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.; Linda Liston, M.D.; John Olson, D.D.S.; Deborah Schelkopf, D.V.M.; Mary Beth Shear, M.D.

BOARD MEMBERS ABSENT: Julia Fauci; Jesus Romero; Scott Starkweather

MINUTES

On a motion by Mr. Wolf, seconded by Dr. Olson, the minutes of the Board of Health meeting of July 24, 2007, were approved.  Motion carried.

On a motion by Mr. Buick, seconded by Mr. Wolf, the minutes of the Executive Session of July 24, 2007, were approved.  Motion carried.

DIVISION REPORTS

Mrs. Grush reported that the agency has started its new FY2008 Planning and Preparedness, Pandemic and Cities Readiness Grants.  The State of Illinois has been waiting months for guidance from the Centers for Disease Control (CDC) regarding funding levels and new requirements.  This adds to the challenges of these grants in that directives come out well into the grant year, yet all timelines for the meeting of requirements must still be met.

On the 25^th of July, Dr. Eric Whitaker, Director of the Illinois Department of Public Health (IDPH) visited our agency.   A tour of the agency was provided, and staff in each program explained their services and some of the significant challenges and rewards they face in delivering public health services.  Dr. Whitaker then addressed the staff as a group conveying his goals for IDPH.  We were the 74^th health department to be visited in the state, and Mrs. Grush was told by George Rudis, Deputy Director, that DeKalb County has the nicest facility.  Dr. Whitaker has since resigned his position, and Dr. Damon Arnold of Chicago will become the new director.

Ground has been broken for the Community Outreach Building.  It is projected to take a year to complete.  Mr. Wolf asked if the same companies bid again.  Mrs. Grush stated that they were the same bidders and they presented repackaged bids.  She added that the budget is very tight and does not allow for any change orders or extras. 

Mrs. Grush stated that the recent flooding in DeKalb County was a good test of our emergency preparedness planning.  Even though flooding does not put a big impact on us as first responders, Public Health does play a role.  For the first time, we were requested to provide nursing services at the shelter, which temporarily housed flood victims, many of them from Evergreen Village in Sycamore.  Many residents requested tetanus shots and these were provided to those involved in clean-up at no charge.  Health Department nurses provided tetanus shots at the shelter and the Health Department.  Mrs. Zanellato, Director of Health Education, provided information to the media.  One lesson from this event was that the media was so overwhelmed initially, our information did not appear until a couple days later in local newspapers.  Mrs. Grush stated that all the planning over the past few years has been worth it since first responders have a comfortable working relationship as community responders in an emergency.

Mr. Drake reported that this is the third time that Evergreen Village has flooded, and it has come close to flooding several other times.  The process has been started to mitigate this park and relocate the residents, which will take a minimum of one year to complete. 

Mrs. Grush explained that a County mitigation plan has to be approved by the federal government to start the trailer park mitigation process.  A plan, initiated by the County in February of 2006, is just about ready to be submitted to the federal government.   Also, DeKalb County will need to be declared a disaster area by the federal government before any federal assistance can be received by those affected, and this has not yet been done. 

Dr. Olson asked the role of DeKalb County Community Services in such a disaster.  Mrs. Grush responded that this department, which is located in our building provides minimal financial assistance.  There are also a number of churches accepting donations and providing assistance to those affected by the flood.  The Red Cross also helped families financially, in addition to providing food and shelter.

Numerous calls were received from county residents believing that spraying for mosquitoes should be done following the flood.  A lot of time was spent explaining to callers that spraying does not really do any good, and that DeKalb County does not have a mosquito abatement program. 

Mr. Drake reported that a dead bird that had been submitted to the State lab tested positive for West Nile virus.  He explained that, per IDPH protocols, no more birds need to be submitted as one positive bird confirms the disease in the bird population in a jurisdiction.

Mr. Wolf asked about the inspection of a restaurant with the report of a foul odor.  Mr. Drake reported that Christel Springmire, LEHP, entered the facility following a complaint and found a large amount of rotting food, roaches and a heavy fly infestation.  In all her years of experience, this was the worst facility she had ever seen.  Apparently, the owner had received a report of a sick relative and immediately left the facility with no arrangement for dealing with food and perishable items.

Bette Chilton, Director of Personal Health Services, reported that July and August were busy with school and sports physicals, travel immunizations and tuberculosis skin testing.  Access to health care continues to affect all programs in her division.  Illinois Health Connect, a program that provides health care to under-insured and Medicaid clients, has been fully implemented.  Unfortunately, the City of DeKalb does not have any Medicaid providers and TriCounty Community Health Clinic has only one physician’s assistant, forcing clients to travel as far as 60 miles for services.  Newborns not on Medicaid are referred to Illinois Health Connect, but no provider can be assigned until a Medicaid number is issued.  Our Pediatric Services staff has started blocking slots in well child clinics for these two- to four-month old infants.

Dr. Liston asked if children on Medicaid fall under Illinois Health Connect.  Mrs. Chilton responded that they do, adding that letters were sent to them this summer advising them to select a primary health care provider or families would be assigned a provider as their primary physician.  Many of our clients threw these letters away as they did not understand the directives.  She added that physicians need to make a choice as to whether to participate in this program, which has a number of  barriers, such as low reimbursement and lateness in payment.  Some of our clients have providers in Geneva, St. Charles, and Aurora, but they do not have transportation to travel there.  The result is overuse of emergency rooms for inappropriate care, which is not cost-effective but is the only place the client can get to when their child is sick. 

Dr. Liston asked if any providers in town were seeing children.  Bette responded that there are some providers in Sycamore that are continuing to see the children that were previously their patients, but are not accepting any new clients that fall under Illinois Health Connect.  There are also some participating physicians in Sandwich.  Mrs. Grush stated that the task force is looking at the access to health care issue and is obtaining information from participating Federally Qualified Health Centers (HQFC).  This issue has been held up temporarily because of the opening of the new hospital and Mr. Poorten’s (CEO of Kishwaukee Community Hospital) involvement with that.  She added that there is no quick fix to the access crisis.

Mrs. Rolf, Director of Home Care, announced that the census today was up to 157 patients.  The contracted physical therapist in the southern part of DeKalb County required an unanticipated medical leave resulting in a physical therapy shortage coverage issue.  Kapper Physical Therapy out of Yorkville and Sandwich has since been contracted with to provide these services. 

Mrs. Zanellato, Director of Health Education, stated that the new grant program, CATCH (Coordinated Approach to Child Health), with the goal of increasing physical activity and improving nutrition in elementary  school-age children, has started.  This year, the program was expanded to the Cortland Elementary School with a one-year $5,200 grant.  Much work has been spent on this grant working to include the whole DeKalb School District (DSD).  The new Superintendent of Education hired substitute teachers to free up staff from all schools for training of this program.  The YMCA donated their facility for this training to train this staff, who are now able to train the rest of the district.  The Health Department assisted the DSD in submitting a grant to the DeKalb County Community Foundation to support the purchase of physical education equipment and classroom materials.

Mrs. Grush stated out that board members may wonder why more programming is done in DeKalb School District than other districts in the county.  She explained that there are target populations that must be reached with grants and DeKalb School District has a much higher rate of Hispanic and low-income children than other districts in the county.

FINANCIAL DATA

On a motion by Mrs. Gastiger, seconded by Dr. Schelkopf, 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

DeKalb County Health Department FY2008 Budget Update

Mrs. Grush presented a chart showing the Health Department’s request of the County in the FY2008 Budget and the recommendation of Ray Bockman (County Administrator) and Gary Hanson (Deputy Administrator). 

The Health Department’s request of the Public Health Levy was $464,000, with $480,000 recommended should the assessed valuation come in as projected.  $200 additional was recommended in the Public Health IMRF/SS line item.  Our request for a new van for the Animal Control Program was denied as the county tries to get seven years out of its vehicles.  The van is six years old.  The request for $15,000 for a spay/neuter program is still in the FY2008 Budget.  Should the Health Department receive the $480,000 from the Public Health Levy, the agency will receive $4,000 less than requested, less the cost of the van or $1,040,700 versus the requested $1,059,500.

Mrs. Grush shared sections of the Narrative for FY 2008 Budget that applied to the Health Department.    Proposed fee increases were recommended for approval, which will generate additional revenue of $61,000.  Based on utilization trends for 2007, county employees should expect an increase in their health insurance premium between 5% and 8%.    Payments to employees that participate in the Insurance Buyout Program will increase from $1,500 to $1,800.  Term life insurance for employees will increase from $41,000 to $42,000 in FY2008.  County departments will be charged an 8% rate for their share of the pension cost as part of the Illinois Municipal Retirement Fund (IMRF).  Facility Management’s request for the addition of a Maintenance II position has been recommended.  This position was requested with the addition of the Community Outreach Building.  The Health Department will receive $341,000 to offset IMRF and FICA charges for their non-Home Care employees, based on a department charge of 8% for IMRF and 7.65% for FICA.  The Health Department will receive $216,700 for building maintenance, which includes utilities, general maintenance and janitorial expenses.  The contribution from the General Fund for the Animal Control Program was increased by $15,000 to provide funding for a to-be-defined spay/neuter program.  Finally, this budget does not establish a “Jail Savings Account” for the eventual funding of a new or expanded jail.  The goal is to set aside 4% of the property tax levy ($635,000) for this project.  If it became necessary to set aside this funding, the Health Department budget would be cut by $17,780, including elimination of the proposed spay/neuter program.

Mrs. Grush stated that past practice has been to give Health Department employees what has been recommended for non-Union non-Health Department employees.  Should a contract agreement not be reached by December 30, 2007, she is recommending the same for 2008, that being a 2.5% cost-of-living-allowance (COLA) effective December 30, 2007, for all regular and temporary employees and a merit increase of 1.5% effective December 30, 2007 for regular full- and part-time staff that have passed their probationary period, for a total raise of 4%.  The merit increase for regular staff hired before December 1, 2007, would be given at the completion of their probationary period.  Salary ranges will be increased by 2.5% at entry level and 4% at maximum of range.  She explained that this plan is being offered because of the transition of the fiscal year changing from December 1 through November 30 to January 1 through December 31.  Since the COLA will be given a month later than it has in previous years, the employee will benefit financially since the merit increase will be given at the same time, which is five months earlier than normal.  Mrs. Grush also recommended not doing performance evaluations in conjunction with the merit increase.

Dr. Liston moved to approve a 2.5% COLA, effective December 30, 2007, for all employees, a merit increase of 1.5% effective December 30, 2007, for regular full- and part-time employees that have passed their probationary period, with the 1.5% being given to staff hired before December 1, 2007, as they pass their probationary period, and salary ranges increasing by 2.5% at entry level to 4% at maximum range.  Mr. Wolf seconded.  Motion carried.

Proposed Changes to County Code – Animals

Mrs. Grush presented the Animal Control Act, specifically Section 10-25.  While developing the FY 2008 Budget, there was discussion about changing the wording from registration fee to rabies inoculation tag.  Many counties have done this to get around charging the $10 unaltered fee.  She did have this reviewed by the States’ Attorney’s office, and received their approval and agreed that this recommendation is allowed by the Animal Control Act.  The other changes recommended are to get the County Code in sync with the State Act.

Mr. Buick moved to approve the change of wording from registration fee to rabies inoculation tag in the County Code, seconded by Dr. Olson.  Motion carried.

IPLAN Part I: Organization Capacity Assessment

Mrs. Grush reported that Jane Lux, Assistant Administrator, has been solely responsible for Organizational Capacity Assessment of the Illinois Project for Local Assessment of Needs (IPLAN). 

Mrs. Lux reported that the Organizational Capacity Assessment is an internal self-review to determine if our agency can carry out identified community health functions.  There were two teams, with senior management looking at indicators to determine the perceived importance and mid-level managers determining the current status of the indicators.  Staff worked on them independently and scores were compared at the end for the 124 indicators.  Out of 124 indicators, 91 of those were scored as “Highly Important” and “Fully Met,” which represents a strength according to the tool. 

Under Authority to Operate, the Health Department is clearly strong in its authority to operate, carry out and enforce regulations.  Positive relationships are maintained with other governmental bodies and representatives. 

Community Relations shows that the Health Department collaborates well with many other agencies and professionals providing services in the county.  There is significant staff participation in interagency networking and planning activities.  Constituency input occurs through the Board of Health, community partnership committees, medical advisors and feedback from annual Client Satisfaction Surveys.  Informing the public about health and services provided is accomplished through regular press releases to multiple media outlets, postings on the DeKalb County website, health fairs, community presentations and informational brochures.

Community Health Assessment and Public Policy Development was presented, with Mrs. Lux pointing out that Community Health Assessment is a requirement for Health Department certification.  The third round of IPLAN is being completed, which encompasses a community committee analyzing data that impacts health, and then developing a community health plan.

Assurance of Public Health Services indicates that the Health Department is very strong in maintaining a level of service to avoid crises affecting the health of the community; however, she pointed out that, in the past two years, the Health Department’s ability to assure an adequate level of services that we do not provide has been compromised by external changes in the local health care environment over which the agency has no control.

The area of Financial Management showed many strengths; however, should the trend of level grant funding with rare cost of living increases and some decreases continue, it will be difficult to sustain programs and current levels of service.

Personnel Management and Program Management shows many strengths for our agency.  The Director of Office Support maintains many human resource functions for the entire agency, including policies and procedures, personnel files, employment transactions, exit interviews and recruitment activities.  Indicators that were scored highly important were fully met.  Personnel management, due to growth of employees and programs, has become more resource intensive.  Mrs. Lux added that the ability to fill vacant registered nurse positions in a timely manner can be a potential challenge.

Policy Board Procedures shows that the Board of Health is vital to the support and functioning of the Health Department.  Regular board meetings address policy determination, program development, financial budgeting and authorizations and assessment of Health Department work.

An open-ended questionnaire was distributed asking for priority areas to work on to improve the organization.  The highest priority concerns were related to the supervisory role, with half of the responses expressing a desire to enhance supervision and related skills to strengthen our capacity to function.  The next most frequent response to the questionnaire was access to health care.

In conclusion, challenges were summarized as: (1) management and labor working relationships are in transition to working with the Union and staff as bargaining unit members under a labor contract; (2) supervisors seek enhanced skills and leadership development opportunities to effectively carry out their role; (3) changes in the external health care environment negatively affect the agency’s ability to assure access to health care in DeKalb County; (4) grant funding for ongoing operations has not kept up with the costs of providing programs and services; and, (5) a competitive market for nurses presents challenges in filling vacant positions. 

The selected priority area was Leadership Development, with the goal of implementing a leadership development model that develops, equips and sustains leaders resulting in high employee retention and organizational effectiveness.  Mrs. Lux indicated that health care organizations have typically not invested a lot in training leaders and people for the supervisory role.  Clinical expertise does not always translate to supervisory expertise.  The Assistant Administrator will facilitate implementation of the leadership development model, and management staff will participate in training, implementation and sustaining the model.

Dr. Olson stated that he knows this project has taken a lot of time and wondered if it would help the Health Department or was just a requirement that needed to be met.  Mrs. Lux responded that it is a requirement, but will provide the impetus to begin to focus on leadership development.  She added that she reviewed the last IPLAN and noted that, while the focus was different, many of the goals have been accomplished. 

Dr. Liston wondered if any thought had been given to involving frontline staff in this process.  Mrs. Lux responded that additional staff input into the Organizational Capacity Assessment could be a consideration for the future.  Mrs. Lux pointed out that the model recommends that senior management respond to “Perceived Importance” indicators because they need to set goals and the vision of the agency. 

Mrs. Lux indicated that she will eventually need a letter from the Board of Health stating acceptance of the IPLAN and Organizational Capacity Assessment. 

Dr. Shear moved to approve the Organizational Capacity Assessment, seconded by Mr. Wolf.  Motion carried.

Board Membership Expirations of November 30, 2007

Mrs. Grush reported that Board of Health membership terms for Dr. Shear, Dr. Schelkopf, Dr. Bishop and Mr. Wolf are expiring.  The Nominating Committee will be meeting to recommend replacements at the November Board of Health meeting.  She asked that suggestions for replacements be given to her or Dr. Liston.  It will also be necessary to present a slate of officers.  She reminded the Board that members do need to live in DeKalb County.

Executive Session

On a motion by Mr. Wolf, seconded by Dr. Olson, the Board of Health voted to enter into executive session at 8:40 p.m. for the purpose of an update on Union negotiations.  On a roll call vote, those voting yes included Dr. Bishop, Mr. Buick, Mrs. Gastiger, Dr. Liston, Dr. Olson, Dr. Schelkopf, Dr. Shear and Mr. Wolf.  Motion carried.

On a motion by Mr. Buick, seconded by Mr. Wolf, the Board of Health voted to enter into regular session at 8:45 p.m.  On a roll call vote, those voting yes included Dr. Bishop, Mr. Buick, Mrs. Gastiger, Dr. Liston, Dr. Olson, Dr. Schelkopf, Dr. Shear and Mr. Wolf.  Motion carried.

CORRESPONDENCE AND ANNOUNCEMENTS

Newspaper articles for the months of July and August covered the visit by Dr. Whitaker to the Health Department, the CATCH Program being implemented in Cortland Elementary School, the flooding in DeKalb County, West Nile virus found in Malta, the hiring of a Roselle firm to fog for mosquitoes in DeKalb, slow payments by Medicaid to health care providers, Medicaid options running out in DeKalb County, hot water myths, the role of breastfeeding, the invasion of itch mites, the recall of Casteleberry’s hot dog chili sauce, and checking your pantry for recalled items.

ADJOURNMENT

On a motion by Dr. Olson, seconded by Mr. Buick, the Board of Health adjourned at 8:46 p.m.  Motion carried.

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

DeKalb County Board of Health

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