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

BOARD MEMBERS ABSENT: Steve Wolf, R.N.

Board of Health members introduced themselves with two new members, Mrs. Gastiger and Dr. Olson,  present.

MINUTES

On a motion by Ms. Fullerton, seconded by Mr. Groark, the minutes of the Board of Health meeting of November 21, 2003, were approved.  Motion carried.

There were no January 2004 minutes as the meeting was cancelled due to inclement weather.

Mr. Kuhn reported to Board members that he toured the facility during Mrs. Grush’s medical leave in January and observed dedicated, happy workers, with many employed here for a number of years.  Staff explained their position within the agency to Mr. Kuhn, which provided good insight to him and showed examples of the ongoing integration of programs. 

Mr. Kuhn announced that there are challenges for Board members ahead.  He noted 1993 revenue of $1.8 million and expenses of $1.6 million.  In 2003, revenue was at $5 million and expenses at $4.8 million, which gives some idea of the growth of the organization.  He indicated that the Board is also looking at long-term planning and the challenge of constructing a facility for the Home Care Program sometime within the next five years.  The availability of qualified nurses will most likely also remain a challenge for the Board.

DIVISION REPORTS

Mrs. Grush reported that the Thirty-seventh Annual Report of the DeKalb County Health Department has been completed.  Copies were presented to Board members.

Agency staff continues with bioterrorism efforts.  All designated employees (53) within the Public Health building have received training and initiated the assessment process in the Learning Management System (LMS).  LMS is an internet-based and competency-based system designed by the Illinois Department of Public Health (IDPH) and the UIC School of Education that assesses each participant’s skills.  Samples of the questionnaires completed by staff were shared with Board members.  As a result of these questionnaires, training plans will be developed for employees based on assessment results. 

Mrs. Grush reported that HB4615, Local Health Protection Funding, has been tabled by the sponsor of that Bill.  This funding helps support a statewide system of local health departments to assure the protection of the public through the provision of various health protection programs.  The dollars are currently distributed based 50 percent on population and 50 percent on the number of persons with income below 200 percent of Federal Poverty.  HB4615 is a movement by the eight largest health departments in the state to change this distribution to being based solely on population.  Of the 94 health departments in the state, 84 would lose money.

Mr. Kuhn asked about the upcoming Crisis and Emergency Risk Communication two-day training program.  Mrs. Grush responded that it will be held June 23 and 24, 2004, at NIU and should be an excellent workshop.  She added that Board members are welcome to attend, and the agency will pay the fees for them.

Mr. Drake, Director of Environmental Health, reported that his staff are getting busy again with Spring approaching and interest rates remaining low.  The recycling rate was computed this year at 42 percent as compared to 44 percent in 2002.  DeKalb County’s recycling rate is one of the highest in the state.  Mr. Drake added that this rate is difficult to track as there are no mandatory requirements for recycling and reporting is voluntary.

The Family Case Management Program (FCM) is collaborating with Kishwaukee Community Hospital (KCH) to provide a trial childbirth education series for women ages 16 to 21.  The “Young Moms Childbirth Education” series will be held at the Health Department and will be taught by Beth Busching, R.N.  Beth is a certified LaMaze instructor for KCH and also works part-time for the WIC/FCM Program of the Health Department.  The first series begins on April 22, 2004.   

Mrs. Lux, Director of Personal Health Services, prepared a summary of a recent outbreak at a long-term care facility where many residents and employees became ill.  Mrs. Carroll, Communicable Disease coordinator, prepared a handout explaining what the agency does when investigating an outbreak.  Laboratory confirmation was received that two of three specimens were found positive for Norovirus, which is what our staff suspected to be the cause.

Mr. Kuhn asked when further expansion at the WIC Sandwich satellite office would be necessary with the increased caseload.  Mrs. Lux projects that it would be within a year.  Mrs. Grush pointed out that Safe Passage rents from the Fox Valley Older Adult Center and the Health Department subrents space from them.  Mrs. Grush will be investigating additional options.

Mrs. Baj, Director of Home Care, reported that the program is in the midst of implementation of laptops in the field.  A timeline of the implementation schedule was attached to Mrs. Baj’s narrative report.  This timeline is updated monthly and includes everything that must be accomplished before the implementation period is finished in May 2004.  A pilot group of home health nurses is currently being trained, and as to be expected, they are extremely overwhelmed at this point. 

Mrs. Baj stated that Mr. Kuhn had mentioned the challenge of the nursing shortage.  She reported that the Home Care Program has been running an ad since January 1, 2004, with no applications received and noone hired; however, with the decrease in caseload, services have remained stable. 

Mrs. Zanellato, Director of Health Education, stated that the agency was, once again, awarded the Comprehensive School Health Education and Services Grant.  This is a repeat grant and the only way to receive it was to come up with a very different approach.  It was decided to target Hispanic students with a program entitled The Future is Ours.  The program encourages goal setting, academic achievement and strengthens general coping and life skills to reduce teen pregnancy.  The program has gone extremely well, and the schools are thrilled.  With the end of the program for this school year, an event is planned for this Friday evening where mothers and daughters attend for an evening out together.  To date, 34 individuals have signed up to attend.  Many school staff are also interested in attending and are welcome. 

Implementation of the Learning Management System (LMS) began over the last two months, and all staff (total of 53) have received training in the system.  The software allows the generation of reports to determine the areas of additional training needed by staff.  Upcoming projects include the development of an emergency plan for the agency.

FINANCIAL DATA

On a motion by Ms. Fullerton, seconded by Dr. Bishop , the Financial Statements for the months of January and February 2004 and the Claims for the months of February and March 2004 were approved.  Motion carried.

NEW BUSINESS

Fiscal Year 2003 Financial Statement

In a review of the Year-End Financial Statement for 2003, Mrs. Grush pointed out that revenue actually received was $5,015,706, while $4,758,500 was budgeted. Expenses were $4.810,295, up 11% over FY 2002.  She cited several reasons for the increase.  Salaries were up by 5.5%, IMRF and Social Security were up 10% and health insurance up 28%.  Another area of increased expenses was Professional Services, with the addition of a physical therapist in southern DeKalb County and increased occupational therapy services.  Psychiatric nurse visits were also up, with increased referrals in that area.  Mrs. Grush pointed out that the Professional Services expenses should be offset by revenue received in the Medicare – Home Nursing line item.  She added that the cost of home nursing visits would not be known until the May 2004 meeting.  There was an excess of $205,412 excess revenue over expenses. 

Mrs. Grush presented a chart, Revenue Comparison: 1993-2003, that shows some cause for concern, noting a trend that is being seen for the first time since 1993.  Each category (Environmental Health fees, Personal Health Services fees, State and Federal grants, and revenue that falls under Other Sources), when totaled, was at or below what was received in FY 2002.  Medicare – Home Nursing was up a little over $200,000, which was surprising considering the slow summer experienced in 2003.  Public Aid was up $26,000; however, Mrs. Grush reminded the Board this was the last year that Public Aid would be billed for vision and hearing because of HIPAA requirements.  While Mrs. Grush reported that the year ended on a sound financial basis, she wanted the Board to be aware of the above trend as an issue of concern should it continue.

A chart entitled Revenue, Expenses, Fund Balance and Average Annual Cash/Investments was presented.  This shows the FY 2003 Fund Balance at $2,648,849.  Average annual cash is $2,080,031, with approximately $600,000 used as cash flow.  $1 million has been allocated to the building fund for Home Care.

Mr. Heinisch pointed out that the portion of the budget from real estate taxes is minimal, while a large portion of the budget comes from Home Care revenue, grants and private pay.  Grants and home care services are subsidized in taxes in other forms but not by real estate taxes.  Mr. Heinisch stated that one could point to the tremendous performance of this agency when the discussion of Health Department expenses and revenue arises.  While over $5 million comes into the agency, only $319,000 of that is from real estate taxes for the Public Health Levy.  He pointed out that the general public does not know that, but it is important for Board members to know and to keep in perspective.  He added that the Board of Health does have control of allocating how funding is spent, but the DeKalb County Board does ultimately give the final approval of the budget.  Mrs. Grush pointed out that 54 cents out of every $100 is expended on public health services by taxpayers.  Mr. Heinisch stated that this revenue effect is directly related to the 40-acre rule in DeKalb County, which affects local businesses.  Mrs. Fullerton, County Board representative, pointed out that the County Board passed this rule to avoid urban sprawl and concentrate services around municipalities and existing sewer lines. 

Mrs. Gastiger made a motion to accept the FY2003 Financial Statement, seconded by Dr. Bishop.  Motion carried.

Discussion Regarding Tattoo/Piercing Regulations

Mrs. Grush reported that there are three tattoo/piercing facilities in the county: one tattoo parlor in Cortland and two piercing facilities in the City of DeKalb.  There are no state laws, other than age requirement, regarding the body art industry.  On several occasions, the Illinois Department of Public Health (IDPH) indicated they had plans to issue rules and regulations; however, this has never been initiated by them or the State Legislature. 

A survey was sent to other local health departments in the state to determine if they had rules and regulations currently in existence.  Nine agencies responded that they did have them, and copies were requested.  A Summary of Illinois City/Counties with Body Art Ordinances was prepared for the Board.  Mrs. Grush pointed out that there is also a book from the National Environmental Health Association, Body Art: A Comprehensive Guidebook and Model Code, with general provisions. While the State’s Attorney in Will County informed them that they did not have the authority to regulate these facilities, our Assistant State’s Attorney, (at the time) Jack Slingerland, interpreted the law as allowing regulation in the name of sanitation and health concerns. 

Mr. Drake, Mrs. Carroll and Mrs. Grush have spent some time investigating the issue of regulation of these facilities.  After reviewing the ordinances and visiting the sites, it appears to be more of a communicable disease issue than an environmental issue and comes down to the operator’s ability to work in a sterile fashion.  The focus should be on the reduction of injury and disease transmission risk by the operators.  It is felt that regulation of these facilities could prevent negative health outcomes for those clients.  There are also concerns regarding the development of a local ordinance and implementation of the regulations.  Those concerns include: (1) no State adopted rules and regulations for body art facilities; (2) no State educational and/or licensure requirements for body art operators as required by the Department of Professional Regulation; (3) a Health Department permit may provide a false sense of security to customers and may indicate that all within a facility is in compliance with acceptable infection control standards; (4) questions could arise regarding liability on the part of the Health Department; and (5) prioritization of agency responsibilities.    Mrs. Grush believes our agency would be covered under tort immunity as far as liability goes.  She added that while this issue is important to us, it would not be considered one of our five major concerns because of other current pressing mandates.  There would also be a significant investment of time in passing an ordinance through the County Board and implementing it. 

Since Mrs. Carroll’s visits, providers at all sites are receiving the Hepatitis B vaccination series.  She has also asked them to bring their used needles to the Health Department in containers so they can be disposed of properly.  The cost of this service is $10 per container. 

Mrs. Gastiger told the Board about a recent article about an outbreak of cartilage infections from a kiosk in a mall where a gun was used for cartilage piercing.  She added that these are potentially very serious infections. 

Mr. Groark asked why WalMart and others are excluded from following these regulations.  Mrs. Carroll responded that piercing in these stores is limited to the lobe of the ear. 

Mr. Kuhn asked the number of complaints received.  Mrs. Carroll responded that she has received two or three since December 2003 and several after CornFest where piercings were occurring at the same place.  She stated that each tattoo/piercing facility has room for improvement, but the biggest thing they need to focus on is an understanding of sterilization technique.  She added that her just being there and offering education was an eye opener for the operators. 

Mr. Kuhn stated that he feels we are responsible for follow-up if we are receiving complaints.  If non-sterile techniques were observed when staff visited the facility, the agency does have responsibility to educate them.

Dr. Bishop asked if some intervention could make a difference.  Mrs. Grush stated that she feels Mrs. Carroll has already made a difference by bringing some weak areas to their attention.  She wonders if making periodic visits with training on sterilization could be more helpful than officially regulating them.  She suggested that the Board write a letter to Dr. Eric Whitaker, Director of IDPH, recommending that the State adopt rules and regulations regarding body art operators and facilities. 

Mr. Heinisch wondered if this was a more prevalent issue because we are a campus town.  Mrs. Grush responded that she wondered the same thing when looking at responses of the participating communities.  Mrs. Gastiger, who works at the University Health Service, stated that she does see piercings, but she is not sure it is because they attend school in DeKalb.  Mrs. Carroll did not think the customers were university students when she was observing the facilities.  She added that the trend, unfortunately, of the younger generation of 16 to 25 year olds is to get tattooed or pierced.  She advised the Board that at-home tattooing is also very popular.  Dr. Shear asked if facilities checked for parental consent.  Mrs. Carroll indicated that they did check identification when she was there, and many parents were with their child.

Mrs. Gastiger proposed telling the facilities that the Board of Health is considering passing an ordinance regulating these types of facilities and suggest voluntary educational participation instead.  She asked if these businesses wanted to be regulated.  Mr. Groark stated that one of the facilities thought regulation would be good for business and would increase his customer base. 

Mrs. Grush indicated that she would draft a letter to Dr. Whitaker and bring it back to the Board for all members to sign.  She added that staff would continue to monitor the facilities periodically and continue with education as needed. 

Dr. Lane moved that Mrs. Grush draft a letter to Dr. Eric Whitaker recommending that the State adopt rules and regulations regarding body art operators and facilities, seconded by Dr. Shear.  Motion carried.

Home Care Administrative Review

Each March, an annual review of Home Care Policies and Procedures, DeKalb County Health Department Personnel Policies and Board of Health Bylaws is conducted in accordance with federal regulations. 

A chart of Home Health Revenue from 1990 through 2003 was presented showing the source and total revenue received.

A chart of Cost, Charge and Limit Per Visit was presented.  The cost per visit for 2003 is not yet known as the Medicare Cost Report has not yet been completed. 

A chart on Home Care patients according to payor, sex, race and age was presented.  There was an increase of 1 percent in patients served in 2003.  Visits by payor were up 4 percent to 957 patients.  A chart of Visits by Payor shows that most disciplines increased except for skilled nursing and speech therapy.  The chart of Source of Referrals/Admissions shows the biggest referral source as Kishwaukee Community Hospital (KCH).   Statistics show that 75 percent of patients in the Home Care Program met their goals.  There were more episodes that were over cost this year as compared to previous years.  It is hoped that those patients that cost the program more to serve are offset by those that cost the program less.

The Clinical Record Evaluation Summary 2003 provides information about program audits. 

Home Care Policies and Procedures – Recommended Changes

New policies requiring approval by the Board of Health related to an Emergency Disaster Plan, Fire Emergency Action Plan, ProTime Mircocoagulation System, Patient Education and Outcome Based Quality Improvement (OBQI).    Changes to current policies related to the Transfer to Inpatient Facility with Resumption of Care or Discharge, Patient Discharge, Chart Order and Filing, Employee Infection/ Illness, Cleaning of Reusable Equipment, Assessment and Determination of Payment Category, Peripheral IV Catheter Insertion and Dressing, PICC Line Dressing Change, and PICC Line Flushing. 

Mrs. Grush pointed out that the program has been in existence for 38 years, is financially stable and sound and provides a good service to the community.

DeKalb County Health Department Personnel Policies

Revisions to the Personnel Policies of the DeKalb County Health Department related to the Use of Health Department Property/Facilities, Yearly Wage Adjustment and Merit Increase, Compensation at One and One-half (1˝) Times the Regular Hourly Rate, Compensatory Time Off, Personal Leave, Permanent Part-time Employee Leave, and Paid Holidays.

Compensation Adjustment

Mrs. Grush is recommending that the salary of Tammy Pieroni, Home Care Office Coordinator, be adjusted by $1.05 per hour from $13.11 per hour to $14.16 per hour.  This is being requested to compensate for Ms. Pieroni’s newly acquired technology responsibilities in the implementation of laptops in the Home Care Program and also for compensation equity in relation to other support staff positions in the Home Care Program. 

DeKalb County Board of Health Bylaws

The DeKalb County Board of Health Bylaws were reviewed, with no recommended changes. 

Mr. Groark asked if a staffing plan was being developed in case the visits slow down this summer like they did in 2003.  Mrs. Baj responded that she monitors the census and admissions and discharges on a weekly basis.  She added that decreased visits is not usually a problem in the summer with staff vacations, but attempts are made to keep staffing patterns at a level basis.  Mrs. Grush added that this situation really is out of anyone’s control, so the same strategy would be followed as last year.  She assured the Board that management would keep a close eye on the situation. 

On a motion by Mr. Heinisch, seconded by Ms. Fullerton, additions and changes to the Home Care Policies and Procedures and the Personnel Policies of the DeKalb County Health Department were approved.  Motion carried

On a motion by Mrs. Gastiger, seconded by Dr. Bishop, the salary increase, in the amount of $1.05 per hour, for Tammy Pieroni, Home Care Program Coordinator, was approved, effective April 4, 2004.  Motion carried.

Committee Appointments

Mr. Kuhn announced that there is an opening on the Long-range Planning Committee of the Board of Health.  Projects that will be addressed include the expansion of space for WIC services in Sandwich and a new building for the Home Care Program.  Mr. Heinisch and Mr. Kuhn are members of the committee.  Mr. Wolf was nominated to serve on the committee. 

The following committee appointments were presented:

Finance: Mr. Heinisch as Chair, Ms. Fullerton and Dr. Bishop

Personnel: Mr. Groark as Chair, Mr. Wolf and Dr. Schelkopf

Nominating: Dr. Lane as Chair, Dr. Shear and Mrs. Gastiger

Bylaws: Mr. Groark as Chair and Dr. Olson

Long-range Planning: Mr. Kuhn as Chair, Mr. Heinisch and Mr. Wolf

Executive Session

Mr. Groak moved that the Board of Health enter into executive session for the purpose of discussing pending litigation, seconded by Dr. Bishop.  Those voting yes included Dr. Bishop, Ms. Fullerton, Mrs. Gastiger, Mr. Groark, Mr. Heinisch, Mr. Kuhn, Dr. Lane, Dr. Olson, Dr. Schelkopf and Dr. Shear.  Motion carried.

On a motion by Mr. Heinisch, seconded by Mr. Groark, the Board of Health reconvened to regular session at 9:05 p.m.  Those voting aye included Dr. Bishop, Ms. Fullerton, Mrs. Gastiger, Mr. Groark, Mr. Heinisch, Mr. Kuhn, Dr. Lane, Dr. Olson, Dr. Schelkopf and Dr. Shear.  Motion carried.

Dr. Olson questioned what position the Board of Health would take in regards to a sovereign nation and casinos as being proposed in Shabbona.  He added that no local taxes would be paid but the County would be responsible for their protection.  Mrs. Grush responded that she is not familiar with government responsibilities of sovereign nations, but would check into this.

CORRESPONDENCE AND ANNOUNCEMENTS

Four letters were received from Home Care patients or their families expressing their satisfaction and appreciation for the services provided to them.  Newspaper articles for the months of January and February related to the Animal Control Program being a dog’s best friend, February as Heart Health Month, a recycling lesson for Cortland students, and an article on recycling on the web site of the Northern Star.

ADJOURNMENT

On a motion by Mrs. Gastiger, seconded by Dr. Schelkopf, the Board of Health meeting adjourned at 9:12 p.m. Motion carried.

Carl Heinisch, Secretary

DeKalb County Board of Health