Cook County Departmental Budget Hearings October 26, 2012

Sheriff Points to Court Case Delays and Economy To Explain Increase in Jail Population and Average Stays

Sheriff Tom Dart appeared before the Finance Committee and explained that his $443.5 million dollar proposed General Funds budget’s increase of $37.6 million from last year’s budget was due mainly to an increase in salaries that were negotiated in union contracts approved by the County Board.  There is also an increase in FTE (Full Time Equivalent Employee) positions of 157, though Sheriff Dart emphasized that, except for the increase in number of correction officers at the jail required by the Federal Court, his department is down by 800 employees since he took office in 2006.  Upon questioning by Comm. Silvestri, Sheriff Dart said that all 798 additional correctional officers required by the Federal Court have been hired and are in place.

The Sheriff’s budget and number of employees are the second largest in Cook County, with the budget and number of employees under the Health & Hospitals System being the largest.

Increase in Jail Population and Average Stay in Jail

The number one goal for 2012 under the County’s Performance Management System (called STAR) for the Public Safety Sector of County government is the reduction in the average daily jail population and cost.  However, Sheriff Dart reported that the current average daily population is up 1,500 from last year.  Sheriff DART reported that the current average daily jail population is 12,760.  The STAR report on the County’s web site has different numbers:  9,322 for average daily population through the end of the 3^rd quarter, up from 8,800 in 2011, or an increase of 522.  Whichever set of numbers is correct, the point is that the jail population is significantly up from last year.

The Sheriff said that about 96% of the jail population is composed of people awaiting trial, with about 4% who have been convicted and are serving short sentences.

Sheriff Dart said that the average length of stay for an inmate of the jail has increased from 54 days in 2011 to 57 days this year.  Sheriff Dart pointed to two causes:  delays in concluding cases and the economy.  With regard to the economy, the Sheriff said that there are more inmates not being able to make bail.  The Sheriff pointed to the need for the Judiciary to adopt a case management system to help identify when cases are taking longer than they should.  The Sheriff pointed to the Trotter Report, commissioned by the County, as a source for many good suggestions as to how the jail population could be reduced.

The Sheriff said that also said that the shrinking availability of mental health services, with the City of Chicago closing clinics and reduction in budgets generally, has profoundly affected the jail population.  Sheriff Dart said that about 20% of the jail population has mental health problems. 

The Sheriff reported that there are about 1250 people released on electronic monitoring, 450 on straight release, and 200 who are released but have to report.  But the Sheriff said that the maximum number who can be released has been reached.  One issue is that while the Judiciary has issued orders allowing more to be on electronic monitoring, there is no one willing to take these people into their homes.  Safe Haven is one entity that will, but that entity only accounts for about 200 inmates, and there are many more who need a place to go to be able to be released on electronic monitoring.

Other Subjects

The Sheriff also reported that the department has handled about 20,000 evictions, which is about 5,000 more than last year.  He said that problems with those being evicted have been minimal due to the many advance warnings that are given and the fact that social workers go with the Sheriff Deputies to help those being evicted find housing and other services.

The Sheriff is also handling more judicial sales than last year, which brings in revenue for the County (as opposed to when private parties handle the sales).  However, the Sheriff said that he is only handling about 800 such sales, as opposed to the 45,000 in total being done in Cook County.  He complained that the Judiciary, despite assurances last year that it would direct more such sales to the Sheriff, has failed to do so.

--Submitted by Priscilla Mims

Cook County Health and Hospitals System

Board Meeting April 29, 2011

The meeting was called to order at 7:40am by Chairman Warren Batts. There were 2 public speakers.

• Mr. Blakemore stated his desire that HHS Contract Compliance be independent from the downtown office since HHS is an independent board they should keep this function separate from the county.
• A representative of AFSCME 31 made an appeal to the board concerning suspension of the WIC program. He stated that the program serves 23,000 women and children and is compliant with the strategic plan and wanted to know why the county program was being suspended and turned over to other non-profit agencies.

The Human Resources Committee reported that significant challenges continue with staff recruitment in part due to the "displacement" issue of union employees. It is still unclear how many positions are available to be filled. Further concerns from the HR committee meeting were to be discussed in closed session.

Mr. Carvalho reported for the Finance Committee. Physician billing continues to be problematic. Coding is an important component of the billing process and the problems seem to be more an issue of incomplete coding information than inaccurate coding. It has now been determined that HHS should plan to outsource the coding function and will issue an RFP within the next 5 months. After 18 months of attempting to handle the coding function internally they have been unable to make the process functional. Management is working with the union on this issue and they are required to notify the bargaining unit 5 months in advance of taking action to outsource.

During his report Mr Carvalho addressed the concerns of the 2 public speakers. He stated that HHS has brought the purchasing function in house and had intended to bring Contract Compliance in house as well but with the change in administration and leadership at the county they now feel that perhaps it is not necessary to create an HHS office of Contract Compliance. He said that they have had discussions with Ms. Hall, the Director of Contract Compliance, and she stated that political considerations play no role in the choice of minority and women contractors for the county.

As to the WIC Program Mr. Carvalho stated that he spoke with Dr. Martin, Director of CC Dept. of Public Health, concerning this program. He explained that the WIC program is actually a state program for which the CC Dept. of Public Health was a vendor. IDHS regularly seeks vendors and CC has historically been a vendor. The amount of money the county has received in the last several years has not covered the cost of the program and Dr. Martin has determined that it is no longer cost effective for the county to run a WIC program. Since it was not clear to the Board whether the discontinuation of this program needed board approval the issue was deferred to the next board meeting.

Dr. Carvalho reported that since the amount spent in overtime has been of concern to the CC Board the committee has been investigating the causes and ways to reduce overtime. He introduced Dr. Tedeschi and representatives from the Nursing Dept. to discuss their report on the OT issues. (They had a power point which the observer was not able to see since I was in the adjacent room listening to the meeting but the report is accessible online with the HHS Board information.) It was reported that OT is being used to cover staffing shortages due to displacement (necessity to relocate union employees before hiring from the outside) and LOAs (emloyees on Leave of Absence). HR can recruit but not hire during the displacement process and while the end date for displacement has been changed many times it was stated that the process should be completed by May 20 as long as there are no additional displacements and then nurses can be hired. Stroger is the most understaffed. As of April 1 there were 1200 vacant positions in HHS with 500 being at Stroger. CNA's are now being hired and previously there were few CNA positions. It was reported that in nursing alone there were 237 employees on LOA. Management of LOA and FMLA have been significant problems since they do not have the resources to mange it well and are looking to outsource this function. Another issue is that HHS has very few part- time positions which relates largely to benefits since the county does not have a good pro-rated benefits system for part-time employees. Hiring challenges were summarized as branding of CC (perception of instability), compensation (inability to compete in salaries), and hiring process technology issues.

An Action Plan for dealing with OT was outlined that included:

1. Completing the displacement process and filling 150 vacant positions in the next 3 months
2. Developing a system to manage the OT better with an electronic system
3. Partnering with the county to manage LOA and FMLA
4. Implementing a system wide nursing float pool
5. Bringing OT spending within budget by July 2011.

Michael Ayres, HHS CFO, stated that at the last County Board Meeting the Revenue Report indicated that HHS was still under their revenue estimate for the year. He indicated that he has since done a critical look at their budget and he is predicting a shortfall of $30-4om for the year. This is due to outstanding medicaide money, a physician billing system that is still not up and running and medicare billing concerns. He further stated that if they are unable to move ahead with the Strategic Plan (conversion of Oak Forest Hospital to an outpatient facility) they may also have to adjust the expense side of the budget as well before the end of the year.

A resolution was approved recognizing William Foley for his 2 year tenure as CEO of HHS as this was his last Board Meeting before he leaves CCHHS on May 6. Chairman Batts reported that Dr. Terry Mason will serve as interim CEO.

Authorization to establish a not-for-profit corporation to raise funds for CCHHS to carry out their mission was requested. It would be called the Cook County Health Foundation and would have a board that would be independent of the county and the independent board. The purpose would be to raise money to support county health services. No action was taken on this.

Mr. Foley reported that a rehearing has been scheduled for May 10 concerning the closing of the Oak Forest inpatient beds. He stated that this part of the Strategic Plan continues to be a challenge since there has been miscommunication about what is planned for Oak Forest. It is not really closing - but changing the nature of the services offered at the facility.

Mr. Foley recognized the Board for their courage in dealing with the issues at CCHHS. He outlined the following priorities for the board going forward:

1. Get past the layoffs and displacement process - rebuild morale and address employee satisfaction
2. Need to implement the Strategic Plan with the changes at Oak Forest being critical
3. Build infrastructure to move system forward ie. hiring process
4. Address revenue shortfall
5. Work with the county administration on the Independent Board structure and function
6. Enhance the image of CCHHS

Neil Khare from President Preckwinkle's office presented the CC Performance Management Initiative which he made clear is very important to the President. The Initiative is intended to provide good timely accurate data so management can make decisions and will make Cook County government transparent and accountable. There will be quarterly reports that will tie performance indicators to budget. There are 2 groups that are providing pro bono consulting services to assist departments in the process of goal setting so that robust goals can be established that are outcome oriented. By 2013 the system will be operational and the quarterly reports will be published. Senior management at the hospital has been trained and the training will continue with all union leadership.

The meeting went into closed session at 10:08am.