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

BOARD OF HEALTH MEMBERS ABSENT: Todd Latham

Mrs. Grush requested that Pending Litigation be added under Executive Session and Extra Compensation for Union Management Team be included under New Business - Personnel. 

MINUTES

On a motion by Ms. Fauci, seconded by Ms. Thompson, the minutes of the Board of Health meeting of March 25, 2008, were approved.  Motion carried.

On a motion by Dr. Olson, seconded by Dr. Liston, the minutes of the Executive Session of March 25, 2008, were approved.  Motion carried. 

DIVISION REPORTS

Mrs. Grush reported that the audit for the Health Department has been completed for 2007.  The auditors made four recommendations:

1.  Individual programs that collect money should be required to sign off on cash sheets.  This has been implemented.

2.  Cash receipts should be submitted by all programs on a daily basis.  Since these receipts are turned in after each clinic or locked in a drawer in the program area, it is felt they are secure and can be submitted to accounting on a regular, but less than daily, basis.

3.  Cash should be kept in a safe with the combination known only to limited staff or access to the key restricted.  The key to the area where the cash is kept is known only to appropriate staff; however, a more discreet location is being utilized.

4.  The Finance Office should track benefit leave of part-time employees of the Health Department.  The software used for payroll at this time is not capable of this activity.

Mrs. Grush reported that the Home Care Program of the Health Department was a beneficiary of the estate of Gordon Walters, a patient who felt he was able to stay in his home for most of his life, in part, due to the services of Home Care nurses.  Mr. Walters recently passed away at the age of 100 years.  We were listed as one of four community agency beneficiaries on an annuity.  The amount received should be around $100,000.  Mrs. Grush recommended that the money be in a restricted fund for Home Care needs.

Meetings have been held with Dr. Linda Herrmann, Assistant Vice President for Student Health and Wellness, and Brian Hemphill, Ph.D., Vice President for Student Affairs, to begin the process of securing NIU’s agreement for the dispensing of medication to faculty, staff and students, should the need arise.  The goal is to develop a non-medical dispensing model and draft Memorandum of Understanding to present to NIU by the end of the summer.  Such activities have been a priority of the federal government since they are aware that local health departments cannot dispense medications on their own to all county residents.   Dr. Liston asked if anyone else from NIU was involved.  Mrs. Grush responded that, at this point, Dr. Herrmann would be meeting with Chief Grady, who is in charge of emergency planning at NIU.  Eventually, it is reasonable to assume the Health Service would be the lead for this distribution planning.  Ms. Fauci stated that there are a number of students in health-related areas attending NIU that should be able to help in a disaster.  Mrs. Grush agreed, adding that the university would have access to students in the College of Health and Human Sciences.  Mrs. Grush stated that a directive of CDC has been to get large employers to dispense to their own employees.  With NIU assuming responsibility for faculty, staff and students, this would greatly reduce the number of individuals needing to be medicated by the Health Department.  In addition, this would address a major concern presented by the NIU police following our emergency exercise in 2006 that the number of people going through the Convocation Center needed to be reduced.  By directing NIU faculty, staff and students to a different location, such as the Field House, this recommendation could be achieved as well.

Jane Lux, Assistant Administrator, has been working with DeKalb School District administration and nurses regarding the Family Education Rights and Privacy Act (FERPA), which is in conflict with the Control of  Communicable Disease Law with regard to the reporting of communicable diseases.  FERPA is the Federal Department of Education Law (ED) which governs education-based records.  While the Health Insurance Portability and Accountability Act (HIPAA) excludes communicable disease reporting from the non-disclosure provision, and the Control of Communicable Disease Law includes school personnel as reporting entities, FERPA prevents the disclosure of identifiable student information without written consent from the student or parent except in times of health and safety emergencies.  Mrs. Grush pointed out that this issue is not something that can be solved at the local level, but rather is a federal issue.  Ms. Fauci asked if this was something that our local legislators could investigate.  Mrs. Grush responded that it could be mentioned to them, but it is federal legislation and would need to be resolved at that level.   Ms. Thompson asked if this included exemption for notifying of HIV status.  Mrs. Grush explained that, previously, it was required that the school be informed if a child was HIV positive, but there is new legislation pending that states that schools no longer need to be informed.

Mrs. Grush reported that she received a call from Dr. Upputuri of DeKalb Clinic wanting to participate in the OB referral program.  Mrs. Grush explained that the Board of Health approved an agreement with Dr. Joseph Baumgart for a three-year period, ending December 2008, to refer our Family Case Management clients to him.  She explained clients always have the right to obtain their own physician.  She explained the history of this agreement, beginning in 2005, when Dr. Baumgart was the only local physician accepting our referrals.  He agreed to expand his practice to absorb the increased caseload and, in return, requested that all Health Department referrals in the DeKalb area be made to him.   Mrs. Grush encouraged DeKalb Clinic to work with Dr. Baumgart regarding referrals.  Dr. Baumgart and DeKalb Clinic did reach an agreement and our staff developed a process to meet their agreement; however, Mrs. Grush reported that Dr. Baumgart informed the Health Department the agreement had been withdrawn by DeKalb Clinic.

Dr. Liston asked if the DeKalb Clinic should be contacted directly regarding not participating in the referral process with Dr. Baumgart for pregnant women on Medicaid.  Mrs. Grush indicated that this agreement is between Dr. Baumgart and DeKalb Clinic; thus, it would not be appropriate for the Health Department to intervene.  The DeKalb Clinic will take pregnant women on Medicaid if they call them directly.  Dr. Phillips stated  that this information was not correct, and that the obstetricians at DeKalb Clinic do not want to be excluded from these referrals.  Mrs. Grush reported that she had an e-mail today from Alice Frier, administrator of DeKalb Clinic, stating that the referral program with Dr. Baumgart would not work out, but that they would accept Medicaid patients if they contacted the office themselves. 

Bob Drake, Director of Environmental Health, reported that the next few months will be busy with applications for food service establishments and relicensing of septic installers and sewage pumpers.  Dr. Liston asked what happened to the dogs mentioned in his report that were declared dangerous.  Mr. Drake responded that certain requirements must be met in order for the dog to remain in their owner’s home so they do not become dangerous to another person.  The Animal Control wardens do follow-up with these owners and the declaration permanently stays with the dog.  Ms. Fauci asked how this determination was made.  Mr. Drake reported that Dr. Augustine (the Animal Control administrator), he and the two wardens meet and conduct an investigation.  He added that the next step after being declared dangerous is to be declared vicious and the restrictions with this are so great that the owner is often forced to have the dog euthanized instead.

Bette Chilton, Director of Personal Health Services, reported that much time was spent over the past two months working with staff in the Communicable Disease Program.  There were a couple of outbreaks, with which the Environmental Health Division assisted, and an active TB client in the county.  Ms. Fauci asked where the TB would have been contracted.  Ms. Chilton responded that it is difficult to say, but foreign-born individuals are at higher risk for the disease and the individual was foreign-born.  Dr. Liston asked if the Gardasil vaccine was offered last year.  Mrs. Chilton reported that it has been offered for almost two years and has had a tremendous response. 

Ms. Thompson asked why all nursing staff in the Home Care Program were not fitted for N-95 masks.   Deb Rolf, Director of Home Care, responded that, at this time, only nurses that were seeing the patient with active TB were tested.  Mrs. Chilton added that it is unusual to have an active TB patient that is on Medicare, so it was helpful to be able to utilize Home Care staff for these home visits. 

Marcy Zanellato, Director of Health Education, stated that the agency met with two visitors from Italy that were interested in the Coordinated Approach to Child Health (CATCH) program.  Nancy Bogle, health educator, did an excellent job explaining her role in CATCH.  They also visited the Cortland Elementary School, where the program was implemented this year.  The students went through a number of CATCH activities and the visitors stayed for the lunch program.  In addition, Marcy has spent a great deal of time learning the non-medical model of dispensing medications and the three-tiered system.  The medical model (yellow) would be used if the event was such that it could be handled by traditional medical outlets; the expanded medical model (orange) would be used if the scale of the event could no longer be handled by traditional medical outlets; and the non-medical model (red) would be when the scale of the event overwhelmed traditional medical outlets.  She explained that training and planning for the medical model has been done for the past four years, but staff are now learning that this will not work if residents are to be treated within 48 hours.  This new tiered system will open up a lot of creative avenues for the dispensing of medications rapidly. 

FINANCIAL DATA

Mrs. Grush reported that the agency has $999,902 in the bank, which on initial review, appears low; however, when taking into consideration building payments and reviewing revenue as compared to this time last year, it compares favorably.   No dollars have yet been received from the tax levy, the Animal Control fund or the Public Building Commission (PBC).  The summer months are when fees for Environmental Health services begin to be collected, so revenue will increase over the next few months.  This past quarter is generally lower revenue months.  The final $500,000 payment toward the new building has been made; consequently, the agency has met its $2 million commitment to the PBC for the new Community Outreach Building (COB) that will house Home Care. 

Dr. Olson asked why different banks are used for the investments.  Mrs. Grush reported that Christine Johnson, DeKalb County Treasurer, invests these monies and searches for the best rate. 

On a motion by Dr. Phillips, seconded by Mr. Romero, the Financial Statements for the months of March and April 2008 and the Claims for the months of April and May 2008 were approved.  Motion carried. 

NEW BUSINESS

Solid Waste Apartment and Rural Recycling Update

Mrs. Grush reported that the owners or managers of four units have agreed to participate in a recycling program for their apartments during the months of August through November 2008.  Each apartment will receive a blue recycle wastebasket with education material regarding acceptable and unacceptable recycling materials at an estimated cost of $800.  The cost of 14 dumpsters, which will be emptied once a week, is $39 per month with the estimated cost of the dumpster at $2,200.  Mrs. Grush pointed out that an evaluation of the program will be done at the end of the pilot project with recommendations for future apartment recycling. 

Mrs. Grush reported that a meeting was held with Waste Management representatives regarding the implementation of rural recycling for 19 DeKalb County townships.  The Solid Waste Management Program would pay the initial cost of four yard commingled dumpsters, to be emptied weekly, at a cost of $60 per month or $720 per year per township.  This cost would be shared with the townships in future years should the program be successful, with townships eventually assuming the entire cost.  Mrs. Grush explained to the board that the site in Sycamore Township was dissolved because it became a landfill with all sorts of non-recyclable items dropped off.  Dr. Diemer stated that he has a personal interest in this issue and offered to become involved with his township in getting the residents to pay to have the containers located in their township.  Mr. Drake indicated that a proposal will be developed and submitted to the townships to determine their interest in participating in an initially shared program, with townships eventually assuming full financial responsibility. 

Spay-Neuter Program Proposal

Mrs. Grush reported that a spay-neuter program was discussed about a year ago, and funding in the amount of $15,000 was requested from the DeKalb County Board.  A committee was formed and a proposal for a Spay-Neuter Program was developed.  Highlights of the program were that the Animal Control Program of the Health Department would be the administrator of the program and the sole processor of applications.  With one entity administering the program, there would be uniform policies and procedures in implementation, monitoring and evaluation of the program.  All DeKalb County veterinarians will be offered the opportunity to participate, and it will be their decision as to the number of surgeries they agree to provide and subsidize.  The veterinarians at the meeting agreed to the all-inclusive fees, which includes blood work, pain medication and surgery.   The pet owner will be asked to sign a disclaimer and would have to make application with the Health Department to determine eligibility.  Proof of DeKalb County residency must be presented.  Financial eligibility at or below 200% of poverty level will also be required.  A  $30 all-inclusive co-pay fee will be collected from the pet owner, and it is their responsibility to make an appointment with a participating veterinarian of their choice.  Program funding would be from the $15,000 contribution from DeKalb County, a newly instituted $25 animal pickup fine and the $30 client co-pay.  

If this is approved by the Board of Health at this meeting, it will be taken to the Finance Committee of the DeKalb County Board and the full County Board in June, with implementation beginning in July 2008.

Dr. Liston stated that is sounds like a good program and the details seem to be well thought out.  Mrs. Grush responded that the consensus of the entire committee was that dogs are not really the issue, but rather cats.  Dr. Diemer added that the big problem that veterinarians are seeing is cats that people are feeding outside, which are reproducing and continually expanding the problem.  Also, people are more likely to have their dogs spayed or neutered than they are cats.  Dr. Diemer commended Mrs. Grush and Ms. Fauci on running an efficient meeting with a great deal accomplished.  Ms. Fauci was pleased with the outcome and feels it will easily be passed by the County Board.  She pointed out that a veterinarian can refuse to serve an animal if they so choose, including if the dog is pregnant or if they feel the animal would not survive the surgery.   Dr. Diemer added that TAILS offers their own spay-neuter program with fees based on income in which people that don’t qualify for this program could participate.  Ms. Fauci stated that discussion was held on also providing rabies shots, but it was determined that fewer animals could be served if rabies vaccination was included.  Educational materials will be distributed and relationships with veterinarians will formed, hopefully resulting in animals being cared for better.  Dr. Diemer stated that this program does not include feral cats, but there are separate programs out there for this problem.

Dr. Liston asked if there were any ideas on the number of pet owners that would participate in such a program.  Ms. Fauci stated that one reason the Health Department was assigned the administration of the program was so that usage could be monitored.

Ms. Fauci moved to approve implementation of the Spay-Neuter Program, seconded by Ms. Gastiger.  Motion carried.

Executive Session

At 8:10 p.m., Mr. Buick moved to enter into executive session for the purpose of discussion on collective bargaining and pending litigation, seconded by Dr. Olson.  On a roll call vote, those voting yes included Mr. Buick, Dr. Diemer, Ms. Fauci, Ms. Gastiger, Dr. Liston, Dr. Olson, Dr. Phillips, Mr. Romero, Mr. Starkweather and Ms. Thompson.

At 9:00 p.m., Mr. Buick moved to reconvene to regular session, seconded by Ms. Fauci.  On a roll call vote, those voting yes included Mr. Buick, Dr. Diemer, Ms. Fauci, Ms. Gastiger, Dr. Liston, Dr. Olson, Dr. Phillips, Mr. Romero, Mr. Starkweather and Ms. Thompson.

Ms. Thompson made a motion to accept the contract of the AFCSME bargaining unit, as presented, effective June 1, 2008, seconded by Dr. Phillips.  Motion carried. 

Personnel

Proposed New Management Classification

Mrs. Grush reported that the agency currently has two HIV Prevention Specialist positions.  She explained that the HIV Program was previously under the supervision of the Communicable Disease Program, and was moved to the Director of Personal Health Services.  At this time, Mrs. Grush is recommending that this program be moved back under the Communicable Disease Program, with a new position of HIV/STD Clinical Team Leader.  This new position will be responsible for grant oversight activities, coordination of client care and providing supervisory guidance to program staff in carrying out the services of the HIV/STD Program. 

Mrs. Grush stated that the salary range of this position is $17.00 to $26.69 per hour.  The position will be filled by an in-house social worker, who will receive a 10% increase, according to agency policy.  This salary is covered by program grants. 

Ms. Gastiger moved to approve the class specification of HIV/STD Clinical Team Leader, seconded by Mr. Romero.  Motion carried.

Extra Compensation for Union Management Team

Mrs. Grush reported that the management team for the AFCSME contract negotiations consisted of Jane Lux, Karen Hills, Bette Chilton and Deb Rolf.  A total of 36 evening sessions were held.  She is recommending that Mrs. Lux and Mrs. Hills receive an additional $3,600 in compensation for their participation since May 2006, and $2,400 for Mrs. Chilton and Mrs. Rolf who participated since January 2007.   This compensation totals $12,000 and will be taken from the Salaries line item.

Dr. Liston made a motion to approve extra compensation for management staff participating in negotiations of the AFCSME contract, as presented, seconded by Dr. Olson.  Motion carried.

CORRESPONDENCE AND ANNOUNCEMENTS

News articles for the months of March and April were related to the appointment of new Board of Health members, the receipt of KishHealth System’s Inaugural Acclaimed Physician Award by Dr. Baumgart and two other area physicians, recognition of 39 Illinois home care providers for their membership in the Illinois Home Care Council, opening of the DeKalb Farmers’ Market, the results of a study showing that one in four teen girls has an STD, CATCH training for Italian officials, piloting of the CATCH Program by Cortland School, the Illinois Smoke Free Act, spay and neuter programs to control cat populations, the finding of a bat with rabies in Kirkland, recycling education by the DeKalb County Extension, and the nesting of a Canadian goose on a DeKalb mulch pile.

ADJOURNMENT

On a motion by Ms. Gastiger, seconded by Ms. Thompson, the Board of Health meeting adjourned at 9:10 p.m.  Motion carried.

Linda K. Liston, M.D.,  Secretary

DeKalb County Board of Health

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