CCHHS Board of Directors Meeting July 25, 2014

The meeting was called to order at 8 am.   All Board members were present except for one who attended by speakerphone.

Public Comments: A member of the public in attendance commented that CCHHS has 4 Board vacancies and therefore conducting the election for Chair and Vice Chair of the Board (on the agenda for this meeting) should be delayed until a full Board was appointed. He also stated that “no bid” contracts approved by the Board was not good governance and member/s of the Board have a conflict of interest because they are involved in the contract benefits.

Chair Carvalho responded to the allegations/concerns:  Cook County President Preckwinkle asked that the current Board of Directors of CCHHS stay on until the transition to the new CEO of CCHHS was complete (Carvalho and Gugenheim have completed their 6 year terms of office and are due to be replaced on the Board).  Ordinance defines the process for selection of new Board members.  Civic organizations (10-12) nominate members for the Board.  They normally meet and slate by 6-30-14, but due to the CEO search, this was delayed. 

 

With respect to “no bid contracts”, Chair Carvalho indicated that he was employed by IDPH (although he had recently resigned from that position and had not finalized  subsequent employment) and some contracts may have constituted a conflict of interest.  He rigorously abstained when there was voting on such contracts.

Board and Committee Reports were approved, including the CCHHS Finance Committee minutes from the July 18, 2014 meeting, which showed CountyCare 6-month revenue at $313,555,104 against expenses of $335,485,843, for a net deficit of $21,930,740.

An Amendment to the Rules and Regulations of the Medical Staff, pursuant to the Bylaws of the Stroger Hospital of CC Medical Staff was passed.  A copy of the Bylaw amendment was not available to the non-Board attendees. The discussion by Dr. Shannon, CEO, and Dr Fagen, Chief Medical Officer, indicated that the bylaw amendment dealt with improper transfer of patients from outside hospitals (dumping) to CCHHS in violation of the Emergency Medical Treatment & Labor Act (EMTALA). The process which will now be in place requires the ER to notify the CCHHS Compliance Dept., which then reports the event to the State of Illinois as a possible EMTALA violation.  Only 6 such violations have been reported this year (not known whether they were validated).  In most cases the transferring hospital calls CCHHS to alert them of the transfer. 

One of the Board members asked who was considered a “qualified provider” in the ER  and whether they all followed “practice guidelines”.  Dr. Fagen indicated that Nurse Practitioners and other allied health providers (non-physicians) were allowed to triage, conduct evaluation and management and treat to the extent of their licenses with the exception of evaluation of “chest pain” which required a physician evaluation.

Chairman of the Board Report:  Chairman Carvalho presented an overview of CountyCare with pros and cons of the transition to a managed care model from the previous “fee for service” funded by intergovernmental transfer.  It was relatively positive for the System model. Going forward, the State of IL requires 50% of Medicaid to be managed care with the expectation that 100% of Cook County Medicaid be managed care by Jan. 2015.

Nursing report:  Dr. Shannon introduced the new Executive Dir. of Nursing,  Agnes Therady (from the VA system), who gave a lengthy power point overview of the Nursing Dept.  including organizational chart, past performance and goals.  A Board member asked her how only 22 FTE of outside agency use by the nursing dept. was possible given the 19.2% vacancy rate in the Dept. of Nursing.  She replied that nurses are cross-trained in different disciplines so that they could cover various areas when needed. They are “competency trained/tested” in all of the disciplines they are assigned to cover. Most of the outside agency use was in the CCHHS clinics/non-hospital use.  The high vacancy rate is due, in part, to the older age of the nurses at CCHHS with frequent retirement.  They are working toward achieving “magnet status” for the nursing dept. over 5-8 years of effort.  Agnes’ goals are to improve the “visibility” of the nursing leadership on the wards, to include the patient/their family when there is change of shift/ pass off of care, and to coordinate transfer between inpatient/outpatient setting.

Report of the CEO:  Dr. Shannon noted President Preckwinkle’s open session on the budget of CCHHS the previous week.  CCHHS has a goal to submit its budget to the CC Board by September 2014.  The CC Board Finance Committee requests monthly updates on the Medicaid program finances.  Dr. Shannon also briefly mentioned the “Stroger Campus Redevelopment plan, next generation” with the relocation of the Fantus Clinic, etc.  Finally,  he recognized the Civic Consulting Alliance students present who were observing/shadowing the CCHHS process.

Election of Chair and Vice Chair of CCHHS Board of Directors: The election of Bill Hammock as Chair, and Jerry Butler as Vice Chair was unanimous.

Meeting adjourned to Closed Session.

--Submitted by Susan Kern