BOARD MEMBERS PRESENT: Steve Wolf, R.N., President; Russell Bishop, Psy.D., Vice President; Jean Gastiger, R.N., F.N.P.; John Olson, D.D.S.; Jesus Romero; Mary Beth Shear, M.D.; Stephen Slack; Scott Starkweather

BOARD MEMBERS ABSENT: Mike Groark, J.D.; Linda Liston, M.D.; Deborah Schelkopf, D.V.M.;

MINUTES

On a motion by Dr. Bishop, seconded by Mr. Starkweather, the minutes of the Board of Health meeting of July 25, 2006, were approved.  Motion carried.

On a motion by Dr. Olson, seconded by Dr. Shear, the Executive Session minutes of March 28, 2006, May 23, 2006, and July 25, 2006, were approved and recommended to remain confidential.   Motion carried. 

DIVISION REPORTS

Mrs. Grush reported that there have been more staffing issues this summer than in previous years, which has made operation more difficult because of how busy the agency is in the summer months.

The agency is gearing up for flu season.  Mrs. Grush reported that no vaccine has been received to date, adding that usually one-half of it has been received by this time.  It may become necessary to cancel or reschedule clinics if the vaccine is not received.  The Health Department is scheduled to hold flu clinics at NIU, which has not been done for the past two years because of the lack of vaccine.  The Fox Valley Older Adult Center in Sandwich had booked with the VNA out of Aurora for their flu clinic, but they have cancelled that and changed their clinics to us.

A grant agreement was received in May as a part of the Cities Readiness Initiative for the period of August 31, 2005 to August 30, 2006.  Because of the short notification period, the State authorized grantees to purchase select items.  The $39,256 grant needed to be expended by August 30, 2006.  With this funding, the agency purchased 22 portable radios, a fax machine for the Communicable Disease (CD) Program, a computer, laptop and scanner, easels and dry erase boards for distribution sites, and a stockpile of doxicycline, N95 masks and identification vests for distribution personnel.  Dr. Olson asked if the agency had any portable electric generators and suggested this as an item that could have been purchased under the Cities Readiness Grant.  Mrs. Grush responded that the agency does not own one, and thought this was an excellent suggestion.

Bette Chilton, R.N., M.S., was promoted to the position of Director of Personal Health Services, effective December 1, 2006, replacing Jane Lux who will assume her position as Assistant Administrator.  The position was advertised in the newspaper and was sent to all local health departments, with only one other applicant, whom Mrs. Grush did interview.  She pointed out that Bette has a strong public health background and is very talented.  She has every confidence that Bette will do an excellent job in her new position.

Mrs. Grush reported that Jane Lux and Marcy Zanellato were recognized last week by the DeKalb County Board for their years of service at the Health Department.  Marcy completed 30 years and Jane 25 years.  Both of these employees are extremely experienced and DeKalb County is fortunate to have them as public health leaders.

Mr. Wolf asked what would cause the cost of birth control pills to increase from 1¢ to $3.20 per pack to $3.20 to $18.76 per pack.  Mrs. Grush responded that the State had a purchasing agreement with Ortho that expired, and the State has been unsuccessful in obtaining a new one at reduced cost for projects.  This increase was estimated to cost our agency approximately $85,000.  An immediate outcry from clinics resulted in Ortho reducing the increase of five brands of pills to $3.20 per cycle, which will result in an estimated increased expenditure to our agency of $13,000 per year. 

Mr. Slack asked about the process for dispensing birth control pills to Family Planning clients.  Mrs. Grush reported that the client makes an appointment, has an exam by a nurse practitioner or physician and is given a prescription for the method of choice.  Our program supplies that method on a sliding fee scale.  She explained that 70% of the clients receive services under our Family Planning Grant; the Illinois Department of Public Aid (IPA) is billed for others and the rest pay based on the sliding scale.  Mrs. Grush indicated that in addition to the Family Planning grant, approximately $100,000 is received in fees, but the cost of the program is $400,000.  In total, approximately $300,00 is received leaving $100,000 needed locally to support the program.  She added that the number of clients increases each year.  Mrs. Lux pointed out that 63% of the Family Planning clients are $0 pay.  Mrs. Grush added that methods, in addition to pills, are offered and we provide them all, but they are more expensive.  Mrs. Gastiger pointed out that Ortho used to use family planning clinics as a marketing ploy, but they are no longer interested in doing that.  They are losing patents on all the pills, so there is no incentive to continue to offer them at a reasonable price.

Bob Drake, Director of Environmental Health, reported that mosquitoes and spinach are the topics this month.  Sewage contamination from flooding of a spinach field at three farms in California operated by Dole resulted in two deaths.  Illinois has reported one case.  He doesn’t think there is much mosquito breeding going on now as catch basins are at a standstill.  The problem mosquito (Culex) bites at dawn and dusk, but they are very sluggish when it is cold and they very rarely bite.  Mrs. Grush reported that there have been 178 cases of West Nile virus reported and 9 deaths. 

Mrs. Grush reported that Wheaton College has reported 30 cases of mumps, but DeKalb County has not been seeing any.    Mrs. Carroll feels that DeKalb County may still see some mumps cases.

Christel Springmire, LEHP, presented on proper food preparation and hand washing at the pre-event for the “Fifty Men Who Cook” event. 

Mr. Wolf remarked that it appears the oil collection held at the IDOT salt barn in Waterman on July 8 was a success, with 3,000 gallons of used motor oil and antifreeze collected.  Mrs. Grush stated that the Health Department received $4,860 for the oil collected in the two summer collections.

Mrs. Lux, Director of Personal Health Services, reported on a number of position vacancies.  A part-time pediatric nurse resigned and was replaced on the 24^th of July.  Positions in the process of being filled are a .6 FTE WIC secretary, a full-time secretary for the CD Program, .4 FTE clinic aide position and a full-time nurse for the CD Program.  Recent resignations have been received from our full-time HIV Case Manager and full-time Community Health Worker. 

The State Vaccines for Children (VFC) program is making Gardasil available, and Peg Carroll, CD Coordinator, who met with the representative today indicated that our agency will be offering that vaccine soon.  Mrs. Gastiger asked how much the Gardasil will cost.  Mrs. Carroll reported that the cost is $120 per dose and three doses are needed.  Mrs. Gastiger asked if there was any talk of insurance companies covering this vaccine.  Mrs. Lux responded that a staff member at DeKalb Clinic was under the understanding that insurance would cover it.  Though her claim was denied initially, she fought it and did get payment approved.  Mrs. Grush added that most insurances typically don’t cover the cost of preventive vaccines.

Mrs. Lux reported that there are many more childhood vaccines available and scheduling appointments for them is much more complex.  She demonstrated a tray that nurses use in immunization clinics, which have slots labeled for each vaccine, thereby reducing the possibility of error.  She added that the record card and consent form may need to become full-size because of the addition of vaccines.  Dr. Olson asked if the record forms could become paperless.  Mrs. Lux responded that this has not been discussed, adding that the data is already entered into the computer.  Mrs. Grush reported that the record card currently follows them through their visit, and they are retained permanently by the Health Department. 

A donation was received from Hub Printing in Rochelle of two sets of glossy prints (3,460 total copies) of research-based handouts on healthy eating.  This was developed last year by an NIU community nutrition class.  

Mrs. Lux stated that a nurse for the Communicable Disease Program was hired full-time and will start on October 11.  She added that she also interviewed another nurse that is commuting and providing on-call coverage that seemed interested in employment with our agency.

Dr. Olson asked why more TB tests were performed in August than in July.  Mrs. Lux responded that this increase is due to school starting and day care enrollments.  She pointed out that August is generally our busiest month in this program.

Mrs. Baj, Director of Home Care, stated that the program was back to full staffing as of September 18, but the resignation of a .5 FTE nurse was received last Friday.  This individual is considering an office position as she is experiencing difficulty transporting the bags and equipment necessary for a home visit.

Much of Mrs. Baj’s report was devoted to accomplishments this past year following meetings with the consultants (Terry Cichon and Sondra Enger) from Frost, Ruttenberg and Rothblatt.  She reported that almost all of their recommendations have been implemented and much progress has been made, especially in the billing department.  Mrs. Grush reported that accounts receivables in the Home Care Program have decreased significantly over the past few years.  Mrs. Baj announced that nursing staff has returned to pre-laptop productivity, and it is hoped that paperwork will become even more streamlined with future computer upgrades.  She added that she does not think the nurses would want to go back to paper and that they like their computers, even though training and orientation do take longer.

Mr. Starkweather asked if there were any benchmark numbers.  Mrs. Grush responded that our agency does not reach productivity of 4.5 visits per day, but she is convinced that our agency’s care exceeds that of many others. 

Mrs. Zanellato, Director of Health Education, stated that her division has been looking at conducting hand washing training in schools, and an enthusiastic response was received today from Davenport Grade School in Genoa interested in implementing this pilot program.  She reported that it is a very successful program aimed at reducing absenteeism and preventing colds and the flu.  Training will begin with the Davenport teachers on November 18 and with the students on the 20^th.  Health Education staff will monitor the program and conduct pre- and post-tests.

Mr. Wolf announced that two more restaurants are now smoke-free: Chipolte in DeKalb and Sweet Dreams in Sycamore.  A plaque is presented to the restaurant to display and it promotes the no smoking concept at no charge to the establishment.

FINANCIAL DATA            

On a motion by Mr. Starkweather, seconded by Mrs. Gastiger, the Financial Statements for the months of July and August 2006 and the Claims for the months of August and September 2006 were approved.  Motion carried. 

NEW BUSINESS

Discontinuation of Hypertension Clinic

In 1975, Dr. Kurt Biss, cardiologist at DeKalb Clinic, and the DeKalb County Health Department received a one-year grant of $50,000 from the Illinois Regional Medical Program to establish a Hypertension Screening and Referral Program.  The Health Department has continued to provide this service at various levels since that time.  Current utilization of our program has decreased to eight or ten individuals each week, and it is no longer cost-effective to continue the program.  Mrs. Grush reviewed numerous sites in the community where individuals can now get their blood pressure taken.

Mrs. Grush is recommending that the Hypertension Screening and Referral Program on a walk-in basis be discontinued by the end of November 2006.  She stated that this service will still be provided at health fairs and wellness screenings.  Mr. Wolf asked that a handout with resources for these clients be provided.

Mr. Starkweather moved to discontinue the Hypertension Screening and Referral Program of the Health Department by the end of November 2006, seconded by Mrs. Gastiger.  Motion carried.  Dr. Shear abstained.

Mr. Starkweather stated that the possibility of reinstating these clinics could be considered if there were changes in the community in this regard.  Mr. Wolf added that it could also be reconsidered if a number of requests were received from clients for the service.  Mrs. Gastiger stated that this is a duplication of service in our community.  Mrs. Grush pointed out that Kishwaukee Community Hospital does a lot of advertising for this service, with large ads placed in the paper.  Mrs. Gastiger pointed out that this could help the hospital maintain their status as a certain amount of non-compensated care must be provided for certain certifications.

FY 2007 Budget Update / Employee Salary Increase

Mrs. Grush reported that a 4% salary increase was budgeted for 2007, but no method of dividing it out was decided.  At this time, she is recommending that a 3% COLA salary increase be given effective with the pay period beginning 11/26/06, a hold be placed on any mid-year raises pending the Union contract agreement and classification salary ranges be increased by 3.4%. 

Mrs. Grush reviewed the 2007 Budget request recommendations of Ray Bockman (County Administrator) and Gary Hanson (Deputy Administrator) regarding the Board of Health funding request.  The total Health Department request was $935,900 and the 2007 recommendation by Mr. Bockman and Mr. Hanson was $935,600.  Recommended changes were in the Public Health Levy with a request of $440,800 and a recommendation of $440,000 and Public Health IMRF/SS with a request of $309,500 and a recommendation of $310,000.  Mrs. Grush pointed out that renewal and replacement money has been budgeted the past few years at $150,000, but this year $175,000 is being recommended. 

Mrs. Grush presented a correction to the FY2007 Budget.  In the proposed budget submitted in July 2006, a vacant nursing position was omitted in error.  The total cost of this position is around $50,000.  In anticipation of transferring monies, interest income was reduced to $50,000 in the proposed budget submitted to the Board of Health.  When the budget was submitted to the county, the $50,000 was added in as expense for the vacant nurse position and also $50,000 for the interest, with the hope that the funds can be transferred later in the year.  The fund balance remains the same.

Mrs. Grush presented general information regarding the County’s Proposed FY2007 Budget, as well as recommendations that relate to the Health Department’s Budget.  She pointed out that increases in health insurance premiums continue to be a major budget challenge for the County, and a 15% increase is being projected.  As the Illinois Municipal Retirement Fund experienced investments losses and returns below the standard target, rates for 2007 will be higher than in previous years.  The overall goal is to charge departments the “ideal” rate of 9.00%.  All County recommendations will be studied by each of the committees, and if there are objections, they can be appealed to the committee to overturn the recommendations of Mr. Bockman and Mr. Hanson.  Mrs. Grush stated that the Health Department would not be appealing any recommendations as our request was received.

Dr. Olson moved to approve a 3% salary increase effective with the pay period beginning 11/26/06, a hold be placed on any mid-year raises pending the Union contract agreement and there be a  3.4% increase in classification salary ranges.  Mr. Slack seconded.  Motion carried.

Home Care Building Update

Mrs. Grush reported that she and Mrs. Baj have met with architects and the core group of the building committee several times.  She presented the design at this point to the Board of Health.  She pointed out that it still needs a lot of refining.  She reviewed some of the changes that will be presented to the architects.  All agencies have committed to the building: the DeKalb County Mental Health Board, Veterans Assistance Commission, Superintendent of Schools and the Home Care Program of the Health Department.  Some storage has also been built in for mowers and snow blowers, as well as growth areas and a conference room.  Mr. Hanson is also requesting an auditorium-type room as the County does not currently have such a room, but this will depend on the cost when the project is bid. 

Mrs. Grush presented the recommendations of DeKalb County Government in relation to the Community Outreach Building.  She added that the project is behind schedule, but our Home Care Program lease does not expire until 2009.  On the other hand, building costs do continue to increase each year. 

SB027 Tattoo and Body Piercing Establishment Registration Act

Mrs. Grush included information in the Board of Health packet from March 2004  regarding tattoo and piercing regulations.  At that time, at the request of Mr. Kuhn (former Board president) the topic was studied and a letter sent to Dr. Whitaker, former Director of the Illinois Department of Public Health (IDPH).  While she would like to believe this letter played a role in getting legislation passed, it really was the blood supply industry.  Currently, individuals receiving tattoos are not allowed to give blood for one year, which exempted many potential donors.  With this licensure, they will not be exempted as it is anticipated all tattooing sites will utilize standard infection control practices and procedures.

SB0927, which was included in the packet, goes into effect July 1, 2007.  The new law states that tattoo and piercing establishments will now be regulated and licensed with inspections by health departments done annually.  The Act also covers violations and the ramifications.  Mrs. Grush was disappointed that the Act reads that a training program would be established for agents to enforce the Act, but no kind of educational licensure required for individuals performing the tattoo or piercing.  She feels that the Act should include a minimum training or education requirement.  She added that the facility could be clean, but if staff are not trained in bloodborne pathogens and cleanliness, that does not really address potential problems. 

Responsibility for these inspections will fall under the Division of Environmental Health.  While our staff feel this is more of a communicable disease issue, Environmental Health staff at the State level don’t think this is the way the law is written.  Mr. Wolf asked if the law would dictate this or if our agency could choose who enforces the Act.  Mrs. Grush responded that she believes our agency could select the staff they feel are appropriate, although almost all local health departments will be using their environmental health staff.  Mrs. Carroll, coordinator of the Communicable Disease Program, stated that Hepatitis C is currently the most reportable disease, and part of the questionnaire asked of people with this disease is if they have had a tattoo or piercing. 

New Employee Classifications: Case Management Assistant / Secretary and Clinic Aide/Secretary

Mrs. Grush reported that staff resignations have been received, which is a time when duties, salary ranges and job classifications are reviewed.  She is proposing changes in two open positions: the Community Health Worker changed to Case Management Assistant / Secretary and the CNA / Secretary to Clinic Aide / Secretary.  Both positions are being recommended at the same Secretary B salary range as both have secretarial responsibilities. 

There has been concern voiced by individuals in the past in those positions as to why the salaries were lower than the Secretary B position as they all do some similar things.  Mrs. Grush stated that when the Community Health Worker and CNA / Secretary positions were implemented, expected skills were lower, but that is not the case any more.

Mrs. Grush is recommending that the three positions all have the same salary ranges, and also that she have the flexibility in making full-time positions into part-time positions, possibly being able to hire someone for an extra day because of not having to pay benefits.  Mr. Wolf agreed that flexibility is good when two staff can do the job rather than one.

On a motion by Mr. Starkweather, seconded by Dr. Shear, the job classifications for Case Management Assistant/Secretary and Clinic Aide/Secretary were approved at a salary range of $10.31 to $15.46 per hour.  Motion carried.

Nominating Committee

Board of Health Memberships

Mrs. Grush reported that the first terms for Mrs. Gastiger and Dr. Olson expire in November and both are eligible for reappointment.  Mr. Slack, as County Board representative, is eligible for another year.  The second term of Mr. Groark is up, and he is not eligible for reappointment. 

A slate of officers for next year is needed.  Mrs. Grush stated that the Nominating Committee consists of Dr. Shear as chair, Dr. Liston and Mr. Romero.  She asked that nominations for an attorney replacement be provided to Dr. Shear before the November meeting.

Mrs. Gastiger and Dr. Olson indicated that they would consider a second term.  Mr. Slack stated that his reappointment depends on the elections in November.

Mrs. Grush reminded those present of the electronic collection to be held next Saturday, October 7, from 9:00 a.m. to 12:00 noon.

Executive Session

At 8:50 p.m., Mrs. Gastiger moved to enter into executive session for the purpose of an update on Union negotiations, seconded by Dr. Shear.  On a roll call vote, those voting aye included Mrs. Gastiger, Dr. Olson, Dr. Shear, Mr. Romero, Mr. Slack, Mr. Starkweather, and Mr. Wolf.  Motion carried.

At 8:54 p.m., Mr. Starkweather moved to reconvene to regular session, seconded by Dr. Olson.   On a roll call vote, those voting aye included Mrs. Gastiger, Dr. Olson, Dr. Shear, Mr. Romero, Mr. Slack, Mr. Starkweather, and Mr. Wolf.  Motion carried.

CORRESPONDENCE AND ANNOUNCEMENTS

Included in the correspondence this month was an invitation to Board of Health members from the Illinois Association of Boards of Health to attend their annual meeting on October 10, 2006, in Bloomington.

News articles for the months of July and August were on a preliminary approval by the DeKalb Plan Commission for Windsong Acres (an assisted living center in the Health Facilities Complex), and the Community Outreach Building which will house the Home Care Program of the Health Department.  Also included was information on flu season, the requirement of more vaccines by the school system, the addition of fruits and vegetables by the Federal government to WIC clients, a site visit to the farmers’ market by the USDA to review their participation in the WIC Program, waste reduction mini-grants available to DeKalb County businesses and industries and the availability of event recyclers for DeKalb County not-for-profit groups. 

ADJOURNMENT

On a motion by Mr. Romero, seconded by Mrs. Gastiger, the Board of Health adjourned at 9:58 p.m.  Motion carried.

Deborah Schelkopf, D.V.M., Secretary

DeKalb County Board of Health

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