Cook County Board of Commissioners Meeting April 29, 2015

Significant Actions –

Ordinance Amendment (15-2992) Performance Measures and Standards (STAR) affecting transparency, service delivery and resource allocation was referred to the Finance Committee for consideration.

Proposed Ordinance (15-3027) banning the sale of powdered alcohol (‘Palcohol’) was referred to the Legislative Committee for consideration.

Resolution (15-3033) asking City of Chicago to adopt reforms recommended by the American Civil Liberties Union (ACLU) with respect to “Stop and Frisk” failed – Several Commissioners expressed concerns about telling other elected bodies what to do in spite of the fact that they were essentially sympathetic to the reforms proposed.  Some were also of the opinion that the changes laid out in the ACLU report could be costly and asking the Chicago City Council to adopt them without consideration of how to pay for them was akin to an unfunded mandate although obviously the Cook County Commissioners cannot mandate what the Chicago City Council does.  Commissioners Voting Yes – Arroyo, Boykin, Garcia, Murphy, Suffredin.  Commissioners Voting No – Butler, Daley, Gorman, Goslin, Schneider, Silvestri.  Commissioners Voting Present – Fritchey, Simms.  Other Commissioners -Absent.

There was public testimony urging support for an anti-sweatshop resolution sponsored by Commissioner Fritchey which the board passed stating that the county was resolved not to procure any goods or services produced using sweatshop labor.

The board also passed another resolution sponsored by Commissioner Fritchey against local “Right to Work” Zones such as the ones Governor Rauner has expressed support for.

Various ceremonial procedures took up a lot of time at the beginning of the meeting resulting in this League Observer having to leave before the meeting was finished.

Submitted by Lali Watt

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

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

Cook County Budget Hearings October 25, 2013

                         The following are budget reports from Cook County
                                  Public Defender and Chief Judge

Public Defender Abishi Cunningham presented some details of his budget requests and changes made to his department in the past year.  First, the employee count (FTE) will increase  by 11 people in the area of line staff, investigators,  and additional attorneys. Last year the increase was 24 FTEs.   This should reduce overtime over the next year.  Staff and attorneys are working with outside groups to do bond reviews in order to lower bonds and/or  increase electronic monitoring.

Three new grants have been received:   to train attorneys on forensics such as DNA results;  for adult re-deployment  for non-violent drug users;  and for mitigation specialists to produce more informal sentencing decisions.

The Public Defender's office is working with the Clerk of the Court to monitor continuances (which appear to be excessive) in order to close cases more quickly.  Staff is being trained to use digital technology to help decrease court case duration.

One money-saving change in this department is purchasing fewer cars for employee use.  Instead, the use of  Zip Car, which is a public vehicle rental used by the county, and sharing the county's fleet vehicles  will lower expenses in this area.

STAR performance management goals include performance goals for staff;  evaluation of attorneys;    decreasing open cases;  and lowering complaints toward the Defender's office.  These last two goals have been accomplished in that there were fewer than 1% open cases and complaints.


Chief Judge Tim Evans appears to disagree strongly with President Preckwinkle's budget recommendation for the court system he leads and has asked the Commissioners to make amendments to increase his budget.  There is about a $6 million difference in the amount he has requested ($146.9 million) and the amount the President has budgeted ($140.6 million). He argued that the separation of powers in government, with all 3 branches being equal, warrants his getting 1/3 of the total budget;  his department currently has 5% of the budget.  He also complained that the President's office has many more highly paid (grade 24) employees than his office.  He has asked for 108 more employees and was budgeted 7 more.

Specifically, he has asked for more employees for a pre-trial service system  to make risk assessments of defendants.  This would aid bond court judges in making better decisions in deciding bond levels.  Currently, 51 probation officers are doing this job.  Judge Evans stated that judges use 38 factors including the risk assessment, current charge, and criminal history in determining bonds.  However, bond hearings usually last less than two minutes per case.

Psychiatric evaluations (to determine if a defendant is sane enough to stand trial) are taking 90 days and DNA evaluations are backlogged, both of  which make cases begin later and last longer.  With regard to juvenile defendants, Judge Evans stated that 5,000 are in alternative programs and 263 are in the Juvenile Detention Center.   He deems these programs a success in reducing recidivism and providing better rehabilitation for young defendants.

The County's new Legistar System (a new computer program) will enable outside hired attorneys to submit their payment orders themselves.  This should reduce transcribing errors, but attorneys and employees in the Clerk of the Court office will need to be trained in how to use the system correctly.

Judge Evans does not use the County's STAR performance management system but has stated "we are going to let the public know how close we are to standards."

Departmental Review Meetings for 2014 Budget : Monday, Oct. 21

The Cook County Board Finance Committee Budget Hearings continued today with presentations from 9 departments. The hearings began shortly after 9am and concluded for the day at 3:30pm. Commissioners drifted in and out of the hearings throughout the day with Comm. Tobolski, Fritchey, and Goslin not in attendance at all during the day. There was very little discussion of actual budget numbers with nearly all departments being in agreement with the President’s budget recommendation for their office/department. Most presenters did highlight the goals for their offices/departments and their success in meeting them but there was little reference to STAR by name and there was virtually no discussion about the goals from the commissioners.  

Board Of Review – Larry Rogers, Commissioner Board of Review

Mr. Rogers expressed support for the President’s budget recommendation for their department and stated his office’s intent to work towards ensuring that tax bills would again be sent out in a timely manner in 2014. Comm. Sims commended his office for their outreach in educating the public about the tax appeals process. He stated that there was a 64% success rate for appeals this past year but he thought a better measure was access to appeals, although he did not state a number for the actual number of appeals filed. (The number is in the budget book)

Assessor – Joe Berrios, Assessor

Mr. Berrios stated the intent of his office is to establish real value in property assessments and their intent to be better, faster, and more efficient so that tax bills are sent out on time. He stated that there is new state legislation that enables his office to pursue those claiming illegal exemptions and that he has 4 attorneys who are working on this type of fraud. These investigations are now done within his office and processed with an administrative hearing, and not contracted out as was done previously.  Several commissioners commended him for his outreach efforts and Comm. Gainer thanked his office for help with the new Land Bank.

Recorder of Deeds – Karen Yarbrough, Recorder of Deeds

Ms. Yarbrough stated that her office is dedicated to Accuracy, Efficiency, and Assistance. Anyone can come in and request and pay for a copy of a deed. One of their goals is to digitize their records back to 1871. Her office was required to hire a full time Shakman Compliance Administrator which did impact her budget and efforts continue to bring the office into Shakman compliance. Fraud related to filing of deeds is dealt with through the administrative judges. The office needs IT upgrades which are included in the IT budget. The President’s recommendation for this office is some $200,000 less than last year with a decrease of about 15 positions which Ms. Yarbrough highlighted as her efforts to reorganize this office through shifting of positions and efficiency. She also expects her revenues to increase.

Human Resources – Terry Larkin, Deputy Bureau Chief

Ms. Larkin related the achievements of HR to President Preckwinkle’s 4 Pillars – the county goals. Hiring time has been reduced. The process for compliance with Shakman went into effect in August and is now being monitored with the possibility of completion in 2014. A reporting tool is now in use for absenteeism and training is ongoing. The time for processing grievances has been reduced. She stated that case management for FMLA will be outsourced in an effort to better monitor its use since HR does not have the personnel to handle this internally. Negotiations with the unions for the 2012-1016 contracts are in process and the goal is to have them completed by the end of 2014. Comm. Gainer asked if there are allowances in the proposed budget for any COLAs that could result from these negotiations for 2014. Andrea Gibson, Budget Director, indicated that there are allowances included. Discussion ensued about employee sick leave, vacation, holidays, disability etc.  Comm. Gainer asked if a plan could be developed that looked at the cost drivers of benefits and how this relates to union negotiations and future budget considerations. Comm. Schneider asked if there is value in knowing the status of union contract negotiations since collective bargaining is such a complicated process. Lisa Medder, Dir. Of Labor Relations, stated that she would provide a status report with as much information as she can since negotiations are confidential. She also stated that only one of the 2008-2012 contracts remains to be settled. It is awaiting arbitration. There are 95 collective bargaining units with contracts to be negotiated and 80% of county employees are in a union.  The Teleo system is now used for posting and hiring of all positions except for those that are Shakman exempt and those that needed training in this system now have been trained so it is working much better than in the past. Comm. Garcia asked about HR for HHS. HHS does its own HR with the exception of collective bargaining and EEO complaints that are still done through the county HR office. Questions from the commissioners continue to revolve around Shakman compliance and there was a suggestion that perhaps an executive meeting needed to be called for training.

Homeland Security and Emergency Management – Michael Masters, Ex. Dir.

Mr. Masters stated that his department is using best practices as a guide for ensuring the safety and security of the residents of Cook County. They deal with the coordination of emergency preparedness throughout the county including all kinds of emergencies – weather, utility, health, law enforcement preparedness etc. Comm. Daley asked whether some of the grant money could be used for violence initiatives in the county or whether it must be used for  “terrorism”. Mr. Masters said there are restrictions on the use of homeland security grant money but perhaps some money can be used for violence initiatives.

Bureau of Technology – Lydia Murray, Chief Information Officer

Ms Murray just completed her first year in her position and highlighted her achievements that were based on her interactions with persons throughout county government. The internet capacity has been doubled. A catalogue of the services of the department has been published and they use this to measure their performance. Contract management has improved and clarifying contracts will be a goal going forward, Cooperation among the many IT efforts has been a primary goal so that there can be better coordination of resources and communication between systems. A $40m investment in IT throughout the county is budgeted in 2014. She wants to have all project managers to be county managers not vendor managers so there is more control over the projects. 18 project managers will be funded from capital money.

Veterans Assistance Commission – Abundio Zaragoza, Supt.

Mr. Zaragoza stated that his office located in the lower level of the JTDC provides services to veterans. These services include career assistance, housing location, rent and utility assistance, money for food, transportation vouchers, clothing and furniture. He runs the office with 2 part-time employees. This commission has a proposed budget of $300,000 which is an increase of $300,000 from the previous year. Mr. Zaragoza indicated that he has run out of money towards the end of the year but it was unclear whether he was still able to provide services..

Human Rights and Ethics – Ranjit Hakim, Ex. Dir. (in his position since August)

Mr. Hakim stated that he oversees the 11 member Human Rights Board that adjudicates complaints against the Human Rights Ordinance and the Wage Ordinance, and the 5 member Board of Ethics that adjudicates complaints against the Ethics Ordinance. His budget in the 2014 proposed budget is a 7.8% reduction so he stated he must be more responsible within his office. His plans include interagency cooperation with the use of Administrative Hearings when necessary, and not outsourcing adjudications. Focusing on investigation and adjudication and identifying and eliminating the expenses within the department that are not part of their mission. Women’s Issues has been removed from this department. He has implemented a case management system to deal with cases. There was a backlog of 150 Human Rights cases when he arrived and that has been reduced to 138. There are also 14 Ethics cases that are older than a year and he would like to expedite these and cut down on the time it takes for a case. Comm. Simms asked him what his role was in payment of the commissioner’s contingency funds. According to the recently approved Ethics Ordinance the ED has to sign off on any requests for reimbursement. Mr. Hakim stated that his role was to ensure that the requests were in compliance with the criteria as outlined in the ordinance. From further discussion it appears that an amendment to the ordinance is forthcoming as there seems to be a lack of understanding among some about what are political activities as opposed to what are the normal duties of a commissioner.

Board of Commissioners – Matt DeLeon, Secretary of the Board

Mr. Deleon outlined the many changes that have occurred within the office. The Legistar System which unifies agendas and the data base is now in place. All board and committee meetings are now live streamed and archived. The budget hearings are online. The commissioners will all be receiving ipads within the next week on which they will have the necessary documents for their meetings in an effort to go paperless. After several minutes of discussion of how to use the ipads and storing information in the “cloud” the meeting was recessed at 3:30pm

Submitted by Cynthia Schilsky, observer