CESSA - Region 4 Committee Meeting Approved Minutes 11/16/2022

Community Emergency Services and Support Act (CESSA) Region 4 Advisory Committee

Meeting Minutes- Tuesday, November 16, 2022 - 10:00-11:30 via Zoom

Meeting Minutes - Approved by Members 12/13/2022

  • Call to Order/Roll Call
    • Meeting called to order at 10:03 am by Co-chair Julie Brugger
    • Attendees:
      • Via Zoom: Julie Brugger, Peter Eckart, Allison Brown, Brenda Hampton, James Hengehold, Jeff Shafer, MD, Matt Fishbach, Randy Randolph, Tonya Beasley, Layla Simmons, Joseph Harper, Cindy Wagner and Tina Saggio
      • Absent - Dana Rosenzerig, Amy Foster, Megan Black, Andrew Stein, Timothy S. McClain, Dennis R. Perez, Steven G. Johnson, Brittany Pinnon-Becker

Julie Brugger- Thanks so much everybody for joining us today. I'm Julie Brugger and I work for Chestnut Health Systems. I am the 590 Co-chair for our Region 4 Advisory Committee. Today also with us we have our EMS Director, Jeff Shafer and Peter Eckart from University of Chicago.

Welcome everyone to our very first Regional Advisory Committee for EMS Region 4. Super excited about doing this work and we are going to be talking more about the work we are going to be doing throughout this meeting. I think it's great all of you are here and will be a great group to work with and figure things out with going forward and what we are going to be doing. Our meeting today, and all of our meetings are subject to the Illinois Open Meetings Act, basically what that says is that we want the State and it's decision making to be transparent to all of its citizen. This means that we publish an agenda, that we publish a link so that the people in the community can join us; and that we have time for public comment at the end in case there is someone who is not a committee member that has something to say about what it is that we are doing. There is an Open Meetings Act training which is really informative. Per Peter, all of our members need to take that training. The training is available on the Office of Attorney General website. You will need to create a registration to complete the training; it is quite lengthy, give yourselves 1 to 2 hours to finish.

Any questions about Open Meetings Act? None. Moving on. Notes will be taken. The meeting may be recorded for the purpose of developing meeting minutes. Please note, you have the right to be on camera but you certainly have the right not to if you wish. When we do have comments please use the hand raise feature so I may see you and be able to call on you. Peter entered information into the chat about the Open Meetings Act and how to access the registration link as well as the training itself. Appointed committee members wishing to contribute to the discussion just raise your hand and we'll get to you. Members of the public will be able to raise their hand during the public comment section also.

Roll call- Megan Black, Andrew Stein, Layla Simmons, Timothy McClain, Dennis Perez, Police Chief Steven Johnson, Brittney Pinnon-Becker, Joe Harper, Cindy Wagner, James Hengehold, Randy Randolph.

Introductions- Please introduce yourselves and share what you are hoping to get out of this. I feel this is going to be great work, we'll be together talking about a lot of things and we are going to get a lot of good out of this. Jeff why don't you start.

My name is Jeff Shafer, I am an emergency medicine physician at St. Elizabeth's in O'Fallon. I am a former paramedic, I service as the EMS Medical Director for our system here at St. Elizabeth's. My role in all of this is that we develop new policies regarding EMS or treatment protocols, we develop those for the states approval.

Hi, I am Peter Eckart, I'm at the University of Illinois Behavioral Health Crisis Hub, and as such I am a member of the expert consulting group, supporting this meeting, happy to be here.

Happy to be here, Randy Randolph, Operations Manager for St. Clair County 911 Central Dispatch and Emergency Management. Big reason why I am here is part of the 911 side, I oversee the training and implementation of all policies and procedures for all of the 911 centers in St. Clair County. Happy to be a part of this group and looking forward to the work we are going to do.

James Hengehold, I am the dispatch Supervisor for the City of Edwardsville. I am the PSAP Manager for our agency, helping out with Madison County 911, to be a liaison to help out with all of the changes.

Julie, please let me introduce myself, Barbara Hampton. I work with Peter in the UIC Crisis Hub, and I am just visiting today to see how you conduct your meetings in preparation for my RAC meetings.

Hi there, I'm Layla Simmons, I work for Alton Memorial Hospital as a Paramedic in Region 4 and as a Flight Paramedic. I'm really excited to join and be a part of the process and get to know everyone.

Comment- Julie The Illinois DHS Division of Mental Health has been charged with coordinating the continuum of crisis services. The continuum of crisis services includes three different legs; the first is "someone to call" -- the 988 call centers, so there are six life call centers funded by the State, the goal is that 90% of individuals in Illinois will have access to 988 by the end of 2023. The second leg is "someone to respond" -- that would be our mobile crisis team services, so Program 590 is in the state expanding capacity of crisis services within the community. There are 66 providers in 83 locations currently in the state. The goal for that is 80% of Illinois citizens will have access by the end of 2025. Third leg of that continuum is "somewhere to go", this would be crisis receiving or crisis stabilization units, and right now there are 21 living rooms, they are not 24/7 365, they have opening and closing hours. There are 11 crisis residential programs throughout the state, as you can tell by those numbers, these things are not available in most parts of the state; the SAMHSA goal here is that by the end of 2027, 80% of individuals will have access. Per the slides, these are the current crisis response systems, you see the six different life line call centers. Path Crisis in Bloomington is who answers for us, they are kind of beige in color, you can see they are pretty much all over the state and provide backup for all the other systems throughout the state for 988. The second graphic which is all different colors is the 590 local response coverage area, it shows the different 590 teams. The third shows the 911 PSAP statewide. As we look at operationalizing the Illinois plan, the Community Emergency Services and Supports Act (CESSA) is what that stands for. That is also known as the Stephon Edward Watts Act. This is State legislation to provide emergency crisis services throughout the state. DHS is mandated to lead the work, it will require the development Statewide Advisory Committee, which has already been meeting and regional committees, which is what we are within the 11 EMS regions. Committees are charged with the coordination of emergency responses of 911 and 988 to address protocols and standards, training communications and mobile response teams. The first part of this would be coordinating with traditional first responders. Our PSAP (Public Safety Access Points) must coordinate with local crisis response teams. DMH has developed through its program 590 to provide community based response to low level and low risk behavioral health crisis. Law enforcement must be integrated into the processes, so that individuals involved in low level, nonviolent misdemeanors can be diverted to the mental health system. In the continuum of police and community response information provided, it tells of innovative law enforcement collaborative models already being tested and implemented across Illinois and nationwide. The CESSA legislation envisions the continuum of responses based on the conditions and potential lethality of each crisis call. CESSA does not prohibit law enforcement from participating in resolving certain situations and co-responder models and CIT training remain valuable assets in the continuum. CESSA establishes 12 advisory committees, 1 statewide advisory committee and 11 regional advisory committees to assist with the execution of this legislation. Regional best practices will be developed by the Regional Advisory Committees, consistent with the physical realities of various locations; this is what we will be addressing. The crisis response system in Illinois is made up of many complementary parts, these include 179-911 PSAP and dispatched emergency services providers, 66 mobile crisis teams, 877 law enforcement entities, 1300+ local fire departments, county fire department based and privately operated ambulances, 6- 988 call centers and many, many advocates and people with lived expertise in crisis. These CESSA Regional Advisory Committee includes the EMS Director, which for us is Jeff Shafer, the Designated Chair of our Regional Advisory Committee. Of the 590 Provider Executive, the Designated Co-chair, would be me, Julie Brugger. Law enforcement entities, advocates, EMS Provider Representatives, EMS Union Representatives, Law Enforcement Representatives, mental and behavioral health providers, 708 and government entity representatives and 911 PSAP representatives. The original implementation time line for CESSA is what the slides shows. In 2021, CESSA becomes law, there are no current changes to policy or procedures until CESSA is complete. In quarter 1 of 2022, the Statewide Advisory Committee members are identified and confirmed, then in quarters 2 and 3, the statewide Advisory Committee launched, regional group members are identified and invited. In quarter 4, 2022, the State Advisory Committee and the Regional Advisory Committees meet, deliberate and develop recommendations, which brings us to where we are now. Final recommendations are to be delivered in 2023, recommendations are converted to protocols and standards, and will get fully approved by governing bodies. Critical staff are fully trained and CESSA recommendations are fully enforced. CESSA is structured in a specific way, there is a Statewide Advisory Committee, which has four sub-committees, one on protocols and standards, one in training, one for data management, and lastly, public messaging. Also, there are regional advisory committees, which we are number 4, and there are 11 of these throughout the state. Our mission, to make recommendations to the regional EMS Directors, to make changes necessary to 911 call protocols and recommend new protocols, following the State Advisory Committee guidance. We need to identify recommendations to address changes in standards in 911 Law Enforcement, EMS and behavioral health mobile crisis services to meet the guidance of CESSA. We need to recommend changes to the State Advisory Committee and the IDPH Division of EMS regulating professional work in law enforcement and fire departments. We need to recommend regional training and technical assistance needs, so the State Advisory Committee is aware of what those needs are. We need to recommend how important the data collection needs are as well, for coordination and improvement of 911 and 988. Our CESSA Charter will include responsibilities of deliverables, a decision making process, and possibilities of regional advisory committee sub-committees and how to handle public comment. This information will be discussed and ratified at our next Regional Advisory Committee meeting.

Our deliverables, in protocols and standards, we need to approve vendor scripts and protocols. We need matrices for risk attribution and for incident types and dispatch priorities based on national best practices. We need new data dispatch priorities given jurisdictional realities and including viability of mobile crisis response teams. We need data informed dispatch protocols when responding in person to crisis involved in nonviolent misdemeanors. We need data informed standard response times for incident types and we need to correlate with dispatch priorities and matrixes. We need to make sure we list all local agencies, boards, commissions with regulatory oversight for appropriate interfacing. There will be additional deliverables in technologies systems and integration management; training education, communications and public messaging.

Additional decisions in our Regional Advisory Committee, the decision making process is consensus of course, when possible; majority vote if consensus is not possible. We will want to look at the different possibilities for our Regional Advisory Committees, sub committees and how we are to manage public comment.

Member discussion. As we look at our deliverables, where to do we want to start, ideas on where do we want to go from here?

Comment- Jeff I think the decision in the deciding of which of these patients meet this category of low risk? I saw the email this morning about the presentation from the State of New York, is that right?

Comment- Yes, I think so. I have to work Thursday, but if there is a Power Point for this presentation will you please pass that along to me?

Comment- Jeff I think that ultimately the initial message that we need to send out is that until these definitions of the low risk patient population is fairly defined, that nothing changes, we continue to do everything that we are currently doing. The fact that the State of New York apparently or at least someone in New York has some of this data, and has policies established and hopefully has some evidence that it is functioning well and safely for all of the responders. I think it's encouraging.

Comment- Peter Jeff, we will be recording this meeting. It's directly relevant to the standards of protocols that you all will be discussing, and so, we will have that recording and make it available and all the members of your region. It will be a rich presentation.

Comment- Randy I echo Dr. Shafer's comment. Obviously coming from a dispatchers prospective, and I'm sure, James is having the same thoughts. I don't want to speak for him. But our concern has been and continues to be through his process is making sure that there is set guidelines in policy and procedure for how when those calls come in because, to be fair, this, yes, you have 988, but 911 is really where a lot of mental health crisis begins. We want to make sure that our policies are clear, I don't want a situation where a 911 telecommunicator answers that call and tries to figure out what they are going to do with it, it needs to be clear and obvious what their next steps are based on the circumstances. I know there are some tools out there, we use ProQA in St Clair County and they have some tools that we can use for things like that. I may be putting the horse before the cart, but from my perspective, one of the biggest concerns I have is making sure that the policies and procedures across the board for everybody to understand how the processes falls.

Comment- I agree. What I often wondered about how actually this will tie into the ProQA with dispatch. It has to tie in there someway otherwise it will not work on the dispatch in.

Comment- I agree. my concern is my people sitting in that chair, where they have to make that split decision of where I'm sending and how fast I'm sending it and what liability is going to land in the seat now in the dispatch center of I sent the wrong this and now something catastrophic had happened, and now moreover, I'm concerned with calls that are for lack of a better term, might be getting dumped on us for 988, that there is a clear protocol for what 988 should be delivering to us and what our response should be from there. Quite honestly, I took a call from 988 the other day and they provided me little to no information and kind of just dumped it in my lap for us to figure out from there.

Comment- We steadily harp on the dispatchers to maintain adherence to the cards into the format of the questions and everything else. This has to get integrated, so that dispatchers have a very clear protocol, very clear direction with these cases. It's just what we preach to those people.

Comment- Jeff, and as you know, it's hard to get a script change done on those cards as well. You have to go through the whole process, so it's not going to be an immediate fix.

Comment- Julie Just so I understand, the ProQA is a list of strategies for figuring out next steps?

Comment- It's step by step, its emergency medical dispatch. So the cards walk you through a medical emergency, it will tell you what to ask, what to do next to help the responders to determine their response.

Comment- Jeff So the EMS protocols are very much evidence based. There is a guy in a position in Colorado that has researched a lot of this extensively. They are not made up, they are not random, at least most of the time yet. You know when Covid comes up or something like that we have to improvise, but in general, they are very structured, so when a patient calls 911 with whatever medical complaint that they have, anything from a major trauma to stubbed toe to a cold, it will fit within 37 cards. This allows them to quickly pinpoint the chief complaint and it tells them in a very structured manner what questions to ask, information to input, and we can find out right away if the patient is conscious or breathing, if they need CPR, if the environment there is safe and so on and so forth. It is very important that the dispatcher stick to these protocols, and adhere to them as much as possible from a quality and safety point of view. In regards to these efforts, this will need to get integrated somehow so we have better information into those dispatch protocols, so they have a very structured method of questions they ask and how they proceed in these cases.

Comment-Julie So basically a script to follow? Which questions to ask when?

Comment- It's more than a script, it's a very structured set of questions that helps you nail down what the actual problem is, and in regards to mental health, if there are any violence or safety issues that represent a threat to bystanders, to the patient themselves, or first responders.

Comment- For the edification, to show you so that you understand how the software works, as I understand a lot of the people in this group are not from the 911 side, it may help you to understand how that software actually works. To further Dr. Shafer's point, I think that it may be New York that is using one of the protocols to this type of response. I do know there is a large entity that is using a special protocol that the International Academy developed to process these type of calls. I'll do some further research to find out.

Comment- That would be great, very important, especially if there is something that already created that meshes with system that you use. I should point out, these things take a very long time to get changed sometimes unless there is a dramatic emergency such as Covid. So yes, if there is something out there especially if it has some research behind it that would be very helpful for the implementation on the dispatch side of things.

Comment- It would and there is a level of liability there as well.

Comment- Julie I would love to see that to just get an example of what that decision tree looks like.

Comment- I can definitely set that up, not an issue.

Comment- Julie We would need something very much like this, correct? Ultimately.

Comment- Yes, I think everyone that is not in the dispatch environment, it will help you to understand what that looks like and guide how we make decisions in the future.

Comment- Julie That will include what questions to ask to determine the risk level of the situation?

Comment- Yes, and safety concerns.

Comment- Julie So asking whether there is violence or weapons or who knows what else? As these are questions we ask before we dispatch our mobile response team about violence, both history and current.

Comment- Ideally if all of the questioning aligns across the board, then your questions are answered already initially, so if we have all of the data upfront we can make the informed decision and already have the answers for you.

Comment- Julie It sounds like we have a great jumping off point for the scripts and protocols and such for this type of thing, what you already have, and looking at that which New York is utilizing too, for things that look more like behavioral health crisis situations.

Comment- Joe One of the things that we recently had happen in an incident, it didn't involve 911 or 988, it was a call to another agency, who handed it off to our agency and it went through a screening process at both that agency and ours. We sent a mobile crisis response team out, when we got there, this individuals had doused them self in lighter fluid, had a knife; in getting the system to respond to that was very, very difficult. So maybe looking at what happens if the information we have and then the scene once we get there being very different, what is the best way to immediately intervene?

Comment- Julie Right, absolutely, that's is a great point Joe; thank you for bringing that up. Yes, even though we ask the questions, doesn't mean the answers and situations won't change between the time of the call and the time of the response. Good point.

In looking at matrixes for risk attribution, what things will this all include? Obviously dispatch priorities come first for sure, and in the determining how much risk there is, and the immediacy of response makes sense. What are the different things we are really looking for there?

Comment- Peter Eckart-UIC Behavioral Health Crisis Hub. The matrices that Julie is referencing is exactly the content that they will be discussing at the Standards and Protocols meeting tomorrow; that is the presentation that will be recorded and made available to all the members of this group. The idea that there is a structured approach to the kinds of crises that happen in our communities, so not exactly the same things as cards or software systems we have been discussing so far. It is really a categorization scheme that typically takes the form of multiple levels of danger. If you look at the slide Julie presented, differing levels a law enforcement or EMS response; this is what the matrix refers to, this will make more sense when you see one. The reason we haven't shared it as part of this meeting is that all of this level setting that we need to do through the efforts of the regional advisory committee, but this is something that we can absolutely share out. You will see a fairly close alignment between the cards and the course of the matrix.

I think one of the things that we want everyone to know is that we will be sharing the draft charter that includes those decisions that the members will make at your next meeting, wanting you to know that you will be making some decisions based on the charter that Julie will send out.

Comment- Julie As were looking at some of the data we are going to need; data informed dispatch priorities, dispatch protocols, standard response times; all requires that. In terms of looking at where we are going to identify who can go where and that sort of thing depending on what the availabilities are, I think will be part of what we will look at. Does anyone have other thoughts regarding these deliverables or what data we are going to use to inform some of these things; how will we get that, where will it come from? I think at least part of it will come from those matrices from risk attribution that will be in the presentation that we will see or hear or have access to later, that will be tomorrow.

Comment- I think is going to help drive some of these decisions too. This is all so new for everybody; that there aren't a lot of people out there doing it, or well they are doing it but they are learning as they go as well. Our concerns that we have, which obviously have been shared, some of those here today, it's hard to say, here's what we need to do next. We know what the goal is, it's just how do we get there?

Comment- One thing that I can do, from the 911 side of things. You and I can work together to a bit of research on what the dispatch centers are using today to start that process

Comment- I agree. As far as response teams, we don't know what is available to us that we don't have that matrix set out. What is an acceptable response time? Because I don't believe that there are any response teams in our area, none that we have been provided with in our area, other than our typical contact team, Chestnut, or that kind of thing.

Comment- Right I agree, we will share our findings.

Comment- Julie Any other comments on this? Like Peter said, were going to determine our charter in the next meeting. I will be sending that out to everybody beforehand. For this meeting, I was thinking monthly. Does that sound doable to people to continue this work? Do we need to try and meet more often than that?

Comment- Sounds reasonable to me; it all depends on what the roadmap looks like and how much work has to be done. I don't think we really know that yet.

Comment- I don't think initially there would be a reason to meet any more often than that simply because it's going to take some time gather so much information before we can actually do anything.

Comment- We are coming up on the holidays too and that's going to make this interesting.

Comment- Julie Generally, is the third Wednesday of the month good or do we need to something that looks like every four weeks instead of third Wednesday of the month? What works better for people?

Comment- Jeff My schedule is completely random, there is no set availability. Set it for whatever you want to. My schedule is already set for December; so if I'm working a shift or two for the meeting the next month, I may have to miss or attend a portion of it. Set what works for you guys. So after that, moving forward I can make sure my schedule is clear.

Comment- Julie Will the third Wednesday work for December, which will be December 21st? I don't know that that is a great time. Do we want to meet in December at all?

Comment- I think we have to. Maybe move the meeting up a week?

Comment- Julie OK. Do we want to keep it this time? How about December 14th? 10:30-12:00?

Comment- Jeff On the 14th, I will not be able to join until 10:30.

Comment- I hate to be a trouble maker, can we bump it back to the Tuesday, December 13th; we are cutting over new 911 in our call center?

Comment- Julie So, Tuesday, December 13th from 10-11:30? Does that work for everyone?

Comment- Works fine for me.

Comment- Julie Ok, that will be our next meeting. After that we will set them for the following months. In this then there are a couple more things we need to go over. State updates still and then have time for a couple of comments. The other things we will need to look at is how much time we want to leave for public comments at the end of every meeting. I think in the statewide meeting they leave 15-30 minutes. I don't know that it is every used up though and our meetings may be different than that. Any ideas? How much time would you like to leave for that?

Comment- Hello, I'm sorry to interrupt, this is Cindy Wagner, Randolph County. I apologize I didn't call in earlier. I just got notice from someone else on the committee of this meeting. I didn't get anything just other than the information would follow calling into this; I got the information from Randy. I don't know if there is a problem with notices?

Comment- Julie I know that for the meeting invite we have to post it on the DHS website. I think there will be an easier way moving forward. Thank you for the feedback, I think that's really important because we want as many people as possible to show up for these meetings. I appreciate you being here.

Comment- Just a side note, I spoke with our law enforcement representative, Police Chief Johnson. He just got sworn in as the Fairview Heights Police Chief last night and lost his calendar, so that's why he wasn't here, and will be in attendance next month.

Comment- Joe Julie I had the same issue as well, I had difficulty finding the Zoom link also. I was wondering maybe if they could just copy that and send it out to this group by email, the Zoom link?

Comment- Julie For sure, I think that will make it easier.

Comment- Peter I'll address this particular issue in the State update Section, I think we have a work around.

Comment- Julie I think we are ready for State updates.

Comment- Peter I do want to recognize that this is the first of the Regional Advisory committee meetings. I have been feverishly taking notes on things that we can improve for the other ones. I'm sure it's no comfort to you that you are the guinea pigs, but just know that you've done a lot of service to the rest of the State from the other regional advisory committees which will all be even smoother for what we have learned today. The issue with how we communicated is related to the restrictions with the Open Meeting Act and how Julie and her team can communicate with all of you regarding putting names in blind copies had some restrictions. We have figured out that we can send by email that has a calendar invite and you will be able to open the calendar invite and add it right to your calendar. Sorry for the confusion for those who got here late, that's an imperfect reflection of us trying to follow the open meetings act and we think that it will be better next time. Secondarily, I do appreciate the fact that we have been talking about the Open Meetings Act because even though it appears to be not responding, that is typically a place where all of the meetings related to CESSA are posted, including a link, including statewide advisory meetings, regional advisory committee meetings, all are open to public. Although, if you are not a member of a particular meeting then you are a member of the public, so you can comment at the end of any of the meetings. Just a couple of comments I wanted to mention based on today's meeting, our team here at the UIC Behavioral Health Crisis Hub and the DMH have had conversations, two of them now, from vendors of 911 who have software for the 911 systems, so we have developed some relationships so when it comes to the difficulty of actually changing the scripts and changing the protocols it's an issue we are really familiar with. I'm pretty sure we have a presentation from one of the vendors at one of the statewide advisory committee meetings and so I will see if I can find that information and share it with Julie so she add it to the minutes.

I did also put into the chat a link to the Zoom for tomorrow's meeting of the statewide advisory committee's standards and protocols meeting because that is where the conversation about the matrices will come in. It will be recorded so you will all have access to it. It is an open meeting so anyone can attend that. There is a statewide advisory committee next week. I will say as someone who has been working in CESSA since last year, it's a lot to take in and I appreciate that. I really appreciate your patience at this regional level for things to get stared, there's a variety of reasons for that but we do have a good sense but, information that we can provide that will help you get up to speed for the responsibilities that you'll be executing in the months. Just to underscore something that Julie said at the top, that we do have a bunch of materials that we will be making available to all of the members of the group not members of the public, but members of this regional advisory committee for example we will be sharing a copy of the legislation itself. If you are not familiar with that, we will be including information regarding the open meetings act so you can do that training. We will be sharing maps of your region which will helpful for you as we start to talk about how the crises responses happen there. Jeff and his team have lots of resources and we kind of wanted this meeting to balance between getting you started and flooding you with information. By your next meeting you will have everything that we have so hopefully and that will support your ability to engage. I'm happy to state any questions from the states perspective. I am not an employee of the state but we are partners with them in this work. No questions. So Julie it is back to you.

Comment- Julie Our next item is public comment. Does anyone who is not a committee member have any questions, comments, anything you want to say or bring up for us to consider, think about and work on as we continue to move forward with this? No comments.

Comment- Julie Anything other than we need to discuss before we dismiss today? No comments. Alright, our next meeting will be Tuesday, December 13, 2022 10-11:30. I will send out calendar invites. You will all kinds of good info. For minutes to this meeting you will find posted on the DMH website. Peter can I send them out also? No, we need to approve them first, correct?

Comment- Peter No, the process is, once you and Tina have confirmed that they are good notes, you will send them to the committee members. The committee members will have them before the next meeting and vote to approve or amend them, at that point, you will send them State for posting

Comment- Julie Thank you all so much for attending and figuring out how to get here, I appreciate that. Also, for you being my co guinea pigs as we begin this great work. I look forward for more to come.

Comments- Thanks Julie. Thanks Peter and everyone else.

Comments- Julie. Do we need to do the Roberts Rule of Order to adjourn? Ok, may I have a motion to adjourn this meeting?

Comment- I so move. Comment- Second.

Comment- Julie Thank you. With that, we are adjourned at 11:10 a.m. Thanks so much.