NEW ITEMS
Meeting of the Cook County Board of Commissioners
County Board Room, County Building
Tuesday, May 21, 2002, 10:00 A.M.
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REPORT OF THE COMMITTEE ON FINANCE
ITEM #1
May 2, 2002
The Honorable,
The Board of Commissioners of Cook County
ATTENDANCE
Present: Chairman Daley, Vice Chairman Carr, Commissioners Collins, Goslin, Maldonado, Moran, Moreno, Quigley, Silvestri, Sims, Steele, Sutker and President Stroger (13)
Absent: Commissioners Butler, Hansen, Lechowicz and Schumann (4)
Also Present: Thomas J. Glaser – Chief Financial Officer; John Chambers - County Comptroller; Grace Colbert - Director of Budget and Management Services; Ruth M. Rothstein - Chief of the Bureau of Health Services; Alvin Holley - Chief Financial Officer of the Bureau of Health Services; Daniel Degnan - Chief Financial Officer, Treasurer’s Office; and Jack Kelly - Chief Financial Officer, Sheriff’s Office.
Court
Reporter: Anthony Lisanti, C. P. R.
Ladies and Gentlemen:
Your Committee on Finance of the Board of Commissioners of Cook County met pursuant to notice on Thursday, May 2, 2002 at the hour of 10:00 A.M. in the Board Room, Room 569, County Building, 118 North Clark Street, Chicago, Illinois.
Your Committee has considered, for informational purposes, the Fiscal Year 2002 1st Quarter report of the County of Cook as submitted by the Bureau of Finance.
Chairman Daley opened the meeting by stating the purpose of the meeting is to discuss the Appropriation Trial Balance which was entered into the record along with a letter on actual revenues dated April 24, 2002 from Thomas J. Glaser, Chief Financial Officer. A report of both program descriptions and operational statistics for the Cook County Bureau of Health Services dated April 30, 2002 from Ruth Rothstein, Chief of the Bureau of Health Services was also entered into the record. (The referenced documents are on file in the Office of the County Clerk.)
Chairman Daley then called on County Board President John H. Stroger, Jr. for remarks.
President Stroger commented that the County’s financial operations should be reviewed on a quarterly basis. He further stated that sound financial decisions made by the administration and the Board have resulted in seven bond rating increases. He said that all commissioners and county elected officials must be vigilant in managing county finances.
President Stroger continued to state that Cook County’s budget and revenue sources are fundamentally different from many other governments. He said county revenue sources have not been dramatically affected by recent changes in the economy, and believes the events of September 11, 2001 only highlighted a preexisting slow down in the economy. He stated that despite the present economy, the fiscal year 2002 budget remains realistic and honors the Board’s responsibility to fund vital public health and safety sources. President Stroger concluded by saying that in light of the slowing economy, and in order to monitor revenues, a hiring freeze was preemptively taken which ended in March 2002. If necessary, he said the County is prepared to reinstate the hiring freeze or take other actions in order to control County expenditures.
Chairman Daley remarked that the meeting is strictly for review of the Comptroller’s Trial Balance Report. The Chairman urged Board members to ask questions of the representatives who will appear before the committee. He also thanked President Stroger for his strong leadership in helping move Cook County forward.
The Chairman then asked Thomas J. Glaser, Chief Financial Officer, for a statement.
Mr. Glaser stressed that it is important to remember that the Trial Balance represents a snapshot of county finances at a particular point in time. He said that since the budget is primarily payroll-driven, expenditures and encumbrances are analyzed as payroll charges are incurred.
Mr. Glaser commented that the general ledger is closed monthly and significant variances are then explored within individual operating departments. He also stressed that the Trial Balance includes both expenditures and encumbrances; and that sometimes there are situations where encumbrances for an entire year are undertaken very early in the fiscal year. As a result, the percentages that seem to be out of line in one quarter will, over time, be more in line with percentage expectations in future quarters.
Chairman Daley asked Ruth Rothstein, Chief of the Bureau of Health Services, for a statement.
Mrs. Rothstein commented that the Bureau of Health Services’ facilities are staffed 24 hours a day, seven days a week. With respect to overtime, there are several factors to be taken into consideration, such as: union contracts enable nurses to have every other weekend off; five of the thirteen paid holidays occurred within the first quarter; scheduled vacations; sick time; work-related injuries; and a hiring freeze which was in effect to March. All of these aspects factor into the use of overtime. Chief Rothstein said the Bureau of Health Services has over 500 vacancies, including nurses, which are very difficult positions to recruit.
Commissioner Quigley asked that he be recognized for a general question to Mr. Glaser. After commenting on news reports of the State of Illinois’ and Chicago’s budgetary problems, Commissioner Quigley asked how is Cook County different from these two governments and seems to be immune from the acute financial problems occurring elsewhere in the public and private sectors.
Mr. Glaser responded that Cook County’s revenue streams are somewhat different from other governments. He said that the County’s revenue forecasts are conservative, and present a realistic view of where the Bureau of Finance expects finances to be throughout the year.
Commissioner Quigley asked which revenue sources are of concern to the Bureau of Finance?
John F. Chambers, County Comptroller responded that the major concerns are the sales tax and use tax. He said the Bureau of Finance submitted revenue estimates that were below actual collections in 2001 in anticipation of an economic downturn. Mr. Chambers said one other major concern is real estate tax collections, which have been flat for the last three years. He said there is further concern this year due to pending refunds.
Other areas of concern expressed by Mr. Chambers were court fees and taxes on gas, cigarettes, liquor and other home rule taxes. He said cigarette use is also down which is why revenue estimates have been decreased. Also, there is concern regarding the personal property replacement tax that was estimated on target at $30 million in fiscal year 2001; however, this year the estimate is $15 million. Mr. Chambers concluded by stating that the County is in a comfortable financial position.
Commissioner Quigley reiterated his concern about financial problems at the state level. He then commented on the dramatic increase last year in fees from the Recorder of Deeds Office for home sales that now may be decreased due to the economy.
Mr. Chambers responded that as County Comptroller, he continues to intentionally underestimate revenues. He said the question of whether revenues can support programs going forward depends upon many factors including collective bargaining agreements.
President Stroger asked to be recognized to make a statement regarding the impact of the State’s budget problems on Cook County. The President informed the commissioners that Governor Ryan deleted the $7.5 million previously allocated to the County for the Juvenile Temporary Detention Center that is very much needed.
Commissioner Quigley continued to say that the County receives a lot of funding through grants and other means, through the state and federal governments. He said he believes eventually a lot of these programs will catch up to the County and if the Board waits until budget time, then it may be too late.
Commissioner Quigley asked Alvin Holley, Chief Financial Officer for the Bureau of Health Services to comment on the issue of overtime at the various facilities within the Bureau.
In response to Commissioner Quigley’s inquiry, Alvin Holley explained that when the budget is prepared, the goal is to fill one hundred percent of the budgeted positions. However, due to staffing shortages, particularly nurses, overtime is used and funds are transferred to the overtime account.
Commissioner Quigley asked if the number of vacant positions in the Bureau of Health Services is constant?
Mr. Holley responded that the number of vacant positions remains at approximately ten percent. He further said that there are five hundred hard-to-fill positions throughout the Bureau and the total number of vacancies is nine hundred.
Commissioner Quigley commented that since the number of vacant positions has remained constant for many years, it seems reasonable that the Bureau would allocate more dollars to pay overtime but has not done so.
Mr. Holley stated that there is no way of knowing exactly what positions are going to be vacant, and funding cannot be made in accounts for both salaries of regular employees and overtime.
Commissioner Quigley asked when the Bureau of Health Services no longer expects these positions to be necessary?
Mr. Holley said that for the last five years the Bureau has been addressing the move to the new Cook County Hospital and a reduction in staff. In response to Commissioner Quigley’s question regarding a recent staffing study prepared by American Practice Management, Inc. (APM), Mr. Holley said he would provide a copy of the study to the commissioners. (The referenced documents are on file in the Office of the County Clerk.)
Chairman Daley stated that a lot of the overtime at the Bureau is in the areas of acute care where it is very difficult to fill positions, even through nursing registries.
Commissioner Collins asked when the budget is prepared, if any consideration is given to weighing the costs for overtime against giving adequate raises for nurses, considering the nationwide nurses shortage.
Mr. Holley stated that there is extreme competition for nurses throughout the country. He said that the County must contend with collective bargaining agreements in addition to competing with other hospitals who are able to give signing bonuses and who still have problems hiring nurses.
Commissioner Collins suggested that the Bureau look at reducing overtime and increase the pay for nurses including signing bonuses and other incentives.
Commissioner Sims asked if a comparison was made in regards to what is paid in base salary to what is paid in overtime in the study prepared by APM.
Mr. Holley said that overtime is paid time and a half and base salary is straight time.
Commissioner Sims further asked if it is possible for a nurse to receive more in overtime than in straight salary.
Mr. Holley responded that based upon the area worked, such as in one of the Intensive Care Units, it is possible to earn more in overtime.
President Stroger commented that many years ago, Cook County Hospital had its own School of Nursing from which staff could be drawn. Since the program was closed, the hospital has not been able to recruit adequate staff.
Commissioner Steele made comments regarding hiring part-time nurses instead of having staff to work overtime. The commissioner also asked for a breakdown on the other areas where there are staffing shortages that require overtime. (The referenced documents are on file in the Office of the County Clerk.)
Chairman Daley stated that Mrs. Rothstein would provide the information.
Commissioner Maldonado remarked that since he has been on the County Board, he has heard that the bulk of the savings to be realized will come from the maintenance side of building a new hospital. He said that the Board cannot overlook the fact that most of the savings has already been projected, and no one should expect a reduction in staffing when there will be an increase in the amount of square footage in the new hospital.
Commissioner Maldonado said he wanted to make the point that there has been a shift in health care to primary care and the County has followed this path. He said that forty percent of the new hospital would be dedicated to inpatient care while sixty percent will be for primary care. In conclusion, the commissioner said that the savings would not necessarily come from staff, but would be in the area of maintaining the physical structure of the new hospital.
Commissioner Goslin asked for an explanation for the ninety-seven percent of spending at Provident Hospital for medical, dental and laboratory supplies in the first quarter and eighty-eight percent for surgical supplies.
Mr. Holley responded that the figures reflect encumbrances as well as actual expenditures.
Grace Colbert, Director of Budget and Management Services, explained that when a department requests a contract for a vendor, the annual contract is committed to for the entire year on the Comptroller’s record. She said the goods and services may not have been shipped or received but the County is committed to that use. Once a purchase order or contract is issued, the entire amount is encumbered.
Mr. Chambers further explained that the encumbrance system of accounting is a level of security so that amount is not overspent unless there is a compelling reason.
In response to Commissioner Goslin’s question regarding “locking in a price” when funds are encumbered, Mr. Chambers said that given market indexes, some contracts such as food and drugs may float but by and large the price is locked.
Commissioner Goslin asked if staff looks for deviations in analyzing the Trial Balance.
Mr. Glaser responded that an analysis begins at the summary level where the expenditures are shown. He said if the analysis suggests that a particular line item is out of line, then explanations are sought from the respective departments.
Mr. Chambers stated that if there is a chronic problem, the issue is addressed during transfer of funds meetings.
Chairman Daley agreed that chronic problems could be addressed at transfer of funds meetings; however, he said department heads and elected officials know how much money is left at the end of the year.
Commissioner Sutker asked when the Bureau of Finance comes across an aberration, if an historical comparison is made.
Mr. Chambers said that historical information depends upon the size of the budget. He said that if everything is constant in certain accounts, historical information is helpful. He said the Bureau of Finance looks at a series of snapshots to determine what is in there, should it be there and was it anticipated.
Commissioner Goslin asked what happens to the balances in the account for regular salaries and wages for nurses and the overtime account at the end of the fiscal year.
Alvin Holley responded that there would still be an encumbered balance in the account for regular salaries and wages at the end of the fiscal year.
Commissioner Quigley commented on the letter previously distributed by Chairman Daley regarding requests for transfer of funds and the justification for the request. (The referenced documents are on file in the Office of the County Clerk.)
Grace Colbert stated that justifications must be submitted with the transfer request.
Commissioner Silvestri asked a question regarding the $20 million revenue source at the Bureau of Health Services.
Alvin Holley explained that there is no single source of revenue for the $20 million. He said there is a timing difference on how the County’s Bureau of Finance calculates revenues and how the Bureau of Health Services calculates revenues.
Commissioner Silvestri expressed concern that as the Illinois Legislature meets, there is the general belief that local municipalities and counties can bear the burden of the decreased revenue of the State. The Commissioner referred to the letter from Thomas Glaser wherein expenditures are substantially less than anticipated. Commissioner Silvestri asked if we expect this trend to continue?
Mr. Glaser said that there are some timing differences that are taken into consideration. He said that the Bureau of Finance is monitoring expenditures on a monthly basis. He further stated that the Bureau of Finance would closely monitor revenues to see whether the County will continue to be in as good a shape in the following quarters as it is in today.
President Stroger asked Mr. Glaser how the County’s records would be affected by the new Governmental Accounting Standards Board (GASB) rules and regulations.
Mr. Glaser responded that the most significant change is the GASB 34 which requires the County to begin to depreciate our fixed assets, with the issuance of the 2002 financial statements. He said the County has spent the last six or eight months working to identify fixed assets, and beginning December 1, 2002, those assets will be depreciated.
President Stroger asked a question regarding the Property Tax Appeals Board (PTAB) and refunds issued by the County Treasurer. President Stroger asked what impact would these refunds have on the budgetary process.
Mr. Glaser said that this is a significant issue for tax-capped entities. Mr. Glaser stated that the County is in the position of having a Working Cash Fund to cover shortfalls from refunds that have been issued. He further said that other governmental units such as the Cook County Forest Preserve District are not as fortunate in being able to address shortfalls with surplus liquidity. He said these refunds might require the County to change its budgetary process in order to increase the loss factor and make certain enough money is set-aside to cover refunds.
President Stroger asked for an explanation on how the loss in collection and the protest funds will affect the County’s budgetary process.
Mr. Chambers said that in preparation of the annual budget and the real estate tax levy component, a three percent factor is built into the numbers. He explained that this means that the real estate taxes the County extends in order to generate cash, are three percent more. History has shown that about three percent of the real estate taxes is not collected in the year it was extended, and now tax caps, PTAB and the elimination of the protest fund are all converging on the real estate tax distribution process. He said the County Clerk and the Treasurer have no choice but to issue the refunds out of current levels. And, in regard to the Forest Preserve District, PTAB has a severe impact. He concluded by saying that current estimates indicate that refunds could be as high as five or six percent.
President Stroger added that the Sheriff’s Office, particularly the Department of Corrections, requests a lot of overtime. He said that the County cares for approximately 1,800 parole violators, who are the responsibility of the State of Illinois. The President further commented that he would like State’s Attorney Devine to look at some of these unfunded mandates, and if necessary, challenge them on behalf of the people.
In response to a question by Commissioner Collins, Dan Degnan, Chief Financial Officer for the Treasurer’s Office stated that the Office would not issue a refund until that refund has been perfected. Part of the perfecting process is the receipt of a court order, and the Treasurer’s Office receives court orders for refunds on a daily basis.
Chairman Daley then asked Thomas Glaser to express any concerns regarding the issue of overtime for the offices of elected officials and departments other than the Bureau of Health Services.
Mr. Glaser commented that overtime is a countywide issue that must be carefully watched. He said that there are select accounts that are of some concern now, but the Bureau of Finance will be looking at them in future quarters.
Chairman Daley stated that there would be quarterly meetings of the Finance Committee in order to monitor the County’s finances. He also was concerned that most of the meeting centered around overtime at the hospital when other county departments and offices have rising overtime costs, too.
Commissioner Goslin asked that an executive summary of problems, expenditures or items that may be out of historical sync be prepared by the Bureau of Finance and distributed to the commissioners prior to meetings.
Commissioner Silvestri noted President Stroger’s comments regarding increased overtime in the Department of Corrections and asked if the Department is having difficulty recruiting correctional officers.
Jack Kelly, Chief Financial Officer for the Sheriff’s Office, indicated that there is a problem recruiting correctional officers, which has impacted overtime. Mr. Kelly also expressed concern that medical expenses have increased due to additional inmates.
Commissioner Moreno remarked that the members need some reports that would help identify issues and problems so the Board can propose solutions. He asked that a study be completed on all costs associated with the Department of Corrections’ budget, including health services, food, housing, and maintenance as well as any other costs.
Chairman Daley reminded the commissioners that they receive a Trial Balance on a monthly basis and department heads, elected officials and their representatives are available to respond to questions about their accounts at any time.
President Stroger asked Grace Colbert to prepare a memo to all departments regarding the monitoring of overtime expenses and a justification for use.
Vice Chairman Carr moved to adjourn the meeting, seconded by Commissioner Silvestri. The motion carried and the meeting was adjourned.
Respectfully submitted,
COMMITTEE ON FINANCE
JOHN P. DALEY, Chairman
ATTEST: SANDRA K. WILLIAMS, Secretary
The transcript for this meeting is available in the Office of the Secretary of the Board, 118 North Clark Street, Room 567, Chicago, IL 60602.
_________________________
Commissioner Lechowicz, seconded by Commissioner Silvestri, moved to suspend the rules so that this matter may be considered. The motion carried unanimously.
Commissioner Daley, seconded by Commissioner Hansen, moved that the Report of the Committee on Finance be approved and adopted. The motion carried unanimously.
REPORT OF THE COMMITTEE ON HEALTH AND HOSPITALS
ITEM #2
May 17, 2002
The Honorable,
The Board of Commissioners of Cook County
ATTENDANCE
Present: Chairman Butler, Commissioners Carr, Collins, Goslin, Moran, Moreno, Quigley, Sims, Steele and Sutker (10)
Absent: President Stroger, Vice Chairman Schumann, Commissioners Daley, Hansen, Lechowicz, Maldonado and Silvestri (7)
Also Present: Ruth Rothstein - Chief, Bureau of Health Services; Patricia Terrell - Deputy Chief Bureau of Health Services; Stephanie Griggs - Chief Operating Officer, Provident Hospital of Cook County; Cynthia Henderson, M.D. - Chief Operating Officer, Oak Forest Hospital of Cook County; James McAuley, M.D. - Medical Director, Cermak Health Services; Robert Weinstein, M.D. - Chief Operating Officer, CORE Center; Terry Conway, M.D. - Chief Operating Officer, Ambulatory and Community Health Network of Cook County; Karen Scott, M.D. - Chief Operating Officer, Cook County Department of Public Health; and Lacy Thomas - Chief Operating Officer, Stroger Hospital of Cook County.
Ladies and Gentlemen:
Your Committee on Health and Hospitals of the Board of Commissioners of Cook County met pursuant to notice on Friday, May 17, 2002 at the hour of 10:00 A.M. in the Board Room, Room 569, County Building, 118 North Clark Street, Chicago, Illinois.
Your Committee received, for informational purposes, priorities and reports of the Bureau of Health Services.
Chairman Butler opened the meeting by asking Bureau Chief Ruth Rothstein for remarks.
Ruth Rothstein, Bureau Chief, stated that every commissioner received information regarding the day’s meeting, including major accomplishments of the Bureau. Ms. Rothstein began by defining the Bureau of Health Services that was established in 1992. She said prior to the Bureau, the county’s health care system was very fragmented and each institution functioned under different rules and different regulations. Now, under the Bureau, all professional and support staff from the various institutions meet in one group to address issues and resolve them in a coordinated manner.
Finally, Ms. Rothstein stated that representatives from the various facilities would be reporting on the major issues that impact the facilities. Future issues to be discussed will be corporate compliance, legislative issues, the Baby Link project and quality assurance issues across the entire Bureau.
Ms. Rothstein further stated that another important component is the Bureau’s community outreach. These efforts include the internal development of a clinical network, broadening the connection to community-based health providers, continuing to lead and help build the Chicago-Cook County community health council, the Access to Care program and how the Bureau participates in that program both financially and in strategic planning.
Following the agenda, Deputy Chief Patricia Terrell discussed Bureau of Health priorities for fiscal year 2002: Ms. Terrell commented on the “Expansion of the Bureau Network” and partnerships with St. Anthony Hospital for deliveries, perinatal referrals and inpatient psychiatry; Bethany Hospital for primary care, deliveries, perinatal referrals and inpatient psychiatry; St. Elizabeth Hospital for deliveries and perinatal referrals; Jackson Park Hospital for perinatal referrals, family practice rotations and inpatient psychiatry; Northwest Community Hospital for primary care and deliveries; St. James Hospital for prenatal care and deliveries; Thorek Hospital for primary care; and Roseland Hospital for perinatal care.
These partnerships were formed for three reasons: 1) to allow for the most cost-effective expansion of services, primarily outpatient care; 2) to generate additional revenue through keeping maternal patients and increasing high risk perinatal referrals to Stroger Hospital of Cook County and 3) to access services for patients that the Bureau does not currently provide.
Ms. Terrell further commented that the Bureau has developed strong affiliations with federally-funded community health centers that extend the Bureau’s ability to access primary care for patients. The affiliation with Rush-Presbyterian-St. Luke’s Medical Center encompasses academic training programs, accessing highly specialized clinical services and the CORE Center. The Bureau is working closely with the Chicago Department of Public Health to assure the effective coordination of services between the two agencies.
Ms. Terrell stated that “Integration of the Bureau’s Medical Staff” has allowed expansion of the clinic system, development of regional hubs for specialty care, and coordination of the clinical care of patients throughout the Bureau’s institutions.
Other Bureau priorities include the ability to secure new sources of revenue and decrease the reliance of the health system on the subsidy of County taxpayers (in 1991 the Bureau was subsidized at 61 percent, today, the subsidy has been reduced to 41 per cent): a Bureau-wide effort to assure the appropriate utilization of all inpatient acute care beds focusing on general medical/surgical beds; the implementation of the new Cerner Clinical Information System will facilitate the integration of patient care between all Bureau institutions; an initiative that will allow the County to contract with one pharmaceutical distributor assuring that medications are available to Bureau patients when needed with lower purchasing and distribution costs; and the coordination of all levels of care in addressing public health issues. In 2002, the Bureau has prioritized the prevention and treatment of asthma and diabetes.
Commissioner Quigley asked Bureau Chief Rothstein where the next clinics in the ambulatory care system might be located?
Bureau Chief Rothstein responded that the Bureau’s thrust is not to do it all. She said that the Bureau is looking at certain demographics across the county and surveying facilities currently in place before making a recommendation. However, one area that seems to be in need is the City of Chicago’s Belmont-Cragin area where the Bureau is working with Resurrection Health System.
In response to comments from Commissioner Quigley regarding the City of Chicago’s public health clinics, Bureau Chief Rothstein indicated that she believes the City does not want to be in the clinic business but wants to focus on the area of public health.
Commissioner Quigley asked how does the building of the New Stroger Hospital affect Provident Hospital?
Bureau Chief Rothstein said that Provident Hospital has always been a teaching hospital and this would not change. She further commented that this year in July, the family practice recruitment would be consolidated at the Stroger and Provident Hospitals under the rubric of Loyola Medical Center for the academic piece which would save revenue because fewer residents would be required and rotations could be handled between the two institutions.
Commissioner Steele stated her concern with the “prime vendor” pharmaceutical contract and the Cerner Clinical Implementation Plan.
Bureau Chief Rothstein responded that now since the lawsuit filed by DMS Pharmaceuticals has been dropped, the Bureau is currently negotiating the contract with McKesson and working out details of an implementation plan.
In response to another question from Commissioner Steele regarding current contracts with DMS Pharmaceuticals, Bureau Chief Rothstein stated that as old pharmaceutical contracts expire, all new requests will be moved to the prime vendor contract. The Bureau Chief further stated that many times the pharmacies have been unable to fill patient prescriptions but this will be eliminated under the prime vendor contract.
In response to a question regarding implementation of the Cerner Clinical Information Plan, Bureau Chief Rothstein commented that the plan will be in place by early Fall 2002.
Commissioner Collins agreed with the need for increased public/private partnerships and observed that because the western suburbs has one of the highest infant mortality rates in the County, the location for new clinics should be based on need.
Stephanie Griggs, Chief Operating Officer of Provident Hospital of Cook County then addressed the Hospital’s role in the Bureau’s Cancer Initiative. Ms. Griggs stated that a task force has been formed and is chaired by Dr. Gail Shiomoto who planned the Infusion Center at Provident Hospital. Currently, approximately nine hundred patients receive outpatient chemotherapy services annually at Provident. Ms. Griggs concluded by stating that patients can now receive treatment at Provident Hospital after being referred by a primary care physician.
Dr. Cynthia Henderson, Chief Operating Officer at Oak Forest Hospital of Cook County was the next presenter. Dr. Henderson said that the goals of restructuring at the Hospital are to improve patient flow through the Emergency Room, to locate long term care residents closer to needed services and to maximize the use of acute care beds to meet Bureau needs and to maximize revenue.
Dr. James McAuley, Medical Director of Cermak Health Services of Cook County spoke on continuity of care at the Juvenile Temporary Detention Center (JTDC). He said the the Bureau provided several reviews in 1999 and 2000 highlighting strengths and potential areas for improvement in the provision of medical and mental health care at the JTDC. Dr. McAuley stated that the decision was made to have JTDC health services personnel and policies directly responsible to Cermak Health Services with finances remaining under JTDC.
Dr. McAuley commented that support was offered to JTDC in the following areas: pharmacy services which is now provided by Provident Hospital; the implementation of infection control instruction; the hiring of new personnel – a health administrator, several mental health staff, several key support staff, and dental staffing support; implementation of a rape crisis and domestic violence abuse counseling program for females; a mental health initiative by the State of Illinois linking children to services; implementation of a new medical records system; and a new policy and procedures manual, orientation manual and treatment protocols.
Dr. Robert Weinstein, Chief Operating Officer of the CORE Center provided statistical information regarding patient volumes and expenditures. He stated that the CORE Center sees between 7,000 to 8,000 patients a year. They also see about 29,000 visits per year for case management, chemical dependency, mental health counseling, and overall there were about 43,000 visits billed in 2001. Further, he stated that pharmaceuticals have been a major cost in the outpatient area, and in FY 2000 over $12 million was spent primarily on medication for HIV. He also stated that from FY 2000 to FY 2001, there was a 22 percent decrease in pharmacy prescriptions or about $11 to $12 million was in 2000 and approximately $5 to $6 million was spent in 2001. This was the result of an increase in the number of patients enrolled in the State-sponsored Aids Drug System Program and the number of patients who have Medicaid who receive medication from outside pharmacies.
In addition, Dr. Weinstein stated that the CORE Center has begun to undertake some activities overseas to export some of the CORE Center’s expertise to other countries. He also informed the commissioners that last year a physician from Mexico spent three weeks in an education session at the Center and some CORE Center physicians are currently working in Botswana and Nigeria. Another activity the CORE Center has is a collaborative effort with the National Institutes of Health and Northwestern University to establish a research program in Nigeria where physicians will function between Nigeria and the CORE Center.
Lacy Thomas, Chief Operating Officer at Stroger Hospital of Cook County, focused on two areas: transitioning staff into the new Hospital and an employee information campaign. Mr. Thomas said that a videotape was developed to further help employees with the transition.
Mr. Thomas made additional statements regarding patient care strategies and coordinated services between the emergency rooms at both Stroger and Provident Hospitals. As it relates to information technology, he commented that the Cerner Clinical Information System will be the hub of the new hospital, particularly, in the radiology and order/entry departments.
Chairman Butler then entertained questions from the commissioners.
Commissioner Moreno asked the presenters to provide a summary of their remarks.
Commissioner Moreno asked Dr. Karen Scott what financial impact, if any, has bio-terrorism had on the Bureau and the Department of Public Health?
Dr. Scott responded that staff has had to take on additional responsibilities because the Department has not received funding; however, federal dollars are expected soon, so the costs of purchasing equipment will be paid using federal grant dollars.
Commissioner Goslin asked a question regarding the Department of Public Health’s immunization program and whether it would be more cost-effective to work with the townships and the general assistance coordinator instead of building new clinics. He asked if this has been discussed at the Bureau or have attempts been made to expand the current program?
Dr. Scott commented on the Wellness on Wheels Program that helps identify health problems early.
Bureau Chief Rothstein further commented that the Bureau is currently working to establish a township advisory committee that will enable the Bureau to find areas that need to have expanded services.
Commissioner Goslin asked a question regarding long-term care services, such as dementia for patients over age 65 at Stroger Hospital.
Bureau Chief Rothstein responded that the number of patients requiring long-term care at Stroger Hospital is not significant; however, there is a large number of patients requiring such care seen at Provident Hospital. She also remarked that Commissioner Goslin’s recommendations will be taken into consideration.
Commissioner Goslin asked if the administration at Stroger Hospital has been in contact with representatives from Northwestern Hospital for recommendations on the transition, since it opened two years ago.
Lacy Thomas responded that representatives from Northwestern Hospital have been very helpful.
Commissioner Steele asked Dr. Weinstein if any funding was received from the Bill and Melinda Gates Foundation to help support the CORE Center physicians now working in Botswana and Nigeria.
Dr. Weinstein stated that funds were received from the Gates Foundation to support physicians in Botswana and funds from the National Institute of Health support physicians working in Nigeria.
Commissioner Steele further commented on the need for mental health services at Cermak Health Services.
Dr. McAuley said that generally, 10 percent of the population or between 1,000 and 1,100 detainees are under care for mental illness daily. He made additional remarks regarding Thresholds and said it is the main organization that they work with regarding discharge. Mainly patients are going to outpatient settings and if they need inpatient services they will direct them to the State Mental Hospitals.
Commissioner Goslin made statements regarding the need for the Bureau of Health Services to be at the table in discussions on uncompensated care, which is a big problem across our country.
Chairman Butler expressed concern about clinics in the Grand Boulevard area that do not have extended hours to accommodate working mothers and children.
Dr. Conway responded that most clinics have evening hours; however, he said many of the clinics are located in facilities operated by the City of Chicago and it has been difficult to have the facilities close later. However, he said there now seems to be a new openness to consider later hours. Dr. Conway asked Chairman Butler to specify those clinics of concern, so he could respond.
The Chairman then asked Bureau Chief Rothstein a question regarding the increase in revenues that the Bureau of Health Services has been able to generate.
Bureau Chief Rothstein stated that because of the aggressiveness of the Bureau of Health Services, there has been a major change in the level of subsidization, and remarked that all revenues generated are deposited in a corporate bank account.
Commissioner Moreno moved to adjourn the meeting, seconded by Commissioner Goslin. The motion carried and the meeting was adjourned.
Respectfully submitted,
COMMITTEE ON HEALTH AND HOSPITALS
JERRY BUTLER, Chairman
ATTEST: SANDRA K. WILLIAMS, Secretary
_________________________
Commissioner Lechowicz, seconded by Commissioner Silvestri, moved to suspend the rules so that this matter may be considered. The motion carried unanimously.
Commissioner Butler, seconded by Commissioner Maldonado, moved that the Report of the Committee on Health and Hospitals be approved and adopted. The motion carried unanimously.
PROPOSED RESOLUTION
ITEM #3
Submitting a Proposed Resolution sponsored by
PETER N. SILVESTRI, County Commissioner
Co-Sponsored by
JOHN H. STROGER, JR., PRESIDENT, JERRY BUTLER, ALLAN C. CARR,
EARLEAN COLLINS, JOHN P. DALEY, GREGG GOSLIN, CARL R. HANSEN, TED LECHOWICZ,
ROBERTO MALDONADO, WILLIAM R. MORAN, JOSEPH MARIO MORENO, MIKE QUIGLEY,
HERBERT T. SCHUMANN, JR., DEBORAH SIMS, BOBBIE L. STEELE and CALVIN R. SUTKER,
County Commissioners
PROPOSED RESOLUTION
WHEREAS, Illinois municipalities receive 1/10 of the Illinois income tax proceeds and all of the revenue from the state photo processing tax; and
WHEREAS, Cook County municipalities rely on this revenue to provide first response in police, fire and public works directly affecting their residents; and
WHEREAS, Cook County municipalities have already received a reduction in revenues due to the national economic downturn, both in the shared income tax and sales tax proceeds; and
WHEREAS, municipal costs have increased this year due to homeland defense costs and providing other vital services; and
WHEREAS, municipalities are currently suffering late payments through the State’s Local Government Distributive Fund, causing shortfalls throughout the state in meeting municipal bills; and
WHEREAS, all state shared revenues are essential to municipal services.
NOW, THEREFORE, BE IT RESOLVED, that the County of Cook does hereby go on record in strong opposition to reducing state shared revenues, particularly the state income tax and photo processing tax.
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Commissioner Lechowicz, seconded by Commissioner Silvestri, moved to suspend the rules so that this matter may be considered. The motion carried unanimously.
Commissioner Silvestri, seconded by Commissioner Carr, moved that the Resolution be approved and adopted. The motion carried unanimously.
PROPOSED CONTRACT
ITEM #4
Transmitting a Communication, dated May 17, 2002 from
LACY L. THOMAS, Chief Operating Officer, Stroger Hospital of Cook County
requesting authorization for the Purchasing Agent to enter into a contract with Ameritech/SBC Paging, Hoffman Estates, Illinois, to provide for the relocation of the existing paging system antennas from the current Pediatric Hospital Building to the New Stroger Hospital of Cook County. This relocation will expand the coverage of the hospital police department's two-way radios and the Ameritech paging system in the new hospital. Ameritech is the hospital's current service provider, and relocation of these antennas, which includes equipment, materials and installation, will cost $168,000.00.
Estimated Fiscal Impact: $168,000.00. One time purchase. Bond Issue (28000 Account). Requisition No. 20310085.
Sufficient funds have been appropriate to cover this request.
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Commissioner Lechowicz, seconded by Commissioner Silvestri, moved to suspend the rules so that this matter may be considered. The motion carried unanimously.
Commissioner Maldonado, seconded by Commissioner Hansen, moved that the County Purchasing Agent be authorized to enter into the requested contract. The motion carried unanimously.
REPORT OF THE TAX DELINQUENCY SUBCOMMITTEE
ITEM #5
May 20, 2002
The Honorable,
The Board of Commissioners of Cook County
ATTENDANCE
Present: Chairman Sims, Commissioners Carr, Collins and Goslin (4)
Absent: Vice Chairman Schumann, Commissioners Butler and Moreno (3)
Ladies and Gentlemen:
Your Finance Tax Delinquency Subcommittee of the Board of Commissioners of Cook County met pursuant to notice on Monday, May 20, 2002 at the hour of 1:00 P.M. in the Board Room, Room 569, County Building, 118 North Clark Street, Chicago, Illinois.
Your Subcommittee has considered the following items and upon adoption of this report, the recommendations are as follows:
248517 VILLAGE OF TINLEY PARK (NO CASH BID REQUEST). Transmitting a Communication, dated December 12, 2001 from Deborah Sims, Chairman, Finance Tax Delinquency Subcommittee, submitting a request from Brad Bettenhausen, C.P.A., Village Treasurer and Finance Director.
Re: No Cash Bid Program
On behalf of the Village of Tinley Park, this letter is a request for the parcels described in Exhibit A to be acquired under the No Cash Bid Program. To enable your office to process the Village's request, I have submitted an original and fifteen (15) copies of all of the following documents.
1. Certified Resolution;
2. Current Title Searches;
3. Sidwell Maps;
4. Photographs;
5. Statement of Benefits (contained herein and in the Resolution); and
6. Legal Counsel Affirmation (contained herein and in the Resolution).
The Village will benefit in obtaining these parcels by their intended use which is described in Exhibit A.
Please be advised that our attorneys, Terrence M. Barnicle and Gerard E. Dempsey of Klein, Thorpe and Jenkins, Ltd., have been retained and are further authorized and directed to take all action necessary on the behalf of the Village of Tinley Park, Illinois, to obtain the tax deeds. The Village of Tinley Park, Illinois, will bear all legal and other costs associated with the acquisition of the parcels.
EXHIBIT A
PROPERTY IDENTIFICATION
Numbers VOLUME NO.
28-19-101-006 031
28-30-301-019 034
28-30-301-021 034
28-30-314-013 034
28-30-406-004 034
28-31-212-057 034
28-31-400-022 035
28-31-401-085 035
*Referred to the Finance Tax Delinquency Subcommittee on 12/18/01.
Commissioner Goslin, seconded by Commissioner Carr, moved the approval of Communication No. 248517, as amended with the exception of pin numbers 28-30-314-013 and 28-31-401-085. The motion carried.
249605 VILLAGE OF TINLEY PARK (NO CASH BID REQUEST). Transmitting a Communication from Deborah Sims, Chairman, Finance Tax Delinquency Subcommittee, submitting a request from Brad Bettenhausen, C.P.A., Village Treasurer and Finance Director, Village of Tinley Park:
Re: No Cash Bid Program
On behalf of the Village of Tinley Park, this letter is a request for the parcels described on Exhibit A to be acquired under the No Cash Bid Program. To enable your office to process the Village's request, I have submitted an original and fifteen (15) copies of all of the following documents:
1. Certified Resolution;
2. Current Title Searches;
3. Sidwell Maps;
4. Photographs;
5. Statement of Benefits (contained herein and in the Resolution); and
6. Legal Counsel Affirmation (contained herein and in the Resolution).
The Village will benefit in obtaining these parcels by their intended use which is described in Exhibit A.
Please be advised that the attorneys, Terrence M. Barnicle and Gerard E. Dempsey of Klein, Thorpe and Jenkins, LTD., have been retained and are further authorized and directed to take all action necessary on the behalf of the Village of Tinley Park, Illinois to obtain the tax deeds. The Village of Tinley Park, Illinois will bear all legal and other costs associated with the acquisition of the parcels.
EXHIBIT A
PERMANENT INDEX NUMBERS VOLUME
27-23-312-060 147
27-25-113-017 147
27-25-217-011 147
27-25-217-046 147
27-26-118-027 147
27-26-301-011 147
27-34-104-023 147
27-34-205-029 147
*Referred to the Finance Tax Delinquency Subcommittee on 2/7/02.
Commissioner Carr, seconded by Commissioner Goslin, moved the approval of Communication No. 249605, as amended with the exception of pin numbers 27-25-113-017 and 27-26-118-027. The motion carried.
249606 CITY OF MARKHAM (NO CASH BID REQUEST). Transmitting a Communication, dated January 22, 2002 from Deborah Sims, Chairman, Finance Tax Delinquency Subcommittee, submitting a request from David Webb, Jr., Mayor, City of Markham:
Re: No Cash Bid Program
As required under the Cook County No Cash Bid Program for tax delinquent property, the City of Markham hereby requests participation in that program and submits herewith the following initial information in support of its No Cash Bid Request as referenced above:
1. A certified copy of Resolution No. 01-R-167 adopted by the City of Markham, Illinois on October 10, 2001 requesting participation in the program has previously been forwarded to your office.
Your reference of this matter to the Tax Delinquency Subcommittee of the Cook County Board of Commissioners and the favorable consideration of the Board of Commissioners will be sincerely appreciated both by me and the people of the City of Markham.
PERMANENT INDEX NUMBERS
28-19-308-013
28-19-311-007
28-19-311-008
28-19-311-009
28-19-311-010
*Referred to the Finance Tax Delinquency Subcommittee on 2/7/02.
Commissioner Carr, seconded by Commissioner Goslin, moved to defer Communication No. 249606. The motion carried.
249607 CITY OF MARKHAM (NO CASH BID REQUEST). Transmitting a Communication from Deborah Sims, Chairman, Finance Tax Delinquency Subcommittee, submitting a request from David Webb, Jr., Mayor, City of Markham:
Re: No Cash Bid Program
The City of Markham, Illinois would like to take advantage of the No Cash Bid process of the Cook County Board in acquiring various tax delinquent parcels of real property here in the City. I respectfully request that the Cook County Board entertain this request for participation in that process, at the next scavenger sale of tax delinquent properties.
As required under the Cook County No Cash Bid Program and the municipal application checklist for tax delinquent property, the City of Markham, Illinois hereby submits the following information in support of its No Cash Bid-Request:
1. Cover Letter;
2. Certified Resolution;
3. Current Title Search;
4. Sidwell Map;
5. Photographs;
6. Third Party Requestor;
7. Benefits; and
8. Legal counsel.
PERMANENT INDEX NUMBERS
29-18-318-035
29-18-318-036
29-18-318-037
29-18-318-038
29-18-318-039
29-18-318-050
29-18-318-051
29-18-318-052
29-18-318-053
29-18-318-054
29-18-318-055
29-18-318-056
29-18-318-057
29-18-318-058
29-18-324-033 (owned by the City of Markham, Illinois but not on the exempt list)
29-18-324-040 (owned by the City of Markham, Illinois but not on the exempt list)
29-18-324-041 (owned by the City of Markham, Illinois but not on the exempt list)
29-18-326-039 (owned by the City of Markham, Illinois but not on the exempt list)
28-13-329-042
*Referred to the Finance Tax Delinquency Subcommittee on 2/7/02.
Commissioner Carr, seconded by Commissioner Goslin, moved to defer Communication No. 249607. The motion carried.
Commissioner Carr moved to adjourn the meeting, seconded by Commissioner Goslin. The motion carried and the meeting was adjourned.
Respectfully submitted,
TAX DELINQUENCY SUBCOMMITTEE
DEBORAH SIMS, Chairman
ATTEST: SANDRA K. WILLIAMS, Secretary
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Commissioner Lechowicz, seconded by Commissioner Silvestri, moved to suspend the rules so that this matter may be considered. The motion carried unanimously.
Commissioner Sims, seconded by Commissioner Maldonado, moved that the Report of the Tax Delinquency Subcommittee be approved and adopted. The motion carried unanimously.
PROPOSED RESOLUTION
ITEM #6
Submitting a Proposed Resolution sponsored by
JERRY BUTLER, County Commissioner
Co-Sponsored by
JOHN H. STROGER, JR., PRESIDENT, ALLAN C. CARR, EARLEAN COLLINS,
JOHN P. DALEY, GREGG GOSLIN, CARL R. HANSEN, TED LECHOWICZ,
ROBERTO MALDONADO, WILLIAM R. MORAN, JOSEPH MARIO MORENO, MIKE QUIGLEY,
HERBERT T. SCHUMANN, JR., PETER N. SILVESTRI, DEBORAH SIMS, BOBBIE L. STEELE and
CALVIN R. SUTKER, County Commissioners
PROPOSED RESOLUTION
WHEREAS, on May 14, 2002, the doctors, nurses and staff at Stroger Hospital of Cook County were presented with a pregnant mother who had been shot four times, the mother and unborn child were both in serious condition; and
WHEREAS, the physicians, nurses and staff responded with extreme speed and skill to attend to the mother and the unborn child; and
WHEREAS, a successful operation to save the mother’s life was performed; and
WHEREAS, the child was delivered unresponsive but was quickly resuscitated; and
WHEREAS, these extraordinary clinicians continue to insure that mother and baby are progressing to recovery.
NOW, THEREFORE, BE IT RESOLVED, that the President and the Board of Commissioners of Cook County recognize and commend the efforts and skills of the following physicians:
Dr. Kathryn Bass
Dr. Faran Bokhari
Dr. Elwyn Grimes
Dr. Tadeusz Konefal
Dr. Julie Schmidt
Dr. Angela Wilks
and the nursing and other support staff of Stroger Hospital of Cook County that successfully responded to the needs of this seriously wounded mother and baby; and
BE IT FURTHER RESOLVED, that suitable copies of this Resolution be prepared and presented to each of the named physicians and the respective clinical departments.
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Commissioner Butler, seconded by acclamation, moved to suspend the rules so that this matter may be considered. The motion carried unanimously.
Commissioner Butler, seconded by Commissioner Silvestri, moved that the Resolution be approved and adopted. The motion carried unanimously.
EMERGENCY ELECTRICAL TRANSFORMER REPAIRS
ITEM #7
Transmitting a Communication, dated May 20, 2002 from
WILLIAM R. HUFFMAN, Director, Department of Facilities Management
requesting authorization for the Purchasing Agent to increase the contract with High Voltage Maintenance Corporation, Chicago, Illinois, Contract No. 01-53-243, by an amount not to exceed $35,000.00, to perform emergency repairs to the electrical transformer at Division II, Residential Treatment Unit (RTU), Dorms One and Two.
On Friday, May 17, 2002, a fault in the 4160 volt transformer that provides the electrical feed to dorms one, two and the RTU of Division II occurred. As a result, these facilities have been running on generator supplied power since the transformer failed. These repairs to the transformer, cable and bushings will cure the fault and restore the electrical feed to these buildings. As part of a large scale electrical renovation, High Voltage Maintenance Corporation is currently under contract to perform high voltage maintenance and electrical repairs at the Department of Corrections campus. They have the manpower and technical capability to perform these repairs in a timely fashion.
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Board approved amount 01-23-01: |
$438,500.00 |
|
Increase requested: |
35,000.00 |
|
Adjusted amount: |
$473,500.00 |
Estimated Fiscal Impact: Not to exceed $35,000.00. Bond Issue (20000 Account).
Sufficient funds have been appropriated to cover this request.
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Commissioner Lechowicz, seconded by Commissioner Silvestri, moved to suspend the rules so that this matter may be considered. The motion carried unanimously.
Commissioner Maldonado, seconded by Commissioner Silvestri, moved that the County Purchasing Agent be authorized to increase the requested contract. The motion carried unanimously.
PUBLIC TESTIMONY
ITEM #8
Pursuant to Rule 4-30, Willene Buffett, Chicago Unit Leader/Cook County Liaison, University of Illinois Extension, addressed the President and Members of the Cook County Board of Commissioners. Ms. Buffett spoke regarding the University of Illinois Extension Program.
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ITEM #9
Pursuant to Rule 4-30, George Blakemore, addressed the President and Members of the Cook County Board of Commissioners. Mr. Blakemore expressed his concerns regarding the Human Rights Ordinance.