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SUP. ANTONOVICH: I ALSO HAVE A MOTION I WANT TO PUT ON THE TABLE AS WELL. THE ANTELOPE VALLEY REHABILITATION CENTER PROVIDES A SERVICE TO THE COUNTY IN ITS COMPREHENSIVE SYSTEM OF HEALTHCARE. THEIR MISSION IS TO CONTRIBUTE TO THE RESTORATION OF OVERALL HEALTH AND FUNCTIONING FOR THOSE COUNTY RESIDENTS WHO SUFFER FROM CHEMICAL DEPENDENCY. THEY PROVIDE LOW COST RESIDENTIAL RECOVERY, REHABILITATION SERVICES TO ALCOHOL OR OTHER DRUG DEPENDENT ADULT INDIVIDUALS IN THE COUNTY ON A VOLUNTARY BASIS. RESIDENTS SERVED AS THE CENTER AS-- AT THE CENTERS REQUIRE A VARIETY OF PHYSICAL, MENTAL AND SOCIAL SERVICES RELATED TO ALCOHOL OR OTHER DRUG ABUSE DEPENDENCY. THE PROPOSED SEPARATION BETWEEN THE DEPARTMENT OF HEALTH SERVICES AND THE DEPARTMENT OF PUBLIC HEALTH WILL HAVE AN IMPACT ON THE WAY THESE SERVICES ARE PROVIDED DUE TO THE ADMINISTRATION OF THIS PROGRAM. FOR EXAMPLE, THE A.V.R.C. ADMINISTRATION CURRENTLY REPORTS TO OLIVE VIEW MEDICAL CENTER, WHICH WOULD REMAIN WITHIN THE DEPARTMENT OF HEALTH SERVICES, WHILE THE ANTELOPE VALLEY RECOVERY CENTER DELIVERY OF ALCOHOL AND DRUG PROGRAMS WOULD BE PLACED UNDER THE ADMINISTRATION OF THE DEPARTMENT OF PUBLIC HEALTH. SO, TO ENSURE CONTINUING CARE, IT'S NECESSARY TO FULLY ADDRESS HOW THE ADMINISTRATIVE CHANGE WILL AFFECT THE OPERATIONS OF THOSE PROGRAMS. WHAT WE NEED TO HAVE IS, WHEN WE MOVE FORWARD WITH THIS SEPARATION OF THE TWO DEPARTMENTS, A COLLABORATION BETWEEN THE TWO DEPARTMENTS TO ENSURE THAT THOSE SERVICES ARE STILL ABLE TO BE MAINTAINED. AND SO, AS PART OF THE MOTION, WOULD BE TO HAVE THE BOARD DIRECT THE DEPARTMENT OF HEALTH SERVICES AND PUBLIC HEALTH, ALONG WITH THE C.A.O., TO WORK IN COLLABORATION WITH A REPORT ON FEBRUARY 7TH ON A COMPREHENSIVE PLAN TO ADDRESS THE RESOURCE AND ADMINISTRATIVE NEEDS OF THE ANTELOPE VALLEY REHABILITATION CENTERS, ASSUMING THE SEPARATION OF THE DEPARTMENT OF HEALTH SERVICES AND PUBLIC HEALTH OCCUR, INCLUDING POSSIBLE FISCAL IMPACTS RELATED TO THE PROPOSED ADMINISTRATIVE CHANGE AND PROVIDE TO THE BOARD A DRAFT MEMORANDUM OF UNDERSTANDING BETWEEN THE DEPARTMENTS OF HEALTH SERVICES, PUBLIC HEALTH AND MENTAL HEALTH RELATED TO A.V.R.C. BY FEBRUARY 7TH. AND I WOULD ALSO HAVE THIS MOTION APPLY TO OTHER PROGRAMS THAT THE OTHER DISTRICTS ARE HAVING AS WELL, SO THAT, IF THE DEPARTMENTS ARE SEPARATED, THOSE-- SAY DRUG REHAB PROGRAMS ARE NOT GOING TO BE PUT IN A CATCH-22 SITUATION. WE WANT TO ENSURE THAT THE SERVICES ARE CONTINUED WITHOUT INTERRUPTION AND THAT THE FINANCIAL IMPLICATIONS ARE ALL RESOLVED PRIOR TO THE SEPARATION OF THE TWO DEPARTMENTS, BECAUSE THE INTENT IS TO HAVE PUBLIC HEALTH BE ABLE TO STAND ON THEIR OWN TWO FEET BUT THE INTENT IS NOT TO HAVE THESE TYPES OF REHABILITATION PROGRAMS BEING ENDANGERED FROM THEIR SUCCESSFUL OPERATION. SUPERVISOR BURKE.


SUP. BURKE: I'D LIKE TO GET A LITTLE BIT BETTER UNDERSTANDING AS IT RELATES TO OUR CLINICS, PARTICULARLY AS IT RELATES TO H.I.V. NOW, H.I.V. WILL BE UNDER-- WILL THAT BE UNDER PUBLIC HEALTH?


C.A.O. JANSSEN: DR. FIELDING, WOULD YOU-- AND TOM?


SUP. BURKE: AND EXACTLY HOW THE CLINICS WILL FUNCTION. HISTORICALLY, OUR CLINICS WERE, FOR THE MOST PART, PUBLIC HEALTH CLINICS BUT NOW OUR CLINICS ARE COMPREHENSIVE AND I'D JUST LIKE TO GET A BETTER UNDERSTANDING AND MOVE FORWARD WITH THIS M.O.U. EXACTLY HOW YOU PROPOSE IT. IT'S GOING TO BE TWO SEPARATE ENTITIES WITHIN THE CLINIC OR HOW WILL IT FUNCTION? AND ALSO HOW DOES THE H.I.V., WHERE DOES IT FALL IN?


DR. JOHN SCHUNHOFF: SUPERVISORS, ON THE H.I.V. PIECE OF THIS, THE PROPOSAL FROM THE WORK GROUP IS THAT THE HOSPITALS AND COMPREHENSIVE HEALTH CENTERS THAT DO H.I.V. CARE WOULD CONTINUE TO DO H.I.V. CARE AND THAT INCLUDES ALL THE ACUTE HOSPITALS, ALL FOUR HOSPITALS THAT HAVE BOTH INPATIENT AND OUTPATIENT SERVICES, THEY WOULD CONTINUE TO DO THAT AND THE OFFICE OF A.I.D.S. PROGRAMS AND POLICY, WHICH FUNDS PREVENTION AND FUNDS SOME OF THAT CARE, WOULD BE WITHIN THE PUBLIC HEALTH PIECE. IT WOULDN'T CHANGE THE RESOURCES THAT ARE PROVIDED CURRENTLY FROM THE OFFICE OF A.I.D.S. PROGRAMS AND POLICY TO THE COUNTY'S HOSPITALS OR COMP CENTERS FOR THE H.I.V. TREATMENT OR CARE OR PREVENTION, EARLY INTERVENTION CLINICS, THINGS OF THAT SORT. SO, IN OTHER WORDS, IT WOULD HAVE NO REAL IMPACT ON THE OPERATION OF ANY OF THE H.I.V. SERVICES.


SUP. BURKE: BUT MY UNDERSTANDING IS YOU WOULD THEN REPORT TO PUBLIC HEALTH.


DR. JOHN SCHUNHOFF: O.A.P.P. WOULD REPORT IN TO PUBLIC HEALTH BUT IT'S NOT MUCH DIFFERENT THAN WHAT WE HAVE RIGHT NOW IN THE SENSE THAT SOME OF THE FUNDS THAT SUPPORT THE OUTPATIENT CLINICS AT THE HOSPITALS ARE FUNDS THAT ARE EITHER CARE ACT FUNDS OR COUNTY FUNDS THAT GO THROUGH A DEPARTMENTAL SERVICE ORDER FROM THE OFFICE OF A.I.D.S. PROGRAMS AND POLICY TO THOSE OUTPATIENT CLINICS AND THOSE HAVE A SCOPE OF WORK ATTACHED TO THEM AND THOSE WOULD CONTINUE UNDER THE PLAN.


SUP. BURKE: THEY WOULD STILL BE PART OF THAT, WHAT DO YOU CALL IT, REGION, IS THAT IT?


DR. JOHN SCHUNHOFF: RIGHT. MOST OF THE RESOURCES ACTUALLY THAT FUND-- ALL THE RESOURCES THAT FUND THE INPATIENT CARE AND MOST OF THE RESOURCES THAT FUND THE OUTPATIENT CARE IN OUR COUNTY HOSPITALS FOR H.I.V. ARE BASED UPON REVENUES AND NET COUNTY COSTS THAT IS IN THOSE HOSPITALS' BUDGET BUT SOME OF THAT COMES FROM O.A.P.P.


DR. THOMAS GARTHWAITE: SUPERVISOR, THE ONLY DIFFERENCE THAT I WOULD SEE WOULD BE THAT, IF THERE WERE A DISPUTE AS TO WHETHER THE REIMBURSEMENT WERE ADEQUATE OR THERE WAS SOME PROBLEM, IT CURRENTLY WOULD COME TO THE DIRECTOR OF THE DEPARTMENT AND, IN FUTURE, IT MIGHT END UP THEN AT THE BOARD LEVEL.


SUP. BURKE: WHO WOULD BE THE ON-SITE MANAGER WITHIN THE CLINIC? WOULD IT BE A PERSON WHO IS A HOSPITAL PERSON OR HEALTH DEPARTMENT PERSON OR WOULD IT BE A PUBLIC HEALTH PERSON?


DR. THOMAS GARTHWAITE: WITH REGARDS TO A.I.D.S. PROGRAMS?


SUP. BURKE: NO. AS REGARDS TO EVERYTHING. THE PERSON WHO IN CHARGE OF THE CLINIC. OKAY, FOR INSTANCE, AT HUMPHREY RIGHT NOW, THE PERSON IS THE HEALTH SERVICE DEPARTMENT PERSON.


DR. JONATHON FIELDING: IT WOULD REMAIN THAT.


SUP. BURKE: IT WOULD REMAIN-- AND THEN THE PEOPLE-- AND THE PUBLIC HEALTH SERVICES, THEY WOULD THEN REPORT TO WHO?


DR. JONATHON FIELDING: THE PUBLIC HEALTH...


SUP. BURKE: THAT ARE IN THE CLINIC. YOU HAVE THE CLINIC AND YOU HAVE COMPREHENSIVE SERVICES AND SO THE PERSON WHO IS IN CHARGE, AND MOST OF THEM NOW ARE IN THE DEPARTMENT OF HEALTH SERVICES, THEY WOULD REMAIN DEPARTMENT OF HEALTH SERVICE PEOPLE. NOW, THE PEOPLE WHO ARE IN THE CLINIC WHO ARE DOING PUBLIC HEALTH SERVICES, WHO DO THEY REPORT TO? ARE THEY GOING TO HAVE ALSO ANOTHER PERSON?


DR. JONATHAN FIELDING: WELL, SUPERVISOR, WITH THE EXCEPTION OF A FEW TUBERCULOSIS CLINICS, PUBLIC HEALTH DOES NOT OPERATE AND DOES NOT HAVE PERSONNEL IN THE REST OF PERSONAL HEALTH SERVICES. SO IT DOESN'T HAVE PERSONNEL IN THE COMP CENTERS. THERE WOULD BE NO CHANGE IN THE REPORTING RELATIONSHIPS.


SUP. BURKE: SO AS FAR AS TUBERCULOSIS, FOR INSTANCE, THAT WOULD STAY UNDER HEALTH SERVICES AND SEXUALLY-RELATED DISEASES AND TESTING WOULD RELATE-- THEY DO THAT AT OUR CLINICS.


DR. JONATHAN FIELDING: A LOT OF THE CLINICS, THE COMP CLINICS AND OTHER CLINICS AND P.P.P.S DO SEXUALLY TRANSMITTED DISEASE SERVICES. PUBLIC HEALTH RUNS SOME SEXUALLY TRANSMITTED DISEASE SERVICES, PRIMARILY FOR THOSE INDIVIDUALS WHO ARE NOT LIKELY TO COME FORWARD TO THE REGULAR SOURCES OF CARE AND NEED ANOTHER PLACE TO GO WHERE THEY'RE AT LEAST MORE WILLING TO COME AND BE TREATED AND TALK ABOUT THEIR SYMPTOMS AND THE ISSUES.


SUP. BURKE: AND ALSO NOTIFYING PEOPLE WHO MIGHT HAVE BEEN EXPOSED. THAT'S A PUBLIC HEALTH RESPONSIBILITY.


DR. JONATHAN FIELDING: RIGHT. RIGHT. THAT'S CORRECT.


SUP. BURKE: AND THE PERSON WHO WOULD BE IN CHARGE OF ALL OF THAT AND DOING THAT IN THE CLINIC WILL REPORT TO THE PERSON FROM HEALTH SERVICES OR ARE THEY GOING TO REPORT TO YOU OR TO WHOEVER IS IN CHARGE OF PUBLIC HEALTH?


DR. JOHN SCHUNHOFF: PERHAPS I COULD GIVE AN EXAMPLE. THE H.I.V. OUTPATIENT SERVICES AND S.T.D.S AND OTHER SERVICES ARE TREATED AT HUMPHREY COMPREHENSIVE HEALTH SERVICES. THAT'S OPERATED BY PERSONAL HEALTH AND THE PROPOSAL WOULD BE THAT THAT CONTINUES. SOUTH HEALTH CENTER, WHICH IS NOT TOO FAR AWAY, PROVIDES SPECIFIC CATEGORICAL CLINICS FOR S.T.D. AND FOR TUBERCULOSIS. THOSE WOULD-- THE SOUTH HEALTH CENTER, IN THIS EXAMPLE, WOULD CONTINUE BE OPERATED BY PUBLIC HEALTH. HUMPHREY WOULD CONTINUE TO BE OPERATED BY PERSONAL HEALTH AND THEY WOULD CONTINUE TO DO THE S.T.D. TREATMENT FOR PEOPLE WHO WALK IN THERE COMPARED WITH PEOPLE WHO GO TO A CATEGORICAL S.T.D. CLINIC AT SOUTH.


SUP. BURKE: I SEE AND YOU'RE PRETTY-- YOU'RE COMFORTABLE WITH THAT?


DR. JOHN SCHUNHOFF: YES.


SUP. BURKE: THAT IT'S GOING TO WORK.


SUP. MOLINA: WHAT BENEFIT WOULD THAT BE? TO ANYBODY?


DR. JONATHAN FIELDING: WELL, THOSE EXACTLY ARE THE ARRANGEMENTS THAT WE CURRENTLY HAVE AND SO THIS DOES NOT ANTICIPATE ANY CHANGE IN THE CURRENT-- IN THE CURRENT ARRANGEMENTS.


SUP. MOLINA: SO WHAT BENEFIT IS THERE, IF THERE'S NO CHANGE IN THE CURRENT ARRANGEMENT, WHAT'S THE BENEFIT?


DR. JONATHAN FIELDING: THE BROADER QUESTION OF HOW...


SUP. MOLINA: YOU COULD CHANGE THINGS TO MAKE IT BETTER OR MORE EFFECTIVE OR...


DR. JONATHAN FIELDING: WELL, I THINK THERE ARE SOME BENEFITS TO PATIENTS, SUPERVISOR, OVERALL IN THE PROPOSED...


SUP. MOLINA: NO, THAT'S NOT WHAT I ASKED. IN THIS ARRANGEMENT, YOU'RE TALKING ABOUT AIDS AND S.T.D.S, WHAT'S THE BENEFIT?


SUP. YAROSLAVSKY: CAN'T HEAR YOU, GLORIA. SPEAK INTO THE MIC. CAN'T HEAR YOU.


SUP. MOLINA: WHAT'S THE BENEFIT?


DR. JONATHAN FIELDING: I'M NOT SURE THAT, FOR AN INDIVIDUAL T.B. PATIENT, FOR EXAMPLE, THAT THERE NECESSARILY WILL BE AN OVERALL BENEFIT EXCEPT THAT I THINK WE'LL BE ABLE TO-- BE ABLE TO DO PERHAPS BETTER PLANNING ABOUT T.B. FOR EXAMPLE, BEFORE HIGH DESERT WAS CLOSED, YOU KNOW, THERE WAS THIS ISSUE OF T.B. PATIENTS WHO DIDN'T NEED TO BE THERE FROM A MEDICAL STANDPOINT BUT FOR WHOM WE HAD COMPLIANCE ISSUES AND DIDN'T WANT THEM OUT, YOU KNOW, WHERE THEY MIGHT INFECT OTHERS. I'M NOT SURE THAT THAT ISSUE WAS ONE THAT WAS PERHAPS BROUGHT BEFORE THE BOARD, SO, IN THAT CASE, WE WOULD MAKE SURE THAT ISSUES THAT WE THINK ARE MAJOR POLICY ISSUES ARE DEFINITELY BROUGHT TO YOUR BOARD.


SUP. MOLINA: THAT'S THE BENEFIT?


DR. JONATHAN FIELDING: THAT IS A BENEFIT. I THINK IT'S A BENEFIT.


SUP. ANTONOVICH, MAYOR: DO YOU WANT TO HEAR THE SPEAKERS FIRST?


SUP. BURKE: LET'S HEAR THE SPEAKERS.


SUP. MOLINA: I WAS GOING TO SAY, ARE WE GOING TO HAVE THE SPEAKERS FIRST AND THEN I'D LIKE TO ASK FURTHER QUESTIONS.


SUP. ANTONOVICH, MAYOR: CHRIS EDWARDS. FIRST OF ALL, WE'RE GOING TO HAVE A COUPLE HAVE SIGNED UP ALSO FOR 59 AND FOR NUMBER 60, AND SO WE CAN DO IT ALL AT ONE TIME BECAUSE IT'S ALL RELATED. KATHY OCHOA, AS I MENTIONED, DR. CLAVREUL AND CHRIS EDWARDS. IS CHRIS EDWARDS HERE? YES. OKAY. THEY WILL THEN BE FOLLOWED BY ROBERT DOWIN, SAMUEL GARRISON, MARVIN ESPINOZA, DR. BRESLOW, AND NANCY WATSON. JUST GIVE YOUR NAME FOR THE RECORD BEFORE YOU SPEAK, PLEASE.


KATHY OCHOA: GOOD MORNING, SUPERVISORS. MY NAME IS KATHY OCHOA AND I AM HERE REPRESENTING S.E.I.U. LOCAL 660. S.E.I.U. LOCAL 660 WOULD LIKE TO EXPRESS WHAT SEEMS TO BE WIDELY SHARED CONCERNS ABOUT THE WORK TO DATE IN ANALYZING THE RECOMMENDATIONS TO BIFURCATE SERVICES WITHIN THE COUNTY D.H.S. AND CREATE A SEPARATE PUBLIC HEALTH DEPARTMENT. WE BELIEVE THAT THIS ITEM SHOULD BE HELD OVER SO THAT THE MILES OF LEGAL, TECHNICALLY-- TECHNICAL BUT, MOST IMPORTANTLY, POLICY ISSUES ARE ADDRESSED. S.E.I.U. LOCAL 660 HAS YET TO TAKE A POSITION AS TO WHETHER WE SUPPORT THE CONCEPT OR NOT. THERE ARE JUST TOO MANY UNANSWERED QUESTIONS AND WE DEMAND A FULL UNDERSTANDING OF WHAT YOU ARE DOING AND WHY YOU ARE DOING IT. WE HAVE ADOPTED A SET OF PRINCIPLES TO GUIDE OUR DECISION MAKING THAT ADDRESS, FOR EXAMPLE, QUALITY, ACCESS, SERVICE INTEGRATION, FUNDING, ADMINISTRATIVE SERVICES, STAFFING AND WORKERS' RIGHTS. ONLY WHEN WE HAVE A COMPLETE SENSE OF THE IMPACT OF THE PROPOSAL WILL WE TAKE A POSITION AS TO WHETHER THIS ACTION IS IN THE SERVICE OF ALL COUNTY RESIDENTS OR NOT. AND WE EXPECT YOU TO RESERVE JUDGMENT UNTIL YOU ARE ASSURED THAT YOU ARE ACTING IN THE COUNTY'S BEST INTEREST. WE APPRECIATE AND SUPPORT SUPERVISOR KNABE'S CALL FOR THOROUGH AND THOUGHTFUL REVIEW AND COMMENT BY THE PUBLIC. WE MUST REMIND YOU, HOWEVER, ONCE AGAIN, OF YOUR CONTRACTUAL OBLIGATIONS TO MEET WITH THE UNION ON ANY REORGANIZATION. WHAT WE TALK ABOUT IN SUCH SESSIONS IS NEGOTIABLE. YOUR OBLIGATION TO DO SO IS NOT. WE PROTEST THE LACK OF RESPECT TO S.E.I.U. LOCAL 660'S MEMBERS DEMONSTRATED BY STAFF CHARGED WITH EMPLOYEE RELATIONS AND FEEL WE MUST DO SO PUBLICLY. WE CANNOT AND WILL NOT TOLERATE THIS. WE SHOULD AND MUST BE INTEGRATED INTO ONGOING DISCUSSIONS AT THE SOONEST POSSIBLE DATE. SUPERVISORS, S.E.I.U. LOCAL 660 IS NOT FOR THE STATUS QUO. THEREFORE, WE BELIEVE THAT THE COUNTY MUST ACT IMMEDIATELY ON THE RECOMMENDATIONS IDENTIFIED BY THE C.A.O. THAT IMPROVE THE COUNTY HEALTH SERVICE, WHETHER THIS BOARD DECIDES TO MOVE FORWARD OR NOT. FOR EXAMPLE, ONE PLACE TO START WOULD BE THE DEVELOPMENT OF AN INTERNAL POLICY DOCUMENT THAT BETTER DELINEATES THE GOALS AND COORDINATION OF PERSONAL AND PUBLIC HEALTH OPERATIONS. ANOTHER WOULD BE TESTING THE VIABILITY OF BREAKING OUT THE SPECIFIC SHARED RESPONSIBILITIES OF BOTH. THIS WE FEEL WILL BEGIN TO ADDRESS THE CORE POLICY QUESTIONS ABOUT THE WHAT AND WHY AND ANSWER WHETHER WE NEED TO PROCEED FURTHER OR NOT. ENSURING ADEQUATE STAFFING FOR THE HUMAN RESOURCE AND CONTRACTS AND GRANTS FUNCTIONS SO THAT THE FULL NEEDS OF THE ENTIRE D.H.S. ARE ADDRESSED IS ANOTHER REASONABLE AND LONG OVERDUE PLACE TO START. S.E.I.U. LOCAL 660 IS COMMITTED TO IMPROVING THE FISCAL STABILITY AND SERVICE CONFIGURATION OF BOTH PUBLIC HEALTH PROGRAMS AND SERVICES AND PERSONAL HEALTH. WE BELIEVE THAT THE CRITICAL PATH TOWARD ACHIEVING QUALITY, ACCESS, FISCAL STABILITY AND SAFE AND CARE WORKING ENVIRONMENTS BEGINS WITH PLANNING. WHAT DO WE WANT OUR HEALTHCARE SYSTEM TO LOOK LIKE? INTEGRATED? SEPARATED? A COMBINATION OF BOTH? IN THE LONG RUN, PLANNING FOR OUR SYSTEM'S FUTURE, WHEREIN THE TALENT AND RESOURCES OF THE S.E.I.U. ARE COMBINED WITH THE TALENT AND RESOURCES INTERNAL AND EXTERNAL TO THE COUNTY IS A CRITICAL FIRST STEP. TODAY IS AN IMPORTANT DAY. WE HOPE YOU VOTE IN FAVOR OF THE KNABE MOTION AND THAT, WHEN YOU DEEM IT APPROPRIATE TO APPOINT AN INTERIM D.H.S. DIRECTOR AND SEARCH FOR A PERMANENT REPLACEMENT, YOU IDENTIFY SOMEONE WHO VALUES OUR LONGSTANDING PARTNERSHIP AND WHO WILL PROVIDE DESPERATELY NEEDED LEADERSHIP AS WE BUILD A SYSTEM FOR 21ST CENTURY HEALTHCARE. THANK YOU, SUPERVISORS.


SUP. ANTONOVICH, MAYOR: THANK YOU, KATHY.


CHRIS EDWARDS: I'LL SPEAK FIRST. CHRIS EDWARDS. I'M GOING TO KEEP IT SHORT BECAUSE I THINK SUPERVISOR KNABE'S MOTION SAYS IT ALL, PRETTY MUCH. I THINK YOU REALLY DO NEED TO TAKE YOUR TIME, TAKE A STEP BACK, REALLY LOOK AT EVERYTHING AND I THINK IT WOULD BEHOOVE YOU TO INDEED ENGAGE THE PUBLIC IN SOME DISCUSSION ABOUT THIS CHANGE, ESPECIALLY WHEN YOU LOOK AT THE ONGOING ISSUES WITH CONTRACTS AT O.A.P.P. AND HOW THEY'VE BEEN DEALT OUT IN THE PAST. MR.-- EXCUSE ME, DR. FIELDING, HEADS OR OVERSEES THAT DEPARTMENT THROUGH HIS ALREADY ASSIGNED DUTIES IN PUBLIC HEALTH. HE HAS NOT BEEN ABLE TO FIX THAT. THE BOARD HAS BEEN UNWILLING TO FIX THAT. SO, BEFORE YOU MAKE A JUMP AND PUT HIM IN CHARGE OF A TOTALLY SEPARATE ARM, LET'S DOT ALL THE IS, CROSS ALL THE TS, ENGAGE THE PUBLIC IN DISCUSSION. ASK YOURSELF, IF WE SEPARATE D.H.S. AND PUBLIC HEALTH, IF IT ALTERS HOW SOME OF THESE HEALTH SERVICES ARE DELIVERED, DOES THIS ASK-- DOES THIS REQUIRE A BEILENSON HEARING AS WELL? OKAY. THANK YOU.

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