CCHHS STRATEGIC PLAN NEEDS MORE WORK

Cook County Health and Hospitals System Board Meeting November 19, 2009

Public comment included a citizen who accused the Board of undesirable relationships with private providers and failure to recognize the role "Chicago politics" will play in their acceptance. The Board responded by assuring him that any relationships that are developed are examined from the perspective of what benefits they bring to the County System. A Dietician from Oak Forest Hospital reported that employees there are demoralized over layoffs recommended in the Navigant Report [a report generated by consulting firm Navigant Consulting Inc.]. She enumerated 200 in non-clinical positions and also related the difficulties of providing efficient meal service in a physical plant spread out over three locations.

As part of on-going Board of Directors education, the coordinator of the Internal Medicine Residency gave an overview of that program which includes 144 positions. Those accepted were selected from about 5000 who apply yearly. The program has been accredited since 1955 and has high standing among 370 comparable programs in the U.S. These Residents participate in every patient encounter throughout the hospital, including the ICU and ER. About 50% go on to Fellowships.

CFO Foley reported that the Strategic Plan would not be adopted at this meeting. It needs further analysis after public and internal meetings. The emphasis will continue on improving access.

The Consultant led the Board through the goals in the Plan and some proposed changes in emphasis. With regard to inpatient facilities several additional data are necessary, particularly an evaluation of the need for services at those facilities and what other resources and alternatives exist. He emphasized that the County mission is fundamentally different from that of the private sector. With regard to out patient services, suitable resources at other Centers must be evaluated. The development of Service Lines such as Trauma, Women and Children, and Surgery also need further analysis. Initiatives will be prioritized with time lines of 3-5 years.

There was considerable discussion regarding how to proceed with the financial future in jeopardy. Enabled by improved revenues, the 2010 CCHHS budget was cut by $75 million. Interjected was the roll back of sales tax and what its impact would be on the 2011 budget. Rumors included another $75 million cut in Health which could translate into losing 1250 FTEs. It was noted that Health spending accounts for about 30% of the budget, but reimbursements for health services (which go into the General Fund) reduce the portion of the tax-generated revenues spent on Health to about 12%. Therefore, any cuts in Health should be proportionate. The challenge is how to maximize income other than tax revenue. Some possibilities are better billing and performance improvement. Other communities have added 501(c)3 status to garner voluntary contributions. Critical to any implementation is a Financial Plan. Its development was assigned to the Finance and Audit Committees.

The Director of Public Health reported on the status of H1N1 immunization and incidence. The program is moving as quickly as possible with distribution of doses. Acceptance has been high except among the African-American population. Efforts are underway to reach Ministers and others who could be influential in communicating the benefits of this immunization.

A report on Phase 1 of the Performance Improvement Assessment was detailed. The consultant gathered data from many sources. It addressed physician alignment, clinics, pharmacy, laboratories, hospitals and showed much "opportunity" for improvement. Implementing change would involve modifying the infrastructure and adding tools, including automation. Services have to be managed frequently and staff training is critical. CFO Foley responded with his intention to implement many of the recommendations using the existing management team.

The Board adjourned to Executive session.

--Submitted by Observer Nancy Staunton

2010 Cook County Budget Passes; $80,000,000.00 over 2009 Budget

Thursday, November 19th, was scheduled for the Cook County Board of Commissioners to deal with over 50 amendments to the 2010 budget. It looked like this would take days, but since numerous amendments were presented by Tony Peraica to reduce the budget, eliminate programs, etc. and no other commissioner would give a second, these were readily dismissed. Some highlights of the day include the following:

All departments, bureaus, commissioners' offices, etc. were previously instructed to cut 5% from their budget requests. Many Commissioners and departments did not do this, and they seemed to be rewarded for their laxness. At this meeting, all areas were cut an additional 1.5% to account for the previous day's sales tax reduction. Comm. Claypool commented that under "best practices" this cut can easily be absorbed by departments due to rotating staff vacancies. Those that had not cut the 5% previously were cut an additional 1.5%. The "unfairness," as Comm. Schneider pointed out, is that those who complied were cut a total of 6.5% and those who did not were cut 3%. This cut the Health and Hospital System (HHS) budget by $13.3 million, which Comm. Schneider said is unwarranted since HHS is well-run.

In the future, grants will have their own line items in the budget and will be made known to the commissioners on a monthly or quarterly basis. Regarding Commissioner expenses, all need to be reported quarterly, with proof, in the future. Comm. Schneider pointed out that some commissioner offices spend $100,000.00 more than others.

The Stroger-proposed new film commission ($250,000.00) was defeated since most commissioners felt now was not an appropriate time to add this type of spending. Some felt current employees could liaison with the Chicago and Illinois Film Commissions already in place.

Some new programs were added to this budget, including one $40,000.00 position in the Ethics, Human Rights and Women Dept. to deal with women's issues.

Money was transferred from reductions elsewhere to aid incarcerated, pregnant women with prenatal care. Funding for counseling services for those experiencing foreclosure was also passed.

The issue of red light cameras at Cook County intersections was discussed. Two red light companies will present contracts to do this at 30 intersections. This appears to be favored mostly by Comm. Moreno, who said up to 150 intersections could be involved. This would provide a large stream of revenue for the County. Several commissioners debated whether this was mainly for revenue or for safety reasons.

Nov. 9, 2009 Finance Committee Meeting to Review the Proposed Budget--Juvenile Temporary Detention Center

Earl Dunlap, Transitional Administrator, Juvenile Temporary Detention Center (JTDC) of Cook County, provided an overview of the Detention Center.  The average daily population from 7/1/08 to 6/30/09 was 390.59 detainees.  The adult transfer population (included in total pop) was 94.78.  The racial breakdown of the population was 84.3% African American, 10.2% Hispanic, 2.6% White. 

There has been a rush of hiring in the last 10 months – 260 total new hires including 130 counselors and 20 team leaders.  Staff received 37,000 hours of training.  New staff gets 6 weeks of training before they begin.  Staff training complies with the Administrative Office of Illinois Courts (AOIC).

Reports on staffing have gone to the federal court in charge of the consent decree, which mandates the changes in the JTDC, Office of the Chief Judge of Cook County (newly made the administrator

of the JTDC) as per the federal court decree.

A dramatic upgrade is being made in the staffing at the Center. It will eliminate the current Juvenile Detention Counselor position and replace it with a Youth Development Specialist.  Making this change will provide more highly skilled workers available to the detention center population. It will also put the JTDC in compliance with the AOIC, permitting the JTDC to qualify for more State of Illinois dollars for costs, reducing its reliance on Cook County revenues. The Juvenile Detention Counselor position has traditionally been a position where only a high school diploma and no specialized training has been needed for direct work with the detainees in the living units. The Youth Development Specialist (YDS) position requires a college degree in an appropriate field.  A Youth Development Specialist Associate position will be available to those who

pass the hiring test for the YDS, get re-hired and are working to complete a college degree. All current Counselors will be welcome to go through the hiring process for the YDS Associate.

In the past year, there have been 88 investigations of instances involving the counselors done by the investigators newly hired by Office of Transitional Administrator (OTA). Of the 88 investigations, 33 involved physical abuse, 9 were substantiated, and employment terminated on that staffer.

Five of nine anticipated living centers are now open.

On Tuesday, November 17th there will be a federal court hearing regarding employees affected by the

recommendations to eliminate the counselor positions and the replacement of those workers by Youth Development Specialists with higher educational requirements.

The JTDC has not exceeded budgetary limits for FY 08-09. In fact, expenses have been below those limits.  There will be a reduction of overtime by 2011. 

Glass doors in the detainees rooms will be replaced by steel doors so that they have more privacy and detainees cannot break the doors as easily.  Safety rooms (padded) will be installed for detainees who need them.  Staff will get 2 way radios with direct contact with detainees.  Time clocks are being installed and activated for all staff. 

JD Counselor position will be upgraded to the YDSpecialist, which has essentially the same qualifications as an entry level Probation Officer.  The job reclassification will cost the JTDC $1.11 million. 

Currently there are 20 staff members in mental health positions, currently paid by the Cermak Health services. Many experts / standards say there should be 44 staff members in MH positions at JTDC. However Dunlap himself recommends a total of 30 MH workers. 

In response to questions from Commissioner Schneider, Dunlap answered that he, his assistant, and the consultants they hire submit itemized expenditures that are paid through funds from the State’s Attorney.  Dunlap works 2 1/2 to 3 days a week only.  There is a full time administrator who comes in on Monday around noon. He works Monday afternoon and into the night; all day Tuesday and Wednesday, including the night; all day Wednesday; and all day Thursday, taking the Thursday train at 4 or 8 p.m. to get back home. He puts in a 40 – 50 hour week at the DC, and works on the weekend at his home.

Regarding expenses, Dunlap said, the JTDC has been greatly ‘underresourced’ for a very long time. Much of the dollar expenditure is to close the gap from what was deplorable to what is proper.  The physical plant itself makes expenses higher than necessary. A more efficient facility could be 30% cheaper.  Just processing the detainees into the facility is expensive, but 26% of all those detained are released in 96 hours or less. Ways to reduce that have been brought to the attention of the Chief Judge of the circuit.

any alternatives to detention already in place should be increased, including electronic monitoring. Weekend courts and/or Saturday court calls would cut down on JTDC population. Evening and weekend court calls mean parents could be there with their kids. Kids on psychotropics now end up in JTDC, though it is not a proper treatment place for them. If the population is reduced, staff can be reduced, and expenses would be reduced. Juvenile crime rates are lower than they have been in 40 years, yet the population of the DC has not fallen by the same proportion.

Commissioner Collins stated that kids are now being punished twice: once by the situation that brought them to do illegal things, once by the very fact of being in the JTDC. It is important to keep the kids out who don’t belong there, and to appropriately assess and treat those who do belong there.

Collins asked why Dunlap thinks he only needs 30 and not 44 Mental Health staff at the DC. He responded that many of the mental health problems detainees have are not treated appropriately at the JTDC. They should have access to detox and other similar services in more appropriate settings. Collins also asked if the court could give a waiver to workers whose jobs will be terminated – there is value in having the good workers who have been with the DC for years stay there. Dunlap stated that the employees will all have a chance to apply for the newly created position.

Commissioner Sims stated that there should have been a way to work things out with the 200 plus workers who are being laid off.  She also said that the Chief Judge will hire a superintendent; after the Transitional Administrator will be out, the court can / will still be monitoring the situation.  Currently there is no superintendent of the JTDC. The office has remained vacant while Dunlap has been TA. Dunlap expects to be gone by the end of summer. 

In his concluding statement, Dunlap noted that Cook County locks up more kids than New York City does – and NYC has four times as many juveniles.  You can educate someone for six years at Harvard for what it costs to keep a youth for one year in the JTDC.

--Submitted by Observer Millie Juskevice, with assistance from Observer Ruby Donahue

Nov. 9, 2009 Finance Committee Meeting to Review the Proposed Budget--Offices under the President

Chief of Staff Joseph Fratto said that the budgets for these offices (Department of Human Rights, Ethics, Women’s Issues; Department of Public Affairs and Communications; and Office of the President) are down from 2009, but the Q-2A chart shows an increase of $175,472 in the Corporate Fund.  However, $251,611 is proposed for a new Film Commission Office that is expected to have a huge potential upside in revenue for the County through the creation and retention of jobs.  The point of the Office would be to market the County and for filming and related services, as well as to provide a central point of contact for necessary permits and regulatory approvals in the different municipalities for the film industry in seeking to film in Cook County.  Several of the Commissioners inquired whether the marketing and permitting/regulatory central point of contact could be done with existing employees, rather than creating new positions.  Mr. Fratto said he would look at that.

There were also many questions regarding the tripling of the budget in the special purpose fund for the Department of Homeland Security and Emergency Management (from $354,000 to over $1 million).  Commissioner Gainer questioned the large salary increases that were proposed for existing employees without any showing that there was a need in order to retain these employees or to recruit new employees.  Commissioner Suffredin noted that $882,000 of this special purpose fund is supposed to be covered by anticipated reimbursements from the State, but the Commissioner expressed concern over whether these reimbursements would ever be received.  Further, apparently there are other budgeted positions that would be funded by grants that are not in the budget book.  Mr. Fratto was asked to delineate exactly what these are.

--Submitted by Observer Pris Mims