Health and Hospitals System Board Meeting January 24, 2014

Chair David Carvalho announced that Dr. Raju is likely to be confirmed as the new head of the New York City Health and Hospital System, so an interim CEO will be needed for CCHHS, as well as a permanent CEO.  "There is no process beyond this board for selecting a new CEO," Carvalho said. After a closed session Jay Shannon, current Chief of Clinical Integration, was chosen by the CCHHS board as Interim CEO.

During discussion of a NuCare Service contract for $5,435,854, Carvalho explained that because Oak Forest no longer provides long term care, an RFP was issued and NuCare was selected to provide custodial care for 45-50 patients. The quality of their care is to be monitored by scheduled and unscheduled visits. Lerner cautioned that there should be clear performance criteria, penalties for noncompliance, and good linkage between CCHHS and NuCare staff to coordinate services. Recipients of these services will be patients ineligible for Medicare or Medicaid (primarily undocumented residents); "We don't apologize for that," Carvalho said.

An intergovernmental agreement with the Forest Preserve District will allow for an ADA-compliant, accessible, paved walking trail on the former Oak Forest Hospital property, as well as a facility to explain the history of the property as a former poor farm.

Former CCHHS chair Warren Batts now heads the new CCHHS Foundation. Batts is currently filling board positions and developing strategy for the new Foundation.

Dr. Raju reported:

1. There will be a 90-day extension of CountyCare so patients can receive care during the rollout of ACA; 
2. 72,716 patients were approved for CountyCare as of January 22, a total of 103,000 applications filed (state backlog of nearly 30,000)
3. 80 people are now hired each month, up from 30
4. A contract monitoring team has been added.  A joint planning team of the Illinois Medical District will coordinate the redesign and reconstruction of the Fantus Clinic to become an ambulatory care clinic linked to Stroger Hospital.  Dr Raju recognized Dr. DuMont, who heads palliative care, for her excellence.  Dr. Raju also commended CCHHS board member Carmen Velasquez, retiring as CEO of Alivio Medical Center at the end of January.

Linda Diamond Shapiro, new Chief Strategy Officer, explained her priorities are to find opportunities to improve the system, build leadership, and improve patient experience.  She plans to pull together communications, media, intergovernmental affairs, community relations, policy decision support, and marketing.  Her team will be active in recommending that the County, through CCHHS, hold an HMO license, and by so doing become Provider, Plan, Payer and monitor of Population Health.

Carvalho explained that though there will be new leadership at CCHHS, the plan is in place, and no changes in strategy are anticipated: "The board is committed to the direction we've been on."

Meeting adjourned to closed session at 9:40.    

 Submitted by Linda Christianson

January 15, 2014 Cook County Board Meeting

Dealing with Recycling, Bad Deeds, Criminal Justice and Ethics

This very long Cook County Board meeting was at times difficult to follow, even for some commissioners:  a lot of switching back and forth between committee meetings, the general board meeting, and the consent calendar.  However, several important ordinances/amendments and resolutions were passed, often with lengthy discussion and public testimony.

Recycling:  With a close 8-7 vote in favor, a very long amendment (20 pages) to the Solid Waste ordinance was passed.  This basically describes a new method of inspections by the County of solid waste and recycling facilities (transfer stations).  New fees will be charged to these facilities, reporting requirements are more stringent and frequent, penalties are delineated, and future policies will be formed based on information collected from these facilities.  Objections to this ordinance included the additional fees per ton of waste that would be passed on to the taxpayers/users;  increased record keeping by owners of the facilities;  possible anti-business focus;  and the large number of exemptions in Cook County making this ordinance cover only 1/3 of the county.  Chicago already has a plan in place to cover this and municipal-owned facilities are exempt.  Sponsor Comm. Moore indicated that this ordinance would help encourage recycling and prevent surrounding land from being tainted by waste pollution--particularly in southern Cook County.

Bad Deeds (Unlawful Clouding of Title):  Apparently in Cook County it is easier to steal a house than steal a car--according to Karen Yarborough, Recorder of Deeds.  It appears that for only a small filing fee, a person can change another person's title of land--their home--and then take it over physically by changing locks on the doors and moving in.  Although there is state law prohibiting this,  the County Board passed an additional ordinance that would address this problem by invoking thousands of dollars in fines and hopefully make the enforcement against this quicker and more effective.  (As an aside, homeowners can sign up with the Recorder of Deed's office to get an alert anytime someone changes their land/home title.)

Criminal Justice:  An ordinance amendment and a resolution were both passed with regard to the criminal justice system in Cook County.  The first establishes an Advisory Committee to the Justice Advisory Council Department.  Members of this non-paid committee (the President or designee, 3 members of the CC Board, 1 law enforcement person, 2 social service people), all appointed by the President, would issue a recommendations report at the end of the year regarding violence prevention, intervention and reduction strategies, and programs.  Topics would include gun court, straw purchases of guns, violence with guns.  This was deferred until the next board meeting as some discussions about this committee are still ongoing.
The second is a resolution transferring the court-ordered Prisoner Release Order to the President's Office instead of the Sheriff's Office, where it originated.  This issue has been in the news quite a bit lately, with controversy over who is in charge of releasing more prisoners from the county jail, which tends to get overcrowded.  Objections to this transfer center on whether this process should be under the Judicial branch rather than the President's office.  This still needs to be approved by  a higher authority (State of Ill., U.S.?) before it can be in effect.

Ethics:  Two items that were passed dealt with ethics in Cook County government.  The first is an amendment to the procurement code sponsored by Comm. Suffredin requiring employees to report "skullduggery" in the procurement process to the inspector general.  The second is a resolution sent to the State General Assembly to include Cook County in the state's Ethics Act.  Apparently this was an oversight on the part of the sponsor of the legislation in the General Assembly.

Notes on the processes at the Board meeting:  This observer has attended numerous Cook County Board meetings over the past six years and procedures have markedly improved.  However,  there are still some that make it difficult for the public audience to fully understand what has transpired at the meeting:
1.  The League is pleased that public testimony is now a part of all meetings, but during this meeting's public testimony, many commissioners were engaged in side conversations rather than listening to the speakers.  Although the commissioners themselves may already know the information, this observer found some valuable viewpoints brought up by some outside speakers.
2.  There were  many "last minute" substitute amendments that were not available to the audience--even on-line.  Because the substitution difference was not  explained nor mentioned at the meeting, the public audience did not know what specifics the Board actually passed.
3.  Committee reports which contain resolutions and other important content are sometimes passed as a whole without mentioning the particulars.  At today's meeting, this lead to passage of a Committee Report without it being obvious what was contained in that report.  This is especially difficult for the observer to know when the committee met and passed ordinances, amendments and resolutions just the day before.
This observer hopes some adjustments can be made to help the public better understand and follow the Board Meetings.

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

Cook County Board of Commissioners Meeting Wednesday, December 4, 2013

One item from the Finance Committee was to move a proposed resolution by Larry Suffredin-- Creating “Accountability Charges” for Violations of the Shakman Consent Decree-- to the litigation committee.  This resolution would deduct an amount equal to five percent (5%) of the total amount assessed for violation of the Shakman Consent Decree from the department’s operating funds and transfer those monies to the Cook County Self Insurance Fund.

One of the new agenda items from the Finance Committee dealt with the authorization of a contract with WestCare Foundation to supply substance abuse and mental health treatment programs for the Department of Corrections.  There was a lot of public testimony against this contract from current employees who fear losing their jobs, impact of wages, and increase in turnover.

Public testimony was given by Sharon Mulruney from Defend the Vote. She expressed concern with party affiliated judges presiding over another party’s voting machines. She stated that this is a clear violation of legal voting systems. The website for Defend the Vote states concerns with election security.

Before the start of the main board meeting, there was a recognition of several local communities and their involvement in Homeland Security. Over 30 people were recognized for their past and current service.

One agenda item dealt with new Time and Attendance Software that will be introduced in the county. Commissioner Daley asked if all separately elected officials would also be part of this new software program. He was told that the software would be converted over to cover all employees. The goal is to move all payroll processing from manual to computerized and improve accuracy and timeliness of payroll processing.

There was a great deal of discussion regarding the annual calendar of the regular cook county board meetings for 2014. Comments from commissioners who felt that there were too few meetings (formerly every 3 weeks in 2013 to 11 total meetings in 2014) included concerns that there may be too few meetings to get the work done and public perception of the how much work the commissioners were doing. Commissioners who supported the smaller schedule commented that the new efficiency of the board meetings allowed for fewer meetings, and Commissioners would be able to get more work done in their own districts.  The resolution approving the shorter meeting agenda was passed 10 to 6 with one commissioner absent.

The highlight of the presentation from John Yonan, Superintendent of the Dept. of Transportation and Highways, was the genuine praise from the commissioners for the work that John has done.  He was praised for his work ethic and ability to work with IDOT, the city, and suburban cook county governments, and coming up with practical solutions.

Submitted by Laura Davis, Palatine Area League of Women Voters