1. Authorize Agreements/ Accept Funds, Health Department/ Administration (Cancer Services Program) – Mr. Cornell moved adoption; seconded by Mr. McKee. Mrs. Gailor indicated that Suzanne Parson will explain more of what we do with this money later in the meeting. There is more work being done with colorectal screening this year than before. Dr. DiGiovanni abstained from voting on this resolution due to a conflict of interest. All members voting in favor; none opposed; resolution adopted.

2. Authorize Agreements, Health Department (SCHC Total Care Inc.) – Mr. Cornell moved adoption; seconded by Mrs. Tytler. Mrs. Gailor indicated that this agency appears to have a very good program. She believes a contract for Medicaid Managed Care with them will benefit the participants. Ms. Monroe has notified Mrs. Gailor that our bringing in another Medicaid Managed Care provider in 2005 could change the base year when we look at a base line for Medicaid. SCHC doesn’t envision anything being in place until October or November. She is asking for permission to contract; however, she will look at this closely so the timing doesn’t impact on our Medicaid reimbursement for the State. Ms. Monroe is looking into this situation further. Dr. DiGiovanni asked if there will be clarification by Session; he hates to do something that we will regret later. Mrs. Gailor has been in contact with Ms. Monroe as of yesterday. She has not heard from anything from Ms. Monroe yet. Mrs. Gailor confirmed that currently Fidelis is the only Medicaid Managed Care provider in Cortland County; this would provide a choice for the participants. Mrs. Gailor indicated that once we have two Medicaid Managed Care providers, we become a mandated Medicaid Managed Care County and all participants would have to choose one of the providers – they would not be able to receive Medicaid under the normal stream. Mrs. Tytler asked if this is a good thing. Mrs. Gailor indicated that Ms. Monroe has heard a lot of negatives from other counties who have become mandated Medicaid Managed Care counties. Mrs. Tytler is concerned whether becoming a mandated Medicaid Managed Care County is beneficial to the recipients and the County. Mr. Willcox asked the County Administrator if this will help our budget. Mr. Schrader indicated that there is anecdotal information that this will actually cost the County money. Ms. Monroe will have more information by the Legislative Session. Mrs. Tytler moved to table to the next session; seconded by Mr. Cornell. All members voting in favor; none opposed; resolution tabled until the next Health Committee.

3. Authorize Agreement, Mental Health Department (Richard McNeilly, CPA) – Mrs. Tytler moved adoption; seconded by Mrs. Tytler. Dr. Capanzano indicated that it is a State mandate that this audit be completed. Mr. McNeilly has done this audit for 10 years or more. Mr. Schrader will provide the County a copy of the contract by the Legislative Session. Chairman Steve indicated that the scope of services and payment will be outlined in the contract. Dr. DiGiovanni suggested amendments to the resolution. By general consent, the committee accepted the amendments. Mr. Williams asked why this contract was not bid; does this individual possess certain skills? Mr. Schrader responded that this was not bid; the individual has done our audits for years, which is the only superior qualification at the time. Mr. Schrader recommends that in the future, all audits be bid. All members voting in favor; none opposed; resolution as amended adopted.

4. Increase Hours, Mental Health Department (Mental Health Practitioner) – Mrs. Tytler moved adoption; seconded by Mr. Cornell. Mrs. Tyler asked who the individual is. Dr. Capanzano indicated that it is Jane Pendergast, who has joined the staff this year, and appears to be working out very well. This is the new nurse practitioner. Mr. Cornell asked if this increase in hours means adding benefits. Mr. Schrader indicated that there are some benefits that can be afforded; however, she is not taking the insurance, which is the costly benefit. All members voting in favor; none opposed; resolution adopted.

5. Approval to Fill Above Midpoint, Mental Health Department (Program Director – Continuing Day Treatment) – Mr. McKee moved adoption; seconded by Mrs. Tytler. Dr. Capanzano indicated that the County has benefited from having Mr. Moss on staff as a shared staff member. He then retired from the State, and worked for us at a much reduced rate, which allowed the program to have the continuity at a much reduced fee. Mr. Moss is looking to retire and look at other opportunities. In looking at hiring a full-time person at the entry level salary, this is a very low salary below most of the other positions at Horizon House. Mrs. Tytler asked if we are hiring a clinic position or are we hiring an administrative person. Dr. Capanzano indicated that the job description calls for both duties. Mrs. Tytler feels that the entire job description needs to be rewritten and the position needs to be re-evaluated and re-graded. Mr. Schrader indicated that Mrs. Barber is looking at the position as a part of the entire Management Compensation Plan overhaul. Mrs. Tytler indicated that she feels we are doing a band-aid fix. The consensus is that is true; however, it is what we need to do at this time. All members voting in favor; none opposed; resolution adopted.

1. Mary Beach provided an updated on the Hospice Division. She distributed a copy of the report, which is attached to these minutes. Ms. Beach stressed the importance of a written Health Care Proxy for anyone over age 18. In New York State, a "Living Will" is not recognized as a legal document.

2. Elaine Lambert provided an update on the JCRH. She reported that there was only one registration for the parent-son retreat; it was cancelled, but they will work on it for next year. A copy of the report is attached to these minutes.

3. Suzanne Parson provided an update on Health Education. She is delighted to state that they are fully staffed. A copy of the report is attached to these minutes. Ms. Parson thanked Mr. Willcox for the incentives he provided to the Health Education Department.

4. Cathy Feuerherm provided an updated on the Nursing Division and Children with Special Needs. A copy of the report is attached to these minutes. She indicated that the total number of referrals was up and the average daily census is up. Ms. Lambert indicated that the Facilitated Enrollment with the JCRH has been a very positive move.

5. Mrs. Tytler indicated that since the issue is on the table of moving the clinical services to another location, can we do a survey of how individuals utilizing the program are getting to the clinic – own transportation; public transportation; walking; etc. Mrs. Gailor indicated that staff have discussed this. Chairman Steve indicated that he supports doing a survey. Mrs. Tytler feels that this is important information in looking at the big picture of the location of clinical services. Mrs. Tytler is concerned about the form of transportation people are using to get to the services and what other form of transportation they have available to them.

6. Audrey Lewis provided an update on Environmental Health. A copy of the report is attached to these minutes. Ms. Lewis indicated that her division did respond to the flood event recently experienced in the County. She indicated that there were very few places that had flooded wells, since most of the water sources were public water systems. They have been contacted by the Nutrition Program regarding funding the water sampling at the nutrition sites. Ms. Lewis indicated that they can assist them with this and they could probably pick up the cost, which will be a saving for the County. The Nutrition Program will have to bring the samples in. There was a review from the State on the lead/copper review. They looked at how we have been doing oversight to the public water supply. A copy of the summary letter is attached to Ms. Lewis’ report; the report was positive. There was a discussion surrounding the penalties imposed on retailers for violation of the tobacco sales law (selling to under age individuals). Mr. Schrader had inquired why the second penalty on a retailer was not higher. Mrs. Attleston responded that the decision has been to work with progressive fines. Dr. DiGiovanni reminded the group that this is a Board of Health issue, and since the Board of Health in inquorate, no action can be taken on this issue.

7. Jackie Gailor reported on Health Administration. Mrs. Gailor indicated that she had some staff who spent significant time on Sunday in the Emergency Command Center. She complimented them on the work they did and the situations they encountered. Since there is not a Board of Health quorum, discussion on particular functioning of the Health Department during an emergency should await the next Board of Health meeting. Mrs. Gailor mentioned the activities for National Public Health Week, including the publicity in the newspaper. Mrs. Gailor indicated that she had a staff meeting – held at two different times, so the department was "manned" – during Public Health Week. The division heads spoke about the duties of the various divisions. There have been efforts by supervisory/management staff to have staff get to know each other better. Chairman Steve commended MJ Uttech and Audrey Lewis for their efforts during the recent State of Emergency in the County. It was extremely helpful to have staff available. Chairman Steve thanked Mrs. Gailor for her efforts during the emergency. Mrs. Attleston commented that as a Board of Health member, she is thankful that we have a local Environmental Health Division. Getting the assistance out of Albany would have made the recent situation much more precarious. Mrs. Tytler asked when the Legislature and Health Committee will receive an update on the flood. Chairman Steve indicated that in a couple of months, we will evaluate what occurred during the State of Emergency and we will be looking at areas where we need to improve and putting a plan in place to improve them. Mrs. Gailor indicated that we have been working on a Health Emergency Preparedness Plan since 2002. This provided her more information of what needs to be incorporated into the Plan. Chairman Steve indicated that on the Cortland County web site there will be information – such as photos, FAQ, links, etc. – by the end of today. Mrs. Attleston indicated that in her mind, the development of an Emergency Preparedness Plan is an on-going process; it is not static. Mrs. Gailor indicated that the Incident Command Center itself is problematic, particularly given the acoustics in the center. The chaos from the facility itself can hamper us from doing as effective a job as possible.

8. Dr. DiGiovanni indicated that he has been asking for an overview of issues germane to the Health Committee/Health Department/Schools. He does not want to initiate a meeting with the Superintendents until we have a complete list of issues. Dr. DiGiovanni indicated that he needs the information from Ms. Feuerherm. Mrs. Gailor indicated that she believes the list goes beyond the CSN division and Dr. DiGiovanni agreed. Mrs. Gailor has been contacted by FHN to facilitate a meeting with school superintendents regarding provision of dental services.

9. Mr. Willcox asked if there is any chance that the two committees can do to enhance our possibility of becoming a Federal Emergency area. Chairman Steve indicated that we have done all we can – and we have contacted all the applicable representatives.

10. Dr. DiGiovanni indicated that with regards to the Family Enrichment Network – as of last Thursday, Dr. DiGiovanni has an e-mail that providers have been contacted with no response. Now, as of today, we have heard from four providers. Dr. DiGiovanni hopes that the Family Enrichment Network is actually working to our benefit. Dr. DiGiovanni spoke with Dr. Tyson Smith from CMH that he had left two messages with Family Enrichment and no response. He hopes that all of this gets on line and straightened out.

11. Dr. DiGiovanni indicated that assignments need to be firmed up for Larry Cornell and Tom Williams with Health Department Divisions. Hospice, Nursing, and JCRH are open. Mr. Cornell offered to do Hospice. Mr. Williams will do JCRH. Mrs. Tytler will do both CSN and Nursing; Dr. DiGiovanni will do Administration; Mr. McKee will do Health Education; and Mr. Willcox will do Environmental Health.

12. Dr. DiGiovanni revisited the list of priorities and goals. He is awaiting hearing from Mr. Schrader about where we can have the most impact. Mr. Schrader indicated that he has been a bit busy and at this point has nothing to distribute/provide to the committee. Dr. DiGiovanni reviewed the list of goals that had previously been discussed. Mrs. Gailor will establish a suggestion box for suggestions to cut costs, improve services, and/or improve efficiencies. Dr. DiGiovanni will make contact with Marcia Bulger about communication/training/joint meeting for and with the Community Services Board. The State will provide training for the Community Services Board later this year – May or June. Dr. DiGiovanni asked Chairman Steve if there is any more information on the relocation of the health facility. Chairman Steve indicated that this should be ready for more in-depth discussion at the next Health Committee Meeting. Mrs. Gailor indicated that staff is asking if they will have input in their needs for space requirements. Chairman Steve indicated that they will have input; we are just not at that point at this time. Mr. Schrader asked out the deficiencies outlined in the State re-licensing letter. The State needs to better identify what the deficiencies are. Mrs. Gailor reported that the FHN new dental facility in the City will open right around May 1. There was discussion about outcome measurement of the programs. Dr. DiGiovanni indicated that the next Committee Chair’s meeting will be Tuesday, April 19, at 5:30 p.m. There is a BOH Strategic Planning Session on April 19 at 4:00 p.m.

13. Discuss NY State Office of Mental Health re-licensing – a copy of the letter from NYSOMH is attached to these minutes. Mr. Schrader wants more specifics from the State on why Horizon House is insufficient – we do not know what is wrong with it. Dr. Capanzano indicated that regulations have a square footage per person requirement. The occupancy of Horizon House is fine – the fire occupancy is 37. Mr. Moss believes this comment by the State is subjective. Mr. Schrader indicated that he will not respond to subjective comments; he will not respond until the State gets specific. Chairman Steve asked Dr. Capanzano if we cannot ask for more specifics from NYSOMH. Dr. Capanzano said we could. Mr. Schrader indicated that we must since we are looking in to building a new building. Chairman Steve indicated that we must address what the requirements and needs are for the facility. Dr. Capanzano indicated that he believes the inside of the facility is sufficient; it is more the outside layout that is deficient. Chairman Steve asked Dr. Capanzano to get more information from NYSOMH now, not later when we are getting ready to build the new building. One of the major issues is the slope of the driveway; secondarily there is a concern about whether a larger second group room may have some benefits; parking is another issue. Mr. Moss indicated that the driveway evaluation is based on accident/incident reports and the number of falls that occur in the driveway. Mr. Schrader indicated that he needs to know how the building is deficient to provide the appropriate services. Mrs. Tytler indicated that if an architect is building a new facility, there are regulations and other pertinent information when doing the design. Chairman Steve asked Mr. Moss if he would also do a service about how people are accessing services – where they come from – how they get there, etc. Mr. Schrader wants a detailed description of the facility now. Mr. Moss indicated that the State does not put the positive comments in the report. They did receive many positive comments, which were not included in the report. We have a solid program that is respected by the State.

14. Dr. Capanzano provided an overview of the Mental Health Department’s involvement in the recent flood emergency.

Dr. DiGiovanni thanked Mr. Moss for his service to the County.

The meeting adjourned at 9:18 a.m.

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