BOARD MEMBERS PRESENT: Russell Bishop, Psy.D., President; Steve Wolf, R.N., Vice President; Jean Gastiger, R.N., F.N.P., Secretary; Kevin Buick, J.D.; Julia Fauci; John Olson, D.D.S.; Jesus Romero; Deborah Schelkopf, D.V.M.

BOARD MEMBERS ABSENT: Linda Liston, M.D.; Mary Beth Shear, M.D.; Scott Starkweather

Dr. Bishop, new Board of Health president, stated that it was a privilege and an honor to serve the Board in this capacity in his sixth year of service.  He stated he is looking forward to the opportunity and has always been impressed with the attention to detail by agency staff in providing information to Board members ahead of time.  Board of Health members and staff introduced themselves.

MINUTES

On a motion by Mr. Wolf, seconded by Dr. Olson, the minutes of the Board of Health meeting of November 28, 2006, were approved.  Motion carried.

On a motion by Mr. Wolf, seconded by Dr. Olson, the minutes of the Executive Session of November 28, 2006, were approved with the correction of the word “temporarily” to “tentatively.”  Motion carried.

DIVISION REPORTS

Mrs. Grush reported that health insurance costs for DeKalb County increased by 18.8% for 2007.  This will continue to be a significant concern for the county in the years to come.  She added that the rate of increase for health insurance is increasing far greater than the Consumer Price Index or wages. 

Notification was received of an increase in the Family Planning Grant from $179,500 to $196,222, an increase of $16,722.  This grant has remained status quo for many years, so the increase was very unexpected.  The grant covers 35% of the cost of the program. 

The Cities Readiness Grant award was received in the same amount as last year at $39,256.  A great deal of time is spent in meeting the deliverables required of the grants. 

In November, Mrs. Lux, Assistant Administrator, and Mrs. Grush participated in a focus group hosted by the DeKalb County Human Services Initiative Project Team and sponsored by the DeKalb County Community Foundation, Kishwaukee United Way, City of DeKalb, DeKalb County Community Mental Health Board, and DeKalb County Community Services.  The goal of this group is to improve the quality of life for the people in DeKalb County and to encourage innovative solutions to the community’s human service needs.  The project has several components including data collection / needs assessment, identification of key areas of human service needs by key focus groups and convening a strategic planning process for solutions to address the needs.  The number one need identified by the participants is access to affordable health care. 

Until 18 months ago, the Health Department conducted a program, Partners in Health, which was a referral program to physicians for individuals on Medicaid.  This program collapsed due to slow reimbursement by Public Aid to physicians for services provided.  An agreement was reached between Pediatrician, Dr. Umesh Goswami was accepting the majority of new babies on Medicaid born at Kishwaukee Community Hospital.  He called the Health Department in December 2006 to report that he was discontinuing acceptance of newborns on Medicaid and would be referring them to the Health Department for their two-week checkup.  Mrs. Grush reported that sick care for babies are being referred to Crusader Clinic in Rockford and Belvidere, TriCounty Community Health Center in Malta, Dr. Federici in Genoa, Dr. Nandra in Plano, and Kathleen Ludwikowski, P.N.P., in Marengo.  Mrs. Grush pointed out that this would put further inappropriate demand on emergency rooms as families seek care for their sick children.

Historically, the Health Department has not conducted exams for two-week old infants because this was an opportunity for the infant to become established with a physician.  Our clinics were adjusted and the Pediatric Services Program was scheduled to begin seeing the two-week babies.  Subsequently, Mrs. Grush reported that family practice physicians and pediatricians in the community met and agreed to take the newborns for their two-week check but would then refer them to the Health Department for follow-up visits.  In the next few weeks, our staffing will be studied, as this will increase our clinic visits.

At the last Board of Health meeting, Mrs. Grush reported on a Task Force created by Representative Pritchard and Senator Burzynski to address access to health care.  The driving force for this group was RAMP, an organization that is an advocacy group that services disabled individuals currently experiencing a difficult time getting into physicians.  A subgroup of this Task Force consists of Kevin Poorten (CEO of Kishwaukee Community Hospital), Michael Flora (CEO of Ben Gordon Center), Alice Frier (administrator of DeKalb Clinic) and Mrs. Grush.  This group has met to discuss health care access issues and alternatives to address this problem.  She reported that the ideal solution would be to have a Federally Qualified Health Center (HQFC) in DeKalb, but she feels DeKalb County is too affluent to meet federal requirements.  Another option is for an established HQFC to open a satellite office in DeKalb as there is federal money available for existing centers to expand but no federal money to start new centers.  Mrs. Grush reported that some of the group would be traveling to Crusader Clinic in Rockford in February.   She is also going to ask Whiteside County to come and speak with the group as they opened an FQHC this past summer.  Whiteside County established their clinic when the steel mill in Morrison closed, leaving large groups of uninsured and 60 to 70% of babies born being on Medicaid. 

Ms. Fauci questioned when the time period between service and reimbursement increased.  She also indicated that she had spoken to Steve Slack, former County Board representative to the Board of Health, and wondered if the county could put up some money that would carry the providers until reimbursement was received.  Mrs. Grush responded that the time for receipt of payment is not the only issue, but it is also the low reimbursement rate.  The State has also expanded the Medicaid Program from KidCare to AllKids, which commits them to even more than they can afford to pay, thus reducing payment time.  Payment by the State can be as low as 60 days early in the fiscal year, and six months or more at the end of the State’s fiscal year.

Accentuating the problem of access to health care is a new state initiative, “Illinois Health Connect.”  This is a managed care model whereby individuals choose their primary physician or clinic as their provider.  If they do not select one, one is assigned.  The primary care physician would be paid at the monthly rate of $2 for children, $3 for parents, and $4 for disabled and elderly enrollees.  Dr. Olson stated that it is better to provide the service pro bono than to have staff complete the necessary paperwork. 

Ms. Fauci asked about the liabilities of the Health Department in caring for infants.  Mrs. Grush responded that there is liability in everything the Health Department does.  She added that the services the agency provides are well child services, which is low risk.  Sick care is not provided.

Dr. Olson asked why health care costs were 25% higher.  Mrs. Grush responded that the inflation of medical care was 6.2%.  There were a couple of very large County claims and it appears County employees do utilize their physicians.  Ms. Fauci pointed out that the County did look into some programs of combining policies together but the rates were not any cheaper.  She stated that there is discussion at the federal level of universal health care and thinks the system will break, with a solution at the national level. 

Design for the Community Outreach Building continues to progress.  Bids will go out in the spring and construction should begin soon after that.

Mrs. Grush reported that 2006 was a difficult year for staffing with many transitions.  Everyone is now in their new position, and Mrs. Grush feels everything is going well.  The recent ad for the Secretary position in the Home Care Program generated around 150 applications.  

Bob Drake, Director of Environmental Health, reported that the Health Department is fortunate to have been selected to host a Hazardous Household Waste day this year.  The cost of this event is about $100,000, and the Solid Waste Program will contribute between $10,000 and $12,000. 

Mr. Wolf asked if there was any discussion on the landfill.  Mr. Drake reported that he is a member of the five-member committee to study waste disposal needs over the next 20 to 25 years in DeKalb County.  Patrick Engineering has been hired as a consultant.  Ms. Fauci stated that she is all for recycling and delaying filling the landfill, while the County makes money by filling it.  Mr. Drake agreed that it is necessary to recycle, but there is still 40% to 50% that cannot be recycled.  East of DeKalb County, they are running out of space and are paying lots of money to transport their waste.  Dr. Olson asked if there was an option to expand the landfill but only for use by DeKalb County.  Mr. Drake stated that is not an option Waste Management would be willing to explore.  The landfill is only processing 300 tons of waste a day, according to Waste Management, and is losing money at this rate.  Ms. Fauci asked who owns the land.  Mr. Drake responded that it is owned by Waste Management, adding that they have options with surrounding farmers for expansion.  Ms. Fauci asked if other counties or municipalities have taken over landfills and run them as businesses.  Mr. Drake responded that a few counties have done this, but the general consensus is that this is probably not an option for DeKalb County.  Mrs. Grush added that DeKalb County has maintained a resolution that they would only take 10% of outside garbage, but Waste Management says they need to accept 1,000 tons a day.  Ms. Fauci pointed out that this is a “hot potato” with county residents.  Mrs. Grush agreed but stated residents would pay more to send their garbage elsewhere.

Bette Chilton, Director of Personal Health Services, reported that most of November was spent hiring staff and most of December spent training those staff.  Access to health care continues to be a challenge and affects every single program in her division. 

Peg Carroll, coordinator of the Communicable Disease Program, announced that she still has flu vaccine available.  She and another staff nurse are traveling to Kane County this week to help with the Hepatitis A foodborne outbreak from a restaurant in their county.  Mrs. Gastiger asked if people exposed were symptomatic.  Mrs. Grush reported this was our first offer of assistance under the Public Aid Mutual Aid Agreement.  Mrs. Carroll reported that she received a call today regarding an elderly woman hospitalized at KCH who ate there.  Mrs. Grush commented that there were 3,000 to 4,000 potential exposures, and so far, 1,300 vaccinations have been given. 

Deb Rolf, Director of Home Care, reported that a new secretary has been hired and starts Monday.  Mrs. Grush stated that March is the month when the annual Home Care review is completed and considerable time will be spent at that meeting reviewing data, numbers and a review of policies. 

Mr. Wolf asked if any staff were now certified to do HIV testing.  Mrs. Chilton stated that former employee, Brad Daehn, has been coming to the agency on Thursdays to do testing and also some training.  Staff is traveling this Friday to Springfield to receive their first set of testing and will be able to do regular testing when they return on Monday.  Another training will be attended in March.  Ms. Fauci asked how many cases of AIDS there are in DeKalb County.  Mrs. Chilton responded that there are 42 active clients in our HIV Case Management Program, with some of these individuals having AIDS and some not.  Mrs. Carroll added that this remains an under-reported disease, and that it is hard to get a good number of how many residents are affected by HIV.  She feels it is far more than the 42 our agency manages. 

Marcy Zanellato, Director of Health Education, reported that DeKalb County now has 82 smoke-free restaurants.  Three nave been added: Pot Bellies, Muggzies in Sycamore and State St. Pizzeria in Sycamore.  She stated that three Chicago suburbs have temporarily suspended their smoking ordinances that went into effect in January 2007.  Mr. Romero stated that the complaint in Chicago is that people consume more at restaurants when they are smoking.  A letter was sent to the National Restaurant Association asking people to come together and send complaints to politicians.  Ms. Zanellato stated that it will be interesting to see if this is a trend or not.  Ms. Fauci pointed out that the number of heart attacks decreased dramatically in Missoula, Montana, when their non-smoking policy was implemented and increased measurably when it was rescinded. 

Marcy pointed out that the state is big on drills and exercises for emergency preparedness as described at the last meeting.  Mr. Wolf asked about the flu clinic drill.  Emergency Preparedness is constantly adapting to CDC criteria and testing collaboration with partners.  Mrs. Zanellato stated that the November and December flu vaccine distribution at NIU were used for this requirement. 

FINANCIAL DATA            

Mrs. Grush explained the financial information provided to new board members.  The year-end financial statement is included under New Business and will be discussed further.

Ms. Fauci asked about the large amount of revenue for Animal Control licenses.  Mrs. Grush responded that one payment is received per year from the County.  She explained that the licenses paid for by the dog owner cover 99% of the cost of the Animal Control Program.  Fees are generally increased every other year. 

On a motion by Mr. Buick, seconded by Ms. Fauci, the Financial Statements for the months of November and December 2006 and the Claims for the months of December 2006 and January 2007 were approved.  Motion carried. 

NEW BUSINESS

2006 Year-end Financial Statement

Mrs. Grush presented the unaudited 2006 Year-end Financial Statement.  Adjustments must be submitted by the end of January, and the auditors will be here in February.  More detail and final numbers will be provided at the March board meeting.  Mrs. Grush explained the columns on the statement for new board members. 

Revenue received in Licenses and Permits is close to the budgeted amount.  Under Intergovernmental line items, a little more revenue was received in grants and Medicare in the Home Care Program.  Under Charges for Services, revenue was down because of the Family Planning Program and that not as many flu shots as anticipated were administered.  Under Non-Operating Revenues, more revenue was received because of better interest rates this past year as compared to previous years.  FY2006 Revenue is estimated at $5,705,205.

In FY2006 Expenses, the budgeted amount is close on Capital Outlay and Commodities and Services.  Expenses in Salaries and Benefits were down by $300,00 to $400,000 because the expenses for IMRF and Social Security were not as great as anticipated.  Total FY2006 Expenses are estimated at $5,503,044, approximately $200,000 revenue over expenses. 

$1.3 million will be transferred to the Public Building Commission year toward the Community Outreach Building.  $300,000 has already been set aside, in addition to $200,000 the year before.  Mrs. Grush hopes to have the building paid off before 2009 (move-in date) as she is aware that expenses in the new building will be higher.  Dr. Olson asked about the interest earned on investments.  Mrs. Grush reported that the DeKalb County Treasurer is responsible for investments.  Ms. Fauci pointed out that the Veterans Assistance Commission is putting a lot of money toward the new building.  Mrs. Grush reported that the building is projected to cost $5.5 million and the Veterans Commission is contributing $800,000 towards that.  The Health Department is paying $2 million and the Public Building Commission (PBC) is contributing a significant amount.  She stated that $150,000 will be needed to do the geothermal system and the PBC will providing financial assistance with that. 

Personnel

Family and Medical Leave Act Policy

Mrs. Grush reported that Personnel Policies are generally reviewed annually for changes, but this was put on hold because of the union negotiations.  The FMLA of the Health Department has always been based on a calendar year, as the County used to be, but the County changed their policies in January 2006 to the leave being on a consecutive 12-month period rather than calendar year.  She is requesting that our policies be revised to follow those of the County.  It will not affect the three employees currently on FMLA, and will only affect those going on leave from this date on. 

Employee / Compensation

Mrs. Grush reported that staff salaries are always reviewed for the December board meeting and market adjustments made at that time based on new hires. 

Mrs. Grush made a request to authorize straight hourly pay for salaried exempt support staff that work extra hours in preparing for union negotiations above the work week of 37.5 hours.  She indicated that this type of reimbursement requires Board approval.

Mrs. Grush stated that she closed the agency on December 1, 2006, due to the heavy snow.  The maintenance workers called, indicating that they would not be able to keep the lot clean because of the blowing snow at our location.  At that time, she did pay staff for the day, when they should actually have been required to use benefit leave, in accordance with County policy made in 1996.

Mrs. Grush reported that the Home Care Program, over the last several years, functioned under the structure of the Director and Team Leaders.  She would like to return to the previous model of the Director and a Patient Care Coordinator because of the decrease in the number of nurses on staff.  Job descriptions for Patient Care Coordinator and Program Development Coordinator were presented. 

Mrs. Grush reported that staff always come to her and ask for a salary recommendation or to hire above entry level, which requires Board of Health approval.  The Finance Office monitors all these activities and classifications, and they have asked that the Board of Health be the monitor of such activities instead, submitting information on changes, signed by the Board of Health President, after meetings with changes.  Mrs. Grush presented examples that would be approved and then sent to the Finance Office. 

Dr. Olson made a motion, seconded by Mr. Romero, for the following: revision to the FMLA, paying of agency staff for the snow day on 12/1/06, payment for Union preparation to salaried support staff working additional hours, the job descriptions of Patient Care Coordinator and Program Development Coordinator, and the assumption of providing the Finance Office with salary changes or classifications, approved by the Board of Health President.  Motion carried.

Committee Appointments for 2007

Dr. Bishop presented the following committee appointments for 2007: Finance – Mr. Wolf, chair, Mr. Starkweather and Ms. Fauci; Personnel – Mrs. Gastiger as chair, Dr. Olson and Dr. Shear; Nominating Committee – Dr. Liston as chair, Mr. Romero and Mr. Buick; Bylaws Committee – Dr. Bishop as chair and Dr. Schelkopf.

Executive Session

On a motion by Ms. Fauci, seconded by Mrs. Gastiger, the Board of Health entered executive session at 8:50 p.m. for the purpose of discussing personnel issues.  On a roll call vote, those voting aye included Dr. Bishop, Mr. Buick, Ms. Fauci, Mrs. Gastiger, Dr. Olson, Mr. Romero, and Mr. Wolf.  Motion carried.

On a motion by Mr. Wolf, seconded by Dr. Olson, the Board of Health voted to reconvene to regular session at 9:12 p.m.  On a roll call vote, those voting aye included Dr. Bishop, Mr. Buick, Ms. Fauci, Mrs. Gastiger, Dr. Olson, Mr. Romero, and Mr. Wolf.  Motion carried.

CORRESPONDENCE AND ANNOUNCEMENTS

Correspondence for the months of November and December 2006 included a commendation for Mr. Berres, Animal Control officer, from Lisa Miller, City of DeKalb.  Newspaper articles for the two-month period covered Home Health Care Month and the availability of flu vaccine.

ADJOURNMENT

On a motion by Mr. Romero, seconded by Dr. Olson, the Board of Health adjourned at 9:13 p.m.  Motion carried.

Jean Gastiger, R.N., F.N.P., Secretary

DeKalb County Board of Health

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