CCHHS Quality Assurance and Patient Safety Committee December 11, 2013 Meeting

Attending: Chairman Collens, Commissioner Munoz, Commissioner Hammond (not a member of the Committee) and Commissioner Lerner (by phone).

Only 50% of hospital staff have received the flu shot.  Legal counsel is ascertaining whether this is a matter which must be addressed by collective bargaining or whether CCHHS can unilaterally make vaccination a condition of employment. Management attributes the low level of vaccination to "cultural barriers," its euphemism for African-Americans’ suspicion of medicine as practiced by whites in general and the government in particular.

Cermak Health Services (serving the Cook County Jail and the Juvenile Temporary Detention Center) gave a comprehensive account of its activities, including an 80% staff vaccination rate. Interim Chief Medical Officer Dr. Concetta Mennella noted in her report that "correctional medicine" once meant controlling communicable diseases but now means treating mental illness and substance abuse.

The Quality Assurance Department has finally created a report form which will show the System’s progress on each identified measurement. The report form likely was created without consideration of the STAR report, which was never mentioned.

The Committee adopted the FY 2014 Quality Assurance Plan after Dr. Das explained that it focuses on four High-Risk High-Volume priority areas: discharge transitions, procedural safety, medication safety and handling malignant pathology. The overall goal, of course, is to prevent "adverse events," and particularly "sentinel events," which are adverse events with catastrophic outcomes.

The plan also provides a smoother system of reporting, from internal committees to the Hospitals’ Executive Staff to the Hospital Board Committees to the full Hospital Board. Each internal committee will track three key indicators, and a combined quarterly report will show up or down arrows reflecting progress or lack thereof in each. Every department has responsibility for improving its own key indicators, and therefore for assessing the performance of physicians and contractors as well as front-line staff.

Overall, the three areas to be tracked are time to treatment, core measures (which vary by department) and patient satisfaction. CCHHS is above the median in patient satisfaction for safety-net hospitals. But now that patients have the option to go elsewhere, their satisfaction is paramount, so the System’s goal for the next year is a 10% increase in that measure, to 71%. Das reported that CCHHS was "near the median" for all hospitals, though that median is 75% and the System is now apparently at 61%.

The ultimate goal, achieved by the top 10% of the nation’s hospitals, is 100% satisfaction plus 100% in each core measure.

Collens suggested that the System communicate to the patients its new commitment to improved quality, as just knowing about the effort might improve their satisfaction.

Das stressed that improved data collection would help CCHHS identify opportunities for improvement. She said the System is implementing "six-sigma" to achieve consistent performance.

Flu: Dr. Shannon reported a minimal flu season thus far in the county and the state. Vaccine has been widely available to CCHHS patients and staff since the first week in October, but only 3000 employees (slightly more than half the workforce) has been vaccinated. To encourage vaccination, CCHHS has set up standing orders for vaccines, and offers them on-site 24/7 free to staff members. Still, the rate of vaccination has slipped since the historical high in 2009, the year of the H1N1 flu.  90% of pharmacy and CORE staff have been vaccinated. The Committee then discussed whether the Board could require vaccination.

Cermak Health Services: Dr. Mennella noted that prisoners were the only Americans Constitutionally entitled to medical care, under a 1976 Supreme Court case, so Cermak provides Constitutionally-required care; but she stressed the goal of improving the health of the most marginalized in society and of their communities. The 100-acre Cermak campus includes 17 buildings providing different levels and types of care, including the newly-opened 979-bed intermediate-care Residential Treatment Facility, which will be used largely for treatment of drug and alcohol problems and the mentally ill.

Menella provided statistics explaining Cermak’s size:

• It does 100,000 intake screenings a year; every detainee is screened, so Cermak is able to capture the 20% who are mentally ill.
• It sees 2,000 of the County’s 10,000 detainees every day.
• It provides 5 million doses each year, using a robotic pharmacy to reduce errors.
• It has produced 5% of CountyCare enrollees, and expects 9 out of 10 of its patients to have health insurance coverage under Obamacare, versus only 1 in 10 now.
• It cares for the 300-plus daily population at the Juvenile Temporary Detention Center (JTDC) with nationally-accredited services.
• Between 1985 and 2012 the jail population doubled because mental hospitals closed and the length of stay increased: 2 extra days adds 600 patients/month to the census.
• 57 days is the average length of a jail stay; 12 days is the median. Every month there are 250 detainees who have been there more than a year.
• Cermak manages chronic diseases including Hepatitis C and liver cancer.
• It handles 550 opiate and alcohol withdrawal cases at a time and is authorized to dispense methadone to those who have already had it prescribed.
• It offers more than the ten hours/month of programming required by the Department of Justice for mentally ill patients.
• It treats most patients on-site, with only 20 people transferred to Stroger each day, mostly for orthopedics (to treat incarceration-induced trauma). Detainees at Cermak are treated without shackles unless the Sheriff insists; at Stroger they are shackled.
• All detox at Cermak will be consolidated in the new Residential Treatment Facility, which has been open since June but is still awaiting necessary equipment. It should be fully operational by June 2014. 86% of its patients will be there for mental health issues.
• 80% of its staff has been vaccinated for flu, and while prisoners often opt out, "they bare their arms when they see others getting sick." Vaccination isn’t mandatory because detainees have the same right to decline treatment as anyone else.

Cermak’s key issue is staffing: because the patients can’t call their doctors or participate much in their own care, intensive nursing is required and Cermak plans to add nurses in 2014. It used to get young providers through the National Health Service Corps but is now trying to recruit those who need student-loan relief. Lerner urged Mennella to provide detainees with navigators to negotiate mental-health as well as medical reimbursement issues.

Other goals for 2014: hire an orthopedist to reduce the need for transfers to Stroger; implement an Electronic Medication Administrative Record-keeping system. (Cermak already has EMR.)

Services are the collective responsibility of the Sheriff, the Department of Facilities Management and Cermak Health Services. Cermak is monitored by the Department of Justice under a consent decree; it’s considered "partially compliant" at 50%, and has no units which are noncompliant. In response to a question, no one could say how the residental treatment unit building was financed, though it costs $90 million.

There was no report from Provident.

From Stroger Hospital, Dr. Ochoa reported that the medical staff had approved the Quality Assurance Plan. It also changed the name and composition of its internal quality group; the new Hospital Quality and Patient Safety Committee will convene in February.

Submitted by Kelly Kleiman

Cook County Board of Commissioners Meeting Wednesday, December 4, 2013

One item from the Finance Committee was to move a proposed resolution by Larry Suffredin-- Creating “Accountability Charges” for Violations of the Shakman Consent Decree-- to the litigation committee.  This resolution would deduct an amount equal to five percent (5%) of the total amount assessed for violation of the Shakman Consent Decree from the department’s operating funds and transfer those monies to the Cook County Self Insurance Fund.

One of the new agenda items from the Finance Committee dealt with the authorization of a contract with WestCare Foundation to supply substance abuse and mental health treatment programs for the Department of Corrections.  There was a lot of public testimony against this contract from current employees who fear losing their jobs, impact of wages, and increase in turnover.

Public testimony was given by Sharon Mulruney from Defend the Vote. She expressed concern with party affiliated judges presiding over another party’s voting machines. She stated that this is a clear violation of legal voting systems. The website for Defend the Vote states concerns with election security.

Before the start of the main board meeting, there was a recognition of several local communities and their involvement in Homeland Security. Over 30 people were recognized for their past and current service.

One agenda item dealt with new Time and Attendance Software that will be introduced in the county. Commissioner Daley asked if all separately elected officials would also be part of this new software program. He was told that the software would be converted over to cover all employees. The goal is to move all payroll processing from manual to computerized and improve accuracy and timeliness of payroll processing.

There was a great deal of discussion regarding the annual calendar of the regular cook county board meetings for 2014. Comments from commissioners who felt that there were too few meetings (formerly every 3 weeks in 2013 to 11 total meetings in 2014) included concerns that there may be too few meetings to get the work done and public perception of the how much work the commissioners were doing. Commissioners who supported the smaller schedule commented that the new efficiency of the board meetings allowed for fewer meetings, and Commissioners would be able to get more work done in their own districts.  The resolution approving the shorter meeting agenda was passed 10 to 6 with one commissioner absent.

The highlight of the presentation from John Yonan, Superintendent of the Dept. of Transportation and Highways, was the genuine praise from the commissioners for the work that John has done.  He was praised for his work ethic and ability to work with IDOT, the city, and suburban cook county governments, and coming up with practical solutions.

Submitted by Laura Davis, Palatine Area League of Women Voters

Cook County Health and Hospital Systems Board Meeting November 22, 2013

Committee reports.
Director Collens reported that 2014 Quality Indicators for Provident Hospital are 2 months behind.

Chairman Carvalho reported that a grant proposal will be submitted in January to get additional federal funds for system delivery, including funds for a system to collect payment data.

The Illinois Hospital Report Card has some data, but inaccurate, Dr. Raju stated. Claims data
does not adjust for socioeconomic status. Carvalho responded that CCHHS needs to code its claims
data properly.

Few Medicare patients are in the CCHHS system; people leave when they become Medicare-eligible. New system will help CCHHS find out where they go.

Chairman Report
Chairman Carvalho reported on a Milwaukee Sentinel article regarding the blood drop taken from babies to test for diseases, looking nationally at (1) are specimens satisfactory? and (2) how long does it take to evaluate specimens? CCHHS was rated unsatisfactory due to incomplete data, but not bad specimens.

Discussion about dates and times for 2014 board and committee meetings.

CEO Report
Dr Raju reported:
● 2014 budget adopted with no amendments, to commence December 1.
● CountyCare has now enrolled more than 57,000 new patients.
● CountyCare has 119,000 applications, 72% initiated through call centers, others through FQHCs. The approval rate is 85%, with a backlog of 27,000.
● CountyCare can now move seamlessly from a "demonstration" project to a fully functioning operation.
● The Leadership Institute, or Cook County University, has successfully completed its first ten-week session of goal setting, management performance expectations, problem solving, and senior leadership. Participants were asked to identify one major issue and use their new learning to solve it. Graduation of first group December 17. Next, 200-300 middle managers to be trained. The first class was handpicked so they can teach the next group.
● ACHNs (Ambulatory and Community Health Network) are committed to reduce wait times and make their centers more welcoming.
● The Call Center reduced dropped calls from 13% to 6.6%.
● Dr. Raju hired 2 more senior officers, Peter Daniels to serve as Chief Operating Officer for Cermak, Provident and Stroger; and a new Chief Nursing Officer.
● Two new dental chairs will go into Stroger soon.
● The state legislature must approve CCHHS proposal to allow CountyCare to function as an HMO, taking responsibility for insurance.

Chairman Carvalho noted that there will be a hearing this week on Chicago's 6 trauma centers (are more than 2 needed on south side?), and noted that U of C Hospital's "bypass rate" (rejecting patients) has declined from 30% to 12%.

Meeting adjourned to closed session at 9:20.

submitted by Linda Christianson

Cook County Board Meeting--November 13, 2013

Committee Meetings

Prior to the beginning of the scheduled County Board meeting, various Board committees held brief meetings:  Legislation and Intergovernmental Affairs, Rules and Administration, Zoning and Building, and Finance.  Of these Finance had the most on its agenda, running to 53 pages. Members reviewed and approved for recommendation to the Board a wide variety of court-ordered attorney’s fees, workers compensation claims, special court case payments,  and self-insurance claims. The dollar amounts of these actions are substantial, workers comp claims for FY 2013, for example totaling almost $5.7.  It appears that these amounts fit into the overall anticipated budget as none of the commissioners expressed any surprise.

Board Meeting

The actual Board meeting was called to order at approximately 11 a.m. by President Preckwinkle, and was mostly uneventful as the Commissioners efficiently and quickly disposed of items on the 71-page agenda plus “errata” and several added items.  

Public Comment

Public comment is allowed at the beginning of the Board meetings, a practice that had been discontinued and then restored in recent months.  Today’s public comment led to some uncomfortable moments, as one speaker used his time to express some strong anti-undocumented immigrant sentiments.  Many Board members exrpessed outrage at the comments, and discussed some possible methods to curb such statements in the future.  Finally, President Preckwinkle stated that she would in future admonish public comment speakers to make certain that their comments were germane to the agenda.

Consent Calendar

Two items were pulled for individual presentation from the Consent Calendar, which consists of congratulatory resolutions to retiring public  officials, private entities celebrating various anniversaries, private individuals being congratulated for various things. Commissioner Schneider introduced some visitors from Ixtapa Mexico who were on a Sister City Visit and presented a Resolution of Welcome.  Commissioner Fritchey introduced a Mental Health Awareness Resolution, presenting Representatives of the Brandon Marshall Foundation and the National Alliance for Mental Illness.

Appointment Approved

The Commissioners approved the appointment of Michael W. Lewis to the RTA Board.

Board Actions

Most of the items on the agenda were devoted to approval of contracts or contract extensions and payments for services and materials, accepting various grants and reports, and transferring funds internally from one account to another at the request of various officials.  Some discussions occurred regarding two contracts related to the Courts Mortgage Foreclosure Mediation Program: $2.2 million and $4.7 million.   Commissioner Collins strongly objected to approving additional  contracts with “outside” entities such as the Chicago Community Trust and the Chicago Bar Foundation when there are community based organizations which know their communities well and are just as capable of doing the work.  She asked for a full accounting of all funds devoted to the program since its inception.

County Revolving Bail Fund

Commissioner Suffredin introduced two proposed resolutions.  The first, directing the Cook County Budget Director and the Executive Director of the Justice Advisory Council to review the legal and financial feasibility of a program to establish a revolving bond fund to provide prompt posting of bail for non-violent detainees with low bail amounts of $2000 (“c” or “d” bonds).  His reasoning behind this proposed fund is that many detainees are non-violent offenders, are not flight risks and are in jail while their families try to scrape up the money for their bail.  Since the jail is at near-capacity, and it costs Cook County $143 per day to house a detainee it would be a cost savings to the County to provided this assistance.  The working group is to make a recommendation to the Board by March 1, 2014.  The resolution passed.

Accountability Charges/Shakman Decree Violations

The second proposed resolution introduced by Commissioner Suffredin was referred to the Finance Committee. The resolution creates “accountability charges” for violations of the Shakman Consent Decree by various departments.  He introduced it because the County has spent millions of dollars in payments for violations and there are currently no financial consequences for individual departments that violate the Shakman Consent Decree.

Mass Transit Budgets

By State law and County and City ordinance, all local transportation Boards are to present their upcoming fiscal year budgets to the 6-county region’s County Boards.  Appearing at this Board meeting were top-ranking executives and Board members of the four transit Boards:  Metra, the CTA, PACE and the RTA.    The region faces no fare increases or  service cuts in FY 14, which was cause for congratulations all around. There is a general increase in ridership for all mass transit providers.  Much praise heaped on CTA and PACE for service enhancements and “green” equipment modifications.  Some concern was expressed by several commissioners about rumors coming from Springfield about attempts to change the current 4-Board structure.  While several commissioners expressed some concern about perceived growth in RTA’s budget, the general sentiment expressed was that local control by the City, and 6-County region was paramount, and Boards and appointment should be kept out of Springfield.  

Submitted by  observer

Jura Scharf, LWV Palos/Orland 

October 23, 2013 Cook County Board Meeting

Board President Tony Preckwinkle’s Chief of Staff is leaving to return to private practice and he was thanked and the new Chief of Staff welcomed.

Sharon Meroni of Defend the Vote spoke during the Public Comment Section and said that there were various issues with voting machines, absentee and early voting in Cook County.  NOTE – David Orr vigorously refuted these charges during his portion of the budget presentation following the board meeting.


Courthouse Parking – Cook County Public Guardian was added to list of people not subject to parking fees at facilities that will be charging those fees.  Parking fees and parking exemptions will no longer be considered a portion of employee compensation.  A management firm to administer the parking fees will be selected in  December or January and it is anticipated that fees will actually start to be charged sometime in the late Spring.

Intergovernmental Agreement – The CFO of the Hospital System explained there was a cash flow problem for the County due to processing delays of the Affordable Care Act.  The State of Illinois is allowing the hospital system to delay payment of $30 million of first quarter transfer back to the State General Revenue Fund to help out the situation.  The Board was assured this was a cash flow timing issue only and that 2014 budget was not impacted in any way.  The third quarter transfer back will have the corresponding increase.

A resolution was passed urging the Illinois General Assembly to Amend the State Officials and Employees Ethics Act to include members of a governmental entity appointed by a county board.  This is to ensure that Metra board members are covered.

Law Enforcement Committee met after the board meeting.  Concealed Carry - Cara Smith of Sheriff Tom Dart’s office presented information on new Concealed Carry of firearms.  $20 of the $150 fee will be going to mental health screenings but this can only be effective if healthcare providers and hospitals do all the required reporting.  Also, there is a for issuing FOID cards and the situation will not improve once Concealed Carry Permit applications are available beginning in early January.  The 30 days legally allowed to issue permits will not be met.

There was also discussion around enforcement of revoked FOID cards.  When someone is no longer eligible to have a firearm they are meant to surrender their card and their firearms.  There has been very little enforcement of this until this summer but now the Sheriffs office is visiting about 4000 individuals in attempts to recover their weapons.  These weapons, which start out as legal, are frequently the ones which end up used to commit crimes.

Finance Committee met after the board meeting – Two presentations were made on budget and activities of the Chicago Board of Election Commissioners and the Cook County Board of Election Commissioners.  Similar things were reported but David Orr described how his (suburban Cook County) office was much further along in implementing new policies and procedures.  His budget is down $1.47 million vs 2010 and headcount is down 8%.  

Some of the most significant developments are:
*Electronic poll books – Another 400 precincts will have these for the March elections and more than half of precincts will use these for the November elections.
*Introduction of Hindi – Elections will be conducted in Hindi (as well as English, Spanish and Polish).  All services will be provided including answering the phone in Hindi.
*TIF information will be on next summer’s tax bill
*Online Voter Registration
*17 year olds voting in Primary if they will be 18 by General election.
*Genealogy and vital records information online (will save lots of staff lookup time)

submitted by Lali Watt

November 8, 2013 Finance Committee and Special Board Meetings

2014 Proposed Budget Passed Unanimously

With all 17 Cook County Commissioners voting “yes,” the 2014 Proposed Cook County Budget was passed with just a few amendments at the November 8, 2013 Special Board Meeting.  Several long-time Commissioners noted that this has not happened in the last 20 years. As Commissioner Peter Silvestri put it “No new taxes, no new fees, no layoffs, no problem.” 

Commissioner Suffredin noted that this Budget reflects a sea-change in the County’s emphasis from focusing on stabilizing the Health & Hospitals System (“HHS”) budget to focusing on improving the workings of the Public Safety function of the County, each of which represents 1/3 of the total County Budget.  Commissioner Suffredin said that the expected monies coming from the national Affordable Healthcare Act, mainly due to the expansion of Medicaid, have enabled the stabilization of the finances of the HHS.  Commissioner Daley spoke about the importance of the meeting of the Illinois Supreme Court Chief Justice next week with the principals involved with the criminal justice system in Cook County as a first step in improving the workings of the criminal justice system here.  As Commissioner Daley put it, “it is about accountability, not control.”  He mentioned that the Board has seen firsthand the lack of cooperation among the various Public Safety elected officials over the past several years.

Amendments to the Budget

During the Finance Committee meeting prior to the Special Board Meeting, the Commissioners considered the 19 Amendments that had been proposed to the Executive Budget Proposal.  By shifting some funds from other sources, and recognizing some additional revenues not already included in the budget proposal, the Commissioners voted to (1) approve 13 new adult probation officers, 2 new supervisors, and a forensic psychiatrist; (2) increase the amount of funding for the Veterans Assistance Commission by $100,000 (which had been urged by veterans groups at a number of public hearings on the budget); (3) fund two apprentice electricians under Facilities Management; add two new members to the Zoning Board of Appeals; and (4) use $100,000 to fund a youth summer jobs program to be administered by the Cook County Forest Preserve District. 

Two substitute amendments proposed by Commissioner Fritchey also passed.  No. 17S requires that the Board approve any transfers of money proposed by a department out of their personnel account to any of their other accounts.  No. 18S provides that the final year-end trial balance for 2013 be made available to the Commissioners and the public by posting it with the 2014 approved line item budget by April 30, 2014 . Unfortunately, both of these passed amendments were substitutes for what had been made available to the public.  While the Commissioners received paper copies, they were not available online or otherwise to this observer prior to the vote.  However, as of the afternoon following the meeting, these two substitute amendments were on the County’s Budget web site.

Commissioner Suffredin withdrew several amendments he had proposed to provide some additional pre-trial services and personnel for the criminal justice system because he was unable to find any revenues to fund his proposals.  Commissioner Suffredin lamented that the County currently has no mechanism to recognize savings being realized as a result of departments’ efforts and then utilize those savings to create more savings.  For example, he had wanted to add 11 more Assistant State’s Attorneys for pre-trial proceedings with the expectation that this would result in a reduction in those going to jail and a corresponding reduction in the costs of keeping people in jail.  He had hoped to utilize the savings from the State’s Attorney’s jail diversion programs. Commissioner Suffredin said that the Budget Department had committed to working on a mechanism for recognizing savings in the future. 

Another amendment that Commissioner Suffredin withdrew was a proposal to amend the Budget Resolution to create an “Accountability Charge” for any department that is found to have violated the Shakman Decree which prohibits the hiring, firing, promotion, or demotion of employees for political reasons.  This “Accountability Charge” would be equal to 5% of the total amount assessed for the violation and would be a deduction from that department’s operating funds for that year.  However, Commissioner Suffredin says that he will present this proposal as a resolution at an upcoming Board meeting.

-- submitted by Priscilla Mims, League Observer

Department Review Meetings for 2014 Budget: Monday, Oct. 28, 2013

Juvenile Temporary Detention Center and Clerk of the Circuit Court

The Juvenile Temporary Detention Center (“JTDC”) has been under the supervision of the Federal Court and a court-appointed Transitional Administrator, Earl Dunlap, for six years.  Mr. Dunlap commended the staff at the JTDC for the major improvements that have been made there.  Commissioner Sims questioned him as to when the Court might find the JTDC ready to be returned to County supervision (which would now be under the Chief Judge).   Mr. Dunlap said that he could not say.  There is a status hearing in January, and Mr. Dunlap wants to establish a transition process with the Chief Judge.  A number of things that have held up the transition are now under way:  a request for proposal for a management information system is now ready to go, but it will probably take 6 to 9 months to implement it; the video system is only now being installed; the work to replace the ceilings has begun.

Besides making the transition back to County supervision, the other major issue for the JTDC for 2014 is dealing with the additional JTDC population due to Raise the Age effective Jan. 1, 2014 (whereby those age 17 will now come under the juvenile justice system, rather than being treated as an adult).  Mr. Dunlap said that he had to open another center within the JTDC in 2013 to deal with the increase in the daily population (now averaging between 290-310/d), and he expects to have to open another one in 2014 due to Raise the Age. 

Clerk of the Circuit Court Dorothy Brown raised several issues.  While news reports have been derisive about her office using carbon paper, she said that is the result of the County Print Shop not stocking sufficient carbonized paper to be able to print forms used by her office.  The Budget Director said that there is an increase in the Print Shop’s budget for 2014 which should help with that.

Clerk Brown complained about not being able to hire for positions that have been approved in her budget.  The Budget Director explained that each department has a turnover adjustment which reduces the amount available for personnel, reflecting the salaries not being paid during the time between employees leaving and replacement employees being hired.  If a department does not experience the expected turnover, departments are advised to delay hiring employees for open positions.  The Budget Director was clearly surprised that Clerk Brown raised this issue has the Budget Director had not heard from the Clerk’s Chief Financial Officer that there was a problem.

Clerk Brown also said that recent State legislation allowing cases to be heard through the County and Chicago Administrative Hearings (such as the red light camera tickets) means that there are fewer court fees being paid to her office.  [Clerk Brown failed to note that there is also a reduction in court costs as a result of cases being dealt with by Administrative Hearings.  Unless the court fees are greater than the court costs, there should be a net benefit to cases being handled through Administrative Hearings.]

Clerk Brown said that the City of Chicago owes $11.2 million in filing fees for lawsuits filed to collect unpaid fines.  Finally, Clerk Brown said that the Illinois Supreme Court requires that there be paper files even though some cases and related items may be electronically filled.  As long as that is the situation, she says she cannot reduce her staffing levels.

-- submitted by Priscilla Mims, observer

Department Review Meetings for 2014 Budget: Friday, October 25, 2014

Sheriff’s Budget

Sheriff Tom Dart was ill, so Undersheriff Zelda Whittler presented the office’s budget request.  The Undersheriff reported that as of that morning, there were 9,893 inmates at the County Jail, with an additional 3,160 people on electronic monitoring or diversion programs.  The daily average of inmates has consistently hovered over 10,000/day this year, with the average length of stay increasing since 2007 from 47.9 days to 57 days in 2012.  The increase in the average length of stay and the number of inmates have a direct correlation to the large increase in overtime:  $8 million had been projected for 2013, but the actual is now expected to be $23 million.  The 2014 proposed budget has $15 million for overtime. Commissioner Suffredin questioned whether this was reasonable in light of this year’s experience and was told “yes.”  The Sheriff’s Office is very hopeful that the November 14 interdepartmental meeting called by Illinois Supreme Court Justice Kilbride will lead ultimately to reductions in the length of stay.

A major issue for the Jail is the number of mentally ill detainees.  To deal with them, the Sheriff has a new Office of Mental Health & Advocacy to interview people at the time of intake to provide information to the State’s Attorney and judges.  The Sheriff now has a 24-hour mental health helpline for former detainees and family members, which is averaging 17 calls/day.  The Sheriff is also establishing partnerships with local entities to continue care after detention. 

Another concern is the Court Services Division under the Sheriff which has lost 517 deputy positions since 2006 due to lack of funding and the need to use personnel for other functions, such as jail guards.  The Sheriff has been recommending that status hearings be conducted via closed circuit television between the Courthouse and the Jail to eliminate the need to transport inmates to court rooms.  The Sheriff is also suggesting that the court rooms in the Daley Center be organized by subject matter so that deputies can be deployed where there are greater risks.

Answering a question from Commissioner Gorman, the Undersheriff said that there has been no decrease noticed in the number of arrests as a result of tickets being issued instead of arresting those with small amounts of marijuana.  In response to a question from Commissioner Suffredin, the Undersheriff stated that it has been taking 9-10 months for the hiring process for correctional officers.  The Sheriff is proposing legislation in Springfield to transfer the employments aspects of the Merit Board to the Sheriff’s office in order to reduce the employment process, leaving the disciplinary aspects with the Merit Board. 

To help reduce the length of stay, Commissioner Suffredin said he was going to propose a revolving loan fund to help inmates post bonds that are under $20,000.  The STAR report shows that the average length of stay for those who ultimately post bond is 13 days, which means that it is taking that long for the inmate or the family to secure the funds necessary.  Such a revolving fund would help in those cases.  Commissioner Suffredin lamented the fact that people lose the right to Medicaid while in jail, meaning that the County picks up the full costs of their healthcare.

-- Priscilla Mims, observer

Department Review Meetings for 2014 Budget: Tuesday, October 22, 2013

Treasurer, Inspector General, and Public Administrator

Treasurer Maria Pappas touted that her office is “almost” totally funded through the Special Purpose Fund of the “Tax Sales, Automation Fund,” which derives its money from user fees for the sale of property with delinquent taxes.  [Note:  $9.6 million of the total Treasurer’s proposed budget of $11.6 million comes from the Special Purpose Fund.  The remaining $2 million comes from the Corporate Fund.]  The Treasurer also reminded the Commissioners that since becoming Treasurer, she has significantly reduced the number of Full Time Equivalents (FTEs) from 250 to 92 in the proposed budget. 

Much of that reduction is due to the use of technology and the use of banks and other outlets for the payment of property taxes, as well as online payments.  Treasure Pappas said that the web site is getting 325,000 hits per month, and that 120,000 e-mails are being answered automatically.  Under the STOPS program, $165,000 has been returned to taxpayers as being duplicate payments.  The tax sales program is now automated resulting in tax sales taking place in 3 days, rather than 6 weeks.  The Treasurer said that her office is now undertaking a comprehensive scanning project with the expectation that there will be no filing cabinets of paper by 2015.  To accomplish this technological push, her department now has 25 full time IT employees.

Commissioner Suffredin inquired as to whether the Treasurer has been able to resolve the issues of whether the data is correct in the government bodies’ debt disclosure publication from the Treasurer’s office.  The Treasurer stated that her office is now contacting the local government bodies to make sure the numbers are correct.

Independent Inspector General Patrick Blanchard reported that his office is now fully staffed having hired 5 new investigators.  His office will be taking over the investigation of all complaints under the Shakman decree, which prohibits the hiring/firing/promotion of employees for political reasons, once the President’s Office is deemed in substantial compliance.  He will have 5 of the 14 investigators available for investigating such complaints.  About 30% of the office’s time is now being spent on Shakman-related matters.  His office is also doing work for the Forest Preserve (and being paid for that work out of the Forest Preserve’s funds).  He anticipates over 500 complaints (not related to Shakman) being received by his office this year, which are reviewed before opening a formal OIG investigation.  One investigator is located at Stroger Hospital, and that proximity has resulted in additional complaints being filed.  As a result of his office’s investigations, the Procurement Code was amended to require itemized bills with the dates and description of work performed by County contractors. 

The main outstanding issue for the office is its jurisdiction over the departments under the Elected Officers in the County, other than the President and Board of Commissioners.  Commissioner Goslin stated that it was certainly his intent when he voted for the ordinance creating the Office of Inspector General that it would have jurisdiction over all Cook County officials and employees.  The Inspector General said that the Clerk of the Court has accepted the OIG’s jurisdiction, despite the fact that there is an argument that as part of the State’s court system, the Clerk would be exempt. 

Nicholas Gapas, the Public Administrator, explained that his is a State office, but his budget is under the jurisdiction of the County Board.  However, the money for the budget comes solely out of the fees generated by the Public Administrator in administrating the estates of decedents who leave no will or whose named executor is not able to be the administrator.  If there are no known heirs of decedents, their real estate in Cook County escheats to the County.  Mr. Gapas estimates that close to $3 million will come to the County this year due to unknown heirs and revenue and interest for administering estates.  The Public Administrator’s expense budget for 2014 is only $1.1 million.

-- Priscilla Mims, observer