Cook County Board Meeting June 19, 2013

The meeting was called to order at 11:15 am by President Preckwinkle after an extended Finance Committee meeting. All commissioners with the exception of Commissioners Tobolski and Garcia were in attendance.

The first order of business was to refer three agenda items regarding amendments to the recently-adopted Source of Income Amendment to the Human Relation Cods to the Human Relations Committee. The speakers for the issue will be given notice of the new meeting time and date.

USE TAX
J. Thomas Johnson from the Taxpayers Federation spoke concerning his view about constitutional problems that might occur with the county's proposed tax levy for personal property. The County's plan is to tax on the value of property rather than on the purchase price. Without amending the municipal tax laws, he feels that this would be unconstitutional and an unfair burden. It would require citizens to file with the state, county, and city.

HONORS
Rules were suspended for the purpose of moving to item 18 on the agenda: a resolution honoring injured Silver Star Family War Veterans in Cook County. Presentations were made by all board members for those in their districts. Veterans included: 2 from the Korean War, 14 from the Viet Nam War, 1 from Desert Storm, 5 from the War in Iraq and 1 from the War in Afghanistan. Names were read for those not present, including one from World War II.

AGENDA
The consent Calendar was approved.  The commissioners then voted to go into closed session to discuss litigation.  The meeting resumed at 12:30.

Interesting discussion took place on the relief of overcrowding at Cook County Jail. Chosen inmates are sent to other facilities in-state for the purposes of safety and cost. There are currently 9,904 in custody. $143 is spent per day on each. 83% are arrested for violent crimes.

A lengthy discussion took place concerning the costs for a disparity study required every 5 years for the Forest Preserves, Hospitals, and Professional Services. Cost for this is shared with the state. It was approved.

Commissioner Daley moved to suspend remaining agenda items to proceed to New Business. All New Business Items were moved to committees.

The meeting adjourned at 3:30 pm.

--Submitted by Pat Lind  

June 12, 2013 Proceedings of the CCHHS Quality Assurance and Patient Safety Committee

Headline News: Edward Michael, QA Committee chair, leaves that post at the end of June to assume an as-yet-unspecified, but apparently paid, role with CCHHS.

Subordinate headline: CCHHS is preparing to hire a "Patient Safety Officer," though Dr. Das (head of Quality Assurance) and her new boss Dr. Shannon (Director of Clinical Integration, including overseeing patient safety) are both already charged with this role.

These items came up as asides at a meeting consisting entirely of "Committee Education," a lecture from Das on how the hospital does and/or should respond to adverse events, ones "leading to the serious injury or death of a patient unrelated to the patient’s underlying illness." (The Joint Commission uses the term "sentinel events.") To deal with these events, hospitals search for correctable systemic flaws rather than punishing care providers.

Issues in dealing with medical error:

• If/when to disclose errors to the patient and if/when to report them to the public: the Joint Commission favors disclosure and reporting, and the State of Illinois requires reporting "but that law is never enforced."
• Three categories of error: violations (intentional), lapses (habitual because tired) and mistakes (cognitive). To handle the latter two, hospitals search for "error traps" and eliminate them or build in redundancies, so only 10% of errors reach patients. Of these, half are preventable.
• Common types of error: adverse drug reactions, procedural complications and hospital acquired conditions. In addition to "Sentinel Events," the Joint Commission publishes a list of 29 "Never Events," occurrences which will prevent reimbursement of the hospital by Medicare/Medicaid.
• CCHHS catches errors when they’re reported by providers, by phone or through the MERS computer system. It also uses surveillance, reviewing all deaths and serious injuries for signs of error. At the time of an event, the doctor calls the Medical Director who assembles a team to talk to the patient and notifies Risk Management and Quality Assurance (Das).

The System take five steps to manage an event:

1. Care for the patient. Be empathetic and apologize but don't admit liability.  Only 1/4 of errors are disclosed, but after disclosure patients perceive they’re receiving higher-quality care.
2. Conduct initial fact-finding.
3. Care for the care-giver, who’s probably upset about the error.
4. Notify the insurance company.
5. Conduct a root cause analysis.

The Joint Commission provides a detailed outline of how to conduct root cause analysis so that all potential sites of error can be identified.: the provider, communications systems, work environment, organizational culture. Unless the error is intentional, the approach avoids blaming a single provider. Experience shows that removing individuals doesn’t solve the problem, and providers won’t report errors at all if they’re punished for doing so. If there’s no problem of criminality or substance abuse, the key test for responsibility is whether another provider faced with the same situation would have done the same thing.

• The System corrects errors using strong interventions (like technology and work flow). Though it talks about avoiding weak interventions like counseling providers, counseling is actually what the System uses most often.
• Solutions are designed collaboratively, responsibility is assigned, and the initial reporters of the incident are informed of results to reinforce their willingness to report.

When Michael asked how to determine if interventions are effective, Das responded that it was too much work to find out (though the Joint Commission requires some investigation so "we try to do it:), and Shannon noted that with only 7% of adverse incidents coming to the System's attention, there's too little data to tell.

When pressed, Das said the anti-error initiatives they’ve devised will require more staffing. Shannon offered that CCHHS’s electronic systems were better than most (for data-crunching) and that this month the System will begin a baseline "culture-of-safety" survey. Michael urged them to work with Dr. Hoda (IT) to determine what enhancements to the system will catch problems automatically. Das noted there are standard interventions already in place concerning allergies and prescriptions but argued that each site requires a system tailored to its activities.

Shannon added that the System uses the "time out" technique, starting every procedure by having participants identify themselves and review their understanding of what they’re going to do, a practice which substantially reduces errors. There is one right way to do many medical procedures and using a checklist based on that right way keeps doctors from having to reinvent the wheel and risk harming the patient.

Dr. Ukoha from Stroger reported great progress in providing translation services there: the hospital now uses a phone interpretation service covering more languages than before, as well as video interpretation and interpreters on-site. Though certain "strategic areas" require a person on the spot, video and audio can plug many of the gaps. The task now is to make sure the entire medical staff is aware of the availability of this service.

--Submitted by Kelly Kleiman

Cook County Board and Committee Meetings of May 29, 2013

A Public Hearing of the Finance Committee concerning a proposed amendment to the Cook County Parking Lot and Garage Operation Tax Ordinance was scheduled to begin at 9am but was delayed as a quorum was not present until 9:15am.

After Chairperson Daley called the meeting to order he announced that the amendment had been withdrawn but did allow those who were in attendance to give their testimony on the issue. A person representing parking lot owners and managers stated that much work had been done to change state law so that a percentage tax would be used and not a flat rate. Implementation was supposed to be revenue neutral though and the proposed amendment included a percentage tax that would increase revenue and thus increase rates. The 3 speakers representing the hotel and parking industries were not in favor of the amendment as proposed. Chairman Daley stated the administration would be back with a new proposal at a later time.

Several other committee meetings were then held prior to the board meeting. The only item of note was during the Finance Committee meeting when John Cookinham, CFO for CCHHS, stated that the first payment for those persons qualified for Medicaid under the 1115 Waiver was received in April. Monthly 1115 Waiver payments will be coming in now and will include retroactive payment to the date of application for those who qualify.

The board meeting was called to order promptly at 11am by President Preckwinkle. Public comment now begins all of the committee meetings and the Board Meeting. Items from the Consent Calendar that were highlighted included memorials to Cal Sutker, a previous CC Commissioner, and Sister Sheila Lyne, a recently retired member of the CCHHS Board.

At 12noon Comm. Steele stepped in as President Pro Tempore to preside over the remainder of the meeting. Each agenda item was moved, seconded, summarized, and voted on in short order with minimal discussion. Highlights: The start time for board meetings was changed from 11am to 10:45am beginning with the next board meeting in June. Another item that was approved was a change to the board rules that clarifies how an item can be divided from a committee report for a vote. (Agenda item #7) According to Comm. Suffredin this is now known as the “Fritchey Rule”, resulting from a parliamentary disagreement at a previous board meeting.

There were 9 items on the New Items agenda, 3 of which could be acted on as they had been posted more than 48 hours before the meeting. An item that was referred to the Finance Committee was an amendment to the CC Procurement Code that will require social service contract providers to submit an annual performance report to the Board of Commissioners. A contract extension was granted to Northwestern for $1.8m to manage the Juvenile Court Clinic for another 18months while an evaluation of this court is undertaken. An RFP was issued a year ago and is considered still active while this evaluation takes place and is intended to result in a new plan by December of 2014. Another new item was the proposed appointment of 4 members to the CCHHS Board. If appointed the new members will include M. Hill Hammock, Wayne M. Lerner, and Lewis M. Collins for 4 year terms ending on June 30, 2017 and Ada Mary Gugenheim until June 30, 2014 to fill Quin Golden’s unexpired term. The appointments were referred to the Legislative and Intergovernmental Affairs Committee for consideration.

The meeting was adjourned at 12:30pm.

Submitted by Cynthia Schilsky, LWVCC Observer