BOARD MEMBERS PRESENT: Scott Starkweather, President; Jean Gastiger, R.N., N.P., Vice President; Linda K. Liston, M.D., M.P.H., Secretary; Kevin Buick; Julia Fauci; John B. Olson, D.D.S.; Todd Latham, David Phillips, M.D.; Sue Thompson, R.N., 

BOARD MEMBERS ABSENT: Jesus Romero; Dennis Diemer, D.V.M.

Board of Health members and staff introduced themselves to new members. 

MINUTES

On a motion by Ms. Fauci, seconded by Dr. Olson, the minutes of the Board of Health meeting of November 27, 2007, were approved.  Motion carried.

On a motion by Mr. Buick, seconded by Mrs. Gastiger, the minutes of the Executive Session of November 27, 2007, were approved.  Motion carried.

DIVISION REPORTS

Mrs. Grush reported that there was a mileage increase, effective January 1, 2008, from the IRS rate of 48.5 cents per mile to 50.5 cents. 

A chart was presented showing the new health insurance rates for the county.  The employee’s portion of family coverage increased from $368 to $386 per month and single coverage from $108 to $114.  The employer’s portion increased from $972 to $994 for family coverage and from $472 to $486 for single coverage. 

Mrs. Grush reported that there was a $115,000 deficit in the FY2008 Budget; however, health insurance rates not increasing as much as anticipated will result in about a $70,000 employer savings.

A PowerPoint presentation was given by Mrs. Grush regarding the Smoke-free Illinois Act, which became effective on January 1, 2008.  This was also shared at a meeting on the 14^th of December for local police, DeKalb County Sheriff’s Department, and municipality representatives.  The purpose of this meeting was to design a strategy and enforcement mechanism for implementation of the Act.  John Farrell, Assistant States’ Attorney, was present to provide counsel to the various entities.  The Health Department recommended that local law enforcement would deal with the complaint if it were on an individual, and the Health Department would follow-up on complaints regarding businesses. 

Mrs. Grush pointed out that private clubs located in DeKalb that were exempt under the DeKalb ordinance are not exempt under this Act.  Exceptions include 25% of hotel and motel rooms, private residences not used for business, private / semi-private rooms in nursing homes or long-term care facilities if the roommates agree and the facility assures smoke does not infiltrate other areas.  Notices are to be posted at every entrance and exit of buildings.  Enforcing agencies are the Illinois Department of Public Health (IDPH), local law enforcement and local health departments.  Complaints can be made to any of the three agencies, but the name of the individual filing the complaint must be provided.  IDPH has developed a website to assist with implementation of this Act, including mechanisms for receiving complaints.  Mrs. Grush pointed out that the rules and regulations have not yet been approved by the State.   She also reviewed violations and fines associated with this Act. 

Mrs. Grush stated that the Health Department would be following up on violations of the Act per State recommendations.  First a friendly letter will be written, followed by a warning letter, then a violation letter with fines and an injunction, if necessary.  The Act has been posted on the agency’s web site with a Frequently Asked Questions section and signs that businesses can download.  Over 1,000 letters were sent to county businesses directing them to the website.  The State has sent public service announcements to the local media.  To date, the agency has received six complaints, all regarding the violation of smoking within 15 feet of an entrance or no signs posted.  To the best of her knowledge, Mrs. Grush was not aware of any complaints against individuals. 

Ms. Fauci asked who made the complaints to our agency.  Mr. Drake responded that the State has that information on file, but does not provide it to our agency.  Mrs. Grush explained that our agency does not enforce this Act on the NIU campus since that is a state entity and our agency does not have authority to enforce the Act there.  Dr. Liston stated that there is a sign requesting that individuals not smoke in their car while on campus.  The hospital and DeKalb Clinic both have policies regarding smoking in vehicles.  Mrs. Grush pointed out that a number of counties have made all their properties smoke-free.  Dr. Phillips added that staff at his clinic need to clock out to smoke and cannot do so in their cars.

Dr. Olson stated that the County is holding a public hearing on February 11, 2007, on the agreement with the proposed casino in Shabbona.  Mrs. Grush indicated that she did plan to call the health department in Wisconsin that is home to a HoChunk casino to discuss their role in relation to the casino.  She stated that Dr. Purdy had addressed the County Board about infectious diseases, and she feels we do have rules and regulations in place where we would have authority on casino grounds.  Dr. Olson suggested a letter be sent to the County Board from the Board of Health for the public hearing requesting assurance that the Health Department be able to carry out its public health responsibilities on the Indian land.  Mrs. Grush indicated that she would draft a letter and have Mr. Starkweather sign it on behalf of the Board of Health as Board president to request assurance that the agreement allows the Health Department to carry out its public health responsibilities on the land. 

Ms. Thompson made a motion that Mrs. Grush draft a letter on behalf of the DeKalb County Board of Health, seconded by Ms. Fauci.  Motion carried.

Mrs. Grush commended the Home Care Program staff for the quality of service they deliver, resulting in licensure recertification by IDPH in November 2007.   She reported that this was the best survey the program has ever had, with only a few minor deficiencies noted.

Mrs. Grush reported that IDPH is providing select health departments with an opportunity to apply for seed money to address sexually transmitted diseases (STD) issues in their county.  DeKalb County is one of 22 health departments with a population between 20,000 and 260,000 that rank in the top 30 counties for prevalence of Chlamydia, earmarking DeKalb County as eligible to receive a one-time award of $10,000 to carry out at least two new STD prevention activities.  The Health Department will be requesting a grant to (1) provide a treatment program for partners of positive STDs and (2) to develop a link on the agency website providing information and resources for STDs and an interactive capability so program staff can conduct risk-reduction counseling anonymously. 

Mrs. Grush added that partner treatment has been a long-time goal of the agency.  Mrs. Lux, Assistant Administrator, stated that medications for treatment would be available from IDPH.  An agency nurse will operate under standing orders, with the service provided at a very low cost.  This program would carve out NIU students who have access to those services at the University.  Ms. Fauci asked how the website would work.  Mrs. Lux explained that she met with Joan Berkes-Hanson, Director of the Information Management Office, who indicated that DeKalb County has staff that can upgrade and modernize a website with interactive capabilities.  She added that clientele have been telling us that this is the method they would prefer to use for resources. 

Bette Chilton, Director of Personal Health Services, reported that a very successful flu season was held this year.  She was happy to report that only a few doses of vaccine are left, and so far this year, there have not been many reports of influenza.  Bette added that the access to health care for the underserved and Medicaid populations continue to be a problem.  The State of Illinois contracted with Illinois Health Connect, and the system forced many of our physician groups out of being able to continue to take Medicaid patients.  She added that the system is very dysfunctional.  Barriers are listed as clients being assigned physicians who have reached capacity or being assigned a physician that doesn’t provide the service they need.  Oftentimes, they are assigned a physician that is more than 20 miles away and transportation is a problem; therefore, clients take the VAC bus to the Emergency Department (ED).  This is the current state of the health care system and she doesn’t see relief any time soon.  Mr. Starkweather asked about progress on the part of the task force.  Mrs. Grush responded that the group is continuing to meet and gathering information and options. 

Ms. Fauci stated that she had read that seniors are advised to get their flu shot later in the season so it has a longer duration into spring and wondered if that was being communicated to them.  Mrs. Chilton responded that it is in the literature, but the seniors frequently want to get them early in the season. 

Deb Rolf, Director of Home Care, stated that their program is required to assess patients until the end of February, but patients start asking for the vaccine in September. 

Marcy Zanellato, Director of Health Education, explained the Coordinated Approach to Child Health (CATCH) program, funded through the Coordinated School Health Grant, which was implemented in Chesebro Elementary School in 2006-07.  In addition to this school, funding was received to expand to Cortland Elementary School in 2007-08.  The DeKalb School District, in collaboration with the Health Department, submitted a DeKalb County Community Foundation proposal to fund CATCH in the remaining seven DeKalb schools, with partial funding received in the fall of 2007.  The Health Department is receiving grants for Lincoln Elementary School in DeKalb and Southeast Elementary School in Sycamore, with implementation at these sites scheduled for the spring of 2008.  Marcy pointed out that Jane Lux wrote a letter of support for the DeKalb School District, since 40% of the students are considered low-income, and that number is increasing dramatically.  Mrs. Grush added that significant Health Department programming is targeted to DeKalb, but this district is different from others in the county.  In DeKalb, the two middle schools and five elementary schools have a combined 53% low-income status.  Mr. Starkweather asked how this compares with other districts in the county.  Mrs. Grush responded that other schools are in the 15 to 20% range of low-income students. 

FINANCIAL DATA

Mrs. Grush reported that she would be having an orientation for new board members.  She explained that DeKalb County changed their fiscal year this year, so the financial numbers are very preliminary.  A final Financial Statement will be presented at the March meeting.  On December 1, 2007, the Health Department’s account balance was $608,497, with approximately $1.1 million in investments.  She pointed out that the Health Department still needs to pay $500,000 towards the Community Outreach Building.  She had budgeted to pay $250,000 this year and $250,000 next year, but the County is asking that it all be paid this year.   

On a motion by Ms. Fauci, seconded by Ms. Gastiger, the Financial Statements for the months of November and December 2007 and the Claims for the months of December 2007 and January 2008 were approved.  Motion carried. 

NEW BUSINESS

Financial Management Policy and Procedure Changes

Mrs. Grush explained that the Board of Health is responsible for approving policies and procedures and reviewing and approving them periodically.  This year, the auditing firm of Sikich Gardner LLP requested a copy of our financial policies in December.  These policies would normally be reviewed in March.  Ms. Fauci stated the emphasis of the auditors this year seemed to be on fraud.  Mrs. Grush responded that several agency employees were interviewed, as they are annually, regarding any known agency fraud and abuse. 

Dr. Phillips made a motion to approve the revisions to the Financial Management Policies and Procedures, seconded by Dr. Olson.  Motion carried.

Implementation of Payment for Services by Credit/Debit Card

Mrs. Grush stated that the agency has looked into the possibility of using credit cards for payment for services in the past, but did not proceed because of regulations imposed by the credit card companies.  The State of Illinois now has a program, Illinois Funds E-Pay (Electronic Payment Services Program) which will process the credit and debit card transactions.  This service has been requested by both clients and staff for some time as some of the bills, especially in the travel immunization program,  can be sizable, and people prefer to use their debit or credit card rather than writing a check or paying cash.  While the travel program was the driving force for this, Mrs. Grush does feel there are other programs that would benefit.

While it is unknown how much additional monies this will bring in, according to the State, based on history, 25% of people will pay with a credit card and 75% with cash or check.  Even with the associated fees, she feels there will be a gain versus a loss for agency revenue.  This method of payment would also increase cash flow, reduce non-sufficient funds checks and, potentially, money will be collected that would have previously been written off to bad debt. 

The types of cards to be accepted and the associated fees were listed.  Mrs. Grush explained how the transactions would be processed.  Three terminals will be installed at the Health Department at a cost of $450 each.  Home Care will not be accepting credit/debit cards as a form of payment until sometime after their move.  Since fees have already been set for 2008, some monies will be lost on fees but will be offset by additional revenue. 

Mr. Latham asked how much was written off each year due to non-payment.  Mrs. Grush estimated between $25,000 and $30,000 per year.  She added that the Health Department does not send clients to collection for non-payment.  Ms. Thompson’s concern was that money would be collected through credit card payments from people that don’t have money, and while this is a convenience to them, we are adding a burden to them. 

Mr. Buick made a motion to implement payment for agency services by credit and debit cards, seconded by Mr. Latham.  Motion carried.

Vision and Hearing Program

Mrs. Grush stated that the Health Department assumed vision and hearing screening for preschool and school-age children many years ago.  At this time, she is recommending transitioning the responsibility of screening for the school-age population to the schools beginning with the 2008-09 school year.  She is also recommending investigation of alternatives for screening of the preschool population.  She presented several reasons for this recommendation.  The primary technician is retiring this year.  The second position has been unstable for five years and the current technician has been out on leave with family medical issues since November.  There is no available backup through the agency for vision and hearing screening.  This past year, the school nurses did help the primary technician.  Also, due to a reduction in IDPH staff, trainings for new staff are very limited and preclude hiring a new person that will be ready to go at the beginning of the school year.

Mrs. Grush reported that this program receives the lower priority for funding from the State Health Department, and the agency has received the same funding for the past eight to ten years.  Grants only provide funding for preschools and day cares and do not cover the whole cost.  The agency is awarded $21,000 annually to screen preschoolers, but only $18,000 to $19,000 is collected during our budget cycles.  No funding is received for the screening of school-age children, so the agency contributes approximately $25,000 annually towards this cost. 

Prior to 2003, our technicians screened many more children, but with the implementation of HIPAA, it was not feasible to bill Public Aid because individual consents would need to be obtained for every school-age child.  Consequently, prior to 2003, IPA was helping to offset the cost of the program.  Since 2003, only mandated grades have been screened.  Mrs. Grush explained that the purpose of the vision and hearing screening is educational to identify barriers to learning and is mandated by the Illinois School Code, and is a responsibility of the schools. 

Mrs. Grush explained that, over the years, many health departments have relinquished their school-age vision and hearing screening to the schools, and it is not the norm for health departments to provide this service.  IDPH-level staffing and funding have declined, with no increase planned for the future, so IDPH supports transitioning the responsibility of the program from local health departments to the schools. 

Mrs. Grush stated that the preschools could still be done if the technician that has been on leave is able to return to work.  She has also approached the primary technician about helping with the preschools, but has not received a commitment from the employee. 

Mrs. Gastiger asked what employees within the school districts would provide this service.  Mrs. Grush responded that most schools hire through a special education team to do the screening, and some larger school districts have hired their own staff.  Some health assistants are certified and the school nurse could help them out, as needed.  She added that this is difficult because she realizes that the school nurses are over-extended.  Dr. Liston asked if a school could say that they could not afford to provide the screening.  Mrs. Grush responded that it is a mandate of the Illinois School Code and a responsibility of the school.

Ms. Fauci asked why the Health Department was helping the school with this in the past.  Mrs. Grush responded that, historically, many health departments provided this service; however, for financial reasons, many health departments discontinued providing the service.

Ms. Fauci asked if an eye doctor could provide the screening for a limited cost.  Mrs. Grush did not feel they would be interested as a great deal of travel and organization is involved.  Dr. Phillips stated that an eye doctor, where he was in prior practice, did free screenings once a week at his previous practice, and wondered if that could be a possibility.  Mr. Latham asked if the preschools would be able to apply for a grant to fund the service.  Mrs. Grush stated that one option would be for an organization, such as DeKalb Coordinated Child Care (4-C), to apply for a grant and hire a nurse that could travel to the day cares and preschools.  Mrs. Lux stated that early childhood or pre-K programs are considered district programs and not day cares.

Ms. Fauci asked if the schools were aware of this recommendation.  Mrs. Grush stated that they are not.  Mrs. Lux had a meeting with school nurses last week where she announced that we were having a staff turnover and this would be forthcoming.  She indicated that none of the nurses were surprised. 

Mrs. Grush is recommending that the school-age population be transitioned to the schools and leaving the preschool options open as long as Health Department staff is available.  In the meantime, agency staff could talk with 4-C to determine their interest in conducting this program to preschoolers and day cares. 

Mr. Latham made a motion to transition responsibility of vision and hearing screening for the school-age population to the schools, seconded by Mr. Buick. 

Dr. Liston did not feel the elementary and middle schools had enough time to make plans and wondered if the letter could get out soon so some responses could be received.  She asked if continuing this service was out of the question for the coming year.  Mrs. Grush responded that the Health Department will not have staff to continue this service at the current level.   She added that all the school districts have school nurses and all are certified in vision and hearing screening.

Motion carried.

Board of Health Committee Appointments for 2008

Mr. Starkweather announced the Board of Health Committee Appointments for 2008.  Mrs. Grush explained the responsibilities of each of the committees.  They are as follows:

Finance Committee:        Jean Gastiger, Chair

Julia Fauci

Jesus Romero                                

Personnel Committee:      John Olson, Chair

Kevin Buick

Linda Liston                          

Bylaws Committee:         Scott Starkweather, Chair

Dennis Diemer

Nominating Committee:  Todd Latham, Chair

Sue Thompson

David Phillips

Executive Session

Mr. Buick made a motion to enter into executive session at 8:57 p.m. for the purpose of a Union update and a personnel issue, seconded by Dr. Olson.  On a roll call vote, those voting yes included Mr. Buick, Ms. Fauci, Ms. Gastiger, Mr. Latham, Dr. Liston, Dr. Olson, Dr. Phillips, Mr. Starkweather and Ms. Thompson.  Motion carried. 

Ms. Fauci made a motion to reconvene to regular session at 9:03 p.m., seconded by Mr. Buick.  On a roll call vote, those voting yes included Mr. Buick, Ms. Fauci, Ms. Gastiger, Mr. Latham, Dr. Liston, Dr. Olson, Dr. Phillips, Mr. Starkweather and Ms. Thompson.  Motion carried.

CORRESPONDENCE AND ANNOUNCEMENTS

Newspaper articles for the months of November and December 2007 covered food safety over Thanksgiving, a spay/neuter program implemented on an experimental basis in 2008, and the Smoke-free Illinois Act.

ADJOURNMENT

On a motion by Ms. Fauci, seconded by Ms. Gastiger, the Board of Health adjourned at 9:08 p.m.  Motion carried.

Linda K. Liston, M.D., M.P.H., Secretary

DeKalb County Board of Health

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