I'm Chris, I think I know most of you in this room. We're gonna kind of change course a little bit. I'm gonna talk about a topic that we hear a lot about in grand rounds, mainly for an M&M series, but I think we should maybe at least talk about kind of the outcomes of some of those cases of endothelmitis that we've been discussing. And so why do we care about endothelmitis? Well, so if we look at Medicare rates from 2010 to 2014, there was reported 1.2 to 1.33 cases per 1,000 cataract surgeries. That resulted in an 83% rise in medical care costs associated with that single surgery. In 40% of those cataract cases and greater than 90% of TRAB surgeries, visual acuity outcomes will be worse than 2,200. And then with the TRAB itself, you have a yearly risk of 1.3% of developing endothelmitis. We're talking a significant vision altering disease process. We have basically one major randomized control trial that was actually performed in the early 90s and was published in 1995 with subsequent kind of iterations of post hoc analyses. And that was the endothelmitis of the TREC to me study, which we're all familiar with and I'll talk more about as we go through this presentation in case you are not familiar with it. And to base our treatment in the clinic at least off of a randomized control trial, like I said, the EVS is one of the only, if not the only randomized control trial and it's specifically looked at acute endothelmitis following cataract surgery. So the endothelmitis had to be within six weeks of surgery, had to be cataract surgery, visual acuity, had to be somewhere between 2050 and light perception. You had to be able to visualize the iris. The cornea had to be clear enough to perform a detractomy. And then there had to be a hypopian or sufficient enough inflammation to at least obscure the second quarter arterioles of the retina. However, that doesn't leave a very broad group of patients to fit into this actual study. And I think it was a great study but doesn't really help us in a lot of other cases. So I'm not even gonna mention all of these because I'm gonna mention them in the next slide. But what do we do? Well, I guess the next slide after this, sorry. So the EDS basically concluded and like I said, there's been subsequent iterations but probably the most that we get tested on multiple board exams that we all talk about is basically performing detractomies for light perception or worse visual acuties at presentation. It also showed that ID antibiotics or of no benefits or no additional benefit. I think you kind of cast a little bit of doubt on that if you actually look at this study because I think it actually reduces some of the complications but wasn't statistically significant. And then there was a subgroup analysis of diabetic patients that seemed to do better with a lower threshold for a vitrectomy than you're just one of the male patients with endophthalmitis. However, this is the slide I was alluding to what do we do in cases of post-injection endophthalmitis, glaucoma endophthalmitis, glaucoma associated endophthalmitis, retinal surgeries, corneal procedures, chronic endophthalmitis, severe cases of endophthalmitis, post-traumatic endophthalmitis, endogenous or exogenous endophthalmitis. That leaves a lot of patients, quite frankly, that we have really not a lot of guidance on. I mean, there have been some non-randomized control trials and some kind of post or basically analyses of those to give us a little bit of guidance but like I said, not a randomized control trial. In these cases here, this is a case that Dr. Shakur actually just operated on for the second time last week. This is a fungal endophthalmitis. This would not have qualified for the EVS. And then here's a no-cardia case which also would not have qualified in the EVS due to the significant inflammation. So these presumably are the ones that have the worst outcomes, right, that don't fit into the EVS. We'll talk about that more as I kind of go through this. I mean, then also the other side of that is there's been some kind of changes in management of diseases since 1995. We've had presumably more patients exposed to the risk of endophthalmitis that's most likely related to intraditory injections. I don't have specific data on that but I think you could easily make that conclusion. You use smaller report sizes for most of the tractanies with the idea of being that there's less risk of a complication related to the smaller report size. And then the EVS, you actually look at the actual IV medications that they gave. They have very little intraocular penetrance. The fluoroquinolones were not even invented in 1995. So now we have better intraocular penetrating medications.  This is just one of them that I'll suggest here that in severely inflamed eyes that you do a tap and inject initially if their vision is better than light perception, see them within 24 hours if they're not improved. These patients seem to do better if they had to retract me within that first initial presentation within 24 hours. There's multiple iterations of this kind of thought process out in the literature. I'm not gonna dwell on it. Still wanna show some data. However, with all that said, we still have poor outcomes with endophthalitis. And are there things that we can do to help improve clinical outcomes? Specifically, non-surgical, even surgical. That's kind of what I'll talk about here coming up. So we basically, and this started with Reese Feist. You all remember him. We started a retrospective data collection where we looked at every post-procedure endophthalitis case treated here at the Moran. So that may be a referral from an outside provider or that may be a case that was actually caused by a surgery or an intravisional injection from in this facility. That included basically charts from 2009 all the way to 2018, some nine years of cases. We collected a bunch of data, most specifically visual acuity and sighting procedures, the long-term outcomes and the treatment administered. And I'll talk through that as we go. And so then this is kind of the demographics of the overall presentation. And I'll get to our main question that I'm not gonna present yet because I just wanna show you the demographics of these nine years of endophthalitis cases. Average age, 72 years. There was a total of 83 cases. Like I said, these are all post-procedure. So all the endogenous or exogenous cases are excluded. And then I don't think, I remember seeing a post-traumatic case, but those have also not been included as well. 88% of them received an initial tap and inject basically off of EDS criteria. 33% of them, so a third of them actually needed retreatment of some types who either have attracted me or a repeat tap and inject, mainly inject. And then what I'll talk about here in a little bit, about 19.3 or 19.3% of them received oral steroids as part of their treatment algorithm. The follow-up time varied anywhere from one to 2,938 days with an average of 471 days. So pretty significant follow-up. A few of these one-day follow-ups were outside referrals and then I think returned back to their referring provider shortly after the tap and inject we performed. So that's pretty common for tertiary referral center. So then what features of these endothemitis cases can we kind of clean? So inciting procedures as you can kind of guess this matches with the kind of amount of procedures that we do here at the Moran. So leading kind of the I guess charge for amount of total endothemitis cases cataract surgery, secondary IOL placement was the leading kind of cause or inciting procedure followed by intravitural injections here. Retina procedures kind of followed that afterwards. The surgical complications. So we looked through all of the surgery, op notes on these procedures that we had available to us and only about 12.2% had actual documented intraoperative complications. And specifically for cataract complications because we always talk about cataract complications and the risk, well-developed and well-documented risk breaking the posterior capsule. I think most of these can be attributed to breaking the posterior capsule except there was a small cohort of cases with just an anterior capsule tear with the developed endothemitis. But most of those related to either dropped lenses or amdor just a posterior capsule tear. Was your previous slide cataract specific? This one? Or the one this one? So this was actually overall. Okay. But yes, so most of those were actually cataract specific. Hard to say exactly from kind of some of the documentation of other specific complications. But yeah, that included everything. Intravitural injections and I think this just states or shows us what we most commonly use in the clinic. So we have Avastin and Iliya kind of leading the charge. And I've talked to the rutina fellows, specifically Dr. Calvo quite a bit about this, but we don't have a lot of cases of Ozzardex or post-Ozzardex endothemitis, which is interesting. And if you look in the literature, you actually don't find a lot of documentation of that. You would think that that would be more common as just steroid, but don't really have an answer for that. Then kind of consistent with what we find in the literature and it's kind of changing how we basically manage endothemitis, but basically a third of cases are coagulase negative staff. Then a third of cases are unidentified species. So something looks like endothemitis, but we can't actually identify an organism. And I'll talk about that a little bit more here in a second. Visual outcomes and sorry, this slide's really, really busy. So I'm gonna break it down into basically two categories. So, well, three baseline presentation and final and then two kind of overall categories. So baseline visual acudes presentation. So at time of endothemitis or diagnosed endothemitis, as you can see very poor visual acudes at that time. And then by the time that their last follow-up that we have documented, kind of a broad spread. And so if we make that easy, I like thinking easy, breaking things down so they're simple. So if we kind of consider anything 2070, 2080 issues, okay, vision, and then everything kind of worse than that is bad visual outcomes. We can see that we kind of have a spread, obviously a presentation poor visual outcomes. We'll talk more about that as we go, but that's just kind of the overall kind of follow-up of these patients. What happens with these endothemitis patients after they've developed endothemitis? Unfortunately, they're not out of the woods, as we all know that they all have high risk of developing complications. Most notably, non-clearing vitreous debris, pretty significant. Some of them actually had to have the tractomies to remove the debris to increase visual acudes. Retinal detachments, macular edema, epiretinal membranes, and then tisis, and or a nucleation or evisceration. And I'll talk more on that here in a second, but we're talking some pretty significant complications. So then what kind of led us to actually looking at this? Yeah, looking at endothemitis outcomes is, I guess, interesting. It's not the most gratifying thing because a lot of them don't do well. But our main underlying question, do steroids help? And there's been some literary kind of question circulating for quite some time on this exact topic. And so let me give you kind of the case for steroids. So in inflammatory, infectious uveotides, like acute retinal necrosis, syphilis toxo, after we've started treating the infection with significant posterior inflammation, we will actually start patients on oral steroids, okay? Specifically for toxo, we may even give intravisual dexamethasone, okay? So that's almost a, I hate to say standard of care, but because it's not truly a standard of care, but that's what's done out in the uveitis world. Then from multiple studies, there have been multiple small randomized control trials. There's been a larger, more recent randomized control trial of patients basically receiving intravisual dexamethasone at the time of diagnosis of endophthalmitis. So they get vancomycin, septasidine, and dexamethasone intraviturally. Data has been unfortunately inconclusive with visual acuties basically unchanged from the control group. The kind of question that we posed was well, intravisual dexamethasone has a half life of five and a half hours. The only thing that we can kind of follow or at least from animal data and then a clinic follow-up appointments, animal data says that hemokine level spike within 12 hours of inoculating the vitreous cavity. However, they say significantly elevated for seven days. We can kind of see that in clinic as well. And then we also know from animal data that the inflammation alone is leading to irreversible retinal damage. So presumably if we impact or reduce the amount of inflammation, do we preserve some retinal function? But with a drug that only lasts five and a half hours, is that truly enough? So we hypothesized similar to like I suggested in acute retinal necrosis, toxoplasmosis, these other significant inflammatory infections that an oral prednisone taper may significantly impact intraocular inflammation resulting in better long-term outcomes. So that was kind of the underlying hypothesis. So just to emphasize after our UGITIS grand rounds two weeks ago, all these patients received a TAP and inject and dexamethasone introvitrally at the time of diagnosis were almost all of them. We did not start oral steroids until 24 or 48 hours after that initial TAP and inject. So they are covered from an antibiotic standpoint prior to the initiation of an oral steroid taper. And that was started with a very high dose one milligram per kilogram typical to what you would see in our UGITIS clinics. So the demographics, unfortunately, this is a pretty small study but I just wanna show you the data to kind of give you some food for a thought. So if we look at the non-steroid group versus the oral steroid group, they were about the same age, 72 versus 69. There were more males for whatever reason than the steroid receiving group. And then diabetics, about the same, maybe a few, a slightly higher percentage of diabetics. And then average follow-up was pretty close to the same. The visual acudes or at least presenting visual acudes seemed to be worse in the group that received oral steroids. So 93.8% of them had count fingers or worse visual acudes at time of presentation compared to 77.6% that did not receive oral steroids. The organisms isolated maybe were suggestive of more aggressive organisms. So you have a stronger or I guess more organisms that are strep species in the group receiving oral steroids than you would otherwise see in the rest of the groups. But like I said, this is pretty small. 16 total cases that received oral steroids. And so you could I guess make the argument and then looking at this that glaucoma procedures were more likely to receive oral steroids than not. And then cataract surgery was kind of the inverse of that where they were unlikely to receive oral steroids in their follow-up for whatever reason. So there seems at least from that data, like I said, very small to be a bias, a bias from us of giving oral steroids to the worst cases, okay, which kind of makes this data that I'm about to show a little bit even more interesting. So the other side of do oral steroids make things better is do oral steroids make things worse? So that's the concern of anyone, right? Anytime we give oral steroids, do we make things worse? When we look at visual acudes, like I said, oral steroids patients seem to have worse initial presentations. However, by their final outcomes, there seems to be no difference. So it didn't seem to lead to worse or better long-term visual acudes. And an interesting thing, and I didn't show this with the entire overall cohort, but by one month you can predict almost 70% of patients' final visual acudes by one month, which isn't that surprising because the inflammation has gone away. But I guess from the standpoint of being a tertiary referral center, it's kind of important because long-term follow-up or at least referral from outside providers, we don't know underlying pathologies, we don't know what their baseline visual acudes were. In most cases, we're literally doing tap and injects to treat the inflammation and infection and then following them thereafter. So we can have discussions potentially with patients at one month stating your visual acudes can be somewhere around what we're seeing right now in most patients. Sorry, can you go back to that slide? Where's the no steroid? So the no steroid is the... It's the paint. Yeah, it's this light gray line on each of these, this here. Can you see that with the laser that I just pointed out? Sorry, that doesn't project very well. I can show you the screen up here if you'd rather see that. But sorry, it's basically trust me on this, I guess, since you can't see it very well. But there is no difference, despite me wanting there to be a difference. Actually, I didn't really care, but there is no difference between them of any meaningful kind of magnitude. However, the one thing that steroids seems to change, and this is probably important from an oculoplasty standpoint. So I started digging through the oculoplastics literature, looking at what happens when a patient actually loses an eye. So there is a huge psychosocial component to evisceration, tycis, and patients have higher levels of depression, anxiety, issues with their overall kind of appearance when they do not have a normal appearing eye, even if it isn't functioning. So we see about the same amount of rates. Can you see that gray? You may not be able to see the gray here. You can, okay. So you see kind of rates of everything with oral steroids, so retinal detachments, non-clearing vitreous degree, macular edema, epiretinal membrane. You do not see any patient receiving a nucleation or evisceration for a blind painful eye. You do not see any cases of tycis develop in the patients that receive oral steroids. So are oral steroids salvaging the globe? I don't know. Like I said, this is a pretty small data set. If you do the math, we should at least see one case of either tycis or a nucleation of evisceration from a blind painful eye. Like I said, we've followed them on average for over 450 days, so this isn't like we're just not seeing long-term outcomes. So concluding thoughts, like I said, you can't take too terribly much, except maybe raising questions to pursue larger studies, but probably the thing that is already well known in the literature is that isolation of organisms is fairly aggravating. We saw about a third of patients did not have an identified organism. That was due to low yields, the way that we send specimens or have previously, and then even mishandled specimens with our lab here at the university. So that is kind of pushing us in a lot of these very atypical cases where we're going in for vitrectomies for diagnostic standpoint of basically using pan-organism PCR. I'm not gonna show you the data, but we seem to be having much more, we're isolating much more organisms, many more organisms than we previously have, and some of them are very atypical that we would have never have found on kind of culturing mechanisms used here at the university. Then one-month visual acuties, like I said, the larger cohort, and then also the visual acuties once you separate the two between oral steroids and non-oral steroids groups, seems to be fairly predicting that one month to their final visual acuity. What that really means in the grand scheme of things, it just helps us kind of talk to the patient as we're developing this new relationship, presumably, or maybe a relationship in a different clinic, a retina clinic instead of a cataract clinic or a glaucoma clinic. Then steroids don't seem to make things worse. In fact, you could say that maybe they actually reduce the risk of losing the global together, so maybe they actually help some. Overall visual acuity, they don't seem to do anything for, but like I said, small study, you'd have to make a much larger study multi-centered to actually answer that question truly. And then I've kind of hounded this from the very beginning, because I've been kind of a proponent of this for quite some time, but I think there actually needs to be an updated version of the EVS, so the endothemitis retract me study. We have enough retrospective data at this point that I think people are, even at this point, if you read some of the retina groups around the country, they are not even basing their treatment algorithms off of the EVS. That's how archaic they feel that it is. I don't know that it's truly that archaic, I think it actually gives us a good framework for treatment. And then probably the overall arch, overall kind of thought and endothemitis, preventing it and then early detection of it is paramount, right? So we're talking minutes to, well, maybe not minutes, but hours for treatment of this, but if we could avoid it all together, that would be ideal. And so I think unfortunately, or fortunately most of the thoughts or at least literature looking into this has been dedicated to prevention and I'm not saying that that's wrong. I think that's actually very good because if we could prevent it all together, then we don't have to worry about actually treating it. But that's kind of been at the expense of looking at treatments or changes in treatments. So with that said, there's been a bunch of people that have helped on this and I guess with that, any questions, concerns, thoughts, I'd be happy to answer those. Dr. Petty. So you don't need to go back to the slide, but at the beginning you showed the baseline visual acuties and with so many of these patients being AMD injection patients, and it seemed like visual acuity was an outcome. They can't possibly have a good output. Can't get that right. So that, how are you accounting for that? And what are your... So I didn't show it, yeah, I didn't show it in this data. And I probably should have because I agree with that 100%. You can't have a patient that has a normal baseline vision of 2100 and expect them to recover to 2040. And so I think, and that's why I emphasize the one month visual acuties. So there's too much inflammation to know a baseline visual acuity. If we've never seen the patient, we have been told maybe there's macular degeneration in this patient, but we don't know what their baseline visual acuity was. By the time you get to one month when inflammation has subsided or most of it has, of course, the case of non-claring vitreous debris, you still have significant visual altering things. But basically what we started to adjust for was actually looking at their preoperative if we had that or pre-endophthalmitus visual acuities, and then comparing that to long-term visual acuities, which then of course weighs in what was their actual baseline visual acuity, rather than, okay, they have count fingers vision due to endophthalmitus plus or minus something else. So the presenting visual acuity is a little bit deceiving compared to what was their visual acuity prior to the presentation. So in a count fingers patient at the beginning, how, let's say 2400, how do you account for... So their return back to their baseline, so if their count fingers before endophthalmitus, you would presume they're gonna return to count fingers. Thank you for telling me. Thanks Chris, it represents a lot of work. And I just wanna point out a couple of things. One is, you know, there are two visual acuity outcome in endophthalmitus and reducing inflammation are two almost separate outcomes in a study like this.  And so the rationale for, as you point out, is to, you know, reduce inflammation and then, you know, get an instant bystander damage from inflammation, presumably, right? So a couple of questions are that we know that the organism that is defending organisms in large part determines outcome at every outset. So it's almost as you point out in your slide, you know, at one month you can predict outcome. So in those eyes that are going to do well, okay, maybe using oral steroids is useful in reducing inflammation, you know, and obtaining a view and hastening that recovery, the inflammation. And also another important component is that some of these eyes are painful and aren't maybe headed to ticis and that maybe steroids will reduce some of those symptoms.  So, and I think that an important finding is that, you know, people did not do worse with steroids because there are papers that suggest that maybe individual steroids, the outcomes, were worse. And it's a mixed bag as you point out in your internet. Oral steroids tend to be used in the more severe cases. Patients that present with ingredients have managed a lot of end-of-the-mind. I seem to find that patients that are less severe tend to do a lot better. It's an anecdotal sort of, right. And it also allows you, I mean, you clear your views so you can see what's happening in the back of the eye, the way that just letting the eye kind of smolder along. Not as slow as Tepromonic, 60 for five days. Yeah. 40 for five days, 20 for five days, stop. So, you know, I mean, there is, as you pointed out in your introduction, there are infectious entities that are not end-of-the-mind cases in which we use oral steroids and the reason for it is to reduce inflammation. It's associated with the infection itself. And it may or may not actually lead to a better outcome. Overall, when you look at a large series of patients, right, I mean, so with acute retinal necrosis, for example, if you have a very large area of retinal necrosis and you can't see anything and you treat them, you know, with any viral medications and with steroids, you may actually hasten the view. But if they have a lot of retina effect, that they may end up having retinal detachment. But the exception is important, right? Don't you think? I mean, the individual patient is also important. So, I mean, there are the individual patients for whom you treat with oral steroids actually do well, you know, so doesn't do any harm is helpful because you might be more apt to treat inflammation in the hopes that that particular patient may do well if there's no, you know, overriding reason that it does harm. Right. Is there a discussion that's so reminiscent of corneal ulcers and some studies showing that there were some showing they do better and in the end with the organism being so deterministic about getting to the point where specific organisms we know respond better to steroid or not and either corneal or overriding. I don't think we have needed. Yeah, from an endothelmite standpoint, no. Organisms that are much more inflammatory but I don't know that we've shown anyone a show that producing that information improves things. Dr. Calvo. One other thing about controlling inflammation which I think makes sense for the steroids is besides, you know, the point of trying to improve the view into the eye, decreasing the media pacification from botrytis and ipokialin, but, you know, it's been shown by, I think a research I was done here at Marin that in ophthalmitus early, you see vasculitis. That's one reason why a lot of these retinobasculitis, that's one reason why a lot of these patients, after the views cleared, their vision remains poor, their retinas thinned. It's because they had a lot of vasculitis during the infection and so that would suggest if you get steroids in early, you're going to theoretically decrease the amount of vasculitis they have and therefore preserve retinal perfusion which would hope to keep their vision. So aside from, you know, improving our view of media pacification, I think that it could have an important, like, vascular benefit as well. That paper by Andrade Imsousis actually showed that the few patients seems to be part of the initial insult in acute retinal necrosis as well in which we have a lot of experience with steroids, so the circuit does make sense. And I think from speaking to my previous life in the research lab, so I haven't looked specifically at the retina but I've looked at both the CNS and in the cornea and I can tell you in tissues that don't regenerate very well or even the cornea, for example, there seems to be an inflammatory kind of response to the infection, it seems to be critical to clear the infection, but there also seems to be some kind of additional inflammation that you can actually reduce or basically ablate and it has no effect on long-term outcome that actually makes things better because it seems to be a pathological immune response rather than a beneficial response. So I think that's kind of the overall thought process and a tissue, brain, retina, wherever you wanna go, tissue that doesn't regenerate very well, if at all, that you can't have inflammation, it's leading to apoptosis, cell death, or just pathological changes. I have a quick name question, like why don't, why do antibiotics not work with staphylococcus right now? Why do antibiotics not? They do. Systemic, that's probably the question you got. Oh, so intraocular penetration of medications isn't great, even with inflamed retinal blood barriers, they still don't seem to get into the tissue very well, so you're not getting high enough concentrations. And I presume nobody's really looked at this, at least that I'm aware of, but if you waited long enough, then maybe it would work, but unfortunately you're talking about a tissue that any damage to it is long-term and can't be recovered. So it's not like a systemic blood infection where you have some time because you're not seeing permanent pathological changes, at least that a patient can describe to you. In the retina, for example, where you need to control things relatively quickly, you don't have time to wait for intravitural concentrations to build, but most of those drugs, like I said, and I didn't even show this, but 10 of the 60-some isolated organisms that we found were actually resistant to levofloxacin, which is one of the highest intraocular penetrating drugs that we have. So that's crazy, thinking, okay, we could use systemic antibiotics, but are they all resistant to the one drug or a class of drugs that we have that actually? I think the drug that has permeability is enough to be good. Yeah, and with a compromised retinal blood barrier, you'd think that the concentrations would be higher, but you just don't have time to wait. So, it's crazy.


I'm Ryan and I'm Allie after falling in love. We decided to ride bikes across America collecting love advice along the way. This is Love Cycles. No flatties! No cruddies! No cruddies! Oh this is a great place to wake up right next to the Mississippi River with all these fun bird sounds. We have less than one mile left here in Iowa. I feel like I miss all the pie and the slip-in slides and I already missed the 27,000 people that we've been hanging out with for the past week. It's going to be quite the transition to go from rag bride to life after rag bride, but I think we can do it. We've done it before. We're getting closer to New York and we can start to like actually feel it. We're in the middle of the country heading further east. Oh it's exciting! Onward to the next adventure. Guess what? We're in a new state. Look at a map. You're probably wondering why we're not just heading straight east from Davenport. That would be the fastest way to get to New York City. We are heading north toward Madison, Wisconsin, specifically Waterloo because that is the home base for trek bikes and we're going to go there and hang out with Jocelyn and the team and we're excited about going up north and then from there we're going to stay north all the way to New York City. These lush green forest here, we're definitely not in the west anymore. Allie, what do you think? Having these trees over us is very cool and calm and comforting. You can just feel their energy getting into your soul and revitalizing you. I've been on this dreamy bike path pretty much all morning about 35-ish miles and man it is nice and I think it's a preview of what's to come as we head further east. Lots of green, lots of trees, and more fireflies. As much as we miss the energy and excitement of Rackbrite, we're really enjoying these quiet country roads. We got them all to ourselves. We've ridden past a lot of these old farmhouses with huge yards and what do we want to do on those yards? Play lawn games. Yeah, we're talking like we're gonna have some serious games of tag, red rover, bocce ball, frisbee, croquet, croquet, horseshoes. I just want to like lay in that grass. It looks so comfortable. At the end of a long day, this is all we dream about right here. And look at that. A bee just landed on your finger. You ruined our shot man or you made it better. Anyway, we're excited to be eating ice cream with our new bee friend. My ice cream is patriotic because we're riding across the USA. I'm repping hard. That's right we are and we're in Shannon, Illinois at the Casey's gas station. This is really cool. We've been in this park for about five minutes and the town mayor and the town pastor and we have some new friends are all helping us find a place to camp. It's amazing. I love this community already. What was your name again? My name is Mike. Mike, this is Pastor Mike and he is cooking it up. Thank you so much. How's it going? I'm Ryan. Oh, I'm sorry, Ryan. I'm Don. Nice to be here. Yeah, this is a camera. Say hi. Hi. We've only been here for 15 minutes and I think we know a quarter of the town and they're all helping us find a place to stay. Hello. How's it going? We just rode up from Davenport today. Davenport? Yeah. So you did ride, Brian? Yeah, we did ride, Brian. Where are you headed? We're going to New York City. Oh gosh. Yeah, it was so great to meet you. Thanks for helping us out. I appreciate it. Good to meet you. God bless you guys. Thank you. Thank you. See you later, buddy. Bye bye. Bye. I have love advice being married for 34 years. Love is a choice and sometimes you don't want to choose it, but you have to choose it. You'd rather choose anger or jealousy or whatever, but you have to choose love. I like that. I like that. Hi, buddy. Hi, buddy. I'm Ryan. Nice to be here. Hi, Allie. Allie, Allie. Once again, road magic in full effect. So cool. Yeah, the people of Shannon are awesome. Yeah. It has been such a pleasure and so just, yeah, enjoyable to roll into this town and all of a sudden there's the mayors being called and the pastor and everyone else. Yeah, and it happened so fast. It happened so fast. Here we are in this beautiful backyard. With our new friend Ken, who did Raghbri last week and he loves bikes and he's raising money for cancer research and yeah. I mean, all he had to do is make one phone call. He didn't even know who we were. He's like, yeah, sure. They can camp here. He's like, actually, they can stay in the house if they want. And it's like, people are really nice. Yep. It's just a good reminder from the universe that we're in exactly the right place right now. Exactly. This is the good life. Thank you, my friend. Yeah, you're welcome. As a kid growing up, I always saw fireflies like in movies or on TV, but we did not have these things in Colorado. I didn't really think they existed until I went out east and I still love fireflies. There's something seriously magical going on. And now to top off a perfect evening with some Casey's pizza, watching fireflies, listening to the cicadas. It was a good day. What do you think? I can't talk. I'm chewing. She can't talk because she's chewing, but she would say though she could talk. It was a good day. Good morning. Good morning, man beast. How's it going? Good. Woke up in some kind of a magical wonderland here. And now we're going to go to breakfast with Ken. He came out and said, hey, I'll buy you guys breakfast. So that sounds like a really good plan. This right here might be the best looking breakfast we've had on our entire trip. I got some sour cherry jam. There's also sour cherry jelly that I chose. These two right here have been married for 48 years. A long time. So tell us, how do you stay happy and healthy and married and smiling every morning when you've been with the same person for 48 years? Yeah, you do your old thing. Yeah, we pretty much do our own thing. We let each other do what they want to do. And what's important to us is church and family. I think as long as the belief structure is there to start out with, you know, you got to trust each other. Like I said, he's rising and taking off and I do, I'm the introvert. I stay home and it works. Yeah, it works, whatever it is we do. The grandkids are the thrusting on the cake of life. The second time around, it's just we were blessed with kids. We never had, and those kids never had a better time.  Final question. Do you think he looks sexy and spandex? He actually does look pretty good most of the time in his bike. Once he loses the weight, the winter weight, you know. So I lost 15 pounds riding for the U.S. Cycle Challenge. So otherwise, the grandkids think grandpa's pregnant, which is bad. So Ken is having a very hard time saying goodbye to us and he said, why don't I just ride with you today? So we're going to ride together. Yeah, my inspiration, a little hula girl, and that was given to me by Dean Fogarty, believe it or not, from Boulder, Colorado. This is really fun. Ken has taken us on some of his favorite bike routes that he rides every single day out here. Ken has just delivered us right to the Jane Adams Trail. Yeah. We have a new friend here in Shannon, Illinois. Thank you so much. Thank you. Come visit us in Boulder. I'm coming to Boulder. Yeah, buddy. Happy trails. Yeah, thank you so much. Going into the forest. This Jane Adams Trail is heading us straight north into Wisconsin for about 15 miles. Then we're going to link up with the Badger State Trail. The past couple of days, we've been relying completely on Google Maps and using the bicycle function. And we really didn't know what we were going to hit or what we were going to see. And we've been very lucky to have found some great bike paths all the way up to Wisconsin, essentially. Nice and safe away from the roads. And I don't think there's any alligators in here, so we're good to go. You know what time it is? Time for a dance party. Okay, here we go. Wisconsin? Yeah. Cheese, baby. Cheese, baby. Have you ever been to Wisconsin? I have been to Wisconsin. I was in Milwaukee once. That's in Wisconsin, right? Yeah. Okay, just making sure. Google Maps has us on the Badger State Trail all the way into Madison. This trail has been so beautiful for 15 miles. And I'm just like to say on it, it's shady, it's cool, great surface, there are birch chattering. What more can we want? This is what the beautiful Badger State Trail looks like. And it's surprising because it covers all the outside world you can't see out. And this is what most of Wisconsin looks like out here. It's just farm fields and corn. And we're liking it in our little tunnel of love in there. We're riding into Madison right now. And we're on this bike path.  Wow, thank you so much. Can I have a high five? Yeah, yeah, that was nice. Can I give you a gift? So I have these really cool stickers. So you can have that and your brother can, here you go. Yeah, you not only gave us lemonade, but you made a smile. And that's very important. Oh yeah, one more. Bam. These little guys right here are the best free lemonade makers in all the world. What a great way to enter Madison. We're rolling into Madison. It's a beautiful evening. The bike path is full of people running and biking and all sorts of physical fitness that reminds me of Boulder. And we are going to stay tonight and a couple other nights with the friends of Jocelyn. She's hooked us up with some nice people. We've never met them, but we're excited to make some new friends. How's it going? We're just like the people in the videos. How you doing? This is so great. Hello, everybody. So great to meet you all. So Jocelyn and Don have been married 60. It'll be 60 years, August 6. 60 years, yeah. The street is sacred. Do whatever she says. It's easy. It's so easy. It's not easy. It's simple, but not easy. I love it. So we just rolled in here and they're having their little Tuesday afternoon cocktail party. We got to know all these wonderful people. And thank you for letting us join you. Well, it's just a pleasure. I'm amazed that you're doing this. All right. Here we are. This is our home in Madison. Thank you so much. You guys are the best. It's great. Seriously. We don't have to camp tonight because of these kind people.  Thanks to YouTube.


Everyone, thank you for joining us today and welcome to the Social Equity Subcommittee meeting for this week. So, before we get started, I'd like to call the meeting to order officially and also take attendance. So, I'm going to start with the subcommittee members and Julio, I can see you, so I'll start with you. Yeah. Julio Thompson, Civil Rights Unit AG's office here. Very good. Thank you so much. And then, Nader. Present. Thank you so much. Susanna. I'm here and I'm going to sign out and back in again. Oh, you can't see it. Oh, no, I'm so sorry. Okay. Oh, good. And then, Lindsay. I am here. Hi, everyone. Fantastic. Yeah. From NACB, we have myself. We have Gina Cranwinkle. Present. Jeffrey Gallegos. Present. And John. Present. Wonderful. And then, from the CCB, we have, I think I saw Julie, and then would you like to introduce yourself? Yes. Wonderful. Fantastic. Welcome, Kimberly, and welcome to the members of the public. So, attendance has been taken. As I do each week, I will go back and just remind everyone that these are our milestones with our next one coming on Friday. So, exciting stuff. I know Gina is very enthusiastic to get these reports in. So, let me move over now to, we're going to go through a few different things today, including the Cannabis Business Development Fund, then also a couple of other things that will be presented today, including the Cannabis Social Equity Board, Social Equity Application Approval, and then, of course, we have time for public comments in person. There were no public comments this week that we received electronically. So, I would like to remind anyone watching this recording or anyone that's with us today, if you would like to make public comments that you may do so at ccb.comots.gov, and there is a public input form very easy to find, and we welcome all comments, and I would like also for everyone to rest assured that comments are reviewed by each of the subcommittee members. They are disseminated among them so that they are able to hear what the citizens of Vermont has to say. So, with that being said, let's move to the last order of housekeeping business, and I would like to see if we could get a motion to approve the meeting minutes for Thursday, October 7th. I'll make that motion. Fantastic. Do I have a second? Second. Thank you. All right. Let's get started, and Gina, I'm going to turn this over to you. You should be able to drive if you'd like to. If not, I will keep going for you. Oh, I'm good. So, we are going to get into what the cannabis development is fun. How are we going to get funding for this? Right now, we have $500,000 that will be allocated. Impossible funds may be included as $50,000 from each integrated licensee. Right now, we cannot say if there's going to be any of these licenses. I know they believe that there may be, so that that is extremely limited. So, one of the recommendations is that 5% of cannabis tax revenue goes to funding the program, and this is every single year, because obviously our first year is going to be the most expensive year, and we do not have a way that is set up yet to keep this program funded and moving into future years. And then a creation of a social equity cannabis trust is being developed to allow anybody who would like to publicly donate to the fund to keep it funded. Some of the expenditures for the program, but not limited to these things, are educational courses, so we were speaking about certificates so that people can be educated in psych cultivation, extraction, retail, workshops, which were in regards to, you know, how to help with assistance with applications, you know, learning about accounting. We need to also do some marketing and outreach of the program, the funding for a social equity co-op program, and if funds are made, or if we can get a bank to supplement this, low interest loans and grants to social equity licensees. Right now, with the funds being as limited as they are, we really have to look at alternative ways to really supplement loans and grants to social equity licenses, so we will be seeing what is out there on what things would be willing to partner with this program. So one of the things that I'd like to talk about is sort of this recommendation, you know, how do we continue to support the social equity program moving forward. Julio, how do you feel about 5% of the Academy's tax from going back to fund this program? I just think it sounds reasonable to me. I'm not sure what legislation permits us to, you know, set a tax rate, or I guess we would be recommending a tax rate, so taxing is usually considered a legislative function, but it doesn't strike me as out of place, no. Yeah, these are all recommendations. Everything that we're going to be suggesting in this program is just all recommendations moving forward. Nada, how do you feel about 5% of Academy's tax revenues to go forward to fund the program? I mean, personally, I don't really know enough about what, you know, the potential revenue will be. So, I mean, I can't say that 5% is a good or a bad number. So, I mean, I think we do, obviously, we need to fund the program. I'm not sure exactly what a good percentage would be, but if 5% is generally what's considered reasonable, I can defer to that. Thank you. Is that your thoughts, feelings? I have a lot of questions. One, yeah, I would say I would want to know the breakdown of how the other 95% would be used. And are we talking 5% of the previous year's tax revenue from this market or projected for the current year? Or how does 5% of what, I guess, because I imagine that's going to vary from year to year. And then I guess how it's, I know this is a different, maybe I'm a little too far ahead, but how it's spent. So, in other words, if that 5% goes to fund the fund and then it dries up, then what? Will we have doled it out to ask, will we have used it? If there are things we wanted to do with it that it didn't stretch enough to be able to do, are we committed to supplementing the fund to ensure that all of that work can be done or 5% of the tax revenue is supposed to be the only source that funds it? And, yeah. Yeah, it's great questions. Unfortunately, I don't know what the other 95% will be going to. I believe that there is another program out there that they want to supplement, I think, about like cannabis education. Julie, would you know what the all-cannabis tax revenue they're thinking about doing? So, the 6% sales tax is going to go to after-school programs. That's already outlined in the legislation. And then 30% of the, so on top of the 6% sales tax, there's a 14% excise tax. 30% of the revenue from that is to go to prevention programs. The other is in the general fund. It's not otherwise, you know, claimed in the legislation. Yeah. Thank you. So, that's 30% of the 14% who still leaves behind 70% of the 14% excise tax, right? Yeah, that's correct. I mean, you know, it seems to me that for a state that frequently runs a surplus to now be creating a new tax that is quite high, I feel like 5% is very modest and we could probably afford to do better with that. And then we will be just discussing later on, I think, next week, on Thursday, actually, about additional funding going to those impacted communities. So, for example, you know, opportunities on that we have created and also, you know, maybe communities of high BIPOC areas in order to get to the root cause of the problem to really change that. So, there will be recommendations made in order to really reverse this problem that has happened there. If that's a forthcoming recommendation, then I would be comfortable with that. You would not be comfortable, you said. I think she would. If we did have that added track of being able to get at some of those upstream factors, then I would be very comfortable with that and I wouldn't necessarily push to raise this 5% if we also are going to be finding other ways to address some of those upstream factors. Okay, great. Thank you. Sorry, you were just going in and out a little bit. Thanks. And Lindsay, what are your thoughts? We really agree with what everybody has said thus far. I struggle with whether that 5% is the right number because I, again, don't know what the realm of the possibilities are in terms of the sun revenue or is this 5% of the 14%. So, I think those details are going to really matter. But I know we have to sort of have a starting point too. So, I mean, in terms of kind of starting somewhere and I know that the legislators will hash this out when they're creating policy, then there's that, right? So, I'm indifferent. I'm supportive of something being there because I believe we have to build this fund, but I just am struggling with the right number. Yeah. I think, you know, this is definitely a number that needs to be looked at and thoroughly investigated as the program permits. And then we will also be talking about an advisory social equity board as well today.  We don't know how many participants are going to be out there. So, this needs to be revisited in six months to a year after the program has started. I'm really to get a true understanding of, you know, exactly how much does it need to be funded and does that come from tax revenue or does that come from the state of Vermont itself or the cannabis control board. And then the second thing was to create a social equity cannabis trust so that if people would like to donate to the program that we can get funding on that way. Who do you know you're doing? I think that, you know, ensuring that there's, you know, the appropriate mechanisms so that it's a blind trust so that you don't have any concerns about influence through contribution. I think that's, I think that's, that could be really useful. When you look at the expenditures or the potential expenditures down here, at least from a perspective, I think that the place that we're in now, it's the last bullet point where I think there would be, you know, that could potentially be a larger number. I think, especially after the first year of the program where you'll have some costs that are in developing the educational courses and doing the rollouts, but low interest loans or any kind of loan subsidies, grants, that could be a substantial amount. And so having a mechanism where it is, you know, a protected, it's a protected fund so that it doesn't drop into the general fund seems intuitive, intuitively appealing. I don't know, and I don't know, either you or Jeffrey or anyone else can offer any examples from any other jurisdictions or views that. So for the social equity cannabis trust, the only one that I know about that is just in legislation process right now is Massachusetts. Jeffrey, do you know of any other states that are thinking about doing a cannabis trust? I do not know off the top right now. I just put it in my notes. I'll take a look and see if I can find any, but as of right now, I don't know. I don't believe, I'm not sure, but I think no Massachusetts have been thinking about it. And it's just sort of a creative way to try to get funding for these programs and support for these programs, but I agree with you. Right now, the fund is not large enough to give anybody a low-interest loan or a grant. That would be worthwhile to any business, unfortunately. And then with all the operating expenses, educational courses, marketing outreach, which is why we sort of made a suggestion of really pooling the funds together and creating a co-op for people because that would be a real significant way to reduce the barrier of entry. Also, you know, I think one of the things to do is to really work with some Vermont credit unions in order to try to see, you know, if they would be able to subsidize this fund, you know, create low-interest loans or, you know, find out if there are some grant programs out there for social equity candidates. So this is just the starting point that we're going to be definitely looking at alternative ways to really kind of maximize our dollars but also maximize what we can use partnerships with other people in order to supplement what we have already. And the same thing will go with any educational courses that we can try to see or mentor chefs or other incubated programs that people will be willing to participate with the Vermont social equity program. Nada, how do you feel about this? One question I had is, do we know if donations to the trust would be tax-deductible? The reason I'm asking is, you know, that if they were tax-deductible, they would certainly attract more donors in the future. So I was just curious. I know we were speaking about this with Ijulio the other day and also Ben Ijulio. I don't know that they could be made federally deductible, whether it's deductible for a state of Vermont and that's just a matter of what you'd have, you would have to have some amendment to the tax code to account for that. So that's sort of, I don't think there's anything that would prohibit it, but you would have to have a change in the code. But as far as the federal code, that seems doubtful. I'm not at that concerning, but just because it's not a recognized trade and if this fund were operated purely to advance that trade and not have any other purpose, that's probably likely. If there were a trust fund that were associated with it, which is just a trust fund, devoted to sowing money back into community redevelopment, but that doesn't actually reach the market participants, conceivably, I might even achieve a federal deduction, but we would have to talk the tax better, equip tax professionals in the state of Vermont about that. But I think contributions to make the market go or a segment of the market go seems unlikely to me from a federal level. I agree, Julio. I don't think there's going to be any tax deduction for a cannabis program on the federal level. Would you like us to make a recommendation to see if a tax deduction can be made for the state of Vermont? It sounds like there would be a lot of moves to jump through to guess that, but I do think it could be worthwhile in order to attract more donors to the funds, because I think it's important that we have multiple funding mechanisms for this and having this trust account would be good, and having a wide range of donors would also be good. But in general, I do support the idea of having a trust. Thank you. Susanna? I agree. I support having a trust. I support it being blind trust and on questions of tax deduction, we can work that out in a way that's compliant with federal and just in state law, but yeah, in general, I'm with it. Lucy, your thoughts? I'm generally with it as well. Thank you. Julio, I want to get into the idea of blind trust. I know you said that if we put someone's name attached to it, they'll feel that they have to have a responsibility of it. What are your ideas if people were able to be named, because that sometimes is a benefit of people saying we're supporting the social equity cannabis trust and they want to be known their business to be known for that. What are your thoughts on that? Just because that sometimes can be a selling point of people making contributions. I think that if you are I mean, when I'm talking about blind trust, I'm talking about not only the source of the donation, but also if you have a set of money that's set aside, you don't just put it in a zero interest bank account. Through the Treasury Department you would have that money if it's not going to be immediately dispersed would be subject to prudent investment and by the Treasurer's Office. We'll need input from the Treasurer's about where that money is expended. The concern is that I don't want to get too far into the weeds, but I am aware that there are in other parts of the country what are called marijuana exchange traded funds where investors invest in the income stream they trade the income stream or projected income stream of marijuana cultivators and distributors and retailers and so I think if you know we need to we need to just have additional input about how the trust would be administered because you could have a situation where someone is donating a large amount of Vermont and there would be concern even the appearance of pride is something that you have to be careful of and so the question would be if there were a big market player that comes from somewhere within Vermont or from outside of Vermont that provides a lot of money and then also you know publicly advocates that the money that's in the pot be invested in some aspect of the marketplace that might be beneficial to them you just have to account for that possibility that because again trust funds or reserve funds typically just don't fit and evolve they're re-invested in the market to the yield traded because marijuana is new commerce I'm wary of situations where players might be using using the size of the notoriety of their donation to raise concerns that they're there on the other end other than just being maybe having the publicity and the good feeling that comes from contributing to part of this economy that they have some benefit in trade later on that's what that's what I'm concerned about it's just making sure that there's no and the professionals who will be aware of those appropriate safeguards and methods or the standards for investment are really folks in the treasurer's office and I'm not really in the quality of library further but that's really what I'm talking about and Leo for declaring buying that for us I would like to vote on this recommendation of five percent of cannabis tax revenue goes to fund the program and then a creation of a social equity cannabis trust to allow for public donation and they obviously the trust to be set up determined by the Vermont Cannabis Control Board Nader how do you vote I sorry if I heard wrong earlier but I thought we were going to be diving more into what what the number should be or should we all agree that five percent is the way that we're moving forward but I think we need to make a recommendation that in six months on this be reexamined to really determine the cost of the program and the revenue that is being made I think Lindsay hands up I'll call on you in a minute Nader what is your question so is this five percent don't know what the cost of the program is going to be so is this five percent is it just a waste holder for now until more and until we understand more six months down the road yeah okay then then I'll vote yeah and we're put a caveat that it needs to be reexamined in six months to determine that five percent cannabis tax revenue is sufficient to fund the program um Lindsay your hand was raised it was really the same thing I wanted to see if we could revise what we're voting on a little bit because it's like I don't want it to be portrayed that I'm you know set on that five percent when I feel like there's a lot of unknown just revise you know what we're agreeing to right now and suggest that it's a starting point or that it will be revisited or something of the such that would make me feel a lot more comfortable um maybe we can say that cannabis tax revenue goes to funding the program and not put any percentage in Nader how do you feel about that Lindsay yeah I could get there for sure um again but I also think there's a place where there could be a recommendation about a set amount that establishes this as well as opposed to a tax so I guess I'm just trying to leave that door open a little bit but I understand why you feel like we definitely need a recommendation to start with thank you I think it's really important because right now nothing there's nothing in the law that says that this will be refunded so I think some sort of recommendation to say that money that this program needs to be replenished because we don't want it just operational for one year Nader do you want it to say that cannabis tax revenue goes to funding the program or I would like I would like cannabis tax revenue to fund the program yes only on your thoughts on that I think I'm comfortable with saying at least 5% and I understand with the caveat that it would be revisited and the reason I say that is because at least I'm anticipating that a component of fund spending will be loans and grants I'm reasonably confident I feel reasonably confident that 5% in the first year won't be too much money set aside because there's enormous capital costs that are associated with the startup of this industry by any kind of growing related industry I think there's a lot of capital costs and even though I don't know the gross amount which is a perfectly valid point that everybody has raised I kind of look at it in terms of proportionality to me it's like does it seem reasonable that 95% of the money goes to things other than something related to social equity to me that seems more than generous to the non-social equity part of it at least proportionally and so it might be that the number we might see the numbers we want to increase it and it could be five years from now it's such a successful program that 5% it's really flush and the market is kind of established and there aren't that many new loan applicants and there isn't that much new capital that the market has sort of reached this equilibrium but I think like in a startup year I just though I'm not worried about 5% being too much of that aside so I can go with without leaving the number in I would be equally comfortable saying a minimum of 5% goes to the fund the program subject to evaluation and it's six months when revenues are more when projections can be tested against actual returns something like that a much shorter version I would just say there we are so we're going to release this recommendation and I can't type and fix it but it will go to at least 5% of the cannabis tax revenue goes to fund the program to be revisited in six months every six months to make sure that program is adequately funded and that a creation of a social equity cannabis trust be established for public donations and types of tests to be determined by the Vermont Cannabis Control Board Nada, how do you feel about that revision yes or no to that yes I'm good for that Anu Julio yes great great we get some funding for this program yay just for the record to yes this to the recommendations with the edits that we have made that at least 5% of cannabis tax revenue goes to fund programs and every six months it should be revisited to ensure that the program is adequately funded and a creation of a social equity cannabis trust to allow for public donations of the program type of trust to be determined by the Vermont Cannabis Control Board now we're going to consider representatives for the Cannabis Social Equity Board so we really want to have 6 to 12 members to represent our social equity candidates and to ensure that the program is moving that there are no issues or if there are that we're addressing them also every six months looking at the program is this really fulfilling what we believe the program should be helping and doing enough do we need to revisit it do we need more education do we need more funding so here are some suggestions of representatives I guess let's start with how many people do you think should be on the board Nada I'm putting here about 6 to 12 members what number are you feeling should it be more towards the 6 or more towards the 12 my first thought is should we try to have it be an odd number for the sake of voting so 6 to 12 so we can have 11 we could have 7 we could have 5 we could have 13 yeah I mean I'm not really sure right off the bat with how many members we should assign to this I think we need to get an idea of interest in the board because we don't want to you know propose 11 members but then we only get 4 or 5 people who are actually interested and available to meet I'm not quite sure yet on an exact number at the moment okay and Julio do you have a number in your mind or is that we just had to do some of the people we think that would be beneficial for the board you're on mute I'm closer to the 12 end than to the 6 end I think there are too many different voices that would be really beneficial to it so I would head for 13 members rather than 5 that's where I would go so one of the first ones we were thinking about having a small business representative on the board to help with some business issues that do come up a really important thing is to have a licensed cannabis representative so to have a retailer a processor, a cultivator to have each part sort of the sector covered so that we can understand the different issues that they may be having in those sectors or how those probably run in order to determine what education or what incubated programs or any assessments needs to be added I think it's extremely important to have a representative from a disproportionately impacted community who has experience in community development a representative from the BIPOC community someone from the Opportunity Zone the Department of Racial Equity and Diversity Susanna Davis has been with us through this entire panel I think there's something to be said to continue on the board as you know where we've sort of started from and what the essence and importance of this program is or someone from your office or community of commerce and community development I know Lucy you've been on these calls with us and have external calls as well about it a representative from a co-op if that does get off the ground so we understand what the issues are having there a member of the social equity caucus I think it will be tremendous to get their insight for the entirety in Vermont and then someone from the cannabis control board hi Julie I know you or someone else might be a great candidate to be on the board so you know what's happening with all what's happening with the cannabis industry as a whole I think it's always great to have these different perspectives and if it was going to be an even number of members of the Vermont cannabis control board as a tiebreaker if there was a tie on an issue that's if we have an even number I definitely agree that an odd number just makes everything easier so we don't have to go to a tiebreaker so Julie or you have thoughts about some of the representatives we've added onto the slide I would say that I'm not sure I understand the social equity caucus is that the legislative caucus is that what you're referring to okay I mean I'm interested in I'm just trying to do my my finger counting here I'm interested in more community representatives or people who have been affected by you know the legacy that this is sort of responding to I think that I don't like I don't so I don't when it does representative from opportunity zones is that a resident or is that someone who runs an opportunity zone program I'm not sure I think a resident or maybe someone who runs I think we're kind of keeping it open-ended but I would want someone who you know is from the opportunity zone area along with the BIPOC community we have also someone from a disproportionately impacted community who has experience in community development as we would want to continue to help the communities that we're saying need it the most and then we also have a representative from the co-op which would be one of a social equity member so from that perspective I'm definitely if we go with 12 one-third of the board would definitely have a direct relation to the people we are trying to help okay I think that again I kind of lean towards greater membership with the idea that the professionals who provide kind of the business expertise can always provide or the board can request their you know their expert opinion on things I don't know that they need just a vote on it necessarily so that's kind of where I am and I'm interested in the connections to that in terms of the language that you know when you're talking about community representation we do have language that like I am I'm going to put it in the chat here and I really pulled it out of the statutes that Vermont has enacted in the past as part of an effort to you know have a diverse a diverse input or participation in government related policymaking so this is language that I just pulled from the statute that preached executive director of racial equity that's the statute and I think we have several other statutes that use almost identical language and so I'm just going to put the link to that statute there if people want to look at the entire statute because I think geographical diversity and you know history of working for for for monitors who've had negative impacts from either enforcement or other aspects of state involvement I think is a valuable measure of contribution to thank you I mean we can add if you would like someone who has been incarcerated to do civil war and drugs as well that would be a good member to add yeah I don't know that you would make that like a right person requirement I think of people who are going to apply I'm not I think we're I might be getting a little ahead of the process here by contemplating how they would be selected if you especially if you have more applicants than you do seats so I you know I'm open to that I'm interested in hearing other reactions to that maybe there will be public comment on the subject as well so we have about one third right now that would come from communities that we would want to help that's including a representative from the co-op if that does happen when the third would come from cannabis from the cannabis industry which is you know representative from retail processors cultivators a member of social equity the Vermont cannabis control board and then a third would be represented from the government that are your thoughts yeah just before time runs out I just want to throw out that I you know after reading this I'm thinking about it for a few or minutes I'm leaning strongly towards having even higher representatives from disproportionately impacted communities I think that if we're creating a cannabis social equity board we want to have a large representation of the people who are directly impacted and you know people who can share lived experience with the board so just wanted to throw out those two some now I think that's great and also one of the things that can possibly happen is to bring those people in you know and have also guests who speak on certain topics that they may be covering as well I think it's always important to get as many voices as possible Susanna your thoughts on this yeah we're definitely going to have to find a good balance of quality and quantity so I like that we're thinking strategically about odd numbers versus even numbers so the decision making can be easier and you know as somebody who's scarred from being put on a 29 member commission recently I am leery of large groups however again this is something that so many people have been shut out for so long that you do need to have that broad representation so I'm comfortable with I'm comfortable with a sort of mid-size to larger size group at least yeah I'm comfortable with it just with the understanding that sometimes decision making can be more difficult the larger groups get and I also do think that having people with lived experience is really important and lived experience means a lot of things in this realm it could mean lived experience in the industry it could mean lived experience being harmed by the system or it could mean lived experience in a different business sector maybe not this one so there's lots of ways that we could get at that I would just also want to be broad and think about what diversity means because a lot of times we just assume it means racial diversity but we're also talking about a business market where people living with disabilities may be able to find opportunity or people who may have other demographic markers that get overlooked so I would just want to be pretty broad in thinking about that and I also appreciate Julio sharing that language that reminds us about geographic diversity as well you know of course the RIC equity office whether it is formally or informally part of the work is excited to participate so you know yes thanks Julio I'm going to go to your comment and I just wanted to let everyone know and you know really start thinking about this so that when we come in to discuss this on Thursday we really have a starting point of who would you like to take off who would you like to add what are some numbers that you would like Julio? Yeah I just when we think I'm just I was going to respond to your one-third one-third one-third proposal I think I'm more comfortable in light of the comments that I've heard so far with a 50% from the community 25 and 25 from the other from the remaining quarters it is true that people will have input but it's also true that this piece of the larger industry is looking at people who have either been affirmatively harmed by enforcement policies or who otherwise might have then or still be kind of shut out of actual decision-making and a vote is a very powerful thing even if it's not a legislative vote so it's not a board vote and I think as experience teaches us what other operational you know what other needs this board has and I think they'll probably I'm guessing the CCB will have other committees or advisory groups that will focus on the more economic aspects or enforcement aspects are important but I think you can always grow or change I think 13 is not so big that if you needed to add a couple of seats to your 15 it's unmanageable 29 is that's that's a big group or anything like that but I view for something like this where you're talking about the size of this market we think that's going to happen I don't think 13 is maybe it's mid-size but I like more at least like the roughly 50% community to the community and then 25-25 because I still think that's enough to have that expertise have input and influence among the board in terms of reaching consensus hopefully and most things thank you Julio Tanika I know it's public comment time Nada before we go are you okay with what Julio just recommended which is the size of 13 and 50-25-25 yeah I think that's a great idea we are going to bring this to public comment time thank you Nada for that answer I will come up with some more categories to get closer to those numbers I'm duly on do we have anyone who would like to make public comment good morning good afternoon everybody actually I thank you for bringing the energy on this Tuesday that feels like a Monday but obviously I'm still catching up thank you again for bringing the energy today this was a really great meeting to be here for I have been following along closely with a group called the working group coalition and they recently released a resource that I will share for the online public comment which is the cannabis social equity policy advocacy handbook and so just doing a quick review with that they just did a presentation on it last week I have a couple of suggestions for you when it comes to the social equity board just to consider particularly from the BIPOC community looking at BIPOC owned businesses so somebody who is already running a business in the state representing different parts of the state also a lawyer or accountant somebody providing professional services to the BIPOC community or a member of the BIPOC community providing those services also looking at national nonprofit experience so whether it's someone from an organization such as the NAACP which I know has struggled to really get their feet under them here in Vermont and might be looking for certain avenues to take or any of the cannabis specific nonprofits particularly one that's focused on expungement and getting people who were previously incarcerated for cannabis into the professional cannabis world somebody from who is either a member of the BIPOC community or providing medical services to the BIPOC community since we know there is a lot of disparity there from the opportunity zones potentially an educator we know that there's a lot of impact from the war on drugs on graduation rates so any representation there also having worked with the Department of Health myself I would recommend something WIC who might be familiar with the types of services and the family impacts in the state and then lastly someone from Veteran Affairs again who might potentially have been working with folks in the state maybe not necessarily impacted by the war on drugs but by cannabis prohibition certainly so that's my first comment my second is I did submit a written public comment it hasn't made its way through the gauntlet yet but it is about social consumption and I apologize because all of you have heard me and I hate sounding like a broken record that written comment does have a lot of information that I haven't said it's breathy, it's wordy, it's lengthy but I just want to give you a snapshot of it which is in reference to a very close friend of mine whose father recently went into an assisted living facility for his Parkinson's Care he's someone who has been using cannabis for 50 years of his life to help maintain quality of life and certainly more so in the last 20 years with his Parkinson's care has become too much of a burden for his family it was becoming impossible to care for him at home and we have a shortage of home caregivers in the state so he's gone into a facility or a residence and the idea that Medicaid will eventually take over the cost of that for the family and he is getting better care than he previously has but it is a Medicaid funded facility at least in part and so he is not allowed to consume cannabis there he's not allowed to have cannabis on site with him so now it's on the family to help him with that outside of the residence the only option that we have is to either bring him to one of our private homes which we're lucky with in the family we have those but they are an additional 20 minutes home 20 minutes back that's the only legal way for him to currently consume cannabis it's basically introduced a whole other burden including the mental health crisis that this has caused for him being a 70 year old man and now being told that he can't use cannabis for the first time in his life which he has been very lucky to use cannabis that whole time there's a lot of members of society who haven't had that privilege that's a hard context to ask a 70 year old to understand though so when we talk about social consumption when you eventually do see all the information in this written comment I want you to think of this gentleman that I was just talking about and the fact that we would love to be able to have a third party place for him to go somewhere where he can legally consume cannabis because like I said the only legal option is home consumption that doesn't happen often a lot of the times I see friends and family smoking in cars, smoking in parking lots this type of public consumption that I think the board doesn't want to see with my public health background I don't want to see that that's not ideal none of it is ideal at least social consumption would provide an option the other folks who are mentioned in my public comment include people who are in public housing people with a tough landlord who doesn't allow them to smoke or even have cannabis on site the fact that if you have a neighbor who doesn't like you and wants to call the cops and say I smell weed even when you're not smoking weed and it can result in a police interaction that can be very unpleasant I just want to continue to provide more context for you all to consider especially since I know there's the opportunity to potentially include some vague wording about revisiting social consumption in this report to legislators just maybe planting some seeds and watering them with time because if we can't get it in right now I think it is important for Vermont to see it in the near future so thank you very much again for your time and all your work thank you and that's it for public comment Gina thank you so much I know Lindsay put in the comments that you would like to see someone from the agency of agriculture to the board and you know geographical representation so we will take that all into consideration when we come back so please put this over you know send me an email if there are any more thoughts that you have before our Thursday call and remember we're also going to be talking about social equity applicants and who should be approving that so please do look through the presentation that was sent to you today so we can get started and we will give you an updated one to include a couple more topics that we can hopefully get to on Thursday as well so thank you everyone thank you for the public comments thank you for all your thoughts I will go back to the drawing board add some more to this cannabis social equity board so thank you all for your time and I'll see you on Thursday thank you Gina can I have a motion to adjourn this meeting I'll make that motion can I have a second I think we have two first second thank you so much


Yeah, I thought we kept our intensity up. That was one of the things that we really wanted to work on is limiting our errors and controlling what we can control, which was on our side of the court as far as passing and serving, and the rest kind of took care of itself. Not necessarily. We do say that the best defense is a good serve, because we can get them out of system. It's a much easier to play defense against them. And we had a lot of nice blocks at the net and really sealed that net off tonight and played good defense. I was. I was. I was glad a couple of the fresher and Davis got her first kill as a freshman. And Grace Chaffee went in there and did a really good job for her three rotations. Made some nice passes. So it's great for them to get some game experience. Well, I felt like last weekend, although we didn't get some wins that we really were very, very, very close to, I think we're getting better every match. And Darian Hillman and Sarah Brighan are really starting to step up as far as in server seed, they've never been played a lot in server seed. So I thought they're really improving and they're playing a lot more confidently.


Hello, I'm Mark Thornton at the Mises Institute, and this is Minor Issues. Today I'd like to talk about the bank failures and bailouts that have happened this week. As most people will know, Silicon Valley Bank and Signature Bank had to close their doors or face a run on the bank by depositors. The Fed and the FDIC came in and bailed out those two institutions. Just as some background, SVB Bank had a lot of big customers in the technology industry of Silicon Valley and the green energy industry as well. Signature Bank, their clients were more from the crypto, currency, market space, and real estate. So both of those banks were sort of on the cutting edge of the economy, and both of them grew very rapidly, especially in the last few years. So they expanded deposits, they expanded their assets, and the amount of loans that they made. But that happened during the Fed's 0% interest rate policy regime, and the new regime of rising rates not only increased rates to fight price inflation, but it also meant that those businesses in crypto and technology, green energy, real estate, they all had to start more or less withdrawing money from their accounts because their businesses weren't so great. That meant that those banks had to sell some assets to meet deposits, but those assets had lost a lot of value. So if they sold them, it was trouble for those two banks in particular. Even though both SVB Bank and Signature Bank are large regional banks, the FDIC, the Federal Deposit Insurance Corporation bailout of the banks is relatively small. Most of the bailout comes from the Fed in the form of changing the rules that were supposed to prevent these types of problems, protecting the bank's assets, and guaranteeing unlimited liquidity. And that's a good thing in the sense that the FDIC Insurance Fund is actually smaller than both of these banks. So the FDIC Insurance Fund is relatively small. It can't protect us or the entire banking industry from the inherent instability that it has. So this could be just the tip of the iceberg in terms of banking problems. This is the Fed's and the FDIC's attempt to prevent the problems from getting out of control, but ultimately there's no costless means of trying to unwind the problems that the Fed's monetary policy guaranteed would happen.