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

BOARD MEMBERS ABSENT: Julia Fullerton, J.D.; Mike Groark, J.D.; Debra Schelkopf, D.V.M.; Mary Beth Shear, M.D. 

MINUTES 

On a motion by Mr. Wolf, seconded by Mrs. Gastiger, the minutes of the Board of Health meeting of March 22, 2005, were approved.  Motion carried.  

DIVISION REPORTS 

Mrs. Grush reported that she had received the Medicare Cost Report for the Home Care Program from our consultants, Health Management Associates.  She presented a chart showing costs per the Medicare methodology and costs per the Health Department methodology.  The cost per visit including the special laptop project using the Medicare methodology was $140.07, while the Health Department methodology reflected a per visit cost of $127.10.  Without including the laptop project, the per visit costs were $132.10 and $119.12 respectively.  The average reimbursement for an insurance visit is $92.13 and for a Medicare visit through PPS is $142.59. 

The agency has started receiving notification of grant awards.  The Family Case Management Grant will decrease from $270,800 to $257,100, Vision and Hearing will increase to $20,100 (the first increase in five years) and the Tobacco Grant will remain the same at $30, 671.

Mrs. Grush reported on several building projects.  Pella was on-site for two weeks replacing defective windows in the Health Department and multipurpose room; the expansion of three offices was completed and the HIV Program has relocated to them; a sound system and Internet outlets have been installed in the multipurpose room; another air conditioner compressor has been installed at a replacement cost of $8,950; new furniture was purchased for the Director of Office Support; and reorganization of the storage and maintenance area is underway with new shelving being purchased.

Mr. Drake, Director of Environmental Health, reported on a skunk in Waterman that tested positive for rabies.  He indicated that the results were just received today at 4:30 p.m. and wardens are out going door-to-door at this time to determine any exposure by humans or pets.  Mr. Drake reported that the skunk was alive, aggressive and moving toward people when the warden apprehended it.

Mrs. Lux, Director of Personal Health Services, pointed out that the Communicable Disease Program always works closely with Animal Control when there is a positive rabies case.  She added that the extra publicity and concern this year is because rabies has affected terrestrial animals.  Previously, there was a positive rabies in a horse in LaSalle County and a cow in Bureau County that was purchased in LaSalle County. 

Mrs. Lux also reported on a foodborne outbreak that occurred in a group of middle school students that had participated in a track meet in Peoria and became ill after eating at a buffet.  Communicable Disease staff is working with Tazewell County on this issue.  19 of 27 families were interviewed, and stool specimens tested positive for the Norovirus. 

Mrs. Baj, Director of Home Care, reported that two full-time nurses were hired in May 2005.  She pointed out that orientation of nurses is very different now with the use of laptops and additional training required.  Mr. Wolf commended staff in the program on the findings of the review by the Illinois Department of Public Health (IDPH) surveyor team.  No findings or recommendations were major and the quality of care and compliance with the many federal and state regulations was considered to be excellent.

Mrs. Zanellato, Director of Health Education, reported on the staff training exercise on March 8 and 10, 2005, with a mock staging process at the Health Department and a walk-through of the NIU Convocation Center, the primary medication distribution site should a bioterrorism event occur.  There were 108 participants: 87 Health Department employees, 14 county department heads, and 7 visitors from IDPH and other health departments.  Evaluation results were exceptionally positive.

Mr. Kuhn stated that he did discuss involvement in a bioterrorism event with the Rotary Club, and they indicated an interest in helping.  Mrs. Zanellato reported that a graduate student from NIU will be with the agency throughout the summer developing a volunteer recruitment program that can be taken out to the community.   

FINANCIAL DATA 

On a motion by Mr. Heinisch, seconded by Dr. Bishop, the Financial Statements for the months of March and April 2005 and the Claims for the months of April and May 2005 were approved.  Motion carried. 

NEW BUSINESS 

Home Care Building  - Authorization to Employ Wold Architects and Engineers

Mrs. Grush reported that the Ad-Hoc Long-term Planning Committee met on May 20, 2005, to discuss plans for a new Home Care facility.  The committee consists of Mr. Heinisch, Mr. Kuhn and Mr. Wolf.   Information was presented to the board on the current space. The agency is paying for 4,656 sq. ft. at the current site, with 2,431 sq. ft. being shared space, which means that 7,087 sq. ft. would be needed if space were not being shared.  She would estimate approximately 10,000 sq. ft. would be needed for this building.

Mrs. Grush reported that there are three and one-half years left on the current lease.   A chart was presented showing the financial aspects of a new Home Care building, including the current least payment to Kishwaukee Community Hospital (KCH), additional costs of a new building and what would be needed annually to own or lease a building plus inflation.  She estimates a new building would cost an additional $100,000 per year and revenue needed for renewal and replacement. 

A letter from Wold Architects & Engineers was presented.  This is the firm that DeKalb County used for the Legislative Center, as well as a number of other projects.  The reason for using this firm is that they know the County systems and would use the same systems as are used in all the other County buildings, which is of extreme benefit to the County Facilities Department.  Wold is proposing a fee of $8,000 plus actual reimbursements to develop a program and space summary to determine the approximate size of the proposed building, to provide a square foot cost estimate based on current market trends and projects of a similar size, and review the DeKalb County Health Department site to determine the best location for the new facility.  Should we decide to use Wold as architects for the Home Care building, they will deduct 50% ($4,000) from the schematic design portion of the architectural fee.

A map of the Health Facilities subdivision was presented showing options for the site of the new facility. 

Mr. Heinisch moved, seconded by Dr. Olson, to hire Wold Architects & Engineers to develop a program and space summary, provide a square foot cost estimate, and make a determination on the best site for the facility, at a cost of $8,000. Motion carried.

Employee Compensation, Salary Adjustments and Classification Recommendations

Employee Compensation

Mrs. Grush reported that DeKalb County recently settled with the AFSCME that represents unionized non-Nursing Home County employees.  The settlement agreement calls for a 5.5% raise, effective December 1, 2004.  Subsequent years will give a 3%, 3% and 3.75% respectively with a 15% cap on health insurance.  Non-union employees in the county received a 1.9% raise, effective 12/1/04 and are slated to receive a 0 to 2% merit, effective 5/29/05.  The County, at its meeting on May 18, 2005, voted to increase this maximum merit to 3.6% for non-union county employees.  In addition, non-union employees will receive a one-time bonus of $165 to $660 based on hours worked, with the intent of increasing their salary by 5.5% annually.  All pay ranges will increase by 3.6%.

Mrs. Grush pointed out that Health Department employees received the following cost-of-living adjustments, effective December 1, 2004: 4.0% for Home Care nurses, 3.0% for Public Health Nurses and 1.9% for all other Health Department employees.  All employees are slated to receive a 0 to 2% merit increase on May 29, 2005. 

Mrs. Grush made the following recommendations: 0 to 2% increase for Home Health Nurses, 0 to 2.5% for Public Health Nurses and 0 to 3.6% for all other Health Department employees, increasing all hourly rates from the previous year up to 5.5% (6% for Home Health Nurses).  The Home Care Billing Coordinator and Speech Therapist are eligible for a 0 to 2% merit.  Since current salary ranges vary from 39 to 55%, Mrs. Grush is also recommending that salary ranges for non-nursing positions be set at 50% and 55% for nursing positions.  She did not recommend the one-time bonus of $165 to $660.

Salary Adjustments

The agency recently recruited for the Community Health Worker position, with a number of individuals applying.  The most qualified would not accept the position unless $9.70 an hour was offered, rather than the $8.95 allowed by existing policy.  Mrs. Grush requested authorization to increase the hourly rate for this individual to $9.70 per hour, which is still less than what the retiring individual was paid. 

Mrs. Grush is also requesting a 95˘ increase, after merit, in the salary of Erica Barnes, HIV Prevention Specialist.  This is a salary equity issue in comparison to the other Prevention Specialist position within the agency. 

A Team Leader from Home Care recently submitted her resignation letter, effective at the end of July.  At this time, Mrs. Grush is requesting the elimination of the Special Projects Coordinator and the addition of a Clinical Coordinator job classification.  This individual will continue to do the duties of the Special Projects Coordinator, and will also assume some administrative responsibilities, as well as supervise the team leaders.  A job description for the new position was presented, as well as a revised Home Care organizational chart.

Mrs. Grush pointed out that the Team Leader position has always been an hourly position, but she is recommending that the responsibilities associated with the team leader functions become salaried, with patient-related visit time paid or accrued as compensatory time in accordance with the agency’s overtime policy. 

Dr. Olson asked how a 5.5 to 6% increase compared with the private sector.  Mrs. Grush reported that the average raise in December 2004 for the private sector was 4.5 to 5%.  Mr. Wolf reported that the Kishwaukee Health System increase was 3.5%.  He asked if most of the employees receive the maximum merit increase, and Mrs. Grush responded that the majority of staff do.

Mr. Kuhn wondered if we would be faced with the same problem of increasing salaries again should the DeKalb County Rehabilitation and Nursing Center lobby and receive another increase.

Dr. Bishop asked what would happen if the increase was not approved.  Mrs. Grush responded that it would send a negative message to staff and encourage unionization. 

Mrs. Gastiger pointed out that attaining and maintaining staff has been a constant struggle since she joined the Board, and she feels that providing a wage adjustment similar to the unionization wage will help.  

Mr. Kuhn asked if a cap on insurance is expected.  Mrs. Grush responded that the County will address this in the coming budget months.

Mr. Wolf moved to accept all proposed personnel compensation, salary adjustments and classification recommendations, seconded by Mrs. Gastiger.  Motion carried. 

Updates 

Obstetric Referrals

Mrs. Grush reported that the departures of Dr. Hirsch and Dr. Lane from Kishwaukee Medical Associates, Ltd. (KMA) were announced at the last meeting, and DeKalb Clinic was concerned there would not be enough physicians to perform deliveries.  The Health Department has conducted a prenatal referral program for 20 years to distribute Public Aid patients evenly among county physicians and clinics.  The Family Case Management Program conducts intakes on 540 to 550 pregnant women per year and refers them to local physicians.  Of that number, approximately 75 will deliver elsewhere or miscarry.  One-half of the babies born in DeKalb County are on Public Aid and are referred to local physicians.

At a meeting in April with county representatives, this concern was discussed.  At that time, KMA was still delivering babies, and there were enough providers to deliver the babies.  A couple of weeks after this meeting, Dr. Thornton informed Mrs. Grush that KMA would not be doing deliveries after July 1, 2005.  Four of the family practice physicians at KMA were discontinuing deliveries because of liability issues.  The plan was to distribute their patients between Dr. Baumgart and DeKalb Clinic or anyone else requested by the patient. 

The following week, staff called in a referral to DeKalb Clinic and were told they would not take any more Health Department referrals, leaving us only Dr. Baumgart and Dr. Hawkins in Sandwich to refer to.   Dr. Chung is leaving the community and not renewing her contract, and Dr. Olofsson is pregnant with twins and on bed rest until October.  At this time, Dr. Baumgart is the only physician that will accept Health Department referrals.  This, however, because of the volume, is a very short-term resolution.  The malpractice issue is the main reason physicians are leaving the state or discontinuing the delivery of babies, with another concern being that Public Aid’s payments are so far behind that cash flow is an issue. Mrs. Grush reported that this is a huge concern to Dr. Baumgart.  At a visit last week with him, he indicated he was willing to take as many Public Aid referrals as possible and could hire a midwife, but he must be guaranteed payment from IPA within 60 days since that is 60% of his practice.  Mrs. Grush wondered if the hospital would be able to guarantee him cash flow while waiting for IPA payments in an effort to protect one of the few obstetricians left in the county. 

Mrs. Lux, Director of Personal Health Services, called surrounding counties to determine if they are experiencing the same problem.  The western counties did not report this as a problem.  Crusader Clinic in Rockford was not open to accepting referrals from our agency as they have recently also lost physicians.  They are in the process of recruiting another obstetrician.  A benefit for Crusader Clinic is that the malpractice insurance is paid for by the federal government and 55 physicians can be insured for $100,000. 

Mrs. Gastiger questioned the number of malpractice suits and pointed out that the largest malpractice carrier is a member of the Illinois Medical Association, which had a record profit last year.  She reported that payouts have not increased over the years.  Mrs. Grush stated that there are so many different fractions to the issue (lawyers, insurance companies and physicians) that it is hard to determine the problem. 

Mr. Kuhn reported that the group that covers KMA physicians would not insure family practice physicians that deliver babies.  He feels this crisis is driven by the insurance companies.

Mrs. Gastiger pointed out that statistics indicate that one-half of babies delivered are on Public Aid.  That number used to be one-third and it is one-third nationally.  Mrs. Grush pointed out that part of the reason is the high infant mortality rate.  Over the last ten years, work has been done to ensure prenatal care for all pregnant women, which has increased coverage.  Mrs. Gastiger asked if there were fewer insured women, and Mrs. Grush responded that there were, as well as increased income eligibility under IPA.  Another concern is that students are dropping their school insurance and being covered under IPA as it is less out of pocket expense for them. 

In the meantime, a trustee of the Illinois State Medical Society (ISMS) connected with Mrs. Grush and she explained DeKalb County’s issue.  She learned that there is a division within ISMS that deals with IPA reimbursement and they will work towards getting reimbursement for Dr. Baumgart.  In a recent teleconference, she learned that there are three IPA staff to deal with 40,000 providers in answering billing questions. 

Mrs. Gastiger asked if the federal budget included a cut in Medicaid.  Mrs. Grush responded that the budget is always trying to push more on the states. 

Mrs. Grush stated that Dr. Baumgart indicated that, once Dr. Olofsson returns and perhaps adding a midwife and with Dr. Dubrick and Dr. Hawkins, there should be enough physicians to deliver DeKalb County babies, but all IPA referrals cannot be made to one physician.

Mr. Heinisch asked if the hospitals were equally affected by the malpractice insurance crisis.  Mr. Wolf responded that he did not know the amount of the increase in malpractice insurance for hospitals, but knows that they are not getting the publicity that private physicians are. 

Mr. Wolf wondered what Representative Pritchard was saying on the topic.  Mrs. Grush reported that there does not seem to be any movement on the issue at this time.  It is anticipated that rates will remain the same, and the physicians that have left will not return. 

School Dental Exam Requirements

A meeting was held with Dr. Curtis (president of the local Dental Society), Dr. Olson, school nurses from Sandwich, DeKalb and Sycamore, Jane Lux, Peggy Newby (Pediatric Services coordinator) and Mrs. Grush.  The Health Department volunteered to provide space and some staffing for screenings if dentists wanted to volunteer some time from January through April.  Dr. Curtis did feel he could recruit some dentists for such an effort, but wondered what would be done when a chid required a lot of follow-up care.  He suggested requesting grant money from the DeKalb County Community Foundation for the purpose of referring children to an oral surgeon. 

Mrs. Grush is also exploring the possibility of a dental van that goes to schools that do the sealant program, which counts as an exam.  Sandwich has a van booked for this program.  Mrs. Grush reported that she is looking into this, and feels that there has been a good effort on everybody’s part to do something towards this issue. 

Recognition of Dr. Rosemary Lane – Resignation from Board of Health

Mrs. Grush presented Dr. Lane with a gift card as she has resigned from the Board of Health due to a move out of state.  She thanked her for her service to the Board.  Mr. Kuhn was especially appreciative of the historical aspect Dr. Lane was able to provide. 

Executive Session – Evaluation of Public Health Administrator 

Mr. Wolf moved that the Board of Health enter into executive session at 8:55 p.m. for the purpose of discussion of the evaluation of the Public Health Administrator.  Mr. Heinisch seconded.  On a roll call vote, those voting aye included Mr. Kuhn, Dr. Bishop, Mrs. Gastiger, Mr. Heinisch, Dr. Lane, Dr. Olson, and Mr. Wolf.  Motion carried.

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

Mr. Heinisch made a motion to provide a merit increase of 3.6% for the Public Health Administrator, seconded by Dr. Lane.  Motion carried. 

CORRESPONDENCE AND ANNOUNCEMENTS 

Newspaper articles for the months of May and June included information on the number of physicians leaving the area, maternal lessons at a childbearing education class through Kishwaukee Community Hospital and the Health Department, “The Future is Ours,” Teen Pregnancy Prevention Month, the elimination of rubella in the United States, raising the awareness of child abuse, Cervical Health Awareness Month, Hazardous Waste Collection on May 21, recycling of electronic equipment, exceeding of recycling standards by DeKalb County, and Animal Control officers and residents assisting an owl stuck in a net. 

ADJOURNMENT 

On a motion by Mr. Heinisch, seconded by Mrs. Gastiger, the Board of Health meeting adjourned at 9:10 p.m.  Motion carried.

Russell Bishop, Psy.D., Secretary

DeKalb County Board of Health