Health Committee

February 8, 2005 – 7:30 a.m.

Draft Minutes

Members present: Dr. Paul DiGiovanni, Chairman; Mike McKee, Vice Chairman; Carol Tytler; Newell Willcox; Ron VanDee

Others present: Ann Homer; Scott Schrader, County Administrator; Mary Beach, Hospice Director; Elaine Lambert, JCRH Director; MJ Uttech, Deputy Public Health Director; Cathy Feuerherm, Director of Patient Services; Suzanne Parson, Supervising Public Health Educator; Jackie Gailor, Public Health Director; Audrey Lewis, Director of Environmental Health; Linda Medeiros, Administrator Office, Mental Health Clinic; Brian Liberatore; Eric Mulvihill

Absent: Dave Wern (notified committee chair); Larry Cornell

Dr. DiGiovanni called the meeting to order at 7:37 a.m.

Mr. Willcox moved adoption of the minutes of the January 11, 2005, meeting; seconded by Mr. McKee. All members voting in favor; none opposed; minutes approved as .

Resolutions:

1. Amend Budget, Health Department (Grant Rollovers from 2004 to 2005 Budget) – Mrs. Tytler moved adoption; seconded by Mr. Willcox. This is merely reappropriation of funds. All members voting in favor; none opposed; resolution adopted.

2. Authorize Agreements, Health Department/ Division of Nursing (Licensed Home Care Agencies) – Mrs. Tytler moved adoption; seconded by Mr. Willcox. Mrs. Gailor explained that this is for specialty nursing services. Mrs. Gailor explained that these referrals come from a hospital. All members voting in favor; none opposed; resolution adopted.

3. Authorize Agreements, Health Department/ Children with Special Needs (NYS Facilitated Enrollment Program) – Mr. McKee moved adoption; seconded by Mr. Willcox. Ms. Feuerherm indicated that the first resolution was adopted without naming subcontractors; we need to name the subcontractors in order to contract with them. Ms. Feuerherm indicated that FHN has written to Chairman Steve asking that the County reconsider the distribution of funds at one-third to FHN and two-thirds to CMH. There were a variety of reasons stated in the request to Chairman on applications visiting individuals in the home/off-site as opposed to the time CMH spends on an application on-site. Mrs. Tytler asked that the committee be provided factual information/numbers on the productivity of the providers in order to assess distribution. Mrs. Tytler moved to amend the third WHEREAS clause by adding "and actual costs"; seconded by Mr. Willcox; all members voting in favor of the resolution; none opposed; amendment adopted. All members voting in favor of the amended resolution; none opposed; amended resolution adopted.

4. Authorize Agreements/ Accept Funds, Health Department (Healthy Heart Program) – Mr. Willcox moved adoption; seconded by Mrs. Tytler. Mrs. Gailor indicated that this accepts funds and authorizes subcontracts. The subcontract we are aware of at this time is with Cornell Cooperative Extension. Ms. Parsons indicated that this is the first time that we have contracted with Cornell Cooperative Extension. Mr. McKee asked who the targeted audience is. Ms. Parsons indicated that it is individuals throughout the County, the location of the training will be the Cooperative Extension kitchen located in the County Office Building. Dr. DiGiovanni asked who provided this training in the past. The response was that this is the first time that we have contracted for this particular service. There will be mini-grants provided from this contract; they have not been advertised yet. All members voting in favor; none opposed; resolution adopted.

5. Resolution Urging Support for Medicare Rural Add-On Legislation – Mr. Willcox moved adoption; seconded by Mrs. Tytler. Mrs. Gailor indicated this is the rural add-on the committee discussed in December. At the point Mrs. Gailor wrote the resolution, it has been re-introduced in the House, it has not yet been re-introduced in the Senate, but it is anticipated it will be. All members voting in favor; none opposed; resolution adopted.

6. Abolish/ Create, Health Department, Medical Typist/ Medical Services Clerk – Mr. McKee moved adoption; seconded by Mr. Willcox. Mrs. Gailor indicated that this position was vacated due to promotion and Personnel recommends that the position be re-titled based on the reclassification study. Mr. Schrader indicated that this is part of the MSD study. All members voting in favor; none opposed; resolution adopted.

7. Amend Agreement, Mental Health Department (NYS Office of Alcohol & Substance Abuse Services) – Mr. Willcox moved adoption; seconded by Mrs. Tytler. Mrs. Medeiros indicated that this is moving money from 2004 from one agency who did not use it to another agency who will use it. All members voting in favor; none opposed; resolution adopted.

DISCUSSION/PRESENTATIONS/DISTRIBUTIONS:

1. Mrs. Medeiros reviewed the first month’s revenue collection report to the committee. She indicated that it is early in the year to have much to say about this.

2. The Mental Health Practioner position has been filled and the individual will be starting on Friday.

3. Audrey Lewis, Director of Environmental Health, regarding Suit-Kote. Dr. DiGiovanni asked who was familiar with the issue with Suite-Kote. Ms. Lewis explained that the question is that the CRC is really a function of the Planning Department and the Planning Committee. For the applicants to understand what is needed before it gets to the Planning Department, this meeting is held so that all applicable information can be gathered and shared before the proposal reaches the Planning Department. Suit-Kote’s proposal is for installation of new tanks at the Polkville facility. Ms. Lewis explained that the recommendations at the CRC meetings are only recommendations – they are not binding. The Health Department’s recommendation of this proposal is that there might be air/carbon filtration installed by the Town as well as air quality/emissions tests being conducted. The recommendation did not make it to the final proposal that went to the Planning Board. DEC then informed them that the applications were incomplete and emissions testing will have to be done on the tanks. This type of review is done on a monthly basis. Dr. DiGiovanni indicated that this puts the committee in an awkward position, since when recommendations don’t reach the board, both he and Chairman Steve then receive inquires and they are not informed about the situation. Ms. Lewis explained that Environmental Health barely has time to look at the applications before the meeting. Ms. Lewis explained that this is a method to inform the applicant and the towns of information, permits, etc. that may be required for a project. It is basically a "heads up" and is an informative meeting, but is not binding. Dr. DiGiovanni asked if minutes are taken at the meeting. If they are, then the committee should be on the distribution list for minutes, so there is a "heads up" to the Legislature. Ms. Lewis indicated that there is always a very fast turnaround time. Mr. VanDee asked if the turnaround is so short, how are good judgment calls made. Ms. Lewis indicated that much of this is routine. She explained that this is not the intense review by the department. Chairman Steve indicated that if there are continuing odor complaints about Suit-Kote, we need to do further investigation, look at the variables, and try to solve the problem. Chairman Steve indicated that if something needs further research, then that should be evaluated before any determination is written. If additional time is needed to conduct research, then that should be noted in the determination so the County is not placed in a precarious situation. Ms. Lewis indicated that every time a complaint is received, Environmental Health does investigate it. It is not that easy to determine where the odor is coming from. Chairman Steve indicated that he understands that it is not an easy process, however, it has not been documented that attempts to investigate have been made. Chairman Steve indicated that we should not be making determinations just because we think it might be a problem; carbon filters are expensive. Dr. DiGiovanni indicated that since we are on the front line and will be receiving complaints back, the committee should receive a heads-up of what is going on. This could be receiving minutes. Also, in the recommendations, it should be noted that there was a short turnaround time to evaluate the project. Chairman Steve indicated that Cortland County is not that big; if only 12 complaints are received…Ms. Lewis interjected that the 12 complaints is an average number; some years we have had many more complaints, and they have been investigated. She has no problem with the committee receiving the material. She will tell Dan Dineen to add the committee to the distribution. Chairman Steve indicated that there are not that many companies in Cortland County that would make it difficult to determined from where the odor is coming. Recently, there was a permit application by Suit-Kote regarding tanks. The interpretation is that is making the tanks smaller, there would have to be carbon filters on each of the tanks. If the study was done and we know the odors are coming from there, our recommendation would be solid and we would know what needs to be done to solve the odor complaints. Mr. Willcox asked at what point does the dollar amount of a recommendation to a company raise a red flag. Ms. Lewis indicated that not in the Health Department, but perhaps in other agencies the cost raises a red flag. As far as the Health Department is concerned, dollar amounts do not play in to the process. Dr. DiGiovanni indicated that is appears that we need to speak to the Planning Department and he agrees that the dollar amount should be taken in to consideration. Chairman Steve asked what has been done recently on this project. Ms. Lewis explained that she has spoken with DEC and they are sending the application back as incomplete, requiring emissions testing on the project. Mr. Willcox asked if this is subject to an individual’s interpretation of what is required. Ms. Lewis indicated that she would not call it interpretation, but it is recommendations. Chairman Steve indicated that perhaps the DEC should be at the CRC meetings when it is applicable for them to attend. He feels that they would be happy to send a representative. Ms. Lewis said she could check; she does not know if Mr. Dineen invites DEC or not.

4. Cathy Feuerherm, Director of Patient Services/Children with Special Needs, regarding the Speech Language Pathology and the meeting with schools and service to Rackers target population. Dr. DiGiovanni asked if the plan is working and what the implications are. Ms. Feuerherm indicated that we need more; there are five children on the waiting list at this time. There are about 300 sessions a week to serve the children, which is 10 to 11 FTEs. We have 8 ½ to 9 FTEs in the community at this point in time. CMH came on board in the fall and started to accumulate a caseload, which maxed them out fairly quickly. CMH is looking to see if they can increase the SLP to a full-time FTE. The mandate is to serve EI kids and we are required to keep sufficient contracts for Pre-K kids. We meet the need for EI kids but we are at the maximum right now. There are two prospective contractors in the works, but we are awaiting insurance, etc. Dr. DiGiovanni asked if we are getting any school SLPs who are looking to provide services. To date, Ms. Feuerherm has not heard from anyone at the schools about providing services. Ms. Feuerherm indicated that Homer’s SLP is not interested in providing services at this time. Mrs. Tytler asked how effective we are at providing services to children in the rural areas. Ms. Feuerherm indicated that we are providing adequate services and no children in rural areas are on the waiting list. Mrs. Tytler indicated that Racker will be adding a part-time SLP with the autism program. Will that impact us by taking someone away or will it provide someone who would be willing to provide services to us. Ms. Feuerherm indicated that Racker intends to use in-house staff. Dr. DiGiovanni asked if the waiting list is because there is lack of personnel to do the job or Racker/CMH doesn’t have additional staff to put on the task. Ms. Feuerherm indicated both impact the program. Her experience is that we will always need more staff. Mrs. Tytler asked if we have run advertisements; she hasn’t seen any. Ms. Feuerherm indicated that we haven’t advertised in a while; people know we are looking by word of mouth. Mrs. Tytler and Dr. DiGiovanni indicated that it isn’t working; perhaps we should advertise and perhaps we should write to all of the providers in the County asking if they will help. Dr. DiGiovanni asked from a financial statement, does CMH’s willingness to increase to a full-time FTE indicate it is working. Ms. Feuerherm indicated it is working for CMH financially; numbers wise in the past it has been cost-effective for us to provide the service with employees; with the 40% fringe, this year it will be fairly close. One of the proposals she hears in discussions is that the County should just hire a SLP to do HeadStart only, which would be a way to decrease the overall numbers. Dr. DiGiovanni indicated that this is a strategic way to meet the needs as opposed to a remedy to the current situation. Dr. DiGiovanni asked where we are in meeting with the schools and discussing coordination of services, such as transportation. Ms. Feuerherm indicated that she meets monthly with the staff who are on her level. She would be happy to facilitate something at a higher level; she would be happy to go where the committee desires her to do. If we are talking about superintendents, the request would be better received if it came from the Chairman of the Committee or the Chairman of the Legislature. Dr. DiGiovanni indicated that some in-house coordination, data collection, etc. must be done before we can coordinate a meeting with the schools. Dr. DiGiovanni is looking for Ms. Feuerherm to provide some insight on to what CPSE can do better or differently (e.g. schools not dealing with an irate parent). Ms. Feuerherm will start the process by e-mail with Dr. DiGiovanni and Chairman Steve. Mrs. Tytler indicated that if we don’t have enough providers in the community and if we are paying a substantial amount of money to transport children out of the community, we then need to look at the dollars we would save by not transporting the children and offering seed grants to providers to start up services in the community. There is a meeting on February 23 with a provider from Broome County who is willing to come in to the community and provide services. Dr. DiGiovanni feels that letters need to be written to our Assembly representatives about the rates that are being imposed because the Racker Center is commencing an autism program.

5. Activity reports from each division of Health Department.

Ms. Lewis reviewed the activity report for her division. Smoking complaints are half of the complaints they received in January. The division is working on the annual report and the strategic planning. Dr. DiGiovanni asked if comparisons could be added to the report, but absent a comparisons, please note when something is unusual (e.g. high or low). Ms. Lewis indicated that violations of the Clean Indoor Air Act are going out and some are high as they are repeat violations. Mrs. Tytler asked about the housing complaints for January. The total is six but the subcategories are three. Ms. Lewis indicated this is to reflect the complaints about heat.

Ms. Beach reviewed the activity report for Caring Community Hospice of Cortland. She indicated that she is presenting the Quality Assurance/Quality Improvement Report, as well as the Performance Improvement. Dr. DiGiovanni asked about in-hospital care. Ms. Beach indicated that they are serving hospital patients who are headed for a nursing home but there is no bed available. Mr. VanDee complimented the program on the work they are doing. Ms. Beach indicated that they are recruiting for on-call staff.

Ms. Lambert reviewed the activity report for the Jacobus Center for Reproductive Health. Mrs. Tytler asked about getting a standalone fax for the JCRH, since faxed medical records are being received on the copies. Ms. Lambert explained that two divisions are utilizing the copier/fax, and it would be better if they could have a dedicated fax. They have the fax machine from before if they can get permission to utilize it. Mrs. Tytler is concerned about compliance with medical records. Chairman Steve indicated that the records could be sent to a document file that can be accessed by a password. Dr. DiGiovanni asked if we couldn’t have Rob Corpora to address the issue. Mrs. Gailor indicated that with faxes of a medical nature, you don’t always know when the faxes are coming. Chairman Steve indicated that the equipment can alert you when a document is received. Ms. Lambert will follow up with Data Processing.

Ms. Parson distributed a new report this month. She has found previous reports boring and not reflective of the work the staff does in the unit. This will provide the committee some background on the work they do and explains the reasons they do things. She would like feedback on whether this is what the committee wants.

Ms. Feuerherm reported on the Nursing Division. She spoke about the appointment of the professional advisory board. She also addressed the financial statement and indicated that she was pleased with January receipts. She addressed the issue of families being able to remain in the EI program until age 5, which will have extensive fiscal implications for the County. Dr. DiGiovanni asked if there were any changes on the Professional Advisory Board and Ms. Feuerherm indicated there are not any changes. These appointments are done by the Board of Health.

6. Jackie Gailor, Director of Public Health, regarding Goals for the Health Department. Mrs. Gailor distributed her listing of goals for the department.

7. Legislators’ goals for committee to be discussed.

Mr. Willcox indicated that he feels Environmental Health should be evaluated; 23 out of 25 counties don’t have Environmental Health Departments, we should look at what the State can provide at no cost.

Mr. Willcox suggested placing a Suggestion Box in the Health Department, with 20% of any cost-reduction going to the employee who suggested the cost-cutting measure.

Mr. McKee feels that we should look at joint meetings with any Boards that have representatives from this committee (e.g. Community Service Boards, Hospice Board, Board of Health, etc.). He feels it was a good experience when this committee meet with the Board of Health.

Mr. McKee feels the financial reports should have not only the current year to date but last year’s year to date for comparison purposes. Mrs. Gailor is working on this report, following the format by DSS. Chairman Steve would like to see these reports across departments and the reports should be web based.

Mr. McKee would like to re-visit the Environmental Health study.

Chairman Steve would like every program evaluated. How are we doing it; why are we doing it; what players are needed to do it better. An example would be the utilization of the SLPs. Evaluate each program independently.

Chairman Steve feels we should look at a total restructuring of the facility – e.g. Mental Health Clinic rental, Horizon House, the layout of the Health Department. How we could better utilize it perhaps with a health care facility.

Chairman Steve indicated that he needs a representative from the Health Department to serve on a communications committee for emergency services in the County.

Mrs. Tytler would like to look at pre-school – there is a huge opportunity to save money as a County and a huge opportunity to improve services. We have young children traveling outside this community on very long bus rides. There are several issues within pre-school that need to be looked at (e.g. staffing, provision of services, shortage of service providers, transportation, etc.).

Mrs. Tytler also believes we need to look at dental services in this community. We should look for every opportunity as a County to support dental services in the County. Mrs. Tytler asked if can look to the STRPDB and the Apalachin Regional Commission for funding for dental services.

Mrs. Tytler would like to see the Health Department and related program expand their interest in outcome-related issues (e.g. bandage coverings, which cost more but result in fewer nursing visits and better health for the patients). She believes this will improve service while saving us money.

Mrs. Tytler would like to see the physical space of the health-related departments evaluated.

Mr. VanDee would like to see us look at all agencies to see if there is duplication of services. Perhaps the development of some subcommittees to do some of this work.

Mr. Cornell would like to see us looking at cooperative efforts across agencies (via e-mail).

Mr. Cornell would like to see the impact of the Governor’s Budget evaluated for impact on the County (via e-mail).

Mr. Cornell would like to see us support full-staffing levels of the Health Department (via e-mail).

Dr. DiGiovanni feels we need a high-level strategic planning meeting involving the schools in order to meet the need within a reasonable cost structure.

Dr. DiGiovanni indicated that there will be monthly Committee Chair meetings following Legislative Sessions to see where we are with goals.

Dr. DiGiovanni would like a listing of cost-savings priorities from the County Administrator.

Dr. DiGiovanni would like to see feedback from the committee members on the items that were discussed today. We may then need to set up subcommittees to look in to the various issues. We may need to do this by division for program reviews.

Mrs. Gailor indicated that NYSAC is putting forth that we support the budget as long as there is Medicaid relief. What is in the proposed budget is moving from an entitlement (which is what we currently have) to receiving a block grant. There is no COLA proposed in the law for this distribution. We would be held to a state-wide cap, and once we meet the cap, we would receive no further state aid. This would be based on the previous three years of funding. Jackie has not been able to analyze the impact at this point. This would take effect in 2006. The first few years, we might do well; however, as we’ve seen with DSS, the top number doesn’t increase, and down the road, the County will have to bear more and more of the administrative costs.

Dr. DiGiovanni asked how the committee felt about today’s meeting format, with the Division Heads in attendance to provide reports. Mrs. Tytler likes to have them here; however, she wants to be certain we are utilizing them in the best format possible to get the information we want. We need to be clear about what we want the exchange to be. Dr. DiGiovanni indicated that the activity reports needs to include comparative information. Mrs. Tytler indicated that the numbers are valuable; however, she would like more information on issues they need the committee’s support on or a heads up on what is coming. She can read the numbers without the Division Heads being present. Dr. DiGiovanni asked Mrs. Gailor if she felt we should start with division reports or if we should start with resolutions. Mrs. Gailor feels that it would be better to have the resolutions processed first and then have the division heads give their reports. Mrs. Gailor indicated that she feels unless there is a need for their presence, JCRH and Hospice only come when an issue needs to be discussed. Dr. DiGiovanni indicated that he doesn’t want to have to wait to have staff called if there is a question. Mrs. Gailor indicated that if there was an item to be discussed, the Director of Hospice or JCRH would be present.

The meeting adjourned at 9:45 a.m.

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