BOARD MEMBERS PRESENT:  Glenda Pecka, R.N., M.S., President; Steve Kuhn, P.A., Vice President; Carl Heinisch, Secretary; Julia Fullerton; Rosemary Lane, M.D.; Fred Peltz, D.D.S.; Debra Schelkopf, D.V.M.

BOARD MEMBERS ABSENT: Russell Bishop, Psy.D.; James Cole, M.D.; Mike Groark, J.D.; Steve Wolf, R.N. 

Board of Health members and agency staff introduced themselves.

MINUTES 

Mrs. Grush stated that Dr. Cole was not in attendance at the November 2002 Board of Health meeting.  On a motion by Dr. Peltz, seconded by Steve Kuhn, the minutes of the Board of Health meeting of November 26, 2002, were approved, as corrected.  Motion carried. 

DIVISION REPORTS 

DeKalb County changed from a self-insured health care plan to a Blue Cross Blue Shield PPO, effective January 1, 2003. 

Mrs. Grush pointed out the value of adding a Home Care position last year to assist in billing with a dramatic decrease noted in the accounts receivable in 2002 as compared to 2001.

Mrs. Grush presented a chart of agency contracts and rates, which were renewed December 1, 2002. 

Mrs. Grush reported that the retirement and termination of state employees has dramatically impacted programs administered through the Illinois Department of Public Health (IDPH). 

The agency has been unsuccessful at filling the maternal child health (MCH) bilingual nurse position. 

Mr. Drake, Director of Environmental Health, reported that there is a new tattoo parlor/piercing facility in Cortland.  There currently are no state regulations regarding these establishments.  IDPH has indicated, from time to time, that they were looking into this issue, but have not, to date, proposed any regulations.  Dr. Peltz asked if regulation of these facilities would be similar to that of tanning facilities.  Mr. Drake responded that tattoo parlors would have additional liability.  Mr. Drake indicated that it is his understanding that Stephenson County passed a regulatory ordinance, and he will obtain a copy of that for discussion.

Mrs. Lux, Director of Personal Health Services, stated that staffing continues to be a problem with nurses and Spanish-speaking professional staff needed.  She included information on an audit of the Family Case Management Program, which had very positive feedback.  Mrs. Pecka asked if the role of the secretaries were changing to include education as they attended a basic breastfeeding training.  Mrs. Lux responded that they attended the seminar since they have a lot of client contact, the WIC Program promotes breastfeeding and the basic training increases the secretary’s awareness.  Mr. Kuhn asked how the Tetanus clinics in the schools were going.  Mrs. Lux that the clinics for high school students who missed booster doses during the vaccine shortage have gone very smoothly.  Nurses have been in Sandwich and are getting ready to conduct clinics in DeKalb and Sycamore. 

Mrs. Baj, Director of Home Care, stated that her program has had a very busy year.  She reported that things are going well in the billing department.  The billing coordinator has had surgery recently and will be off one month on medical leave.  Because of continued program growth, meetings have begun with design staff to add space for staff.  She added that there are not a lot of options for growth in the building, and at some point, staff may have to double up.  Mrs. Grush pointed out that the competition for home care services is gone and our volume has increased since moving into that site four years ago. 

Mrs. Pecka asked who was providing occupational therapy (OT) services.  Mrs. Baj responded that this service was added to the license three years ago, and it has been very difficult to locate an occupational therapist that would provide the service on an as needed basis.  Three different individuals were contracted with over the course of the first year, but the current contracted staff has been with the agency almost a year and she sees more patients and makes more visits.  Mrs. Pecka questioned why speech therapy visits were down in 2002.  Mrs. Baj reported that there was one patient in 2001 that required quite a number of visits and that was unusual.

Mrs. Zanellato, Director of Health Education, announced that the Health Department now has its own web page at www.dekalbcountyhealthdepartment.org or .com.  The page has a new design, but a software glitch is currently being experienced. 

FINANCIAL DATA 

On a motion by Mr. Heinisch, seconded by Mr. Kuhn, the Financial Statements for the months of November and December 2002 and the Claims for the months of December 2002 and January 2003 were approved.  Motion carried. 

NEW BUSINESS 

Backup Generator 

At the November 2002 Board of Health meeting, it was thought that it may be necessary to make a decision on purchasing a generator in December because of the requirement of the grant money being expended by December 31, 2002.  At that time, Mrs. Grush indicated she would obtain more information and communicate that to the Board.  The State did send a check for the full amount.  Mrs. Grush did check with the State, explained this has developed into much more than ever anticipated, and the State money would be authorized for expenditure in January.  This was acceptable

A grant was received for $78,000 to upgrade the agency’s computer system, with a part of that designated toward ensuring the agency would still have connectivity with the State should the power be down.  The cost of the Health Department hooking onto the system of the DeKalb County Rehabilitation and Nursing Center (DCRNC) to keep the server and two computers operating would cost $25,000 because of the distance from the Nursing Home to the Health Department.  Another issue is that the Nursing Center’s entire building is not completely powered by a backup generator and they have limited space on the current generator for expansion.  These reasons prompted us to begin to pursue our own generator for everything in our building.  At the time the new building was built, backup power was not as critical as it is today.  Mr. Campbell of DeKalb County Central Plant did bid out for a generator in early December.

Mr. Campbell indicated that the generator would backup a number of items, including computers, phones, refrigeration, and pumps on the roof.  He indicated that the manpower involved in isolating circuits to be on the generator is complicated.  The generator was priced out two ways: a 200 kW for the whole building minus the air conditioning and a 250 kW to run everything.  He did point out that it would be unbearable to work in the building if the air conditioning was out as windows do not open and the sun continues to beat in.  He does not feel it would be beneficial to purchase the 200 kW generator if people cannot work in a hot building. 

The Patten generator, the low bid, is the same generator as found in the other county buildings, at the 911 Center and the Legislative Center.  The County has an existing maintenance contract for them and this generator would be added to that contract as a third generator.  A complete preventive maintenance is done on the generators each year, including bearing tests and a check of load capacities.

Mrs. Grush stated that she would recommend going with the 250 kW generator from Patten Power, which was the low bid.  An architect will need to be hired to write the specifications, which should cost no more than $10,000.  Mr. Campbell added that hooking up the generator would cost around $25,000 because of the switchgear.  Mr. Kuhn asked where the generator would be placed.  Mr. Campbell responded that it would go on the existing concrete pad by the dumpsters, depending on approval by the architect.  Mrs. Grush added that there would be approximately $2,000 in carpenter work and a part of the Health Education closet would be used for the switchgear. 

Mr. Campbell feels that this project can be completed for under $100,000.  Mrs. Grush stated it would provide another space in the county that could operate in case of a disaster.  Funding of this expenditure could come from the fund balance of the Health Department.  Mr. Campbell indicated he would contact the same architect that is being used for the courtroom renovation and the Legislative Center as the County has a relationship with this company. 

Mr. Kuhn moved to approve the purchase and setup of the 250 kW generator from Patten Power at a cost not to exceed $100,000, seconded by Mr. Heinisch.  Motion carried.

Year-end Financial Statement

Mrs. Grush reported that accounts receivable is low this year because of the change in reimbursement in the Medicare — Home Nursing line item.  With the hiring of the secretary in the billing department, the revenue has come in quicker.  Also, the Medicare revenue is now received up front with the Prospective Payment System (PPS) of reimbursement rather than based on the Medicare Cost Report that is paid back at a later date.  Mrs. Grush pointed out that the program is doing quite well under PPS.  Total Health Department revenue was $4,729,037 in FY 2002, between $800,000 and $900,000 more than was budgeted.  Medicare receipts were $335,000 more than budgeted.  The $203,000 revenue and like expenditure under IMRF was an auditor recommendation from last year.  Previously, the County paid the IMRF and Social Security from the retirement fund for each department.  The auditors recommended that each department show it as an expense, consequently, revenue from the Retirement Fund was transferred to each department.  Several additional new grants were received: the Federal Match Grant for $88,000, Bioterrorism for $68,000, and Vector Control for $15,000.  In addition, $100,000 more was received in Home Nursing – Patient Care than expected.  Approximately $50,000 of this revenue is reimbursement that the new billing person has aggressively pursued.

Mrs. Grush reported that expenses were up a little at $4.53 million instead of the projected $4.338 million.  Money was transferred into the Office Furniture and Equipment line item due to recommended cubicle completion that had not been budgeted.  The end result was $375, 000 more revenue received than expenses. 

Mrs. Grush pointed out that the majority of the revenue growth was in the Home Care Program.  She stated that it will be necessary to do some long-range planning as she sees space as a big issue in the Home Care Program with no potential for growth in the current facility.  She added that it may be necessary to allocate some of the agency’s fund balance toward erecting a building for that program.  Mrs. Grush pointed out that Public Health was close to paying its own expenses, except for IMRF and Social Security.  She added that the audit will be finalized in March and she does not expect many changes.

Bioterrorism Progress Report

Mrs. Grush presented a progress report of Bioterrorism Planning at the Health Department.  Management staff have been designated as part of the Bioterrorism Committee.  A requirement was the institution of an on-call system.  A plan was submitted to IDPH on the distribution of antibiotics in the community, and a plan was also developed to be a Smallpox Vaccination Site.  The Region is adding an epidemiologist and a regional health coordinator, with the epidemiologist to be housed at the DeKalb County Health Department.  Mrs. Grush participated in the interviewing of candidates for our region, and the group is almost ready to offer the position to a candidate.  There will be twelve epidemiologists throughout the state, but it has been difficult finding them.  A local planning committee has been established and responsibilities are being coordinated.  A list of members of the Planning Committee was included.  The primary purpose of the committee is to get to know one another before an event occurs and keep each other updated as to what is occurring in each department.  Mrs. Zanellato has prepared a directory.  The group has also attempted to sort out the primary responsibilities of each organization involved.  Mrs. Grush stated the Committee hopes to have a tabletop exercise in April with the various agencies to sort out the weaknesses.  A Communication Subcommittee was created as communication was identified as a major weakness.  A letter has been sent to Dennis Hastert, Speaker of the House, regarding the difficulty to obtain frequencies from the FCC to meet additional communication needs.  Contact has been made with the HAM radio operators and they are more than willing to help. 

Drug Distribution Committee meetings have been held to develop a detailed plan and recruit professional and support staff to do mass distribution of drugs or smallpox vaccination.  Membership includes staff from the Health Department, Convocation Center, Kishwaukee Community Hospital, NIU Health Service and Environmental Health and Safety from NIU.  Should there be a case of smallpox, health providers and their families would be vaccinated first and then the general public.  Mrs. Grush added that Dr. Peters, NIU President, has been very cooperative and has actually encouraged his staff to work with us and approved the use of the Convocation Center facility should it become necessary.  It is an ideal location because of the parking and that the facility is designed for crowds.

A diagram of the Convocation Center was prepared by Mrs. Zanellato showing the flow for a drug distribution event.  A staffing worksheet was included for 16 hours a day, seven days a week and 335 workers each day.  The next step is to determine the staff available and the source of these staff.  Mrs. Zanellato has been working on compiling the vast amounts of information available, preparing packets and resources.

CDC has provided a number of satellite trainings for local health departments and has worked hard on communication during a crisis with the public.  Mrs. Grush stated that a couple of the trainings were excellent.  The first media update was held at the Health Department, with all area newspaper and radio station staff invited to attend.  Smallpox information was provided to them.  Computerization in the agency has been completed except for the purchase and setup of the generator discussed this evening.

Dr. Lane shared a letter from Dr. Lumpkin, Director of IDPH, to physicians regarding the reporting of smallpox vaccine related problems and who to contact to receive expert advice.  Mrs. Grush announced that Dr. Lumpkin is retiring and leaving IDPH, which is unfortunate.  Dr. Lane added that the old statistics of 1 in 1,000,000 deaths from smallpox vaccination probably did not include the type of medical screening for problems that we would do.  We would be vaccinating a lot more adults who had not previously been vaccinated because, in the past, it was mostly children who were vaccinated.  She is not sure how an adult fares with a primary vaccination as compared with a child.  If sufficient screening takes place, it seems to Dr. Lane that the mortality rate should be lower rather than higher.  Mrs. Grush stated she believes that the adults who had the vaccine previously will not have as severe a reaction as those who have not had it. 

Participation in President Bush’s Smallpox Plan

Mrs. Grush reported that she has taken the agency’s Smallpox Plan to the States Attorney for review and is now requesting Board of Health approval.  She explained the three phases of the Plan.  Phase 1 calls for the vaccination of a core group of front-line health workers who would be responsible for investigating and providing treatment in a possible smallpox outbreak.  The Plan suggests 7 to 10 staff from each Health Department to be vaccinated and 50 to 100 from each hospital, which would take 30 days to complete.  Participation, at this point, would be strictly voluntary.  This Phase was scheduled to begin the week before Christmas 2002, but has been postponed pending the resolution of liability concerns.  The legislation that provides liability protection did not take effect until January 24, 2003, and Congress had the power to change that date.  Mrs. Grush stated that she feels the program would have been progressing had it started on time, but there are now so many issues because of the liability raised, it will be much more difficult to implement. 

The vaccine comes in 100 dose vials, and there is a question as to how long the vials are good once reconstituted.  The insert with the vaccine says 15 days, but the State is saying 60 days.  Hospitals are concerned about staff receiving the vaccine and caring for seriously ill patients, especially when the insert says this should not be done.  The State decided that one health department in each region would be selected as an administration site, based on population.  DeKalb County Health Department was selected in our region, and we will vaccinate local health department and hospital staff from other counties in the region.  Because of the size of our region, Whiteside County will also be a clinic site for Phase 1.   Mrs. Grush pointed out that it is recommended that the individual not receive the vaccine if any contraindications exist, so she does not expect a large number of people receiving the vaccine in Phase 1.  This Phase should take 30 days to complete.

Phase 2 is to vaccine additional health care providers and police, fire, and emergency service responders to be front-line providers of service, vaccinators, and providers of treatment should the need arise to do mass vaccination.  This Phase will last approximately six months.

Phase 3 would offer the general public the opportunity to be vaccinated.  Should this occur, it is anticipated to happen in 2004.

Mrs. Grush presented the document, “Guidance for the Healthcare Community Concerning Section 304 of the Homeland security Act,” which states: “no claim for liability for injury or death arising out of the administration of smallpox vaccine, other substances used to treat or prevent smallpox, or vaccinia immune globulin can be brought against entities or individuals who are covered by Section 304’s protections.”  The Act protects (1) the manufacturers and distributors of countermeasures, (2) hospitals, clinics and other healthcare entities under whose auspices the countermeasures are administered, and (3) licensed health care professionals or other individuals authorized to administer the countermeasures under state law.  Officials, agents, and employees of these entities are also covered for claims arising out of the administration of a countermeasure that occurs within the scope of employment.  This would include coverage of members of the Board of Health.  The Homeland Security Act is not a compensation act for individuals who receive the vaccine and experience a problem.  Those claims would have to go through the Federal Tort Claims Act to determine compensation. 

Another big issue is that it is estimated that one individual in three become ill from the vaccine and need to stay home for a day or two.  The question is if this would be a workers compensation issue.  At a teleconference last week with the States Attorney’s office and local health departments, it was stated ,t meets the requirements to be covered under Workman’s Compensation, but since it is “voluntary,” there is still considerable debate regarding this.

Dr. Lane stated that there is quite a long incubation period before symptoms are experienced.  Mrs. Grush indicated that the agency has begun stockpiling supplies for smallpox vaccination.  Mr. Kuhn pointed out the physician’s concern that if they receive the vaccine and a patient comes down with something, they could say it was because of the physician receiving the vaccine and he is not protected against liability.  A second concern is the physician working around immunosuppressed patients and the possibility of transmission to them.  Mrs. Grush agreed that these are very big issues in hospitals as well, and think they have been addressed for the program to move forward.

Dr. Lane made a motion that the Board of Health authorize the DeKalb County Health Department to be a vaccination clinic site, seconded by Dr. Peltz.  Motion carried.

Position Classification Range Change

Mrs. Grush stated that individuals at the top of their classification range are eligible for the percent merit increase as a bonus that is not added to the employee’s base rate of pay.  This presents a problem when the employee is in a salaried management position and is expected and required to work considerable overtime for which they are never compensated.  This results in the individual’s hourly rate being much lower than what it actually appears.  Mrs. Grush stated that this situation currently exists in the position of the Director of Office Support.  She is recommending a change in salary range of the position from $15.71 to $22.46 per hour to $17.53 to $25.24 per hour. 

Mr. Kuhn moved to approve a change in the classification range of the Director of Office Support position from $15.71 - $22.46 per hour to $17.53 - $25.24 per hour, seconded by Mr. Heinisch, effective December 1, 2002.  Motion carried. 

Board of Health Committee Appointments

Mrs. Pecka presented the Board of Health committee appointments for 2003 as follows:

Finance Committee:  Mr. Kuhn as chair, Mr. Heinisch and Ms. Fullerton

ByLaws Committee:  Mr. Groark as chair, Dr. Cole

Personnel Committee:  Dr. Peltz as chair, Mr. Wolf and Dr. Schelkopf

Nominating Committee:  Dr. Bishop as chair, Dr. Lane and Dr. Cole

On a motion by Mr. Heinisch, seconded by Dr. Peltz, the Board of Health committee appointments were approved as presented.  Motion carried. 

CORRESPONDENCE AND ANNOUNCEMENTS

Newspaper articles for the months of November and December 2002 included the decrease in the teen birth rate in Illinois, the strain that bioterrorism readiness puts on local health efforts, local health workers receiving shots in the U.S. smallpox vaccination plan, preparation by the County for a smallpox attack, information on the smallpox disease, the proper care of a humidifier in the home, the prevention of illness during the holidays, options to eliminate holiday waste and January as National Cervical Health Month.

Correspondence included a letter in Nursing Spectrum from Marie Jobe, DeKalb County Health Department WIC Coordinator, on public health initiatives raising the breastfeeding rate in Illinois, and a thank you with a donation from the family of a home care patient.

ADJOURNMENT

On a motion by Mr. Kuhn, seconded by Dr. Peltz, the Board of Health meeting adjourned at 8:55 p.m.  Motion carried.

                                                                                   
Carl Heinisch, Secretary
DeKalb County Board of Health