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; Rosemary Lane, M.D.; Debra Schelkopf, D.V.M.; Mary Beth Shear, M.D.; Steve Wolf, R.N. 

BOARD MEMBERS ABSENT: Mike Groark, J.D.; Fred Peltz, D.D.S. 

MINUTES 

On a motion by Mr. Heinisch, seconded by Mr. Wolf, the minutes of the Board of Health meeting of July 22, 2003, were approved.  Motion carried. 

DIVISION REPORTS 

Mrs. Grush introduced new Board of Health member, Mary Beth Shear, M.D., family practice physician at Kishwaukee Medical Associates, Ltd.  Dr. Shear replaces Dr. Cole, who recently resigned from the Board.  She also provides physician services at Health Department well child clinics.

Mrs. Grush reported that DeKalb County had one confirmed case of West Nile virus in an individual whose job required extensive travel throughout the country, so it is unknown where the individual contracted the disease.  There has been very little activity with West Nile this year with 25 calls regarding dead birds as compared to 400 calls at this time last year.  The weather has cooperated for the breeding of mosquitoes, and citizens are handling the situation better.  Community education has continued.  There was a tremendous response to the tire drive in July, which would also help abate the mosquito population.  Municipalities began larviciding much earlier this year.  Mrs. Grush reported that this trend was similar to that of New York as they also experienced fewer cases the following year. 

Dr. Lane questioned if there was any evidence that animals would develop immunity to West Nile, making their susceptibility lower than when the disease first appeared.  Mrs. Carroll, Communicable Disease coordinator, stated that the disease has been in the Middle East for a long, long time and Egyptian children have been studied.  Titers have shown that these children have been exposed yet never experienced symptoms.  She thinks maybe our population has also been exposed and is developing immunity.  Marcy Zanellato, Director of Health Education, indicated that she had read an article from CDC on the buildup of immunity in birds this year as compared to last year.  Steve Wolf pointed out that there has been a significant loss in the bird population from this year to last year.

Mrs. Grush presented a chart, 2002 Home Care Visit Costs.  The final 2002 Medicare Cost Report has been finalized.  The chart summarized the visit cost and reimbursement using Medicare methodology indicated the cost per visit at $115.25.  In 2002, the program received $134.00 per visit from Medicare and an average of $80 per visit for insurance visits.

While no information has been heard regarding the Bioterrorism Grant, notification was received today of the Tobacco Grant award of $30,000, which is the same as was received last year. 

Mrs. Grush received notification that $12,200 is to be received in additional WIC funds because our program is over caseload and still growing.  To her, this is an indication of the economy with a lot more people qualifying and unemployed.

Notification was received that federal Bioterrorism dollars that the State of Illinois received and would not release last year to hire regional response coordinators and epidemiologists were being distributed to local agencies based on population.  Our agency will receive $26,000 under this distribution.  State staff has now been hired, and our agency will be housing the epidemiologist.  Mary Kay McDonnell will start on October 4, 2003.  She has worked in communicable disease at the State Health Department for a number of years, and will cover a nine-county region, excluding Rockford.

Mrs. Grush reviewed legislation at the state level that impacts our agency.  Changes were made to the Animal Control Act and signed by the Governor.  She has been unsuccessful in receiving a return phone call from the Department of Agriculture in response to her numerous questions.  Mrs. Grush has reviewed the legislation and has sent a list of questions to the States’ Attorney’s office waiting for interpretation by them.  Numerous changes were made to the vicious and dangerous dog section.  Some interpreters of the legislation say it requires the registering of non-feral cats, while others disagree.  Mrs. Grush feels we would need to register cats if the County Board passes such an ordinance, but that is not her interpretation of the revised Act.  She hopes to have more information for the Board by the next meeting. 

HB 777, the Physical Fitness Facility Medical Emergency Preparedness Act, was signed by the Governor, with one of the requirements being that facilities have at least one automated external defibrillator (AED) on the premises and a trained AED user on staff.  Mrs. Grush stated that the Act requires IDPH to investigate compliance, which they will delegate to local health departments as IDPH does not have the staff to do this.  She reported that she purchased AEDs for both Home Care and Public Health and numerous staff has been trained on its use. 

Mrs. Grush reported that a new Animal Control warden has been hired from the 148 applications received.  Janet Ott has a B.S. in Animal Science and experience as a farm manager and at Garfield Museum in LaFox. 

Mr. Kuhn asked if the generator was up and running and how long it could run on a tank of gas.  Mrs. Grush responded that it is running, but she would need to check on how long a tank would last and will get back to the Board at their next meeting with that information.

Mr. Drake, Director of Environmental Health, reported that building continues in DeKalb County, keeping their division very busy.  He added that, in terms of West Nile, it is hard to measure prevention. 

Mr. Wolf questioned the statistics of one rabies specimen sent in July and nine sent in August.  Mr. Drake responded that was because of a problem with bats in August.  He added that our staff do go into homes to help people remove them.  He added that, by law, every bat, skunk or raccoon that is captured must be submitted for a rabies test. 

Mr. Kuhn questioned the provision of rabies shots by the agency.  Mrs. Carroll responded that the vaccine was given to a gentleman who was traveling to the Middle East and surrounding area and was staying for an extended period of time.

Mr. Heinisch asked whose responsibility it is to pick up dead deer on the side of the road.  Mr. Drake indicated that the County Highway Department picks up dead animals on county roads or state highways. 

Dr. Lane asked if there were any cases of bovine spongiform encephalopathy (BSE) (mad deer disease) in DeKalb County as that is a concern that it does exist in deer.  Dr. Schelkopf indicated that it does exist in Wisconsin but she had not seen any cases here yet.  Mrs. Carroll indicated that deer are tested during hunting season and 12 cases have been confirmed in Illinois in Winnebago, Boone, and McHenry counties.

Mrs. Lux, Director of Personal Health Services, distributed charts of performance indicators for Maternal Child Health (MCH) programs comparing our agency with downstate Illinois averages.  As noted, our agency compares very positively with others.  In addition, it creates a picture of how our agency has increased performance indicators over the last couple years, which is the result of hard work by our staff.  Plans, goals and objectives are developed based on these data.  Mrs. Grush added that FY2005 funding will be based on how agencies achieve these performance standards.  There will be level funding and penalties may be imposed for those who do not meet their standards.  Mrs. Grush is on this committee at the state level and pointed out that even though an agency may work very hard at meeting goals, they don’t always have control over many factors that could end up affecting funding. 

Mrs. Lux reported that the case manager in the HIV Case Management Program resigned.  The program had 25 open clients in September and has recently added two more, totaling 27 clients.  Mrs. Carroll and Gary Judd, HIV Prevention Specialist, have been maintaining that program while the search begins for a replacement.  Mr. Wolf asked the demographics of this program.  Mrs. Carroll responded that one-third are female heterosexual non-IV users.  She added that, generally, the population is one-third MSM, one-third IDU and one-third the female population.  Mrs. Lux added that the Rockford population has always been unique in that their majority is from non-IV users.  Mrs. Carroll stated that our population is unique because we are sandwiched between the collar counties and Rockford.  Mr. Kuhn reported that CDC is saying that the growing number is females between 18 and 25 years of age.  Mrs. Carroll stated that our program was seeing those numbers before CDC was reporting such statistics.

Mrs. Pecka commended Mrs. Lux for the excellent statistics and realizes how difficult it is to maintain this year after year.

Mrs. Baj, Director of Home Care, reported that the program was gearing up for growth at the beginning of this year, but in July and August, patients and visits dropped.  Time has been spent in determining why this would have occurred and also in making sure that the current staffing is what is needed to serve the caseload.  In the past week, there were 24 admissions, and all staff is once again busy and hopeful the trend will continue.  Mrs. Grush feels that the caseload may be down because the hospital’s census has been down and more physicians have taken longer vacations this year.  She added that Whiteside County has experienced the same thing as us, but not all home care agencies have.  She is uncertain if the economy has had an effect on it or not.  The slowdown started on June 1 and is still not at Spring levels.  Today, the daily census is at 153 and it usually runs between 170 and 180.  At the lowest point, the patient census was at 140. 

Mrs. Zanellato, Director of Health Education, included the four-year project end report for the Comprehensive Health Education and Services Grant.  She provided a listing of DeKalb School District members that worked with the Health Department on this grant.  These were hard working, dedicated individuals that made a significant impact and created sustainable programs.  Over 900 students now participate in the Second Step Program.  Mrs. Zanellato has reapplied for the grant with an entirely different focus.  No word has been received on funding to date. 

Mrs. Zanellato pointed out that many states conduct a youth tobacco survey.  In the past, Illinois has participated but has never been recognized.  Criteria include that there must be over 3,000 students and each school must have 80% participation.  We have finally been able to participate and it will give us, year after year, a way to study and determine what makes an impact.  Statistics indicate that 29% of high school students have smoked cigarettes at least once in the last 30 days.  It is a known fact that students that experiment with tobacco are the ones that will continue smoking.  36% have used some type of tobacco.  55% of high school students and 75% of middle school students said they could purchase cigarettes without providing identification.  40% of responders said someone at home smokes, which increases the likelihood that they will become smokers.  A recent study released by CDC with their standard being the number of cigarettes purchased indicates that fully funded comprehensive control programs have resulted in 43% fewer cigarette purchases.  Mr. Kuhn asked if there were previous statistics on high school smoking.  Mrs. Zanellato responded that the State has conducted surveys for some time, but never had what CDC considered a legitimate sample.  Now that the schools have this sample, they can participate and conduct studies.  CDC states that the longer the states have this funding, the more efficient they will become and better able to isolate an area and funnel the money into areas where it will make an impact.  Mr. Wolf stated that it seems this has been a worthwhile program for the last four years and wondered if there was any chance it could continue.  Mrs. Zanellato responded that the Comprehensive Health Education and Services Grant is an excellent program, but it is very rare that the state would typically re-fund someone without funding a new applicant in the state.  However, since our agency has such a good track record, they did encourage us to submit an application.  Mrs. Zanellato pointed out that only eight projects are funded each year. 

Mrs. Pecka asked what the statistic was of having a smoker in the household.  Mrs. Zanellato responded that 41% indicated someone at home smoked.  Mrs. Pecka wondered if there were any statistics that show what happens when there are no programs available.  Mrs. Zanellato reported that she has not seen any such statistics. 

FINANCIAL DATA 

Mrs. Grush stated that the agency is nearing the last quarter of FY2003.  The only revenue line item of note is Animal Control, which shows revenue of only $14,151 to date.  This is because the County has changed their reimbursement method and will be giving us all the money at the end of the year instead of on a quarterly basis.  Expense line items show office furniture and small equipment budgeted at $130,000 and only $17,000 spent to date.  Partially, this is a grant issue and some money was spent last year for bioterrorism projects.  Line item 7861, Emergency Power System, is the generator that was recently installed and the cost will end up at approximately $80,000.  It has been a hard year with regards to building maintenance.  Professional Services is way over because of physical and occupational therapy and psychiatric nurse services in the Home Care Program.  This expenditure will be reimbursed as revenue when payments for services are received.

Mr. Kuhn moved to approve the Financial Statements for the months of July and August 2003 and the Claims for the months of August and September 2003, seconded by Dr. Bishop.  Motion carried.

NEW BUSINESS

FY2004 Budget Amendments 

Mrs. Grush presented the request of the County Board for the Health Department’s 2004 Budget of $336,400 for the tax levy, $241,300 for IMRF/SS, $17,600 for the Animal Control Program, and $156,000 from the Public Building Commission (PBC) for a total of $751,300.  She explained that the IMRF/SS request is the amount the County pays for Public Health employees, while the Health Department pays that of Home Care employees.  The Animal Control Program request covers utilities, maintenance and janitorial expenses and costs of the program not covered by tags and registration fees.  The County recommended a $13,000 decrease, budgeting $227,400 for IMRF/SS instead of the requested $241,000.  No reason was given for this decrease.  Mrs. Grush feels the agency can assume this as the budget is based on every position being filled for the entire year and that rarely occurs.  Mr. Hanson, DeKalb County Deputy Administrator, did speak with Mrs. Grush in July regarding the agency also picking up the IMRF/SS of Public Health employees.  Mrs. Grush’s response to him was that this would be a hardship for the agency and the Health Department should be treated the same as other county departments for which the building expenses, IMRF and Social Security are paid. 

Since the County has a $1 million liability in the health self-insurance fund, a recommendation was made to eliminate the debt by special assessments to each county department.  Non-general fund departments are being assessed $2,000 for every employee that was eligible for health insurance on December 31, 2002.  The Health Department’s assessment is $88,000 to be paid over a two-year period.  Mrs. Grush recommended paying the debt in full in the next budget year.  2004 rates for Blue Cross Blue Shield have not yet been announced. 

The County’s budget recommendation for salaries was a 2.4% COLA in December and 0 to 2 % mid-year merit increase for employees hired before December 1, 2003.  Mrs. Grush’s recommendation is a 3% COLA in December and 1% mid-year bonus, thereby not increasing the base salary rate.  While this would actually be 1/2 % more of an increase for the employee next year, it would be less money the following year because their base rate would not have increased.  She indicated that she would provide examples at the November meeting once the County has decided what they are doing with salaries.

The Health Department is projecting a $78,600 deficit with $180,000 budgeted for Special Projects (laptop implementation at Home Care) and $88,000 for the assessment towards the self-insurance liability explained above.  However, until the final year-end numbers are received, the total deficit won’t be known.

Policy to Implement Illinois E-PAY for Birth and Death Certificates 

Mrs. Hills, Director of Office Support, reported that the representative from the State office of Vital Records visited and explained the Illinois Funds E-Pay program whereby customers could access the Internet to purchase birth and death certificates.  She explained the process and pointed out that there is no charge to the agency for this service.  This is being proposed simply as a convenience to customers.  Knox County projected they would fill five to six requests per month via the Internet but now do over one-half of their business this way.  Mrs. Hills explained the depositing of the credit or debit card payments which she has been working on with Christine Johnson, DeKalb County Treasurer. 

Mr. Heinisch indicated that he had personally checked this program out and explained that any fees to the county are eliminated because of consolidation at the state level, thereby avoiding the credit/debit card fees. 

Mr. Wolf made a motion to approve the acceptance of credit/debit card payments for the Division of Vital Records and to pass the information on to the DeKalb County Board for final approval and acceptance.  Mr. Heinisch seconded.  Motion carried.

Personnel Policy Revisions 

Mrs. Grush reported that some of the agency’s personnel policies need clarification, specifically in the areas of Probationary Period, Vacation and Sick Leave benefits, and Employee Performance Appraisal.  Changes in the area of Probationary Period included the establishment of a new probationary period should an employee still in probationary status accept a position in a different classification.  In the Vacation and Sick Leave areas, an employee who is in a new probationary period because of changing job classifications is entitled to use the sick and vacation leave earned in the previous position after that six-month period has passed.  Mrs. Grush explained that the employee would need to reimburse the agency for time used if their employment was terminated before the new probationary period had passed.  The Employee Performance Appraisal was clarified to an annual evaluation rather than on June 1 of each year and also at the end of a probationary period and not on the employee’s anniversary date. 

Mr. Heinisch moved to approve the revisions to the Personnel Policies of the DeKalb County Health Department, as presented, seconded by Ms. Fullerton.  Motion carried.

Home Care Program 

Caseload and Staffing

Mrs. Grush reported that the Home Care Program has experienced a significant drop in patients and visits over the summer months.  She presented several graphs and charts illustrating the occurrence, which showed growth until the third quarter when skilled nursing visits decreased by 28 and visits by 601.  Many areas were studied to determine the cause for the decrease, but those all seemed to be normal.  The census of DeKalb County Rehabilitation and Nursing Center and Kishwaukee Community Hospital have been lower than usual this summer, as well as the caseload of Northern Rehabilitation and Sports Medicine. 

Home Care staff and Mrs. Grush worked very hard in avoiding the laying off of any nurses.  In July and August, staff had scheduled vacations.  Additional staff were asked to take extra vacation and use accumulated compensatory time.  Nurses were allowed to have a negative compensatory balance up to three days (22.5 hours), which resulted in 2.85 FTE staff gone during the summer and, of that, 1.53 FTE were staff nurses.  This will result in a much lower earned leave time liability to the agency when it is calculated at the end of the fiscal year. 

1.42 FTE staff nurses and .25 FTE home health aides have resigned and these positions are not being replaced. 

In August, full-time staff was asked to work a nine-day pay period versus ten-day.  Mrs. Grush made the administrative decision to allow these full-time staff working at a reduced rate to remain eligible and be covered for health insurance.  Leave balances will be prorated based on the actual number of hours worked.  Mrs. Grush reported that Home Care staff has been very cooperative in taking time off to accommodate the current caseload.  She asked for a motion by the Board of Health authorizing that staff working a nine-day pay period on a temporary basis remain eligible for health insurance coverage. 

Mr. Kuhn moved to authorize that Home Care staff working a nine-day pay period on a temporary basis remain eligible for health insurance coverage, seconded by Mr. Wolf. 

Mr. Heinisch commended the management staff for being sensitive to the issue and bringing the information to the Board.  Mrs. Grush reported that she and Mrs. Baj talked earlier today about another nurse taking a week of vacation, which would make current staffing about one-half a nurse position over.  However, more referrals have recently been received and a few staff have vacation scheduled so the program should be fine through the month of September.  Mrs. Grush indicated she would update the Board at the next meeting.

Motion carried.

Space/Lease Agreement

Mrs. Grush reported that she had hoped to have more information on the space and lease issues by this meeting as the Board must advise Kishwaukee Community Hospital (KCH) of their intent to renew the lease or not by December 1, 2003.  There is an option to renew the lease for five years.  Mrs. Grush spoke to Kevin Poorten, KCH CEO, and he indicated the lease could be renewed for five years or for a shorter period of time.  KCH prefers a three-year lease, but would go annually if needed.  KCH is in the midst of their space study at this time and do not have those recommendations yet. 

Mrs. Grush reported that she is uncomfortable with a one-year lease because KCH’s need for space could have an impact on that.  She projected the building of a 10,000 square foot building at $2,000,000 based on construction of the new Legislative Center.  She reminded the Board that, at the May meeting, Mr. Kuhn proposed a committee to study agency long-term planning and feels this would be a good idea.  Mrs. Grush asked for volunteers to serve on such a committee, and projects that it has the potential of meeting once or twice before the November meeting.  Mr. Kuhn agreed to chair the committee, with Mr. Heinisch and Dr. Peltz also serving as members.  Mrs. Grush stated this committee will meet prior to the next Board meeting to sort out options as a decision regarding the length of the lease with KCH must be made at the next meeting.

Laptops

Mrs. Grush reported that the recommendation on the implementation of laptops will be made to the Board at the November meeting.  This would, of course, create a totally different design for a building than if it were being built today, as less space would be needed. 

Staff Compensation 

Mrs. Grush reported that extra compensation is generally recommended at the November Board of Health meeting; however this year, it is necessary to do it now because of the closing of the fiscal year in mid-November.  She recommends that Dan Berres, Animal Control warden, receive an extra $100 per month for the four months that he was acting as the sole warden, including assuming all of the on-call responsibilities.  Total extra compensation requested for Mr. Berres would be $400.

Mrs. Grush is recommending $2,500 extra compensation for Mrs. Lux who willingly assumed the additional responsibilities of the WIC coordinator, who resigned in February.  A replacement was not hired until June.  She is recommending $1,000 for Mrs. Zucker, Coordinator of Support Services, Personal Health Services Division, who assumed many additional responsibilities because of unusual staffing vacancies experienced over the past year and her willingness and ability to ensure the provision of support services in a time of staff shortage.  A letter to Shirley Smith of the Illinois Department of Human Services was included that reported on the staffing issues the agency experienced the past year.  Mrs. Grush stated that Mrs. Lux has done an outstanding job, and it is very obvious in the letter to Mrs. Smith.  The programs were not only able to retain performance standards, but actually increased in some areas.  Mrs. Grush added that the agency is not only short-staffed when people are gone after a major life event, but they are also not up to par for a period of time after their return.  Mrs. Grush reported both Mrs. Lux and Mrs. Zucker are salaried employees and, consequently, are not compensated for all the additional hours required.

Mrs. Grush reported that an additional $11,000 is being received in the HIV Case Management Program because of increased caseload.  She is requesting the Board’s authorization to increase hours in the HIV Case Management Program in accordance with the increase.  Currently, the case manager position, which is vacant, is .5 FTE.

Mr. Kuhn asked if these proposed compensations were post- or pre-tax dollars.  Mr. Wolf asked if this would be setting a precedent for future additional compensation.  Mrs. Grush responded that these recommendations are pre-tax dollars, and that additional compensation is done rarely and only during very unusual agency circumstances. 

Dr. Lane moved to approve the proposed additional compensations, pre-tax dollars, seconded by Dr. Schelkopf.

Mr. Kuhn proposed a friendly amendment to pay the compensations post-tax.  Dr. Lane accepted the amendment. 

Mr. Heinisch suggested increasing the compensations by 25 percent to allow for the difference in pre- and post-tax dollars.  Ms. Fullerton seconded the motion.  Motion carried.

Donations 

Mrs. Grush reported that, occasionally, the Home Care Program will receive a donation from the family of a patient in appreciation for the quality of care provided.  Samples of donation cards were included in the packet for both Public Health and Home Care.  These will be placed in the intake packets for Home Care patients and placed throughout the Public Health building in pamphlet holders for individuals who may wish to make a donation.  While Mrs. Grush does not recommend that donations be actively sought from our clients, it does make our services and organization more visible to individuals who are looking for an opportunity to donate money. 

Mr. Wolf stated that he feels this would be appropriate as long as it was treated in a low key manner. 

Ms. Fullerton moved to proceed with the distribution of donation cards for both Public Health and Home Care, seconded by Mr. Wolf.  Motion carried.

UNFINISHED BUSINESS 

Litigation Update 

Mr. Kuhn moved to enter into executive session at 8:55 p.m., seconded by Mr. Wolf.  On a roll call vote, those voting yes included Ms. Fullerton, Dr. Shear, Mr. Heinisch, Mr. Kuhn, Dr. Lane, Mrs. Pecka, Dr. Schelkopf, and Mr. Wolf.  Motion carried.

On a motion by Mr. Heinisch, seconded by Mr. Wolf, the Board of Health moved to enter back into regular session.  On a roll call vote, those voting yes included Ms. Fullerton, Dr. Shear, Mr. Heinisch, Mr. Kuhn, Dr. Lane, Mrs. Pecka, Dr. Schelkopf, and Mr.  Wolf.  Motion carried.

Mrs. Grush provided an update to the Board of Health on the litigation pending against the DeKalb County Health Department and three of its employees.

CORRESPONDENCE AND ANNOUNCEMENTS 

Newspaper articles for the months of July and August 2003 focused on the recycling of used oil and tires locally, the annual Health Clinic at the Farm Bureau, National Immunization Month, Breastfeeding Month, West Nile virus, and National Food Safety Education Month.

Correspondence included a thank you note from Somonauk High School students written on seven layers of toilet paper thanking for their education on food safety, thank you notes from the family members of Home Care patients, and notification from Castle Bank of a donation from them as a result of a marketing research study.

ADJOURNMENT 

On a motion by Mr. Wolf, seconded by Mr. Heinisch, the Board of Health meeting adjourned at 9:18 p.m.  Motion carried.

                                                                                   
Carl Heinisch, Secretary
DeKalb County Board of Health