October 10, 2013 The 2014 Executive Budget Recommendation

This special meeting was held for Cook County President Toni Preckwinkle to present the 2014 Budget for Cook County to the Cook County Commissioners.  Some major revenue points made by the President include no new taxes, fees, or fines, although at least one new Special Purpose Fund  will be started to pay for a Solid Waste ordinance;  increased grant revenue, such as a $6 million grant to the Landbank;  and more thorough collection of taxes, such as cigarette taxes.

The subsidy to the Health and Hospital System (HHS) is down to $76 million which is a 50% decrease since Pres. Preckwinkle took office.  This is in large part to the waiver received by HHS this year to sign up newly eligible Medicaid patients to County Care through the Affordable Care Act.
Savings in employee health care and pharmacy costs will occur due to better management of employee benefits.  Pension reform at the county level is being worked on in hopes of savings there.

One tax from last year's budget--the tax on out-of-county non-registered purchases over $3,500--will not be collected as it is being litigated.  Two other taxes from last year--on guns and gaming machines are also in litigation but will be collected this year.

Expenditures will be increased in the Technology area ($40 million total) since much of the Information Technology used at the county and court system is outdated, lacking integration, or missing entirely.  Some targets for this improvement are the Property tax system, Time and Attendance system, and Financial Compensation system, and training in the Court system.  There is a 3.3% increase in Public Safety expenditures and 16.8% increase in the Health Fund.  The newly passed law, "Raise the Age," where 17 year-olds charged with felonies will now be sent to Juvenile Court rather than Adult Court, will increase expenditures in housing defendants.

Increases in employees ( up 504 FTEs from last year) will be in the Inspector General's office to reduce misconduct in county government;  the Sheriff's office as part of a court ordered mandate to increase staff;  tax collection;  at HHS for faster sign-up of County Care patients;  Medical Examiner's Office to gain accreditation;  and some other departments.

Four Public Hearings on this budget will occur throughout Cook County on Monday, October 21 through Monday, October 28. Departmental Budget Hearings will begin Thursday, October 17 through Monday, October 28 at the Cook County Board room.  Go to home.cookcountyil.gov/budget for details.

The Cook County Finance committee and sub-committees also met with some other business.  All Metra Board members (directors)will now have to sign affidavits regarding their residence, conflict of interest, etc.  Two items regarding Metra Directors (one requesting resignations, the other requesting stricter criteria for Metra directors) were both deferred due to the absence of their sponsors.  A new Metra Director from suburban Cook County was approved--Romayne Brown--who has had CTA  management experience.

A resolution to examine the automation and integration of the Cook County Criminal Justice system was passed.  It is currently a paper-based system which causes confusion, errors, and inefficiencies in the court system.

Cook County Board Meeting October 2, 2013

All Commissioners were in attendance.  The Finance Committee met early and passed the following which was later approved by the Board of Commissioners as a whole:

• Amended the Code of Ethical Conduct to add that appointees of or those requiring approval of the Commissioners shall not serve on the political fundraising committee of any elected official or candidate for County office.  And the Code now limits the contribution amount up to, but not exceeding, $1,500 in a candidacy year by appointees to county positions.
• Amended the Rules of Organization to require a signed and notarized affidavit from Presidential appointees or reappointees attesting to their ability to fulfill the requirements of the position.  [Outgrowth of the Metra Board resignation after it was learned a Metra Board member no longer lived in the area he was supposed to be representing].

Health & Hospital Systems CEO, Dr. Raju, reported that 107,000 applications for CountyCare have been received by Cook County under the Affordable Care Act.  The goal is 115,000 by the end of the year.  His 2013 budget projected 56,000 application approvals, and 41,000 have been received from the State of Illinois to date.  Dr. Raju is encouraged that the State is now processing 500 applications per work day–almost an 100% increase--due to staff hiring.

The Commissioners approved a resolution requiring all employees within President Preckwinkle’s office to receive cyber security training.

The Commissioners moved the following to various committees for consideration:

• Concealed Carry Enforcement sent to Law Enforcement Committee.
• Amendment to allow for public camping and the privatization of equipment rentals in/on certain Forest Preserve lands sent to Building and Zoning Committee. 
•  Amendment to create an intergovernmental task force to reduce crime committed by persons with mental illness and/or substance abuse sent to the Criminal Justice Committee. 
•  Amendment to create a Cook County jail diversion program for mentally ill and/or substance abuse detainees or arrestee sent to Legislative & Intergovernmental Relations Committee.  The program’s goal is to intercede prior to a detainee landing in jail and/or the bond courts.  [Note:  per Sheriff Dart on TV’s September 29, 2013 60 Minutes, the CC jail system has 2,500 inmates that are mentally ill and require care].

Submitted by Diane Edmundson

Cook County Health and Hospital System Board Meeting September 27, 2013

After routine committee reports, Chief Information Officer Dr. Das reported on the Adverse Event (i.e., an injury or harm due to medical care, unrelated to the underlying disease or condition of the patient) Reporting System now being implemented at CCHHS.  48,000-98,000 deaths annually are due to medical errors, 50% preventable.  New expectations: Disclose error to patients; report error to  Hospital Compare. "Never events" that can't be billed include infection in catheters.  

CCHHS has a higher percentage of patients in burn units and high risk settings, so CCHHS error percentage may look higher but in fact is close to the norm. Error types include violation, slip or error, or mistake.  About 10% of errors result in adverse events.  Common types include adverse drug reactions, procedural complications, and hospital-acquired infections.  

 Dr. Das reported that to find errors, nurses review charts to look for non-reported events, and staff are rewarded for reporting "near misses."  Board members expressed concern regarding rewarding staff for reporting errors, which Dr. Das defended as making it possible to use root cause analysis, creating a "just culture" approach to assign accountability in a structured fashion.  Lerner pointed out that payments are reduced for negative events.

Chief Business Officer Anthony Rajkumar introduced lots of discussion on the proposed use of 10 acres of property owned by the Illinois Medical District Commission (IMDC), a zoning agency created in the 1940s, delegated by the state and overseeing 560 total acres including UIC, Rush and Stroger, and roughly extending from Ashland to Congress and south of Roosevelt.  Through acquisition of tax delinquent properties, the IMDC also owns some property.  IMDC's 7-member board meets monthly to discuss how to best use and develop the 560 acres it oversees.  

The CCHHS board was asked to vote to approve an intergovernmental agreement to allow IMDC, the Office of Capital Planning and Policy (OCPP), and CCHHS to collaborate on redevelopment opportunities within the IMDC, to better account for existing and future needs of the County and CCHHS as well as the IMDC.  Dr. Raju strongly supported the agreement, saying CCHHS needs a medical  laboratory that might serve the whole district, and  Fantus Clinic needs to relocate.  Lerner also supported the agreement, saying it would be good to collaborate and talk about other possibilities, including biotech investment. Gugenheim felt CCHHS was giving IMD power by agreeing; Carvalho pointed out that CCHHS is a "small fish", and now we could sit with the "big fish" and have our voice heard at the table.  Velasquez voiced reservations due to CCHHS history with IMDC, but Dr. Raju said this board is new, we should join the conversation.  Gugenheim felt more information should have been provided to the board beforehand for review.  As a result of these and other concerns the issue was tabled, but the county board may vote to move ahead on the matter without CCHHS input.

A $14m new "clean steam"  heat system was approved to be installed at Stroger after the failure of the first system installed when Stroger was built in 2002. (Two steam systems are required, one a "clean steam" system to sterilize medical instruments.  After failure of initial system, it was "cobbled together" to keep it functioning.  A lawsuit against initial construction company yielded $17m, some of which is being used for the new system.) Collens asked whether CCHHS board had power over capital expenditures and was told NO, the full County board retains power over capital decisions, but CCHHS approval is usually sought anyway. Lerner requested that in future a member of buildings and grounds be present to provide a fuller explanation of such proposals.

More discussion of timing of meetings, the idea of combining several on the same day.  No decision.

Dr. Raju said CCHHS budget has been approved and will be included in the full county budget to be voted on and to go into effect December 1.  22 FQHCs ("Federally Qualified Health Centers") are now recruiting enrollees for CountyCare, with outreach planned for 100 churches this Sunday.  As of September 26 there are 103,000 applications for Countycare; Dr. Raju expects to exceed the 115,000 goal.   

Oak Forest opened officially as an intermediate care, regional ambulatory care center after a $6m investment.

CBO Anthony Rajkumar explained his job: standardize work processes, redefine roles, renegotiate contracts, evaluate real estate, assess life safety of patients, staff and facilities.  His challenges: contract oversight, electronic procurement system, aging infrastructure, replacement of aging medical equipment.  Lerner asked how many patients were undocumented immigrants and pointed out that the ACA will not cover these persons. Munoz said there will be 30 million without insurance.

Meeting adjourned to closed session at 11:10.

-submitted by Linda Christianson

Cook County Board Meeting September 11, 2013

The Finance Committee meeting met before the General Board meeting.  Of interest was elimination of the Office of Coroner, which is now the Medical Examiner office. Also, the Medical Examiner now has the power to cremate bodies.  Most big cities allow cremations, and this will allow the medical examiner's office to act more quickly to deal with remains of indigents, unless the remains are unidentified.  Cremation will save the County almost half the amount that it now costs the County to bury unclaimed bodies.

Two interesting agenda items, a proposal urging the IL General Assembly to create stricter criteria for who can serve as a Metra Board Director, and one asking for resignations from suburban Cook County Metra Directors, were moved to the Legislation Committee.

A very involved ordinance amendment dealing with Solid Waste and the county code was referred to the Finance Committee. 

An agreement between the Cook County Medical Examiner office and the Gift of Hope was proposed for organ and tissue donation.  After death, tissue can be retrieved for up to 24 hours.

Several contract extensions or transfers of funds to the Court System were approved.  There was a lot of discussion, particularly from Commissioner Sims, on the award of a contract to Aunt Martha's Youth Service Center, Olympia Field, and how the guidelines are written for an agency to bid for the business. Comm. Sims asked the representative from the Chief Judge's Office to arrange a meeting with Judge Evans to discuss the guidelines.

A new agenda item, offering a proposed resolution by Comms. Goslin and Schneider, urging the Illinois General Assembly to amend the Ethics Act, was sent to the Finance Committee.  Comm. Goslin explained that he sought to have County or board appointees to be included under the Act and used the Metra Board Members as examples of folks who would be covered with this resolution.  There was debate about which committee to refer this amendment to, and President Preckwinkle conferred with her counsel  who suggested that finance was the correct committee.  An amendment giving the Cook County Inspector General the authority to request the State's Attorney to enforce subpoenas was approved, with Comm. Sims voting present.

--Submitted by Laura Davis