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DeKalb County, Illinois |
Minutes of the
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BOARD
MEMBERS PRESENT: Fred Peltz, D.D.S.,
President; Katy Eaton, F.N.P., Vice President; Glenda Pecka, R.N., M.S.,
Secretary; Sonja Conway; Carl Heinisch; Steve Kuhn, P.A.
BOARD
MEMBERS ABSENT: Mike Groark, J.D.; Photine Liakos, M.D.; Joe Seneczko, D.V.M.;
Brazilian Thurman, M.S.W.; Darrell Wiley, M.D.
Mrs.
Eaton moved to approve the Board of Health minutes of March 27, 2001, seconded
by Ms. Conway. Motion carried.
The
County’s FY 2000 audit, completed by Sikich, Gardner and Co., is in the final
stages of closure. Because the
FY2000 Medicare Cost Report has not yet been completed and a payback is
anticipated, this audit will not reflect an accurate revenue and fund balance
figure.
Medicare
is being billed by the Home Care Program, but it is difficult to understand the
reimbursement by the Prospective Payment System (PPS) and changes in the payment
rates. Mrs. Grush pointed out that
the reason for the potential FY2000 liability is that payment from Medicare in
2000 was based on the FY99 rate when there were many one-time expenses moving
into the new building. She added
that there have been some increased expenses this year, but not as much as in
1999.
Problems
are anticipated again this year in receiving flu vaccine.
Only one manufacturer (Aventis Pasteur, Inc.) issued a bid for the
vaccine with the Illinois Public Health Association with no guaranteed delivery
date. In addition, unused vaccine
cannot be returned and syringes will be provided as in the past.
A vial of vaccine this year will cost $4.75 per dose as compared to $2.35
last year and $7.25 per dose for prefilled syringes as compared to $4.05 last
year.
The
Health Department continues to have what seems to be an overabundance of state
auditors. In March, a Department of
Human Services (DHS) auditor conducted an on-site review and analyses of the
organization’s fiscal and administrative policies, procedures and records to
assure that a proper accounting system is maintained. Also in March, a DHS regional representative conducted the
Family Case Management recertification audit of all cost documentation reports,
reimbursement certification reports and staff and agency operating expense
reports.
The
agency continues to experience staffing concerns. Home Care has been unable to hire very little staff, and for
the first time, have had to deny referrals except for two or three patients
known to be short-term. The Home
Care Program has one nurse on maternity leave, one who had surgery today and one
whose husband had surgery last week. The
decision was made last Thursday to not accept patients because the agency did
not feel it had nurses to provide adequate care. Referral sources were called and advised that the program
would be operating on a day-to-day basis and not taking new referrals until a
current patient was discharged from service.
Four nurses have interviewed, but all have declined the position for a
variety of reasons.
Mrs.
Eaton asked what happens with the patients when referrals are not accepted.
Mrs. Baj responded that current staff is only able to serve the patients
presently open, and as patients are discharged or the needs of the current
patients change, new patients will once again be accepted.
She added that staffing in the summer is always difficult, and a couple
of part-time nurses have indicated they will work extra time this summer.
Mr. Kuhn pointed out that the community does rely on this program for
home care as there are no other local providers.
As this is the agency’s largest revenue-generating program, he feels
the Board should express their concern at this situation and monitor it closely.
Mrs. Grush agreed with Mr. Kuhn, but feels it is better to not accept
patients than to not be able to provide quality care.
An
interesting article from J.A.M.A., “Current and Future Public Health
Challenges,” was shared with the Board and presents ten issues facing public
health in the next century.
Mr.
Drake, Director of Environmental Health, reported that the Environmental Health
Program is beginning the licensing of food service establishments in June.
Mrs.
Lux, Director of the Personal Health Services Division, presented a flyer for
the Illinois Breast and Cervical Cancer Program, with screening beginning this
week. She pointed out that a great
deal of time has been invested in collaborating with area providers in referring
women to the program. The grant
period is from October 1, 2001, through September 30, 2002. DeKalb County’s caseload is 50 women, and it is hoped that
screenings will be done this summer with follow-up in the fall.
She added that there is a Bill awaiting signature on the Governor’s
desk allowing women that are on Medicaid in this program to be treated.
Mrs.
Lux stated that, unlike Home Care, her staff has been stable for a number of
years, but she has recently had a couple staff leave and has not had any
qualified applicants.
Mr.
Kuhn noted that the Family Case Management Program is gradually closing out the
majority of children over 1 year of age, and asked if the agency could continue
to provide services to these families since research indicates a long-term
relationship yields the most positive results.
Mrs. Lux responded that the agency is already subsidizing this program by
quite a bit. Mrs. Grush stated this
is the most costly program in the agency with approximately $200,000 received in
grant moneys and the overall cost at around $400,000.
She added that the program was implemented in 1994 and is the one grant
in the state that has proven to be of value in reducing infant mortality and
having healthier babies, yet has never received an increase in funding.
Agency administrators in the state worked very hard last year at lobbying
for an increase, but no additional funding was received; however, the State has
finally acknowledged that they are aware of this situation.
Mrs. Grush stated that a high-risk child over the age of 1 would be
retained on the program since the value of a long-term relationship with the
nurse is known. Mrs. Lux added that the State has asked the agency to
continue serving these children with local funding.
Mrs.
Grush reported that she feels very comfortable with the FY2001 Budget despite
the expected substantial payback to Medicare.
Mr.
Heinisch moved to approve the Financial Statements for the months of March and
April 2001 and the Claims for the months of April and May 2001, seconded by Mr.
Kuhn. Motion carried.
Mrs.
Grush reported that there were a couple of emergencies this year, resulting in
overspending in the Office Furniture and Small Equipment line.
Cubicles were added at Home Care and computer problems were experienced
and it was also necessary to purchase a new file server, all unanticipated at
budget time. The budgeted amount in
this line item is $10,000, but $19,000 has been spent to date.
Mrs.
Grush stated that the agency is now in a situation where three of the four
agency copiers are very old. One of
the copiers was donated to the agency, and supplies for all three of these
machines are very costly. Current
cost per copy is 2.5 cents. By
purchasing two new copiers, $2,506 would be saved per year or $12,979 over a
span of nine years (length of time the agency has owned these copiers).
Mr.
Kuhn moved to approve the purchase of two new Sharp copiers, seconded by Mrs.
Pecka. Motion carried.
Mrs.
Grush stated that she asked Dr. Palmer, Animal Control Administrator, and Dan
Berres, Animal Control Officer, to attend this meeting with the anticipated
discussion of the TAILS vision.
Mrs.
Grush presented an outline for Board of Health discussion regarding endorsement
of the TAILS vision. The ultimate
question is if the Board would support a community-owned multi-purpose
state-of-the-art animal control center for DeKalb County through a
public/private partnership, that being the County/TAILS.
She reviewed the proposed services to be provided by the TAILS
organization and the sources of funding to provide the services.
Mrs. Grush presented a preliminary budget of the revenue that she feels
would be needed to fund such a center. She
took the County’s Animal Control Program budget, as well as Rockford’s
budget (of which DeKalb County is about one-third the size) into consideration
for the estimates. She feels the actual costs would be around $500,000 per year
and feels that the TAILS plan for three wardens for the level of service desired
is very slim for 24 hour a day, 7 day a week coverage.
Mrs.
Grush calculated options for funding of the center. Current registration tags for DeKalb County are $10.25 for a
one-year tag and $27 for a 3-year tag. Many
communities charge more for dogs and cats that are not altered and that was
built into the proposal. She
assumed cat registration at 50 percent of the dog population since Rockford and
MacLean County are at 40 percent cats as compared to dogs.
She pointed out that the TAILS information was based on 14,000 dogs and
the same number of cats. Mrs. Grush pointed out that the current program currently
registers 10,000 dogs and feels it would be pushing it to register 14,000 dogs.
In her opinion, there is no way that 10,000 cats could be registered.
If the fees were $10.25 for a one-year and $27 for a three-year for
altered animals and $15 for a one-year and $37 for a three-year for unaltered,
approximately $200,000 would be received. To
generate an additional $100,000, fees would need to be raised to $15 for a
one-year and $40 for altered and $22 and $55 for unaltered dogs.
Mrs. Grush stated she feels the center would require
$500,000 at a minimum to operate. She
presented a chart demonstrating the payments municipalities would need to make
in order to generate $100,000 in revenue. She
reviewed the revenue sources as $205,000 from registrations, $100,000 from
municipal contracts, $20,000 in boarding fees, $40,000 for the adoption of
animals, and $30,000 from donations, for a total of $395,000.
Should the cost of the tags be increased, $305,000 would be realized from
registrations generating $495,000. She
feels the success of the center would depend on the revenue generated from both
dogs and cats being vaccinated, municipal contracts, adoptions and donations.
The program would have to be scaled back without one of these revenue
sources or a substitute source of revenue created to support the program.
Dr.
Palmer stated that county government will need additional holding runs, given
the growth in the county. He stated
that his shelter operates at maximum. He
explained that an animal is euthanized after seven days of being boarded if it
is not claimed or is unadoptable or it is sent to the current shelter.
He added that he is not ready to endorse the TAILS concept because of
some specific concerns. Mrs. Grush
explained that the county built the shelter in Rockford, the director is a
department head, and the county department operates the shelter.
She added that the Rockford program recommends that a shelter like TAILS
be owned by the county because it operates by the law rather than being run on
emotions. She pointed out that
there are other places that have shelters run by organizations and the county
uses them only to board strays that are strictly within the rabies control
realm. Mrs. Grush feels this will
be a difficult decision that cannot be made at this meeting.
She feels the County would say that funding for such a facility would
need to be taken from other county departments due to the tax cap.
Mr.
Heinisch asked if Mrs. Grush was indicating, in her proposed budget, that the
program could sustain itself if the buildings were paid for.
Mrs. Grush stated that she feels it could sustain itself, in time, but
12,000 to 14,000 dogs and 5,000 to 6,000 cats will not be registered at the time
the facility opens. She added that getting cats vaccinated would be difficult
since owners will not be in favor of that.
In addition, the States’ Attorney’s office will not want to prosecute
cat owners.
Mr.
Berres asked if the TAILS proposal could be scaled down, and stated he does not
see the county becoming involved in the wildlife arena.
He pointed out that no revenue is received from wildlife and different
permits, training and equipment are required.
In addition, there is the problem of where to release the wildlife.
He feels there are enough services in the private sector to operate this
aspect of the program.
Mrs.
Grush stated that the selling point is that this would be a better center for
animal control services in the county. At
any given time, the facility would have two wardens working, and with the size
of DeKalb County, it is time-consuming to pick up dogs.
She added that the current Animal Control Program does need more warden
and secretarial time, and even with two wardens, it may still not be at the
level of service people desire. Mrs.
Grush stated that she agrees with Mr. Berres that there is no way the program
can become involved in the wildlife aspect, and it must be kept in mind that the
responsibility of county government is rabies control and stray dogs.
She stated that the registration of cats would generate additional
revenue in the program, and added that it is not the responsibility of
government to pick up wildlife unless they pose a public health threat.
Dr.
Peltz asked if cats were a threat to public health. Ms. Conway stated that cats have more contact with wildlife
and could be rabid. Mrs. Grush
stated that she is under the impression that Dr. Seneczko feels cats should be
vaccinated. Dr. Balster feels it is
not generally necessary to inoculate a house cat, but an outside cat should be
vaccinated. Dr. Palmer stated that
the registration of cats in a farming community is an unenforceable law.
He added that one of the opinions on the vaccination of house cats is
because bats can get into a house once in a while and bite the cat.
While this is a rare occurrence, it has happened in Rockford in the past
couple years.
Dr.
Palmer stated he has not had any cats test positive for rabies, but a few have
had to be vaccinated. Mrs. Grush
stated that, occasionally, a child will be bitten by a wild cat that can’t be
caught and will have to receive the rabies series.
Dr. Palmer also recommends vaccination of outside cats, but not indoor
cats. He stated that sometimes the
transfer of rabies is related to the habits of animals, and that is why cats are
at a higher number than dogs. He
does not feel that this law is enforceable in this county and that there should
not be a law that cannot be enforced. Mr.
Drake said that cats would need to be micro-chipped if they were vaccinated.
Dr. Palmer stated that his cost for a chip is $17.75 each.
Mrs. Grush stated this does get costly on top of the vaccination and
registration fee. Dr. Palmer
charges $25 for micro-chipping cats, and added that the USDA would like to chip
farm animals so they can trace activities in concerns about foot and mouth
disease. Mr. Kuhn stated that it
costs $40 to $50 to take his cat to the veterinarian once a year.
Mr.
Kuhn stated there is a lot of emotion on the side of TAILS and asked if the
current shelter is adequate. Mr.
Berres stated that it is in the process of being upgraded, but it is not a
state-of-the-art facility. Mrs.
Grush stated that the shelter operates with a board of directors, and it is her
understanding, a relative of the current owner plans to continue the shelter
should the current owner be unable to do so.
Dr. Palmer stated that the county would most likely want a separate
organization from the current facility. He
stated that his facility boards dogs for seven days and adopts them out, if
possible, but the shelter will keep them for a greater length of time.
Mr.
Drake stated that the Animal Control Program does have needs, adding that more
dogs could be picked up if wardens were available to patrol in the evening.
He added that TAILS is right when they say that people are demanding more
services of the program than current staff is able to provide.
If the program had two wardens on board, another six dog runs would be
necessary immediately. He added
that the registration of cats may eventually become a state law, but currently,
it is only a recommendation.
Mrs.
Eaton asked if the proposal could be modified.
Mrs. Grush responded that the Board of Health would need to state what
they support and endorse. She added
that some County Board members feel strongly about not putting taxpayer money
into such a program. Animal Control
is a public health issue and a law, but to what extent and how much county
revenue go into it are other issues. This
Board can voice support of the issue and state that more needs to be done, but
must also be prepared to show how the program will be funded.
She stated that registration of cats is a revenue-generating means there
is a limit to how much can be generated with dog registrations alone.
Mr.
Heinisch stated that he was contacted after the last board meeting by residents
who were strongly opposed to general property taxes going into this project.
He feels it goes back to “user pay,” and pointed out that one source
of revenue not mentioned is a sales tax on pet supplies.
Mr. Heinisch feels that, as the community grows, there is a need and he
is not opposed to the county being involved, but does feel very strongly, as
does a segment of the community, that it should not be a general tax liability
in the community.
Ms.
Conway stated that there is a difference in rehabilitating wildlife and picking
up animals that could be dangerous. Mrs. Grush agreed and stated that she did
not include the cost of rehabilitating a wild animal, but she was able to
estimate the cost of the dog portion of the proposal. Mr. Heinisch felt the board could respond in regards to the
animal problems, but not the education or wildlife portions.
Mrs. Grush stated she was not sure the county should be involved in the
adoption of cats and dogs. She
feels that the Animal Control officer should be enforcing the current laws, with
a humane society providing other portions of the proposal.
Ms.
Conway asked how a humane society functioned differently.
Mrs. Grush responded that humane societies are generally supported by
adoption fees and donations with no time limits on keeping the animals.
Dr.
Peltz asked if Mr. Berres responds to all animal problems.
Mr. Drake stated that the program would need to be subsidized with tax
dollars and need additional staff to respond to all animal problems.
Mrs. Grush stated the police do not want to become involved, but when it
is a municipality violation, they are the ones that are often called.
If a call is received that a resident has a raccoon in their chimney,
that call is referred to a wildlife trapper.
However, if there is a raccoon around a house acting strangely, we would
respond to it. She stated that,
while there is public health significance in the example of the raccoon in the
chimney, in that it could be rabid, the program does not have the staff to do
provide this service.
Mr.
Kuhn asked how many wildlife trappers there are in the area.
Mr. Berres responded that three individuals hold permits.
Mr. Drake stated that he would like to have another warden and a
full-time secretary in the program, with patrolling in the evening, and six more
runs to be able to respond in the evenings.
Dr.
Peltz asked what services TAILS proposes that we, as a county health department,
could support in asking for endorsement with the County Board through the Board
of Health. He feels that what
should be done is a statement of services that should be provided with projected
costs and anticipated revenue. Mr.
Drake pointed out that he does not see the County Board taking funding from
other county departments to fund this venture.
Dr. Palmer asked if he, Mrs. Grush, Mr. Berres and Mr. Drake should
present a list of services they view as needed.
Dr. Peltz feels this could be helpful, but for this evening, the issue
should either be tabled until further information is received or support
expressed for all or a part of the proposal.
Mr.
Heinisch stated that the issue needs to be addressed with the community
continuing to grow and change, and he does not wish to table the matter.
Mrs. Grush stated that her purpose for this meeting was discussion, and
she is sensing that some pieces of the proposal could be endorsed while others
should not be considered. She
stated the Board needs to remain within the realm of what must be done as a
government entity. She stated that
she, Dr. Palmer, Mr. Drake and Mr. Berres will prepare for the Board what they
feel the program as a government entity should provide.
On
a motion by Mr. Heinisch, seconded by Mrs. Pecka, the Board of Health entered
into executive session at 8:55 p.m. for the purpose of discussing the merit
evaluation of the public health administrator.
Those voting aye included Dr. Peltz, Mrs. Eaton, Mrs. Pecka, Mrs. Conway,
Mr. Heinisch, and Mr. Kuhn. Motion
carried.
At
9:05 p.m., the Board of Health entered into regular session on a motion by Mrs.
Pecka and seconded by Mr. Kuhn. Those
voting aye included Dr. Peltz, Mrs. Eaton, Mrs. Pecka, Mrs. Conway, Mr. Heinisch,
and Mr. Kuhn. Motion carried.
Mr.
Heinisch moved to approve a 3 percent merit increase for the public health
administrator, effective June 3, 2001, seconded by Mr. Kuhn.
Motion carried.
Newspaper
articles for the past two months included the election of Dr. Peltz as new Board
of Health president, the benefits to residents with public health improvements,
May as National High Blood Pressure Month, the topic of healthy eating for
National Nutrition Month, a live theatrical, educational production teaching
about recycling, a children’s screening held at the Health Department by the
local Shriners organization and the provision of tobacco vendor training by DCP/SAFE.
A certificate of appreciation was also received from DeKalb Community
School District #428 in recognition of the agency’s contribution and
distinguished service to the students and staff.
On
a motion by Mrs. Eaton, seconded by Mrs. Pecka, the Board of Health meeting
adjourned at 9:12 p.m. Motion
carried.
Glenda Pecka, R.N., M.S., Secretary
DeKalb County Board of Health
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