BOARD MEMBERS PRESENT: Russell Bishop, Psy.D., President; Jean Gastiger, R.N., N.P., Secretary; Kevin Buick, J.D.; Julia Fauci; Linda Liston, M.D.; Mary Beth Shear, M.D.; Scott Starkweather

BOARD MEMBERS ABSENT:  John Olson, D.D.S.; Deborah Schelkopf, D.V.M.; Jesus Romero; Steve Wolf, R.N.

Ms. Fauci asked that two agenda items be added: cremation of animals through TAILS and the Illinois Public Health and Safety Animal Population Control Program Act.

MINUTES

On a motion by Ms. Fauci, seconded by Mrs. Gastiger, the minutes of the Board of Health meeting of January 23, 2007, were approved, as presented.  Motion carried.

On a motion by Mr. Buick, seconded by Mr. Starkweather, the minutes of the Executive Session meeting of January 23, 2007, were approved, as presented.  Motion carried.

DIVISION REPORTS

Mrs. Grush reported that the financial books for FY2006 have been closed out with the County’s auditors, Sikich, L.L.P.  The Year-end Financial Statement will be presented under New Business.

Mrs. Lux, Assistant Administrator, has begun the recertification process for the Health Department through the Illinois Project for Local Assessment of Needs (IPLAN).  This Plan, which is a requirement of all local health departments every five years, is due in November 2007.  It has actually been seven years since our last assessment because, three years ago, the State staggered the submission dates due to a lack of staff to review all plans in one year.  Mrs. Grush indicated that the Plan would come to the Board of Health before its submission in November.

Mrs. Grush announced that it is budget time at both the State and Federal levels.  The Illinois Department of Public Health (IDPH) recommends level funding for most programs.  An overview was provided of IDPH with a summary of their mission, priorities, program and budget initiatives for 2008. 

Mrs. Grush announced the FY2008 budget proposal of President Bush to cut Medicare and Medicaid by more than $100 billion over the next five years.  This would be accomplished by freezing or reducing inflation updates to Medicare providers.  The proposed budget cuts Medicare home health spending by $9.68 billion through freezing home health payments over a five-year period.  While home health constitutes only about 5% of the Medicare budget, it makes up nearly 20% of the recommended cuts.  She pointed out that Medicare is about 85% of the agency’s Home Care revenue.

The Public Health building had a flood on the 5^th of February when a sprinkler head broke during the night, flooding approximately 20% of the building.  At that time, it was learned that a sprinkler must come on full force to trigger the fire station, so no alarm was set off, and the water continued to pour in for a period of time.  We also learned that the corner offices of the building are not insulated as well as they should be, so it may be necessary to fix this problem.  The coordinator, whose office is the one where the sprinkler broke, is the last of the staff to move back in and this will occur tomorrow.  Total damage came to $17,342.56, with most of the cost to be paid for by the County’s insurance less the $1,000 deductible.  Except for the cancellation of one Family Planning clinic, the area was able to maintain services, which is a testament, once again, to the dedicated, hard-working staff within the agency.

Mrs. Hills, Director of Office Support, has been working on the goal of digitally storing Health Department records, thereby freeing up building space, especially in the proposed Home Care building, and making record retrieval easier.  Records are secure through this process and backed up daily in three different areas.

Mrs. Grush presented an overview of IDPH, and stated that she feels the department is currently at its lowest level due to the early retirement of many long-term staff five years ago.  They have been replaced by a number of political appointments that don’t know public health.  Local health departments are really struggling because they are not getting the direction and leadership they need.  She is hopeful this situation will improve. 

Mr. Drake, Director of Environmental Health, commented on the detective work by his staff in locating non-licensed food establishments. 

Mrs. Chilton, Director of Personal Health Services, reported that her division is finally fully staffed, except for a two-day a week nursing position.  This position is being vacated by a nurse that is expecting twins, but she is giving us a transition period to hire a replacement, which is appreciated.  Mrs. Chilton stated that the Communicable Disease (CD) Program was very busy the past two months with the Peter Pan and Great Value Peanut Butter salmonella outbreak, as well as a Hepatitis A issue through a food handler in Kane County that impacted our residents that had eaten at that food establishment.  She reported that the HIV Program is up and running with its new staff. 

Dr. Bishop indicated that he had brought his family in for vaccinations and stated that it was a wonderful experience.  Mrs. Grush confirmed that Mrs. Carroll, CD Coordinator, and her staff do an excellent job in their program. 

Mrs. Rolf, Director of Home Care, announced that all staff have been oriented and are in place in their new positions.  Dr. Bishop questioned how the nurses were responding to the laptops and the recent upgrade, and Mrs. Rolf responded that they have indicated they do not wish to return to the pre-laptops method.  Mrs. Grush reported that the program had a good year and productivity is back to where it was before implementation of the laptops. 

Mrs. Zanellato, Director of Health Education, announced that the smoke-free legislation has passed the House and will be up for Senate vote this week so there has been a flurry of e-mails to legislatures in support of the tobacco-free bills.  Public Health Month is in April, and Mrs. Grush approved two media releases: one on family emergency preparedness and the other on infection control, such as Pandemic Flu prevention and hand washing. 

Ms. Fauci asked about the effectiveness of the N-95 masks in preventing disease.  Mrs. Carroll pointed out that a problem with these masks is that the user must go through a fit test procedure by certified personnel, with annual updates.  The controversy is that surgical masks were acceptable until the Pandemic Flu issue arose, and now the N-95 masks are stressed.  The N-95 do cost more money and are not as readily available to the general public, in addition to the fit testing and annual updates requirement.  She added that surgical masks are designed to protect most people against influenza and is the recommendation for the mass community.

Dr. Bishop thanked Health Department staff for the quality of their reports and minutes assisting members in being well informed.

FINANCIAL DATA

Mrs. Grush stated that revenue and expenses are normal for this time of year, with less cash available because fees and tax monies have not yet started coming in. 

On a motion by Mr. Starkweather, seconded by Mrs. Gastiger, the Financial Statements for the months of January and February 2007 and the Claims for the months of February and March 2007 were approved.  Motion carried.

NEW BUSINESS

2006 Year End Financial Statement

Mrs. Grush reviewed the Health Department revenue and expenses for FY2006, showing $5.716 million in revenue and expenses at $5,509 million.  She stated that this was a hard year operationally for the agency with a lot of staff turnover and vacancies, but a strong year financially. 

Mrs. Grush reviewed a summary chart of FY2006.  At Home Care, the biggest revenue generator is Medicare (85% of patients), with an increase of $110,956 (5.5%) increase over FY2005.  Overall in Home Care revenue, $120,982 (5.2%) more revenue was generated over last year.  Home Care expenses increased by only $33,169 (1%).  This is due to the fact that there were not as many patients that cost the program money and staff have reached the productivity level they were at before implementation of the laptops.  The program was down about one full-time staff nurse because of this increased productivity.  Mrs. Grush stated that the program would have to become more cost-efficient if Medicare rates do go down over the next few years as predicted. 

Public Health had a good year financially because of the open positions, resulting in decreased salary expenditures.  In FY2006, there was $122,077 increased revenue over expenses.  Part of this increase is due to the generation of more fees for service.  Revenue in Environmental Health and Animal Control were down by 5.4% and 3.2% respectively.  Environmental Health fees have showed a steady decline each year because of the decreased number of well and septic inspections being requested with the decline in the number of subdivisions being authorized.  Funding is received from the Public Building Commission (PBC) for building expenses, and 2006 was the first year that no major projects were completed.  Another area of saving was in the Salaries line items, which includes IMRF, Social Security and health insurance, again because of staff vacancies.

Mrs. Grush pointed out an increase in the Interest line item of $65,693 (124%), which will not occur again this year because of the payment of one-half the agency’s fund balance towards the new Community Outreach Building.  Another area where there may not be an increase this year is in the FCM Federal Match since the agency got money back this year, but won’t in 2007.  Also, the agency generated more revenue on flu shots because the State almost doubled the reimbursement rate, which will also not occur next year. 

The Fund Balance of November 30, 2006, is $3,309,421, with $1.8 million owed to the PBC, leaving the agency $1,509,421.  Average annual 2006 cash / investments were $2,788,584, but Mrs. Grush cautioned the Board about this getting too low as the agency needs two to three months of operating money, with $500,000 per month needed at any given time.

2006 Solid Waste Annual Report

Mrs. Grush presented that 2006 Solid Waste Annual Report to the Board.  Mr. Drake presents this to the Planning and Zoning Committee of the County Board.  She reported that DeKalb County/s recycling rate of 46% is very good, with the goal of 51%.  Mrs. Grush reviewed the charts presented.  She pointed out that responses to the survey are voluntary, so some organizations do not respond.  The Solid Waste Management Program has a little higher fund balance than normal.  Last year, three mini-grants were issued to businesses in the county, with about $30,000 designated for awards. 

Ms. Fauci reported that she serves on the Environmental Committee for the City of DeKalb, and that Ms. Springmire (Solid Waste coordinator) has been attending those meetings.  She indicated that she heard of two entrepreneurs that were using cooking grease to power vehicles.  Mr. Drake stated that most grease is recyclable, and this type could possibly be refined down for such a purpose.  

Ms. Fauci stated that a big issue with the City of DeKalb is recycling in apartment buildings.  Mr. Drake reported that several other counties have passed laws regarding this.  Mrs. Grush stated that this is a project that the program will be looking at this year.  Initial discussions indicate that this recycling is not very successful with apartment renters, possibly because they don’t have the space to hold recyclable items.  Ms. Fauci asked if it would be possible to get a model ordinance.  Mr. Drake responded that Ms. Springmire is contacting Kane County as they have this as a law. 

Mr. Drake explained that the State is considering recalculating the way the recycling rate is determined so our rate may change in the future.  He pointed out that DeKalb County is at 61% with construction and demolition waste, with the true recycling rate at 48%. 

On a motion by Ms. Fauci, seconded by Dr. Shear, the 2006 Solid Waste Annual Report was accepted.  Motion carried.

2006 Home Care Administrative Review

Mrs. Grush reported that patients were down in FY2006 by about 15 and visits were down approximately 6%.  She explained to the Board that it is good to have a decrease in visits as a set amount of money is received for a patient over a 60-day period, so fewer visits are desired.  Episodes over cost were down, and there were more episodes per patient.  SCIC (Sudden Changes in Patient’s Condition) were up significantly, and the episode can be reassessed generating more money received for that episode. 

Another area that generates revenue for Home Care is therapy services.  More money is received when ten visits are made rather than fewer than ten.  This has resulted in staff doing a better job of evaluating patients and doing additional therapy, when justified.

The summary of chart audits show that good quality care is provided and all requirements set by the federal government have been met.  A summary of patient assessments with current numbers, prior numbers and how we compared nationally was presented.  Mrs. Grush reported that, when compared to the national average and our previous year, we almost always meet or exceed outcomes. 

Dr. Bishop stated that he was impressed with the responses from the satisfaction surveys, and that it is good to know that patients would refer friends and family to our service in this competitive environment.

Mr. Starkweather made a motion, seconded by Mr. Buick, to accept the FY2006 Home Care Administrative Review.  Motion carried.

2007 Home Care Policies and Procedures

Mrs. Grush reported that a review of Home Care policies and procedures is an annual federal regulation.  Policy books were made available for Board members to review.  She explained that a Professional Advisory Committee was established this year to review the major and minor revisions and the new policies.  Members of the committee were Mrs. Gastiger (nurse) and Mr. Starkweather (consumer), Dr. Thornton (agency medical director) and Home Care staff. 

No changes were made to the Personnel Policies of the DeKalb County Health Department at this time.

Mr. Buick moved to approve the changes of the Home Care Policies and Procedures as reviewed, revised and approved by the Professional Advisory Committee of the DeKalb County Board of Health, seconded by Ms. Fauci.  Motion carried.

HIPAA Officers

Mrs. Grush stated that it is an annual requirement to appoint HIPAA Security Officers for the agency.  This year, she is recommending Karen Hills, Director of Office Support, as the Security Officer for Public Health and Tammy Pieroni, Home Care Office Coordinator, as Home Care Security Officer. 

Mrs. Gastiger moved to approve the appointment of Karen Hills and Tammy Pieroni as Security Officers for the Health Department, seconded by Dr. Liston.  Motion carried.

Personnel Compensation / Status Change

2007 Mid-year Salary Increase

Mrs. Grush stated that mid-year salary increases are generally voted on by the Board of Health at budget time, but because of Union negotiations and the fact that a contract may not be reached by the May meeting, she is recommending a 2% mid-year increase for all permanent full- and part-time staff and temporary part-time nurses. 

Employee Status Change

A temporary part-time clerk was hired to do data entry for Animal Control, and Mrs. Grush is recommending that she be given permanent status to give the employee the ability to earn some leave time.  Her classification would change from that of Clerk to Office Assistant B, with a salary increase from $9.27 to $9.43 per hour. 

Compensation for Support Staff for Special Project Weekend Work

Mrs. Grush recommend that Tammy Pieroni, Home Care Office Coordinator, who is in a salaried position, be compensated at straight time for 12.5 hours spent assisting with Home Care laptop upgrades in February. 

Dr. Liston moved to approve: a 2% mid-year salary increase for all permanent full- and part-time staff and temporary nursing staff, effective May 27, 2007; the position of temporary part-time clerk be changed to permanent part-time Office Assistant B, effective April 1, 2007; and, that Tammy Pieroni be compensated at straight time for 12.5 hours.  Mr. Starkweather seconded.  Motion carried.

TAILS Information

Ms. Fauci, a member of TAILS, spoke on the two agenda items she requested be added at this meeting.  She pointed out the changes in DeKalb County and the growing residential areas, and feels the Board needs to start rethinking its animal policy to some extent. 

Ms. Fauci distributed a handout of the cremation fees at TAILS.  She explained that animals being cremated are currently being sent out of the county, and she feels the TAILS organization could be helped financially by paying them for the cremation of animals picked up by our wardens that are not adoptable rather than sending them out of the county.  Doing this would keep the money in DeKalb County, and she added that a lot of operating money comes from cremations.  Ms. Fauci pointed out that TAILS is willing to match the cremation costs currently being incurred out of county.  The group did speak with Dr. Augustine, the agency’s Animal Control administrator, and she stated he also feels it would be a good idea to keep the money in DeKalb County.  She is requesting a vote on this topic at the next Board of Health meeting. 

A handout on the Illinois Public Health and Safety Animal Population Control Program, which was effective in January 2007, was presented by Ms. Fauci.  She explained that the purpose of this program is to allow animal owners that meet certain eligibility requirements to apply to have their pets spayed or neutered at a cost of $15.  Vaccinations can also be received at a reduced rate.  She pointed out pets that come in contact with wild animals could carry diseases or illnesses.  It is her understanding that Health Department approval is required to get this program started in DeKalb County

Mrs. Grush pointed out that this Act is in relation to SB 315 that she previously brought to the Board of Health.  She explained that this Act has changed significantly and would involve a number of fees that would be collected by our staff and then forwarded to Springfield.  These rules and regulations have not yet been published, so the law has not been implemented by DeKalb County (or many other surrounding counties).  She did agree that the Board of Health does need to revisit this.  One area of concern is the $10 differential for unaltered pets when they are registered, and the controversy over if that should be paid for by the dog owners.  Many counties, like DeKalb County, do not have the unaltered fee.  Ms. Fauci suggested that the Board look at this again as there are certain philosophical issues to consider.  One could be finding a different way to have a spay and neuter program in our county.  Mrs. Grush stated that DeKalb County puts minimal money into our Animal Control Program, and it operates financially primarily through fees to dog owners.  She pointed out that the registration fees for DeKalb County are high when compared to other counties.  A problem our program encounters is when a dog is picked up and boarded for two or three days and the pet owner does not want to pay the fees to have the dog released to them.  Ms. Fauci stated that an internal way could perhaps be found to fund some of the program.

Mrs. Grush stated that she will come back to the Board with more information at the next meeting.  Since Dr. Augustine does not itemize his bills to us, she is uncertain what his charges for service are.  Ms. Fauci feels if we can help out our local organization, it would be wise, and the Board should have some say in the way this money is spent.  She added that Sheriff Scott supports this, and people like to see their money remaining in DeKalb County.

Executive Session

On a motion by Mr. Starkweather, seconded by Mr. Buick, the Board of Health entered into executive session at 8:45 p.m. for the purpose of an update on Union negotiations.  On a roll call vote, those voting yes included Dr. Bishop, Mr. Buick, Ms. Fauci, Mrs. Gastiger, Dr. Liston, Dr. Shear, and Mr. Starkweather.  Motion carried. 

On a motion by Mr. Buick, seconded by Mrs. Gastiger, the Board of Health voted to reconvene to regular session at 8:52 p.m.  On a roll call vote, those voting yes included Dr. Bishop, Mr. Buick, Ms. Fauci, Mrs. Gastiger, Dr. Liston, Dr. Shear, and Mr. Starkweather.  Motion carried.   

CORRESPONDENCE AND ANNOUNCEMENTS

Newspaper articles for the months of March and April 2007 focused on the promotions of three Health Department staff, the appointment of Dr. Bishop as Board of Health president, AFCSME Union negotiations, initial drawings for the Community Outreach Building, the availability of vaccine for the Hepatitis A exposure at a Kane County restaurant, CDC’s efforts to locate the source of the peanut butter salmonella outbreak, a panel hosted by the NIU Health Enhancement to raise HIV/AIDS awareness, the availability of flu shots, and making weight loss fad-free.

ADJOURNMENT

On a motion by Mr. Starkweather, seconded by Mr. Buick, the Board of Health adjourned at 8:55 p.m.  Motion carried.

Jean Gastiger, R.N., N.P., Secretary

DeKalb County Board of Health

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