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.; Mary Beth Shear, M.D.; Steve Wolf, R.N.

BOARD MEMBERS ABSENT: John Olson, D.D.S.; Debra Schelkopf, D.V.M.

Mr. Kuhn reported that he recently visited the Home Care site and agreed that they are in need of additional space.

MINUTES

On a motion by Dr. Shear, seconded by Ms. Fullerton, the minutes of the Board of Health meeting of March 23, 2004, were approved.  Motion carried.

DIVISION REPORTS

Mrs. Grush reported that the agency has not yet heard the amount of State grant awards.   Speaker Madigan is demanding that only a six-month budget be approved for the Department of Human Services (DHS) because of proposed changes directed to disability, mental health and substance abuse providers.  Since we do receive substantial funding from DHS, this could affect our agency.  She reported that the agency has not received any Home Care Illinois Public Aid (IPA) payments since last October.  Supposedly, the checks have reportedly been processed and are awaiting signatures in the Comptroller’s office. 

The WIC Grant will increase from $226,000 to $255,700 with the requirement of increasing the caseload and seeing pregnant women every two months instead of every three months.  A new State initiative that was implemented April 19, 2004, will assist women leaving the Medicaid program to better prepare for economic independence by avoiding unintended pregnancies.  Clients benefiting from this program should begin to be seen in early June, and it is hoped this will bring in additional monies to the Family Planning Program. 

Information was provided on the 2003 Medicare Cost Report for Home Care, which included the cost per visit in 2003 and the nursing visit cost.  This year, the nursing visit cost increased from $115.04 to $133.09, a result of the decreased caseload of the summer of 2003 and no associated decreases in salaries.  Mrs. Grush reported that she will provide an in-house nursing visit cost, as this differs from that compiled by Health Management Associates, our cost report consultants.  She feels the in-house cost is more accurate for direct costs since it uses actual program costs as compared to percentages of the agency as a whole.   

Agency staff continues to spend a great deal of time on bioterrorism preparedness.  A flyer was included in Board packets regarding a “Crisis and Emergency Risk Communication” workshop to be held at Northern Illinois University on June 24 and 25.  Barbara Reynolds, M.A., CDC Crisis Communication Specialist, will present on contingency plan development, crisis analysis, message guidance and training.  This workshop is sponsored by the Illinois Department of Public Health (IDPH) and the DeKalb County Health Department and funded by CDC.  Mrs. Grush stated that the agency is fortunate to be co-hosting this event as it should provide valuable information, and is the last one to be held in the State of Illinois.  If Board of Health members wish to attend, their registration fees will be paid. 

Mrs. Grush reported that the recent lawsuit against the agency has been finalized, and the check has been mailed to the defendant’s law firm.  She does expect publicity to appear in the near future, and indicated all contacts will be referred to the State’s Attorney’s office for comment. 

Mr. Drake stated that 2004 could be the year of the mosquito.  The flood water mosquitoes are hatching now, and they are vicious biters.  While they do not carry disease, they do bite two to three times and hurt.  The mosquitoes that bite at dawn and dusk can carry the disease, but generally flood water mosquitoes do not.  Mr. Drake reported that no crow samples have been submitted to the State lab yet, but each agency is allowed to submit a total of ten crows or blue jays.

Mr. Wolf stated that the statistics appear to indicate steady growth in OB-related programs.  He asked for an explanation in the Family Planning Program area related to individuals accepted directly by physicians for prenatal care.  Mrs. Lux, Director of Personal Health Services, responded that physicians can and do accept patients on their own and those numbers are tracked.  Mrs. Grush added that the client may have been a patient of a physician for a period of time, and that physician will continue to provide their prenatal care.  If a client does not have a physician, they are told to contact the Health Department for a physician. 

Mr. Wolf questioned the decrease in HIV clients tested from March to April.  Mrs. Carroll, coordinator of the Communicable Disease Program, responded that an African-American sorority had a large screening in March, as well as several tests conducted at New Hope Baptist Church.

Mrs. Baj, Director of Home Care, reported that the third group of nurses began utilizing laptops in the field this past Monday.  Training is now halfway completed and should be done by October or November.  She reported that there are, of course, always “bugs” to work out and office staff is frequently called upon to troubleshoot.  A meeting was held today, and it is felt that the office portion of the project is in place.  Mr. Kuhn asked if the project was staying within budget.  Mrs. Grush responded that it is, for the most part, but there are always incidental expenditures that were not considered.  Mr. Wolf asked if disappointments have been noted in the system.  Mrs. Baj responded that they are not disappointed, and a major upgrade was recently received that should address some of the issues to which users have requested changes.  McKesson does conduct surveys and call agencies when preparing for upgrades. 

Mrs. Zanellato, Director of Health Education, stated this is a busy time of year for her department as they are finishing up all school programs.  Year-end reports and pre- and post-test results were included in the Board packet.  Positive swings in terms of students’ factual knowledge, awareness and confidence levels are studied.  Mrs. Zanellato reported that Mr. Kuhn signed a letter to Health Department staff, on behalf of the Board, that was provided to staff at their first bioterrorism training held at the May agency staff meeting.  This letter expressed the Board’s concern for the safety of the employee and their family in regards to bioterrorism events.  Mrs. Grush added that agencies are being told that staff will not be of any real value unless they know that their families are okay.  Staff was given a packet at the training session and can enter a drawing for a prize when they have completed activities for their emergency preparedness at home.

FINANCIAL DATA

Mr. Heinisch questioned the difference in income of approximately $90,000 from March to April in the Planning and Preparedness and AIDS Grant line items.  Mrs. Grush responded that the difference relates to the receipt of quarterly grant payments. 

She noted that revenue to date is $1.3 million and expenses $1.2 million.  In looking over the past two years at the same period of time, the same trend was noted as less revenue is received early in the year.

On a motion by Mr. Heinisch, seconded by Dr. Bishop, the Financial Statements for the months of March and April 2004 and the Claims for the months of April and May 2004 were approved.  Motion carried.

NEW BUSINESS

Copier Replacement

Mrs. Grush stated that she had no intention of purchasing a new copier this fiscal year, but the current machine that is eight years old has experienced numerous breakdowns requiring frequent service calls.  Mrs. Hills, Director of Office Support, arranged for three companies to provide demonstration copiers to be used for a week at a time.  A chart was presented comparing various features of all machines.  Additional charts compared the cost of outright purchase versus leasing.  Mrs. Grush pointed out that Gordon Flesch (Sharp 550 copier) came in with the least expensive option through an outright purchase.  The cost of the machine is $11,800, less a 2% discount for a total of $11,564.  Because the other three machines were also purchased from Gordon Flesch, they agreed to a maintenance charge of $.007 per copy on all machines, a substantial decrease from the current $.015 cents per copy.  Total outright purchase price of the Sharp 550 over a three-year period would be $16,856, while a lease purchase agreement would be $19,059.  Mrs. Grush   recommends an outright purchase of the Sharp 550 copier from Gordon Flesch. 

Mr. Heinisch asked about plans for the current copier.  Mrs. Grush responded that she is considering having it moved to the Sandwich WIC site, but if that is decided against, Gordon Flesch will remove the machine and use it for parts.

Mrs. Grush pointed out that this copier was not let for bids since the cost was under $20,000.  It will be necessary to transfer money at the end of the year to cover the cost of this unplanned expenditure. 

On a motion by Mrs. Gastiger, seconded by Mr. Groark, the outright purchase of the Sharp 550 from Gordon Flesch at a cost of $11,800 less a 2% discount and $.007 cents per copy maintenance was approved.  Motion carried.

Satellite Space Expansion in Sandwich

Mrs. Grush reported that the agency has sub-rented space from Safe Passage at the Fox Valley Older Adult Center in Sandwich since 1997 at a cost of $1,750 per year.  The space includes a waiting room and one small private office.  Safe Passage currently pays $6,000 per year ($500 per month) for this space and has an additional small private office.  Services currently provided by the Health Department include WIC clinics and HIV counseling and testing clinics. 

Since this is an area where growth is occurring and the space is needed for additional days, Mrs. Grush did visit the site.  She called Ms. Wiseman of Safe Passage to ask if the Health Department could increase their use of the space (including the additional office) to every Thursday and Friday and every other Wednesday.  Ms. Wiseman stated that she was going to give up the space on June 30^th due to budget constraints.  Mrs. Grush did speak with Dave Ruggles, Director of the Fox Valley Older Adult Center, and he agreed to help look for a tenant to share the space with the Health Department.  Mrs. Grush feels that we have little choice but to pay the $500 per month ($6,000 per year).  Fox Valley is very accommodating to us, welcoming to our clients, and provides other services, such as the food pantry, which our clients may also utilize at their visit.  If a sub-renter should be found, Mrs. Grush feels we should rent to them, but if not, we should proceed with renting on our own.

Staffing Recommendations

Mrs. Grush reported that these staffing recommendations are brought to the Board because, in order to change agency positions, the Finance Office requires Board of Health approval and documentation.

Departmental Support Aide

The agency has employed one Departmental Support Aide since moving into this facility in June of 1999.  This individual has recently resigned to accept a position at Delnor Hospital.  At this time, Mrs. Grush is recommending that this full-time position be changed to two part-time positions.  This would actually increase the number of hours between the two positions and cost savings would be realized because no health or life insurance would be paid, as well as the fact that the new employees would be making less than that of the previous employee.  Mrs. Grush is also requesting to increase the salary range for these positions.  She pointed out that to find the caliber of person needed at $6.87 per hour is difficult, and she requested that the range be increased from $6.71 to $9.53 per hour to $8.15 to $11.65 per hour, changing the full-time position to two part-time. 

Clinic Staffing

Mrs. Grush reported that the agency is desperate for bilingual clinic staff.  The State continues to add rules and regulations requiring two people needed to carry out the directives; one to perform the function and one to interpret.  The agency currently has a maternal child health secretary that works 3.5 days per week.  This individual is bilingual, is a graduate of the University of Pennsylvania in Environmental Sciences and has had two years of nursing education.  Mrs. Grush is requesting to change her position to a Secretary – Clinic Aide, primarily to work in Family Planning, the one program that does not have full-time Spanish-speaking staff.  With the additional clinic aide responsibilities, she is requesting a 3% salary increase.  The cost of this increase is approximately $4,700, which should be offset by the newly implemented Medicaid waiver program.

Nurse or Nutritionist

With the $27,900 increase in the WIC Grant, it will be necessary to hire a nurse or nutritionist two days a week to serve the additional clients.  It may be necessary to do this before the next Board meeting, so Mrs. Grush is requesting the addition of the position at this time.

Recommendation to Add Full-time Occupational Therapist in Home Care Program

Mrs. Grush is recommending the addition of the position of Occupational Therapist to the Home Care Program.  She and Mrs. Baj have been working on this position for a long time, but never thought it would be a reality because of the lack of available occupational therapists.  The individual being considered previously worked as a contracted employee for our agency through Alliance Rehabilitation.  She recently resigned her position with them and had accepted a position with Kishwaukee Community Hospital (KCH).  In talking with her, she indicated that she would prefer to work in the home care field, and called KCH to decline their offer. 

Justification was provided regarding this staffing change and the addition of this position.  All publications today indicate the need to move forward with a strong therapy program that will, in turn, reduce nursing and aide costs. 

Currently, Alliance Rehabilitation is paid $80 per visit.  Mrs. Grush is proposing a salary range of $22.00 to $31.46 per hour.  She is recommending that an offer of $25.50 per hour be made to the candidate.  Total cost to the agency would be $60,867, but this should be covered by revenue generated.

Mr. Heinisch questioned the difference in paying Alliance Rehabilitation $37,680 for 471 visits at $80 an hour and hiring an individual at a cost of $60,867.  Mrs. Grush responded that it is hoped savings will be realized through the therapist getting patients independent quicker, thereby reducing the number of nursing visits.  She explained that the agency is paid a set amount for every patient depending on their diagnosis.  Mrs. Baj pointed out that reimbursement changed in 2000 from visit-based to episode-based, with a lump sum payment received on a 60-day basis.  This new therapist will assess the patient’s status and review their activities of daily living (ADLs).  While aides go into the home and provide personal care, the therapist could go in and train the patients to care for themselves, resulting in them meeting their goals earlier, becoming independent, and being discharged from service quicker, thereby saving the program money.  Mrs. Grush pointed out that the nurse could also indicate that a patient could benefit from occupational therapy and the therapist could get the patient discharged quicker. 

Mr. Kuhn stated that Mrs. Grush had spoken to him about this agenda item and it seems like a perfect fit.  The individual has worked with our organization for four years on a contracted basis and knows our patients and the area.  The occupational therapist would train the patient on ADLs, rather than just providing the care as an aide would do. 

Mrs. Grush stated she is hopeful this position will also be able to do some of the coordination of care and review of the patients served by home health aides to ensure timely discharge. 

Mrs. Baj reported that the agency is paid in three categories for therapy utilization: clinical (what is wrong with the patient), functional (ability to perform ADL) and service utilization.  If ten or more therapy visits are provided, more money is received.  If visits are coordinated between physical therapy and occupational therapy, it could decrease visits and the patient would do better faster, ultimately making more money in the end.

Dr. Bishop asked if the individual should be offered the salary they were to receive at KCH.  Mrs. Grush responded that our benefits are better, which should offset a slightly lower salary.

Dr. Bishop made a motion to accept all staffing recommendations, as presented, seconded by Mr. Wolf.  Motion carried.

Mrs. Grush added that the addition of this position is not just about making or saving money, but is really a part of the program’s mission to provide good patient care.  She feels strongly that this will add to the quality of care the program provides. 

Mr. Wolf expressed concerns that the shortage of occupational therapists nationally could mean that a program was built around this position, and should the individual resign, it would be difficult to find a replacement.  Mrs. Grush stated that she still feels the program would still have benefited from the addition of this position, and if this individual were not available, the service would probably be discontinued. 

“Public Health in Action” – STD’s in DeKalb County

Peg Carroll, Communicable Disease coordinator, gave a PowerPoint presentation on sexually transmitted disease (STD) prevention to Emergency Room (ER) physicians at KCH, and it was felt to be worthwhile with a good overview of public health and activities the Communicable Disease Program provides in DeKalb County, such as Tuberculosis (TB), STD reporting and follow-up and communicable disease reporting.  Mrs. Carroll reported that, for the past three years, STDs have been tracked in the county and ER staff have been supplied with data on the STDs seen through the ER. 

The PowerPoint presentation, “DeKalb County – Partners in STD Prevention,” showed the 2002 Illinois STD rates by county for chlamydia, gonorrhea and syphilis.  Mrs. Carroll pointed out that, as a mobile society, if a problem is seen in a neighboring county, DeKalb County will soon encounter it.  Our county is also near the “collar counties,” which are high-risk areas.  She reported that syphilis, nationwide, has decreased considerably over the last few years, but has been a big problem over the last couple of years in Illinois, California, North Carolina and Florida. 

A chart of reported gonorrhea and chlamydia cases in DeKalb County from 1999 to 2003 shows a relatively small number of gonorrhea cases, but a large number of chlamydia cases, with statistics steadily increasing. 

Mrs. Carroll attended an STD update where she learned that the high-risk group is age 15 to 24 years for both males and females, and statewide statistics indicate that 75% of cases fall into this age category.  In DeKalb County, 86 to 96% of STD cases seen are in this age group, indicting a need to focus on this age group for both gonorrhea and chlamydia. 

Mrs. Carroll reported that the majority of gonorrhea reports come from NIU Health Service.  Mrs. Gastiger, who is a nurse practitioner at NIU Health Service, stated that the Health Service is switching to urine testing from swabbing so it will be interesting to see if the rate of positive gonorrhea cases increases with more individuals possibly being tested.  The turnaround time from diagnosis to treatment for NIU Health Service patients is less than three days. 

The presentation was developed for the ER physicians because of the need of increasing the awareness of the percentage of untreated STD cases, as well as that of cases lost to follow-up and the length of time spent in tracking down affected individuals.  Mrs. Carroll reported that an average of 45% of untreated STDs were seen at the ER in 2003.  The average of 13 days from diagnosis to treatment is significant because clients are unknowingly continuing to spread the disease.  Four patients in 2003 were never reached.  Mrs. Carroll reported that all untreated patients were female, adding that it is not as easy to diagnose because the problems being presented could also be related to other problems.  She also encouraged presumptive treatment for STDS and education for risk factors at this presentation, as it is not currently routinely done and could decrease the incidence of STDs. 

In addition to STDs, the program is seeing a fair number of the high-risk heterosexual population that is being co-infected with HIV.  The economic burden associated with the increased incidence of STDs and the complications associated with untreated STDs must also be considered.  Mrs. Carroll reported that DeKalb County is seeing a trend of increased heterosexual HIV transmission and STDs.  Of the current clients, 60% are heterosexual and 40% are females.

In regards to the association between HIV and STDs, Mrs. Carroll reported the following.  According to CDC, any activity that decreases the prevention of STDs in a population will also decrease the prevalence of HIV.  Mrs. Carroll reported that DeKalb County shares a similar trend as that seen nationwide of the increase in heterosexual HIV transmission, especially in women under the age of 25.  Since Public Health has recognized that the at-risk population cannot be reached, additional effort and collaboration is needed to enhance screening, detection and treatment.  Studies have shown that approximately 80% of females and 50% of males that are infected with an STD are asymptomatic.   Finally, enhanced STD screening and lifestyle risk assessment is the key element impacting individual behavior in risk-taking adolescents and young adults and to decrease the incidence of HIV in the community. 

Screening in the ER provides an opportunity to ask questions to determine the possibility of an STD and the need for treatment.  Mrs. Carroll added that presumptive treatment could decrease the risk of complications such as PID and infertility.  It could also minimize the burden of time and expense in locating infected untreated patients. 

Dr. Shear asked if the State provides medication.  Mrs. Carroll responded that the State does provide STD medications if the patient cannot afford treatment or is uninsured.  The State does provide the Family Planning Program and TriCounty Community Health Center with these medications. 

Mr. Groark asked if a patient’s insurance would pay for medications if the diagnosis were not confirmed.  Mrs. Carroll indicated she believed they would pay for it.  She pointed out that reports of cultures are generally received fairly quickly and risk factors could be documented.  Mrs. Gastiger added that she does not believe that insurance companies look at the diagnosis.

Mrs. Carroll indicated that the State is considering the use of urine testing, and the Acting Chief of STDs has requested to use this presentation for emergency room staff.  Mr. Kuhn asked if the presentation was well received by ER staff.  She responded that she is unsure at this time, but it was provided at their request, indicating an interest on their part. 

Mr. Wolf asked if ER staff indicated they were willing to do presumptive treatment, but Mrs. Carroll indicated that was not clear at this time.  She added that staff were very receptive to their visit and presentation. 

Mrs. Gastiger wondered how many of the untreated females were asymptomatic and how many were actually presenting with symptoms.  Mrs. Carroll stated that she did not know how many were caught through routine exams.   She feels ER staff could ask appropriate questions to identify those with designated risks.  Mrs. Lux added that women are asymptomatic, and it is not always clear.   She pointed out that by not knowing the diagnosis or determining risk factors, the real problem could be masked. 

Executive Session

Performance Evaluation of Public Health Administrator

On a motion by Mr. Groark, seconded by Ms. Fullerton, the Board of Health moved into executive session at 8:47 p.m. for the purpose of conducting the performance evaluation of the public health administrator.  Those voting yes included Dr. Bishop, Mrs. Fullerton, Mrs. Gastiger, Mr. Groark, Mr. Heinisch, Mr. Kuhn, Dr. Lane, Dr. Schelkopf, Dr. Shear, and Mr. Wolf.  Motion carried.

On a motion by Mrs. Gastiger, seconded by Dr. Bishop, the Board of Health reconvened to regular session at 8:57 p.m.  Those voting yes included Dr. Bishop, Mrs. Fullerton, Mrs. Gastiger, Mr. Groark, Mr. Heinisch, Mr. Kuhn, Dr. Lane, Dr. Schelkopf, Dr. Shear, and Mr. Wolf.  Motion carried.

On a motion by Mrs. Fullerton, seconded by Dr. Shear, the Board of Health authorized a 2 percent merit increase for Mrs. Grush, Public Health Administrator.  Motion carried.

UNFINISHED BUSINESS

Mrs. Grush presented a letter she developed, at the Board’s direction, to Dr. Whitaker, Director of Illinois Department of Public Health, requesting that IDPH pursue adoption of rules to regulate the body art industry in Illinois.  This would be to ensure safety standards that will protect the health of consumers who desire tattoos, piercings and other forms of body art.

CORRESPONDENCE AND ANNOUNCEMENTS

News articles for the months of May and April 2004 focused on Public Health Month in April, the inspection of pot lucks, DeKalb County Animal Control being the dog’s best friend, a report on DeKalb County recycling rate, a composting workshop at the Center for Agriculture building, and a shoe drive by Genoa Middle School students marking Earth Day.

ADJOURNMENT

On a motion by Mr. Heinisch, seconded by Mrs. Fullerton, the Board of Health meeting adjourned at 9:02 p.m. Motion carried.

Carl Heinisch, Secretary

DeKalb County Board of Health