Health Committee

April 6, 2004 – 8:30 a.m.

DRAFT Minutes

Members present: Dr. Paul DiGiovanni, Chairman; Larry Cornell, Vice Chairman; Steve Dafoe; Mike McKee; Carol Tytler;; Tamara Wyant

Others present: Ann Homer, Secretary to the Legislature/County Attorney; Jackie Gailor, Public Health Director; Audrey Lewis, Director of Environmental Health; John Helgren, Public Health Engineer; Jamee Sobko, Mental Health; Linda Medeiros, Mental Health; John Carroll; Cara Hoffman, Cortland Standard

Absent: Newell Willcox

This meeting was held at the offices of Family Counseling Services, 10 North Main Street, Cortland. Prior to convening the meeting, Bob Gardner, FCS Executive Director, gave the members a tour of his facility.

Dr. DiGiovanni called the meeting to order at 8:36 a.m.

Mrs. Tytler moved approval of minutes of the March 9, 2004, meeting; seconded by Mr. Cornell; all members voting in favor; none opposed; minutes approved.

Mr. Cornell moved approval of minutes of the March 18, 2004, meeting; seconded by Mr. McKee; all members voting in favor; none opposed; minutes approved.

 

1. Authorize Agreement/Accept Additional Funds, Health Department/Administration (Breast and Cervical Cancer Early Detection Program) – This is an additional award above what has been received. Mr. Cornell moved adoption; seconded by Mrs. Tytler. Mrs. Tytler asked if this allowed us to serve additional individuals. Mrs. Gailor responded it does. All members voting in favor; none opposed; motion adopted.

 

2. Authorize Agreements/Accept Funds, Health Department/ Administration (Community Coalition for Diabetic Prevention Project) – Mr. McKee moved adoption; seconded by Mrs. Tytler; all members voting in favor; none opposed; motion adopted. (Notation – Clerk Carletta Edwards stated "Accept Funds" needed to be removed from the title. Consensus of committee is that it needs to remain as this resolution is in fact accepting additional funds; if it is determined that it needs to be removed, the committee agreed to removal.)

 

3. Authorize Agreement/ Accept Funds, Health Department/ Administration (Susan G. Komen Breast Cancer Grant) – Mr. Cornell moved adoption; Mrs. Tytler seconded; all members voting in favor; none opposed; motion adopted.

 

4. Authorize Agreement/Accept Grant Funds/ Amend Budget, Health Department/ Administration (Healthy Heart Disabilities Initiative) – Mr. McKee moved adoption; seconded by Mrs. Tytler. It was noted that it is ironic that the publicity is more than the equipment itself. Mrs. Tytler asked how we know if the media campaign is effective. Mrs. Gailor responded that without her Supervising Public Health Educator, she was unable to respond to the question at this point in time. However, the department does conduct analyses of all media effectiveness. The publicity also covers the accessibility of the pool with the addition of this equipment. All members voting in favor, none opposed; motion adopted

 

5. Authorize Agreement, Health Department/ Nursing Division (Licensed Home Care Services Agencies) – Mrs. Tytler moved adoption; seconded by Mr. Dafoe. Dr. DiGiovanni asked how this was changing our staffing. Mrs. Gailor responded that this is actually in response to last year’s survey to address some of our staffing issues. Mrs. Tytler asked if we have a continued shortage. Are we not being active in recruiting? Mrs. Gailor indicated that we are being very active in recruiting. The only way we could gain union support for this contracting is to guarantee continued recruitment efforts. Mrs. Tytler asked why we had recruitment problems. Mrs. Gailor responded that there are several reasons – the bad survey adds to it, the hours, the salary, nurses have left to go to Monday through Friday jobs, etc. Mrs. Tytler asked if there is a time frame that needs to be attached to this agreement. Mrs. Gailor said that due to the change in the DPS, it was not noted that this needed to be renewed as of January 1. Mrs. Gailor responded it would be through December 31, 2004. All members voting in favor; none opposed; motion adopted.

 

6. Transfer Funds, Health Department/ Children With Special Needs – Mr. Cornell moved adoption; Mrs. Tytler seconded. Dr. DiGiovanni asked if this would allow independent contractors. Mrs. Gailor indicated that yes, it would. This transfers money from the personal services line to independent contractors. Mrs. Tytler asked what about the money allocated for fringe benefits. The dollar amount needs to be adjusted to reflect the amount budgeted for fringe benefits. Mrs. Tytler asked if we can stipulate a service analysis based on the contractor v. employee for this service. Mr. McKee moved to postpone consideration to the next meeting; seconded by Mr. Cornell; all members voting in favor; none opposed; motion to postpone to next meeting adopted.

 

7. Authorize Grant, Mental Health Department (Family Support Services) – Mrs. Medeiros distributed additional information. Mrs. Tytler moved adoption; Mr. Cornell seconded. Ms. Sobko explained the purpose of this resolution This provides family respite for two to three hours per week from the child who is part of the target population. This tries to prevent out of home placement of the children. This also tries to target those youth who are headed for PINS. Dr. DiGiovanni asked if this is the same program as the member item from Assemblywoman Lifton. Mrs. Medeiros indicated that it is all part of the same program. Mr. McKee asked how old the kids are. Ms. Sobko indicated the grant stipulated they must be between ages 7 and 17. Ms. Wyant asked if all children are in their own homes. Ms. Sobko indicated yes. Ms. Sobko indicated this money is from DCJS, which is federal money. Mrs. Medeiros indicated that the member item provides additional hours of service. Mrs. Medeiros indicated that this is the last year we will have full funding; the third year, there is an expectation that we will find matching funds of 50%. For 2005, we need to look carefully at whether or not we can continue and how we will do that. They are keeping statistics about this program. Mr. Dafoe asked if it is under-funded and understaffed to have 15 children on the waiting list. Ms. Sobko indicated that any child coming through the doors could benefit from the program. She does feel it is under-funded and understaffed. Mr. Dafoe asked if there are other streams of funding we can pursue he hates to see kids in need of services. It hurts the kids an it hurts the community. Mrs. Medeiros said we have pursued other funding streams in the past and we will continue pursuing alternative funding. Mr. McKee asked what type of services this program provides. Ms. Sobko indicated that it depends on the child. Mr. McKee asked about Cooperative Extension and 4H. Ms. Sobko said that would be additional activities but they do need the mental health component. Mr. Dafoe asked how children come to the program. Ms. Sobko and Mrs. Medeiros indicated that most come through referrals. Mrs. Tytler asked Mrs. Medeiros if they have considered where they may look next year for funding. Mrs. Medeiros indicated that CTC is a strong possibility but they will continue to look for and pursue grants through the year. She will keep the committee informed of their success. They will also bring it back to the committee when putting the budget together to see if there is interest in investing the $20,000 to continue the program. All members voting in favor; none opposed; motion adopted.

1. Health Department Financials -- Dr. DiGiovanni indicated that he has spoken with Mrs. Gailor about more financial reporting to the committee. Mrs. Gailor has provided a document entitled "Attachment A" that provides more financial information as well as the Board of Health packet. Mrs. Gailor explained that this is what goes to the Board of Health at this time. Mrs. Gailor asked the committee for input on what information they want – is the packet sufficient, is there material they would not like, is there more information you would like.

Mrs. Gailor spoke about the Pre-K program with the Racker Center. This will be about $130,000 to $150,000 more than budgeted. The County is required to provide and fund this program. The program is not required to be in the Health Department. It does, however, lend to coordination with the Early Intervention Program. The rates for last year were increased. We had to pay the Racker Center the new rate retroactively and have to pay it from here forward. Additionally, the number of children to be served is likely to increase. As of yesterday, we are projecting a $105,000 more to be charged to the program and 40% of that is direct from the County. There are travel costs associated with this program for services that are not available in the County. There is one program in Syracuse, and the cost for that is $160 per day per child. The school district’s Committee on Preschool Special Education decides what services children will receive and where the services will be provided. Mrs. Tytler asked who is providing transportation to Syracuse. Mrs. Gailor indicated that we have a contract with Birnie Bus. Mrs. Tytler asked what happened to having the corrections staff transport the children. Mrs. Gailor indicated that the individual providing the transport must have a CDL. The correction staff do not have a CDL and we cannot make them obtain a CDL. Mr. McKee asked about using staff who have been laid off. There is a person in his district who he is sure would be willing to obtain a CDL, who has indicated that she would like to work for the County again. Mrs. Gailor stated this issue is still being looked at and was discussed yesterday in a meeting with Scott Steve and Scott Schrader. Mrs. Wyant asked if it wouldn’t be cheaper to bring some one down here instead of sending the children out of County. Mrs. Tytler indicated that it is important to provide services to children in a "program" setting. There was discussion about what we want to do—provide service or look at dollars. Is there a way we can reconcile the two?

Mrs. Gailor indicated that she has received a model budget format from Kurt Behrenfeld. It will be available to the committee next month. This will flag over and under budget items. Mrs. Gailor reviewed the financial information that was in the Board of Health packet. Looking at the insurance area of the report – it will be okay in Administration but will most likely be a problem area in Nursing. The sub areas don’t show up in the report – there are two sub items in Nursing – liability, which is the County liability and Nursing malpractice insurance. Because the insurance line in the budget contained all the money for insurance, including both subcategories and the county took the total line for county liability, there will be a shortage equal to the nursing malpractice insurance expenditures required by contract. Mrs. Gailor looked at the line items where they have spent more than 16.6% to date. Mileage reimbursement is going to be a problem area. It was identified as soon as the budget was passed and Mr. Schrader was notified of the problem. Local travel lines were cut considerably by the County Administrator and personal mileage reimbursement that was included in those lines wasn’t taken into consideration with the cuts. Since 1996, most nurses have been hired with the understanding that they would drive their own vehicles as this was the advice of our auditor to save money. These lines in both Hospice and Nursing do not have enough money to cover daily expenses. Mrs. Gailor indicated that telephone expenses are likely to be a problem as well, since they are over the benchmark number at this point in time. This will be looked in to to determine why. Mrs. Gailor indicated that the committee members should feel free to call her if they have questions once they look at the report more in depth. Mrs. Gailor also reviewed the revenue report. She explained that this will be changing with the new report. Dr. DiGiovanni indicated that this is a helpful start. The reporting format will change in the future as more direction is provided by the Budget and Finance Committee.

Mrs. Medeiros explained the "Clinic Write Offs" report. Annually, they look at the amounts that need to be written off due to patient movement, refusal to pay, etc. This goes to the subcommittee of the CSB for approval and then to the Health Committee for informational purposes. The write off amounts are personal client accounts that Mental Health has identified as uncollectible. These are reflective of self pay fees. 2003 is higher than we have seen in previous years. Mrs. Medeiros reviewed in depth the adjustment portion of the report. She indicated that she is not convinced that these numbers are totally accurate, but they are the best that can be obtained from the system at this point in time.

3. Board of Health – Dr. DiGiovanni talked about what is reported to the Board of Health and how the Board of Health and Health Committee interact. He addressed how he visions the Board of Health and Health Committee/Legislature function together. Dr. DiGiovanni feels that the Legislature is the funding source and the Board of Health is more of the policy body. Dr. DiGiovanni indicated that the only financial information he has seen has been reported to the Board of Health; he feels that the Health Committee should receive this same information as the stewards of the taxpayer dollars. Dr. DiGiovanni said that Mrs. Gailor is indicating that this is a starting point and what might the committee like to see from her. Mrs. Tytler said she feels this is a solid idea. Once they have had time to look at the information, they can decide what they would like to see.

Dr. DiGiovanni, Dr. Gillim, and Mr. Steve met last Wednesday after the Guido Summit. They are all not happy at where we are. Dr. Gillim agreed with what is being said. They left the meeting with a game plan. Mr. Steve will solicit information from the State that clearly defines that the Board of Health should do and what the Health Committee should do. The response is "no, there is not a cut and dried formula." The plan is then for the three individuals to sit down and have a philosophical discussion leading to Board of Health being policy recommendation and clinical oversight and the Health Committee should be the financial oversight. Philosophically, they all agree, and the question is then how do we get there. Does the committee have ideas on how you want this to play out? Mr. Cornell asked if we have looked at other counties to see how they do it? Dr. DiGiovanni said we haven’t done it yet, but we can. Mr. Dafoe said that Health Committee should meet with Board of Health and see what they are doing. He is not even aware of when the Board of Health meets. Dr. DiGiovanni said that his role as Chairman of the Health Committee is, on paper, the liaison. He is not certain that this has been the most effective means. He is surprised at the amount of financial information the Board of Health receives. He feels that Health Committee should receive the financial information and the administrative end of the programs as well. Dr. DiGiovanni feels that policy development should be the focus of the Board of Health. He indicated that Dr. Gillim feels that the Board of Health should also have a quality assurance function as well. Mrs. Gailor explained some of the current quality assurance functions of the Board of Health and some of the subcommittees. This is one of the problems with the CHHA as for some reason the policy reviews were not being done as they had been done in the past. Ms. Wyant asked if the Health Committee and the Board of Health ever meet together. Dr. DiGiovanni indicated that to his knowledge, this has not been done traditionally. Mrs. Gailor said that a joint meeting has never, to her knowledge, occurred. Dr. DiGiovanni asked for clarification of what the committee wants in the steps to go forward. Do you want to leave it with Dr. DiGiovanni, Dr. Gillim, and Mr. Steve, do you want to form a subcommittee, or do you as the entire group want to work on it. Dr. DiGiovanni feels a small group effort will be most effective. Mrs. Tytler indicated that she feels that Mrs. Gailor or a staff member be included. Mrs. Gailor is more than willing to participate with Dr. DiGiovanni, Dr. Gillim, and Mr. Steve. Dr. DiGiovanni indicated that there are also legal implications that need to be looked at with this function as well. He would like to have John Bardsley, our County Attorney, review issues as they come to ensure we are within legal bounds. Mrs. Tytler said as we evolve to a model, we don’t make staff do double work to provide information to both groups. The committee is okay for the small group – Dr. DiGiovanni, Dr. Gillim, Mr. Steve, and Mrs. Gailor to move forward. The next Board of Health meeting is April 20^th. They are normally the third Tuesday at 4:00. This month, the meeting is April 20^th at 4:15 p.m. on the third floor of the County Office Building. They are public meetings, so feel free to attend.

Stakeholders meeting on water quality is Friday, April 9, at 3:00 p.m. at the New York State Grange on Clinton Avenue.

Dr. DiGiovanni stressed that the health risk at this point in time from nitrate effect is extremely low.

5. Mr. Cornell spoke about the Albany Lobby Day next Wednesday, April 14, 2004. If anyone wants to accompany Larry, please let him know.

On motion of Mrs. Tytler, seconded by Mr. McKee, unanimously adopted, meeting adjourned at 11:10 a.m.

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