DEKALB COUNTY BOARD OF HEALTH
MINUTES OF THE MEETING
DATE: September 27, 2011

 

BOARD OF HEALTH MEMBERS PRESENT
Linda Liston, MD – President
Jesus Romero – Vice President
Kevin Buick, JD - Secretary
Dennis Diemer, DVM
Tim Duez, DDS
Scott Starkweather
E. Sue Thompson, RN, MS

BOARD OF HEALTH MEMBERS ABSENT
Karen Hagen, RN, MS
Todd Latham
David Phillips, MD
Paul Stoddard

STAFF MEMBERS PRESENT
Jane Lux, Administrator
Bette Chilton, Director of Personal Health Services
Brenda Courtney, Director of Administrative Services
Marcy Zanellato, Director of Health Education
Greg Maurice, Director of Environmental Health
Lisa Hardcastle, Director of Home Care

CALL TO ORDER

The DeKalb County Board of Health meeting of September 27, 2011, was called to order at 7:34 PM by Dr. Linda Liston, MD, President.

MINUTES

On a motion by Dr. Tim Duez, seconded by Mrs. Sue Thompson, the Board of Health Minutes of the Meeting for August 2, 2011, were approved. Motion carried.

DIVISION REPORTS

Public Health Administrator – Jane Lux
Mrs. Lux stated July and August are the months we finish program and financial reports for last years’ grants and begin our new State fiscal year, including grant application preparations and Agreements.

She gave an overview of the Partnering for Healthier Communities conference she attended in Washington, DC. The YMCA and Kishwaukee Hospital received this grant to establish a leadership team for assessment and planning focused on healthy eating and physical activity. Mrs. Lux said the conference was excellent, and the team meets every two weeks for planning.

Mrs. Lux reported on the ongoing vicious dog case that has taken extensive administrative and Animal Control program resources. A jogger was attacked by two boxers in Sycamore on June 6th. The owner relinquished ownership to the Health Department, with consent to euthanize the dogs after completion of the ten day bite confinement at Malta Veterinary Hospital. In the mean time, the owner’s ex-husband came forward to claim ownership, and he secured legal counsel to challenge us. At the hearing on July 28th, the case was continued to August 17th. The States Attorney requested that we complete a detailed report in accordance with the Animal Control Act. The August 17th hearing was cancelled that morning, and the judge reassigned the case to another attorney with a new hearing date of October 11th. We had numerous contacts with the gentleman claiming ownership, and also from residents of the neighborhood seeking a safe and fair resolution. The responsibility of payment for boarding the dogs for this extended period is in dispute.

Mrs. Lux reviewed census data for the Home Care program. The average monthly census has not increased, and was particularly low in July and August, thus we continue to monitor activity and revenue closely. Mrs. Lux stated there are several contributing factors, and it is difficult to pinpoint a single cause for the decline. Some of these are marketplace changes, regulatory changes and the persistent economic downturn. Mrs. Thompson concurred, and added that hospitals are experiencing similar trends in that patients are delaying care, and are sicker when in the hospital. Dr. Diemer raised the question of whether these services should be tax supported if the private sector can handle the need. Mrs. Lux explained that the Home Care program is self-supporting, and is not tax subsidized, in accordance with County policy. As discussed in January, we plan to hire Terry Cichon, an accountant and management consultant with Frost, Ruttenberg and Rothblatt (FR&R). Mrs. Cichon is well respected in the industry at the state and national level for her regulatory, financial and management expertise and knowledge. In addition to implementing the business plan presented with the 2012 budget, Mrs. Lux and Mrs. Hardcastle are preparing a proposal to FR&R in order to schedule the consultation. We anticipate the recommendations will be critical to meeting our unprecedented challenges in 2012.

Mrs. Lux attended presentations on high deductible health plans and Health Savings Accounts given by Tim Kearns, the County’s health insurance consultant from R.J. Lee & Associates. She will discuss this further in New Business.

Mrs. Lux highlighted our cost containment practices to further reduce expenditures. These include savings from attrition and an agency wide supplies management system. While demand is decreased in Home Care, that is not the case in Personal Health Services (PHS). With reduction of staff and services in PHS, it is a challenge to be confronted with some expectations from the public that we are no longer able to meet, especially during the late summer and early fall months when school health requirements sharply increase demand.

Environmental Health – Greg Maurice
Mr. Maurice highlighted activities in the Environmental Health Division that occurred in addition to the vicious dog case. In collaboration with Communicable Disease program staff, The Division conducted an investigation of a probable foodborne illness outbreak associated with a county food establishment. Staff conducted thirty-seven (37) interviews. Thirty-two (32) of these individuals had moderate to severe gastroenteritis symptoms. We collected and submitted five stool specimens. The employees’ specimens tested negative, and two patrons’ specimens tested positive for Norovirus, the most common cause of acute gastroenteritis in the United States that is highly contagious. Our hypothesis was that there was viral contamination causing transmission, but we could not conclude it was from food.

Environmental Health investigated failing septic systems discharging into field tile. Staff worked with homeowners to disconnect from the tile and install an approved septic system. Mr. Maurice said that many older homes throughout the US are attached to field tiles, and over the last thirty or forty years, they have been hooking up to proper septic systems.

The Solid Waste Program had a very successful used motor oil collection in July. We collected about 4,800 gallons of oil brought in from throughout the community. Mr. Maurice announced the electronics recycling event is this Saturday.

The Division has been investigating an alleged livestock kill of five or six sheep in separate locations. The owner claimed they were killed by dogs. The Animal Control Act says that if a stray dog kills livestock, the county has to reimburse the owner for the fair market value. Our investigation did not conclude the deaths were caused by a dog. The Act requires if we cannot determine the cause, a veterinarian must examine the livestock. If it is not a dog kill, the owner is responsible for the veterinarian fee. Subsequent to explaining this procedure to the owner, we had no further contacts or reports.

Personal Health Services – Bette Chilton
Mrs. Chilton reviewed Division changes in July and August. Two full-time staff members resigned their positions. With our previous workforce reduction, and planned and unplanned absences, it has been a challenge to maintain services, even at a reduced level. This prompted Mrs. Chilton to review historic utilization data, comparing this year to the last two. The reduction in utilization was expected in some Maternal and Child Health (MCH) programs after we streamlined and reduced services. Mrs. Chilton explained that we have been successful at targeting services to those at highest risk in these programs. In the Women, Infants and Children (WIC) program, our caseload started to decrease in July 2010. For the WIC grant, we have been attempting to maintain caseload, as funding has remained stable and is contingent on caseload. We attribute the decrease partly to the closure of our Sandwich WIC site. In order to sustain our WIC funding, we are working toward a more efficient model so we can increase caseload to pre-July 2010 levels. Mrs. Chilton presented positive outcomes in the MCH programs for fiscal year 2011, an especially great achievement with reduced resources, and she also noted that these prevention programs save health care dollars in reduced morbidity and mortality of pregnant women, infants and children.

Trends in the Communicable Disease Program, such as increased sexually transmitted diseases (STDs) and other reportable diseases and outbreaks, are unpredictable. In Adult Immunizations, utilization stayed comparable, even without a 1.0 full-time equivalent (FTE) nurse.

In July and August, we worked on preparing for the annual Flu Prevention program, using our Emergency Preparedness team and model. Applying emergency preparedness and response policies and practices to our usual public health activities (described as “every day use”) has been very successful. New this year, we developed the “Flu Prevention Alliance” to promote access to flu vaccination, and our publicity and website included collaboration with pharmacies. Our goal is to increase the percentage of people who get a flu shot.

Mrs. Chilton conducted a Division team building exercise titled “The Marshmallow Challenge.” This enhanced efforts to provide staff recognition, celebrate positive outcomes and promote staff feedback during times of change.

Home Care – Lisa Hardcastle
Mrs. Hardcastle attended a meeting hosted by Kishwaukee Hospital to discuss Accountable Care Organizations (ACOs). The federal rule has not yet been finalized. ACOs are planning for bundling of services with the goals of reducing re-hospitalizations and associated costs, and ultimately, improving patient outcomes. The focus is on transitioning of care after hospital discharge.

Mrs. Hardcastle has initiated the Quality/Education Coordinator conducting case management meetings with nurses and therapists. The purposes include discussion of patient progress toward goals, reduction of barriers and determination of the most effective and efficient utilization for both good outcomes and maximum reimbursement. Regulatory and reimbursement changes require more oversight.

In order to improve our case mix target, we initiated an on-line OASIS training course for the nurses. The course consists of ten (10) modules focusing on how to accurately complete the OASIS data set. This has been an ambitious undertaking for the staff that we think is critical to our business plan and to patient outcomes and outcome data.

Mrs. Hardcastle explained the StuderGroup Stop Light report tool for communication regarding changes, and how we use rounding to elicit staff feedback.

Health Education – Marcy Zanellato
Mrs. Zanelatto highlighted the work the emergency planning and response team has done and the new grant year deliverables. The team consists of the managers present and two additional nurse coordinators. Mrs. Zanellato explained the National Incident Management standards we are required to follow for our two Emergency Preparedness grants that align our practices with other response entities, such as fire and law enforcement. There are thirty-seven national capability requirements, fifteen of which are specific to public health. This year’s grants are based on a five year plan to meet all the capabilities.

As mentioned in Mrs. Chilton’s report, we have adopted the “every day use” recommendation to integrate the response model in our routine public health activities. We practiced this with the foodborne illness outbreak, and utilized it with the flu response and planning team. Mrs. Zanellato gave examples of some of the public health capabilities: medication dispensing, material management and distribution, non-pharmaceutical interventions, public information, emergency operations coordination and surveillance.

FINANCIAL DATA

Kevin Buick moved to approve the Financial Statements for July and August 2011, seconded by Jesus Romero. Motion carried.

Jesus Romero moved to approve the Claims for August and September 2011, seconded by Scott Starkweather. Motion carried.

NEW BUSINESS

Budget Update
Mrs. Lux presented excerpts from the administrative recommendation to the County Board for the County budget. Beginning with the budget basis, the downturn in the economy continues to put a stain on local revenues. The proposed County budget utilizes $900,000 of fund balance, and the discussion includes the auditor’s recommendations with regard to the fund balance. Under salaries and benefits, there is a discussion of the investigation of health insurance options, including high deductible health plans with Health Savings Accounts. They have decided to continue with the current “traditional” preferred provider organization (PPO) plan in 2012. In 2013, employees would be offered the option of a PPO Plan or a high deductible plan with a Health Savings Account. They are looking at moving the traditional plan from a two tier system to a four tier system. The County has been advised to allow six months for employee education before implementing the new options. Under Boards and Agency Funding, our request for the replacement Animal Control vehicle is not mentioned because this item comes from a separate asset replacement fund. The parking lot project for 2012 does not come out of our budget, as there is a separate fund.

Mrs. Lux stated that our County request is being recommended as we proposed except for the tax levy, which is $5000 less than our request. The July budget figure was based on an estimate of taxable assessed value which was updated in August at a lower assessed value. Thus, the tax levy, at $470,000, is the same amount that we received in 2011.

Mrs. Lux requested a revision to our Home Care fees to enhance our negotiating position with the third parties that are the payers.

Scott Starkweather moved to approve the increase in fees as presented for Home Health Care, seconded by Kevin Buick. Motion carried.

Vision and Hearing Grant Update
In May, the Board of Health gave approval to Mrs. Grush to discuss the Preschool Vision and Hearing Screening grant with Community Coordinated Child Care (4-C), as that organization is a child care clearinghouse and provides advocacy and resources to child care centers and providers. In addition, they have certified screening technicians on staff. Mrs. Grush and Mrs. Lux met with Micki Chulick, Executive Director, and subsequently with the 4-C Executive Committee regarding their interest in the grant and the services. While preschool vision and hearing screening is within their mission, they would not be interested in administering the grant at this time, mainly due to late payments from the Illinois Department of Public Health. During our discussions, we learned the grant was cut twenty-eight percent. Mrs. Lux said we will have to re-evaluate the grant if we lose our certified staff or there are further cuts in funding.

New Home Care Management Classifications
With the layoffs in December 2010, we eliminated a Program Development Coordinator in the Home Care Division. The new job classifications represent a new configuration of responsibilities for the reduced management staff. The new job classifications are Clinical Coordinator and Quality/Education Coordinator, and the salary range is the same as the eliminated classification. As indicated in the job descriptions, the Clinical Coordinator supervises nurses and home health aides. The Quality/Education Coordinator supervises the Quality Improvement Nurse and the Quality Improvement Assistant.

Dr. Duez moved to approve the new Home Care Management Classifications for Home Care, seconded by Mrs. Thompson. Motion carried.

Community Cares Clinic (CCC) Request
CCC, a program of Kishwaukee Hospital, is expanding and remodeling, and they are looking for clinic space during expansion estimated to be six to eight months. Mrs. Lux would like to offer them our available clinic space under a mutually acceptable agreement. We do not anticipate any additional cost to us, but the hospital would cover any cost incurred. In accordance with advice from our insurer, we requested that they list the Health Department on a “Certificate of Insurance” as an additional insured. Mrs. Lux will be working with the States Attorney’s office to develop a written Agreement. They are requesting two or three exam rooms five days a week beginning in October to serve approximately twenty patients a week. Mr. Starkweather asked if there is value doing something longer term with the clinic. Mrs. Lux stated we consider them to be partners, as we serve the same population and they provided a medical home for our Well Child Clinic clients. Mrs. Lux stated she would consider future mutually beneficial partnership opportunities. Board members expressed support of moving forward with the Agreement.

Nominating Committee
Mrs. Thompson is the Chair of the Nominating Committee, and Dr. Duez and Dr. Phillips are members of the committee. We have three memberships that expire at the end of the year: Dr. Liston, a physician member, Jesus Romero and Scott Starkweather, community members. We need to replace these three members. Paul Stoddard is our County Board representative, and Mrs. Lux will ask him if he will serve another term. She would like to have a brief meeting of Nominating Committee in October. If Board members know of anyone who is interested, please let Mrs. Thompson or Mrs. Lux know. We will also need a new slate of officers, as Dr. Liston, President, and Jesus Romero, Vice President, are going off the Board, and Kevin Buick’s term as Secretary will be expiring. If anybody is interested in being an officer, please let Mrs. Thompson or Mrs. Lux know.

November Meeting Date
The November meeting date will be held on November 29, 2011.

EXECUTIVE SESSION

At 8:56 PM, Kevin Buick moved, seconded by Sue Thompson, to enter into Executive Session for the purpose of discussing the semi-annual review of Executive Session Minutes under Miscellaneous Exceptions, Number 21 of Section 2 (c) of the Open Meeting Act. Motion carried.

Number 21 pertains to semi-annual review of the minutes as mandated by Section 2.06.

On a roll call vote, those voting yes were Dr. Linda Liston, Jesus Romero, Sue Thompson, Dr. Tim Duez, Dr. Dennis Diemer, Scott Starkweather and Kevin Buick.

Kevin Buick moved to reconvene to Open Session, seconded by Jesus Romero. Motion carried.

At 9:04 PM, Dr. Liston stated that the Board of Health is now in Open Session.

On a motion by Kevin Buick, seconded by Scott Starkweather, the Board of Health approved the release of the Executive Session Minutes of the Meetings held on April 19, 2011, April 25, 2011, April 29, 2011, and May 3, 2011. Motion carried.

On a motion by Kevin Buick, seconded by Dr. Tim Duez, the Board of Health accepted Resolution 92711 to destroy the verbatim tape of the Executive Session Meeting held on September 29, 2009. Motion carried.

CORRESPONDENCE AND ANNOUNCEMENTS
See highlights as noted.

ADJOURNMENT
On a motion by Scott Starkweather, seconded by Jesus Romero, the Board of Health adjourned at 9:07 PM. Motion carried.

 

 

________________________________________________
Kevin Buick, JD, Secretary
DeKalb County Board of Health

 

________________________________________________

Kevin Buick, JD, Secretary

DeKalb County Board of Heath