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DeKalb County, Illinois |
Minutes of the
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BOARD MEMBERS PRESENT: Steve Wolf, R.N., President; Jean Gastiger, R.N., F.N.P.; Linda Liston, M.D.; John Olson, D.D.S.; Mary Beth Shear, M.D.; Stephen Slack; Scott Starkweather
BOARD MEMBERS ABSENT: Russell Bishop, Psy.D.; Mike Groark, J.D.; Jesus Romero; Deborah Schelkopf, D.V.M.
With four new members, the Board of Health and Health Department staff introduced themselves.
MINUTES
On a motion by Dr. Olson, seconded by Dr. Shear, the minutes of the Board of Health meeting of November 29, 2005, were approved. Motion carried.
Mrs. Grush indicated that Mr. Heinisch (former Board of Health member) had asked, at the last meeting, the balance the agency had in accounts receivable with the Illinois Department of Public Aid. She reported that it has been determined, as of the end of November 2005, that there is $83,905 outstanding, over one-half of the annual agency total receivable from IPA. She added that this large an outstanding balance is a problem for our agency and other organizations relying on this revenue source.
DIVISION REPORTS
Mrs. Grush reported that the cost of health insurance for 2006 did not increase, but the county did negotiate some changes in the pharmacy benefit with Blue Cross Blue Shield. Employees will be required to pay a larger share for preferred drugs, thus encouraging the use of generic drugs, when possible, as well as utilizing the mail order option.
At past meetings, requirements of the Emergency Preparedness Grant have been shared with Board of Health members. These requirements include the agency conducting an exercise to determine the number of individuals that can be treated in a one-hour timeframe. From this activity, the agency will be able to determine how many staff is needed to serve the entire DeKalb County population in 48 hours. The event will be held March 30, 2006, at the NIU Convocation Center. The disease selected for the exercise is Tuleremia, which can be treated with antibiotics. She invited board members to attend the exercise as a county resident. Dr. Shear reported that she had just taught emergency preparedness badges for the scouts this past weekend and thought they could be a source for residents.
Mrs. Grush reported that other organizations, such as the hospital, law enforcement, and fire departments, may use our exercise as an opportunity to test a segment of their planning. Kishwaukee Community Hospital (KCH) will actually start our drill with a call that a number of “pretend” patients are being seen with symptoms, and she is hoping that the law enforcement partners will participate as well to assist with traffic, which will be a huge concern in an actual event. Denny Miller, DeKalb County ESDA (Emergency Services and Disaster Services) Coordinator, will be involved in setting up an Emergency Operations Command center. Also required to be tested is the amount of time it takes to get information out to the public. Mrs. Grush added that a lot was learned from the tabletop exercise last fall, but more will be learned from an actual drill.
Mrs. Grush pointed out that DeKalb County is considered the far western county in Illinois in CDC’s Readiness Program for larger metropolitan areas. Additional funding is supposed to be coming for this initiative. There is also a postal plan whereby pills are placed in mailboxes with law enforcement accompanying each postman. She added that this is probably the fastest way to distribute medication, but would have many problems. In reality, the capability of any health department to treat all county residents within 48 hours is unrealistic since the time starts when the call is placed requesting the need for medication. Setting up the clinic and treating first responders also has to be completed in this 48 hours.
Dr. Shear asked who is reaching out to the county. Mrs. Grush responded that the plan is for all DeKalb County residents to come to the Convocation Center. The reason for this is because the Health Department does not have enough staff to set up multiple sites and the majority (68%) of county residents live within seven miles of the Convocation Center. Mr. Wolf stated that the hospital tested the distribution of medication to their staff, and Mrs. Grush reported that the State tested their plan of actually dropping the medications at the site. Mrs. Grush reported that the distribution of medication to first responders will not be tested at the March 30 event.
Mr. Wolf asked what weaknesses were determined at the tabletop held last fall. Mrs. Grush stated that this was a State test of their ability to deliver the medication. Areas of concern noted by us and conveyed to the State were the following: no identification of the receiving individual was required, there were no copies available to the receiver of what was being signed for, and there were no quantities listed. Mrs. Zanellato added that the palette was shrink-wrapped so the labels could not be read without unwrapping it. Mrs. Grush reported that the medications were delivered by highway trucks and escorted by law enforcement, and the trucks had three different stops, which took a great deal of time. She stated that it was determined it would work better if one truck delivered to one site.
Dr. Olson asked if the smoking ban had passed the DeKalb City Council. Mrs. Grush responded that it will come up for a first reading on February 13, 2006, and a vote on February 27. She added that she did speak at last night’s City Council meeting. It appears that there is support for the ban in restaurants, but the problem lies with Class A bars. She got the sense that it is difficult for members to vote for the smoking ban in bars, even though they know it is the right thing to do, because some of the bars have been in existence for years. One argument at the meeting was that, as long as smoking is legal, people need a place to go to smoke, and that is typically in the bars. Dr. Olson asked if the health of workers was addressed. Mrs. Grush responded that the health of employees was the driving force for the ordinance, adding that she spoke about the general public health concern of smoking. There were a lot of different aspects presented, and not all of them just for the workers, but rather for the good of the community. She added that there appears to be a better chance of it passing because many cities are adopting such laws. Also, there is a Bill in the legislature now that would allow counties to pass smoke-free ordinances in non-municipal areas.
Mrs. Gastiger asked if there was any discussion on grandfathering in existing bars and restaurants and also on expanding the number of establishments. She thought it would be interesting to see, as a social experiment, how non-smoking bars compared financially with smoking bars. Mrs. Grush reported that a letter had been received from Pizza Villa, which is now a non-smoking facility, indicating that the change by them to non-smoking has not hurt their business financially. She stated that there was no discussion about adding additional licenses.
Mrs. Grush stated that some private clubs spoke against the ban, as did the bowling alley owner in DeKalb, who stated that customers would go to the bowling alley in Sycamore instead of his establishment. She added that the mayor of DeKalb was very articulate in conveying his support of this ordinance. Mr. Wolf asked if Sycamore has made any effort in going smoke-free. Mrs. Grush responded that the issue was denied several months ago by the Sycamore City Council.
Mr. Drake, Director of Environmental Health, reported that an electronics collection will be held from 9:00 a.m. to 3:00 p.m. at the Health Department on the 22nd of April. There will also be an oil collection at the Health Department on the 24th of June and at the Waterman barn on the 8th of July.
Mrs. Lux, Director of Personal Health Services, reported that the State is gearing up for the All Kids Program, the new health expansion program for children in the State of Illinois. She feels it is important for the Board to know that the agency is receiving information from the State and is expected to be a part of this program in some way. In early December, the Illinois Department of Public Health (IDPH) informed us that we could now help get more people on this program. Concerns have been expressed including meeting the increased need if a large number of individuals apply. She reported that this is not a simple process as our agency (as a Kid Care application agent) has been helping WIC/FCM clients apply. This need will increase with more eligible people and older children. She has had a couple of conversations with the local Public Aid office administrator, who reported that they are not adding additional staff to meet their needs, but that they are going to be assisting families. It is already very difficult for clients to get through to an IPA caseworker or to get a call returned, and while they will be mandated to help people in this All Kids Program, they simply don’t have the staff to do so.
Mrs. Lux’s other concern is the issue of this campaign that says to people that now all children can have health care with these covered services. The problem in DeKalb County and other counties is that providers are not accepting this health insurance because of untimely payments and low reimbursement rates by IPA in the past. She feels that this is very misleading for families, making it difficult for them to obtain health care. Health Department staff is scheduled to attend training on the 1st of February for the purpose of gathering information to determine how to proceed. She reported that, once the information starts to go out, our agency will be a part of that information, and will begin receiving requests for assistance to help families. This program goes into effect on July 1, 2006, and the State is asking that individuals pre-register. Also, many Hispanic families whose children were born in Mexico will now be eligible as citizenship is not a requirement to participate.
Mrs. Gastiger asked if TriCounty would be helping to meet this need. Mrs. Lux responded that she has not talked to them specifically about All Kids, but thinks they are trying to help as well; however, they are still in a transitional phase of increasing staff to meet their current needs and she does not know when they will be able to assume additional activities, such as All Kids. Mrs. Gastiger asked if TriCounty would receive an increased reimbursement because of their rural health clinic status. Mrs. Lux responded that reimbursement for rural health clinics, such as TriCounty, will be cost-based. She added that the selling feature for the KidCare Program was that primary care providers would do some case management that would help them save money.
Mr. Wolf asked if the State had indicated where the funding was coming from for this program. Mrs. Grush responded that it has been said that it is from saving money from the case management aspect of the KidCare Program, but that case management will pay for the expansion in the first year only. Dr. Olson stated that some people may think it is the same as commercial insurance. Mrs. Lux agreed that people are confused about that. She added that KidCare was an idea to reduce some of the stigma associated with Medicaid.
Mr. Wolf noted the significant increase in positive HIV tests. Mrs. Lux indicated that it has been an unusual year as there were 5 positive tests out of 543 tested in 2005. Usually, our agency has up to three positive tests in a year, and there has already been one in January. She stated she did not have an explanation for this increase, but likes to think it is because program staff is reaching out to the right population. Mr. Wolf asked if this indicates that there is an IV drug needle-sharing problem. Mrs. Lux stated that this is not the case among any of these positives.
Mrs. Gastiger reported that she has had students express positive statements about HIV counseling and FCM case management services received at the Health Department. Mrs. Grush reported that there are 41 HIV case managed clients in the county, and that is of significance, as not long ago, there were only a few case managed clients. Mr. Wolf feels this needs to be watched to determine if it is a fluke or a growing trend. Mrs. Grush stated that the agency used to test the many worried well, but the State and CDC has encouraged moving away from that toward the target populations as that is where the positives are found.
Mr. Wolf asked if there were any documented cases of flu. Mrs. Grush responded that Mr. Kuhn from Kishwaukee Medical Associates, Ltd. called to report one case so far. Mrs. Gastiger had her first student today diagnosed with the flu. Dr. Shear reported that she has seen Influenza A cases. She asked if the Health Department still has flu vaccine for infants available. Mrs. Lux reported that she received the directive today to not schedule any more appointments for flu shots for babies.
Mrs. Gastiger asked if the Health Department was giving Pertussis boosters yet. Mrs. Lux explained that these new adolescent boosters are not yet available through the Vaccines for Children (VFC) Program but are expected next year.
Mrs. Baj, Director of Home Care, briefly explained the services of the program as an orientation for new Board of Health members. She discussed referral sources, services provided, and operation under physician orders for 60 days with orders for all visits. Since 2000, the program has operated under the Perspective Payment System (PPS) for Medicare, with 80 to 85% of the patients covered by Medicare. Mrs. Baj explained that a lump sum payment is made to care for the patient for 60 days based on an OASIS assessment that gives a score and determines the rate for that 60-day period. She described the staff located in the building, as well as that of contract staff providing service for the program. Program statistics for November and December 2005 were presented. Mrs. Grush explained that the program has been renting space for seven years from Kishwaukee Community Hospital (KCH) and consideration is now being made regarding building a facility for the program on our site since there is no more room for growth at the present site and money in the Fund Balance has been set aside for the proposed building. The County is considering including other services in the proposed building and making the facility large enough to also accommodate them. Mrs. Grush has studied the numbers of potential growth and obtained data from the School of Medicine that says the program should remain level until 2010 when baby boomers start to need home health care and growth will be experienced.
Mrs. Zanellato, Director of Health Education, reported that the State started a smoke-free recognition program where restaurants voluntary choose to be smoke-free. Currently, DeKalb County has 78 participating restaurants to whom the Health Department provides a certificate with the signature of the Board of Health president and the administrator.
Mr. Slack asked about the Future is Ours program. Mrs. Zanellato responded that this grant-funded program targets the Latina population. Currently, we are in the third year of the grant with Hispanic students in the DeKalb School District targeted to address CDC priorities. Typically, health departments only receive this grant one time, but our agency was awarded it a second time because of the success in working with the Latina population. Mrs. Zanellato reported that this is a highly successful ten-session program, and the students love it and actually ask the schools for it. Mr. Slack asked if there were any numbers in terms of an assessment on progress. Mrs. Zanellato responded that one goal is pregnancy prevention, and Lake County (the parent organization) had a couple of schools where rigid assessments could be done, so data should be forthcoming. She cited the example, in our program, of a couple of students with ongoing absences that were cutting classes, and had poor grades. After participating in the Future is Ours program, neither of the girls have had an unexcused absence, they have brought their grades up, and one joined the school choir. FINANCIAL DATA
On a motion by Mr. Starkweather, seconded by Dr. Shear, the Financial Statements for the months of November and December 2005 and the Claims for the months of December 2005 and January 2006 were approved. Motion carried.
NEW BUSINESSUnaudited 2005 Financial Statement
Mrs. Grush presented a preliminary unaudited financial statement. She stated that, on our first review of revenue, it appears that approximately $280,000 more was received over expenditures in FY2005 or approximately 3% ($175,000) more than was received in FY2004. It appears taking out the special project expenditure, expenses were up 4.6% in 2005. In 2004, there was an overall 4% increase in revenue over expenditures without the special project expenditure, and 2% with the special project. In FY2004, the Fund Balance was $2.9 million. Since there is always about $700,000 out in accounts receivables, the Fund Balance averages $2.2 million. This is the account that will be used to pay for the proposed building, with $1.2 million already set aside for the building project. Mrs. Grush reported that she would provide a detailed Financial Statement at the March 2006 Board of Health meeting.
Mrs. Grush explained that the Home Care Program is similar to the County Home whereby both the County Board and the Board of Health have developed a philosophy that this service is not something that the county is mandated to provide so operation of the services should be paid for by the revenue generated. She indicated that she will recommend additional money from the Fund Balance be designated to the Building Fund. She pointed out that owning the building would mean additional expenses that we do not have as tenants. At this point, Mrs. Grush indicated that she sees no reason why the building project would not move forward even if only for Home Care.
Union Organization UpdateMrs. Grush explained that, a couple years ago, Governor Blagovich changed the law on how unions organize. The American Federation of County, State and Municipal Employees (AFCSME) contacted Health Department employees and got a majority of eligible staff to sign cards to petition for a bargaining agent. Jill O’Brien from Laner Muchin (the labor firm that represents DeKalb County) visited the Health Department and spoke to management staff providing general information on unions. Employees will soon vote on whether to have one or two units. Mrs. Grush pointed out that different benefits can be negotiated for classifications within the same unit.
Mr. Slack asked if Health Department salaries are comparable with the private sector. Mrs. Grush responded that increases have been good and better than many employers. In the past four years, Public Health employees that received the top merit averaged a 5.2% increase, and Home Care nurses received 5.4% per year. Mrs. Grush indicated that other benefits surpass those of many organizations. She added that she is not sure what the issues were that prompted union activity. Update to Animal Control Act (PA 094-0639)
Mrs. Grush stated that she wanted to provide an update for the Board because the new Animal Control law that took effect on January 1, 2006, has not been implemented. She explained that the American Society for the Prevention of Cruelty to Animals (ASCPCA) was successful in passing a law mandating animal control programs to collect additional fees for a Pet Population Control Fund, requiring that they be forwarded to Springfield. A newly developed statewide committee of animal control providers proposing amendments to the Act will be bringing it to the legislature in the Spring session. At this time, most counties are not implementing the Act until rules and regulations have been published by IDPH. IDPH has indicated there is some concern about the legality of the proposed fees. As a result, with the concurrence of Ray Bockman, DeKalb County Administrator, Mrs. Grush is recommending that the Health Department not implement the fee collections outlined in the new Act until direction is received via published rules and regulations by the State.
Mrs. Grush reported that there is currently a lot of legislation regarding vicious dogs. One of Mrs. Grush’s concerns is that dog owners will be expected to pay board fees, vaccination and registration fees, a $50 ticket fee, and then another $25 fee (to be sent to Springfield) when they claim their dog after being boarded for running at large.
Mr. Slack reported that he had an incident with bats and was surprised there was no fee to dispose of them. Mrs. Grush responded that our Animal Control Program does not routinely deal with nuisance animals, but is concerned about bats because they are highly rabid. Since the program is extremely concerned about rabies, generally assistance with bats is provided at no charge.
Mr. Slack asked how the mission of the Animal Control Program of the Health Department differs from that of TAILS. Mrs. Grush explained that the mission of our program is to control stray dogs and rabies. We are to enforce the Animal Control Act. The mission of TAILS is to promote the welfare of all animals.
Appointment of 2006 Board of Health Committees
Mr. Wolf presented 2006 committees for the Board of Health. They are as follows:
Finance: Dr. Bishop, Chair, Mr. Slack and Mr. Starkweather Personnel: Mrs. Gastiger, chair, Dr. Olson, and Dr. Schelkopf Nominating Committee: Dr. Shear, chair, Dr. Liston, and Mr. Romero Bylaws: Mr. Wolf, chair, and Mr. Groark
The Slate of Officers for the Board of Health for 2006 is Mr. Wolf as President, Dr. Bishop as Vice President, and Dr. Schelkopf as Secretary.
CORRESPONDENCE AND ANNOUNCEMENTS
Correspondence for the months of November and December 2005 included a letter to the editor of the Daily Chronicle from Mrs. Grush and Mrs. Lux thanking Dr. Joe Baumgart for his service to Medicaid patients. Also included was a thank you letter from a FCM/WIC client for services she received. Correspondence was included regarding two cases of meningitis at DeKalb High School, the closing of the Jewel deli for sanitary reasons, and the CCA fifth graders winning first place in the Health Department’s recycling project.
ADJOURNMENT
On a motion by Mrs. Gastiger, seconded by Dr. Shear, the Board of Health meeting adjourned at 9:25 p.m. Motion carried.
Deborah Schelkopf, D.V.M., Secretary DeKalb County Board of Health |
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