Cook County Health and Hospitals System Board of Directors Meeting May 29, 2015

        I.          Chairman Hammock called the meeting to order at 9:00am

      II.         Public Speakers: There were 6 speakers representing the public.  A representative from the Service Employees International Union (SEIU) Local 73 representing the Health Care Professionals, Hospital Technologists, Service Employees and Hospital Technicians of CCHHS complained that labor contracts had expired and the new negotiated wages and healthcare changes which had already been approved by the Cook County Board were being held up by the CCHHS Board.  Chair Hammock responded that the Board required comprehensive comparative metrics from other hospitals to determine the criteria for a decision.  This data was now available and a vote would be taken later in the meeting.

Nurses from Stroger Hospital and Cermak and SEIU representatives for the nurse’s union contract spoke.  They stated than there were insufficient nurses per patient leading to unsafe practices.  CCHHS had cut nursing overtime leading to a more severe shortage, there were over 200 nurse position vacancies and wages were inadequate.  One of the nurses from Stroger Hospital stated that “a strike vote by the nurses” had been taken and introduced a representative who served the Chair of CCHHS Board with a formal notice that the nurses will begin picketing. Chair Hammock responded that filling vacancies was a high priority for the CCHHS Board as reflected in the monthly metrics on vacancies.

A citizen spoke complaining that Oak Forest Hospital had been closed and the patients moved to nursing homes. “There is not enough money spent on real health care”,  “the CCHHS leadership don’t receive their  health care at CCHHS, and they should! Its good enough for the poor.”

    III.       Employee Recognition:  CEO Dr. Shannon recognized the CCHHS/Stroger physicians from the “internal medicine jeopardy team” who had progressed to the national semi-finals.  He acknowledged an ophthalmologist who was listed as one of the “40 under 40” by the Ophthalmology Association.

   IV.            Board and Committee Reports

A.  Minutes of the CCHHS BOD from 4-24-15 were approved

B.    Quality and Patient Safety Committee Meeting 5-12-15 

Dr. Das reviewed the metrics of quality measures and 12 month trending pointing out that on-time OR start was only 17% (target 80%) at Provident Hospital and the “patient experience and willingness to recommend the hospital” was 71% at Stroger and 67% at Provident Hospital (target: 85%). This represented a small improvement from the previous 60-70% for Stroger but little change for Provident Hospital. Director Dr. Marsh requested better trending to understand any improvement, not just monthly variations.   Director Weise asked whether a survey of CCHHS employees on whether they would recommend the hospital might be useful. Director Gugenheim reported that Provident Hospital had been granted full accreditation by JCAHO.

               C.  Audit and Compliance Committee

Director Velasquez reported that IlliniCare, Medical Director malfeasance (as reported in the press) was being addressed. Cathy Bodnar reviewed the CountyCare oversight structure (grievances, complaints, appeals etc.).  Fraud Waste and Abuse program training is on-going for staff.  Only 8 allegations of FWA were validated in the previous year.  Director Lerner requested a deeper evaluation of the metrics to include rate of 1) repeat allegation by type and 2) what was the outcome.  Cathy Bodnar noted that the prescription abuse program included restricting a member to a single pharmacy if there was a pattern of abuse and working with the member personally.

 D.  Managed Care Committee

Steve Glass reported that CountyCare membership in May 2015 was 183,415 exceeded the goal of 155,860 but that the “total member months was only at 97.6% of budget."  In the last 6 months (Dec. 2014—June 2015) CountyCare has doubled in size and is now the 2^nd largest Medicaid managed care organization in the area (2^nd to Family Health Network).  Director Junge asked what % of the of membership are due to auto enrollment versus actively choosing CountyCare.  Mr. Glass responded that he would follow-up with the State of IL who would have this information.  State of IL sent out new annual re-enrollment letters to members in February, 2015, with a 60 day deadline for member redetermination which at this time, is reported as 8,000 who had Medicaid cancellation.

                  Director Lerner asked for sources of Medicaid cancellation and the response was that        there were multiple reasons including 1) members not completing the process of                  redetermination and 2) members now employed and no longer meets Medicaid eligibility                   or another such change in status.  Member/provider surveys required by the CCHHS                   contract for Medicaid with the State of IL shows only 99 member responses with 44%                  worried about where they will stay tonight and 32% worried about food availability.

           E.    Human Resources Committee

Director Wiese and Gladys Lopez reported that they are focusing on filling vacancies particularly nursing ones which are reported in the monthly metrics. Lopez noted that compared to May, 2014 when 216 CCHHS vacancies were filled, in May, 2015, 448 were filled.

F.       Finance Committee

Mr.Elwell reviewed the contracts that required action and all were approved with the exception of  item #14, “First Transit,Inc” providing transportation benefit for the Managed Care System, contract $8,000,000  which required further fact checking prior to approval. He reported that CCHHS has YTD  ($23 million) income loss with a poor operating margin compared to other hospitals.  The “plant/buildings/equipment” are aging and now 17 years old and “going in the wrong direction”.  There has been inadequate funding for renewal of this capital equipment, most of which dates from the opening of the new Stroger Hospital. 

Overtime is very high at 8% of worked hours costing CCHHS $40 million. It should be less than 5%.  Monthly Inpatient days (9,225 vs 8,315), emergency room visits (14,261 vs 12,887) and outpatient registration (7,821 vs 7,543)  are all down significantly from 2014 but there is no decrease in the overtime!  

 Mr. Elwell stated that there needs to be realignment of CCHHS managers with the new business model of managed care.  All positions must be looked at to determine whether they are needed.  

Director Marsh inquired about wait time in ER.  Elwell responded that no one is left in the ER waiting room, they are placed in exam rooms waiting for the physician to see them.  

Director Lerner asked about metrics on nursing FTEs per occupied bed.  Elwell responded that they are working on an automated system for nursing documentation to derive the metrics from.

 

      V.             Board Education

     A comprehensive focus area power point presentation and overview of the  responsibilities of the Cook County Department of Public Health, a component of CCHHS, was given by COO of CCDPH Dr. Terry Mason.  It will be posted on-line on the CCHHS web site.

    VI.            Action Items

 The Board adjourned temporarily to Executive Session for 20 minutes to discuss the SEIU   union negotiated wages and healthcare changes for CCHHS employees including SEIU   Local 73 Health Care Professionals, Hospital Technologists, Service Employees and    Hospital Technicians.  The open BOD meeting was reconvened and it was announced that  the Board had approved the contracts.  These do not include the more comprehensive nurses'  contract.

  VII.            Report from the Chairman of the Board

Chair Hammock noted that the Board has invested tremendous efforts into recruiting nurses.

VIII.            Report from the CEO Dr. Shannon

Dr. Shannon rebutted the comments made by various nurses/union representatives public comments. He stated that there are appropriate nursing levels at CCHHS based on the acuity of the patient care derived from national standards and metrics.  Most hospitals no longer base nurse staffing on a specific ratio of nurse to patient, which is what the union wants, but on acuity of care. CCHHS has used “floater nurses” to cover periodic shortage rather than overtime. He disagrees with the nurses’ union demand for a wage increase of 5% for each of the next several years and the demand that seniority not performance serve as the criteria used for retention.  “We are far apart on the terms for the new nursing contract”. Dr. Shannon indicated that the Union must give CCHHS 5 days notice of a strike.  He feels that the BOD could obtain a legal stay of the strike action.  However the CCHHS BOD are creating contingency plans to maintain nurse staffing of CCHHS Hospitals and clinics.

The meeting adjourned at 1:15 pm.

Submitted by Susan Kern, MD,  observer for LWV Cook County, Health Issues Committee

Cook County Board of Commissioners and Committee Meetings February 10, 2015

The Zoning and Building Committee began at 10 a.m. 

The room was packed to capacity with union members, students, and opponents to the Mission Hills zoning variance request to allow a new Planned Unit Development (PUD) by Red Seal Development Corporation in unincorporated Northbrook. The PUD would include 137 homes on 44 acres, or half of an 18-hole golf course, within the 43-year-old Mission Hills PUD.  Mission Hill’s residents and those employed by Red Seal  (lawyers, appraisers, and land use engineers), numbering about 35 persons in total, addressed the Committee even though there has already been 17 hours of testimony. When Mission Hills was constructed in 1972, the 18-hole golf course that spreads through the property was the required Open Land needed in the PUD to counter the land use intensity of the 780 units. The golf course also acted as a flood plain during heavy rain storms. The 20-year Covenant retaining the Open Land use of the golf course ended in 1992.  Mission Hills resident groups had an opportunity to buy the golf course, but refused.

Proponents for the development stated the benefits of constructing additional homes: increased tax revenues, increased jobs, and improvement in the current water drainage system that will be included in the project. Mission Hills residents stated they would suffer increased flooding, property value loss, and that their PUD permit had been issued on the basis of the open land of the golf course.  Commissioner Silvestri asked for an individual voice vote from the commissioners regarding the approval.  The commissioners voted 13 yes, 2 no, and 1 present, approving the zoning variance.  The meeting ended at 12:05.

The Finance Committee met from 12:15 to 12:40, hearing the Proposed Ordinance Amendment 15-0703 on Zero-Based Budgeting (ZBB). The discussion described the ZBB process as being accountable and transparent. Additionally, a new report will be available to the commissioners which will report expenditures and revenues together, with both reflecting current status.  The report in the past reflected revenues, such as property taxes, as 1/12 of the budget, while this report will reflect the actual taxes received. This was stated to be considered a best practice. Commissioner Fritchey described 15-0703 as a collaborative project between the Rules Committee and President Preckwinkle’s staff.  Hearing that, the Committee voted unanimously and respectfully for passage. 

The Finance Committee also passed 15-1232 guaranteeing hourly workers for the county against loss of wages by contractors stealing worker’s paychecks and refusal to pay.  Over the year, workers lose millions in wages.  Commissioner Steele said the County Board is a safety net protecting these hourly workers.  The Finance Committee adjourned at 12:47.

The Board meeting was called to order at 12:55 by President Preckwinkle.   After a tribute to Chicago Alderman Joanne Thompson, 20 files were rapidly passed including the Mission Hills variance, which included a roll call vote, as well as Zero Based Budgeting (15-0703).

Next, Helen Thornton, Director of AFCSME, the union representing Cook County workers, spoke, saying the employees had not had a pay raise in two years and needed a fair and decent contract to cope with rising prices.  Then the consent agenda was addressed with five items discussed or read, and four group pictures taken.  Beginning at 2:05, 47 items were rapidly passed before the session was adjourned at 2:30 p.m.  Ordinance 15-1565 banning chokeholds by County Law Enforcement officers was passed and as was a proposed resolution to the Illinois General Assembly, 15-1585, to support SB 105 restoring $300 million dollars to the Child Care Assistance Program for FY 2014 which has a $190 million deficit.

Submitted by Laura Davis and Eleanor Prince

Cook County Board of Commissioners Meeting, October 18, 2011

The meeting was called to order at 10:00 a.m. by President, Toni Preckwinkle. A retirement resolution was read for Kathleen McDonnell who worked in the office of the Clerk of CC.

Several Commissioners expressed concern about the new Procurement code change.  They wanted to be sure that the “bid box” will stay in the Board Room and not move to the Administrative offices. They were assured that the box and the opening bid process will continue to be handled in the Board Room.   Another Commissioner suggested that the process be taped and put on Cable TV.

All business handled during this morning meeting was voted on a pro forma basis and the Board meeting adjourned just after 11:30 a.m.  There was no discussion about Medicaid reimbursements or the status of the current or proposed budged except for the following:

·         The Commissioners were asked to ratify new contracts covering 1,900 Teamster employees for the period 2008 through 2012.  This is another of the issues that the President and Board inherited and covers employees working for the Circuit Clerk, Chief Judge, and in Preckwinkle’s administration.  However, the Administration is asking for this contract to be approved knowing that immediately it will ask all the County’s unions to reopen contracts to negotiate for 6 unpaid holidays and 2 furlough days in 2012.  Commissioner Suffredin questioned the reasoning of approval only to immediately ask for a change.  The Administration’s Human Resources Director was firm in her recommendation to follow this two-step approach.  She argued that the negotiated Teamster contract is a good one for the County and it needs to be finalized.  Further, unions including the Teamsters have signaled their refusal to go along with unpaid holidays and furlough days.  In the end, the Board voted to approve the contract.  President Preckwinkle stated that 500 layoffs are likely in either case, but the number will double without this concession.

·         Commissioner Earlean Collins proposed having department heads at committee meetings so that questions that arise can be addressed immediately.  The resolution was sent to the Rules Committee for review.

·         Commissioner Suffredin offered a resolution that would allow tickets issued by the Forest Preserve to be heard by a county administrative judge.  The resolution Passed.

·         Finally, the Board approved the appointment of Takashi Reinbold as Interim Comptroller until a permanent candidate can be appointed and approved.

Report Submitted by:

Diane Edmundson, LWV Chicago

Finance Committee Budget Hearings – Feb. 10, 2011

Exploring ways to reduce the number of layoffs.

The first public hearing on the proposed budget where members of the public could testify was held the evening before at the Maybrook Court House in Maywood. Employees who are union members turned out in force to protest the layoffs called for in this proposed budget. Commissioners were clearly affected by what they heard the prior evening. Finance Committee Chairman Daley brought Jonathan Rothstein, interim director of Human Relations, to this budget review meeting to update Commissioners on talks with unions about the possibility of unions accepting furloughs or other ideas to reduce the number of layoffs necessary. Mr. Rothstein indicated that no firm proposal had been put on the table, but when the subject had been brought up with at least some of the unions, it was indicated that this was not worth pursuing. However, Chairman Daley urged both Mr. Rothstein and the President's office and the unions to talk again to explore any and all ideas, including pay freezes and unpaid holidays. Commissioner Reyes stated that he was going to introduce an amendment to the budget that would reduce the salaries of department heads by 10% in order to free up money to reduce the number of layoffs.

Bureau of Administration

This Bureau is composed of a great variety of departments, the largest being the Highway Department, but also including the Office of the Chief Administrative Officer (which works on projects that often cut across departmental lines), the Department of Environmental Control, the Zoning Board of Appeals, the Medical Examiner (i.e., the county coroner), the Office of Adoption and Child Custody Advocacy, the Veteran's Assistance Commission, the Animal Control Department, and the Cook County Law Library.

The majority of the questioning was directed to the budget of the Highway Department which calls for a net decrease of 74 FTEs, many of them union positions. An additional 36 positions were saved by transferring their costs to the Special Purpose Fund MFT Illinois First, which gets money from the State for the design, construction, maintenance, and operation of highways. In response to Commissioner questions, the Superintendent of the Department confirmed that he had conferred with the Illinois Dept. of Transportation to make sure the employees transferred qualified under this Special Purpose Fund.

As the Commissioners had done with the Facilities Department earlier in the week, several Commissioners pressed the Superintendent as to whether there were sufficient positions in the budget to be able to do the necessary work of the department, particularly during times like the recent blizzard. He said that there were, but also said that the department would be at a bare bone level, and he would prefer to have a cushion of 2 or 3 more positions in most of the areas. The Superintendent also said they were looking at how they can improve operations by working across the 5 districts of the department. Commissioner Gainer pressed the superintendent to look at closing down District 3 during the non-winter months (and moving the employees to the other districts) since it sounded like it might only need to be open for the purpose of salting. Several Commissioners brought up the idea of whether employees who were losing positions and were close to retirement could "buy out" in order to bridge their service and benefits.

There was also concern about the staffing of the Medical Examiner's area, and Dr. Jones said that she does not see how she can live with only the $60,000 budgeted for overtime. She also mentioned that several maintenance projects in her department were on hold because of the pending layoffs in the Facilities Department.

The one department that is adding people is Environmental Control, which is adding 2 inspectors and 1 administrative assistant. On average, each inspector brings in about 3 – 4 times his/her salary due to fines levied for violations. In the budget, about $300,000 more in revenues are projected as a result of the proposed addition of inspectors.

-- submitted by Priscilla Mims

Health and Hospitals System Board Meeting January 28, 2011

As usual the meeting began at 7:30am at Stroger Hospital with public comment. Five of the seven speakers were concerned with staff morale and 3 people specifically addressed concerns with nursing shortages at Stroger Hospital with one speaker stating the ratio of nurses to patients was 12 to 1 and another speaker indicating the ratio was 7:1, and both indicating that patient care was suffering due to nursing shortages. The meeting then continued with approval of minutes of previous meetings and committee reports.

During the report from the Quality and Patient Safety Committee, Director Ansell discussed a systemwide process (Quality Dashboard) that is being used to look at quality measures. He thought perhaps a presentation on the process would be useful to the HHS Board for looking at patient quality issues. This provoked an outburst from one of the public speakers who accused the board of not listening to how nursing shortages are resulting in inadequate patient care, and accused the Board of not wanting to take care of poor people. The Board seemed quite stunned by the outburst which continued until the speaker was escorted out of the meeting. Another of the directors stated that since specific allegations had been made by the public speakers (a patient dying due to lack of decubitus ulcer care, and patients not being cleaned for entire shifts) that she would like Mr. Foley to investigate these charges and get back to the board with information about the incidents. Director Ansell acknowledged that nurse staffing is an issue and that the parameters on the quality control scale he was presenting indicate problems with nursing. He further stated that communication between nursing management and labor needs to be improved.

Ros Lennon, Chief Clinical Officer, was asked to address the board concerning the nursing shortage. She stated that there are nurse staffing issues particularly at Stroger Hospital. They have not hired nurses externally in more than 18 months due to "displacement" - the union requirement that nurses from within be moved to positions before there are hires from outside. The closing of Oak Forest and Provident Hospitals have resulted in a number of displacements and the goal is to finish the process by the end of February. Vacancies must first be filled by qualified candidates from within the system and the displacement process stops nurse recruitment. When asked by the board what was taking so long for the process to be completed they were told that the vacancy list has been hard to complete.

Deb Tate, from Human Resources, was asked about the problems with the vacancy list. She stated that it has been difficult to verify that positions are actually vacant. An inaccurate list has apparently resulted in some volatile meetings with the nurses union so HR is now trying to be sure the list is correct before calling another meeting with the union. The difficulty in obtaining the list is that the data from the employee tracking system that has been used does not correspond with actuality. The HHS Board thought it would be okay to take the risk of presenting an inaccurate list to get the process moving but Deb stated that frankly HR does not have a relationship with the nurses union that allows for negotiation.

The Board continued to discuss this issue, at one point considering a motion to expedite the process, but finally decided that they would make a "recommendation" that the administration complete the displacement process as soon as possible so that staffing levels can be optimized. Director Ansell summarized some of the discussion by stating that the Board is going to need to address issues of capacity - they want to say they can do it all, but the money is not there to do everything. Director Carvalho stated that perhaps it would be a good idea to include data on nurse ratios on the Dashboard. He also said that they have to be cautious with the language they use. The HHS is providing as much care as the money they have allows. When their budget is cut they move from not meeting the health needs of Cook County residents to meeting less of the health needs of Cook County residents. They will never have enough money to meet all unmet need.

Human Resources Committee - A compensation audit has been completed and will be discussed in closed session. Mr. Foley stated that the report indicates that the CCHHS administrative compensation levels appear to be comparable with other large urban public hospitals. Director Carvalho stated that in the future they should have the comparative information upfront, prior to hiring individuals, and not have to gather the information after the fact.

Deb Tate, Human Resources Director, was asked to comment on an incident at Cermak Hospital, where personal information on a nurse was obtained by an inmate. Comm. Steele, from the CC Board, was at the meeting and expressed great displeasure at the handling of the situation. Dr. Pisius, Director of Cermak Hospital, stated that the nurse has been moved to a different facility and the incident is being investigated by the Sheriff as that falls under his jurisdiction.

Finance Committee - Director Carvalho reported that they now have an internal auditor. He reported on a special earnings review that indicated significant funds being paid for moonlighting and shift differentials that lacked clear guidelines for who can receive such payments, as well as unclear guidelines for authorization of such payments. Price Waterhouse Coopers provided an update on their ongoing efforts as consultants within the HHS. Their projects include training CC employees to do medicaide authorizations; working on the supply side to reduce expenses; doing efficiency studies in the OR and the ICU; doing a process study on how a bill gets paid; working on standardization process for the clinics; and working on recruitment. Mr Ayres, CFO, was asked how the medicaide authorization backlog is going and he responded that they are still talking with the state about moving the process along.

Director Carvalho pointed out that at the present time increasing the revenues at the hospital will not increase the HHS revenues since all their revenue goes into the General Fund of Cook County. He made a motion that they seek a provision in the Cook County Budget Ordinance that increasing HHS revenues will allow HHS to increase expenditures. He said otherwise they have no incentive to increase their revenues if they are not going to be allowed to keep them. This year HHS decreased their subsidy from Cook County by $95m. The motion was approved.

Chamberlin Edmonds and Assoc. then gave an eligibility enrollment optimization report. Director Carvalho said that he wanted to get the information from both reports to the commissioners on the CC Board.

At 11:00am the meeting went into closed session and the observer left.