Cook County Board Meeting, May 18, 2010

Todd Stroger, President of the Cook County Board of Commissioners, said the May 4, 2010 ordinance limiting some of his powers regarding personnel violates the statutory and Constitutional authority of the President of the Cook County Board. He stated that the Ordinance is an unconstitutional attempt to alter the form of County government. A long discussion followed and a vote was taken over whether to override Stroger's veto of the May 4th statutory that limits his hiring. The tally was 9 to 6, failing to override his veto because eleven votes would be required.

Questions were raised, including, Does the override apply to the new President? Is there an expiration date at the end of the fiscal year? The questions were not answered or resolved.

The County has a significant revenue shortfall. It may be over $50 to $70 million. There has been a sales tax roll back of 1/2 of l per cent. The budget will be reduced so a deficit will not be expected. There will be an effort to increase revenue.

Oak Forest and Provident Hospital have had a severe drop in patients. Mr. Foley reported that the staff at Oak Forest has been reduced from 934 to 743. The staff will continue to be reduced and the outpatient clinics will be redesigned. Oak Forest has only sixty in-house patients. There have been 30,000 outpatient visits this past year. There has been a 33% revenue shortfall and a deficit of $l5 million dollars. A new contact has been made with Price-Waterhouse. All salaries for Grade 24 positions must remain fixed or adjusted by the Board of Commissioners.

Submitted by Arline Doblin

May 5 Meeting of the Cook County Forest Preserve Commission

Chairman Stroger did not show up so Commissioner Reyes ran the meeting. It started with a break for the Finance Committee agenda where Commissioner Peraica questioned whether there is enough reporting. It was explained that much of the Forest Preserve spending is seasonal as are revenues and that Cash Flow reports do not reflect the overall financial picture for the Forest Preserve (which is quite healthy). There was general satisfaction that the Forest Preserve finances are in good financial shape.

After various other business there was some interesting discussion during the vote on payment to lawyers for the Shakman compliance work. Commissioner Silvestri and others concur that the Shakman compliance is taking too long and is expensive. Commissioner Collins expressed her desire not to try to meet the requirements inhouse but to change personnel to get into compliance, as the Sheriff's office did. Commissioner Sims thought it would be a good idea to go back to court -- perhaps to get a change in the decree?

There was a long report on the Bass Fishing Sectionals which were apparently very successful. Also an award was given to an exemplary CCFP Police Officer.

Cook County Board's Hot-button Topics

Despite all being present and on time, the May 4th meeting of the Cook County Board of Commissioners started 25 minutes late; at 11:00, after memorials, tributes, picture-taking, etc., the business portion of the meeting began. Last minute changes to the agenda were addressed first. It should be noted that many of these changes were distributed to the Board during the meeting and were not available to observers. This caused confusion, since it was not clear what exactly was being voting on.

Commissioners Reyes and Moreno presented a resolution to protest Arizona's recently passed immigration law by boycotting Arizona businesses and canceling Cook County contracts with Arizona companies. However this desire was cut short when some realized that minority businesses in Cook County could be hurt by this. No vote on the resolution was taken today and it was sent to the finance committee for further discussion.

Commissioner Goslin submitted a resolution (passed) regarding PC Power Management which should reduce electrical costs to the county.

The majority of time was spent on three ordinances (all passed by large majorities or unanimously) designed to keep closer watch on the expenditures of the county elected officials and departments, particularly President Stroger's office. Reports are to be submitted to the Board of Commissioners within 72 hours of any purchases and contracts over $750.00. Board approval is still necessary for all contracts of $25,000 or more. The Board also approved a requirement for departments to submit information regarding promotions and changes in salary and job titles. Third is a hiring freeze throughout the county. There was a lot of discussion on this last issue as some commissioners felt the county could not do its job with fewer people if some retired or left their positions.

Commissioner Daley requested that pay raises for grades 24 and up be put on board agendas for the necessary approval. This was an ordinance passed last December, but was not being followed by various county officials.

Commissioner Collins once again stated the county is not proceeding fast enough to comply with the Shakman Decrees regarding political-based hiring. Her resolution to create an ad hoc committee to analyze the cost of Shakman Compliance options was referred to the litigation committee. It was brought up that President Stroger has retained the law firm Sidley & Austin to represent him regarding Shakman. It was unclear why he required this.

Commissioner Sims presented an affirmative action hiring resolution which would have a personnel goal of 50% minority, 25% women, and 5% disabled.

This observer could not get a copy of this resolution/ordinance, so the specifics are not known to me.

CFO Jaye Williams spoke about the OPTIMA program which is designed to move from a paper to on-line methods for doing business. This will first be used for procurements and the tax process. Bid openings will also go on-line. This should make for more efficient and less costly procedures. Many commissioners were unaware of this program.

CCHHS Board Presented with Options in Delivery of Care

Cook County Health and Hospitals System Board Meeting

April 30, 2010 7:30 am to 4:00 pm

This was an all day meeting which covered regular Board agenda matters and a review of the Strategic Plan. The regular meeting spilled over its projected two hour time frame because of lengthy public comments, a protracted discussion of a contract for laundry linen services and a closed session regarding personnel matters. The current provider of laundry services was underbid by the GPO (Group Purchasing), a mechanism which had been approved several months ago to seek the lowest bidder for all services. Proponents of the current provider and losing bidder spoke of jobs lost by local residents to an out-of-state company. But Board members responded with arguments that the $2 million saving over 3 years of the contract could not be ignored. They recognized that use of GPOs represents change that may be hard on previous vendors and asked for a report on the efforts of the GPO to mentor small vendors to encourage their participation. The contract was approved with one negative vote.

The meeting resumed with a presentation of the current state of the Strategic Plan and the challenges inherent in it. Integrated Clinical Solutions, Inc., the consultant team, provided an in-depth assessment of community needs and related access factors, an overall evaluation of the System's current state, and key issues and a framework for the System to reach its goals. Four staff physicians then reported the progress of certain service lines whose development they are responsible for shepherding.

A few key issues drove the discussion: (1) There are significant unmet healthcare needs in Cook County. The community areas with the lowest health rankings – near south side, southland, east southland – have the least health resource coverage. Access to health care is a major issue in these communities. (2) System access points are not aligned geographically with patient populations having the greatest healthcare needs. There has been a significant geographic redistribution of the vulnerable population over the past 20+ years. (3) The current system configuration does not support a population/patient-centered approach to healthcare delivery. CCHHS is disproportionately skewed toward the provision of acute inpatient services, while evolving healthcare models are placing increased emphasis on primary care/prevention and comprehensive case management/care coordination. A greater proportion of CCHHS' traditional patients will have a choice in selecting their providers as national health care reforms. (4) CCHHS' current cost structure is not sustainable. Its cost per inpatient day is high, its losses are projected to increase; there is a significant opportunity to modify these by reallocating dollars.

Proposed scenarios would develop Regional Outpatient Centers that provide specialty services and are accessible to geographic areas with greatest needs – South, DT/West, and North, formalize partnerships with existing FQHCs (Federally Qualified health Centers) and other providers. The options include considerable detail regarding existing inpatient facilities, emergency services and long term care.

The final hour or so was devoted to four Service Lines which are considered critical to the Plan; Outpatient, Emergency, Maternal/Child Health and Surgical Services were scrutinized. The status and needs of each was detailed by the lead Physician especially as to how each fits into a long term plan.

The Board had many questions and will continue to peruse the mass of information that was provided. They hope to come to closure on a direction by their June meeting.

--Submitted by Observer Nancy Staunton