BOARD MEMBERS PRESENT:  Glenda Pecka, R.N., M.S., President; Steve Kuhn, P.A., Vice President; Carl Heinisch, Secretary; Russell Bishop, Psy.D.; Julia Fullerton; Mike Groark, J.D.; Fred Peltz, D.D.S.; Debra Schelkopf, D.V.M.; Steve Wolf, R.N. 

BOARD MEMBERS ABSENT: Rosemary Lane, M.D.; Mary Beth Shear, M.D. 

MINUTES 

On a motion by Dr. Peltz, seconded by Mr. Wolf, the minutes of the Board of Health meeting of May 27, 2003, were approved.  Motion carried. 

DIVISION REPORTS 

In May, Health Department staff involved in the bioterrorism planning attended the Bioterrorism Summit in Oak Brook sponsored by the Illinois Department of Public Health (IDPH).  The biggest issues this year were the sessions on isolation and quarantine.  Illinois’ laws are outdated and, currently, individual groups must give consent or obtain a court order for isolation and quarantine.  Legislation is before the General Assembly to allow public health officials to order isolation and quarantine without the individual’s consent or a court order.  Staff has spent time discussing these issues with NIU Health Service because of the number of students and/or faculty traveling to or from high-risk areas.

Our agency did monitor and quarantine an animal from the pet store that was involved with the Monkeypox.  We also had a suspect case of Monkeypox, a healthcare worker in DuPage County who lived in DeKalb County.  The individual cared for a confirmed case in a physician’s office and was isolated in her home for the 14-day incubation period, pending testing.  Close family contacts were also monitored daily by phone. 

IDPH requested that our agency host a Smallpox clinic for northern Illinois Department of Agriculture workers that were requesting the vaccine.  After much preparation, including review of the 90-page consent for participants and obtaining answers to the liability questions, noone showed up for the clinic.  The United States Public Health Service was slated to administer the vaccine.  Since smallpox for prevention of monkeypox is considered investigational, our staff did not have liability protection to administer it.

We continue to experience building problems.  A large tile fell off the barrel ceiling in the lobby, which could have been very serious had it not occurred in the evening when the agency was closed.  The tiles are about 10 ft. by 6 ft. and weighs at least 40 pounds.  It was repaired by the company who sold and installed the tiles by putting stripping on the top and bottom of all tiles and drilling it into the studs.

The Public Health side of the agency has experienced a difficult year with staffing. However, a new WIC coordinator has been hired and a nurse for the position that has been open since November.  Unfortunately, one of our MCH nurses has resigned to take a position at DeKalb Clinic so we continue to be short-staffed.

Dr. Bishop asked if NIU has a policy on the restriction of students with communicable disease.  Mrs. Grush responded that some communicable diseases have restrictions for certain activities (i.e., food handling) that would be required.  She stated there are situations where she feels NIU could enforce certain requirements of students that they do not.  She cited tuberculosis as an example, pointing out that a significant number of students from foreign countries have the infection and refuse to take the preventive drugs.  Some have become communicable and our agency ends up providing medication, treatment and follow-up.  Mrs. Grush added that some of this could possibly be prevented with additional requirements.

Mrs. Grush reported that Environmental Health staff has been busy with summer food inspections.  The regular rains this spring have helped to keep the mosquito population under control.  The agency has received very few calls of dead birds, however the peak time for these calls is at end of July or the beginning of August.  Municipalities have the larvicide briquettes and a training session was conducted for them by Health Department staff. 

Mrs. Grush stated that Mrs. Lux, Director of the Personal Health Services Division, is on vacation this week.  She reported that the Personal Health Services Division has continued to deal with either surveyors or staffing issues.  She stated that she has not seen a decline in State staff spending hours in agencies reviewing the enormous requirements of the grant programs.

Mrs. Baj, Director of Home Care, stated that the program patient census is down because of fewer admissions.  Mr. Wolf asked if there were seasonal trends in home care, and Mrs. Baj responded that she has not seen a trend of that sort and, generally, doesn’t notice a big change from month to month.  Mr. Wolf reported that the hospital’s inpatient census is down in the summer as compared to winter or spring.

Mrs. Zanellato, Director of Health Education, pointed out that this is the time of year when fourth quarter and end-of-year project reports are done.  The 2002-2003 Evaluation Summary of the Postponing Sexual Involvement program was presented.  Highlights of the report were reviewed, showing that 737 sixth, seventh and eighth grade students participated.  In looking at the confidence level of students, especially that of eighth graders, there was an increase from 92% to 96% in their confidence to handle sexual pressure and an increase in their ability to determine a healthy relationship from an unhealthy relationship from 97% to 98%.  Mrs. Zanellato announced that DeKalb County now has 60 smoke-free restaurants in the county.  Mrs. Pecka commended the programs for youth in DeKalb County, adding that it is easily seen that they are beneficial. 

FINANCIAL DATA 

Mrs. Grush pointed out that a number of grant payments have not yet been received, however several Illinois Department of Public Aid payments were received today.

Mr. Heinisch moved to approve the Financial Statements for the months of May and June 2003 and the Claims for the months of June and July 2003, seconded by Mr. Groark.  Motion carried.
 

NEW BUSINESS 

FY2004 Budget 

Mrs. Grush presented the current program fees and proposed increases for FY2004.  Increases in the Animal Control Program consist of one-year tags increasing from $10.25 to $11.00, Pickup First Offense from $35 to $50, and Pickup Second Offense from $45 to $50.   Increases in Food Sanitation in the Division of Environmental Health include Class A Food Establishment permits from $315 to $335, Class B from $210 to $220, Class C from $105 to $110, Class D from $80 to $85, and Class E from $55 to $60.  Proposed increases in plan reviews for new restaurants is from $200 to $210 and in established restaurants from $100 to $105.  Well inspection and water tests increases are proposed from $105 to $110, water sample tests from $25 to $30 and water sample tests with collection from $45 to $50.  Septic installer licenses are being proposed to increase from $105 to $110, established septic permits from $160 to $165, new septic permits from $210 to $220 and septic inspections from $95 to $100.  Mrs. Grush reported that the increase in the late fee for obtaining a restaurant permit to 50 percent of the cost of the license was very effective.  Generally, about one-third of the establishments would have required follow-up and would have had to pay the late fee.  This year, this number was down significantly.  A fee increase in providing flu shots is from $15 to $20, which is the standard fee for a flu shot locally.  The agency does bill Medicare for the flu shot, so only the private pay individuals actually pay the $20.  Mrs. Grush presented a chart of Family Planning fees as the formula for their charges is set by the State through that grant.

Mrs. Grush presented a recap of the agency’s County Request, which shows the maximum Public Health levy of .0232 cents.  She pointed out that more than .0232 cents cannot be received without a referendum.  $336,400 will be requested based on the assessed valuation received from county taxpayers if the full amount is approved.  Currently, the County pays the IMRF and Social Security for Public Health staff and Home Care pays their own.  The County’s auditors told the County that these items needed to be put in each department versus a line item in the County Budget for all departments.  $156,000 is being requested from the Public Building Commission who pays for utilities, maintenance and janitorial supplies, as they do for all other County departments. 

Mrs. Grush explained that Animal Control is obligated by state law to pick up stray dogs.  She is estimating registration and pickup fees of $125,800 and Health Department/County support at $50,150 or 8 percent of the department.   $17,650 will be requested from the General Fund to provide enough revenue to pay the direct costs of the Animal Control Program. 

Mrs. Grush presented a comparison of the total County request between 2002 and this year, showing a 12.8 percent increase, primarily because of the increase requested from the Public Building Commission for building expenses.

The Health Department revenue request for FY2004 shows a 5.4 percent increase in Environmental Health fees.  Mrs. Grush indicated that she is not expecting as many late fees from restaurants next year and also expects less turnover in restaurants and the issuance of licenses.  Line item 4035, Medicare – Home Nursing, the agency’s largest revenue sources, is projected to increase because of the increases in physical therapy and occupational therapy visits in spite of an 8 percent cut in Medicare reimbursement implemented in October 2002.  Grants are down somewhat with the loss of the Comprehensive School Health Grant and the uncertainty of the Bioterrorism and Tobacco Grants.  Mrs. Grush pointed out that FY2004 will be the first year the agency will not have IPA Vision and Hearing revenue as it was decided not to bill electronically because of the HIPAA regulations and the burden this would place on the need for parental consent to share information.  Private pay line items will increase some because of the increase in the charge for flu shots and expected increases at Home Care.

The Health Department FY2004 budgeted expenses was presented, with personnel line items being 72 percent of the total budget.  The Salaries line item shows a 7 percent increase because, in budgeting, it is estimated that all positions will be filled for 12 months, when in reality this most likely will not occur.  This year, a 3 percent cost-of-living adjustment (COLA) was given in December 2002.  This FY2004 budget includes a 3 percent COLA in December 2003 and a 0 to 1 percent merit bonus mid-year.  She is recommending that a 1 percent bonus be given to all employees this year rather than a merit increase as this would not increase the base salary and could save money in future years. The Health Insurance line item for FY2004 shows an increase of 23 percent over this year, which is the figure provided by the County for budgeting purposes. 

Budgeting for two special projects is included in the FY2004 budget in the amount of $180,000: two additional software modules for the current Home Care software that will help with profitability, data collection, and performance data and to implement laptops for nurses in the field rather than the manual system currently used.  Mrs. Baj is in the process of gathering data for these projects.  Mrs. Grush pointed out that these one-time expenditures could come from the agency’s fund balance.  She added that maintenance contracts for these projects are very costly and are ongoing expenditures. 

Mrs. Grush is recommending replacement of the Environmental Health vehicle at a projected cost of $15,000.  Endless problems with the agency’s air conditioning has resulted in exceeding the FY2003 budgeted amount.  Over $90,000 has been spent so far this year on building maintenance.  The Professional Services line item shows an increase, primarily due to the increase in physical therapy and occupational therapy visits in the Home Care Program, an increase from $238,000 in FY2002 to $310,000 in FY2003.  This money returns to the agency, however, in Medicare and Private Pay – Insurance revenue received.

FY2004 Proposed Salaries for Public Health and Home Care were presented.

A Budget Summary was presented, showing anticipated expenditures in FY2003 at $4,831,500 and revenue at $4,758,500, a deficit of $73,000.  This deficit is due to two large expenditures: a generator for the agency and the exceeding of the Building Maintenance line item.  Mrs. Grush pointed out that we could request the increased maintenance costs from the Public Building Commission, but feels this is something that the agency could absorb this year. 

FY2003 Revenue was budgeted at $4,497,400 and it is anticipated $4,758,500 will be received.  Projected revenue in the FY2004 budget is $4,988,000, an increase of 10.9 percent.  Mrs. Grush’s revenue concerns are as follows: state grants remain at level funding or with minimal increases, while the increases require client increases that increase expenses; fee increases in the Personal Health Services Division must remain minimal due to the low-income clients served; there is potential for Home Care Medicare revenue to decline due to current and proposed federal government cuts in payments and the implementation of co-pays; the ability of Home Care to sustain covering some of the Health Department overhead is uncertain; and the County’s financial situation could result in less financial support to Public Health.

FY2003 Expenses were budgeted at $4,647,100 and it is anticipated $4,831,500 will be spent.  Projected expenses for FY2004 is $5,232,700, an 8.4 percent increase over FY2003.  Mrs. Grush pointed out that these figures do include the special projects.  Expenditure concerns presented by Mrs. Grush included: the County shifting the cost of Public Health IMRF and Social Security to the Health Department; poor stock market investments in the Illinois Municipal Retirement Fund could increase the employer contributions; increases in the cost of health insurance, a 23 percent increase projected in FY2004 over FY2003; the uncertainty of the Health Department assessment in eliminating the County’s $1,000,000 liability to the insurance fund; and a potential building project for Home Care, thereby reducing the agency’s fund balance.

The FY2004 Health Department budget currently shows a deficit of $244,700.  If special projects are removed, the deficit remains at $64,700.  Options for reducing the deficit include: reductions in staff; elimination of the salary COLA; elimination of the 1 percent employee bonus; possible health insurance savings; and small reductions throughout the budget. 

The FY2004 Budget Summary was presented, which shows a $2,125,737 fund balance, a decrease from the FY2003 anticipated fund balance of 10 percent, primarily because of the generator funded this year and the $180,000 for Special Projects in FY2004. 

Mrs. Grush's recommendation is that the Board of Health pass the budget, as presented.  At the September Board of Health meeting, the County’s recommendations will be known and adjustments can be made at that time.

On a motion by Mr. Groark approved, seconded by Dr. Bishop, the FY2004 Health Department Budget was approved, as presented.

Mr. Kuhn suggested that the special projects not be included in the budget at this time, especially if we consider funding a Home Care facility.  Mrs. Grush stated that the Health Department would most likely have to pay for construction of the Home Care building, and she hopes to have a proposal from Kishwaukee Community Hospital (KCH) at the September meeting with their plans for the current building.  At that time, a commitment can be made to build, move to another site, or remain in the current setting.  The hospital is in the process of a space study, and Mrs. Grush stated they hope to have these results by the end of the year.  Mrs. Baj has spent a great deal of time working on the laptop issue and would like to proceed with that since the timing is desirable in that the additional time available due to a lower caseload would be offset by additional staff time that would be required to implement the change.  At this point, Mrs. Grush is recommending that the projects be left in the budget and revisited when more information is available.  The consideration is for the purchase of 18 laptops, with licensing for them expected to be $56,800.  The projected hardware expense is $41,752, with training and implementation at $19,000.  Mrs. Baj stated that she prefers the touch screens because it would increase productivity in the admission process and while doing visits.  Dr. Bishop asked what the cost savings would be in utilizing laptops.  Mrs. Baj responded that she could have this information available at the next board meeting, adding that this could also save space in terms of the building.  Ms. Fullerton asked how much time was currently involved in a visit.  Mrs. Baj responded that an admission takes approximately 90 minutes in the home and one hour finishing up the paperwork in the office, with one and one-half hours of data entry by support staff.  She pointed out that this would not increase the productivity of the nurse, but would require less data entry by the support staff with time savings experienced in that area.  Mrs. Baj also feels that the accuracy of the data entry should increase. 

Motion carried. 

The FY2004 Solid Waste Budget was presented, showing $87,000 to be received in tipping fees and $30,000 spent on special projects, such as tire day, oil day, and a $10,000 contribution to the University of Illinois for recycling education in the schools.  Mrs. Grush stated that she prefers to maintain $25,000 in the bank account.  Tipping fees received are $1.10 for every ton of waste that goes to the landfill, with a quarterly check received from the landfill.

Mr. Wolf approved the FY2004 Solid Waste Budget, seconded by Steve Kuhn.  Motion carried. 

Executive Session – Pending Litigation 

On a motion by Ms. Fullerton, seconded by Mr. Heinisch, the Board of Health voted to enter into executive session at 8:20 p.m.  Those voting aye included Dr. Bishop, Ms. Fullerton, Mr. Groark, Mr. Heinisch, Mr. Kuhn, Mrs. Pecka, Dr. Peltz, Dr. Schelkopf and Mr. Wolf.

At 9:10 p.m., the DeKalb County Board of Health reconvened to regular session.  Mr. Groark moved to pass the pending litigation on to the DeKalb County States’ Attorney’s office, with a vote of confidence expressed in the three individuals being sued, seconded by Mr. Kuhn,  

Motion carried. 

Home Care Space - Tour 

A tour of the Home Care space was conducted. 

CORRESPONDENCE AND ANNOUNCEMENTS 

Correspondence for the months of May and June 2003 included a thank you and donation from the family of a Home Care patient.

Newspaper articles for this two-month period included the importance of blood pressure checks, keeping party food safe in the summer months, no plans of spraying mosquitoes by the City of DeKalb, prevention of West Nile Virus, the recycling of used tires and oil locally, a warning by Animal Control officers to keep dogs inside over the Fourth of July weekend because of fireworks causing them to panic and flee, and an article giving tips on staying safe from the contracting of rabies from bats. 

ADJOURNMENT 

On a motion by Dr. Peltz, seconded by Ms. Fullerton, the Board of Health meeting adjourned at 9:31 p.m. Motion carried. 

                                                                                   
Carl Heinisch, Secretary
DeKalb County Board of Health