DeKalb County, Illinois

Minutes of the
DEKALB COUNTY HEALTH BOARD

November 27, 2007

BOARD MEMBERS PRESENT: Russell Bishop, Psy.D., President; Steve Wolf, R.N., Vice President; Jean Gastiger, R.N., F.N.P., Secretary; Kevin Buick, J.D.; Julia Fauci; John Olson, D.D.S.; Jesus Romero; Mary Beth Shear, M.D.; Scott Starkweather

BOARD MEMBERS ABSENT: Deborah Schelkopf, D.V.M.; Linda Liston, M.D.

MINUTES

On a motion by Mrs. Fauci, seconded by Mrs. Gastiger, the minutes of the Board of Health meeting of September 25, 2007, were approved.  Motion carried.

On a motion by Dr. Olson, seconded by Dr. Shear, the minutes of the Executive Session of September 25, 2007, were approved.  Motion carried.

DIVISION REPORTS

Mrs. Grush introduced Sue Thompson from Malta, who is a nurse manager at Valley West Community Hospital.  Ms. Thompson is being nominated as the replacement for Mr. Wolf’s position on the Board.

Mrs. Grush thanked Karen Hills, Director of Office Support, for her 25 years of service to the Health Department and to the Board of Health.

The 2008 DeKalb County Budget was adopted by the County Board at their meeting of November 21, 2007.  All Health Department funding requests from the county were approved.  The $15,000 for the spay/neuter program remains allocated, but the County Board Finance Committee requested that this money be withheld until details of the program are presented to them.  Mrs. Grush clarified an article in the Midweek that was inaccurate in that it made it appear the Health Department was going to operate a feral cat spay/neuter trap/release program. 

Mrs. Grush reported that the State Legislature passed an amendment to the Local Health Protection Grant for an additional appropriation of $5 million.  This one-time funding, provided by the General Assembly, was to be used to support the operations of certified health departments and was to be distributed equally among all local health departments.  The Chicago area was opposed to this equal distribution of funds in that, historically, the grant distribution was based on population and per capita income.  However, in the end, the intent of the legislation to “distribute equally” prevailed.  Every health department will receive a one-time additional award of $52,631.57. 

Mrs. Grush reported that a couple of sizable monetary donations were made to the Home Care Program by patients or their families, which was very much appreciated.

Newspaper advertisements were run by the Health Department offering local businesses an opportunity to apply for waste reduction mini-grants to implement source reduction and recycling activities.  The response to the ads was very disappointing, with only the DeKalb Park District applying to expand their recycling efforts at two golf courses.  Mr. Wolf indicated that he was aware of a couple of businesses in Sandwich that may be interested, and Mrs. Grush encouraged him to ask them to contact the Health Department if interested.

Mrs. Grush stated that she recommended Dr. Thornton and Dr. Baumgart for the Mandy Derrington Friend of the Child Award, and they were both selected.  Dr. Thornton was the founder of the agency’s Well Child Clinics in 1986, wanting to reach children who could not access preventive health care for financial reasons.  Dr. Baumgart contacted the agency in the late 1980’s and began working family planning clinics, becoming the Medical Director of the Family Planning Program in 1994.  Most recently, he established the “I Care” clinic within his practice and became the sole physician accepting Health Department referrals of women on Medicaid delivering babies at Kishwaukee Community Hospital (KCH).  These babies account for approximately 50% of all babies delivered at KCH. 

Mrs. Grush also acknowledged Dr. Shear and Dr. Feldmann, colleagues of Dr. Thornton, for their services provided to the agency.  She recognized Dr. Shear as a physician providing services for the Well Child Clinic for over 20 years who has been a tremendous asset to the community.  Dr. Shear is leaving the community and will certainly be missed by both staff and clients.

Mr. Drake, Director of Environmental Health, and Mrs. Zanellato, Director of Health Education, traveled to Springfield today to attend a training on the new Smoke-Free Illinois Act that goes into effect on January 1, 2008.  A report will be forthcoming at the Board meeting in January. 

Mr. Drake reported that the food establishment reported on at the last meeting, remains closed.  A tire recycling event was held in November and went very well.  However, the owner of the lot was promised by EPA that the tires would be removed within 48 hours, but 72 hours later they were still there.

Mr. Wolf asked about a restaurant being closed at the Sandwich Fair.  Mr. Drake responded that they did close a food establishment at the Fair, but stayed with them until the problems were corrected at which time they were allowed to reopen.

Mrs. Chilton, Director of Personal Health Services (PHS), reported that there are only about 200 doses of flu vaccine remaining.  She commended Mrs. Lux, Assistant Administrator, and Mrs. Carroll, Coordinator of Communicable Disease, for their leadership with the flu vaccine activities.  Outreach clinics were held, as well as walk-ins on Thursdays, with a nice, steady flow of clients at all sites.  Another big issue occurring over the past two months is community-acquired MRSA.  Mrs. Chilton reported that Mrs. Carroll was a pioneer in this topic from her days at KCH as infection control nurse, and has been an outstanding stable resource for the community, providing a great deal of education on the topic. Once again, with increased caseloads, it has become necessary to look at space in the PHS area.  Some rearranging of staff and maximizing the use of the space will occur over the next couple of months.  Mrs. Chilton added that she would report back on this restructuring at the next Board meeting in January. 

Mrs. Fauci stated that an interesting article in the Chicago Reader talked about the importance of wound inspection, and that a couple of hospitals were fighting conducting wound inspections before admitting the patient.  Mrs. Chilton pointed out that KCH has always been very proactive about wound inspection.  In her previous teaching experience, she was always impressed with how well KCH worked at prevention.  Dr. Shear added that there is a fine line between overdoing inspections of wounds and providing care to the patient, which is not as good when the patient must be isolated.  There are mechanisms in the hospital to identify high-risk people, but there is some MRSA in the community without any symptoms.  Dr. Shear explained that the new hospital is set up much better for the handling of such infections.

Mrs. Fauci pointed out that the article also talked about MRSA in the jail population and the fact that inmates would return to their neighborhoods upon release and introduce the infection there.  She did learn from our Sheriff that DeKalb County has had a couple of such cases.

Mrs. Chilton indicated that MRSA will be a reportable infectious disease in 2008.  She pointed out that the media did not do a very good job at differentiating between community-acquired and hospital- acquired MRSA.  Mr. Wolf explained some new technology that has been perfected for the rapid diagnosis of MRSA at the cost of about $38,000 for each machine. 

Mrs. Fauci asked about the reports on deaths from the cold virus that is rare but morphing into something more dangerous.  Mrs. Chilton responded that she had not heard of excessive calls on this topic, but did hear something briefly in the media.

Mrs. Grush reported that the surveyors from IDPH arrived unannounced yesterday to conduct our Medicare / Home Care Licensure Recertification Survey.  She stated that the surveyors would be here most of the week.  Mrs. Rolf is in the midst of dealing with the survey; consequently, she is not here at the Board meeting this evening.  In Mrs. Rolf’s absence, Mrs. Grush reported that a number of changes are coming to the program in January.  Years ago, agencies were paid by Medicare for their program costs, so some inflated their costs.  Reimbursement was then changed to the Prospective Payment System (PPS), and now some agencies are manipulating the system to receive higher reimbursement.  The reimbursement methodology is being changed again to prevent the ability to manipulate the system to gain financially.

Mrs. Zanellato reported that a throughput exercise was held in conjunction with the flu clinic of October 18.  This type of exercise is used to determine the number of people that can be medicated per hour, per nurse.  At this flu clinic, the adults and children were served in separate areas.  55 adults were medicated per hour per nurse and approximately 25 children per hour per nurse.  This was the first exercise to determine the throughput rate for children.

The Coordinated Approach to Child Health School Grant (CATCH) is a program that works with teachers, grades kindergarten through fifth grade, in teaching nutrition, physical education activity, support from the schools, the cafeterias offering healthy choices of foods, and the involvement of parents.  A new CATCH grant was received for the Cortland School this year.  The Division of Health Education worked with the DeKalb School District in completing a grant application to the DeKalb County Community Foundation to obtain financial support to expand the program across the district.  Notice was just received of an additional grant to add the CATCH Program in the Sycamore School District. 

Mrs. Fauci stated that she read an article about children and rickets, which occurred because the children were inside and not receiving enough sunlight, as well as not drinking milk.  She wondered if the CATCH program addressed this issue.  Mrs. Zanellato responded that the program does not address specific issues, but rather focuses on general good nutrition.  It teaches children a healthy approach, with “go,” “slow, and “whoa” foods.

FINANCIAL DATA

Mrs. Grush pointed out that the agency is normally ending their budget year on November 30, but this year a thirteenth month is being added, with FY2007 ending on December 31, 2007.  She added that December is typically a month for lower revenue, and money will be transferred from the fund balance in January 2008 to cover expenses.  Auditors will be interviewing agency staff this month regarding any knowledge they may have of fraud occurring, as well as reviewing processes currently in place.

On a motion by Mr. Starkweather, seconded by Mr. Wolf, the Financial Statements for the months of July and August 2007 and the Claims for the months of August and September 2007 were approved.  Motion carried. 

NEW BUSINESS

Presentation and Adoption of DeKalb County Community Health Needs Assessment and Plan

Mrs. Grush stated that Mrs. Lux directed the IPLAN process this year, holding community meetings and writing the plan.  The Plan requires Board of Health approval and a letter from them submitted to the state, which will continue our certification as a health department. 

Mrs. Lux stated that the Community Health Needs Assessment and Plan is the second part of the Illinois Project for Local Assessment of Needs (IPLAN).  The Organizational Capacity Assessment was presented to the Board at the September meeting.

Mrs. Lux provided the following summary of the Plan.  She reported that a systematic process is followed to assess health needs to determine priority health problems in our county.  The three problems identified were inadequate access to primary health care, type II diabetes, and cardiovascular disease.  DeKalb County was the sixth fastest growing county in Illinois from 2005 to 2006, with population now exceeding 100,000.  She pointed out that the large college-age population affects the statistics with a younger population and more poverty.  The largest change in race and ethnicity was in the Hispanic population at 8.5%, up from 6.6% in 2000 and 3% in 1990.  Many health status indicators for our county compare favorably with the state and nation. Inadequate access to primary health care was the major discussion throughout much of the community meetings and led as the number one priority.  Diabetes and cardiovascular disease are also prevalent health issues nationally, with much publicity on contributing factors of obesity and overweight.  The committee chose to address these priorities by an emphasis on primary prevention, with a focus on youth. 

Mrs. Lux explained that the IPLAN is a planning process based on the Assessment Protocol for Excellence in Public Health (APEXPH), developed through a collaborative effort involving many state and national organizations.  The purpose is to meet requirements of the Certified Local Health Department Administrative Code, which requires a community health needs assessment that systematically describes the prevailing health status and health needs of DeKalb County.  This plan also serves as a guide to help the Health Department and community to prioritize health problems and determine how to address the identified needs. 

The Community Health Committee consisted of 16 members named to conduct the needs assessment and plan.  These volunteer members were chosen based on a number of attributes.  A listing of the members is located in Appendix A of the Plan.  Mrs. Lux reported that there was good attendance by the committee, as well as good participation and input.  Data necessary for the decision-making process was provided by the Health Systems Research Unit of the University of Illinois College of Medicine at Rockford and presented by Deborah Lischwe and Assistant Dean Joel Cowen, who facilitated the process.  The Plan will be put on the DeKalb County web site.

The committee was selected based on representation of multiple sectors and interests in the community.  They met four times, starting in June 2007.  In addition, four subcommittees met between August and October to work on specifics of the intervention strategies.  Mr. Cowen presented and led a discussion of a broad data set describing socio-demographic and health status data for the county.  The committee then identified eleven topics to be considered for potential priorities.  Mr. Cowen then prepared an in-depth supplementary data set to facilitate further discussion of the identified areas.  This process culminated with the committee members individually scoring nine selected health problems utilizing a modified Hanlon tool.  The committee then discussed total and average scores calculated from the tool and then refined the health problem descriptions and judged each for a variety of factors.  Thus, the three priority health problems were identified. 

Health Problem Analysis Worksheets were then completed by the committee through discussion by the committee on reasons that may cause or contribute to each of the identified problems.  Risk factors, direct contributing factors and indirect contributing factors were discussed for each priority.  The committee discussed available community resources to address the priority problems, as well as potential barriers.  Following this analysis, the committee determined how to best address the problems in a plan.  The committee developed outcome objectives, impact objectives and proven intervention strategies for each priority health problem.

Dr. Shear asked if this discussion included dental care.  Mrs. Lux responded that it did discuss access to dental care and also mental health care.  The need for all problems raised was great, but all could not be dealt with at this time.  The committee decided to first address the access to primary health care issue, since they are feeling this is a crisis in our community.  Since an Access to Health Care Task Force, consisting of health care leaders and decision-makers, has been formed to study options and models for primary health care, the committee recommends continuation of efforts by this group with enhanced focus on the urgency of a resolution.  The Access to Health Care Task Force, was initiated by Representative Bob Pritchard, who had received many concerns from providers and constituencies regarding the seriousness of the access issue. 

While the percentage of adults in DeKalb County reporting being diagnosed with diabetes was lower than the state percentages, the county age-adjusted death rate due to diabetes in 2004 exceeded state and national rates by more than 65%.  In addition, the rate and proportion of deaths due to diabetes in DeKalb County doubled from the rate and proportion of ten years earlier.  As overweight, obesity and level of physical activity are modifiable risk factors, the Committee felt strongly that the Plan should adopt prevention strategies and include youth in this effort since early lifestyle and behavior change can have a potentially positive impact on adult behavior and health.  Another rationale is that lasting behavior change may be more effective the earlier it begins.  In addition, the Hispanic population is at higher risk for diabetes than the general population, and this population has increased in DeKalb County.  The Federal National Diabetes Information Clearinghouse reports that Mexican Americans are 1.7 times as likely to have diabetes than non-Hispanic whites, resulting in the committee also supporting a targeted prevention strategy for Hispanics.

Coordinated Approach to Child Health (CATCH) was selected as the youth strategy because it is a multi-component strategy addressing the major risk factors leading to diabetes and is an environmental approach in schools.  The Illinois Department of Public Health (IDPH) supports this program because it has been scientifically demonstrated that CATCH reduced the total fat and saturated fat content of school lunches, increased moderate to vigorous physical activity during physical education classes, and improved students’ self-reported eating and physical activity behaviors.

After a one-year trial in a DeKalb School District (DSD) elementary school, a commitment was made by the new Assistant Superintendent of Curriculum and Instruction to expand the program district-wide.  IDPH funding was obtained to add Cortland Elementary School in the 2007-2008 school year.  With the help of Mrs. Zanellato, DSD submitted a grant request to the DeKalb County Community Foundation to fund the remaining seven schools at a cost of $21,000.  It has been learned that they were funded for over half of this request.  As of the final meeting, the Community Health Committee learned that IDPH has also committed funding the Health Department to implement CATCH at Southeast Elementary School in Sycamore.  In addition, the YMCA may be interested in pursuing an after-school CATCH program component.  The Committee expressed an interest in recommending and facilitating expansion of CATCH to include all eight school districts in DeKalb County. 

The KishHealth System Diabetes Education Program will develop and offer a health promotion session that specifically addresses the role of modifiable risk factor reduction in the prevention of diabetes.  The session will be offered in Spanish targeting the Hispanic population. 

Mrs. Lux reported that heart disease was the leading cause of death in DeKalb County and the nation in 2004.  Due to the size of this health problem and that the modifiable risk and contributing factors overlap those of Type II Diabetes, this was chosen as the third priority health problem.  The strategies for prevention of heart disease and type II diabetes are complimentary.  KishHealth System Community Wellness Department offers educational programs at the hospital to help the community prevent and manage health problems.  For this IPLAN strategy, the program will be taken to the participants, offering an outreach class on “Understanding Cholesterol” at a local church, since faith communities offer social support.  If this session is successful, it will be offered to other churches through the pastoral network. 

Mrs. Lux added that since Mrs. Carney of the DeKalb County Mental Health Board was planning on doing a more in-depth needs assessment of mental health needs in DeKalb County, this area was not selected as a health priority.

Dr. Olson asked if the one-time Local Health Protection Grant funding increase could be used to expand CATCH to the rest of the school districts in the county.  Mrs. Lux responded that there was discussion on doing a private/public partnership for this venture, and one committee member thought businesses may be interested in participating and in funding such a project.  Mrs. Grush stated she felt it was too early to indicate priorities for use of the one-time funding.

Mr. Wolf commended Jane and her committee for their excellent choices of priorities.  Mrs. Fauci complimented Mrs. Lux on her excellent job in conducting and completing the Plan. 

Mrs. Gastiger made a motion to accept the DeKalb County Community Health Needs and Assessment and Plan, seconded by Mrs. Fauci.  Motion carried.

Personnel: Reclassification of Secretary B to Quality Improvement Assistant

Mrs. Grush proposed changing the classification of a current Home Care employee from a Secretary B to a Home Care Quality Improvement Assistant position.  A class specification was attached.  Mrs. Grush is proposing a 5% increase with this change, effective 12/30/07. 

Mr. Starkweather made a motion to eliminate a Secretary B position and approve a Quality Improvement Assistant position at a salary range of $13.97 to $21.26 per hour, with a 5% salary increase to the affected employee, effective December 30, 2007, seconded by Mr. Romero.  Motion carried.

Proposed Bylaw Revisions

Mrs. Grush presented revisions to the Board of Health Bylaws related to the County changing its budget year to January 1 thru December 31 from December 1 through November 30.  The revisions include changing the make-up of the Board of Health from one representative of a health care profession and two consumers to three community members.  She added that this would provide more flexibility in making up the membership of the Board.

Mr. Wolf moved to accept the revisions to the DeKalb County Board of Health Bylaws, as presented, seconded by Ms. Fauci.  Motion carried.

Mrs. Grush presented another issue for consideration.  She pointed out that that the terms of Dr. Shear, Mr. Wolf and Dr. Bishop end on November 30, 2007.  Technically, the new terms of office for replacement Board of Health members do not start until January 1, 2008, leaving the Board short three members through the month of December.  She asked for general agreement of these expiring Board members to continue to serve should an emergency situation arise requiring Board action.  Likewise, an emergency appointment by the County Board would be required.   Dr. Shear, Mr. Wolf and Dr. Bishop were in agreement with this request.

Nominating Committee

Board of Health Membership

Mr. Buick announced that the Nominating Committee of the Board of Health met on the 16^th of November and identified four replacements for members whose terms are expiring on November 30, 2007.  He reviewed the backgrounds of the four nominations.  Todd Latham of Sandwich has been nominated to replace Dr. Bishop.  He is an NIU employee in the College of Education and currently serves as President of the DeKalb County Chapter of the American Red Cross.  Sue Thompson, R.N. from Malta and nurse manager at Valley West Community Hospital, has been nominated to replace Mr. Wolf.  She has held a variety of nursing positions in the community, including as a home care nurse for a period of time.  Dr. David Phillips, a pediatrician at DeKalb Clinic, will replace Dr. Shear.  He is currently serving as Chairman of the Pediatrics Unit at KCH and was a member of the IPLAN Committee.  Dr. Dennis Diemer, a partner in Prairie View Animal Hospital, will replace Dr. Schelkopf.  Dr. Diemer also serves on the TAILS board.

Mr. Starkweather made a motion to accept the nominations of Mr. Latham, Ms. Thompson, Dr. Phillips and Dr. Diemer as Board of Health replacements and forward their names to the DeKalb County Board for appointment to the DeKalb County Board of Health.  Dr. Shear seconded.  Motion carried. 

Slate of Officers

Mr. Buick presented the proposed 2008 Slate of Officers for the Board of Health as Mr. Starkweather as President, Mrs. Gastiger as Vice President and Dr. Liston as Secretary. 

On a motion by Mr. Wolf, seconded by Dr. Olson, the proposed slate of officers for the Board of Health was approved, with Mr. Starkweather as President, Mrs. Gastiger as Vice President and Dr. Liston as Secretary.  Motion carried. 

Recognition of Retiring Board Members

Mrs. Grush recognized the retiring Board of Health members and thanked them for their years of service and commitment to the community.  Plaques were presented to each member, and they expressed their appreciation to Mrs. Grush for her leadership and the staff for the quality of services they provide to our clients. 

Executive Session

Mr. Starkweather made a motion to enter into Executive Session at 8:40 p.m. for the purpose of the bi-annual review of executive session minutes, an update on Union negotiations and a personnel issue. Ms. Fauci seconded.  On a roll call vote, those voting yes included Dr. Bishop, Mr. Buick, Ms. Fauci, Mrs. Gastiger, Dr. Olson, Dr. Shear, Mr. Romero, Mr. Starkweather and Mr. Wolf.   Motion carried. 

On a motion by Mr. Buick, seconded by Mr. Starkweather, the Board of Health voted to reconvene to regular session at 9:13 p.m.  On a roll call vote, those voting yes included Dr. Bishop, Mr. Buick, Ms. Fauci, Mrs. Gastiger, Dr. Olson, Dr. Shear, Mr. Romero, Mr. Starkweather and Mr. Wolf.   Motion carried. 

Mr. Buick made a motion to approve Resolution 2007-01 for the destruction of verbatim tapes of executive session minutes of 3/23/04, 5/25/04, 5/24/05, 3/28/06, and 5/23/06, seconded by Mrs. Gastiger.  Motion carried. 

Mr. Starkweather made a motion to eliminate the job classification of Support Staff Team Leader, Personal Health Services Division, and add a Secretary B job classification, seconded by Ms. Fauci.  Motion carried. 

CORRESPONDENCE AND ANNOUNCEMENTS

Newspaper articles for the months of September and October 2007 covered CLC giving the Mandy Derrington Friend of the Child award to Dr. Thornton and Dr. Baumgart, inadequate reimbursement and time lags for payments to physicians providing services to Public Aid patients, flu vaccine season, November as National Home Health Care Month, a letter to the editor touting hospice and home care providers as heroes, the importance of good hygiene to prevent the spread of MRSA, the CATCH Program, used tire collection, the positive effects of holding electronics collections, tips on how to quit smoking, females facing more medical risks from smoking, and the Great American Smokeout in November.  Correspondence included a letter from State Representative Bob Pritchard and a letter and contribution from the family of a Home Care patient thanking for the services provided.

ADJOURNMENT

On a motion by Dr. Olson, seconded by Mr. Wolf, the Board of Health adjourned at 9:17 p.m.  Motion carried.

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

DeKalb County Board of Health

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