Cortland County Health Committee

 

Minutes

7/9/08

7:30 AM

County office building room 304

 

 

 

Meeting called by

Mrs. Tytler @ 7:31 AM

 

Type of meeting

Regular Committee

 

committee Members present

Carol Tytler, Chairman; Sandy Price, Vice Chairman; Larry Cornell; John Steger; Dan Tagliente; Kathie Wilcox; Steve Dafoe

 

attendees

Dennis Whitt, County Auditor; Mark Suben, County Attorney; Jacquie Gailor, Health Dept.; Mike McKee, Legislator; Brianne Parker, Secretary I

 

Not present

Scott Schrader , County Administrator ; John Daniels, Chair of Legislature

 

Ms. Price moved for the adoption of the June 11, 2008 minutes as printed.

Seconded by Mr. Cornell.

All members in voting favor, none opposed; minutes approved as printed.

 

 

Agenda topics

 

Resolution ~ Health

NO.1 Authorize Agreement/Accept Funds Health Department/Environmental Health Rabies Program

 

Discussion

Ms. Tytler called for a motion.  Mr. Tagliente moved the motion.

Mr. Cornell seconded.

 

 

Ms. Gailor introduced the item as the mandated rabies program which the state pays for. 

Ms. Tytler inquired if the department is still keeping things in freezers at different locations.

Ms. Gailor stated that the department has a refrigerator at the Highway Department in a shed that was built several years ago. 

Ms. Tytler asked Ms. Gailor to explain the situation to Ms. Wilcox.

Ms. Gailor stated that when there is an incident where a human is exposed or possibly has been exposed to a rabid animal’s bite, then we take the animal (if it’s able to be contained) and send it to a lab to be tested for rabies.  She stated that they have a three to four day window to get the results back.  If the animal can’t be contained and there is no known history of the animal, then the person will have to be proactively treated for rabies.  If the animal is positive for rabies, then the person would be treated accordingly.  She stated that this year she was unsure of how many animals were sent to the lab, but knew that two animals came back positive for rabies.  She stated that one animal was a small brown bat and the other was a raccoon.  She said that the two positive instances had been since the end of June although they have been sending animals throughout the year.  She said that it has not been a year where rabies has been prominent.  She explained that rabies is a cyclical disease that has certain periods of time when it seems that animals that carry the disease get killed off.  She also explained that there may be small outbreaks of the disease and it will increase and then becomes a huge problem. 

Ms. Tytler asked her to explain the refrigerators.

Ms. Gailor explained that when an animal is picked up there is a period of time before it gets mailed out to Albany to be tested.  The animals are refrigerated before they are sent out.  The animals used to be stored in the refrigerator located in our office.  She stated that skunks tended to make the whole building smell.

Ms. Tytler stated that was the reason why the refrigerator was moved over to the Highway department.  They were more tolerant.  It was better than having the animals stored in this building in the lunch room refrigerator.  The result has seemed to work for all parties involved. 

Ms. Tytler asked if there were any more questions or concerns and called for a vote.

 

 

 

Conclusions

All members voting in favor; None opposed; Motion carried.

 

 

 

 

 

Resolution ~ Health

NO. 2 Authorize Agreement Cortland County Health Department ( Nursing Division) Secure EDI

 

Discussion

Ms. Tytler called for a motion.  Ms. Price moved the motion.

Mr. Cornell seconded.

 

 

Ms. Gailor explained this is a software company that they have been using to bill Fedelis, which is our Medicaid managed care provider in the county.  The service has been free of charge.  As of July 1, there was a charge of $45.00 per month.  Last month a new software program for nursing was approved.  She stated that some of the things they do in this particular program are they bill Fedelis to Article 28: EMT center for their clinics.  She is unsure whether the billing will be able to be done through the Home Care packet.  She said that Jack had been looking into free software that would provide a billing program in the interim, but called yesterday and discovered that the software would not be free to us.  She was unsure what would happen if the software for Home Care didn’t cover that piece.  She stated that the proposed agreement would bind the County to a charge of $45.00 per month.  She stated that they didn’t have to use the software, but wanted the committee to know that there would be an out clause in the contract that states when there is another replacement, they would use that software. 

Ms. Tytler added that many times when a packet is purchased, like the one purchased for Home Care, there are modules included in the packet.  There may be a possibility that the department could utilize a module to add the needed component.  There may be a fee to get the module, but she doubts that it would be an ongoing fee.  She asked Ms. Gailor to explore that option and keep the committee updated.

Ms. Tytler asked if there were any more questions and called for a vote.

 

 

 

Conclusions

All members voting in favor; None opposed; Motion carried.

 

 

 

 

 

Discussion ~ 2006 Annual Report- Mental Health

 

 

 

Discussion

Ms. Tytler introduced the discussion on the 2006 Annual Report for

the Mental Health Department.  She informed the committee that Mr. Kilmer had contacted her.  She asked the committee to recall that Mr. Kilmer came into the position half way through the year in 2006.  Now that he is settled, he is looking at the situation and realized that there was no annual report done for 2006 during the transition.  She stated that the 2006 report was completed and he is working on the 2007 report, which should be received shortly.  She thought that the report was supposed to be submitted for the meeting and is going to check with Ms. Morgan to see if she has received them.  She asked Mr. Whitt if he had the same understanding.

Mr. Whitt stated that in his opinion the annual report is more of an operational report for the department.  He questioned if that was the report Ms. Tytler was referring to.  He stated that there are a couple reports that are submitted besides the annual report for the Mental Health Department.  One of the reports is the fiscal report which is for financial auditing purposes.  He stated that particular report was timely.  He stated that he was not aware of the requirement for an operational report, but there was a report filed in regards to finances. 

Ms. Tytler replied that all of the mandatory things had been completed. 

 

Conclusions

Ms. Tytler ended the discussion by stating that other departments

use the report as narrative about the department.  She then asked Mr. Cornell if he would like to discuss the issue he had presented to her before the meeting or if he would like to wait. 

Mr. Cornell stated that he would like to discuss the issue in executive session.  He makes a motion to enter executive session in regards to personnel issues.

 

*** Committee into Executive Session *** Motion moved by Mr. Cornell, seconded by Mrs. Wilcox. *** Committee adjourns Executive Session *** Motion moved by Mrs. Price, seconded by Mr. Cornell.

Discussion ~ Intensive Case Management – Mrs. Price

Discussion

Ms. Price begins the discussion stating that she had met with some

individuals about an issue in regards to Intensive Case Management (ICM).  She stated that there is a possibility that ICM may end by the end of this year as we know it.  The reason she has been given is that there have been some changes in the regulations, a possibility for more changes and there has been a decrease in referrals.  The individuals she met with would like an opportunity to address these issues and if possible turn them around.  Ms. Price stated that she cares about their jobs, the community, and the people ICM serves.  Ms. Price reminds the committee that these individuals are chronically mentally ill neighbors and residents of Cortland County that need these support services to maintain independence from a hospital, institution or jail.

Ms. Tytler stated that she was contacted and had originally thought that Mr. Schrader and Mr. Kilmer had sat down with the individuals to tell them their jobs had been cut.  She said Mr. Schrader and Mr. Kilmer informed her that was not the message they had been conveying.  She also stated that there are clearly financial issues associated with this matter along with the decrease in referrals.  Her comment to Mr. Schrader and Mr. Kilmer was that the committee should be made aware of these issues before individuals are calling stating their job has been cut.

Ms. Price commented that it was a surprise to her and Ms. Tytler when they were at lunch when an individual approached them and said their job had been cut; as they were unaware there was a problem to begin with.

Ms. Wilcox expressed her concern about not being made aware of the issue.  Inquired if it was the decision of Mr. Schrader and Mr. Kilmer to cut the jobs.

Ms. Tytler responded that she believed as administrator’s to the program, Mr. Schrader and Mr. Kilmer are looking at all the factors involved and will make a decision to move in that direction of continuing the service or not.  She has requested that Mr. Schrader and Mr. Kilmer to put together a report that would encompass the following areas: number of staff involved, number of people served, and a 5 year financial outlook because they have commented that the program has been losing money for awhile.  She stated that as a legislator if there is a program that has been losing money and is at risk of being cut or defunded she would like to know.  She stated that she previously asked Mr. Troy if there could be a 1 to 2 page report produced through the Budget and Finance committee that flags or highlights these issues.  The report would provide a “red flag” list of the programs that are struggling financially or are not getting the volume of business they had been.  She stated that the committee should not be caught off guard by these situations.  She said she assumed that Mr. Schrader and Mr. Kilmer could put together a report of this nature and possibly present the information at next month’s meeting.  Ms. Tytler stated that this probably would be one of the programs that would have some cuts to funds from the State.  She is not aware if the changes will all be in regards to regulations, funds or the volume of services.

Ms. Gailor asked if she could comment.  She explained to the committee that the issue was also brought to the attention of her department.  She wanted the committee to know that Home Health Agency follows some patients that utilize the ICM program.  She stated that there is always an ICM manager present during the visits due to the fear that the staff would not be able to serve the client.  She has found it best if someone is with the client that understands them and relates to them.  These individuals are able to keep the client calm during the visit.  She stated that this does not pertain to all the clients they serve, but the department staff has depended on the assistance from the ICM program.

Ms. Tytler informed the committee that her advice would be to inform individuals that may call that the issue has been brought to the attention of the legislature, a formal report has been requested and that no decisions have been made at this time. 

Ms. Price expressed her thoughts to the committee. She stated first that in the 1960’s and 70’s there was an option to be institutionalized and there were programs available to assist individuals in the hospitals financially.  Once again the responsibility is shifting to the municipalities, which she stated makes her believe there will be a change in funding.  She is also concerned about the timeframe of the change.  She wondered if next month’s meeting would be diligent enough if things were to change in December.

Ms. Tytler stated that there needs to be a plan in place in case the service changes.  She does not want individuals to just be cut off from the service.

Ms. Price stated that she understands that change is difficult for this population of people and suggested that the decision be made with a lot of thought.

Ms. Wilcox questioned how cutting the employees would affect the program.

Ms. Price responded that Mr. Kilmer had stated that because of the training and skills the employees have, they would be a possibility they would be able to transfer somewhere else.

Ms. Tytler inquired if the transfer would be within the county.

Ms. Price responded that it would depend on a few factors: openings, pay scale, comfort level, and job duties.

Mr. Whitt commented that those issues do arise.  The main issue that must be alleviated is that a decision has already been made which is not the case. 

Ms. Tytler suggested that the best action would be to get everyone involved together and present all the accurate information so decisions can be made.

Ms. Price inquired if there were other programs under this committee or another committee that are at risk.

Ms. Tytler stated that this situation has been a red flag.  There needs to be a way to keep the legislature informed about at risk programs.  She also stated that the State occasionally makes a decision that no one can anticipate.

 

 

Conclusions

Ms. Tytler said that the process would begin with gathering all the

information and present it at next month’s meeting.  She asked if there were any questions and respectfully asked for a motion to adjourn.

 

Meeting Adjourned

Motion to adjourn by Mrs. Wilcox @ 8:18 AM.  Seconded by Mr. Cornell.

Special notes

 

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