BOARD MEMBERS PRESENT: Russell Bishop, Psy.D.; Secretary; Julia Fullerton, J.D.; Jean Gastiger, R.N., F.N.P.; Carl Heinisch; John Olson, D.D.S.; Debra Schelkopf, D.V.M.; Steve Wolf, R.N., Vice President

BOARD MEMBERS ABSENT:  Steve Kuhn, P.A.-C., President; Mike Groark, J.D.; Mary Beth Shear, M.D.

MINUTES

On a motion by Mr. Heinisch, seconded by Dr. Olson, the minutes of the Board of Health meeting of May 24, 2005, were approved.  Motion carried. 

DIVISION REPORTS 

Mrs. Grush reported that most of the FY2006 grant awards have been received.  Most disappointing was that the $35,000 Teen Pregnancy Prevention Grant that the agency has received for the past 13 years was not received.  The grant was previously renewed automatically from year to year, but was put out for competitive bid this year as a part of the State’s MAX initiative.  The rationale for this was that the funding should be redirected to areas that are currently high in need.  Since the teen pregnancy rate in DeKalb County is low compared to many others, it was felt our agency did have many of the components the grant was requiring, thus we decided to complete the grant process.  Many previously funded agencies did not receive funding, and most of the money went to the Chicago area.  Mr. Heinisch asked how this would affect Health Department programming, and Mrs. Grush responded that this program would no longer continue.  Mr. Heinisch questioned whether we should utilize some of our fund balance to continue this program since it has been so beneficial.  Mrs. Grush reported that she had considered recommending this, but is not because this funding would probably never be received again by our agency and it is difficult to sustain new expenditures, especially since a deficit budget is being proposed this year.   Mrs. Zanellato and Mrs. Grush also considered a “train the trainer” program this year, but in all reality, teachers are already overburdened and it is not their responsibility to assume such a program.  Mr. Heinisch indicated that he feels this is a very good program and one for which he would support funding from the agency’s fund balance. 

The settlement of a 13 year old class action law suit will allow for better payments by the Illinois Department of Public Aid to physicians and dentists that accept Medicaid-eligible children.  Payment to a doctor for an initial checkup of a baby will increase from $42.45 to $91.90, and will also pay doctors a $30 bonus for each child who receives all required exams and immunizations in a given year.  Our agency has not received any Medicaid payments in any programs for six months.  Dental screening rates will increase similar to that of physicians.  Mrs. Grush reported that there are now organizations that have dental vans that travel the state to conduct checkups and these organizations will make substantial money.  The problem remains of lack of resources to refer those children needing follow-up care as Public Aid is not increasing restorative care rates but only screening rates.

At this time, Dr. Baumgart and Dr. Hawkins are the only two obstetricians available for Health Department referrals of pregnant women.  Mr. Wolf reported that he had heard that Dr. Baumgart was close to having another partner signed, and Mrs. Grush indicated that she heard Dr. Hawkins is pursuing a partner as well.  Dr. Baumgart’s partner that has been on maternity leave is scheduled to return to work in October.  Dr. Dubrick has resigned from DeKalb Clinic, effective December 2005, leaving only Kim Vittorio, a midwife, at that facility.  Mrs. Grush reported that staff from Provena of Aurora visited Mrs. Lux and her and indicated that they want OB patients and that they have physicians available.  Mrs. Grush stated that our loyalty, at this time, is to Dr. Baumgart and Dr. Hawkins, but if we get into a situation where they cannot take any more patients, we may need to refer to Provena even though transportation is always a concern for our clients.  She added that it is comforting to know that there are some options available since that impression was not received from Crusader Clinic in Rockford.

Mr. Heinisch asked if the air conditioning system was past warranty, and Mrs. Grush indicated that it was, but that the problem with the compressors is a manufacturing problem.  All have now been replaced, and the new ones are being made differently

The legislature passed a bill of medical malpractice reform, including a negotiated package of judicial, medical discipline, and insurance regulation reform, however, the Governor has not yet signed this into law.  Mr. Wolf reported that the Wisconsin Supreme Court ruled their malpractice legislation, in regards to limitations on pain and suffering reimbursement, as unconstitutional last week. 

Mr. Drake, Director of Environmental Health, reported that his staff will begin checking catch basins in municipalities for mosquitoes next week.   There is an oil recycling event scheduled for this Saturday, July 30, at the Health Department from 8 a.m. to 12:00 noon.  Mr. Wolf noted that Mrs. Dashney, Solid Waste Management coordinator, is leaving her position.  Mr. Drake stated that this was the second hire for Mrs. Dashney, and she is leaving in the middle of August to go to nursing school. 

Mrs. Lux, Director of Personal Health Services, pointed out that there were 20 more pregnant women this year as compared to last year at this time, and she is hopeful that the new physicians will be on board by the time these clients are ready to deliver.

Mr. Wolf noted the increase in the number of Menactra vaccinations given.  Mrs. Carroll, Communicable Disease coordinator, stated that she believes this increase is due to the publicity of the vaccine and acceptance of the vaccine by ACIP guidelines for all entry college bound students.  Mrs. Lux added that the agency would also begin giving this vaccine to younger children.  Mrs. Gastiger noted the decrease in the statistics of sexually transmitted diseases from May to June and attributed this to students leaving town at the end of the NIU school year.

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Mrs. Baj, Director of Home Care, reported that two new full-time nurses were hired in May.  The position of occupational therapist has not been filled, and no responses to advertisements have been received.  The Medical Social Worker that has contracted with the agency for seven years has recently resigned, which has been a loss.  Family Service Agency is hoping to have a replacement by September 2005.  Mrs. Grush feels confident that this position could be filled if advertised. 

Mrs. Grush reported that four meetings have been held with Wold Architects and Engineers regarding the new Home Care building.  A considerable amount of work has been done in gathering information for Wold in their preparation of a proposal.  This should be an agenda item at our September 2005 Board of Health meeting.   Mr. Wolf asked if the visit to Spring Valley was helpful, and Mrs. Grush reported that something is always learned from site visits although that facility is much smaller than ours would be and of residential construction quality. 

Mrs. Zanellato pointed out the Postponing Sexual Involvement year-end evaluation in the packet.  Nancy Bogle, part-time health educator, works with this program and has done some revitalization of it with the five schools involved. Letters will be sent to the schools regarding the discontinuation of funding for the program.  The program is in the third year of a three-year grant for the Comprehensive School Health Education and Services Grant, and we are confident the grant will continue for a fourth year.  Mrs. Grush indicated that the full-time health educator that recently resigned would not be replaced, and the two part-time health educators would each assume an increase of one day per week for the Tobacco-free Communities Grant and Comprehensive School Grant.  The program also has limited hours of a part-time Hispanic NIU student.  Mr. Wolf questioned the percentage of the Health Education programs that were covered by grants, and Mrs. Grush responded that it was 100%.

Mr. Wolf noted that there are now 75 smoke-free restaurants in DeKalb County.  Mrs. Zanellato reported that there have not been any additional facilities reported in the past two months, but feels they will be coming soon as the idea has gained momentum.  Mrs. Grush indicated that the House and Senate has passed legislation opening up the ban on smoking in public areas to all other communities not originally covered under existing resolutions, but the Governor has not yet signed the Bill.  The proposed legislation for a ban on smoking in public places did not pass the Sycamore City Council.  The local coalition will most likely still pursue the ban for DeKalb, but are waiting for the new mayor to take office.  Mrs. Gastiger noted that New York City has had this legislation in place for years, and it has been shown that business actually improved.  Mrs. Grush stated that a Letter to the Editor in tonight’s paper suggested a referendum so the citizens can decide on the issue. 

FINANCIAL DATA    

The Illinois Department of Public Aid is six months behind on their payments to the agency, and the State is behind on their grant payments.  Mr. Heinisch pointed out that the agency does, in spite of these late payments, have a positive cash flow.

On a motion by Mr. Heinisch, seconded by Mrs. Fullerton, the Financial Statements for the months of May and June 2005 and the Claims for the months of June and July 2005 were approved.  Motion carried.

NEW BUSINESS

FY2006 Budget

Health Department 

Mrs. Grush stated that the Health Department Budget would need to be submitted to the County by August 5, 2005, at which time they will begin their budget process.  Funding recommendations for budgets will be made at the Finance Committee meeting in September. 

Mrs. Grush presented 2006 Proposed Program Fees for the Health Department.  She is recommending that one-year registrations in Animal Control increase from $11 to $12 (last raised in December 2004) and three-year registrations (last raised in 2001) from $27 to $30, generating an additional $13,500.  Food sanitation permits would increase as follows: Class A from $345 to $360, Class B from $225 to $230, Class C from $115 to $120, Class D from $90 to $95, and Class E from $65 to $70.  Plan Review – New Restaurant would increase from $215 to $220 and Plan Review - Established Restaurants from $110 to $115.  These increases would generate $3,000.  Well Inspection and Water Test would increase from $110 to $115, Water Sample Test from $30 to $35 and Water Sample with Collection from $50 to $60, generating $600.  The Septic Installer License would increase from $115 to $120, Septic Permit – Established from $180 to $185, Septic Permit – New from $250 to $255, and Septic Inspection from $100 to $105, generating $1,300 in additional revenue.  Increases in adult immunizations are still being considered, and other health departments have been requested for their fees in this program.  Family Planning fees are set by the State and will be effective July 1, 2006.  An increase, generating $9,000, in Vital Records is being requested with the first copy of a death certificate remaining at $14 and additional copies increasing from $5 to $7 each.  A surcharge of $2 for each death certificate issued is sent to the State so does not affect agency revenue. 

Mrs. Grush reported that a new Bill has been proposed in Animal Control where the agency would collect an extra $25 for every unaltered dog, with that forwarded to the State and no additional revenue for the Health Department. 

Mrs. Grush presented the 2006 Health Department Budget, revenue and expenses, which shows FY2003 Actual, FY2004 Actual, Board Adopted FY2005, 6 Months Actual FY2005, 12 Months Projected FY2005 and the Department Request FY2006.  The budget is an estimation of what has been received to date, what has been received or spent in the first six months of this year as compared to last year, and what is expected to be received before December 1, 2005. 

Under Revenue, Mrs. Grush explained that the most the County can levy for the Health Department under Property Tax is .0232 cents per $100 of assessed valuation.  Right now, the county is at $1.6 billion assessed valuation, which means the County can levy up to $371,200 on behalf of Public Health.  There will be some increase in Animal Control revenue with the proposed increase in fees.  Well permits are up and septic permits are down.  The increase in the Planning Preparedness Grant (Bioterrorism) was due to a second supplemental funding in the amount of $33,000 from the State during the 2005 grant year.  Grants remained the same again this year.  There was a decrease in Account 4609, Flu Shots, because of the unavailability of vaccine as compared to previous years.  Revenues will be $5,414,100 and $5,534,300, a 2.6% increase over budgeted and 2.2% increase over projected.

Personnel is obviously the largest expense for the agency.  Salaries will be down somewhat this year because of the elimination of the health educator position, reducing one day of a staff person in Environmental Health and some of our part-time staff hours being reduced.  The Salary line item is based on a 3% COLA in December 2005 and 0-2 % merit in the Spring of 2006.  Historically, the Health Department follows the County’s lead in terms of non-union salaries.  The 3% COLA will cost the agency approximately $90,600 and the 2% mid-year increase would be an additional $60,200.  The next biggest expenditure is health insurance, which is increasing from $386,000 to $494,000, if there is only a 15% increase, which is what the County is advising departments to budget.  The County pays 75% of the premium and the employee pays 25%.  Dr. Olson asked if there were a trend in other counties regarding insurance increases.  Mrs. Grush responded that many organizations are requiring higher deductibles.  The AFCSME union settled for a 15% cap on insurance increases, but they will only receive a 3% increase and no mid-year raise.  She pointed out that IMRF is also increasing.  For years, IMRF was at 6%, but because of years of not making much on investments, it is necessary to increase the rate to 8%.  Therefore, the County has opted for IMRF increases by ½% every year until reaching 8%.  This year, the rate will be 7% and next year 7½%.  Another line item of note is Special Projects, which is the Insight Program for Home Care that would help the program manage the data better.  The program is not ready yet, but should be available next year.  It was included in this year’s budget, but is now being budgeted in 2006.  An Animal Control truck is also included in the FY2006 budget, at a cost of $17,000.  This vehicle would be replaced at the end of 2006 when it is projected to have 160,000 miles on it.  $5,709,700 is being budgeted for Expenditures, an increase of 6.5% over projected FY2005 expenditures.

Mrs. Grush presented the FY2006 County Request, which includes $371,200 from the Public Health Levy, $291,500 for IMRF and Social Security from the Tort Fund, $20,100 from the General Fund for Animal Control, and $170,300 from the Public Building Commission (PBC) for building expenses, for a total of $853,100, an increase over FY2005 of 6.6%.

The FY2006 Budget Summary was presented.  FY2005 started with a Fund Balance of $2,922,091and the projected Fund Balance for FY2005 is $2,993,569.  Mrs. Grush pointed out that a deficit budget was presented for FY2005 in the amount of $75,000, but this was made up throughout the year.  She is recommending that $100,000 be added to our Building Fund, making it $1.3 million.  A Fund Balance for FY2006 is being projected at $2,818,169, with $1,518,169 in unrestricted funds.  Mrs. Grush reported that, of the unrestricted funds, approximately $600,000 to $700,000 is accounts receivable and cash flow.  Actual cash-on-hand runs around $900,000 for unrestricted funds.  Mrs. Grush projected that building expenses will increase for the new Home Care building and that is a part of the reason for a reserve.  Mrs. Gastiger asked what Mrs. Grush’s thoughts were for the future.  She responded that revenues are not increasing at the rate of expenditures and health insurance is the biggest concern at this time.

Mrs. Grush explained that this budget may be changed following recommendations of the County.

Solid Waste Budget

Mrs. Grush stated that the Solid Waste Management Program is funded solely by tipping fees at $1.10 per ton.  She is recommending reducing the full-time coordinator position to a three day a week position.  With that reduction in staff, annual activities will continue, those being oil recycling events and a day for hazardous waste recycling, which has already been requested from the EPA with $15,000 built into the budget for such an event.  $15,000 has also been built into the budget to offer grants to businesses to conduct recycling projects.  Mrs. Dashney has been working with Dimco regarding electronics recycling, and Solid Waste would support this by paying for some of their advertising costs in implementing such a program. 

On a motion by Mrs. Fullerton, seconded by Mrs. Gastiger, the FY2006 Budgets for the Health Department and Solid Waste Management Program were approved.  On a roll call vote, those voting yes included Dr. Bishop, Mrs. Fullerton, Mrs. Gastiger, Mr. Heinisch, Dr. Olson, Dr. Schelkopf and Mr. Wolf.  Motion carried.

Personnel

Change Home Care Team Leader Classification from Salaried to Hourly

At the last Board of Health meeting, Mrs. Grush requested a change in the Team Leader classification from hourly to salaried.  She is now requesting to rescind that recommendation because of problems in compensation for the staff in this position since they must also provide direct patient care in the absence of adequate nursing staff. 

Additions: Licensed Environmental Health Practitioner Classification

With the departure of Patricia Dashney, Mrs. Grush is requesting a reorganization of the Environmental Health programs.  She is requesting the reduction of the full-time Solid Waste Program coordinator to three days per week, with this position filled by a Licensed Environmental Health Practitioner.  The other two days for this full-time person would be in Environmental Health, assuming responsibility for the Food Program and assisting with other Environmental Health programs.  Christel Springmire, a sanitarian with over 11 years of experience with our agency, has agreed to assume this position.  A job classification for the Licensed Environmental Health Practitioner was presented.

Mrs. Grush indicated that Mrs. Dashney would remain on staff on a part-time basis up to two days per week in the Environmental Health Division, primarily to conduct food inspections. 

Mr. Heinisch made a motion to accept the proposed personnel changes in the Team Leader position and Environmental Health staff changes, seconded by Dr. Bishop.  Motion carried.

Home Care: Policy Notice of Medicare Provider Non-coverage and Expedited Appeal Process

Mrs. Grush presented a new policy required by the Federal Government in regards to the notification of Medicare patients with a Notice of Medicare Provider Non-coverage at least two days in advance of agency discharge, effective July 1, 2005.  If the patient does not agree with their discharge, there is an appeal process outlined in which they can appeal the decision. 

Mrs. Gastiger moved to approve the Home Care Policy, Notice of Medicare Provider Non-coverage and Expedited Appeal Process, seconded by Dr. Schelkopf.  Motion carried.

Personnel Policy Revision – Health Insurance 

At the January 2005 Board of Health meeting, a change was made to the Personnel Policies in the Health Insurance area allowing part-time staff that work 30 hours or more a week to be eligible for health insurance coverage.  The employee would pay 80% of the premium and the County would pay 20%.  This policy is being changed to note that part-time staff that are eligible for health insurance are not eligible for the buyout.

On a motion by Dr. Bishop, seconded by Mrs. Gastiger, the proposed revision to the Personnel Policies in the area of Health Insurance was approved.  Motion carried.

Mrs. Grush stated that the Nominating Committee is searching for a replacement for Dr. Lane, and a couple of names have been submitted for consideration.  She indicated that this would be an agenda item at the September meeting.

CORRESPONDENCE AND ANNOUNCEMENTS 

Correspondence for the months of May and June included a letter of resignation from Jauna Royal, contracted nurse practitioner in Family Planning and Pediatric Services, as a result of a move out of state and thank you notes to Home Care staff from patients expressing their gratitude for the care provided to them.

Newspaper articles included the decline in the number of physicians in the area, cases of rabies in DeKalb County in a skunk and a bat, West Nile virus found in a dead crow in Sycamore, information on the prevention of West Nile virus, a health clinic to be held at the Farm Bureau on June 23, pap and mammogram tests offered by the Health Department for low-income women in the county, the lack of public health workers in the event of a bioterrorism event, tire collection on the 9^th of June, used oil collection on July 30, a Latina Mother Daughter Night presented by the “Future is Ours” program, and a career night on the 20^th of May with area Latina professionals for the purpose of increasing the awareness of career opportunities for participants and their families.

ADJOURNMENT 

On a motion by Dr. Bishop, seconded by Mrs. Gastiger , the Board of Health meeting adjourned at 8:45 p.m.  Motion carried.

Russell Bishop, Psy.D., Secretary

DeKalb County Board of Health