Cook County Board of Commissioners
Committee Meetings
December 18, 2024

Criminal Justice Committee
The meeting began with 45 minutes of Public Comment from advocates and family members of those persons who have died while incarcerated at the Cook County Jail. Comments focused on the need for better procedures to ensure the health and safety of persons while they are incarcerated. Also requests for more transparency and better notification procedures when deaths occur. 

​Public Comment was followed by a presentation from representatives of the Sheriff’s Office and Cook County Health (Cermak Hospital) to educate the County Board about the policies and procedures in place to address the health and safety of detainees. (Agenda Item 25-5416) The following points were made during the presentations:

• 40,000 people per year cycle through the Cook County Jail System
• In 2023 44% of inmate deaths involved drug soaked paper
• Initial assessments for health risks and medications are done on all individuals when they go through intake
• The Sheriff’s Office has programs for individuals with Substance Abuse and/or Mental Health Issues as well as anti-violence and anger management programs. 
• Naloxone is available across the compound and training of personnel is done. 
• Attempts are being made to review all mail so that drug soaked paper does not get into the jail. 
• Cermak does initial assessments on approximately 82 persons per day

Commissioner Questions and responses:

• Comm. Quesada asked for the numbers of deaths and cause of death. In 2024 there have been 10 deaths and in 2023 there were 18 deaths. In 2024 2 were natural causes, 1 overdose, 1 suicide, 2 homicide, 1 accidental overdose and 3 undetermined to date. In 2023 there were 6 from natural causes, 8 overdoses, 1 suicide and 3 homicides. He also asked about the procedure known as “cross watching” which is when staff have to oversee more than one unit. Response was that it does occur when staffing is not adequate. It is not prohibited but also not ideal and is used judiciously when necessary.
• Comm. Anaya asked how the jail and the health system collaborate to ensure that individuals receive the care they need while incarcerated. Inmates are assessed for health needs when they enter the system and can request health services anytime if they want to. Cermak îs not an emergency facility but they will respond as necessary but also outside emergency services are enlisted when necessary. 

Legislative and Intergovernmental Relations Committee

• An amendment to the Board Rules was proposed requiring that any reports and documents pertaining to board agenda items must be attached to the original filing of the item. If not attached initially they must be filed 48 hours prior to a meeting or the item must be withdrawn, deferred or referred to committee. (Agenda Item 24-6376) The item was approved. The League of Women Voters of Cook County did submit written comments to the board supporting this amendment. 
• A technical amendment to the Paid Leave Ordinance was approved to address some of the concerns that school districts have been raising with this ordinance. (Agenda Item 24-6496) Comm. Britton stated that he has been attending municipal meetings over the past few weeks and more entities are opting out of the County's Paid Leave Ordinance. He said that by not excluding Park and School Districts from the ordinance it has probably resulted in fewer people being covered than was originally intended. Comm. Morita said that they will continue to work with the school districts to ensure that their concerns are addressed. 
• A representative from the Assessor’s Office presented an Update on “split-classed, commercial mixed-use properties” -  a new definition for the sub category of 3-18 under multi-use Class 3 property assessments. (Agenda Item - 24-6504) This classification addresses properties that have commercial space as well as residential space and considers square footage as well as % of living space vs commercial space.  Several speakers spoke during the Public Comment at the beginning of the meeting about the tax burden being placed on certain small business owners due to the reclassification of 3-18 properties in the last assessments. The presentation outlined the process the Assessor’s Office used to change the definition of the 3-18 to address the concerns of the 30 property owners in the south suburban area and the city who will benefit from this change. In the next assessment of the northern suburban area there could be more properties that will be affected.  

Finance Committee

• During the Cook County Health Financial Report, CCH reported that there has been a 14% decrease in the utilization of agency workers throughout the system, an initiative that Comm. Degnan and  Anaya have been pursuing. Comm. Gainer asked whether this was a sustainable decrease and what factors changed to allow this to happen. CCH staff stated that salary adjustments and reassessing staffing needs/requirements were key. Also some agency employees are converting to County employees which is expected to result in a savings. Comm. Gainer also requested information about how much the agencies are paying their contracted employees and how much the agency is keeping. CCH said they would attempt to get that information.

Observer - Cynthia Schilsky

Cook County Board of Commissioners
Health and Hospitals Committee 
December 17, 2024, 1:30pm
​
Dr. Hasbrouck, head of Cook County Public Health, did a presentation on Data Collection through a Health Equity lens. 

• He emphasized fast versus slow data collection and explained why it took so long for some data to appear (up to two years delay).  The slow data is more trustworthy than the fast data.  Data from 2022 is now available in 2024.  National Data and Illinois Dept of Health data is likewise as slow as Cook County for many health statistics.  The reason data takes so long to be accurate is that it needs to be “cleaned” and analyzed.  He said there were many examples of the same individual going to multiple Cook County clinics with the same health concern, and CCH has to make sure they are not double or triple counting that same person.  In many cases the clinics are reporting data by fax or paper rather than entering it via a spreadsheet.
• Ways to access health data for CC, include the apps, Health Atlas and Shiny.
• Com. Anaya wanted to make sure CC and Chicago were synced better than they are now.  Dr. Hasbrouck said they meet on a regular basis and the data would be available on Health Atlas in the next 3 to six months.
• Com. Daley wanted to know why COVID results were available so much faster (week to week) while current data takes years.  Apparently COVID reporting was mandated while other data is not, by Illinois Dept of Health.  Daley also asked how citizens can learn about health stats, and Dr. Hasbrouck says they help produce newsletters and work with the 31 communities within Cook County.
• Com. Trevor asked about early warning signs like wastewater testing, and Hasbrouck said those and police data are gathered by their data contractor.
• Com. Aguilar was also concerned about data timeliness.

Observer - Amy Little

Cook County Board of Commissioners 
Health and Hospitals Committee Meeting
November 20, 2024


The Committee approved a nonbinding resolution that Cook County Health's (CCH) agency-hired personnel should not exceed 20% of the budgeted full time equivalents (FTE) personnel for each job classification approved in the annual budget.

• Prior to the start of its formal agenda the Committee heard 20 minutes  of testimony from 5 CCH union workers regarding support of Resolution 24-5841.  Impacts of having many agency employees working in the hospitals included reduced permanent staff morale and productivity.  Staffing shortages were attributed to lower pay and no sign-on bonuses for permanent hires compared to agency personnel.  Disrespectful behavior of agency personnel toward staff and patients were also noted as issues impacting patient returns for treatment. 
• There were comments against the Resolution. 
• Resolution 24-5841:  Chairman Lowry, Vice Chairwoman Anaya and several Commissioners spoke in favor of the Resolution and thanked Commissioner Degnen and her cosponsors for working with the local union representatives and hospital staff, drafting the Resolution, and then amending it to define specific goals and timeframe to meet them.  Resolution 24-5841 was approved 14-0 with 3 absentees.
• The amended Resolution 24-5841 Goal is to reduce the CCH System’s agency staff levels to not exceed 20% of the budgeted FTE in every department within 5 years.  Progress updates will be provided to the Board of Commissioners, Board of CCH, and the public via biannual reports and an annual hearing.  The Resolution will sunset in 2029 (or sooner if compliance is complete).

Mr. Craig Williams, CCH Chief Administrative Officer, presented the CCH Agency Reduction Plan’ (Oct 2024). 

• While the system-wide agency use is ~10%, several departments contract >20% of staff from agencies, including out of state companies
• FMLA backfilling is often addressed using agency staff
• Job classifications utilizing 20-50% agency staff include Hospital Security, Nurse, Respiratory Therapist, MRI Technician, Medical Technologist, Phlebotomist III, Building Service Worker, Clerk, Food Service Worker, and Transporter
• CCH will add budget for departments who have exceeded budgeted FTE to right-size them;  new agency FTE additions have been paused
• Permanent staff turnover is improving (7-8% vs. 20% US average) as is personnel engagement 

​Observer - Susan Gregory                       

Cook County Board of Commissioners
Committee Meetings
November 20, 2024   

Finance Subcommittee on Litigation 

• A Public Speaker stated that he objected to the proposed settlement of his complaint against the Board of Review for his termination.   He wants to be reinstated as well as having a monetary settlement.
• The Commissioners discussed all items before them in closed session and voted to receive and file.

Audit Committee
 24-5692  Proposed Fiscal Year Audit Schedule
Mary Modelski, Auditor,  reported that the 2025 schedule will include among other audits:

• ARPA programs
• JAC grant utilization to check controls previously recommended have been implemented
• Chief Judge case management system
• Procurement
• Forest Preserve financial processes including concession revenue.

Legislation and Intergovernmental Relations Committee
24-5896 Proposed Changes to the Vacation and Excused Absence with Pay ordinance.
There were several public speakers that addressed this proposed change to the ordinance.  The current ordinance applies to full time, part-time and seasonal workers in Cook County.  It requires that employers allot 1 hour of paid leave for any reason for every 40 hours worked in a 12-month period. The amendment would exempt school districts and park districts.
Several representatives from suburban school districts and park districts explained the problems with the current ordinance:

• For many teachers and others who work under existing contracts, these days are in addition to those agreed in the contract.  This results in more time the regular teacher is away from the classroom.
• When those contracts are renegotiated, these days will be included, probably at the cost of sick days.   Teachers can accumulate sick days toward their requirement, so they will lose some of that benefit.
• It requires more substitute teachers who are in short supply.   The cost of the substitutes is increased.
• Park Districts will have to cut the number of young people hired during the summer because of the increase in cost.
• Home rule municipalities can opt out of this ordinance and then the schools  and park districts within its boundaries would be exempt.  However, many school districts and park districts cover more than one municipality and so there would be unequal treatment of employees. 

Speakers from Women Employed and the Shriver Institute spoke in favor of keeping the original ordinance as it gives a benefit to the lower earners.
Commissioner Sean Morrison pointed out that the Illinois State Law on paid leave exempts school districts and park districts.
Commissioner Britton reiterated the issue of some municipalities being able to opt out while others can’t.   He pointed out that this will have more of an impact on southern and western suburbs who have fewer home rule towns.   This could result in higher property taxes. 
The Commissioners who did not support the change acknowledged the issues for the districts, but felt it was more important to protect the lower income workers across Cook County.  
The ordinance amendment failed to pass.

Observer:  Kathi Graffam

Special Cook County Board and Finance Committee Meetings
November 21, 2024

Following the Finance Committee meeting at which the Commissioners recommended 21 amendments, the Board passed the 2025 Budget.  The amendments added $53 Million to the budget originally proposed by the President in October.  The resulting total is $9.94 Billion.  Following are key amendments:

• Adds $11.58 M to the budgeted revenues to reflect the increase in the amount of TIF funds expected to be received from Chicago due its declaration of excess funds.  Then that amount was allocated to a modular pilot program ($3 M) and a downpayment assistance program ($8.6 M) for use within Chicago.  (Amend. #11 and 12)
• Reallocates $6.34 Million from the Sheriff’s budget pertaining to Electronic Monitoring (EM) to the Chief Judge’s budget (specifically, Adult Probation) in anticipation that EM that is currently done by the Sheriff will be assumed by the Chief Judge.  The offices of the two officials are in discussions about this, along with the President’s Office and the Justice Advisory Council, as reported in prior observer reports on the 2025 proposed budget.  It was confirmed that no final decision or timetable or agreed upon milestones for achieving such a transfer have been reached.  Comm. Gainer again raised the need for such milestones and for there to be regular updates to the Board.   (Amend. #15)
• Assigns $15 M from the unassigned fund balance for FY2023 to the Homeowners Relief Fund.  This Special Purpose Fund was recently created to help homeowners to pay property taxes.  (Amend. #19 and 20)
• Reallocates money within the Cook County Health budget to create a $2 M grants disbursement fund to provide wraparound services for reproductive health, including transportation, lodging and childcare.  Comm. Degnen spoke on the importance of this in light of other states which have passed laws which dramatically impact what reproductive health services can be provided to women. (Amend. #16)
• Adds 19 FTEs (Full Time Equivalents) to the Sheriff’s budget to provide 911 service for Des Plaines, Worth, and the Office of the Chief Judge.  The costs will be fully reimbursed by those receiving the services so there is no budget impact.  (Amend. #8)
• Increases each Commissioner’s total budget by $10,000 to provide a cost-of-living adjustment.  (Amend. #9)
• Adds 2 positions to the Dept. of Environment and Sustainability to facilitate implementation of environmental justice policy. (Amend. #10)
• Reallocates $150,000 from the capital budget to do a feasibility study and market analysis identifying the future use for the former Logan Square Health Clinic. (Amend. #13)

Observer:  Priscilla Mims

Cook County Board of Commissioners Finance Committee
2025 Budget Hearings 
October 30, 2024, morning

Cook County Health – Dr. Erik Micaitis, CEO
    2025 Proposed Budget:  $5.247 Billion
    2025 Proposed FTEs:      7,809

The Cook County Health System (CCH) provides patient care to all residents and immigrants regardless of ability to pay.  Locations include Stroger and Provident Hospitals, the new Bronzeville family health center, an HIV-AIDS clinic, and 12 community health centers throughout the county.  CCH also provides health care at the Cermak Jail, the Juvenile Temporary Detention Center, and through its Managed Care Insurance Plan known as CountyCare.  CCH reported that over 600,000 patients walked through its doors this last year. The following shows the totals for the Health Enterprise Fund only (exclusive of Special Purpose Funds and Grants)
​                                     
                              2025 Proposed Budget        Proposed FTEs:
   Public Health:                      $24 M                       125
   Managed Care:                $3.189  B                       435
   CCH [all other]                $1.933  B                       6,766
   CCH   TOTAL                   $5.146  B                       7,326

Highlights from the Presentation and Commissioner Questions

• Pam Cassara, Chief Financial Officer, noted that the budget and priorities for the budget is based on the 7 pillars set forth in the 2023-25 Strategic Plan:  (1) Patient safety, clinical excellence, and quality; (2) Health equity, community health and integration; (3) patient experience; (4) growth, innovation and transformation; (5) Optimization, systemization, and performance improvement;(6) Workforce talent and teams; and (7) Fiscal resilience.  
• As Commissioner Lowry said in his closing remarks, the two items most emphasized by Commissioners were the reduction of contracted (agency) help and keeping the Cook County Board apprised of expanded services.  
• The Provident replacement question came up several times, but with Cook County doing a review in 2025 of all properties, there are no plans for 2025 other than changes already anticipated such as the move of family, maternal, and pediatrics healthcare to the near-by Bronzeville facility, the increase in surgical cases, and more emphasis on cardiology.
• Commissioners repeatedly questioned by line item the increase or decrease in headcount.  The most common reason given was the re-allocation or centralization of headcount (for example, behavioral health employees).  There is no increase in the total headcount of 7,326 from 2024.
• For Contract hiring, monthly reports have been initiated as both the Commissioners and the CCH Human Resources Dept. have made the reduction of contract hires a top priority.  There are 581 vacancies for nurses out of a total of 1835 positions.  Maintenance personnel are also difficult to find.  Commissioner Degnan noted that operations headcount was used for other hires.  She expressed concern over neglecting equipment, infrastructure systems, etc.
• Job fairs have been a big success with a 71% offer acceptance rate.  And the pilot that allows to immediately offer a position at fairs will be continued. More outreach to Macomb Community College has also begun for nursing graduates.
• There are 113 bi-lingual positions across the system in all types of positions.
• A Doula RFP to advise, inform, and offer emotional and physical comfort to a pregnant person before, during, and after the birth of their child. is in the works this month, and the rollout will begin in 2025.  Commissioner Miller is very interested in this expanded service.
• The Public Health Department noted that ARPA funds are being used to hire/place Behavioral Health specialists at every CCH site.  It is also investing ARPA funds into community organizations to provide behavioral health services to CCH patients.
• Housing for the homeless is an important issue for Commissioner Quezada.  He noted that the homeless population has increased 12% nationally and asked for data on how many homeless individuals come thru the system.  CCH will get back to him on the request.
• Dental care was another issue for several Commissioners. The challenge in filling positions at each of the 12 health centers is staffing:  I dentist, 2 assistants, 2 hygienists and 2 registration clerks are needed at each site.  The plan is to have 3 sites with dental services by the end of 2024, and 3-4 more sites with services by the end of the 2025 summer.
• Clinical trials are being brought in-house.  The Hektone contract will end in March of 2025 and research work will increase.  CCH will be adding investigators and researchers.  When asked if this move would impact Grantors continuation of grants, Dr. Mikaitis said that four funders have already agreed to continue, and CCH expects the remaining to continue when their current grants expire in 2025.
• When asked what the System is doing to attract more patients to in-house services, staff noted that the jail population is being encouraged to continue with CCH after release; a new marketing plan is encouraging CountyCare Insurance customers to use Stroger, Provident, etc.; and the influx of immigrants also is a potential pool.

Meeting Length:  Over 4 hours in total

​Observer:  Diane Edmundson