic meds, but things to treat depression, things to treat anxiety and and some things to help with um insomnia and sleep as well.

Uh just a quick look at the psych meds. I just wanted to show the same numbers that we showed on the um u um HIV cost. Again, total costs continue to climb. We

saw a significant jump in 2021. uh and we are continuing to watch and monitor that starting to level off. So that's not only going along with the total number of uh uh prescriptions that are being dispensed. Uh that's the orange line and then the blue bar obviously being the cost.

so uh proportional and one of the things that we know um that are driving that is if you'll look at your anticycchotic costs uh and what we're seeing is in an effort uh one of the one of the problems and I think all of us have had family members that I won't say all of us many of us have family members with psychotropic psych psychotic is issues and one of the hardest things is to keep patients on medication they'll be doing really well for a while and then they stop taking their meds and then you start to see uh some behaviors. And so one of the things that we are noticing is an increased use of um um long acting injectables. So instead of giving someone a pill every day, we're starting to see an increased

use in those once a month injectables. Um unfortunately, uh while there may be a benefit in compliance, we have not yet seen a decrease necessarily in incarceration or them being justice involved. Just a hard population to take care of. that cost delta is significant.

You're talking about the difference about a 10 time 10-fold increase in cost for those injectable medications. And so that is something that the county will need to continue to look at, continue to monitor uh along with the mental health uh partners because that is definitely going to be a driver of cost. The difference between 300 and 3,000 uh can be significant, but we continue to watch that. Again, another uh slide looking at one month usage uh the atypical anticycchotics which includes those long acting injectables.

Again, not a huge amount of patients have to be on those. It's not like everybody gets put on it. Doesn't don't need a huge amount of patients. It's just the cost is significant enough that that movement of

10% can make a significant difference in your overall uh pharmacy cost. And this is the slide showing uh that difference. So that's just the growth. I'm not sure there's more more to add on that.

It's just we wanted to continue to speak to something that needs to uh continue to be monitored. Before I pass it back over to talk about the outpatient and off-site costs. Uh you know, I think one of the things I want to say is while we monitor the drivers, the other question would be, well, we appreciate you keeping up with where things are going. Do you have programs in place?

What are you doing to help us control that cost? And we are continuing to do that uh through wellpath. And so we have uh implemented uh we have we have we obviously have a formulary uh which is monitored by our our clinical providers. So when someone uses medications that are not on the formulary and we expect that our formulary is used 80% of the time. We know that patients have some unique characteristics. We don't expect 100%

compliance just like you wouldn't expect that for your personal formulary. The other thing that we have been able to access this year is uh couponing. Uh and so a lot of you may use co-ay coupons. Obviously, our inmates don't have coupons, but we do use cash discount coupons through our pharmacy partners to help control the cost as well as is any federal programs around 340B.

We have implemented those as well. So, we are continuing to look at uh ways and we send notices to your prescribers to make changes when there's something that needs to be changed. We continue to look at it, but we do have those two areas that really are pushing us forward and we're just, you know, continuing to look for what's the option. Will there ever be a cure?

Thank you. >> Thank you. So now we just wanted to give you a quick overview of outpatient cost, which is another big driver of cost. Um, so first I wanted to start just with an overview of your outpatient costs year-over-year. Um, and then the the

blue bar is the outpatient cost and then the ADP is our average daily population. So it doesn't look that dramatic, but the average daily population has gone from about 368 to a little over 450 in the past 5 years. Um, and so of course that's going to drive your outpatient cost expenses. So outpatient expenses include emergency care for patients.

That includes um if a patient comes in with cancer and they need chemotherapy, radiation, dialysis. Um there's a number of things that patients are sent off site for. Um you can see from our next slide that emergency room care is the by far the largest expenditure um the largest claim treatment uh for Durham County. Um we have a m we have many cost mitigating efforts that we implement at the jail.

Our biggest one is um virtual emergency care. Do you want to talk about virtual? Yeah, >> I can go. >> Yeah, as Emily said, ER is is our

highest cost driver. Uh you know, one of the things that makes ER and also if you look be underneath that inpatient hospitalization from the ER is also very high. And what happens in the emergency room, as many of you know, is sometimes patients will come in and and there will be what's called a soft admit where they're not sure and they're just going to want to admit for observation. And that cost can be high, too.

And we found that across our platform, we the the same situation has been occurring in in hospitals and in Durham County especially, there's been a high ER utilization. And so what we have implemented is a virtual emergency care. We have this is a great program where we've employed um emergency room professionals both physicians and advanced practitioners and we have created a system where when a a patient comes down to see the nurse with some sort of acute condition typically the response is let you know they need to be worked up in the emergency room and and let's get them there to be seen and

evaluated and and brought back. the problem is when they're not brought back. And what can we do on site to mitigate that? And so by using these virtual emergency providers who are wellversed in emergency medicine, they're able to see the patient uh make an assessment, give some orders to the nurse, and uh and as the the number there shows, about 65% of those acute calls were able to treat on site.

And that way it avoids uh an unnecessary sendout which not only uh is the cost of the emergency room but also the cost of having custody. Uh usually two officers have to leave the facility. And so um the our virtual emergency provider is there uh 24/7 and um that it has been a huge cost-saving uh measure that we've implemented. And with Durham County, we've actually heightened the focus uh increased educational efforts because what we want is for nurses to feel comfortable that they can call a virtual

provider rather than just immediately call 911 when they get worried about a condition that presents to them. >> That concludes our presentation. So now we wanted to leave a significant amount of time to talk and have you guys ask questions and we can we can answer anything you want. I think.

>> All right, just looking around here. All right, we'll start with Commissioner Burton. >> Thank you, Chair Lee. I really don't have any questions.

This has been very insightful and to see the cost of taking care of inmates in the Durham County jail and that many of them um are have health issues. And a lot of this has to do with, you know, a lot of factors. And I think what I'm going to do with this is just sit on this information. I appreciate you giving us such thorough numbers, things like that. I'm really

concerned about HIV now in our community, and I know maybe um Dr. Jenkins can share how what we are doing here in Durham County to get those numbers lowered because it shouldn't be they have to come to the detention center to get care for their HIV. So um and also mental health. We have to continue to focus on how do we you know support our residents with mental health.

So this was just very insightful. Thank you so much and I'll yield to my colleagues. Thank you for those comments, Commissioner Burton. And you all have heard me say this a number of times.

We're we're running a hospital, running a full-fledged hospital. We're obviously running the largest mental health facility in Durham County. Uh we work closely with um the public health and Dr. Jenkins. As as it was said earlier, jail health is an extension of community health. uh and and so we there is that intersection and unfortunately they do

enter our facility carrying those uh diseases or their uh acute illnesses that some simply have not been diagnosed until they get to us and that that truly is unfortunate but I appreciate your comments. Thank you. >> Commissioner Burton, I do want to say one thing. You mentioned a uh the factors that bring them in.

You're spot on. I think one thing that get oftenimes gets overlooked um is the social determinance of health. They a lot of our patients come from homes and families and environments where they have physical abuse, mental abuse, emotional abuse, food deserts. I mean there's just so much that ends up uh causing them to be incarcerated and then we are now left to uh take care of the medical conditions that come along with that.

You're you're exactly right. >> Yes. And that's why, you know, this is why we're up here to figure out how do we make sure our residents are taken care of? Um because it shouldn't be they

have to come to the detention center to get health care, right? Health care should be a right for everyone. Um, and so I just appreciate you all giving us the data and the facts and something for us as commissioners to really think about working with our county manager about how do we, you know, help our residents. So, thank you so much, >> uh, Vice Chair Long. >> Yes, thank you so much uh for this presentation and for the work you all are doing. I was wondering um we it was like a NCAACCC conference one year two years ago um where we had uh Sheriff Paula Dance talked about I know there's like a lot of there's like a long wait list for this program but wondering or so I guess for sheriff Burkhead or uh um attorney love lace the p county sheriff had just uh in 2024 started a program that they were able to do with the state department of health and human services to have like beds for uh inmates who

aren't able to go to trial. Do we know like when the state is going to start letting more >> what you're talking about is the incapacity to proceed program. Um the state department of health and human services refers to it as rise. You have that program in Meckllinburgg County, Wake County and Pit County.

And I think conceptually what they wanted to do was set up regional um uh areas where um and actually the state is divided. The counties are divided into those three regions. What has happened Wake County was the most recent one I believe to open up. Right now they are only servicing Wake County.

Um so if we were inclined to do so, we could transport folks to Meckllinmberg County um to get that type of treatment. Um I don't think there is any plans or ar there aren't any plans to expand it beyond those three. It's basically divide the state into three regions. Um western, middle,

eastern and it just so happens that Durham in the middle area. Wake County would be where we go, but right now they're only servicing Wake County. So we would have to transport people to other basically Meckllinburgg County is our option. And is that like a Wake County decision or was it a state decision of that wake is only >> I'm not entirely sure.

When Wake County opened up, we did have some conversations with Sheriff Row and I believe what he wanted to do was focus on getting that implemented. Um it's something that sheriff is very interested in. I can turn it over to sheriff if you want to speak a little bit. >> Vice Chair Lum.

It's a little bit of both. It was it was a personal decision or professional decision by Sheriff Row in conjunction with his public health and and the state to uh basically get the program off the ground in Wake County before they opened it up. You know, and and just for uh everyone's knowledge, we were approached before they approached Wake County and Wake

County just moved a little quicker than to get the program there. I I would have welcomed the opportunity to be one of those regional centers, but we just weren't ready to to to step up and take that opportunity. >> I just want to jump in because I do have an update from the stepping up initiative um at our meeting about a week and a half ago, two weeks ago. Um, and maybe you all I don't know what kind of information you have yet, but um, what we heard at the and the stepping up initiative is Durham County's um, effort to reduce the number of people with mental illness going into our detention center because we know that that is the problem to begin with. Um, but um, what we the update we got at our stepping up initiative was from Dr. canal that there are two detainees um in the Durham County Detention Center who have been approved by the state um DHHS to be able to go to Meckllinmberg

County to res participate um in the capacity restoration program which is great news because uh every day they sit in our detention center they are costing us an enormous amount of money for their um psychiatric treatment and plus just the daily um uh cost and they can't go to trial until they have received the capacity um restoration services and I know Wake County is not um taking people yet because they're just getting started. So, it's fantastic news that we have been um have these two detainees that have been approved uh to go to Meckllinmberg and I don't know where that was at with you all or if you were aware of that, Sheriff Burkehead, but be great to get an update on that. >> Yes, we are aware of that and we've been in conversation with Justice Services is why I just asked uh Miss uh Humphre to

come up. Thank you. Good morning everyone. Um yes, Dr.

Canal is the psychiatrist that we work with under contract and we have been in conversation with the state for a few months in reference ensuring that individuals that we have waiting to go to Central Regional Hospital um for capacity restoration are able to quickly move through that process. So, um, in conversation with the state, they indicated that we could send, um, the detainees to the Meckllinburgg County, um, program because they have capacity right now to receive them. However, we have been in conversations with the sheriff's department about that. And I think our sticking point at this um, juncture has been around transportation and who would cover the cost for transportation, participation in the program. The costs are all covered by the state except for how those individuals would actually be transported to um the program in Meckllinmberg. >> Do we know what that cost is?

>> I don't have that figure off the top of my head. Sheriff, do you know? >> Okay. >> It's uncertain because we would be responsible for transporting them to and from Durham any time or to and from any other location.

So, no, we don't know that cost is a financial cost as well as a manpower cost. >> And then, oh, I had one more question. Um, and it's great that Miss Humphre is here because that was going to be my next question about, you know, obviously I know that the jail we hear Sheriff Rickett and we've seen it also on our tours. It is the largest mental health facility in Durham County. And so obviously we want folks to receive the care that we're able to give them, but what type of partnerships exist with the Justice Services Department to kind of be have that intervention beforehand um of providing resources of like working with whether it's formerly justice involved or people at risk of being justice involved of providing them that

mental health access and resources also working with public health before they end up in the now. >> Yes. >> Yes, we definitely are working together um to address those issues. I think that the issue that continues to come up for all of us is about when a person is released back into the community, the continuity of care.

Um we have several community providers that we work with. But what continues to be missing is that inpatient um mental health treatment that's that's needed for the highest level of individuals that have severe and persistent mental illness. And so when we don't have the inpatient capacity locally, they end up back in detention because they are they are going to their outpatient provider um as um the other panelists um talked about not taking medication, stopping medications, and then it continues to create a cycle of individuals that go back to um detention because they're not able to be managed either by ACT team or a forensic community support team. their level of need is just so high that they continue to come back to detention.

>> And uh Vice Chair Lum, you're absolutely correct. What we're missing in Durham is the ability to catch them on the front end through our juvenile justice services, through the youth home, through our schools. We're we're just missing them because we know the individuals that we're unfortunately seeing uh between the ages of 18 to 30. uh and they are coming in with ACEs, adverse childhood uh experiences that they have not dealt with and we unfortunately we don't get a hands on we don't get our hands on them until they're incarcerated.

So the the community piece is a gap that we would love to address. >> Commissioner Valentine. >> Thank you Sher. Uh if we could, I'd just like to go back to the issue of the two uh inmates who have problems with competency. And so that's important so we can we can uh get them to trial and um you know expedite you know either their long-term plment uh long-term placement, excuse me, or or otherwise. And so with

respect uh to the transportation uh cost uh county manager that's is that something that that the county would undertake or is that an issue for the the the sheriff's uh particular budget? >> We would need to better understand what that cost means. Um cuz I'm not sure is it per transport or um but that we would definitely work with the sheriff's office to support it espe when we especially if you're looking at a cost benefit that this would be a lower overall cost but I would need to better understand sort of what that means when you talk about cost um because if you're having personnel to transport report coupled with multiple visits, doing it on site may be more cost effective. But if looking at what this

particular issue is, if they are um housed there for an extended period, it may be a different scenario. So I am less familiar with the nuances, but we can come back to talk through what that is. But definitely we'll work through that. This is >> I mean but certainly um if if I to understand the program all the costs would be captured once they got to to Mech Meckllinburgg and so we'd be disresponsible for the transportation right and so you're saying that's something that we can can work out to >> we can definitely work out >> the issues I'm just less familiar with this particular okay issue so I just need to have more information.

>> Okay Commissioner Valentine if I may. Uh there are a number of um moving pieces. So you you raised a very good point. Is it just transportation?

Not just transportation. It's transportation is staffing. It's court. So the coordination between the DA's office, the court. So um because that individual

would still need their day in court. So if it's is it a short-term visit, is it 7 days, 10 days, is it two weeks, then we got to go come back, pick them up, and go from there. There's a waiting list across the state right now for um uh competency evaluations, and Meckllinburgg has the space to house an individual for that. So it could be a much longer stay than we anticipate.

But if the DA's office says we we need a report and we need it now, we need to push this through, then we just got to move quick enough to get the pieces back. So, it's not as smooth as we think it is. And there's some pieces that need to be addressed through multiple agencies, not just the sheriff's office. And and it's not just a matter of cost, but cost certainly would factor into it.

>> Okay. Thank you for that. just to add um one in addition to that we actually have three folks now awaiting um bed space we've been in contact with the state yes mechanburgg has that um program the wait time for

central regional is approximately 60 days in addition to what sheriff was saying it's a manpower issue that would since they were in custody that would require our deputies to do those transports our deputies also are doing the transport for involuntary commitments whenever Whenever someone goes to the hospital, those inpatient hospitalizations or emergency room hospitalizations, um, we have deputies that must sit on those individuals. Our number from patrol for last year was 1,800 hours of deputies that were pulled from patrol to go over there. I don't have our civil deputies. They also get pulled. So when we're talking about the transport piece, we already have deputies being pulled from other services we provide in the county to do the IVC transport sit on folks at the hospital from our patrol and civil divisions. So when we talk about that transport to and from Meckllinmberg County, we have to also take into when we say manpower, take into consideration all of those other things um that we have going on when so

>> I I think and I'm not certain, but I believe that Durham County would still be responsible for the medical costs of the patient as well. So >> okay >> actually for this particular program the rise program the state is handling all the costs except for transportation. So once they arrive there the whole process of capacity restoration while they're in that program um the state would pay. >> That's great.

Okay great. >> Can I ask one question? How so how long can an inmate stay in the program? Is there a >> they have transfer to Meckllinburgg County and is it >> it's not indefinite.

They don't have like a time frame because for each individual is different for how long it takes that for capacity to be restored. So they haven't given us like a 30-day 60-day. They have not given that because they know for each individual it will be different. But it's exciting that this is an option

for us to consider. >> So the next uh sort of statement, not a question, I just want to appreciate the concerns that were raised by uh Commissioner Burton here today regarding HIV in our county. Um, just looking at those numbers tells me that we probably be should be doing something else to to to address what uh the numbers suggest could be a growing sort of public health issue. And so now that that is on our radar, I'm hoping that uh we can give that uh the attention that it uh that it deserves.

Uh sheriff, we've been talking for over a year about uh medical director's position. How does that fit into, you know, sort of the the overall discussion that we've been t having here today? >> Thank you for the question, Commissioner Valentine. It fits perfectly into what we're talking with today. And I'm happy to announce that that position has been

finalized and posted. So, we're receiving applications. Um, this would be uh a position that works in conjunction with our mental uh MAT first and foremost because we're looking for an addiction specialist that also has some understanding of obviously the the mental health issues working alongside justice services and of of course our wellpap partner. So this would fit perfect into us getting a higher level of oversight with these patients who are suffering these these acute illnesses and uh who need special services.

Absolutely. >> All right. So with with respect to the issue of oversight uh giving you backing your authority with regards to that position and uh removing the director of health from the equation I guess our not our my concern would be do do you have the the uh required capacity once those supports aren't in place outside of the oversight that the

department of health will continue to do say on a I believe it's on a quarterly bas cases. >> Yeah. No, absolutely. We're we're doing it now by by state mandate statute.

Public health director is responsible for signing of the medical plan, our partnership with wellpath that we've had as you heard from the presentation for 25 years of such. Our relationship with justice services, our in-house capacity to manage the billing with along with well, you know, I think we are well suited to to manage that contract. Well, I'm hoping that we can come to a resolution regarding that uh sometime here in in the new the near future. And my last uh sort of question is the the psychiatrist.

Um next time you come, maybe you can bring him. We'd like to hear directly from him if we could. >> Commissioner Valentine, if you're referring to the jail mental health psychiatrist. >> Yes. >> Okay. um she was unable to attend this morning because she was in clinic at at

the detention center. Okay. But our our contract with her um currently, I know this question isn't on the table, but she is in the detention center 3 days a week. And based on the increased numbers that you saw, we have increased her hours for next year potentially from 19 hours a week to to 24 hours because she's brought in a second person to assist her with clinic because we see the increased numbers.

But we depend heavily on her for her expertise around mental health and and so she apologizes for not being able to be here this morning. >> And and does uh that particular provider interface with uh Wellpath at all? >> Yes, they they are in >> partnership >> partnership. David >> All right.

Thank you so much. >> All right. I'm going to quickly go to vice chair alum. She thinks there's some clarification.

>> Yeah. Can we just get clarification on the um alignment on the medical director position because it was my understanding that it isn't going to be fully removed from public health. There's going to be a dotted line to the public health department.

>> So you asking for my understanding? >> Well, manager. >> Okay. >> The position is in the sheriff's department with the dotted line coordination as they've always done with public health.

that coordination, as the sheriff noted, um is statutoily driven and that they have to sign off on um the medical strategies and how things are managed. >> I see Dr. Jenkins shaking his head. >> I just wanted to clarify that there's still that dotted line because I know Commissioner Valentine mentioned said fully removed and I just wanted to clarify that there is that dotted line still remaining.

>> Yes. So, what I meant to suggest was is that in terms of like the day-to-day managing of the the contract, you know, giving the the uh the authorities back to to the sheriff and that oversight continued through um Director Jenkins's office. >> Yeah. And so to the extent that the the

sheriff's office has the the capacity to do that because right now um the director's taken that up and he's made it clear that you know he thinks that this should be handed completely back to the sheriff in order for him to be able to um provide the dayto-day uh transactions regarding this contract. I think it was mine. Yeah, I think it was always that the medical director was going to be in the jail in the sheriff's office and then it's just the alignment of what information what back and forth the public health department has with the sheriff's office to receive information for reporting back to commissioners, but it was always to report to the sheriff's. >> I think we're saying the same thing here.

So, Dr. Jenkins, did you want to add? Good. Good afternoon, Dr.

Rod Jenkins, public health director. I co-sign everything the sheriff said. Uh we have always been in good contact with each

other, but as we have indicated, uh capacity personnel, particularly uh the the the the fine job that the sheriff has had with aligning himself with the medical personnel and operational personnel to manage this contract is certainly there. Uh public health will always be here to advise. uh sheriff and I maintain an excellent relationship. So I certainly um want to um commend him for that.

Um as has been touched on with uh two commissioners. Uh we spend an extraordinary amount of time with this Wellpath contract. Uh uh Emily Emily and I have have grown to know each other very very well. Uh but you know again we want to do public health which is HIV in public in in Durham County and being able to really focus a lot of our energies on what is true public health in an effort to make sure that these individuals don't go into the uh detention center with these ailments

that plague our community. Uh happy to answer any additional questions you have. >> Okay. Thank you.

Thank you. Appreciate that. I think we're I think we're clear. No.

Um, did you have any other questions, Commissioner Valentine? >> No, Chair. Thank you. >> Okay.

Thank you, Commissioner Jacobs. >> Well, thank you so much for being here and for this presentation. I especially um appreciated all of the data that you provided about the um pharmaceutical pharmacy related expenses. That was really really helpful. Um, I just want to say that we really need to take and it's been referenced already a systems approach to the the issues around the costs related to taking care of people in our detention center. Um, as we see the costs are increasing and we have a responsibility

to the people in our community with our overall challenges around funding in this community. Um, that we have got to work together and really dig into what is happening. You referenced this related to social determinance. Um but again as we have less and less money to spend we have got to dig into these costs and really take advantage of every opportunity we have to reduce the costs.

Again taking a big picture approach. We it's again it's a it's a system. It's our whole justice system. It's our crisis system. It's our mental health system. And you know, we we are doing a lot in Durham, but we still have a lot of gaps and um I just I just hope in the you know, in the next year um we can kind of really dig into some

of the trends and things. Um I I've been a part of the stepping up initiative which is again Durham County is an innovator county nationally. We have our um so many people work on that. Um and you know we have an entire department justice services that is working on pre-trial release and ways that we keep people out of our jail.

Our mental health court um our recovery court. Um we have all these programs in the detention center like the star program. We've got the trying to do the warm handoff with programs like our re-entry council, the FIT, our um our peer support specialists. Um but I think we need to understand, you know, where things are working and where they're not. Um, I know we have a great um forensic act team now that um

is helping people specifically re-enter, but as was mentioned both I think the sheriff mentioned it and um director Humphre mentioned we don't have um because this we deinstitutionalized psychiatric care in this country. We don't have places for some of the severely mentally ill people in our community that leave uh that are either picked up through IBC's or through released from the prison or the detention center to recover uh with long-term care. And I know that that is something I I hope that we can look at maybe if um this is part of a bigger conversation, but how do how do we do that? Is it through partnering with Duke Duke regional? Is it with our recovery response center? Maybe having one or two beds that they're people can

be in for long-term care. Right now we have a problem with IVC's um that the magistrate right now and I don't know if sheriff if you're familiar with this or maybe you can help um that they used to folks used to you you all would take folks to our recovery response center to get the care that they need for involuntary commitments. Right now they're getting sent to Duke Regional. Duke Regional stabilizes them for like 24 hours and then they're out the door and back on the street again. So if you might be able to help with conversations with the magistrate to have your folks law enforcement in the order to take folk take people to the recovery response center because they are we're paying for that place and they are willing to have people stay for longer there to get stabilized. So that that's something that I've learned about being part of the stepping up

initiative. Um, and around the HIV I guess Rod. Oh, there you go, Rod. You know, the county started funding an HIV navigator years ago because we do have a big disparity.

So, I think we need to revisit um maybe get an update from them um on this issue. Um, but bottom line is we we need to keep people out of our jail in the first place. Um, through what, you know, through diversion, uh, 911 diversion, um, getting help in our community, um, through all the, you know, as we're doing a violence prevention plan now, right? How all the things the sheriff mentioned, how do we keep people out of our jail in the first place um, who shouldn't be there? um because it's it's just not it's not fair for them and it's not fair to the taxpayers in our community. We shouldn't be running a mental health facility in

our detention center. Um I really hope we can look at also partnering with the state on the capacity restoration program because I just can't believe that whatever it's going to take for transportation, it's not going to be a win-win. um if we get people somewhere else getting that capacity restoration and their care and then getting them to trial. And the last thing is um we have to look at the numbers that are happening in our justice system.

Why are people in sitting in our detention center waiting for trial compared to Wake County? What is going on? I think we've got to work with our DA and everybody on that side. People need to be disposed. They shouldn't have to be sitting there with the our staff taking care of them. They need to have their cases come to trial and be

disposed of. And why is it taking so long in Durham? So again, these are systems issues that I really appreciate what you all are doing. And I would ask if we could get maybe at May um for um Roshana and her team to come and present with Dr.

Canal about our mental digging in more about what are the other pieces of the puzzles here and getting more like everyone here learning about the stepping up initiative, the sequential intercept map just and like what happens when people leave the detention center. um how is that going with the fit program and and all those other things um so that we can really understand the system and how we can do better. So thank you. >> All right.

Thank you, Commissioner Jacobs. Um I had a question here. So a lot of times when I look at So in your

presentation there was a lot of cost, you know, numbers, dollars and so forth. What are what are outcomes? What what do you shoot for for outcomes? So, at on the last slide, I see like a 100,000 plus consults in correctional facilities since inception.

Um 3 minute average provider response time, around 65% acute calls treated safely on site. Um what were the So when you when when you're working with our um detention center, what are we shooting for? And what are these numbers in relation to what we're shooting for? So like what are the goals?

What are the outcomes? We're spending the money. I see the I see the cost. I see the the spend.

I see all of that. I don't really know if it's high or low. Just kind of depending. But I what I look for are goals like what should we

be what is our return on investment and what's actually happening here. >> Well, I want to preface this by 100,000 consults is through our whole platform of using the systems, not just Durham County. Uh and the threeminut response time is really just how quickly they they're going to be able to see an emergency provider. But what we would like to see is a higher and higher number.

We don't act, you know, what we want to see is that a higher and higher number of acute calls that are able to be managed safely on site with reduced send out. >> Um the the more we can do that, the more cost savings we can have. Now, we do realize that there are some conditions that we will have to go to the emergency room. I we'll never get 100% because there will be certain conditions that require a CAT scan and and and higher diagnostics.

But a lot of the conditions that had been previously been sending out is for example chest pain was a big one. People just come down and say chest pain and it's very difficult when you're on site to say this is cardiac or not cardiac. Do I send them? Do I not send them? But there are ways to risk stratify these individuals and prevent

them from going to the hospital by being able to watch them. And that's what we want is uh because the majority of medical providers that um staff these facilities are typically internal medicine doctors, family doctors, um occasionally an ER doctor. Um but the the reality is most of them don't know how to manage as they would in the emergency room. So their default is to send to the emergency room.

And so the more we can get our providers to learn how to triage appropriately because over time what we find is that by using this system, they actually learn that they can manage a lot more on-site safely without the risk that comes with those conditions. >> Right. Okay. And I and I appreciate that.

Uh but what I'm more looking for is you all internally at Wellpath. Um when you're uh looking at, you know, approaching Durham County saying, "Okay, we want to refresh our we want to renew our relationship. " What are the metrics

that you uh that you collect or look at to say, "Okay, we're being successful in Durham County. we are doing what we're supposed to be doing and that would justify us, you know, re redoing relationship. Now, I'm not questioning a relationship. I'm not doing that.

But I like to see those sorts of things. That's kind of what I do professionally. And so, um, is there a way for us to have those metrics, you know, uh, the with the office of the sheriff or even from you all to say, uh, this is what we look, this is what we expect to see when we consider ourselves successful in this relationship, in this uh, partnership and, uh, this is how we performed. um you know associated with those particular metrics. >> So one of those metrics that that I think is very important is how timely are we seeing the the individuals that

are incarcerated. >> That's a good one. >> Because what's going to happen is that there are going to be patients that refuse to be seen. Um and we need to make sure they're still getting seen because what happens is if if we there's a backlog in chronic care visits, there's bad stuff happening in those in in those backlogs.

Okay? And so one of the metrics that we try to look at is how quickly how can we bring the backlog down to zero. >> Um and then also how quickly can we get them seen in a timely manner from when they when they file a grievance that they have a a sick call request. >> So some operational measures that we use to provide so clinical and operational obviously we're clinical first um but they kind of flow together.

So I would say that as an operator we our biggest metrics are exactly what he's saying. So I have a regional director of operations who is held to account to do a we call it a regional director checklist. But it's really just compliance, right? So it's it's looking at your backlogs. Is

there a chronic care backlog? If so, why? And what's your plan to solve it? Um so no chronic care backlog.

Sick calls must be seen within 24 hours. H a complete history and physical must be done within the first 14 days. We make sure that our intakes are robust and dynamic. We don't want intakes to be uh on autopilot.

We want our nurses interacting with that patient, really keeping an eye out for them. And then also making sure they're making the appropriate referrals to either chronic care, acute care, um mental health, whatever it may be. And so for me from a success from a success standpoint, the number of sendouts because if you are not addressing a patient's acute needs immediately, they're going to get sent right to the ER. And just what Dr.

Terrenath just said is that, you know, if a patient is not seen in chronic care and they have anything chronic, they're they're going to get worse and worse and worse and then they're going to get sent out to the hospital. So I do look at outpatient sendouts as a metric of success. Um there's always going to be some because we it's a high-risisk

environment. Um but one of the things so I would say that and then I would say also like see protocol. So detox protocols are extremely important. Our highest risk patients are those that are in the first seven days of detox.

Um they're at the highest risk for um suicide and and just deterioration I think in general. And so we see what cause have see what cows have very specific clinical metrics. So making sure that your patients are seeing we have to check on the patients every eight hours. We have to make sure they're hydrated.

We're checking their vitals every eight hours. Like basically keeping a really really close eye on our patients that are detoxing. And then of course medically assisted treatment is the same kind of clinical oversight. That's why we have a whole separate matrix dedicated to that medically assisted treatment. Um, and so I we have a daily whiteboard. Um, and it's basically where the provider, the HSA, like our

administrator, um, >> nurses, >> the nurses, basically everyone kind of goes over their high-risisk patients. So like we've got three pregnant patients. We have this person in the hospital currently. we've got, you know, 40 people on SE was and eight people on C, like whatever it is.

Um, we go over kind of all those metrics to make sure that everyone knows their daily assignments and they understand where they are clinically um needed to act. And so, anytime to Dr. Terren's point, anytime one of those metrics kind of gets out of whack, that's when we start having conversations about pulling it back in line and making sure that we're addressing clinical needs. I deeply appreciate that.

Um I don't don't really want to get in the weeds of like the whiteboard kind of thing, but like the higher level Yeah. >> measures of what makes it successful. You know, what do you look at to see that >> uh you're doing what you uh what you what you're expected to do. That's

really important to me. So, I really appreciate you explaining that and kind of walking through just kind of the higher level parts there. So, thank you. that that that answers my questions.

So, thank you. See there, everybody's smiling because they know I asked about that that that kind of thing. So, >> the one other thing about that, there's also a lot of clinical standards that we hold to providers too, you know, for like their diabetes, making sure they're getting better over time, >> right? >> So, >> Okay.

Thank you, Sheriff. >> Yeah, I would just say add chair Lee that that's an excellent question and the Wellpath team answered it the way I wrote it down. We want to reduce those outpatient visits because that's that's a whole another level of risk. We want to we want to treat those inmates uh as best we can to lower their risk of whether it's uh dying in the jail from >> the the illness or suicide for depression working with mental health. So I look at it every single day >> of what the outcome is and then just

making sure that we provide the best care possible through the synergy that we have with all of our partners certainly our our staff from Wellpath which I think we've achieved. So if you look over the past seven years how our health care has increased how our ability to care for the some some really sick sick folks has increased. we've gotten better at at doing this unfortunate job that we shouldn't be doing. >> Uh but that was my commitment when I was elected because our suicide rate was off the chart.

Our death rate in the jail was off the chart. We brought that number down and I God forgive me. I hate to even bring it up now. Somebody something's going to happen, but that's the outcome that we look for every single day and we evaluate that on a regular basis.

How are we treating our inmates? How are we making sure they get what they need? How are we servicing with our working alongside our partners to make sure that the community is receiving some of this before they come to us? So, so your

question is spot on. I just don't know that there's a way that we can actually quantify it. >> We can we certainly can give you the numbers I just gave you, but it it is just every day day in and day out what we're doing. >> It changes every day.

I'm not even saying that it's just kind of in general, right? you know, I'd like to see which direction we're going, you know, as we're uh going through the programs and getting these updates. I like to put that out there because that's where I um that's the foundational layer of my understanding of how things work is understanding if they're working right. So, I I appreciate the answers deeply.

What were you going to say? >> I just had something to add. Um, and I'm happy to address this um, offline if you would like to talk about it some other time, but we have not had I believe in the last five years there's not been one completed suicide at Durham County. I'm pretty certain.

>> And knock on wood on that. >> Yeah. >> Yeah. And then um anytime there is an

adverse event in the jail, whether it be um a su a death of any kind or um a clinical a patient that we're concerned about, we have these internal calls. So if it's a patient that has a number of chronic care issues or particularly complex patient and we're a little worried about them, for example, if a patient goes on a hunger strike or something of that nature, we would have an internal um we call it a morbidity review. And so it would be Dr. Someone from Dr.

Terran asked, I'll let him. >> Yeah, it's a multi-disiplinary team. So, we have nurses, we have physicians, we have uh attorneys, we everybody's looking at the case about what we can do for these patients to make sure we reduce those morbidities and they don't turn into mortalities. >> Right.

Okay. >> And one last thing about the question you're asking, this was just a subset of the data that Wellpath has. There's a lot more data out there. one metric that I think would answer uh data set that would answer your question. They have reports dealing with length of stay and what the reports that I've seen the

longer they're with us the more stable they are and where the issues we're having correct me if I'm wrong Emily the issue that we're facing the folks who are there 60 days or less or the recidivist out and in out and in are the ones that have the higher costs the ones who have the lengthy stay 90 days or more several years particularly going through the chronic care clinics, they're stabilized, they're healthier, >> um dealing with their diabetes, dealing with their um >> high blood pressure. And so, one of the things that um I'm glad we have this presentation for is for mental health and public health to see because it really can drive where our programmatic needs within the facility. The longer we have them, they're stabilized, but we're not, you know, we can hand them off. So, what are the successful ways or what programs can we have to successfully hand someone off in the community to make sure they remain stable um and not

coming back? And so, this can really drive programming at public health in justice services division and really focus our resources because it is a snapshot of what's going on in the community. But we do have that data if you want to see that. Is that correct?

>> We do. It's it's flawed, I will admit. Um but this is just this is an intrammon look. So this is just for the munch of month of March 2026.

So what I would like to develop is a cumulative look. So for you to be able to look at recidivism on like an annual basis. But right now we have the ability to look at it um for a year. So we call it familiar faces.

So out of 503 bookings in March, 173 were recid were recidivists, which puts you um that would make us if we were looking at it per thousand bookings, it would be 344 would be familiar faces. And that compares to similar contracts, similar jails of a similar size typically see about 218. So the recidivism that you're

experiencing durm is a little bit higher than other counties of or other jails of a similar size. And then the average time between fi from between bookings is about 56 days. So that means that I get arrested, I get out and about two months later you'll see me again. >> Right.

>> Okay. Yeah. I was looking at this um the >> indices here um a little bit earlier. So I appreciate that.

>> Thank you all for your answers. I really appreciate it. Oh yes, ma'am. >> I just want to mention one is policy.

We didn't bring this up, but one of the biggest cost drivers is that when people come into the jail, their Medicaid benefits end. Uh so you know that has been a big national uh and state priority um for counties for this to for us to be able to continue to have Medicaid coverage. That would that would be a a big big

difference for us in terms of the costs if that happened. So I just want to make sure we didn't forget to talk about that. Um, also I was going to ask when Rashana if you could come back maybe in May. Rashana um and I've been working with Rashana and Brian Smith from the heart program and a lot of other folks on a Durham familiar faces initiative and they have been doing a pilot which I think it would be good for you to give an update on because related to this number that you just which was this is great um the slide that you just shared because we have what revolving door between the jail, the emergency department and our home u unhoused folks are are familiar faces. And so um how how are we doing around that and this ties into also the city county homeless plan? Um again getting back at at that.

So it would if we could get an update and then sheriff if you I forgot to ask are we still doing a mental health pod in the jail and if so what what what is the status on that? >> Yes we are doing the mental health pod for male and female chief. Uh yes ma'am. We still have a therapeutic housing unit in the facility for um specifically for the male detainees suffering from a severe and persistent mental illness.

Uh the female housing unit they receive theirs in the female pod female housing unit. Yes ma'am. >> And I will just interject that that is staffed with um justice services department clinicians. So we provide the services in that male mental health pod and then we also provide because the number of females is less we couldn't designate a pod for them but they go into that female pod and provide

services. Thank you. you. Let me just say this, just all of you being here together, the collaboration that is happening between justice services, detention center staff, Wellpath, public health, it it is truly amazing and I appreciate the way there are so many partners who are working together. Um and to your point chair about data. I think one of the ways that we can really hold ourselves accountable is trying to and this may be in the coming year is to look at data around prevention diversion um the disposition to trial rate and also recidivism and that will help us I think see kind of how we're how we're doing and where we can really improve and maybe other data points that you think of, but those are the ones that

came to mind for how we could measure ourselves. >> Yep. Absolutely. All right.

Thank you all. Really appreciate y'all being here. All right. And that brings us to the end of our agenda.

Um I don't think we need a motion to adjourn. Not in a work session. So we are adjourned. Thank you. And we're just slightly late, but