BOARD MEMBERS PRESENT:  Steve Kuhn, P.A.-C, President; Carl Heinisch, Vice President; Russell Bishop, Psy.D. Secretary; Julia Fullerton, J.D.; Jean Gastiger, R.N., F.N.P.; Rosemary Lane, M.D.; John Olson, D.D.S.; Mary Beth Shear, M.D. 

BOARD MEMBERS ABSENT: Mike Groark, J.D; Debra Schelkopf, D.V.M.; Steve Wolf, R.N. 

MINUTES 

On a motion by Dr. Bishop, seconded by Dr. Olson, the minutes of the Board of Health meeting of September 28, 2004, were approved.  Motion carried. 

DIVISION REPORTS 

Mrs. Grush reported that the Health Department has experienced another challenging year with regards to the flu vaccine.  The agency currently has 200 doses remaining and requests by individuals meeting CDC guidelines has been limited.  She thinks it is partly because CDC has made such a big effort in announcing that it is only for high-risk individuals, as well as the fact that many probably already received the shot from their doctors.  In addition, not many cases of flu have been reported to date.  Mrs. Grush announced that the agency does have a lot of childhood flu vaccine left and 500 doses to return.  She reported that the same amount of childhood vaccine as was received last year was ordered, but since there were a couple of deaths of children last year from the flu, the demand then was far greater.  She pointed out that it has been difficult to schedule and staff clinics, which takes a great deal of time, then the clinic is cancelled, then vaccine is received, and once again, staff must be rescheduled.  One positive is that the flu clinic of October 27, 2004, was used as a test of the agency’s Bioterrorism Medication Distribution Plan, which worked very well; however, staffing for mass distribution will never be adequate.  Many compliments were received on how smoothly the clinics operated.

Mrs. Grush reported that 80 health departments have now been authorized by their County Boards to participate in the intergovernmental mutual aid agreement for the establishment of the Illinois Public Health Mutual Aid System.  This agreement states that one of our neighbors, in an emergency, could request assistance from our agency, and spells out the responsibilities, such as salaries, workman’s compensation and litigation, should that occur.

Mr. Drake, Director of Environmental Health, reported that the Household Hazardous Waste day went well, with a smaller turnout than usual.  $68,000 of products were collected, while $85,000 to $90,000 was collected at past events.  Mrs. Grush stated that she knows the public appreciates this event.

Mrs. Baj, Director of Home Care, stated that all Home Care staff have been trained on the laptops and changes made in the responsibilities of office staff.  The Home Care Program is now being served by the County’s Information Management Office (IMO), which has been a positive change.  With the increase in the number of computers and the upcoming implementation of HIPAA Security Policies in 2005, it switching computer maintenance and support from a private individual to that of IMO was warranted.   Mrs. Baj reported that virus protection software was being updated today, with checks completed every 120 minutes.  Mrs. Grush stated that we were fortunate that there were no resignations during the conversion to laptops, even though it is often difficult for some of the older nurses, who struggle with the process. 

Mr. Kuhn noted statistics that reflect a decrease in the patient load over the last two months.  Mrs. Grush added that, overall, it is actually up a little over last year, and there is also slightly more revenue now as compared to last year at this time.

Mrs. Zanellato, Director of Health Education, shared a press release regarding teen birth rates for Illinois and the nation.  CDC recently released statistics showing that the teen birth rate for 10 to14 year olds has dropped to the lowest level in 60 years.  This is attributed to a decrease in the percentage of teens that are sexually active at this age, as well as that those choosing to be sexually active are more likely to use contraceptives.  Another press release said that birth rates for women aged 40 to 45 increased by 5 percent, and births in this age range exceeded 100,000 births for the first time.  

FINANCIAL DATA 

Mrs. Grush stated that December begins the close-out of the agency’s books for the 2004 year.  The auditors will return in January or February 2005 to finalize the year-end books. 

On a motion by Ms. Fullerton, seconded by Ms. Gastiger, the Financial Statements for the months of September and October 2004 and the Claims for the months of October and November 2004 were approved.  Motion carried. 

NEW BUSINESS 

DeKalb Smoke-free Coalition – Board of Health Support of Resolution

Mrs. Grush presented a revised resolution from Mr. Jim Grosklags, Chair of the DeKalb Smoke Free Coalition.  A clear definition of “public places” was included, which was the major concern of the Board of Health at their last meeting.  She added that the Coalition considers endorsement by the Board of Health to be of great significance. 

Mrs. Gastiger stated that she feels, as a member of the Board of Health, that this health issue must be supported.  She added that it would be the responsibility of the City of DeKalb to enforce the resolution, and not a function of the Board of Health.  She suggested that the City possibly consider a couple of liquor licenses be added for smoke-free bars to determine the response. 

Mr. Heinisch stated that the Board has recently discussed the legislation that a child must have a dental exam before they can receive their report card, and it is his feeling that such issues could be accomplished through education and leadership.  He pointed out that many restaurants have become smoke-free through a sense of leadership and responsibility, and feels this is the way to go rather than enforcing such a resolution.   He added that he is as much against smoking as anyone, but does not feel a resolution is the way to proceed.

Dr. Lane stated that the limiting of smoking in public places is becoming more widespread worldwide.  In France and Italy, there are major anti-smoking efforts underway and many areas where smoking is prohibited.  She indicated that she does understand Mr. Heinisch’s concern, but thinks that protecting the work environment is important.  While OSHA protects a factory worker against a hazardous environment, this would also be a work environment issue. 

Dr. Olson stated that he would be more in support of the resolution if it were for all of DeKalb County and not just the City of DeKalb.  He added that, if prohibiting smoking was such a good thing economically, businesses would be doing it on their own and they’re not.  In addition, with Sycamore and DeKalb located right next to each other, he does not feel it would be fair to the DeKalb business owners.  Dr. Lane suggested advertising the resolution as a positive thing. 

Dr. Shear feels, as a medical professional and a representative of the Board of Health, the economics of this resolution are not our responsibility and questioned how the Board could not be in favor of it.  She feels the Board would be criticized if they did not support the resolution.

Mrs. Gastiger made a motion to support the DeKalb Smoke Free Coalition resolution, seconded by Dr. Lane.  The motion carried with Mr. Heinisch and Dr. Olson voting no.

Mrs. Fullerton asked what the penalties or fines would be for non-compliance, and Mrs. Grush responded that this has not been discussed. 

2005 Fee Increase for Home Care Services 

Mrs. Grush is recommending that Home Care fees be increased effective December 1, 2004.  A chart was presented showing current charge per visit, recommended increase (3.7% increase), 2003 Health Management Associates Cost Report figures per visit, and Direct Cost figures per visit calculated by Mrs. Grush.  She pointed out that she uses actual program expenses with no overhead depreciation built in rather than the Medicare cost methodology used by the cost consultants. 

The 2004 Cost Report Study of the Illinois Home Care Council was presented.  This report shows that our cost per visit was somewhat higher on therapy visits, but lower on nursing visits when compared to the average in Illinois.  While we are located in Region III, we are physically located much closer to Chicago and our reimbursements are at the Chicago rates.  Our program is similar to that of other Illinois agencies, whose costs have increased 30 percent over the past three years, with ours increasing 10 percent each year. 

Dr. Olson asked if services are also offered on a sliding scale.  Mrs. Grush responded that the client could pay on a sliding scale with a minimal amount per visit or they could also be on Public Aid.  In addition, the program does receive $25,000 from the Senior Services Grant that subsidizes those clients with no means to pay for services.

Mrs. Fullerton made a motion to accept the recommended rate increases, effective December 1, 2004, seconded by Dr. Bishop.  Motion carried. 

Salary Raises/Adjustment 2005 Mileage Reimbursement for 2004

Mrs. Grush reported that the FY2005 budget included a 3 percent salary increase for staff and $30,000 in salary adjustments for nursing staff. 

Mrs. Grush is recommending that all staff receive a 1.9 percent cost-of-living adjustment effective November 28, 2004, with a mid-year merit increase of 0 to 2 percent.  This is what non-union county employees are receiving.  She pointed out that giving two raises in a year would increase the percentage given in 2006.  While the annualized increase for 2005 is 2.9 percent, FY2006 starts with a 3.9 percent raise.  She added that this happens every year when two adjustments are given.. 

Mrs. Grush is also recommending a market or parity adjustment for nursing staff in FY2005.  She is proposing that all R.N.s and one LPN at Home Care receive a 4 percent increase in December, with a 0 to 2 percent merit increase mid-year.  She pointed out that Hospice nurses at Kishwaukee Community Hospital and bedside nurses received a 4 to 5 percent increase this year.  In Home Care, there is a Billing Coordinator and an Office Coordinator.  Mrs. Grush is recommending that the Billing Coordinator not receive an increase this year as her supervisory responsibilities decreased with implementation of the position of Office Coordinator.  An increase from $22.38 per hour to $26.00 per hour is being recommended for the Speech Therapist position at Home Care, as this employee has been with the agency since 1996 and her salary has fallen behind as she never receives the mid-year increase as a temporary employee.

Mrs. Grush is recommending a 4 percent increase for the following: Director of Personal Health Services, Pediatric Services Coordinator, Family Planning Coordinator, Director of Health Education and the Fiscal Coordinator.  She is recommending that staff in Public Health Nurse positions receive a 3 percent increase. 

Recommendations for increases in on-call compensation were as follows: Home Care weekend and holiday from $50 per day to $55 per day, Home Care weekday evening and night from $15 to $16.50 per day, Animal Control from $80 to $90 per week and Public Health from $80 per week to $85.  

A change in the salary range of the Vision and Hearing Technician from $10.27 - $14.65 to $10.85 - $15.65 per hour is being recommended. 

Mrs. Fullerton asked when on-call compensation was last increased.  Mrs. Grush responded that the last Home Care increase for on-call was in 2000, and 2002 for Animal Control and Public Health.  She added that all on-call staff do carry beepers. 

Dr. Shear made a motion to approve the proposed 2005 salary increases and adjustments, the Vision and Hearing Technician salary range increase, and the increases in on-call compensation, seconded by Dr. Lane.  Motion carried. 

Mileage: Additional Compensation for Work-related Mileage 

Mrs. Grush pointed out that the increased price of gasoline over the past year has personally cost Health Department staff who use their own car for work-related business.  Staff are currently reimbursed 37.5¢ per mile for work-related travel, which is the IRS-allowable Standard Mileage Rate (SMR) that is based on an annual study on the fixed and variable costs of operating an automobile.  She presented the fixed and operating costs from the IRS Code.  Individuals can use the SMR or actual car expenses according to the Code.

Based on the costs from the IRS Code, it is assumed that 16¢ is for depreciation, 7.5¢ for leasing costs, insurance, registration fees and license and 14¢ for gasoline, oil, maintenance, repairs and tires.  With an operating split of two-thirds for gasoline and one-third for operating costs, the result is 9¢ for gasoline.  Because reimbursement would be above the 37.5¢ IRS reimbursement rate, it would need to be taxed as income, so an extra cent would be given to the employee to offset this additional tax.  Mrs. Grush is recommending paying all Health Department staff an additional 4¢ per mile for work-related travel in 2004.  This would result in a $6,000 expense to the agency.  She would like to pay this additional compensation out in January 2005 for miles driven from January through December 2004.  The County has indicated that the IRS mileage rate will increase to 40.5 cents per mile next year.   

Mrs. Gastiger moved to approve the payment of 4¢ per mile, in addition to the IRS-allowable 37.5¢ per mile, to Health Department staff for work-related travel in 2004 in personal vehicles, seconded by Dr. Lane.  Motion carried. 

Nominating Committee 

Board of Health Members

Dr. Lane presented a listing of Board of Health members that are due for reappointment as of November 30, 2004.  She announced that all members eligible for reappointment have agreed to serve another term, and their names will be submitted to the County Board for appointment at their December meeting. 

Dr. Lane made a motion to approve the proposed Board of Health memberships to the County Board, seconded by Dr. Olson.  Motion carried.

Slate of Officers

Dr. Lane presented a slate of officers for 2005: Mr. Kuhn as president, Mr. Wolf as vice president and Dr. Bishop as secretary. 

Dr. Lane made a motion to approve the 2005 slate of officers, as presented, seconded by Mrs. Gastiger.   Motion carried.

Mr. Heinisch stated that he has become aware that property on this campus is being looked at by other organizations and wants to be sure that the Health Department has expressed their preference for additional building space.  Mrs. Grush responded that it has been proposed that a supportive living facility be built on the campus.  Mrs. Grush indicated she has spoken with Ray Bockman, Gary Hanson and Bob Hutcheson, Chairman of the Public Building Commission, regarding the Health Department’s desire for space for a Home Care building.  She indicated that two of the three lots in front of the current building have been tentatively designated for a Home Care site.  Gary Hanson, Deputy County Administrator, questioned the possibility of Home Care being attached to our building.  Mrs. Grush agreed that this would be a better option than building separately. 

Mr. Heinisch wondered what the involvement of the Ad Hoc committee of the Board should be at this point.  Mrs. Grush reported that she feels Health Department space is protected.  She stated that the Ad Hoc Committee would certainly have a role once actual planning begins. 

Mr. Heinisch stated that he saw on television where dentists and other practitioners from Mexico were practicing in immigrant communities and charging much lower prices.  The report stated that there were public funds available for dentistry work for the indigent and Hispanic children, with either the county or state providing the funds for that population.  He continued that the issue was in regards to educating individuals about not utilizing unlicensed practitioners, primarily in the Hispanic areas.  However, since clients could not afford care by licensed professionals, they were keeping the unlicensed physicians and practitioners in business.  What Mr. Heinisch thought was important was that there were funds to pay for care for the indigent and Hispanic children.  Mrs. Grush stated that the State Medicaid program would pay if the provider and patients are legal and meet eligibility guidelines.  Dr. Olson added that this is a big issue in Chicago and that it is more comfortable for this population to go these providers.   

CORRESPONDENCE AND ANNOUNCEMENTS 

Correspondence for the last two months was from Kevin Poorten, President and CEO of Kishwaukee Community Hospital, thanking for the offer of flu vaccine. 

Newspaper articles focused on the smooth operation of flu clinics at the Health Department, flu vaccine availability and the cancellation and scheduling of clinics by the Health Department, viruses of mass destruction, October as National Breast Cancer Awareness Month, November as Home Care Month, the Great American Smokeout in November, appreciation expressed by DCP/SAFE, the scarecrow contest with scarecrows made of recyclable products, and America Recycles Day at Cornerstone Christian Academy.  Letters to the Editor from Mrs. Fullerton and Mr. Kuhn, who were running for County Board seats, discussing their campaign issues were included. 

ADJOURNMENT 

On a motion by Mrs. Fullerton, seconded by Dr. Bishop, the Board of Health meeting adjourned at 8:37 p.m.  Motion carried.

Mike Groark, Secretary

DeKalb County Board of Health