BOARD OF HEALTH MEMBERS PRESENT:  Scott Starkweather, President; Jean Gastiger, R.N., N.P., Vice President;, Secretary; Kevin Buick; Julia Fauci; Todd Latham; John B. Olson, D.D.S.; David Phillips, M.D.; Jesus Romero; Sue Thompson, R.N.

BOARD OF HEALTH MEMBERS ABSENT: Dennis Diemer, D.V.M.; Linda K. Liston, M.D.

Mrs. Grush asked to add an agenda item under New Business, “Cobra Reimbursement for Karen Hills’ Replacement.”

MINUTES

On a motion by Mr. Buick, seconded by Ms. Fauci, the Board of Health minutes of the meeting of May 27, 2008, were approved.  Motion carried, with Mr. Latham abstaining as he was not in attendance. 

Dr. Phillips moved to approve the Executive Session minutes of the Board of Health meeting of May 27, 2008, seconded by Mr. Romero.  Motion carried, with Mr. Latham abstaining as he was not in attendance.

DIVISION REPORTS

Mrs. Grush reported that staff was pleased to receive an increase in mileage reimbursement from 50.5˘ to 58.5˘ per mile for the period of July 1 through December 31, 2008. 

Mrs. Grush and Ms. Fauci attended the meeting of the Finance Committee of the DeKalb County Board in June 2008, following the Board of Health meeting, to present the proposed Spay-Neuter Program.  After the presentation to the Committee, the proposal died for the lack of a motion, so did not proceed to the full DeKalb County Board.  Mrs. Grush feels this was related to the program starting up mid-year, and the Finance Committee wanting an evaluation in three months, which would mean evaluating it after only one or two months of operation.  The proposal will be taken back to the committee with the 2009 Budget.  

Mr. Drake, Director of Environmental Health, reported that he conducted a smoking complaint at a diesel engine shop today.  The place smelled of smoke and the ashtrays were full.  The facility will be receiving a follow-up letter to this investigation. 

Mrs. Grush recommended to stay away from bats as three have tested positive for rabies in DeKalb County in the past two months.  A family in Kirkland received the rabies vaccine, but a Hinckley family declined treatment.  In the Hinckley situation, a family cat had the bat in its mouth and woke the family up in the middle of the night, but there was no known exposure to any of the household members.  Since the rabies vaccine, nationwide, is in very short supply this year, it is being saved for true exposures.  The shortage is due to one company discontinuing manufacture of the vaccine.   Mrs. Chilton, Director of Personal Health Services, reported that permission must be received from the Illinois Department of Public Health (IDPH) before the vaccine will be released.  Mr. Drake added that the Hinckley family is quarantining the cat for the required six-month period. 

Mr. Romero stated that the National Restaurant Association previously reported a problem with tomatoes and salmonella, and now is reporting the same problem with jalapenos.  Mr. Drake indicated that a recall on this was received today, and Mexico was one of the places listed as providing the jalapenos.  Mrs. Chilton reported that there have been no reports of salmonella locally due to tomatoes.

Mrs. Chilton reported that her division is currently fully staffed.  Mrs. Grush added that it does take employees in the Personal Health Services Division a good six months to navigate the various programs due to the numerous grant requirements. 

Ms. Fauci asked about the misdiagnosed case of Burkholderia mallei (glanders).  Mrs. Chilton reported that a laboratory employee called IDPH to report the presumptive glanders disease in the culture of a patient specimen, which has not been seen in humans for 40 years.  She consulted with Mrs. Grush and Mrs. Lux (Assistant Administrator) regarding the report as it is a biological weapon used in the Middle East.  The family was called, and the patient was doing well and responding to antibiotic therapy, which would not have been the case if it truly were glanders.  After much consultation, they were confident that it was not glanders disease.  Mrs. Grush added that Dr. Thornton, Health Department medical director, was wonderful and was very helpful in getting staff through the right questions to ask, resulting in a good learning experience. 

Mrs. Grush reported, in Mrs. Rolf’s absence, that staffing at Home Care was difficult in March and April because a staff nurse was off and a lot of referrals were received.  This summer, referrals dropped off more than ever before.  She did check with Kishwaukee Community Hospital, who reported that their census was also low.  Staff were asked to use accumulated compensatory time during this period.  Mrs. Grush is hopeful that the caseload will return to normal in August. 

Mrs. Zanellato, Director of Health Education, stated that a Northern Illinois CATCH training will be held in our multi-purpose room, with seven or eight staff from Sycamore attending.  Our agency is also hosting a Train-the-Trainer for CATCH, and a Sycamore physical education teacher and our newly hired health educator, Lindsey Hochgesang, will be attending that training. 

Mrs. Grush added that the Site Visit Executive Summary for the Strategic National Stockpile (SNS) Assessment, which was very grueling, shows the improvement made from 2007 to 2008.  While looking at the different criteria evaluated, it appears to be a simple process; however, numerous requirements make the process very difficult.  Ms. Fauci asked about home health nurses assisting in an emergency event.  Mrs. Grush responded that early planning had them caring for the acute ill, but since the agency does not have enough staff to fill positions, it was decided the nurses would assist our agency instead. 

FINANCIAL DATA

Mrs. Grush reported that the $1 million in revenue on the financial statement for June 2008 was primarily from the receipt of tax payments and general fund revenue. 

On a motion by Ms. Gastiger, seconded by Ms. Fauci, the Financial Statements for the months of May and June 2008 and the Claims for the months of June and July 2008 were approved.  Motion carried. 

DIVISION REPORTS

FY 2009 Health Department Budget

Mrs. Grush presented proposed program fees for 2009, which included increases for food establishments, sewage, water, flu shots and the cost of additional certified death certificates. 

The Health Department requests funding from the County to support the agency.  This funding comes from the tax levy (.0232˘ per $100,000 of assessed valuation), which generates $510,000.  Historically, the County has paid the Social Security and IMRF for Public Health employees, while Home Care pays their own.  The Public Building Commission (PBC) pays for building utilities, maintenance and janitorial for the Health Department, as well as for the multi-purpose room.  A request of $20,000 is being requested for van replacement in the Animal Control Program and $15,000 for the Spay-Neuter Program.  This is approximately a 5.5% increase over last year’s funding. 

The Animal Control budget was presented.  In regards to the $15,000 request for the Spay-Neuter Program, the committee felt strongly that the problem was cats and not dogs, so the proposal is now being made for cats only.  Mrs. Grush projects that $4,000 will be collected for the pickup of dogs by Animal Control staff.  Of this fee, she is recommending that $25 be given toward the spaying and neutering of dogs that are adopted or go to the shelter.   Dr. Augustine of Malta Veterinary Hospital, where dogs our staff pick up are boarded, has agreed to reduce the rate for this service to $100 for females and $175 for males.  Most of our dogs are adopted out either from the shelter or from Malta Veterinary Hospital.  The shelter also has a PetSmart Grant that will pay $25 toward the cost, so it would be a share program with the county putting in $25 and the owner putting in $25 or $50, with the animal spayed or neutered before it got to the shelter. 

Mrs. Grush reported that the Finance Committee of the Board of Health, consisting of Ms. Fauci and Ms. Gastiger, met on the 17^th of July.  She reported that Home Care revenue is down more than usual, State public aid payments are slower than ever, and some of the Environmental Health revenue is down because of the housing trend.  She added that no public aid payments have been received for Home Care yet this year, but thinks some will be received in September.  Fortunately, in the overall scheme of things, our IPA revenue is a small amount of our funding source.

Mrs. Grush projects that tax revenue should be up about $45,000.  Environmental Health revenue is projected to be down about 1 or 2% because of the housing market and the decrease in well and septic inspections.  She is anticipating a 4% increase in Environmental Health revenue next year with the proposed fee increases and a change in the housing trend.  Medicare revenue in the Home Care Program is down.  $2.3 million was budgeted, and Mrs. Grush feels $2 million will be received.  $2.2 million is being budgeted in the FY2009 Budget for this line item.  Grants are estimated to be down approximately 3% as there has been a cut in the Bioterrorism and Basic Health Services Grants.  Public Aid has been slow to pay again this year, and an 8% increase is being projected for next year.  If the Home Care census increases, a 5.5% increase is estimated.  A 9% increase is projected in the Miscellaneous line item. 

Projected revenue and what is estimated for expenditures next year is a 5.2% increase over FY2008. 

The largest expense category is Personnel, with the FY2009 Budget based on a 4% salary increase for all staff.  Mrs. Grush reported that the AFCSME contract gives bargaining unit staff a 3% cost-of-living-allowance (COLA) on January 1, with a 0 to 2% increase mid-year.  She feels there will be further discussion on these increases after the County recommendations for raises for non-union employees is learned.  IMRF is increasing from 8% to 8.5% next year, and she has been told to budget a 10% increase for health insurance.  Overall, this is a 5.3% increase for Personnel line items.

In the Capital expenditure line items, the Health Department has paid off its portion of the Community Outreach Building.  $20,000 was budgeted for a van for Animal Control (which the county would pay for), but this is not being replaced this year.  Because this money is not being spent this year, Mrs. Grush feels the 1997 Chevy Cavalier (at 150,000 miles) could be replaced.  She added that cars are reasonable at the State rate, and there may be some local dealers that may be willing to meet those rates this fall.  The 2002 Animal Control van, which is a gas guzzler, has 135,000 miles on it.  The 1999 truck has 170,000 miles on it, and the 2000 truck is at 168,000 miles.  At this time, Mrs. Grush is recommending replacement of the van (which the County will pay for through General Fund revenue), replacing one of the trucks with another truck and replacing the other truck with a small economical car.

Contractual Services line items are down about 3.5% because only one month of rent to Kishwaukee Community Hospital (KCH) is included.  This year, Public Health had three air conditioning units that needed to be replaced at an expense of $25,000. 

Mr. Latham asked Mrs. Grush to explain the PHO Contingency line item.  She responded that this is the payouts of accumulated leave time when an employee terminates their employment.  She added that retirees may also be paid for up to 60 days of unused sick leave, and there were three large payouts in 2008. 

Commodities remain about the same.  In the FY2008 Budget, $85,000 is the rent to KCH and cleaning of that facility.  Mrs. Grush is hopeful that expenses will remain approximately the same after the move to the new building.  The Home Care Program will be allocated 28% of the cost of the new building for utilities, cleaning, garbage, and water.  Overall, expenses are up 4.6% over last year. 

Proposed salaries for 2009 for Public Health and Home Care were presented, including the 4% increase. 

A Budget Summary showed expected revenue and expenses.  Mrs. Grush stated Home Care would have $207,000 in excess revenue if they increase somewhat, and Public Health will be short about $160,000.  She always projects about $100,000 of Home Care supporting Public Health for administrative purposes.  $60,000 will be transferred from the fund balance to offset the cost of Public Health.  Mrs. Grush added that Public Health has always been able to pay all their expenses. 

The fund balance for FY2008 is anticipated to be $1,761,554 and $1,807,254 for FY2009.  Mrs. Grush pointed out that this is not cash in hand as about $600,000 is accounts payable.  She tries to keep $1 to $1.2 million in cash reserves on hand to cover expenses. 

Dr. Olson moved to approve the FY2009 Budget, seconded by Mr. Latham.    Motion carried. 

Solid Waste Management Program FY2009 Budget

Mrs. Grush reported that the Board of Health was delegated with administration of the Solid Waste Management Program years ago.  The program currently has a large fund balance of  $86,000.  Previously, four quarters of money was put into this fund every year, and the last quarter was always put into the next fiscal year.  This year, the auditors recommended that the final quarter be put into the current fiscal year; so the FY2007 money of $142,400 was five quarters, while this year and future years will be $113,000. 

Salary expense in the Solid Waste Budget is for a .6 FTE coordinator.  About $10,000 is spent for the distribution of flyers for collections.  $18,000 is projected to be spent for the U of I Extension that does all the school and natural resource education.  Commercial services includes one oil and two electronics collections.  Since the program does have a fund balance and because a number of requests are made for a hazardous waste collection, this may be done again next year.  $40,000 is also being budgeted towards rural recycling.  A fund balance of $86,538 is projected for FY2009. 

Ms. Fauci moved to approve the FY2009 Solid Waste Management Program Budget, seconded by Dr. Phillips.  Motion carried. 

Position Reclassification

Mrs. Grush announced that this is the last board meeting for Karen Hills (Director of Office Support), as she is retiring on September 5.  She is requesting that a reorganization be made in moving the fiscal part of Ms. Hills’ job to a newly created position of Director of Fiscal Operations with a salary range of $17.95 to $27.32 per hour.  This position would replace the current position of Fiscal Coordinator and report directly to the administrator.  Mrs. Grush added that the fiscal responsibilities for the agency have grown tremendously in the past few years.  She explained that there would be two classifications: Director of Office Support, who would perform all the office operations, and the Director of Fiscal Operations, who would assume responsibility for all financial duties. 

Mrs. Grush explained that the current policy is that a person can only start in a position at 10% above entry, except for nurses (which was approved several years ago by the Board of Health).  She is requesting that the Board authorize the administrator to hire management staff above the 10% entry level based on market, equity within the department and qualifications.  If the Board is not comfortable with leaving this solely to the administrator, the executive committee of the Board of Health could be consulted with such hires.   She would prefer to not have to convene a Board meeting for this purpose.

Mrs. Grush reported that there were 36 applicants for the Director of Office Support position, and an individual has been selected.  She is currently an administrative assistant to a Chief Operating Officer at SHARE in Hoffman Estates, which is an inpatient substance abuse program similar in size to our organization.  The candidate lives in Sycamore, and Mrs. Grush feels she is a good fit for our environment and mission.  She has been offered $23.50 per hour and has accepted the position. 

Mrs. Grush explained that employees are not eligible for health insurance until the first day of the month following the 75^th day of employment, so most employees must pay up to three months of COBRA.  She would like to be able to offer one-half of the COBRA amount at $650 per month to the new Director of Office Support.  Mrs. Gastiger questioned if this had been done for other staff as it could be setting a precedent.  Mrs. Grush responded that she feels management is different than other employees.  Ms. Thompson asked who would affect a change in the 75 day wait period.  Mrs. Grush indicated this was passed by the County Board because of the issue of turnover at the Nursing Home and has been on the books for years.  She added that the Health Department has not hired management staff outside of the agency for years.  

Ms. Thompson moved that the administrator be authorized to extend an offer above the 10% entry level to management staff and that $1,000 be given to the new Director of Office Support toward COBRA expense, with reimbursement in this amount should the new employee not remain employed through the probationary period.  Ms. Fauci seconded.  Motion carried. 

Ms. Thompson made a motion to accept the new position classification of Director of Fiscal Operations at a salary range of $17.95 to $27.32 per hour, replacing the current classification of Fiscal Coordinator, seconded by Ms. Fauci.  Motion carried.  

Mrs. Grush introduced guest, Erin Reuter, intern under Ray Bockman, DeKalb County Deputy Administrator.

Executive Session

At 8:35 p.m., Mr. Buick moved to enter into executive session for the purpose of biannual review of executive session minutes and Union contract update.  Ms. Fauci seconded.  On a roll call vote, those voting yes included Mr. Buick, Ms. Fauci, Ms. Gastiger, Mr. Latham, Dr. Olson, Dr. Phillips, Mr. Romero, Mr. Starkweather and Ms. Thompson.  Motion carried. 

At 8:48 p.m., Mr. Buick moved to enter into regular session, seconded by Dr. Olson.  On a roll call vote, those voting yes included Mr. Buick, Ms. Fauci, Ms. Gastiger, Mr. Latham, Dr. Olson, Dr. Phillips, Mr. Romero, Mr. Starkweather and Ms. Thompson.  Motion carried. 

Mr. Buick made a motion to accept the written resolution authorizing that verbatim recordings of executive session minutes for 7/25/06, 9/26/07 and 11/28/06 be destroyed, seconded by Mr. Latham.  Motion carried.

CORRESPONDENCE AND ANNOUNCEMENTS

Correspondence for the past two months included a thank you from a Home Care patient for the excellent care provided.  Newspaper articles were published on the retirement of Marge Clawson (Home Care Intake/Home Health Aide Coordinator) after 45 years of nursing, services of the Health Department’s WIC Program, protection against bat rabies, the appearance of West Nile virus, the opening of the new Community Outreach Building this fall, and the scaring of pets by fireworks.

ADJOURNMENT

On a motion by Ms. Gastiger, seconded by Ms. Fauci, the Board of Health adjourned at 8:50 p.m.  Motion carried.

Linda K. Liston, M.D., Secretary

DeKalb County Board of Health

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