Health Committee

September 7, 2004 – 7:30 a.m.

DRAFT Minutes

 

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

Others present: Ann Homer, Linda Medeiros, Administrative Officer – Mental Health; Jackie Gailor, Public Health Director; Scott Schrader, County Administrator

Absent: Tamara Wyant, Newell Willcox, Steve Dafoe

Dr. DiGiovanni called the meeting to order at 7:35 a.m.

On the motion of Mr. Cornell, seconded by Mr. McKee. All members voting in favor; none opposed; minutes of the August 10, 2004, meeting were approved as amended.

 

Resolutions:

 

     

  1. Authorize Agreements/Accept Funds, Health Department/Special Programs (Cancer Services Programs) . Mrs. Tytler moved adoption; seconded by Mr. Cornell. Mr. McKee inquired if this is basically a bookkeeping issue. Dr. DiGiovanni explained that it is. All members voting in favor; none opposed; resolution adopted.

    2.  

  2. Authorize Agreements/Accept Funds, Health Department/Special Programs (Breast & Cervical Cancer Early Detection Program). Mr. Cornell moved adoption; seconded by Mrs. Tytler. Mr. Cornell asked how women would know about this service. All members voting in favor; none opposed; resolution adopted.

    3. Note: Mrs. Gailor explained that both 1 and 2 are additional funds received over what was placed in the budget.

     

  3. Authorize Agreements/Accept Funds, Health Department/Special Programs (Healthy Living Partnership Tobacco Use Prevention and Control). Mr. McKee moved adoption; seconded by Mrs. Tytler. Dr. DiGiovanni explained that this is another award of $208,000. Mrs. Tytler stated that this seemed to be a lot of money for tobacco prevention. Mrs. Tytler would like to know that our investment of these funds is making a difference. Mrs. Gailor indicated that youth is one of the major target groups; however, there are other target groups as well – college students and adults. Dr. DiGiovanni indicated that smoking rates have decreased; this appears to be a lot of money for what we need to do. Mrs. Gailor explained that this is the money that the State receives from the Tobacco Settlement. Mrs. Gailor indicated that she has concerns because the grant is requesting more staff time, including the full-time commitment of a staff member. Mrs. Gailor indicated that in Cortland County our youth smoking is still higher than it is elsewhere in the state. Mrs. Gailor is concerned that our county was co-located with Tompkins County in the survey. The Tompkins County population is totally different from Cortland County. They have requested that Cortland County’s data be extrapolated, but the State has indicated they cannot do that. We are still showing 38% to 40% of our youth are smoking. The mindset of the State is that we must spend more and more on education. Dr. DiGiovanni indicated that this is how it was sold to the public. The County chose to securitize the funds and put it in the general fund. We did not use it towards education. Mrs. Gailor indicated that we did receive $144,000 the following January to enhance our education. This plan is now focusing more on adults, since if we don’t change the perspective of the adults, it will be difficult to change the perspective of the children. All members voting in favor; none opposed; resolution adopted.

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  4. Authorize Agreement/Accept Funds, Health Administration (Traffic Safety/Child Passenger Safety Program). Mr. Cornell moved adoption; seconded by Mrs. Tytler. Mrs. Tytler asked why there were no budget numbers on the resolution; does this program work in conjunction with the hospital? When new babies are born, are the parents educated on the need for car seats. Dr. DiGiovanni asked about a tie-in with the budget. Mrs. Gailor will add budget line item numbers. Dr. DiGiovanni asked how this is being done with newborns – pre-natal care or time of delivery? Mrs. Gailor indicated that this is being done through the Health Educational Department; individuals must make an appointment to come in, as there is an education component. We are also doing this in conjunction with the Sheriff’s Department. Most of our work is being done through the Health Education Department. All agencies with whom we work are aware of the program. In addition to the education component, the car seat is actually fitted to the car and the parents are shown how to ensure it is fitted correctly. Mrs. Tytler asked if we worked in conjunction with programs such as Lamaze classes. Mrs. Gailor indicated that we don’t actually go to a Lamaze class, but information is provided to them. Dr. DiGiovanni asked if we work with the OB providers. Mrs. Gailor indicated she is not aware that we are, but she will look in to this. All members voting in favor; none opposed; resolution adopted.

    5.  

  5. Authorize Agreement, Health Department, Onondaga County/City of Syracuse (Metropolitan Medical Response System). Mr. McKee moved adoption; seconded by Mr. Cornell. Mr. Cornell asked if there is any local cost for this program. Dr. DiGiovanni indicated that they are probably related to indirect costs, such as staff time. Mr. McKee would like confirmation of local cost. Mrs. Tytler indicated that it is probably staff time only. Dr. DiGiovanni asked if there is going to be additional cost beyond staff time to participate in meetings and teleconferences. Mrs. Gailor indicated there should be no additional cost unless it is training and then it most likely would not be Health Department staff. This program started prior to 9/11 to bolster metropolitan areas in the country for bioterrorism preparation. Syracuse was not initially in this program, but received funding as a result of 9/11. This brought supplies and equipment for their Metropolitan Medical Response System. This is the fifth year of the grant and Onondaga County has purchased nearly everything they need, therefore, it was expanded to include other counties. Mrs. Gailor indicates that there should be absolutely no cost to the County for our participation. This brings us in to a more regional planning system for bioterrorism. All members voting in favor; except Mr. McKee opposed; resolution adopted.

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  6. Authorize Agreement/ Mental Health Department (Greenbriar Home for Adults, Inc.). Mr. Cornell moved adoption; seconded by Mrs. Tytler. Mrs. Medeiros indicated that this is an on-going agreement at the initiation of Greenbriar. Because they have a certain population of residents who have mental health issues, they are required to have a contract with a mental health provider. Cortland County provides that service. Greenbriar brings the clients to the clinic and they are treated as all other clients are treated. For the Mental Health Clinic, it is "business as usual." Mrs. Tytler asked about the retroactivity date. Dr. DiGiovanni asked why we are just seeing this now, since it started on February 1, 2004? Mrs. Medeiros indicated that she did not track when this agreement expired; she had hoped to have a multi-year agreement; they were contacted by Mr. Francher who brought this to their attention. Dr. DiGiovanni asked how many people Greenbriar is currently serving under this provision. Mrs. Medeiros indicated that the clinic is probably seeing four or five clients active who come to the clinic. Dr. DiGiovanni asked why we have to have this. Mrs. Medeiros indicated that we do not have to have this; Greenbriar is required to have it. All members voting in favor; none opposed; resolution adopted.

 

Discussion:

 

1. Mrs. Medeiros provided an in-depth review of the financial statements. She informed the committee that the September numbers will most likely be new due to computer upgrades and problems. The revenue will be made up in October.

2. Mrs. Medeiros distributed information she has gathered from other counties regarding how they work with and/or employ psychiatrists. The counties didn’t answer all the questions, so it was not as helpful as it could be. Next month, they will need to come back with a recommendation/resolution. Linda has gone on-line to research insurance companies that will add Cortland County as additional insured. She has found one who will. Dr. Sillars and Dr McGregor have been provided the information for the insurance company and an application. Dr. Sillars indicated that he will look in to the alternative insurance. Dr. McGregor is not willing to change insurance companies. Mrs. Medeiros would like to see this resolved soon. Broome County does have a provider whose insurance lists the County as an additional insured. Dr. Capanzano will contact Broome County and see if we can find out who the insurance carrier is. If Dr. Capanzano doesn’t receive a response, Mrs. Medeiros will contact Broome County. Dr. DiGiovanni asked if the doctors were getting antsy about not having the signed contract. Mrs. Medeiros indicated they are not. However, Dr. Sillars is determined that she will not change insurance companies. Mrs. Medeiros has indicated to the doctors that the County may be willing to pick up any additional cost to have the County listed as an additional insured, since we have done this with our third psychiatrists. Dr. DiGiovanni asked if all our psychiatrists are consultants? Mrs. Medeiros indicated that they are all consultants, and they are all paid the same. Our 2004 rate is $87.40; she has put $90.00 in the 2005 budget. This does not include any benefits. For Dr. Merhof, we are reimbursing him approximately $450 for having Cortland County listed as an additional insured on the insurance policy. Dr. DiGiovanni indicated that Mr. Schrader is to be looking in to cost of an insurance policy that will cover the liability for these providers. Mrs. Medeiros indicated that Greg Moss, Horizon House Director, would like to meet with Mr. Schrader so we don’t lose Dr. McGregor.

3. Mrs. Medeiros reported that we will have someone from OMH office of Children and Family visit next Monday and attend the Children’s Services subcommittee. They are interested in having Cortland County receive four (4) Medicaid waiver slots, which allows the clinic to buy services for children so the children stay in the home. The parents may not be eligible for Medicaid, but the children would be. This would allow the children to stay in the home and receive the mental health services they need. Kristen Monroe, Commissioner of DSS, is interested in receiving this service. Mrs. Medeiros will send an e-mail to the Health Committee on this meeting so they may attend if they wish; the meeting is September 13, 2004, at 2:30 p.m. Mrs. Medeiros has further information on this service and she will put the information in the Committee’s mailboxes.

4. Dr. DiGiovanni asked Mrs. Gailor to provide an update on the Plan of Corrective Action (CHHA). Mrs. Gailor reported that the Plan of Action the committee has outlines three areas still needing improvement/correction. The Health Department is continually working on these areas. One area is wound assessment and documents. Every nurse gets an audit monthly on every case with a wound until they are providing accurate documentation. Mrs. Gailor indicated that there has been improvement shown in every month. The average is down but the median is all over. The State survey has shown significant improvement but additional work needs to be done. Full chart audits – this means that the entire chart is reviewed. Mrs. Gailor indicated that the new software should prevent nurses from omitting document. Nurses are removed from full chart audits when they meet requirements set by the department. Every nurse is currently getting full-chart audits on a monthly basis. The mean was decreasing but it has gone back up; median is still all over the place. Mrs. Tytler asked why the numbers still seem to be all over. Mrs. Gailor indicated that a full-chart audit means that everything is looked at; not just the things that are caught in the system. We now have newer nurses handling caseloads and it takes about a year for a nurse to be fully oriented, so there will be errors. Mrs. Tytler asked who is doing the audit. Mrs. Gailor indicated that peers are doing reviews and then quality assurance nurses are reviewing them. The quality assurance nurse may be doing the full-chart audit. Dr. DiGiovanni asked if the Board of Health is involved in the process? Mrs. Gailor indicated only to the level of receiving information. Mrs. Gailor indicated that when a nurse comes off a monthly audit, they are placed on a quarterly audit and do not immediately do to an annual audit. Mr. McKee asked if the hands on standard of care is being provided correctly and it is the documentation that is lacking. Mrs. Gailor indicated that she believes the State feels we are providing adequate standards of care and we have not had a recent issue with standards. Dr. DiGiovanni indicated that a meeting was held regarding flow of information. Some of the information that is not being documented is continuing care issues, which are not necessarily a part of home health nursing. (e.g. A patient is receiving home health care for colon surgery, but the history of breast cancer and medication is not necessarily included/covered.) CMH is looking in to how further information can be provided with discharge planning while maintaining the needed confidentiality ensured by HIPAA. Mrs. Gailor indicated that this additional information will be helpful in providing good patient care.

5. Dr. DiGiovanni brought up the Water Survey. Mrs. Tytler indicated that they should be commended because it was an excellent survey.

6. Dr. DiGiovanni brought up the interaction between the Board of Health and Health Committee. He is still no clear about their relation to each other. Dr. DiGiovanni feels perhaps the two groups should have joint meetings so each group knows what the other group is doing. At the Board of Health, all the Division Heads are there and they provide an update. Dr. DiGiovanni feels that the Health Committee should hear that information. Should there be one joint committee a month where certain information is shared. Mrs. Tytler asked when Board of Health meets. Mrs. Gailor responded that they meet the third Tuesday of the month at 4:00 p.m. Dr. DiGiovanni is going to request that the meeting be held later in the day. At the October Board of Health meeting, the State will be coming down to discuss the role of the Board of Health. All Health Committee members are invited to attend. Dr. DiGiovanni indicated that this month’s meeting is September 21 at 4:00 p.m. He encourages all Health Committee members to attend if they are available. Mrs. Gailor indicated that one other thing she has brought to the Board of Health since they are no longer approving bills, is a record of revenue and expenditures. The timing is difficult, but she will provide this information to the Committee if they would like it. Dr. DiGiovanni indicated he would work with Mrs. Gailor on format.

7. Dr. DiGiovanni addressed the issue of the Budget. He understands that Mr. Schrader and he have different philosophies on the budget preparation, but he feels that committees should be aware of what is being submitted. Mrs. Gailor indicated that her meeting with Mr. Schrader is currently scheduled for September 21.

8. Mrs. Gailor indicated that Dr. DiGiovanni has facilitated the contract with the hospital so the children are covered. They are working with the County Attorney’s office to get the Pre-K provider contracts signed.

 

The committee convened in to executive session at 9:18 a.m. for the purpose of discussion of personnel. Staff were excused.

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