DEKALB COUNTY BOARD OF HEALTH

MINUTES OF THE MEETING

JANUARY 26, 2010

 

 

BOARD OF HEALTH MEMBERS PRESENT

Linda Liston, M.D. – President

Kevin Buick, J.D. - Secretary

Dennis Diemer, D.V.M.

Karen Hagen, R.N.

Todd Latham

David Phillips, M.D.

Scott Starkweather

Paul Stoddard

E. Sue Thompson, R.N.

 

BOARD OF HEALTH MEMBERS ABSENT

Jesus Romero – Vice President

Tim Duez – D.D.S.

Staff Members Present

Karen Grush, DeKalb County Health Department, Administrator

Jane Lux, DeKalb County Health Department, Assistant Administrator

Bette Chilton, DeKalb County Health Department, Director of Personal Health Services

Brenda Courtney, Director of Fiscal Operations

Bob Drake, DeKalb County Health Department, Director of Environmental Health

Ruth Patton, DeKalb County Health Department, Director of Office Support

Deb Rolf, DeKalb County Health Department, Director of Home Care

Marcy Zanellato, Director of Health Education

 

STAFF MEMBERS ABSENT

None

 

 

CALL TO ORDER

The DeKalb County Board of Health meeting of January 26, 2010, was called to order at 7:33 p.m. by Dr. Linda Liston, President.

 

 

INTRODUCTION OF NEW BOARD MEMBERS

Dr. Liston started the meeting by welcoming one of the newest Board members, Karen Hagen.  Mrs. Hagen is the Executive Director of the DeKalb County Hospice.  Mrs. Hagen has been an R.N. for many years and has worked for DeKalb County Hospice for 26 years.

 

Tim Duez, D.D.S. has also been appointed to the DeKalb County Board of Health.  Unfortunately, he was unable to attend tonight’s meeting due to previous commitments. 

 

 

MINUTES

On a motion by Mr. Stoddard, seconded by Dr. Phillips, the Board of Health Minutes of the Meeting for December 1, 2009, were approved.  Motion carried.  Mrs. Thompson abstained from approval due to her absence of the December 1, 2009 meeting.

 

 

Division Reports

 

Public Health Administrator

Mrs. Grush reported that the Health Department has begun finalizing the financial statement for FY2009.  An audited financial statement will be presented at the March 2010 Board of Health meeting.

 

Mrs. Grush also reported there was a decrease in mileage reimbursement from .55 cents per mile to .50 cents per mile for DeKalb County Government employees effective January 1, 2010.  Mileage reimbursement is based on the current IRS rate.

 

Mrs. Grush reported on changes made to employee health premiums which took affect January 1, 2010.  AFCSME changed the distribution of what union members pay for health insurance and decided on a 25 percent equal split between single and family rates.  As a result, the amount employees with family coverage have to pay decreased and the amount employees with single coverage will increase.

 

Mrs. Grush reported on several concerns regarding funding for 2010 – 2011.  With our Case Management Federal Match grant beginning in July 2009, we just became aware that the State made a change in determining clients that are eligible for match funding from the federal government.  This will not affect our revenue for 2009 but will for 2010.  This has the potential to have approximately a $50,000 decrease in revenue.

 

Also, funding for our HIV Prevention Grant is in limbo at the moment.  This grant runs from January to December so funding crosses over two State fiscal years.  At the current time, our Region, the northwest corner of the state, is expecting a 63 percent reduction in funding.  We have received a Bridge grant of $5,000 (2009 grant $64,250) while the State works with the Governors office to secure more funding to save the HIV Prevention Program statewide.

 

Mentioned previously, the State has hinted at cuts of up to 20 percent in our Family Planning funding, though additional money potentially at the federal level could cushion those cuts.

 

Mrs. Grush reported a change made to the Vital Records Division in 2010.  All births are now electronically entered, which makes this program much more efficient.

 

Dr. Diemer asked how frequently health insurance benefits were reviewed and what type of policy we have.  Mrs. Grush replied that Health Department employees are covered under the DeKalb County Government’s Group Blue Cross Blue Shield policy.  This policy includes medical, dental, vision, and pharmacy coverage and the policy is reviewed and negotiated each year by insurance consultants hired by the county.  Dr. Diemer further stated upon reviewing the rates paid out by the Health Department they seem very high and that we may save money by changing to a health savings account. 

 

Dr. Liston asked about the reimbursement for IPA clients under the Family Case Management Grant (FCM).  Mrs. Grush responded that the state receives funding from the federal government to help subsidize the Medicaid Program.  With this grant, local costs that are not paid for by the FCM grant are eligible for 50 percent reimbursement from the federal match money.  The federal government has determined the state is not eligible for reimbursement for children put on Medicaid under the Blagojevich Medicaid expansion program.  Since a number of the children in our Family Case Program receive coverage under this expansion program, federal match money for the Health Department for serving those individuals will no longer be available.

 

Dr. Liston asked what was new with the freedom of information act.  Mr. Buick responded there a lot of changes and the nature of the expansion is designed to make it more difficult to evade what might not be good faith requests.  Mrs. Grush added that most requests are for the Environmental Health Division.  If records are maintained in an electronic form then they can request it in an electronic form. 

 

 

Environmental Health

Mr. Drake reported there has been a potential spot located in Kingston for a rural recycling drop off.

 

Dr. Liston asked about critical food violations and what they consist of.  Mr. Drake responded examples are an employee not washing their hands, temperatures not cold enough or hot enough, chemicals stored above food products, sewage, etc.  Mr. Drake further responded that some of the violations can be corrected on the spot.  If not, the establishment gets 24-hours to correct the problem.  Mr. Drake stated that most violations are temperature issues. 

                                                        

Personal Health Services

Mrs. Chilton reported the Public Health Services Division is being kept very busy in this economy.  Mrs. Thompson asked if the Health Department utilizes the use of volunteers.  Mrs. Chilton responded that using volunteers would require the hiring of a volunteer coordinator.  Mrs. Chilton further stated that utilization of volunteers in our programs would require an enormous amount of training, not providing a cost effective benefit.

 

Dr. Diemer asked about losing funds and what programs will be cut.  Mrs. Grush responded as we know more about the 2010 – 2011 financial picture, a plan with recommendations will be presented to the Board. 

 

Dr. Liston asked about the funding for the HIV program being lost.  Mrs. Chilton responded if funding is not restored, services will need to be cut.  Mrs. Thompson asked who we would refer our clients to.  Mrs. Chilton stated they would be referred to the Community Cares Clinic, Tri-County or Crusader Clinic.  Unfortunately, the clients would not receive in depth counseling the Health Department provides. 

 

Home Care

Mrs. Rolf reported as of January 1, 2010, the new Medicare documentation system is in place.  Unfortunately, due to the large amount of paperwork involved, it has affected business operations.  Typically an admission visit would take three hours but now with changes it’s taking four to five hours.  As staff becomes familiar with it, time will decrease.  Now private pay insurance companies require the OASIS as well and providers are being paid by performance or paid by the patient’s outcome. 

 

Health Education

Mrs. Zanellato presented highlights of the Future Is Ours program.  This ten session program was implemented on October 21, 2009, at the Clinton-Rosette Middle School for Latina sixth and seventh grade girls.  The program will expand into Huntley Middle School starting February 2, 2010. 

 

 

Financial Data

Mrs. Grush reported we are financially stable at this time but future operational funding is of concern.  2009 Financials books must be closed by February 22, 2010.  Once this is done, and the auditors have completed the audit, we will have a better financial picture. 

 

Mrs. Thompson moved to approve the Financial Statements for the months of November and December 2009, and Claims for the months of December 2009 and January 2010.  The motion was seconded by Mr. Buick.  Motion carried. 

 

 

NEW BUSINESS 

H1N1 Update

Mrs. Grush reported while the theme of the previous report was a very high demand for vaccine combined with a very low and uncertain supply, these variables have reversed over the course of the last two months.  With influenza illness decreasing and less media attention, the demand for vaccine has moderated.  More predictable vaccine shipments have provided an ample supply of vaccine.   After our first public clinic at the Health Department on November 1^st, we proceeded with our school district-based plan to increase access for preschool and school aged children.  We held a school-located clinic in the northern, southern and central geographic regions of the County.

 

The Illinois Department of Public Health (DPH) expanded H1N1 influenza vaccine eligibility to the general public beginning December 15^th.  At this point, to provide expanded availability, we began offering once or twice weekly clinic days at the Health Department that the public could access by making an appointment.  We utilized Protocol Services Acquisition Corporation for their Call Center service, which allowed the public to call a toll free number to schedule an appointment 24 hours a day, seven days a week. 

 

The call center appointment system offered us many benefits.  The main benefit was predictability of numbers of persons and timing.  It allowed us control of client flow, parking, and ability to plan staffing according to needs.  We are able to operate these clinics with fewer staff resources and decreased transport of supplies, thus gaining efficiencies. 

 

Through December 2009, 17 clinics were held administering 6,673 doses of vaccine. Because local health care providers had received limited or no vaccine, the Health Department shared its supply by transferring 3,160 doses to them.

 

The flu team continued weekly planning meetings in conjunction with IDPH conference calls.  Conference call topics included influenza illness, surveillance updates, various clinical updates and clarifications, H1N1 vaccine updates, sharing of IDPH and local strategies for the prevention and vaccination campaign, and discussion of the Public Health and Emergency Response (PER) Grants. Additional meetings were held to plan our local clinics, discuss public information and media and delegate responsibilities.

 

An electronic data spreadsheet and process for tracking staff time, compensation, claims and cost documentation for the purposes of grant staff time allocation and PHER Grant reimbursement was developed.

 

Partner collaboration continued. We worked with school personnel to conduct our school-located clinics. We partnered with county EMS and law enforcement for assistance at public clinic sites. Mrs. Zanellato continued work with Elder Care Services staff, in their capacity as the designated agency to distribute information we develop to the “Trusted Sources Network” (TSN).  

 

Weekly or biweekly public service announcements (PSA) were sent to local media regarding our clinics and vaccine availability.  In addition, the H1N1 page of the Health Department website was updated as new clinic and other information changed frequently. 

 

The Communicable Disease program completed investigations for fourteen confirmed cases of H1N1 influenza in November.  There were no reported cases in December.  The total confirmed cases for 2009 is 28. Of the 14 cases hospitalized, the age range was from one year to 53 years of age.  One patient was transferred to a higher level of care, improved, and was subsequently discharged to further rehabilitation. DeKalb County had one death in September.

 

We received a Strategic National Stockpile “drop” of 1,740 N95 masks, 1,000 procedure masks and 616 courses of antivirals on November 19^th.  Mrs. Lux sent an email to our healthcare provider distribution list to notify them of the availability of antivirals, and Mrs. Newby managed the transfer of requested supplies.  We distributed 442 courses of Tamiflu and 16 courses of Relenza to 10 providers in November, and 255 courses of Tamiflu to three providers in December.

 

Mrs. Grush reported, according to the January 2010 Morbidity and Mortality Weekly Report (MMWR) released by the Centers for Disease Control and Prevention CDC), as of January 2^nd, an estimated 20.3 percent of the U.S. population had been vaccinated for H1N1 influenza, including 27.9 percent of persons in the initial target groups.  She indicated when all vaccine numbers are reported she believes 20 to 25 percent of DeKalb county residents will have received the vaccine.

 

According to the report, an estimated 29.4 percent of U.S. children aged six months to 18 years had been vaccinated for H1N1 influenza.  Among children under five years, who have been among the groups most severely affected by 2009 H1N1, first-dose 2009 H1N1 influenza vaccination coverage was 33 percent, approaching seasonal influenza vaccination coverage estimates (35 percent - 43 percent) during recent seasons. An estimated 38 percent of pregnant women had been vaccinated for H1N1 as of January 2^nd.  Nearly 90 percent of adults less than 65 years of age with medical conditions that increase their risk for influenza-related complications remain unvaccinated. 

 

Mrs. Grush stated our public health challenge is to continue to improve vaccination coverage, even as many in the public perceive decreased need.  The CDC reminds us that although influenza activity has declined, cases of 2009 H1N1 influenza, including cases of severe disease, continue to occur. It is also unknown at this time if a third wave will appear in the spring. 

 

There was a brief discussion regarding seasonal flu vaccine.  Mr. Stoddard asked how much seasonal vaccine we received in 2009.  Mrs. Chilton responded 3,000 doses were received and given.  Mr. Stoddard asked what percentage of the population must be vaccinated to affect immunity.  Dr. Phillips responded approximately 95 percent.  Dr. Phillips added that the H1N1 vaccine may be a part of the seasonal flu vaccine for the next two to three years.

 

 

2010 Committee Appointments made by President Liston