Welcome all.

We're gonna call the special select board meeting of July 28th to order.

6.15 p.m.

There was no executive session today.

And uh board, any adjustments to the agenda?

Seeing none.

I'm gonna open public comment for the meeting.

And as a reminder, if you're in the room, please just raise your hand and I'll call on you.

If you're on Zoom, use the raise hand thing, and Seth will bring you to my attention.

And when I recognize you, please come up to the microphone, state your name, and make your comment.

And any comments you make today should be about items not otherwise on the agenda.

So if you have comments about the two birthing center items, please hold them until regular business.

So uh any members of the public with a comment or question.

Yes, Tom.

And then Dick.

Tom Frank Sprotleboro.

Members of the Select Board.

At the July 23rd meeting of the Charter Revision Commission, the Chair of the Commission informed the members and public present that it was not humanly possible to hold the vote on their charter proposal at the November general election, as had been their expressed intent since June of last year.

Their chair explained that this conclusion and a decision to hold the vote on charter changes in March of 2027 was reached in a meeting with the full select board, the town clerk, the town manager, the town attorney, and two members of the commission.

The chair also reported that they had been in conversation with the town clerk for the about the schedule for the vote for approximately two weeks.

The chair of the CRC also noted that the select board's decision to hold this meeting on July 28th, this particular meeting preempted the Commission's meeting at which they intended to finalize their proposals.

This makes it impossible for the Commission to meet its proposed schedule for a town wide vote in November, according to the Chair.

The July 23rd meeting of the Select Board was not warned, was not open to the public, was not recorded, and there are no published minutes.

A member of the public was told that this was because it was a scheduled meeting and thus exempt from Vermont's open meeting law.

It is appalling that a decision of this consequence was made in a rushed secret meeting.

The schedule for the general election and the proposed schedule for the charter change have long been a matter of public record.

There is sufficient time to warrant a special meeting to address this issue, just as the select board did for this meeting tonight.

This decision to schedule a town wide vote is not a minor scheduling change.

It is a matter of great importance to the town.

By shifting the vote from the November general election to the town meeting day, the number of people likely to vote has been slashed from an average of roughly 5100 voters in the midterms to 2100 on town meeting day.

This is effectively voter suppression.

The on-warn meeting on July 23rd, the unwarned July 23rd Select Board meeting was not consistent with the intent or even the letter of Vermont's opening meeting law.

The statutes are explicit as to the permissible exemptions from the public meeting requirements.

One exemption does relate to scheduling a meeting.

However, meeting is defined as a gathering of a quorum of the members of a public body and nothing else.

The statutes explicitly limit the scope of these exemptions.

In one it states that uh it shall be exempt, provided that the public body does not discuss specific business of the public body.

That at the time of the exchange, the participating members expect to be the business of the public body.

This exemption clearly does not apply to a town wide vote.

This is the select board's business.

There is no credible argument that the select board didn't know this would be a matter for public meeting, considering the involvement of town staff, legal team, and other members with the CRC over the last two years.

There is still time to have the vote in November.

It may not be easy, but it is possible according to statutes.

Please tell us all what you plan to do about this abuse of power.

Thank you.

Thanks, Tom.

That's a great question.

I'll speak briefly about it, and then if town attorney has any comment, that's useful too.

Yes.

I just wonder, may I get some more chairs?

Chair?

Chairs?

Sure.

Okay.

Um the Vermont statutes do carve out an explicit exemption for conversations about scheduling.

The question of how to schedule the meetings and the process in the run-up to a charter change is complex and relies on a bunch of things that run into one another.

There are questions of when the charter commission is done with its work.

There are questions of logistics with the town clerk's office, and all of those decisions have to be made quite a bit in advance because otherwise we can't roll out the right schedule.

In this case specifically, um we had to make a scheduling decision quickly because a November election affected the schedule of meetings we needed to have in the run-up to that.

So I think the plain language of the statute as I read it speaks for itself.

We also consulted with the town attorney behold before holding the meeting and got their opinion.

And as someone who is at the meeting, I think probably five or ten times as chair, I reminded people when we were getting away from scheduling matters and towards substantive things and reminded them that we could only discuss scheduling.

So if you have any follow-up, I'm happy to discuss it outside the meeting, but that's my response for now.

Other questions or comments from the public?

Yes, Seth.

Yeah, Kurt Times on the line.

Hello.

Everybody hear me.

Kurt.

Can you hear me?

Yes, we can.

Yes, um, this is Kurt Dimes with Brattleboro Common Sense.

I recognize uh that the town is gonna consider a substantial expense, perhaps in um endorsing the uh birthing center.

Um I'm not gonna talk about the merits of that.

I'm just gonna say that we need new funding sources, and um this is a perennial problem.

Uh on the back burner of Brattleboro common sense over the last three years, while the select board was pursuing its ill-advised and unfair lawsuits against us about the homeless center.

Uh we put our tax proposal on the back burner.

But uh we are coming back now and hope to uh reorganize and reinvigorate our uh our agenda, including the these tax proposals.

Um they can raise uh considerable amounts of money for the town, uh, especially from capital gains on uh Wall Street investments.

Um in 2011, and the project goes back quite a ways.

In 2011, um uh Bernie Sanders uh helped us with this.

He referred us to Doug Hoffer, who is the state auditor, and uh Doug uh did the first uh uh study of uh a simple tax proposal on capital gains that would raise um five hundred eighty thousand dollars or a million dollars.

Uh and we had another study which anyway, there were two studies.

One said a million, the other said 580,000, and uh we had uh Doug Hofer's help on that.

This is a really potent uh project.

Um there are three other tax uh methods, um one of which could possibly be enacted without state approval.

Uh we need a little bit more legal work on that.

But the point is the project is over the heads of the people who are in the organization now, and uh we would be glad to have uh anyone from the public, uh an economist, uh finance specialist, uh, help us develop the project further.

And um anybody on the select board could help too.

There's a lot to learn.

Like I say, the project is way over my head, it's way over the the heads of the other people who are still with the organization.

Um several PhDs have worked on it, and it's it's ready to go.

Uh we could have you could put it on the books now, but there's there are some there are some things that still need to be done for best for best promotion for best uh dotting of eyes.

Anyway, uh there's um plenty to do on this, and we are open to the select board's help.

over the the heads of the other people who are still with the organization um several PhDs have worked on it and it's it's ready to go uh we could have you could put it on the books now but there's there are some there are some things that still need to be done for best for best promotion for best uh dotting of eyes could I uh there's um plenty to do on this and we are open to the select board's help thank you thank you other comments by the public Randy uh Randy Dick and then Sue I Randy Bloggy Bradleboro just to follow up so can you tell us when or if there's a current new schedule for the charter vote and when there'll be an info hearing when there'll be whatever next steps are that and when they'll occur throughout between now and March because we for for years we thought it was November for months now we thought for sure it was August 4th vote with you guys then November and now everything's just flipped around and besides the supermajority problem now it's not even in November it's in March have problems with that but I mean obviously it seems like we are where we are which I don't agree with but if we could get a schedule of when things are happening so we know when to be there when to testify and what to do very helpful.

Thanks Randy I what I can say about that is that when the select board there is no formal schedule decided on yet just the question of if we were to do it in March that would have required a series of scheduling decisions that we would have had to make and we felt with the input from the town clerk that that schedule wasn't tenable.

When we make what's that for November you said for yes sorry for for November.

Thanks John but when we make any formal decisions about the process it will be in public for example when we warn a meeting or warn an info session it will be in public it will be at a select board meeting and it will be by vote.

And of course if we know anything in advance of that or if the Charter Commission does we'll try to push that information out as early in the process as we can any other comments or questions?

Yes Sue and Dick I forgot I'm sorry.

Susan Bellville Brattleboro I'm going to push back a little bit on the answer with regard to the timing of the meeting on the 23rd the 23rd was last Thursday this meeting was already on the schedule and it was warned on the 24th how come you didn't put this that particular CRC discussion for timing on this agenda so that we could all be part of that discussion and not have it as a meeting without public input with no record of what was said and how it was discussed to come up with postponing things until sometime in March maybe.

And there's plenty of time to do it there's plenty of time to have those public meetings between now and November I I don't understand the delay.

Thank you.

Thanks Sue I I don't want to wait too far into specifics now during public comment but I'm happy to talk about it after with anyone who's interested Dick DeGray Brattlebrough and one thing Mr Chairman when people come up if you could ask them to say what town they're from I think that would be important uh especially given what's in front of us this evening thanks Dick uh I have a few things uh one that concerns me is uh I believe that uh our ladder truck the big two million dollar ladder truck that we waited for two years has been responding to EMS calls and the reason that I know that is that it came to my neighbor's house when they needed uh EMS to come there that's a that's an expensive piece of machinery to be driving it around and and also I think dangerous to be driving around the streets and if uh someone uh uh hopefully John could find out why we're using that two million dollar truck that took us two years to get and a significant hit on our taxes that would be great item two is uh that uh I believe someone told me that there's some construction going on and then I heard a rumor that we're moving our finance department uh in the municipal building I don't know if that's true I hate to bring up rumors but if it is true uh I would like to know why we're moving it from where it's been from when the municipal center opened where I've been paying my taxes for 44 years and people who have lived here a lot longer and what the justification is and where the money is coming from given how much money we spent to redo the area that they are sitting in now to get the full finance department in there.

I hate to bring up rumors, but if it is true, uh I would like to know why we're moving it from where it's been from when the municipal center opened, where I've been paying my taxes for 44 years and people who have lived here a lot longer.

And what the justification is and where the money is coming from, given how much money we spent to redo the area that they are sitting in now to get the full finance department in there.

And then lastly, I'd like to mention uh that next week is bridge week.

Uh, and there's uh for the covered bridge.

And sadly, the evening that there's festivities, uh there's a select board meeting.

I'm not sure if anybody checked the schedule, but uh I remember last year it was sparsely attended, but uh, as people know, I do a little bit of work down there, my small part for beautification gets harder every year, and this probably will be my last year, but I digress.

Uh so I'm hoping that there's a huge turnout.

We're so fortunate to have that bridge in our community, and I can tell you uh from someone who spends a considerable amount of time up at that area.

The people that it draws from all over the country is just unbelievable.

And I hear all this talk on economic development.

I think that area is right for economic development to be a feeder into businesses in the community if we really look at it and want to do something.

Thank you very much.

Thanks, Dick.

And I've taken some notes on your questions and we'll follow up with you on that.

Other questions in the room?

Seth?

Timothy Balknapp, Brattleboro Vermont.

I too would be a proponent of making sure that we get the CRC vote in November.

Uh we can all come together and vote on it and get it done with.

Um I also wanted to ask the council what the difference could be between scheduling a meeting and scheduling a vote.

And something so important as a vote.

Uh it seems to me that we had better had some notes on this meeting revealed to the public.

Thank you.

Thanks, Tim.

Any other comments or questions?

Okay.

We're going to move ahead to the consent agenda.

John?

Uh yeah, just one item on the consent agenda tonight, and that is to appoint Dan Tyler as a town agent for the town on an upcoming tax sale.

Great.

And to approve voting on or approve the town to bid on any properties of the tax sale.

Oh, thank you, Hannah.

Great.

Okay.

Um, board members, any comments or questions about the consent agenda?

Seeing none.

All in favor.

Actually, I'd like a motion.

I'll motion to uh accept the consent agenda as presented.

Okay.

Peter has moved to accept the consent agenda as presented.

All in favor, please raise your hand and say aye.

Aye.

That carries five zero.

Moving ahead to regular business item A, uh birthing center discussion with some guests from the hospital.

So I'll invite Tony and Chloe up to the table.

Thank you for joining us.

Welcome both of you.

Thank you.

Thanks, thank you for the invitation.

Yes, of course.

Um, you did uh point out invite three of us.

Dr.

McClarney is at the end of a well-deserved and overdue break, so she couldn't be heard tonight.

Great.

Well, I'm glad to have both of you with us.

If you wouldn't mind just introducing yourselves to us and to the public, and then if you have any um opening comments, we can start there and then see what questions the board has.

I'm Tony Blofson.

I'm a family doctor and the acting co-CEO of Brattleboro Hospital since last October, uh, resident of Brattleboro.

And I'm Chloe Leary.

I am the chair of the Brattler Memorial Hospital Board of Trustees and a resident of Brattleboro.

Um I want to thank you for the invitation.

And it's um obviously very important what we're talking about today, about the birthing center, and particularly talking about whether the town should uh be interested in municipal tax.

Um I really want to thank the entire community.

It's been extraordinary, the outpouring of support.

As we try to keep the birthing center open.

Making it clear that we agree with that from the beginning.

We'd want to keep it open too.

And we uh have both financial and workforce challenges about that, as everyone knows, and we can get into that later.

Um I want to make it very clear that Bradebrows Hospital did not ask for a tax increase.

We did not request this.

There was nothing behind those doors or anything saying we could use the help here.

This has been raised and offered to us.

While we are eager to accept help in different ways, there are other revenue streams that we have been pursuing very hard.

There's a rural health transformation grants out there, as everyone knows, a lot of money, and we've applied for that for the birthing center.

Um there's been several different ways we've talked about trying to increase the revenue for this.

I I'm going to mention three of them today now.

Using the hospital, that everyone can support their community hospital by being there.

Philanthropy, everyone can personally give on their own.

We've always had a philanthropy current.

We have an annual appeal coming out very soon.

And the other is paying bills.

We run a large bad debt, as do I think all the hospitals in the State, but Brattleboro, especially too, has a high bad debt number, and that would be very helpful for us too.

So there I just want to I will echo what Dr.

Blasson said that um this is not something anybody wants to do.

There are financial realities that are impacting rural health care.

And while we have to get our financial house in order, absolutely, there are some things that are systemic that this actually is an opportunity, I think that we see for our state to tackle rural health care issues that uh one institution can't do alone.

Or municipality.

So deeply appreciative of the support and I think the opportunity to bring the community together around something that we share and feeling um uh concerned about the impact on taxpayers and that this is uh again a systemic issue.

Brattleboro Memorial Hospital is a regional facility.

Um there are lots of things that we are not going to be able to solve with one-time payments.

So being cognizant or aware of the challenges that this kind of funding might um might bring with it.

Uh we appreciate the support and think that there are other opportunities for us to find solutions to this uh very challenging issue.

And what I would add to Dr.

Blofson's um what can we do?

How do we channel the energy?

Because there's a lot of really positive energy.

I think that uh the advocacy that people have done so far uh to calling the governor, being in touch with the administration has made a very big difference.

We've seen, you know, we have been talking with stakeholders at the state level, with legislators, there's a lot of support, some good questions, but a change in I think how willing how it's like, oh, BMH has a problem too.

Oh, maybe the state can work together to think about all of rural health care because Vermont is rural, and it's a national problem.

So uh, you know, some of you have probably heard me say this.

I think we have a cattle, this can be a catalyst for us figuring out how to solve some of those problems more broadly.

So um that's what I would add.

I'm gonna amplify a couple of things.

There's statistics that we've been throwing out to people you're aware of.

Over half the rural hospitals in this country do not offer birthing centers anymore.

All right.

Over 700 rural hospitals in this country are at risk of closing in the next year or two.

That's out of 1,400.

Um of the revenue streams we have been working on is the legislators.

Our local legislators have been right there with us.

We've mapped this several times.

They're talking about what they will be able to accomplish.

Again, they're not going to be in session until January, but they're working hard and they've been working on a plan with us too.

I'd like to just make a comment if I can, because there's um we've been receiving mail today about a digger article today that will also be in the commons today, which I think has something that's um a little inaccurate that I would like to address.

It says we've had a $30 million loss last two years.

You can't take one number, which was a loss for one year, and take a budget number and add those together.

The budget is dominant.

We budgeted as ever no at $14.5 million loss this year.

That's not gonna happen.

We're doing better than that.

So adding those two numbers, I thought somewhat unfair and inaccurate.

We've been getting a lot of questions and response about it.

I wanted to bring it up now.

One more thing I'd like to add.

Everybody has been supportive.

We're collaborating, everybody wants the hospital to survive.

Everyone wants the hospital.

I think we all want the birthing center too, but primarily, right?

The hospitals to stay alive.

Everybody's together in this.

I'm worried about this tax issue because this is going to be divisive.

There's going to be people say we can't afford it.

People say I can't afford it.

And this is going to be a divisive issue at a time when we really need to all be together.

Thank you.

Thank you.

Thank you.

Thank you both for those comments.

I think there's quite a bit of wisdom in there.

Um for the board and the public.

Um we only have you with us for this one agenda item, but I'd like us to try to keep our comments and questions informative and uh sort of information based in this first agenda item, and then we can talk about what the town may or may not do in the second agenda item.

Um so I'd like to open it up to questions from the board.

And uh I'd like to start off myself with just a couple simple factual ones that I have.

Um I think one of the great things about having this conversation today and having you guys here today is that opportunity for something that's been really confusing and sort of scary for people.

Now we just get to have a community conversation about it and get some information out there.

So I think that's great.

Um I think on Peter's show recently, you and Dr.

McClarney uh said that the the sort of magic budget number for the to keep the birthing center afloat for the full year for this year was 3.8 million.

Is that am I parsing that right?

The budget as as is uh being submitted if the birthing center was open for the year was estimated to be a four and a half or five million dollar loss.

The board, and correct me I'm wrong, was willing to accept some loss, more on the order of two million dollars in an attempt to have a long-term solution and keep it open.

Um that map is about three million dollars.

Okay.

Great.

And then the other question I had I just what are what are some milestones in terms of what's happening in the next month-ish that would be good for us to know about budget submission.

I know there's a Green Mountain Care Board meeting in mid-August.

Um, any timeline around the rural health transformation funds.

And I'm not expecting you guys to have everything at your fingertips, but anything you can share will be.

Those are three different numbers.

The budget submission is, I think tomorrow morning, if it didn't go in tonight.

So by tomorrow, the end of the day, tomorrow.

We have a uh hearing in front of the Green Mountain Care Board.

Brattleboro is slated for August 14th.

I think it's 10.30 in the morning.

The rural health transformation money, the grants are in, it's a matter of the Vermont and the uh agency of health services, AHS making its decisions on that.

There's no set timeline.

They seem to be very receptive to our needs, and I expect that'll happen this month in August.

I can't hold them to that.

Right.

And when we spoke earlier, the the thinking seemed to be that by September 1st we hope to know a good deal more.

Yes, we hope to know a whole lot more by then too.

Okay.

Well, great.

Um, other board members with comments or questions, either for us as a group or for our guests.

I have a question.

I'd love to start.

That's okay.

I would love if if you could speak about um Brattleboro becoming a critical access hospital and how that factors into what we're looking at for the long term.

Because I've I've heard in other meetings, and I think the public would like to learn more about that concept.

Okay, I'll try to keep it short, it's a little complicated.

Critical access hospital is a designation that happens, um, and if there's uh specific federal rules that apply, you have to have less than 25 beds, licensed for 25 beds, and you have to be a certain distance from other hospitals.

The idea being critical access, there's not anyone else close, right?

Um we are currently licensed for more beds than that.

Since we average a census less than 25, we could qualify for that.

We do not qualify for the mileage right now.

It's 35 miles from the nearest, but there's exceptions depending on the roads, winter, mountains, those kind of things, that can be less.

Vermont right now has eight out of the 14 hospitals or critical access.

You'll notice it one of them is particularly close to us, and we're equidistant to Grace Cottage.

But the rules that got some of them in before not necessarily applied now.

The reason we talk about critical access and being helpful is it reimburses differently.

Medicaid reimburses at a very low rate Medicare that increases for the critical access hospitals.

They get much more instead of 335%, it should be more like 80%.

Very helpful to get reimbursed in that way.

So could we qualify?

Possibly if we have, as Dr.

McLean say, an act of Congress.

It used to be the governor can make an exception, that's gone, which is how some of the other ones are critical access now.

So we it's potential getting bending, being flexible with some of these rules.

And I don't know if that can be.

But that would have to come through, I believe, the Senate right now.

US Senate.

And I think I'd like just like to add to that.

That's one of other options we're thinking about, right?

Healthcare is gonna have to transform.

The hospital will survive.

What will it look like in five years?

We'll find out.

And we have to think about things like critical access hospital, federally qualified healthcare systems.

That's another reimbursement change.

Um whether or not there are solutions around Medicaid reimbursements for um for birthing, or you know, they're up there a lot.

I just want to put it in that's not just the only answer.

We are looking at lots of options, and we will need to advocate and put that puzzle together to figure out how to make um BMH and our health care system sustainable.

So just that's one piece of a puzzle that we are looking at a lot of pieces.

There's no Hail Mary here.

Oh, sorry for the religious.

Sorry.

No uh silver bullet, maybe that's another one to say.

Thank you.

Thank you.

Thanks.

Other board members with questions or comments.

No, is that a hand raise?

Yeah.

Hi.

Uh, thank you guys for coming tonight.

Um I was curious, as it stands, uh, on July 1st, when you guys had announced the potential to close the birthing center, and we were given six to nine months for the budget that will be submitted tomorrow morning.

Does that include funding the birthing center through the first quarter or the first two quarters of the budget?

The first quarter.

So the six to nine months was the remainder of this year through the first quarter of so our fiscal year is October 1st through September 30th.

So it'll be through December.

So we're in that last fourth quarter now, that's three months.

First quarter takes us to December 31st.

Yeah, thank you.

Um it's helpful to hear about the potential timeline for the rural transformation funds.

Um we were able to see a letter saying from the AHS secretary saying that they were going to prioritize it.

Um then I had also seen the letter that was signed by something like 30 care providers requesting for a consideration of the Medicaid rate reimbursement rates to be increased to match um other primary care services, I think was the wording.

Have you guys had much traction on that?

I'm sure it's a longer process, but have you had any initial responses?

Not that I know of it.

That is a primary, I think that is a primary strategy.

So that as you point out, that's a more complicated long-term other states are doing it.

Um I I think that there's a model for it.

Um so I guess I think what a lot of people uh have been wondering, have been asking me what I've been wondering, um is essentially we've talked about you know the acceptable level of loss for the fiscal year, that three million being received could essentially support the board submitting an amended budget to consider funding the birthing center through the remainder of the fiscal year 27.

Um you guys know if the rural transformation grant was awarded to you, would that meet that marker?

So we asked for it's a very big ask.

I mean, I think what it's like over 10 million dollars with lots of different projects.

So it will depend on what they approve.

And we we put together a grid of like what would need to be in place.

So if they gave us three million and we had operational efficiencies of 500,000, and we raised another 500,000, and we looked at, you know, that that puzzle of what it at what it takes.

So I you know, when I look at that puzzle, I think there's a good range that the re the health care transformation money, even if we didn't get all 10 million, uh, would uh be a significant um indicator that we could remain open.

So we can't it promise anything.

I understand that.

We put it for several different grants.

I think eight for that total of 10 million.

And for different uh causes, yeah.

What I had read at least from what I had read, which had been forwarded to us by our town manager from the Secretary of AHS, AHS noted that they were um prioritizing the birthing center specific grant for the rural transformation funds.

Essentially the larger question that I'm asking is if a lot more is going to be known in early September, and I I apologize because I know you had said some of those other things outside of the rural transformation grant, um what may come down the pipeline and how would that affect your decision for the birthing center?

Um so the things that I mentioned were um philanthropy.

And you know, I think that certainly we've gotten a lot of feedback at that um in the past several years, sort of the focus on development and philanthropy at the hospital has fallen off.

So I think that there is an opportunity there for us to develop that must no pun intended, that muscle.

Um look there are plans for operational efficiencies.

There's been a lot of work, it just in and of itself wasn't enough to make the decision, but there's some some things that um that we can do to create efficiencies.

Um I think the in the short term the grant funds are pretty significant when the legislature gets into session.

I think there are opportunities there for things like I mean, I think the Medicaid reimbursement would take longer, but knowing that things are on the horizon would be helpful.

Um looking at uh long term, whether, you know, I think the Green Mountain Care Board, we there's no revenue, like we're not allowed to increase revenue or only a little bit, so I think there's opportunity to advocate there.

Um and then other um legislative uh or state possibilities around um the phrase for fixed costs.

Uh there's a couple other things that could happen to reimbursement.

One standby costs so that's the nurses and uh obstetricians, midwives are available even if there's no one laboring.

Right?

So with that the standby costs just means that they're paying and and some reimbursement acknowledging that they aren't the ready, similar to an emergency room.

They're there and ready whether the customer is there or not, the patients come.

So stem by costs.

The other is that um obstetrics you uh uh paid in a global, it's X amount of dollars for the birth, the whole thing, all the 15 visits or 30 visits, or two visits, it's a state global, and there's the opportunity to break that up into reimbursement uh piecemeal.

So those are available.

And honestly, I don't know if that's legislative or decision making by Diva and AHS.

Okay.

Um and so that that thank you for sharing that.

That's super interesting.

That to me also sounds like something that probably would not be do you guys anticipate you would hear about something like that or the freeze for fixed costs before by September?

I anticipate that would be longer, right?

Um if the board were to submit an amended budget to fund the birthing center for more of the fiscal of FY27, um when would you have to submit that by I don't think there's a deadline for that.

If there is a change in a service line, we would notify the Green Mountain Care Board AHS in that.

But I there's no set deadlines for that because it can be an unexpected change.

Okay.

So that theoretically that notification could be made December 30th of 2020.

There's timelines now after um S 190, there's timelines to close a service giving 30 days.

Notice 60 days that's that.

But I don't know of um deadlines for making an adjustment like that, like for um amping something up.

You know, we're gonna put in a budget for X amount of revenue.

If more people come in and then we have better access and we take care of more people, it it adjusts the budget adjusts.

The budget is the best guess.

And so has the board discussed when that assessment would be made in the first quarter.

Um not specifically.

I mean, we have monthly board meetings, there's a finance committee meeting.

I think the way information flow, I mean, certainly this is on the the top of the radar and would not, you know, special meetings can happen.

So I think all eyes are on and all intention, if there is a solution or if there is a path forward, we're gonna follow it if at all possible.

Yeah, I always said it it's monthly.

We're looking at it, I mean we're looking at more than monthly, but the board meets monthly and has special meetings if they need to.

We're not waiting for a quarter to go through.

No.

Thank you.

And I think I think uh the the last thing that's top of my mind here um is just what we've heard uh from some of the employees and the concerns about essentially their job security and how that creates challenges for you guys with employee retention.

Right.

Uh so is there like a communication plan in process with the employees?

I had heard that maybe the nurses had signed like a letter of intent.

I may be using I apologize.

Letter of commitment.

Thank you, yeah.

Um but if uh there's been a lot of discussion of um essentially showing from the community, I'm not putting this wholly on the hospital, but showing the staff that we are behind them and we are committed to them and we are you know are trying to support them as it is asked of them to stick through a pretty like a tough and insecure patch.

Very difficult time, right?

Very emotionally difficult.

It's their job, it's their it's what they do and love and how they support their families.

So we need this stand behind them too.

Remember, if there's no nurses or no midwives, you know, it doesn't matter how much money there is.

When we talk about workforce, we're talking about the nurses and the midwives and the obsturations and the pediatricians and all of the sports that bind them, and they all need to be there to do this job.

So I'm curious does the board or the administration um how have a plan for communicating updates to the staff, or has there been do they have a reasonable expectation of what the chances that the funding that the service will continue past the first quarter?

The chance one is very hard.

Because that what's the chance of the real hot transformation?

That's our are we communicating them?

We try as hard as possible to stay as transparent as possible.

That's what Dr.

McClare and I have been doing since meaning to keep people updated because there was too many surprises came in October.

And since then we've tried, we do announcements usually by um a video to the to the hospital staff to everyone to keep them updated.

We're especially in touch now with the um I'm gonna say birthing center staff, that's a wide variety of people of plans and what we're doing, all these things that we're talking about here, letting them know that we're we're attempting to get these revenue streams going.

And how we're supporting them when we we really appreciate the commitment that they're saying.

Nurses there have been there for 40 years.

You know, they've been there a long time, they've been very committed.

Thanks, Nell.

Um Peter, Isaac, questions for our guests?

Yeah.

Um well, thank you for bringing up the issue of the systemic challenges with funding and the need for advocacy.

I appreciate I see Ellen Schwartz is here, and at a recent meeting when we were discussing the birthing center, she talked about the failures of a profit-driven health care system in adequately meeting the needs of our communities.

Um I understand there's also a long history of underfunding of women's health and women's health care, and I imagine that plays a role here in terms of the Medicaid reimbursement rates for birthing births.

Um you've addressed actually many of the questions that I had become prepared for and that I had shared with you ahead of time, Chloe.

And I see there that the budget Brattleboro Advisory Budget Committee, which we used to, it was roughly equivalent to the finance committee that we used to have, um, had a bunch of questions that I think you also have addressed.

Um my way over here, I was talking with someone who who raised the question about the hospital's finances in general, and just I think we're we're all concerned about the hospital.

Um and understanding that for a hospital with low of low birth volume, that this is um that generally low birth uh birthing centers, hospitals, uh birthly centers with low volume tend to be really dependent on the financial stability of the hospital or long term.

And curious, I know that you had um a lot to deal with over the last several months, um, but curious what your what your plan is or what your the hospital is doing to address the the long time long-term finances.

And also if there's uh the the idea of regionalization, if that's part of what you're looking at.

I can do it.

So I'll do a little second part first.

The regionalization, there's a whole um the state and the AHS agency human services uh really promoting regionalization.

So there's meetings, regular meetings now between our Southeast Corner, right?

Bradborough, Grace Cottage, Springfield, um, what services can be shared, what can go back and forth.

All of these are small hospitals, right?

Um should there be divided up, should this service be here and that service so they can be shared?

Because it gets very difficult in small towns to maintain everything.

You can't be everything for everyone.

Not everyone can have oncology and OB and cardiac, and your et cetera, et cetera.

It's very hard to staff that.

At Bratto Bros, you know, we have service lines of one person, right?

We have a urologist.

We have a gastroenterologist.

So that gets hard and maintaining is as people get older and leave the workforce keeping that.

So there's talk of regionalization, how that can be shared.

That's um Oliver Weimer report that came out two years ago, uh, started to push in that direction of some help.

Isaac, what have we done the last nine months?

Um we did a forensic uh look, which means we looked uh had an accountants come in and say, was there a criminal wrongdoing?

Did this money disappear because of embassy multi-anthologic?

No.

Um it was not due to any criminal act, it was not due to fraud or anything like that.

Health care in this country, I'm gonna agree, is very much driven on profit.

We can see that down the line, insurance companies, drug companies, medical schools, all of it.

It's very problematic that it's not focused on health rather than profit.

There's reimbursement problems all over the place.

And it becomes a game almost of how to beat the system to offer the services with trained people and get paid to cover that.

Medicaid, Medicare, what we bill, they pay a fraction of that.

30 something percent.

35 percent, let's say a third, we over.

There needs to be a systemic change in how health is reimbursed in this country.

Rural health care will become ever more in trouble.

Hospitals will close.

OB centers are gonna close.

It's been happening, it's happening already.

Um that's gonna take change at a state level, clearly at a federal level.

But it's I we have done a lot.

I mean, I think this is years of this is true, and on our level, we do a responsibility and we to look at keep our financial health in order.

And I will say um in the past um nine months, we've made significant gains and understanding how we got here.

This is years in the making.

Um, so much better reporting.

Um, you know, one of the things to talk about billing, it is a game, but we weren't even billing everything we could bill, right?

So lots of improvements and what people call revenue cycle, which if I hear that word a lot more, I might go crazy.

But I think we've done a lot to get our financial house in order, and we are definitely on the right track.

I feel very confident about that.

I hate to be the one on the board to uncover the problem, but I would way rather know what exists because that's the way we're gonna fix it.

And if we have to play the game, I think that we are well positioned as a community and a hospital if we continue on this path to make it.

I mean, we have to keep the hospital.

We have to keep a health services system here.

It's just we have to figure it out, and we will figure it out.

People made the system, people will fix it.

Working together we will.

So I I'm really I mean, I we could go through all the things, but it's been a lot of people.

We're billing better, we're gonna we're working back in the denial.

So you get put in a bill, insurance company denies it, you have to rework that again.

We're doing much better on those two things.

There are revenue streams.

Um, if there's bad debt on Medicare, bills unpaid, you can actually reapply to Medicare and get partially paid back for that.

We're doing better at that.

Um so there's quite a number of ways.

We've brought in uh a trio of really strong financial people to push on this, teasing experience from um many years as well as working in other institutions to change this around.

A lot of it's been one of the reasons it's discouraging slow, discouragingly slow for my surgeon colleague and I is that there's been a lot we had to fix.

We it's hard to move forward until you fix what's in the back, and there were a lot of um financial systems that needed to be repaired at the hospital, and it's taken a lot of time to fix those.

It's one of the reasons our budget couldn't go in on time, right?

Supposed to be July 1st, because we were still getting the okay from the accountants for last year.

Because we kept finding things.

So that had to go back in the 25 budget and find something new, and that goes back.

We weren't done.

And I'm gonna forget when the account file is in okay, May?

Yeah, very late.

So really recently, which means we really weren't ready to uh submit the Green Mountain Care budget in time because those had to be done.

We had to know the last one before we could do the new one.

And one more piece I'll say because I get to ask this question a lot is um how I mean people I think have said anecdotally, the birthing center loses money.

Like we I think we knew that.

Everybody knew that.

But the other thing that's improved is access to data.

So understanding how much we lost.

We didn't know that until April.

And suddenly that was a shock.

Like, oh my gosh, we knew it was losing money.

Um so until you know the scope of the problem, you can't fix it.

So having access to data, not just frankly for the birthing center, but other service lines, looking at the full service line picture is part of what we've been doing, and that again.

I I'm heartened by that.

As as hard as it is, impressing as it is how much time it's taking.

I I feel really confident and good about the information we're getting now, and that will help us be able to move forward.

Thank you.

Thank you both.

Uh Peter.

Yeah, sure.

Um again, thank you both for being here.

Um some some good conversations, some tough conversations.

Um since injecting myself into this conversation on on the second of the month, um I have learned way more than I'm comfortable knowing.

Okay, truth be told.

One of those things is when you take a look at other birthing centers.

And again, we can only control ours.

I understand that.

But trying to find out if everybody else is suffering the same fate.

And it would seem to me that they are.

And it is just but we do it because there's half the population that needs that health care.

And it's it's important, and that we should never never lose sight of that.

And that to me is first and foremost.

And then I delved into the numbers of other hospitals.

That because of the size of the bills sometimes we get, there's a reason for why sometimes those bills are as large as they are, and that's because of reimbursement rates.

Um, you know, and and these are the harsh realities that I think a majority of people who are just on the street until they need a doctor, they don't come in contact with that.

I mean, how much if you can if you can sort of speak to like that again, just maybe recap that that reimbursement rate, even from oncology to birthing to to emergency room.

I mean, it's tough.

I just had an emergency room visit we talked about when we met, and I just got my bill.

Wow.

Look forward to get cashing the check.

Yeah.

You're welcome.

Um, yeah, I mean, but but there are reasons for that.

And I and I'm I'm I'm one of the fortunate people have private insurance.

So, you know, so my uh I'm I'm the guy you like to see walk through the door, but there are other people who are not.

Right, right.

And then what happens there?

So remember there's Medicare for the elderly and disabled, that's the federal.

There's Medicaid, that's the state based on income, which gets some federal dollars too.

There's commercial insurance, blue cross.

There's a few others in the state, they keep leaving.

There's other smaller ones, workers' comp, tri-care, military insurance, that there's uninsured.

Which is a significant population too.

Right.

And so when I spoke about bad debt before, sometimes that comes that's partially from the uninsured people who probably can't afford that ER bill that you just got.

Right.

Can you I'm you know, I'm gonna put you on the spot a little bit.

So of the uninsured, um, do you have like a percentage of the of the people who come into, I'm assuming it's it's uh entry through the hospital via the emergency room, correct?

Um yes.

People also come through other services without insurance.

I'm a family doctor of a few people will come without insurance.

Remember, we also have a um the free clinic here in town, people will go through there too.

Right.

Small number.

And and is there is there a dollar amount that's attached to the uninsured that you're also trying to battle?

Um maybe battle supply.

So I don't have that number for you.

We we have numbers of charity care, the people who sign up for free care, and how much that is, we have bad debt, which is the people who have insurance and then it hasn't been paid, whether the insurance paid some and they owe some, they owe all of it, the people without insurance, though there can be a significant discount if there's no insurance.

Um then I know those numbers, they don't have to get back.

We could find out that the number and no, but it's interesting, right?

What percentage of of uh uh the um money is on uninsured.

Because I think that factors into the conversation because everybody, you know, the the health care is a human right is uh is an argument that that I've I've believed in for a very long time, and and you uphold that.

Yeah.

Remembering that there are people uninsured because they have no way affording it.

There's also people uninsured because they choose not to, because they think it's too expensive, or they're wealthy enough they'd rather just pay out of pocket.

We've had that too.

So the it doesn't necessarily provide that uninsured means indigenous, right?

There's a variety in there.

So we could come up with a member of um uninsured money, but it you have to remember that there's a large um a variety of people in that package.

That's fair.

Thank you.

And remembering that insurance, the way insurance works is everybody gets insurance because not everybody needs it all the time.

So that's why this is sort of the failed market, right?

Like it doesn't work if only some of us have insurance.

And so we're playing this patchwork of how do we cover some people, um, and how do we deliver to everybody?

I think I just want to also um tie into I even if we don't fix the obcentric service line, and it still needs it's gonna lose some money.

The the service lines all together, some service lines make money, right?

So it's uh us understanding that full picture is part of the buying time and the solution that we're gonna build here.

That the if we need to, you know, as an institution, we're gonna keep see the value of that service.

We can't, you know, right now we're in a bind about it, but I see a future where if we can put these things together or find other solutions, we can also contribute to continuing to buy provide that service line even if it's not a moneymaker.

So even though birthing centers across rural America are closing, doesn't mean that we have to close.

I think it just means we have to solve for the the whole picture of the hospital, and I would say the health services system that we have, because it's the hospital and primary care and partnering and regionalization.

There's a whole bunch of opportunity here that I think we have to solve for this if we can buy some time, which is what we're trying to do.

And I have to correct you, can't worry, you said we're profit, we're a nonprofit hospital.

Positive margin.

Yeah.

Um Amanda and then Nell, and then I want to make sure we get to the public as well.

I forgot to say thank you when I first brought out the comment.

And I want to thank you both for all the work you've been doing for our community for Tony and um Elizabeth stepping up for Chloe and her leadership in the board uh for coming to our meeting tonight and answering all these questions.

It's um part of what makes Bratabro Bravo and I appreciate it so much.

And I also wanted to ask, since we're in a public meeting, so say we think maybe we haven't paid the a bill.

How does an individual approach that?

Like who do we call?

Do we call the finance office?

Um is it by social security number or name?

I mean, how the heck is it?

So I believe it's on the website, there's a pay the bill on um I haven't used that one.

You could go to the hospital, your bill has an it probably came in an envelope, you could write a check, you could send it in, you could do it by credit card.

Shouldn't be that tricky.

If it is that a big thing, what if it's an old bill?

And what if it's for a child that was now an adult?

How do you do that?

We'll still take a look at the bigger.

And just closing a little too much.

But I mean just these are sometimes these are sometimes the barriers that occur.

Yeah.

So like what's the roadmap to if there's any barriers, uh oh, you can get in touch with me if you want to, because I know revenue cycle.

Um we go through the revenue cycle, we'll figure out how to fix barriers.

I saw a couple head nodding before about not getting bills and not.

Yeah, well, I've heard that for four.

I saw you six months ago.

Where's my bill?

Sorry, but should be out within a couple of weeks.

We should be getting bills out to the insurance company within five days.

They should be responding in two weeks, and then we have that, then we send it out.

Yes, that should all be done in a month.

So when it takes six months nodding heads, that's terrible.

That's we're losing that time of being having that revenue stream in there so we can pay the employees.

I just want to say nodding heads in the audience are great, but let's make sure not to comment out loud while other people have the floor.

Um I'm sorry.

No, no, not at all.

Um, you had a question, and then we're gonna go to the public.

I do.

Thank you guys.

Thank you for answering all of these.

Um it's it's very helpful.

Uh so I just want to confirm some of my understandings and probably reiterate a question, but essentially um, so and I know this is theoretical, I'm not asking promises.

I know you can't make promises, I know you are but two people.

Um if the if you were to be granted just the birthing center portion, that that world transformation grant that was that has been applied for.

Um, and if you find out about that in early September, will that alone be enough to make a decision about the continuation of the birthing center through the 27th fiscal year?

If you're asking if we got three to five million dollars of transformation and we still have the staff here to do it, we would do everything we can to keep that open.

Okay.

That would completely be the intention.

And so so operating, you know, under the assumption that the AHS secretary says they've uh expedited or you know, forgive my wording, um that specific grant, is that was that a application for three to five million dollars for the birthing center?

I I don't remember the breakdown.

Literally was eight grants totaling ten to eleven million dollars, and I don't remember.

Okay, so we don't we don't know if that were received at the moment, it's not clear if that would actually be the three three million dollar bridge that's needed.

But if it were received, it would have to be spent on birthing services.

Uh the grants are specific.

Yeah.

So there's a grant for telehealth, right?

Because we're uh adding on new communications with UVM.

So that grant has to go to that.

So these grants are from the feds funnel through the state.

Yeah.

If you do it not the way the federals like it, it's called a clawback.

They take it back.

Yep.

Thank you.

Um after you've spent and I think Nell, it will depend on what they decide to fund out of all the requests.

These grant funds were not meant to sustain operations per se.

So I think the way we created the argument was yes, we're going to transform.

They were rural health transformation program because we have to figure out a different way.

So I think it's it will depend on which things, which pieces of the grant and how much.

I think it's just more complicated than yes or no about these grant funds.

But I think just to your point, um the state uh understands the situation and I think has is trying to figure out how to use this program to help us transform and get to where we need to be.

So I'm hopeful.

Right.

And we would have, and knowing that we all want to keep it open, we are going to look for every opportunity to do that.

So hopefully we would know by then.

Keep in mind that these grants are federal guidelines.

Yeah.

And well, so my understanding is essentially my understanding is that essentially rural transformation grant or philanthropy, whatever the the metric of stopgap funding is, is to attempt to have some some slack for the fiscal year 27 for the birthing center such that there is time for the transformation you're talking about for the efficiencies you're talking about.

Um for the changes in reimbursement of birthing centers.

Yes.

Yeah.

Um that's kind of what I'm asking.

Because if if the stopgap, if the funding, the intermittent funding is the first, you know, like that's the major, and then secondary or maybe also right there is staffing.

Um I'm asking because I've heard it asked in many different circles around our town.

Um what can be done or is being done at the hospital level to attempt to retain staff in the interim.

Like if there's a potential that the birthing center portion is of the rural transformation grants are reviewed in August, you know.

If does that allow a potential for communication to the staff in September of what are the chances that we have another quarter?

What are the chances that we have another three quarters you know before December?

Like can the question of can you guys wait six weeks before making your decisions to leave is a different thing than can you wait until December 1st when you may only have three weeks.

Exactly what we were talking about today at the hospital of notifying that crew, that staff, the nurses, the OBs of where we're at with it, what timeline will we expect, and hoping that they had that commitment that they signed that they'll stay with us until we figured that out.

Again, we're really looking for September 1, but it's a we don't have control on that date.

Absolutely.

And so that was a conversation the hospital administration was having or was had with staff.

Um how are we going to present that to the school?

Okay, absolutely.

Thank you.

So I shouldn't tell you that because we have to tell them first.

Um I was also I assume that this won't be the case given what's been shared about potential funding sources.

Um it had also you know been raised of whether or not the the hospital would request the Green Mountain Care Board to allow you guys to increase the at least budgeted deficit for the fiscal year 27 to allow a continuance of the um birthing center service, knowing that that might, you know, funding could come in in the interim.

Does that make sense?

No, I didn't follow that one.

Sorry.

My understanding was that with the with last year's fiscal, with last year's budget, um, there was a budgeted 14.5 million dollar deficit, and I heard you say that it's looking better than that, but that part of that commitment was to cut that deficit in half when you proposed the fiscal year 27 budget to the Green Mountain Care Board this summer.

And that that was part of the limiting factor for what can be allowed in a service.

Okay, I think that was our commitment to try to do regardless.

They don't tell us what we can submit for a deficit budget, but if we were to submit a deficit budget that was equal or more, it just looks like we're not doing the work we need to do.

We need to signal that we're trying to get our house in order too.

So I think that it was sort of uh our goal.

Um and if we to ask permission, I think it you know it's I you know I've been asked the same question now, and I think the challenge is um that's not signaling the dire situation we are in.

You know, to to leave all the service lines in place and submit a so that would have been a um you know a 12 million dollar budget.

Look better than 14.5, but if we're on track to be less, you know, we're on a good track.

It just it's it's uh yeah, I think it's feels uh a little irresponsible.

And so trying to do both and like we're and I uh you know I've been in meetings where it's like we are trying to do both things at once and um and hopeful that we can sort of thread that needle in a way that will work.

But I appreciate the clarification of the explanation.

Um I hear you.

I will wrap it up.

Um a lot of what's coming through here are many questions that have happened in public sphere, and so I hope that this will be helpful for people watching.

Um or I'll go tell them to watch next time they ask me.

Um the reason part of the reason why I asked that is that a lot of the conversations I've been privy to have talked about how there is a struggle to secure uh significant philanthropic commitments towards a service line that has no promised future.

Um there's been a lot of discussion around that, and then that kind of circulates into the whole issue of obviously the hospital has to be responsible to their financial reality, so they're not making a commitment.

People don't want to commit funds if they don't see the commitment there.

Staff doesn't want staff feels insecure about their ability to stay if they don't see a commitment.

Um I'm trying to parse through and nail down or like things that could be presented to people, and it sounds like the hospital is not comfortable in attempting to commit to more than a quarter of the birthing center because of the potential deficit.

Um there may be a more imminent change depending on what happens with the review review renew, sorry, the review of the rural health transformation fund.

Um and Chloe, you had mentioned efficiencies, and I have seen um, you know, the chief of the Department of OB has talked to great length about potential efficiencies.

It's been said to me that that's been reviewed with administration.

Is that something that's being looked at for implementation?

Is there a timeline for that?

Um I you know, I think that I don't know if there's a timeline and I'm not in the operations, but I do know it's been presented and talked about, and certainly again, transformation is expected.

You know, we aren't it's not gonna be business as usual.

And so those kinds of models or other ideas will be part of the work that I think the grants were written about too.

So it's sort of like and what you know, I guess whether or not the grants come, we can do that work, but I think that a lot is sort of hinging on uh this resource that could make a big difference and help us know where we're gonna be.

So the efficiencies come from either personnel, how people are used as well as billing, that kind of thing, too.

But we're talking a few hundred thousand.

You've seen anywhere to two hundred and four hundred.

Yeah.

So that's right, a smaller piece of that project.

Yeah, different numbers have been shared with me.

I appreciate that clarification.

So Nil, I'm sorry, we have to move forward.

We're half an hour behind schedule.

The only thing I was gonna ask is in the in the interim between now and September first, how can we municipally, how can we the public be helpful to you?

So I want to uh go back to something you said before.

We talked about philanthropy.

When we had a campaign for the emergency room, the door, that was a camp c capital campaign, raise money for that specific thing.

We're talking now about philanthropy.

That's donating to Bratabor Memorial Hospital.

It's not going to here for the birthing center.

It's a donation of whatever amount, including potentially larger ones, because people have been talking that there's large donors out there, which will be great.

But that's the Brattaborough Memorial Hospital.

One aspect of which is the birthing center.

But it's a we're not asking for a capital campaign or a say the birthing center fund.

That doesn't make sense because of what you said, people say, how do I know it's gonna be there?

Okay.

That's that's a a helpful clarification too.

I think that people will appreciate hearing that.

Okay.

Thank you.

So I'd like to open it up to the public.

So yes.

If people have a lot of things, yes, certainly.

Public.

Okay.

Um two reminders.

One is that what the town may or may not do is the next agenda item.

So let's keep this to informational questions and second, please remember you direct all your questions or comments to me as chair, and I will do the uh traffic coordination on that.

So yes, members of the public with questions.

Yes, in the background.

And please, if you can say your name and uh your town of residence.

Yep.

Uh good evening.

I have to remember it's night time.

Uh my name is Jean Marie Davis.

I am actually the CEO of Branch's Family Resource Center in Bratterboro, but I live um in Hinsdale, so uh I'm talking as just uh an employer of the community.

Um good evening.

I had just a couple of questions.

Um I've been trying to actually have an appointment with you guys.

Um I used to work in the HR department of two different hospitals.

One was um critical access hospital in Peterborough, New Hampshire, and one in Green Um Gardner, Massachusetts, which was Haywood Hospital.

Um both of them I was in the HR department.

Both of them I was in the HR department.

So the questions that I would have as a HR, just putting on my HR hat, would be when we I was working in Peterborough, New Hampshire at Manadinaw Community Hospital, we were actually losing money, just like Brattleboro is losing money.

And we had the option, there was a couple options.

Either you could get a grant from the governor, you can have the f uh uh flow the lamp therapy department um collect all of the grants because they are we are a nonprofit organization, or we would have a hospital like Dartmouth to take us over.

So usually what happens with critical access hospitals or hospitals that are going under is they would look to the other hospitals.

If you look into Mass uh Massachusetts, you'll see that UMass took over a few of the hospitals.

One of the hospitals was the Gardner Haywood.

So the question is, have we looked at the resources of the other hospitals in the uh vicinity, especially with Dartmouth Hospital supplying a lot of the doctors and other people in the um in the hospital at Brattleboro?

And then also too, if this one-time fund happens, which I am not because I like I said, I I work for a branches family resource center, so we are so for the birthing center.

However, because of the amount that is deficit and asking the town who already they already pay almost 20 million dollars in property taxes.

I'm sorry, I'm gonna have to ask you to keep this part of the comment to the next agenda item when we talk about what I'm sorry.

So then my question would be for just right now for information purposes is are we looking at other hospitals um to take on the different uh to take this uh hospital on and come under them?

And are we uh looking at longevity of how long will the birthing suite actually maintain?

If we meet the budget for this year in 27, um, are we strong enough or confident to meet it going forwards?

Or are we doing critical access because we have Bay State that is less than 20 minutes away from us?

Does that affect your um your funding that you guys are getting?

Great, thank you.

Um I think the longevity question we would all agree is very much up in the air, and that's one of the big unknowns about this.

Um I also want to say you're our guests here.

This is not an inquisition.

If you don't have an answer at your fingertips, that's completely understandable and totally fine.

But I do want to pass along the question of if you've explored an external partnership or takeover.

So the short answer is yes.

Chloe's actually in charge of the planning committee.

Um couple of corrections.

Dartmouth in the past has supplied clinicians and services.

Those have all been drawn back.

I could name them one after another, but they've all been drawn backward down to just um sharing radiology with them.

We've looked at an affiliation with Dartmouth in the past.

Um various reasons wasn't working out at the time.

Dartmouth El Vermont is gonna on the hook, I think, to a $60 million loss at this time.

They're not looking to take on more trouble at this time.

Um it's been a conversation we've absolutely had in the past and can have in the future.

Um Bay State in Franklin, uh sorry, Franklin, which is a half-hour away as part of the Bay State system.

They just laid off 142 people.

People uh these institutions are looking to write themselves first before the other possibility is getting bought by a private equity system.

I believe the legislature was trying to outlaw that in Vermont, which personally not speak for the hospital.

I would agree with private equity generally tends to shove down the quality of your institution back to the hospital.

Thank you.

Other questions?

Yes.

Ellen, I think.

Um Ellen Schwartz, District A Brattleboro.

Um thank you.

Well, I have to address it to you, but thank them, I guess, for being here.

Um I have a quick comp comment and then I have two questions.

Um my comment is I was really um pleased to hear both of the guests talking about the systemic nature of the problem and this being an opportunity for the state to actually do something about that.

I would be thrilled if they did, because that has not been the will of the state for many years.

It's been a lot of tinkering around the edges.

So if this is the catalyst, that would be awesome.

The thing that I wanted to point out is, and it had to do with what um Chloe said about how insurance doesn't work if everybody isn't in it, that in 2027, we're anticipating that thousands of people are gonna be losing their Medicaid with the new work requirements, and there's already people who have lost um the ACA plants because they can't afford it without the subsidy.

So I'm hoping that any systemic work that happens will both look at the reimbursement, which our guests have been talking about, but also if people are uh if they're not on Medicaid and show up at the hospital, that those are not the uninsured people who are likely to be able to pay the bills themselves.

And so it's gonna end up hurting the hospital to have more people who can't pay and yet need medical care because it's something we all need.

So I hope that's part of what the state looks at, and I hope that I invite the hospital and select board to join all of us who've been organizing around this for years in like making a concerted effort to bring about that um change.

I have two questions.

My first one is the World Transformation Fund.

I'm curious about other than um preserving the birthing center, what other transformations are being in we're we're in those grants, like what other what other transformations might we look forward to if we get if BMH gets the money.

And my second question is um I believe that the Green Mountain Care Board has to consider the community impact of a service closure.

That was part of a law that was passed, I think, in 2025.

And I'm curious whether though I think there was some debate about the board wanted to pass it off to AHS and AHS didn't want it, but is that is that um has have the people from the hospital heard anything from the either the board or from AHS about that community impact uh gathering that information.

Great.

Thank you, Ellen.

So those two questions, if you have anything to add, the I think the other grants or purposes of the rural health transformation funds.

A lot of the uh um grants that have been put out as proposals by Vermont State around technology.

So there's a in trying to follow up and get that money, there's a lot of technology-oriented grants, telehealth uh robots and the OR, ultra-various things, uh transforming um uh physical plants, that kind of thing.

Um so we've put in for those kind of grants for quite a bit of them.

Uh the other question is about the process of closing and the effect it'll have.

Um Vermont legislature passed S 190, which lays out the process that that goes through that um for eight different services.

I'm not gonna remember all of them, OB and Pediatrics ICU is certainly in there.

Um alerting the Green Mountain Care Board, AHS, and uh the Vermont Health Af uh Advocate, and then if uh 30 days for that, and then a time for public comment.

I believe the law says that it's the hospital's decision.

That there can be input from the community, there can be information, but if the hospital has the final decision on that.

Thank you.

And it's a new law, we're the first ones to come up uh experience it.

Experience for them to experience us.

Yes.

Other comments?

Richard.

Uh Richard Davis from Brattleboro, uh, I'm retired registered nurse after 47 years, uh working primarily in the Broadboro area.

Spent 25 plus years working on health care reform, which obviously wasn't that successful.

Uh and it's a struggle that we all tried for.

Came clear that uh states really can't do much.

It's a bigger issue.

We've heard that tonight, about all the bigger issues that are facing us and the problems we have.

Um I think it's it's really fantastic that the community has come together, uh supporting the hospital.

And it's such an integral part of what we have here that to lose it, the community would die a certain way that we don't want it to die.

It's not good.

We all know that, it's clear.

I would ask the uh hospital board to do one thing, and I think it would be very helpful.

Um we talk in circles, we're talking bigger issues, and we hear bits and pieces of everything.

But I think we need to be uh informed about what is happening on a regular basis, because the unknown, the fear of the unknown is is greater than what we know.

And being recruited is they think the hook it's gonna close.

I think the birth is, but they don't know.

And so when people are unclear about what's happening, the anxiety level goes uh you know, sky high, and then you start living a life filled with rumors and no nothing concrete.

So what I would like to see the board do, hospital board is every three months.

I think a reasonable amount of time, every three months, come out with a document that says this is what we're doing, you know, no platitudes, no thank you, none of that BS.

You know, a lot of it's PR, and I and I understand that.

But I think the people in Brattleboro are craving more concrete information in the whole process and everything that's going on.

So I don't think it's unreasonable to say, okay, if you just have a list of four things you did in the last three months and tell us about it, and also tell us perhaps what you plan to do in the next three months.

That would be very comforting for the community, and I think that it would help us understand what's really going on.

We'd provide more transparency, and it would provide more town support.

So that's thank you, Richard.

Um let's go to the people online real quick so we don't always leave them till last.

Start with Kevin.

Thank you.

My question is to the chair.

Um, there was a reference to a question about what the deficit for the hospital is.

Um I listened to the Vermontitude podcast last week, and the hospital officials gave the deficit numbers for the past fiscal year and the current fiscal year.

I emailed the hospital spokesperson and said, are these numbers correct?

I received an email saying yes, they were, but I was also warned that there were multiple death deficits before the past two years, going back to the pandemic.

So my question is if the numbers that are being reported in terms of multi-year deficits are incorrect, then what is the correct number in terms of the multi-year deficit for the hospital dating back from the pandemic to the current time?

Thanks, Kevin.

Is that a question that we have an answer to?

I think so.

Kevin, the FY, sorry, to the chair.

Um FY uh 25.

I think you are uh fairly accurate.

Um it was within a minimal amount of to say a deficit of 16 million for last year.

We can't give you a deficit for 26, which is what we're in, because we haven't finished it yet.

It was a budget projection sent to the Green Mountain Care Board of 14 and a half million.

That is not where we are gonna end up.

It's going to be considerably less than that, as we're finishing.

Um there have been deficits most of the years going back um to COVID.

Sometimes those have been offset because there was COVID money sent in.

Everybody lost a tremendous amount of money in 2020 when no one went to the health care in the hospitals.

Um, but there was some federal money to offset that.

Everyone was given so it did not look like a loss that year, even though there was an operating loss.

But there has been losses many of those years on a much smaller scale, not this kind of I'll say 10 to 15 million dollars, much less.

Thank you.

Elizabeth on Zoom.

I don't think so.

Can you hear me?

Hello, can you hear me?

Yes, we can hear you.

I feel like you can't hear us.

Okay, thank you.

I can't see anything, so I wasn't sure.

Um, so um Elizabeth Crowe here in Brottleboro.

Um I speak as uh an engaged citizen, uh, a mother and a retired teacher.

Um our community needs to do whatever it takes to keep the Brattleboro Hospital Birthing Center services in place.

Um I feel that we need to have a local hospital that is staffed, equipped, and prepared for any childbirth or neonatal contingency.

If we want to keep and attract young families here in Vermont and in Southern Vermont, we need to support all their health needs.

The emergency room is not suitable or equipped to handle birth or neonatal complications and emergencies.

This could put local lives and safety at stake.

Local birthing services at the hospital strengthen and support our entire community.

We're talking about the health and safety of our next and future generations of Vermonters.

And maintain these services for our young families here in Vermont in which and ensure our whole community.

And affects everyone in it, whatever age they are.

That's our future workforce.

And that's our current young families.

Thank you very much.

Thank you, Elizabeth.

A couple more comments in the room.

In 10 minutes, we will be a clean one hour behind schedule.

So let's see where we are then.

Uh Maggie and then Dick.

Hi.

Um first I want to say thank you so much for being here.

Would you just say your name?

I think oh, Maggie Lewis, I am from Brattleboro, Vermont.

Um, thank you for being here.

I want to say how encouraged I am by what I've heard tonight.

And the fact that the hospital leadership has identified where the weaknesses are, where the problems are, and now have the data that they can look at to make informed decisions on what their future next steps are.

The fact that the hospital is looking at critical access hospital as an option for prospective payments, and also looking at being a federally qualified health care facility, I think is great.

Um the one thing I would like to ask is with all this what I think is really good news, um, is have you had the opportunity to talk to leadership at Grace Cottage who went through this same exact thing 25 years ago?

And I know there are people that still work there that were born there that went through that process to find success in yes, they had to close some of their services, but they pivoted and were able to meet the needs of the community as well as survive as both a critical access and um an FQHC.

So just curious.

Thank you.

Thank you, Maggie.

Yeah, uh one of the things that's so exciting about regionalization is that we get to talk to other hospitals about how to strategically sort of all keep surviving.

Grace Cottage, actually, I had never done a tour.

I got to go last week and get a tour.

I was so impressed with um what an amazing facility it is, and I think that the leadership there is creative and thoughtful, and I I think that uh we have a lot to learn.

They also we have a lot to learn about raising money from them as well.

Thanks, Chloe.

So yes, we're in touch with Olivia, who's the CEO and the rest of them too.

But a reminder that they closed their birth, et cetera.

Yeah, they did.

They also closed their long-term care.

Maggie.

That's okay.

Um it's I think they do have emergency room and primary care, and that's their services.

Right.

And we support them as much as we can for all the other specialties.

Dick.

Uh Dick DeGray Brattleboro.

I was asked to be on my best behavior tonight, Tony, so I'll try to do that.

Thank you.

Uh I thank you and Dr.

McClarney for the uh the roles that you've been thrust into.

I don't know if you asked for those positions or not, but I do have some concerns about uh the timeline from this announcement.

Uh the first one that uh I believe happened, and you can correct anything that I say, is that the administration or uh the chair of the select board wasn't given a heads up on this information that was coming down the pike.

Uh I think that's essential when something of this magnitude is happening that you give the administration a heads up.

Um I also appreciate the fact that in your opening remarks, you talked about you were not looking for the town to implement any sort of tax on the residents uh to move forward with an open town meeting.

And nowhere did you mention that you were not looking for revenue from Brattleboro and or the surrounding communities, nor did the questioner ask you that, which I thought would have been a pertinent question to ask.

And then thirdly, there was an article in the reformer the other day where there was another opportunity for the administration to say, no, we are not looking for any communities to send us revenue.

We are pursuing other avenues.

And the reason I say that is because of something you said early on.

This has caused a great deal of stress.

I believe I agree with you 100 percent.

We think that the hospital is essential.

I certainly do, along with everybody else.

The stress part also comes from the impact on an additional tax.

And you both are aware, living in Brattleboro, of the challenges that we are facing and have faced in the past several years.

So I do think it would have been in the best interest to come out early on and to announce that we wouldn't be looking for any com any uh municipalities to implement some sort of assessment to give us money.

And if someone wanted to write a check, which you did say, please do write a check to us and we will put that to good use.

So if you want to talk about those, great.

And if you don't, that's okay too.

Thank you.

Thanks, Dick.

If you have any reply, you're welcome to make it.

If anybody can help me with the timeline, I think you voted for that to look at this last week.

Right?

The idea of raising a tax?

That's right.

A week ago.

So and asked at that time that we come here and talk.

So I'm sorry if we didn't get something in in that week, but we were here to talk about it too.

And I hope what we said today was another.

I I can clean the timeline up a little bit as I was part of this.

Um the meeting had been warned.

I I'm not even sure that the meeting had been had been warned, and this was an item you guys came on on a Tuesday later on that night we had our our meeting where we discussed this formally.

So I'm not sure if I were speaking from co-CEO seats that it would have been anything that would have ever entered my orbit to think, boy, I better tell the municipality.

Please don't raise this as an issue.

So just in in your defense.

I'm just, you know, I'm I'm just gonna put that out there.

Right.

That was last Tuesday, I think.

So that gave us, you know, we had today to come and talk and say what we thought.

Yep.

And I have no concerns around the timeline of all of that.

So other comments from the public?

Yes.

I think you'll be our last one.

I'm really ready for launch.

Uh Gina Farrell, can you hear me?

Okay.

Yes.

Um Brattleboro resident, thanks everyone for all the work.

Um I heard something today from a woman who's pretty much in the know of things.

She's told me that insurance will not cover prenatal care if the mother actually gives birth in, say, Greenfield.

So the insurance for the birth and the prenatal care would be paid to Massachusetts, even if she had her prenatal care at BMH.

So that's what we talked about.

Please.

That's what we talked about for about a global payment.

A global payment.

Uh if you go for an operation, there's the seeing uh seeing the clinician beforehand, the operation, seeing them afterwards, global payment.

Same thing with the birth, global payment.

That's what we talk about.

One of the opportunities is to change reimbursement so that is broken up.

Payment for visits.

So you could, for example, do prenatal claim in Brattleboro for 10, 12, 15 visits, have a delivery elsewhere, and there would be some payment then to do it.

So that would point.

Um after there is you can have it where you've done all the prenatal care and someone moves and just gives birth same time.

All that money we get there.

You can try to apply for that money.

You can show the insurance company.

We did this work, can we get some?

Good luck, but you can try and can sometimes I've seen that go.

But it is a global payment to where the delivery happens.

One more question and then uh actually two more.

Um I live where a lot of the helicopters go over my house.

Who's paying for those helicopters?

If you could ask those to me.

Who's paying for all those helicopter rides?

Well, only two things, paper.

That's it's either going to be the insurance or whose insurance.

The person that the that's going to Dartmouth or Massachusetts or Brattleboro.

Um all the helicopters going over your house, formally next to my office, are going from our emergency room to Dartmouth.

And occasional, if they're filled, they'll go elsewhere.

But let's say 90, way over 90 percent.

Braterburger Dartmouth, that gets submitted to the insurance, maybe paid or not, and then they otherwise it goes um to the patient who got the ride.

Okay.

And the final question.

And the final question is what is the percentage of out-of-state and out-of-town people, women who come to Brattleboro Birthing Center?

It's a great question.

Do you happen to know?

I would like to know that.

So would everyone else?

Um no, because we've been working in the other question, which is how many of the Wyndham pregnant persons are delivering at Brattleboro.

And I'm a little discouraged to say we've come up with two fairly different numbers depending on which source we look at.

So I'm reluctant to say this to my members because they're really different, like 30 percentage points different from two reliable government sources.

Um that's the number we're looking at.

It makes a difference if we're delivering 90 percent of the uh local pregnant people versus 60 percent.

What's the utilization here?

But you're asking how many go out of state.

Uh sorry.

How many from out of state?

From out of state coming.

Um there would be sorry, sorry, there will be a small percentage because we get a number of uh people from Hinsdale.

Out of state being just across the border there.

So Hinsdale, um, a lot of the popsicle there.

I don't know how many um pregnant people in Hinsdale come deliver there.

Can't tell you that one.

Great.

Well, thank you.

Thank you to everyone for your comments and questions.

I think we need to move on now.

So I'm going to thank our guests very much for coming.

I think this was a fantastic conversation to have.

Thank you again.

And we'll take a five-minute recess.

Thank you.

Thank you.

Thank you.

All right.

So we're moving on to regular business item B, which is a discussion of possible action by the town.

Um I would like to structure this conversation by first seeing if a member of the board has a motion they want to make or not, so that when we get to the public, people know what we're actually debating.

Um I'll say that based on what I heard tonight from the hospital team, it it feels a little premature to move forward at this time.

So I don't plan to make that motion.

Um if there is no motion made, we'll still, of course, hear from the public.

Um is there anyone on the board who'd care to make a motion or a comment?

I will I'll I'll comment.

Please.

Um I agree with you, um, given the information that uh was just presented before us.

I don't feel like um warning a special meeting um for the purposes of trying to raise some funds is is a necessary um thing.

I do um can I continue?

Is this a good time to do that?

All right.

Um I do want to say that this was an item that I had recommended putting on the agenda for the sole purposes of making an entire community understand what the loss of a hospital would mean to the community.

Um the idea behind it was that if we can engage an entire community for this one resource that it would be an important and a vital conversation.

If at a spe if if at a special town meeting we decided not to fund the hospital, that would have been a decision that the community made for a hospital in our community.

Um I would have lived and died by those results either way.

Um as I think I said when I proposed the idea that it wasn't ideal, but it was an emergent situation, a lot of information flowing in and out, um, trying to keep it up, trying to pin it down, trying to you know stick a stick a flag in something that'll that'll stay down what was difficult.

Um this was a mechanism in which we can engage people, and to a degree it worked, because we probably have three times the amount of people we normally have here.

Um whether you're for or against it is inconsequential, you are in the conversation, and I I for one appreciate that because I think when we get more people in on a conversation, we get better ideas and better ways to move forward, and everybody is now better educated as to how hospitals run.

And so I appreciate the fact that and and want to thank the the literally the bravery of hospital administrators and board members for coming back and thanking us for the thought, but saying let's wait until we have the answers on September 1st.

So I I appreciate that.

I appreciate that pressure being taken off.

I do uh at the end no matter what we decide tonight, and I I feel as though at least two of us have decided that this community values the birthing center.

Um we value our hospital, and I hope that everybody in this community and in this region, because this is a regional hospital.

This is not just a Brattleboro problem, this is a regional problem.

Stays engaged and and keeps an eye on what's happening here because it's really important.

Great.

Thank you, Peter.

Other board members with a comments or a motion.

Okay.

Seeing none, there's no motion on the table.

We'll open it up for public comments.

I will say, of course, well, we welcome all the public comments and feedback you have to give us.

Um, but also please make it in the context of there is no pending board action on the table right now.

So um Eric.

Thank you.

Thank you.

Um thank you, Oscar, Chairman.

Um, this is probably I feel the most important three minutes of uh the of comments I'll probably have made ever.

So if I get to two minutes and thirty seconds, somebody give me a verbal, Eric?

Okay.

Um I I respect you guys so much, and I and I think what you do for our town and what you're trying to do is so important.

And I think each one of you has an incredibly big heart, and I actually voted for everybody sitting up there.

And I believe in you so much.

But what you guys did bringing this to here terrifies me to my soul.

Because you following the pattern that got our town into a terrible financial problem.

You talked about the hospital's financial problem, but we're no better.

We might actually be in worse shape.

And by bringing this forward to to tax the the 12,000 people here to make us somehow like put on our table that we're accountable to fix this or make it better when we're already struggling to keep this town well going, you lost track of what I think your real purpose is, and I beg you to rethink two things.

One, how do we get here?

Because you have big hearts.

I like that part.

But you led with your heart and not with your head.

And I need you to be lead with your head and be guided with your heart going forward, because this is a pattern that's got us into big trouble.

You become we have big issues in this town that are so important from homelessness, you know, and and and and just uh endless things of care.

And I've seen this board do this over and over and over.

My heart touches, so I'm gonna make I'm gonna fix it.

How am I going to fix it?

I'm gonna tax the people more and get money and solve the problem.

And that is how you folks did this, and that's how you've done it over and over, and we can't solve problems that way.

Now, what do we need to look at?

Did we remember a few things?

Do you know how far you know behind we are on on sidewalks, roads, retention walls?

You know, uh our our our whole poor department of public works always gets pushed to the end.

Do you remember our lovely recreation center?

And we've committed to our town to be a town that cares about that.

What about our pool?

And and and we talk about these the the Chiefs fire truck and the the HVAC and all this stuff that we keep dipping into capital funds and then ask us to pay that back later.

Well, we have to be thoughtful about this stuff.

And let's just throw in I don't know, you guys know so much more than me.

What about the folks that would like to access the community room in the fire department?

And there's been like almost no talk about the fact that the community with that?

Okay, thank you.

They can't access that.

So my point is I care about you guys.

I think what you do for us is really important, and I know you have heart and care.

But if you follow this pattern of leading with your heart instead of your head, instead of leading with your head and getting guided by your heart and continue to follow the pattern of taxing us to fix all problems, we're going to be in horrific trouble very soon.

So please think that through in future decisions, because we shouldn't even be here today.

Thank you.

Thanks, Eric.

Yes.

Jean-Marie Davis, Branches Family Resource Center.

Um so I just wanted to bring to the select board that understand that with the hospital and their situation, that there are organizations in the community that we are actively working to try to step in the gap.

If there were to have a no more birthing suites.

Um I have said it since the day I walked into branches that when our you know be ready to my board be ready to deliver a baby in our center because we deal with women that are um dealing with pregnancies.

So I I can speak now.

I know my board is probably gonna be like Gene, but I'm gonna let you know that I am actively working um to make a point to be an emergency access.

I'm I've talked to the uh rescue Inc., they're doing stuff.

So understand when you talk about the community coming together, I just want you to acknowledge that there are organizations that are actively trying to step in the gap for if a situation like this happens at the hospital because essentially there's no birthing center in Wyndham County.

I we have a center in Greenfield, Massachusetts.

I've talked to the Bayside Hospital, their tax.

I've talked to Cheshire, it's taxed.

So we are trying to step in the gap.

So I just want to make that um apparent to the select board that we are trying to actively make sure that we step in the gap.

Also, just um real quick, I know that it was not on the budget um or you guys did not um take on a vote for this, but I do mimic I did say that at this town hall um to the town meeting, uh I think it was back in July or not, we are in July.

Forgive me.

I've been all over the place.

Um in April when we were at the ho um at the school, is you guys have already put 20,000 20 million dollars on your citizens here.

When is the board going to suggest and look in bringing in a middle grade company, even a high grade company?

I know that this area I've talked to a lot of the monteers.

You guys want to keep it very um travel oriented and having people come and visit.

However, when you have a city, and I brought this up three years ago, because I'm from Oakland, California, and you have almost 10 to 15 kilos of drugs that are running through your community, and you having girls that I've had to deal with that are either being um sexually assaulted or whatever.

How are you going to when you bring in middle grade that there's some there's a there's a balance there?

So when are we gonna start having a conversation with a middle grade company coming into this town to be able to help relieviate some of the pressure on your citizens?

Thank you.

Thank you.

Richard.

Then we'll go to Bob Only.

Uh Richard Davis Brownboro.

I think it's a good thing that um there was no motion made.

I think that sends a good signal and uh especially the sentiments that I've heard around town.

Um I think the most important thing in actually uh a major fundraising effort for the uh birthing center would be to uh support and lobby Governor Scott's recent statement about increasing the Medicaid reimbursement for uh birthing centers.

I don't know if we made that statement today or yesterday, but um that that would solve a lot of problems and your efforts in doing that kind of lobbying would really bring in a lot more than a million dollars.

Thanks, Richard.

And it's worth mentioning that there's been some I think pretty wide-ranging efforts by different groups um strategizing around lobbying and uh um those efforts are underway.

I'm sure we can do more, but we are we are at least in the early stages of that.

Let's go to Bob.

Hello.

I think you can hear me.

Robert Robert Ozer, Brattleboro.

Um This may be redundant since you talked about lobbying.

Um I know at least anecdotally that two towns, select boards in Wyndham County have written to the governor.

And I'm wondering if all the towns, if you know there could be some organization, and all the towns in Windham County uh would write to the governor uh with respect to the birthing center.

Uh and to Brattleboro Hospital generally because this is the hospital for our area.

Um I I think people are talking to each other, but um I just want to get some confirmation of that, whether a lobbying effort in that form would be good.

Thank you.

Thanks Bob So just to reply to that I don't have the names of all the towns at my fingertips but we did send out those letters to the entire region and we have begun to get responses.

We have begun to see other towns pass resolutions at their select boards um I've gotten some personal outreach from members of select boards at other towns so we want to do more there too but that is starting to fan out across the region other comments or questions seeing none I'll bring it back to the board we don't have a motion on the table so unless there's any other comments from the board we'll move on to the next item which would be adjournment.

I'll motion to adjourn okay Peter's move to adjourn all in favor please say aye aye carries five zero thank you all thanks Seth Hannah Bob is here I didn't notice welcome to BCT