DEKALB COUNTY HEALTH DEPARTMENT
MINUTES OF THE MEETING
MARCH 24, 2009

 

BOARD OF HEALTH MEMBERS PRESENT

Scott Starkweather – President
Jean Gastiger, R.N., N.P – Vice President

Linda K. Liston, M.D. – Secretary

Todd Latham
John Olson, D.D.S.
Paul Stoddard
E. Sue Thompson, R.N.

BOARD OF HEALTH MEMBERS ABSENT
Kevin Buick, J.D.
Dennis Diemer, D.V.M.
David Phillips, M.D.
Jesus Romero

Staff Members Present

Karen Grush, DeKalb County Health Department, Administrator
Jane Lux, DeKalb County Health Department, Assistant Administrator
Bette Chilton, DeKalb County Health Department, Director of Personal Health Services
Brenda Courtney, Director of Fiscal Operations
Bob Drake, DeKalb County Health Department, Director of Environmental Health
Ruth Patton, DeKalb County Health Department, Director of Office Support
Deb Rolf, DeKalb County Health Department, Director of Home Care
Marcy Zanellato, Director of Health Education

 

Mr. Starkweather, President, called the DeKalb County Board of Health Meeting of March 24, 2009, to order at 7:37 p.m.

MINUTES
On a motion by Mr. Stoddard, seconded by Mrs. Gastiger, the Board of Health minutes of the meeting of January 27, 2009, were approved.  Motion carried. 

Agenda
Mrs. Grush added two new agenda items, the first regarding emergency on-call compensation for Home Care nurses, and the second regarding the new classification of Accounting Assistant.  Mrs. Grush also requested that agenda item number five be tabled as Dr. Diemer is absent from tonight’s meeting.  Dr. Diemer has been involved in this issue from the start and she would like input from him.

Mr. Stoddard added an agenda item regarding the proposed wind farm in the southeast DeKalb County and the affect it may have on resident’s health.

 

DIVISION REPORTS

Public Health Administrator
Mrs. Grush reported that January and February were very busy months.  The financial books for FY2008 were closed and Home Care was moved into the new Community Outreach Building.  Most of the furniture at the old location was moved to County storage awaiting the County Auction to be held in May.  A small amount remaining at the facility was sold to Kishwaukee Hospital for $1,000.00. 
Mrs. Grush also stated that the Public Building Commission will be holding an Open House for the Community Outreach Building on Thursday, May 12, 2009, from 4:30 p.m. to 7:00 p.m. 

Dr. Liston asked for clarification regarding the billing issue that the State Family Planning Program didn’t know.  Mrs. Chilton responded that we were given notice through the Department of Health and Family Services (Medicaid) that 340B providers, of which the Health Department is, were to bill Medicaid only the actual cost paid to purchase contraceptives for family planning clients.  Programs have never been made aware of this.  This would result in a substantial loss of revenue in serving Medicaid clients.  Mrs. Grush explained in researching this, an alternative is to purchase “off 340B” for Medicaid clients and “on 340B” for other clients.  We are able to do this through a purchasing cooperative in California and still receive affordable pricing.  This option then allows us to receive a higher Medicaid reimbursement rate.

Mrs. Grush reported that the new Vital Records system for death certificates was activated this month.  Mrs. Brenda Courtney, Director of Fiscal Operations, also directs this program and has spent a great deal of time over the last six weeks implementing the system.  Over the last 10 years, the State has collected $2.00 from every county in Illinois for each death certificate issued with the goal of making the issuance of death certificates electronic.  Mrs. Courtney has spent a lot of time learning the process and teaching it to the county’s funeral directors, coroner, county clerk, and Health Department staff.  Mrs. Grush commended Mrs. Courtney for her hard work in getting this system in place. 

Dr. Olson asked Mrs. Grush if she was encouraged by the new governor.  Mrs. Grush stated we have heard so little and nothing about stimulus for public health.  It’s too early to say.    

Environmental Health
Mr. Drake stated he had nothing further to add to the information provided in his written report other than the rabies information provided is quite significant.  Mrs. Grush stated that in the information provided to the Board stating that since 1999 bats were the only species identified with rabies.  However, in 2005, there was a cow, a fox, and six skunks.   

Mr. Stoddard asked why the County is seeing an increase in rabies cases.  Mrs. Grush stated rabies may have always been present but now that testing is occurring more frequently, it’s showing up more often. 
 
Mr. Stoddard stated this problem is concerning and is there anything we can do to curb the problem.  Mrs. Grush stated there isn’t.  Bats like to live in old homes.  The county makes every effort to educate the owners of these homes of the importance of covering openings to discourage bats from gaining entry. 

Personal Health Services
Mrs. Chilton stated she had nothing further to add to the information provided in her written report other than one correction regarding HIV funding.  In her report, Mrs. Chilton states that Governor Quinn has proposed cutting HIV funding by three percent.  However, she has just attended the grant writing conference and it was announced that funding was going to remain the same as of this time.

Dr. Liston stated that the STD Partner Treatment Program was a great idea and asked if the clients are examined or are they just given medicine.  Mrs. Chilton stated that the Health Department has standing orders from Dr. Thornton.  The client is required to bring their referral card, fill out a brief health history, and get counseling services. 

Dr. Liston also stated that it is distressing to read that patients are unable to find a primary care provider.  Mrs. Chilton stated that Personal Health Services spends an enormous amount of time counseling women on the importance of having a primary care provider.   

Mrs. Grush stated she was unsure of the status of the Monsanto Clinic and hoped the opening of that facility would help provide for those who have difficulty accessing primary health care.    

Home Care
Mrs. Rolf stated she had nothing further to add to the information provided in her written report and would be happy to answer any questions. 

Dr. Liston asked if anyone from the Health Department attended the meetings regarding the closing of Kishwaukee Community Hospital’s Mental Health Unit.  Dr. Liston also asked if there has been a positive or negative impact on home visits and the types of payments seen. 

Mrs. Rolf stated mentally ill patients are difficult to manage in Home Care and they don’t have a large caseload.  Mental health referrals for Home Care do not generally come from the hospital.   

Mrs. Grush stated that John Olson called asking if the Board of Health should make a statement regarding this issue.  Mrs. Grush responded that the Board of Health could if they wanted to but in our county public health and mental health are two different entities.  Because mental health is not our focus, Mrs. Grush indicated she does not have an understanding of the reasons that led to this decision by the hospital. 

Health Education
Mrs. Zanellato stated things are going well and that it has been a busy couple of months.  Health Education had the opportunity to partner with the WIC Program targeting WIC families using the “Take It Outside” smoke-free homes and cars program. 

A local resident quit smoking and in order to keep her hands busy, made layettes and donated 20 to the Health Department.  A sample of the layettes was shown to the Board.

Dr. Olson asked if the numbers of smokers are going down with the increase of price in cigarettes. 

Mrs. Zanellato stated that as costs go up smoking rate goes down, especially with adolescents. 

 

FINANCIALS
Mrs. Grush reported most of the revenue brought in was for December.  Our January revenue was $35,000 and our expenses were $354,000.00 which is why it’s important to have the fund balance.

Dr. Liston moved to approve the Financial Statements for the months of January and February 2009, and Claims for the months of February and March 2009, seconded by Dr. Olson.  Motion carried.

 

NEW BUSINESS

FINANCIAL
2008 Year-End Financial Statement
Mrs. Grush presented the 2008 audited Financial Statement.  Revenue was $6,081,240.94.
Home Care Revenue was $2,461,240, and Public Health Revenue was $3,580,526.  Interest on Investments was $39,475.  Expenditures were $6,303,615.12   Home Care Expenditures were $2,357,307 and Public Health Expenditures were $3,446,308.  In addition, expenditures included the final payment of $500,000 toward the Community Outreach Building resulting in a deficit of $222,374 in expenditures over revenue.  Mrs. Grush reported the original budget anticipated utilizing $500,000 from the agency fund balance for the final building payment.  However in reality only $277,626 was actually used. 

In reviewing the Revenue and Expenditures, Mrs. Grush stated that had the full $500,000 been taken from the Fund Balance’s Investments, the Home Care Program would have realized a $103, 933 in revenue over expenses for 2008.  Public Health would have realized a $134, 218 in revenue over expenses for 2008.  Mrs. Grush further explained that one time Basic Health Grant Supplemental funding of $52,630, $26,000 was other one time grant funding, and $5,000 from an accounts receivable for 2007 offset having to utilize other public health revenues that subsidize public health programs.  These revenues cannot be counted on from year to year.

Mrs. Grush reported the agency’s fund balance as of December 31, 2008, was $2,034,279.  The agency’s average annual cash and investments available in 2008 was $1,503,218.  Mrs. Grush reported the agency’s financial standing is strong; however, there is certainly concern with the current economic situation for the next couple of years.

On a motion by Mrs. Gastiger, seconded by Mr. Latham, the 2008 Financial Statement was approved.  Motion carried.

PERSONNEL
Buy Down of Vacation Hours for Exempt/Salaried Employees
Mrs. Grush indicated that the County amended the Paid Hours Off System to allow select employees with five or more years of service to buy down accumulated hours in excess of 200 hours.  The Health Department has not offered this in the past.  Mrs. Grush recommended that Exempt/Salaried Employees with five or more years of service as of December 31, 2008, be allowed a one time buy down of up to three weeks vacation (112.5 hours) at their December 31, 2008 salary rate.  She explained that it is often difficult for management employees who have been here more than 10 years to take all their earned vacation time. She estimated the cost to be $12,000 to $15,000.
                                     
Dr. Liston moved to approve the recommendation for the Buy Down of Vacation Hours for Exempt/Salaried Employees, seconded by Mrs. Thompson.  Motion carried.

Emergency On Call Coverage
Due to an injury suffered by one of the Home Care nurses, four dates she was assigned to on-call need to be covered.  Therefore, an agreement has been negotiated with the Bargaining Unit to offer a one time incentive to nurses who volunteer to take the on-call assignments this nurse had been assigned to.  The dates involved and the incentive to be paid are: 

            Friday, March 20, 2009 - $30.00
            Thursday, March 26, 2009 - $30.00
            Saturday, April 4, 2009 - $110.00
            Sunday, April 5, 2009 - $110.00
Dr. Liston moved to approve the recommendation for the Emergency On Call Coverage, seconded by Mrs. Thompson.  Motion carried.

New Accounting Assistant Classification
During the Board of Health meeting of January 27, 2009, Mrs. Grush asked the Board for authorization to work with the Executive Committee to approve the new Accounting Assistant classification.  The Executive Committee has approved this new position at a salary range of $12.82 to $19.47 per hour.

Dr. Liston moved to approve the recommendation for the New Accounting Assistant Classification, seconded by Mrs. Thompson.  Motion carried.

HOME CARE
Approval of Home Care Policy Revisions
Mrs. Grush explained that a professional advisory committee was appointed to review the policies and procedures of the Home Care Program, which is a requirement of the federal government.  The committee was composed of: 

            Dr. Michael Thornton, Agency Medical Director
            Jean Gastiger, RN, Nurse Practitioner, Board of Health
            Scott Starkweather, Board of Health Member
            Karen Grush, RN, MS, Administrator
            Deb Rolf, RN, BSN, Home Care Director
            Kathy Condon, RN, Home Care Patient Care Coordinator
            Tracy Busby, RN, MS, Home Care Program Development Coordinator
            Kathleen Carlson, RN, Intake/Home Health Aide Coordinator
            Tammy Pieroni, Home Care Office Coordinator

The Home Care Policy Revision Approved by the Professional Advisory Committee Members handout indicated which current policies were revised and what new policies were added to the Home Care Policy and Procedure Manual.   All committee members reviewed the policies and procedures and approved the policy revisions and additions. A statement is needed in the minutes of the governing board of the Home Care Program that this has been satisfactorily completed.

On a motion by Mr. Latham, seconded by Mrs. Thompson, the Home Care Policies and Procedures were approved.  Motion carried.

Home Care Annual Report
Mrs. Grush reported that the Home Care Program is required by the federal government to annually conduct an administrative review.  A review of Home Care revenue indicates a decrease of approximately $150,000 compared to the previous year.   However, the average reimbursement per episode increased by five percent to $2,625.04.  Cost per visit is determined by completion of the Medicare Cost Report which will be submitted next month.  Patients and visits in 2008 decreased by approximately eight percent.  Seventy-one to 100 is the largest age group served.  The 2008 Clinical Record Evaluation Summary for 2008 indicates a high level of requirement compliance.

Mrs. Grush presented several bar graphs, which illustrate how patients are evaluated when discharged.  These graphs indicate that the Home Care program provides a high quality of care and compares favorably when compared to State and National reference points.

Mrs. Grush commended Mrs. Rolf for her leadership in directing the Home Care program and further indicated the county is fortunate to have such an excellent program available for its residents.
Mr. Latham moved to approve the 2008 Home Care Administrative Review, seconded by Mrs. Thompson.

HIPAA Privacy and Security Update
In accordance with the HIPAA Privacy Rule, security officers and a security team must be reappointed annually.  Privacy officers must be reappointed every six years and along with the continuation of existing policies and procedures.  This year, Mrs. Grush is recommending that Tammy Pieroni be appointed as the Security Officer for the Home Care Program and Ruth Patton be appointed as the Security Officer for Public Health.  Members of the Security Team are being proposed as follows:

            Tracy Busby, Program Development Coordinator (Home Care)
            Brenda Courtney, Director of Fiscal Operations (Public Health)
            Jane Lux, Assistant Administrator (Public Health)
            Kari Owen, Senior Biller (Home Care)
            Ruth Patton, Director of Office Support (Public Health)
            Tammy Pieroni, Office Coordinator (Home Care)
            Deb Rolf, Director (Home Care)
            Bette Chilton, Director of Personal Health Services (Public Health)
            Information Management Office (IMO) Office Staff

Mrs. Grush is also recommending that Deb Rolf and Ruth Patton be appointed as Privacy Officers.

Dr. Olson moved to approve the HIPAA Privacy and Security Update, seconded by Mrs. Thompson.

Board of Health Bylaws
Mrs. Grush stated that the Board of Health Bylaws must be reviewed annually.  She has reviewed the bylaws and nothing has to be changed at this time.

SOLID WASTE
Host Community Agreement
Mrs. Grush discussed the Host Community Agreement with the Board.  Waste Management wants to expand the landfill and increase garbage brought in from outside the county.  The county has always had a policy of not having any more than 10 percent of the garbage in the landfill from outside the county.  Waste Management’s position is that in order for them to stay in business they need to increase the volume they receive. 

Mrs. Grush provided the Board with the major elements of the Host Community Agreement as recommended to the county.  The items or “earmarks” that pertain to the Health Department are a fee of $25,000 per year for an annual Household Hazardous Waste event and $200,000 every year with a three percent adjustment annually for inflation for the ongoing Solid Waste Program.

Mrs. Grush stated that during the County Board meeting there was discussion stating that these earmarks should not be in this host agreement and these programs should come as any other department into the budgeting process and be given money each year based on the merits of what they were proposing.  The proposed funding for Solid Waste would replace the current tipping fee.

2008 Solid Waste Annual Report
Mrs. Grush presented the 2008 Solid Waste Annual Report.  She explained that the DeKalb County Board gave authority of the Solid Waste Management Program to the Health Department to administer in March 1995, and an annual report is a requirement.  The program is funded by a $1.27 per ton tipping fee imposed on waste deposited in the landfill.  After approval by the Board of Health, the report will be submitted to the DeKalb County Board.

Mrs. Grush presented a number of graphs and charts recapping the waste recycled in DeKalb County in 2008.  The first, Composition of All Waste Recycled in 2008, showed percentages of all waste recycled.  The recycling rate decreased in 2008.  DeKalb County generated 49,000 tons of recycled material and 109,000 tons of municipal waste.  The comparison of Waste Recycled in DeKalb County from 2000 – 2008 shows, by ton, that commingled material has increased and paper recycling has decreased.    In 2008, Waste Management included paper with commingled material; adding those together they’re down about 10 percent.  It has been said that when the economy goes down, the amount of garbage produced goes down.  Two companies that produced a large amount of recycling in DeKalb County closed down in 2008.  One of the companies was DB Hess which made text books and recycled a lot of paper.  The other company was a plant that slaughtered horses and generated a large amount of grease.  The closing of these two companies made an impact on the recycling numbers. 

The Final Disposal of DeKalb County Waste in 2008 shows 82 percent as DeKalb County waste, 16 percent from Rochelle, and zero percent from Winnebago.  A table was presented showing the recycling rate for DeKalb County from 1996 to 2008, with the 2008 recycling rate at 40.3%, excluding construction and demolition debris.  Again Mrs. Grush added that this is all voluntary reporting.  The goal is to have a recycling rate in the county of at least 50%.  Mrs. Grush added that recycling rates in 2008 had decreased, apparently due to the economy.  Construction and Demolition alone was down 75 percent from recent years.

Major program achievements for 2008 were presented and included one used motor oil collection, two electronic recycling collections, printer cartridge and lead acid battery recycling, a compact fluorescent lamps and household batteries collection, education to 5,847 DeKalb County children and adult students, the loaning of event recycling containers, and miscellaneous other administrative duties.  A summary of the Apartment Recycling Project was presented.

On a motion by Dr. Olson, seconded by Mr. Latham, the Annual Report of the Solid Waste Management Program was approved.  Motion carried. 

Rural Recycling
Last month the Board recommended proposing recycling to all 19 townships in DeKalb County.  The townships would be offered a four or six cubic yard dumpster for recycling.  The Solid Waste Program would pay 100 percent of the cost the first year, 50 percent of the cost the second year, and 25 percent of the cost the third year.  After the third year, the continuation would be dependent upon the township agreeing to assume the cost.  Waste Management would be the hauler.  The townships would have to agree to securing the dumpster and monitoring it on a regular basis and agree to remove items left by residents that are not recyclable, i.e., couches, chairs, tables, etc.  One time grants in the amount of $1,000.00 would be made to the townships for minor improvements such as adding a concrete slab for the dumpster or, as suggested by Mr. Drake, putting up a fake camera. 

However, in the Host Fee Agreement, Waste Management has agreed to provide and pay for four rural recycling sites in the county.  Based on that proposal, Mrs. Grush and Mr. Drake suggest the Rural Recycling Project be postponed at this time until further details are received regarding the future of the Host Agreement. 

On a motion by Dr. Liston, seconded by Dr. Olson, the Board agreed to table this issue and pursue sites in the county in conjunction with the host agreement.  Motion carried.

Proposed Wind Farm
Mr. Stoddard stated he attended the public hearing on the proposed with farm in the southeast corner of the county.  There are several objections citizens have raised regarding noise, decreased property values, and especially the reports that low frequency noise could have adverse health effects on people in the area.  Mr. Stoddard asked the Board if they had heard about any research regarding this claim.    

There was a discussion among the Board members regarding the concerns of the citizens, however, no one was aware of health effects.

Body Art
In 2004 the Board of Health discussed concern about there being no rules or regulations for body art establishments in the County.  However, the State has now established rules and regulations.  Mrs. Grush stated that she would like to think that the DeKalb County Board of Health played a role in getting the State to move forward establishing rules and regulations as the Board of Health at that time sent the Director of IDPH a letter regarding the lack of rules and regulations for body art establishments.  Mrs. Grush further stated that, at this time, she’s not sure what the Health Department’s role will be, but most likely we will be doing the inspections, following up on complaints, etc.  Mrs. Grush commended the Board for making a statement on that on this issue.    

ADJOURNMENT
On a motion by Mr. Latham, seconded by Dr. Olson, the Board of Health adjourned at 8:59 p.m.  Motion carried.

 

 

_______________________________________
Linda K. Liston, M.D., Secretary
DeKalb County Board of Health