CCHHS STRATEGIC PLAN NEEDS MORE WORK

Cook County Health and Hospitals System Board Meeting November 19, 2009

Public comment included a citizen who accused the Board of undesirable relationships with private providers and failure to recognize the role "Chicago politics" will play in their acceptance. The Board responded by assuring him that any relationships that are developed are examined from the perspective of what benefits they bring to the County System. A Dietician from Oak Forest Hospital reported that employees there are demoralized over layoffs recommended in the Navigant Report [a report generated by consulting firm Navigant Consulting Inc.]. She enumerated 200 in non-clinical positions and also related the difficulties of providing efficient meal service in a physical plant spread out over three locations.

As part of on-going Board of Directors education, the coordinator of the Internal Medicine Residency gave an overview of that program which includes 144 positions. Those accepted were selected from about 5000 who apply yearly. The program has been accredited since 1955 and has high standing among 370 comparable programs in the U.S. These Residents participate in every patient encounter throughout the hospital, including the ICU and ER. About 50% go on to Fellowships.

CFO Foley reported that the Strategic Plan would not be adopted at this meeting. It needs further analysis after public and internal meetings. The emphasis will continue on improving access.

The Consultant led the Board through the goals in the Plan and some proposed changes in emphasis. With regard to inpatient facilities several additional data are necessary, particularly an evaluation of the need for services at those facilities and what other resources and alternatives exist. He emphasized that the County mission is fundamentally different from that of the private sector. With regard to out patient services, suitable resources at other Centers must be evaluated. The development of Service Lines such as Trauma, Women and Children, and Surgery also need further analysis. Initiatives will be prioritized with time lines of 3-5 years.

There was considerable discussion regarding how to proceed with the financial future in jeopardy. Enabled by improved revenues, the 2010 CCHHS budget was cut by $75 million. Interjected was the roll back of sales tax and what its impact would be on the 2011 budget. Rumors included another $75 million cut in Health which could translate into losing 1250 FTEs. It was noted that Health spending accounts for about 30% of the budget, but reimbursements for health services (which go into the General Fund) reduce the portion of the tax-generated revenues spent on Health to about 12%. Therefore, any cuts in Health should be proportionate. The challenge is how to maximize income other than tax revenue. Some possibilities are better billing and performance improvement. Other communities have added 501(c)3 status to garner voluntary contributions. Critical to any implementation is a Financial Plan. Its development was assigned to the Finance and Audit Committees.

The Director of Public Health reported on the status of H1N1 immunization and incidence. The program is moving as quickly as possible with distribution of doses. Acceptance has been high except among the African-American population. Efforts are underway to reach Ministers and others who could be influential in communicating the benefits of this immunization.

A report on Phase 1 of the Performance Improvement Assessment was detailed. The consultant gathered data from many sources. It addressed physician alignment, clinics, pharmacy, laboratories, hospitals and showed much "opportunity" for improvement. Implementing change would involve modifying the infrastructure and adding tools, including automation. Services have to be managed frequently and staff training is critical. CFO Foley responded with his intention to implement many of the recommendations using the existing management team.

The Board adjourned to Executive session.

--Submitted by Observer Nancy Staunton

2010 Cook County Budget Passes; $80,000,000.00 over 2009 Budget

Thursday, November 19th, was scheduled for the Cook County Board of Commissioners to deal with over 50 amendments to the 2010 budget. It looked like this would take days, but since numerous amendments were presented by Tony Peraica to reduce the budget, eliminate programs, etc. and no other commissioner would give a second, these were readily dismissed. Some highlights of the day include the following:

All departments, bureaus, commissioners' offices, etc. were previously instructed to cut 5% from their budget requests. Many Commissioners and departments did not do this, and they seemed to be rewarded for their laxness. At this meeting, all areas were cut an additional 1.5% to account for the previous day's sales tax reduction. Comm. Claypool commented that under "best practices" this cut can easily be absorbed by departments due to rotating staff vacancies. Those that had not cut the 5% previously were cut an additional 1.5%. The "unfairness," as Comm. Schneider pointed out, is that those who complied were cut a total of 6.5% and those who did not were cut 3%. This cut the Health and Hospital System (HHS) budget by $13.3 million, which Comm. Schneider said is unwarranted since HHS is well-run.

In the future, grants will have their own line items in the budget and will be made known to the commissioners on a monthly or quarterly basis. Regarding Commissioner expenses, all need to be reported quarterly, with proof, in the future. Comm. Schneider pointed out that some commissioner offices spend $100,000.00 more than others.

The Stroger-proposed new film commission ($250,000.00) was defeated since most commissioners felt now was not an appropriate time to add this type of spending. Some felt current employees could liaison with the Chicago and Illinois Film Commissions already in place.

Some new programs were added to this budget, including one $40,000.00 position in the Ethics, Human Rights and Women Dept. to deal with women's issues.

Money was transferred from reductions elsewhere to aid incarcerated, pregnant women with prenatal care. Funding for counseling services for those experiencing foreclosure was also passed.

The issue of red light cameras at Cook County intersections was discussed. Two red light companies will present contracts to do this at 30 intersections. This appears to be favored mostly by Comm. Moreno, who said up to 150 intersections could be involved. This would provide a large stream of revenue for the County. Several commissioners debated whether this was mainly for revenue or for safety reasons.

Nov. 9, 2009 Finance Committee Meeting to Review the Proposed Budget--Juvenile Temporary Detention Center

Earl Dunlap, Transitional Administrator, Juvenile Temporary Detention Center (JTDC) of Cook County, provided an overview of the Detention Center.  The average daily population from 7/1/08 to 6/30/09 was 390.59 detainees.  The adult transfer population (included in total pop) was 94.78.  The racial breakdown of the population was 84.3% African American, 10.2% Hispanic, 2.6% White. 

There has been a rush of hiring in the last 10 months – 260 total new hires including 130 counselors and 20 team leaders.  Staff received 37,000 hours of training.  New staff gets 6 weeks of training before they begin.  Staff training complies with the Administrative Office of Illinois Courts (AOIC).

Reports on staffing have gone to the federal court in charge of the consent decree, which mandates the changes in the JTDC, Office of the Chief Judge of Cook County (newly made the administrator

of the JTDC) as per the federal court decree.

A dramatic upgrade is being made in the staffing at the Center. It will eliminate the current Juvenile Detention Counselor position and replace it with a Youth Development Specialist.  Making this change will provide more highly skilled workers available to the detention center population. It will also put the JTDC in compliance with the AOIC, permitting the JTDC to qualify for more State of Illinois dollars for costs, reducing its reliance on Cook County revenues. The Juvenile Detention Counselor position has traditionally been a position where only a high school diploma and no specialized training has been needed for direct work with the detainees in the living units. The Youth Development Specialist (YDS) position requires a college degree in an appropriate field.  A Youth Development Specialist Associate position will be available to those who

pass the hiring test for the YDS, get re-hired and are working to complete a college degree. All current Counselors will be welcome to go through the hiring process for the YDS Associate.

In the past year, there have been 88 investigations of instances involving the counselors done by the investigators newly hired by Office of Transitional Administrator (OTA). Of the 88 investigations, 33 involved physical abuse, 9 were substantiated, and employment terminated on that staffer.

Five of nine anticipated living centers are now open.

On Tuesday, November 17th there will be a federal court hearing regarding employees affected by the

recommendations to eliminate the counselor positions and the replacement of those workers by Youth Development Specialists with higher educational requirements.

The JTDC has not exceeded budgetary limits for FY 08-09. In fact, expenses have been below those limits.  There will be a reduction of overtime by 2011. 

Glass doors in the detainees rooms will be replaced by steel doors so that they have more privacy and detainees cannot break the doors as easily.  Safety rooms (padded) will be installed for detainees who need them.  Staff will get 2 way radios with direct contact with detainees.  Time clocks are being installed and activated for all staff. 

JD Counselor position will be upgraded to the YDSpecialist, which has essentially the same qualifications as an entry level Probation Officer.  The job reclassification will cost the JTDC $1.11 million. 

Currently there are 20 staff members in mental health positions, currently paid by the Cermak Health services. Many experts / standards say there should be 44 staff members in MH positions at JTDC. However Dunlap himself recommends a total of 30 MH workers. 

In response to questions from Commissioner Schneider, Dunlap answered that he, his assistant, and the consultants they hire submit itemized expenditures that are paid through funds from the State’s Attorney.  Dunlap works 2 1/2 to 3 days a week only.  There is a full time administrator who comes in on Monday around noon. He works Monday afternoon and into the night; all day Tuesday and Wednesday, including the night; all day Wednesday; and all day Thursday, taking the Thursday train at 4 or 8 p.m. to get back home. He puts in a 40 – 50 hour week at the DC, and works on the weekend at his home.

Regarding expenses, Dunlap said, the JTDC has been greatly ‘underresourced’ for a very long time. Much of the dollar expenditure is to close the gap from what was deplorable to what is proper.  The physical plant itself makes expenses higher than necessary. A more efficient facility could be 30% cheaper.  Just processing the detainees into the facility is expensive, but 26% of all those detained are released in 96 hours or less. Ways to reduce that have been brought to the attention of the Chief Judge of the circuit.

any alternatives to detention already in place should be increased, including electronic monitoring. Weekend courts and/or Saturday court calls would cut down on JTDC population. Evening and weekend court calls mean parents could be there with their kids. Kids on psychotropics now end up in JTDC, though it is not a proper treatment place for them. If the population is reduced, staff can be reduced, and expenses would be reduced. Juvenile crime rates are lower than they have been in 40 years, yet the population of the DC has not fallen by the same proportion.

Commissioner Collins stated that kids are now being punished twice: once by the situation that brought them to do illegal things, once by the very fact of being in the JTDC. It is important to keep the kids out who don’t belong there, and to appropriately assess and treat those who do belong there.

Collins asked why Dunlap thinks he only needs 30 and not 44 Mental Health staff at the DC. He responded that many of the mental health problems detainees have are not treated appropriately at the JTDC. They should have access to detox and other similar services in more appropriate settings. Collins also asked if the court could give a waiver to workers whose jobs will be terminated – there is value in having the good workers who have been with the DC for years stay there. Dunlap stated that the employees will all have a chance to apply for the newly created position.

Commissioner Sims stated that there should have been a way to work things out with the 200 plus workers who are being laid off.  She also said that the Chief Judge will hire a superintendent; after the Transitional Administrator will be out, the court can / will still be monitoring the situation.  Currently there is no superintendent of the JTDC. The office has remained vacant while Dunlap has been TA. Dunlap expects to be gone by the end of summer. 

In his concluding statement, Dunlap noted that Cook County locks up more kids than New York City does – and NYC has four times as many juveniles.  You can educate someone for six years at Harvard for what it costs to keep a youth for one year in the JTDC.

--Submitted by Observer Millie Juskevice, with assistance from Observer Ruby Donahue

Nov. 9, 2009 Finance Committee Meeting to Review the Proposed Budget--Offices under the President

Chief of Staff Joseph Fratto said that the budgets for these offices (Department of Human Rights, Ethics, Women’s Issues; Department of Public Affairs and Communications; and Office of the President) are down from 2009, but the Q-2A chart shows an increase of $175,472 in the Corporate Fund.  However, $251,611 is proposed for a new Film Commission Office that is expected to have a huge potential upside in revenue for the County through the creation and retention of jobs.  The point of the Office would be to market the County and for filming and related services, as well as to provide a central point of contact for necessary permits and regulatory approvals in the different municipalities for the film industry in seeking to film in Cook County.  Several of the Commissioners inquired whether the marketing and permitting/regulatory central point of contact could be done with existing employees, rather than creating new positions.  Mr. Fratto said he would look at that.

There were also many questions regarding the tripling of the budget in the special purpose fund for the Department of Homeland Security and Emergency Management (from $354,000 to over $1 million).  Commissioner Gainer questioned the large salary increases that were proposed for existing employees without any showing that there was a need in order to retain these employees or to recruit new employees.  Commissioner Suffredin noted that $882,000 of this special purpose fund is supposed to be covered by anticipated reimbursements from the State, but the Commissioner expressed concern over whether these reimbursements would ever be received.  Further, apparently there are other budgeted positions that would be funded by grants that are not in the budget book.  Mr. Fratto was asked to delineate exactly what these are.

--Submitted by Observer Pris Mims

Cook County Board Once Again Approves Reduction in Sales Tax

November 17 at 10:30am

The Cook County Board met in Special Session to consider 2 amendments to the Home Rule Sales Taxes in the county. The amendments called for a decrease from 1.75% to 1.25% in both the County Retailer's Occupation Tax and the County Service Occupation Tax. The meeting was called to order by President Stroger at 10:50am and Comm. Suffredin moved the approval of the 2 amendments.

After establishing that public notification of the meeting met the Open Meetings Act requirements, Comm. Schneider introduced amendments to the amendments that changed the percentage reduction of the tax from 1.75% to 0.75%. This provoked discussion of whether such amendments were in order and after establishing that they were Comm. Schneider stated that his amendments were intended to get rid of the tax which is driving business out of the county and look to other ways to broaden the tax base to produce revenue if it is needed.

Debate ensued with nearly all commissioners having their say about the taxes once again. The roll call vote to accept the substitute amendments was as follows: Yes(6): Claypool, Gorman, Goslin, Peraica, Schneider, Silvestri No(10): Beavers, Butler, Collins, Daley, Gainer, Murphy, Reyes, Sims, Steele, Suffredin Absent(1): Moreno

Then the original amendments were brought back to the floor for action. Again there was debate. Comm. Collins stated that Cook County was "the worst structured and run government in the country" and it needs to be restructured since so many departments have strayed from their core mission. Comm. Daley stated that Cook County goverment will change in 2011 and agencies will have to combine. He further stated that the Board needs the power to make changes. Comm. Peraica apparently insulted a relative of Comm. Daley, that resulted in accusations of politicking, looking out only for one's constituents not the county as a whole, looking to doing what was politically expedient rather than what is good for the people.

After all the Commissioners who wanted to were able to speak, President Stroger then made his speech saying this was a battle of the haves and the have nots, and again stating that the poor will suffer with a lack of health care. He accused the Unions of having done nothing - just standing on the side lines. He stated that he is there to represent all of Cook County and to remind people of what really matters. Then he called for the roll call vote.

The vote on the amendments changing the tax from 1.75% to 1.25% was done on each amendment separately. The vote was the same for each. Yes(12): Claypool, Collins, Daley, Gainer, Gorman, Goslin, Peraica, Reyes, Schneider, Silvestri, Steel, Suffredin No(5): Beavers, Butler, Moreno, Murphy, Sims

A move to reconsider each was made and another roll call was done. It was not approved. The meeting was adjourned at 12:40pm.

Nov. 9, 2009 Finance Committee Meeting to Review the Proposed Budget--Clerk of the Circuit Court

Clerk of the Circuit Court Dorothy Brown appeared to discuss the proposed budget which has a $370,000 decrease from 2009 in the Corporate Fund, but increases of $193,720 in the Document Storage Fund and of $440,974 in the Administrative Fund, as well as $4.3 million in the Automation Fund (all 3 are special purpose funds).  Overall, the Clerk is seeking an increase of 9 FTEs (full time equivalents) over those authorized in the 2009 budget.  The Clerk said that she expects that the costs for overtime will be reduced considerably because she is now in the process of posting positions that would have a Wed.-Sun. workweek so that weekend courts will no longer be staffed by employees being paid overtime.   The Clerk’s office rolled out E-filings (Electronic filings) for some of the court divisions and hopes to expand to all the other divisions over the next 18 months.  The Clerk hopes to have a computer available for each judge’s use at the bench so the judge can access all these electronically filed “documents.”  However, the Illinois Supreme Court still requires that there be a paper copy of all these electronic filings, which means the Clerk’s employees must print these out.  Commissioner Peraica complimented the Clerk for making electronic filing available, but expressed concern that this automation hasn’t resulted in a significant reduction in FTEs, and thus hasn’t significantly reduced the costs of this office.

Nov. 9, 2009 Finance Committee Meeting to Review the Proposed Budget--Chief Judge

Chief Judge Timothy Evans explained that while the Executive (proposed) Budget presented by the President has a 1.1% increase over 2009, the Chief Judge had sought a 3.3% increase due to the increase in juvenile justice cases (now handling 17 year olds charged with non-violent crimes, but the Chief Judge says that the money from the State that used to go to the Criminal Courts for these cases has not come over to the Juvenile Justice system), more domestic violence cases, and the mortgage foreclosure crisis.  However, the Chief Judge reported that he has applied for and received grant funding for probation officer positions that had been cut in the Executive Budget, so he will seek an amendment to add those positions back.  Chairman Daley asked the Chief Judge about the backlog of criminal justice cases that the Sheriff had discussed.  The Chief Judge said that there had been great strides in eliminating the backlog and currently, 94% of the cases are disposed of within 2 years.  With regard to the Sheriff’s comments that more arrestees should be on electronic monitoring, the Chief Judge said that 1/3 of those arrested are on electronic monitoring or on their own reconnaissance.  The Chief Judge also said that the Sheriff’s proposal to close courtrooms after 6 pm would not be feasible because it is in the evening that the Traffic Safety School, Juvenile Deferred Prosecution program, Victim Impact panels and other programs run.  He also expressed concern over the impact that municipalities would have if the weekend bond court closings were done as the Sheriff had suggested.    

Commissioner Beavers said that he feels that the Interim Administrator of the Juvenile Detention Center is spending too much money and is concerned that long time employees are being laid off just because they don’t have college degrees.  The Chief Judge said that the Juvenile Detention Center still has not been turned over to him, but that he has heard that that might occur by June.  [As a result of a lawsuit, a federal court has appointed an Interim Administrator who reports to the court.  Once the federal court feels that sufficient improvements at the Center have been made, then it would go back to being run by the County.  Previously, the Center was under the President, but as a result of state legislation that was passed after the federal court took jurisdiction, the Chief Judge will assume responsibility prospectively.]  The Chief Judge pointed out that the Interim Administrator would be appearing before the Finance Committee that afternoon and Comm. Beavers could address his concerns directly to him.  [However, Comm. Beavers was not present then – see the post for the Juvenile Detention Center.]

--submitted  by Observer Pris Mims

Nov. 4 Cook County Board Meeting

The Cook County President and Board of Commissioners met on November 4 at 10:00 A.M. for the monthly board meeting.

The Regional Transportation Authority (RTA), which manages Pace buses in the suburbs and Chicago's CTA, is facing a significant financial shortfall, and, therefore, the agencies will raise their fares. A bus ride in the suburbs will be raised to three dollars per ride, and the city's public weekend train pass will shortly be raised to seven dollars. Commissioner Murphy suggested van pools as an option for people who depend on public transit to take them to work. She also inquired about other sources of funding for the mass transit system, such as stimulus money or sales tax revenue. Commissioner Simms expressed concern that, with unemployment at such a high point, the lack of public transportation is an additional hardship for people who rely on the bus system. Commissioner Peraica questioned why buses in the western suburbs look empty. Commissioner Silvestri asked whether ridership increased during the recession, although there has actually been a decline. Pace is suffering a $64 million shortfall from the RTA.

Cook County Circuit Court Chief Judge Tim Evans was recognized for the William Rehnquist Award by the National Center for State Courts [press release].  He is the first judge from Illinois to receive such a prestigious honor. The commissioners expressed their congratulatory comments and Justice Evans pointed out that reform in the courts of Illinois was a collective effort of commissioners and the court system.

Discussion of a potential strike by AFL-CIO employees at the Juvenile Temporary Detention Center ensued. 180 employees who have a high school degree but no college education were recently given pink slips, as the authorities have decided employees must have a college degree or be working toward one in order to keep their job.  A motion arose to cover payment to Wackenhut, an outsourcing company which will provide the Juvenile Temporary Detention Center with employees, in the event the employees decide to strike.

--Submitted by Observer Stephanie Polito

CC Board Finance Comm. Budget Review - CCHHS - Oct. 29, 2009

The proposed budget for the Health and Hospitals Systems (HHS) was previously presented to the Commissioners in September so this meeting was an opportunity to again question CEO, Mr. Foley and the Independent Board President Mr. Batts about the proposed budget. The CCHHS Board is also in the midst of holding public hearings concerning their proposed Strategic Plan for the System so there were questions also about the plan. The President’s proposed budget for HHS is $968.5m. When asked if they would be able to cut their budget if the sales tax was decreased Mr. Foley stated that his management team is working with the CCHHS Board to identify opportunities for budget cuts with or without a tax decrease and how this will impact delivery of services is what they are working on in their Strategic Plan.

Several of the Commissioners raised questions about the layoffs which had just occurred in the system. Comm. Sims was concerned with how this would affect the morale of employees and whether it would result in lawsuits. Comm. Daley stated that if the layoffs were done in compliance with labor contracts, they could be done. Comm. Collins requested information on the amounts spent on registry nurses, on outsourcing, on overtime and administrative costs including contractual studies. She was not able to find this information in the budget books and thought the layoffs could have been done in a better way. Comm. Beavers and Comm. Sims both wanted information on the new Executive Team that is running the hospital - were they from Cook County. Comm. Beavers said the word was that the new CEO was bringing in his own people and he referred to it as "pinstripe patronage" and said this was not a fair way to run the system. Mr. Foley and the HR Director provided information on the new Executive Team - some are from Cook County and some are from outside but with experience relevant to public hospitals.

Comm. Suffredin had questions about reconciling the proposed budget with what had been previously approved and some coding errors were noted in some line items which will be corrected. He also requested that the HHS Board send any employee communications to the Commissioners as well, so they know what is going on. He stated that there have been many rumors circulating and it is helpful to have the facts to deal with the rumors that get going.

Comm. Gainer was concerned with the number of employees that are out on disability and how this impacts reliance on the use of the nurses’ registry and how it impacts overtime. She also wanted to know how the transfer to the Independent Board was progressing. Mr Foley reported that HR is in the middle of their transfer to become separate from HR at the county, and that the purchasing function has mostly been switched from the county to the Health and Hospitals System. It was also clarified that the sunset date for the CCHHS Independent Board as of now is February 28, 2011.

Comm. Schneider raised the issue of the H1N1 vaccinations and there was a lengthy discussion of that issue with Dr. Martin, Chief of Public Health. Comm. Claypool was concerned with how the Strategic Plan is integrated into the budget and how the plan will be carried out. Mr. Foley gave a figure of about $30m for implementation of the Strategic Plan but he said that was hard to say since the plan is still being devised.

Comm. Butler wanted to make clear that the budget for 2010 reflects a decreased subsidy paid by taxpayers to the HHS of $74m. In 2009 the amount of subsidy to support the HHS was $382m and in 2010 it is estimated to be $308m due to anticipated increased revenue generated by HHS.

Comm. Gainer asked about the progress on bringing Cermak Hospital up to the standards necessary for the County to comply with a consent decree dealing with issues there. The person in charge of Cermak Hospital stated that staffing there is now adequate but there continue to be IT problems that result from structural wiring problems. Comm. Daley stated that the Commissioners should ask the Sheriff about the money for dealing with the IT problems and Capital Planning about the plans for dealing with the problems.

Comm. Daley ended the session stating that the budget request for HHS should not be a surprise to anyone since it had been presented in September and was essentially the same budget as they reviewed then.

Forest Preserve Commission Meeting of November 5

It was a short but instructive Board Meeting on November 5 as the Commission steamed through a number of items with very little discussion. There was an Ethics Ordinance Amendment which had been proposed by Com. Peraica. This would have died as Com. Peraica was not present and no one else volunteered to make the motion for it, but Com Suffredin made the motion to "lay it on the table" which means it must wait until a Commissioner moves to bring it off the table in the future before it can be considered.

The only matter of contention during the meeting was over a request from ATT to allow use a small amount of Forest Preserve land to place a cable TV box for people across the street. Some Commissioners (Murphy, Butler, Sims) argued that the permission ought to be allowed on the basis that it would not be a big inconvenience to the Forest Preserve and that we ought to help businesses in Cook County. Some, including Commissioners Suffredin, Claypool and Collins, argued that this is a test case for how we treat all requests. If these services are not essential to the mission of the Forest Preserve then it is not a good idea to make an exception to the land-use policy in order to accomodate them. Commissioner Collins also noted that the fee for ATT was $74 for a 10-year-lease "an amount that would not cover the cost of processing the check." The motion NOT to allow the request passed 6-5 with Commissioner Silvestri voting present.

With regard to the ongoing debate about individual requests for land favors, Commission Collins introduced an Amendment to the Transfer of Land statutes. She is in favor of making the land-use policy more clear and explicit so that it can be adhered to consistently with no exceptions. Her proposed ordinance amendment was referred to the Finance Committee, with the comment that "if it were referred to the Real Estate Committee we would never see it again."

Respectfully submitted by Observer Henrietta Saunders

CCHHS Takes Another Look at the Strategic Plan

November 5, 2009 Meeting of Cook County Health and Hospitals System Board

During the public comment period, a nursing representative spoke regarding the issuance of 100+ layoff notices to nurses. She claimed that management had not provided a list and that there was a data problem regarding seniority. The nurses look for a process that is fair and accurate. She also challenged the patient/nurse ratio used in determining staffing.

Chairman Warren Batts, while looking at other systems, reviewed a report on Grady Hospital in Atlanta and the recent improvements achieved there over a two year period. Grady hospital is now part of a 501(c)3 Foundation that permits community investment, diminishing its dependence on County support, and staffed by the medical schools of Emory and Morehouse Universities. The Board received a complete report.

CEO William Foley reported that the Performance Improvement final report from Navigant Consulting will be ready for the next meeting in two weeks. Some consulting expertise will be required to implement it and an RFP will be channeled thru the Finance Committee for review.

The Board and management noted that the Strategic Plan needs refinements. After a huge response at the meetings of the public and employees, it was clear that proposed locations, transitions and partnerships need further examination, in conjunction with financial projections. The 3-year financial plan needs to be extended to 5 years. The goals remain intact but there must be analysis of hub-sites. Advisory groups, including patients, need to be engaged for input. The Board will be asked to approve the concepts and time lines at the next meeting.

A late addition to the agenda brought a proposal from the Director of Facilities Management for the County to consolidate CCHHS employees in trades and engineer positions with the County roster. Layoffs might be better absorbed by moving the affected employees to openings throughout the County as needed. It would mean transferring this line item in the CCHHS budget to the Corporate budget. The facilities management director said it would streamline capital planning and regulatory compliance. Board members questioned attention to diversity. The proposal was referred to the Finance and HR Committees for further discussion.

Committee reports were accepted and the Board adjourned to Executive session to hear issues regarding employees, litigation and collective bargaining.


--Submitted by Observer Nancy Staunton

Status of the Cook County Budget Review

The Finance Committee is on track to complete the meetings with the individual elected officials and department heads to discuss the proposed 2010 budget by Monday, November 9.  Chairman Daley said on Nov. 3 that amendments to the proposed budget are due by November 12 from the Commissioners for the “amendment book” that will be distributed prior to the meetings to vote on budget amendments.  However, Commissioners may still offer amendments during these meetings (termed “floor amendments”).  Commissioners are expecting to vote on the budget prior to Thanksgiving, or about one month after receiving the proposed budget from the President on October 22. 

--Submitted by Observer Pris Mims

CC Board Finance Committee, Budget Review of County Assessor, November 3, 2009

Cook County Assessor James Houlihan explained that he is seeking a $3.5 million increase over the 2009 budget, with the increase primarily due to wage increases. The number of employees would remain the same. Mr. Houlihan understands that the Board may decide to reduce his proposed budget by 5% if there is an across the board reduction, but he said that the resulting reduction in employees would slow the work of his office. Mr. Houlihan urged the Board to consider the resulting costs. He said that each day that property tax bills are delayed costs the county $50,000 in interest, not to mention the negative effect on local taxing bodies which may need to take out short term loans when bills and resulting payments are delayed. He said that delays this year have been caused by the number of appeals to proposed assessments, as well as the complications in processing 8 different exemptions for over 1 million parcels. Some of these exemptions, such as the senior freeze, are income tested, and are particularly difficult for his office to process, as well as requiring annual filings that have to be reviewed.

Assessor Houlihan explained that there were several reasons why so many property tax bills that have just been received reflect an increase. A number of the taxing bodies increased their levies for 2008. The 7% cap is also being phased out and that is reflected in a lower homeowner exemption than would have otherwise been applicable. Finally, for parcels in the south and western suburbs, the bills reflect a higher reassessment that went into effect for 2008, which was at the height of the property boom. The Assessor is in the process of lowering assessments for 2009 due to the fall in market value, but that does not affect the assessment for 2008. Remember that we pay property taxes one year late. This year’s bills are for 2008.

However, he said that the higher state multiplier that is reflected on the bills does not impact tax bills. The multiplier is used by the State to equalize assessments across all counties for purposes of determining the amount of school funding from the State. The State uses a multiplier for Cook County because it is the only county that classifies property (recently changed to 10% of market value for residential and 25% for industrial). Other counties assess at one-third the market value across the board, said Mr. Houlihan.

Assessor Houlihan says he supports the consolidation of the areas in the county involved with the property tax process in order to streamline the process, though he thinks that the cost savings will be negligible.

--Submitted by Observer Pris Mims

CC Board Finance Committee, Budget Review of Cook County Board of Commissioners, Nov. 3, 2009

Each Commissioner’s budget and that of the Board Secretary were included in this review.  There was discussion that the Board Secretary’s budget should be reduced by at least 5% from 2009.  Commissioner Silvestri said that he thinks it is wrong that he and 6 other Commissioners have reduced their budgets by 5% from 2009 in accordance with the President’s request, while 6 others have proposed increases and 4 have stayed the same.  Further he noted that he and only some of the other Commissioners reduced their budgets by 4% last year in compliance with an across the board reduction.  While in the ensuing discussion, no individual names were used, the proposed budget reflects that Commissioners Collins, Sims, Murphy, and Reyes have sought increases (ranging from $24,000 to $50,000); Commissioners Steele, Beavers, Moreno, Suffredin, Peraica, and Gorman  have essentially held their budgets the same or with negligible increases (less than $5,000); and Commissioners Butler, Silvestri, Gainer, Daley, Claypool (who is not running for re-election), Goslin, and Schneider have all reduced their budgets (ranging from $17,500 to $28,000).

Commissioner Schneider, who is in his first term, said he recognized that the Commissioners will not have the same budgets because longer-serving Commissioners will have longer-serving staff who, in accordance with county practices, will have higher salaries.

--Submitted by Observer Pris Mims

CC Board Finance Committee, Budget Review of Recorder of Deeds, November 3, 2009

Gene Moore, the Recorder of Deeds, stated that his budget request reflects a 5% reduction from 2009. The proposed budget shows a $425,000 decrease and a reduction of 10 employees from 2009 in the account which is part of the corporate (or general operating) fund. However, a review of the budget also shows that he is seeking a $400,000 increase in expenditures from an account that is funded by a special purpose fund, which in turn is funded by a portion of the fees charged by his office. This special purpose fund is limited to funding technology and employees related to technology, said the deputy recorder. This money will be used to pay the salaries of 5 employees being added to this account who will be part of a new fraud prevention effort involved in reviewing computer data. Commissioner Collins expressed concern over the Recorder undertaking this initiative that is not mandated, but said she would support it.

Commissioner Peraica questioned why the Recorder has not been able to reduce his staff by more since in 2003 the office handled 1.9 million recordings (the peak) while in 2009 it is expected that there will be only 800,000 processed due to the downturn in property sales. In addition, there have been significant expenditures for computer support and automation. The deputy recorder said that there are more and more unfunded state mandates that the office has to comply with, and that the office has assumed some of the work previously done by a few employees in the Assessor’s and Treasurer’s office, thereby allowing their offices to reduce the number of employees. Commissioner Collins requested a list of all the unfunded mandates.
--Submitted by Observer Pris Mims

CC Finance Committee Budget Review – Risk Management, Nov. 2, 2009

Because of Comm. Gainer’s questions regarding employee absences and because Lisa Wallach, the Director of Risk Management, had been ill the day that the Finance Department had appeared for the budget review, Ms. Wallach was asked to attend the hearing today.  Risk Management only administers workers’ compensation claims and absences, however.  Comm. Collins was surprised to find out that the County self insures workers’ comp claims.  It appeared that there has been little review and analysis of whether certain employees and certain departments have more claims than others.  Comm. Steele brought up the fact that he had brought a potential vendor in who would do such analysis, but there had been no follow-up by Risk Management to issue a request for proposal.  Ms. Wallach was encouraged to consider this.

--Submitted by Observer Pris Mims

CC Finance Committee Budget Review – Independent Inspector General, Nov. 2, 2009

Patrick Blanchard, the Independent Inspector General, explained that his budget is lower than 2009 because the costs of the Shakman decree oversight officer are being paid out of the County’s litigation budget, not his budget, and he cut several lower level Investigator II positions in order to fully fund some higher level positions that will be more valuable to the work of the office.  He currently has 9 filled positions, and the 2010 budget proposes 15.  The ordinance that established this department was recently amended by the Board, at Mr. Blanchard’s request, to expand his authority.  He expects to come to the Board in 2010 to seek recognition as an Illinois law enforcement agency so that his area can qualify for grant money.  In determining which issues to follow up on first, he and his deputy perform a triage analysis to determine if criminal behavior might be involved, the availability or potential availability of evidence, and the wideness of the effect of pursuing the issue.  In response to a question from Comm. Gainer, Mr. Blanchard agreed that his area was authorized to pursue issues related to employee absences of all types.

---Submitted by Observer Pris Mims

CC Finance Committee Budget Review – Public Administrator, Nov. 2, 2009

Public Administrator Nicholas Grapsas reported that his budget is up from 2009 due to regular salary increases and the hiring of one attorney for this area, which he feels is needed to help oversee the outside law firms that handle the legal work for the office in dealing with estates where there are no known heirs or, if known, can’t be found or can’t or won’t act. For this department’s $1 million budget, the County has obtained $5 million from the closed estates. If this budget were cut, that would simply slow down receipt of these funds. Comm. Gainer suggested that Mr. Grapsas consider seting up criteria selecting the law firms that handle the legal work for this office to make the process more understandable and transparent.

--Submitted by Observer Pris Mims

CC Finance Committee Budget Review – Bureau of Human Resources, Nov. 2, 2009

The Director of the Bureau of Human Resources, Joseph Sova, stated that the proposed budget for this Bureau met the target of 5% less than 2009.  If the sales tax were reduced and an additional 5% reduction were required, that would mean that he would only be able to fill 1 out of the 8 open positions he has, though he feels that he is already currently understaffed.  In the 2009 budget, $2 million was allocated to implement an online employment application tracking system, which he feels will eliminate most of the human errors that occur in trying to handle 13,000 applications each year.  Negotiations are in progress with the vendor for the Taleo system, with the expectation that the Board will be asked to approve the contract in Dec.  This system will only be implemented for the departments reporting to the President, the Health & Hospitals System, and the Forest Preserve District.  The other elected officials are responsible for their own hiring, though they may choose to utilize the system for their departments in the future.

Comm. Peraica stated that he would like to add more money for this Bureau, which he feels is critical to the proper working of Cook County.  He noted that the County has paid close to $2 million in fees for the court-appointed Shakman decree compliance officers.  Mr. Sova stated that he thinks they are within 30 days of having a hiring plan, one of the elements that needs to be in place before the County can come out from under the Shakman decree oversight. 

Comm. Gainer would like the County to get a better handle on the total costs for absences of all types:  workers comp, Family Medical Leave Act absences, short-term and long term disability, leaves of absence, as well as ordinary sick days.  The responsibility is split among Risk Management, the individual departments, and Human Resources.  Comm. Simms inquired as to whether Human Resources is any closer to properly classifying employees in appropriate job titles, which has been recognized as being a problem for many years.  Mr. Sova said that he is in the process of looking into the Request for Proposal and responses from 2007 to perform such a task using outside contractors.  One response to cover only 8 of the grades was for $1.8 million, while another proposal that covered additional grades was for $3.5 million. 

--Submitted by Observer Pris Mims

CC Board Finance Committee Budget Review Meeting, Oct. 30: Sheriff

Sheriff Tom Dart explained that the $35 million increase over the Cook County Sheriff's Office 2009 budget contained in the budget proposal is due primarily to required salary increases (90% of the increase), with the rest due to projected overtime expenses and food service costs.   However, the Sheriff also identified several ways that cost savings could be achieved.  He recently sent a letter to the Chief Judge seeking (1) elimination of the weekend bond courts in all but the 26^th & California and Markham courthouses; and (2) the closure of suburban courthouses at 6 pm during the week, as is done at the Daley Center.  The Sheriff said that these initiatives would free up 50 deputies who could be used elsewhere (to cut down overtime and provide more security for the courtrooms, which he believes is needed). 

The Sheriff also wants Judges to permit the utilization of video conferencing for prisoners on certain court dates where all that is happening are status reports and the setting of future court dates.  This would save the time and money of moving prisoners from the jail to the courthouses and back again.  The Sheriff is also urging that Judges make greater use of electronic monitoring in more cases in lieu of holding defendants in jail pending trial, which is much more costly.  Currently, there are under 300, though the Sheriff estimates that there could be closer to 1,000 who would qualify (e.g., no record of violence and not accused of a violent crime).  The Sheriff has brought both of these cost-saving initiatives up in prior years' budget reviews. 
To comply with Federal court orders in the Duran case, the Sheriff will be adding 210 new correctional officers for the jail this year.  Because the hiring will be spread over the 2010 fiscal year, the costs will be manageable this year, but the Sheriff is warning that there will be a much larger cost next year when these 210 positions will be on the payroll the entire year.

The Sheriff highlighted the fact that no prisoner has had to sleep on the floor of the jail for over a year, for the first time in many, many years.  The Sheriff hopes that this will help pave the way for finally ending the Duran case. 

Commissioner Peraica urged that a desk audit of the many positions under the Sheriff be done, as has been done for the Health & Hospitals System (the only area with more employees in county government).  Sheriff Dart said that his area is undertaking an internal desk audit, and though it is taking longer than expected, the audit has resulted in some shifting of employees.  The Commissioner also brought up the Trotter Report which he said estimated that $160 million was being spent to detain non-violent drug self-abusers in jail.  Commissioner Silvestri raised concerns, as he did last year, about the Sheriff having to provide policing for Ford Heights, which eliminated its police force due to lack of money.  Sheriff Dart said that his department has made sure that all steps have been taken to ensure that if Ford Heights ever does get revenues, the county is in line to be paid for providing the police services.
--Submitted by Observer Pris Mims