Cook County Board of Commissioners 
Committee Meetings 
​March 13, 2024


FINANCE SUBCOMMITTEE ON LITIGATION
During the public comment period, the League of Women Voters of Cook County expressed its concern that the position of the Cook County Independent Inspector General (“IIG”) has not been filled on a permanent basis for 17 months.  

• The prior Inspector General retired in October of 2022.  The League said that the General Council of the Office of the IIG has ably served as the Interim IIG.  However, the League stated that having this top position along with one of the two Deputy positions not being filled on a permanent basis for so long must be having a detrimental impact on both the work and personnel in this small, but critical office.
• The League said it would like to know that the process of filling these two positions has been moving forward and that the public will soon be hearing about the appointment of a new IIG. 
• Commissioner Britton, Chair of the Subcommittee, said he will follow up to see where the process stands.

Observer:  Priscilla Mims  

AUDIT COMMITTEE:
County Auditor Mary Modelski presented her report on Grant Administration and general Management at the Justice Advisory Council (JAC) in fiscal year 2022.  No audit had been done in at least 10 years.  The report (item 24-1025) included only grants administered through the operating fund budget (about $14 million in 2022) and excluded any ARPA grants, which will be looked at later.
    Issues brought up in the report or by Commissioners included the following:

• JAC did not use their own rubric for grant distribution, instead used their own discretion, so some higher ranked applicant organizations were not fairly considered.
• Documentation of grants, reporting mechanisms, mis-filing of information, fund tracking, and payment procedures are concerns.
• Site visits to check on grant funds use needs to be regularly done with a check list and agenda.  Also visits need to check on accuracy and effectiveness of the service provided by the organizations—validation.

Four recommendations were made by the Auditor:    *

• need to update, from 2018, the policies and procedures they use regarding the grants distributed
• ensure funding documentation is collected, stored, and retained appropriately—currently not consistent
• improve tracking of funds distributed
• structure a fraud awareness program

These were accepted by the JAC—to be completed by May, 2024.  JAC will also use the Federal Government ARPA’s (more strict) standards on all grants going forward.

The Audit report of ARPA on the Small Business Grant Program showed adequate controls on the $50 million distributed to 3,000 small businesses in Cook County.  $18 million more will be granted out by 2026.

Building Healthy Communities ARPA grants of about $5 million were also audited.  Because of a change in designation of recipients (from sub-recipients to beneficiaries), these grants were not required to be monitored. Commissioners were concerned that no metrics, risk assessments, or financial monitoring was done. The Public Health (PH) department wanted to get the funds out upfront and quickly as COVID was prevalent at that time.  The grants were intended to increase access to healthy foods, youth development, mental and behavioral health.  PH department was told by Commissioners they should establish base-line monitoring so the county knows where the funds went and what the outcomes of the programs were.

RULES AND ADMINISTRATION COMMITTEE:
    There was a lot of discussion among commissioners and the staff of the Dept. of Human Rights & Ethics (HR & E) regarding the rules for the public to follow on the recently passed Paid Leave ordinance—effective for private businesses since January, 2024.  Concerns by some Commissioners were

• The public local governments that will have to follow this ordinance by January, 2025, have not had time to give their input on these rules. HR & E wants the rules made public now so businesses have knowledge of how to follow the ordinance; changes can be made later. 
• There was concern that the rules were not contained in the ordinance when passed (quickly) last year.  This ordinance goes further than a similar law at the state level, which did contain the rules.
• Questions arose on how specifically to amend these rules at a later date—Counsel explained process.
• Several commissioners noted they had numerous complaints about the ordinance, especially from school and park districts that hire part time employees for only part of the year. 

The vote to accept the public-facing rules (24-1181) was very close:  4 Yes, 4 Present and 1 absent.  PASSED in committee.

ASSET MANAGEMENT COMMITTEE:
    Item 24-1056 regarding a lease in Sauk Village for a new restorative justice court was passed in committee.  Both the Public Defender and a representative from the States Attorney office seem to have smoothed over any concerns by commissioners from 2 weeks ago when those offices sent a letter stating they could not staff a new court this year.  All involved will “continue conversations,” so it seems to this observer that behind the scenes agreements were made that the lease go forward and any problems would be dealt with later.

What to watch for:

• ARPA funding monitoring
• Paid Leave ordinance rules and any amendments to the ordinance

Observer :Karin Hribar

Cook County Board of Commissioners Committee Meetings
February 28, 2024

Technology Committee:

• Various County Departments and Offices gave their Strategic Goals for Technology advancement. However, any observer watching via ZOOM could not see any of the reports shared by the various departments as they were not posted. 
• The Tech Department of the County is ready to use AI for various aspects of County work, but will not do so until the Board approves.
• Concerns by Board members on use of AI included:  racial bias and discrimination, expanding the surveillance state,  protecting residents with current policies such as sanctuary cities,  misuse, profiteering, misinformation, and that the current workforce not be decreased.
• Concern by some Board members of the costs of maintaining the legacy mainframe system due to continuous delays.
• Board of Review presentation highlighted modernization of website enhancements and other user upgrades  (TALEO for hiring, electronic signatures, etc)  There is still a lot of controversy in this Office regarding moving from an old computer system to the new Tyler system that the other tax offices are using.  The old system requires double entry to correlate with the other offices.  However, the next round of property taxes will be on time.
• Assessor says their complete upgrade will be ready to go live during the 3rd quarter of 2024.  Treasurer has become very efficient using technology automation—no longer using “paper.”
• Court System (Sheriff, Clerk, Clerk of the Court, Chief Judge, States Attorney)—all of these offices are in varying stages of fully moving to the more modern Tyler system.  Some goals for 2024:  provide WIFI in all courts, fully integrate with the other offices, get new tech vendors, security measures, data point mapping.

Rules and Administration Committee and Legislation and intergovernmental Relations Committee: 

• The paid leave ordinance (24-1181), which would give one hour of paid leave for every 40 hours worked up to 5 days per year, was deferred since some more changes need to be made for local governments who cannot afford to incorporate this requirement.  Many speakers were against this ordinance and a few for it.  An amendment to align with State law is being considered.  The amendment to the Paid Leave Ordinance (24-1233) was also deferred.  As a note:  after this meeting, the new substitute ordinance was listed as exempting ALL government entities from this paid leave requirement.  Essentially only private business will need to follow the ordinance.

Asset Management Committee: 

• Several Commissioners questioned why a lease for a new Restorative Justice Court in Sauk Village was being proposed when both the Public Defender and States Attorney sent letter stating they could not staff that new court in this budget year.  After a lot of questioning and controversy it was agreed to defer this item (24-1056) until the next meeting so that correct information could be obtained.

Environment and Sustainability Committee: 

• This Committee convened at about 4:30pm.  Six persons gave public testimony; five against and one for the Coal Tar Sealants Ban Ordinance (23-5769) Of the opponents of the ban were two employers, Coppers and Sealmaster, one representative of the Pavement Coatings and Technology Council, one lobbyist for the Chemical Industry and one employee in the industry. The only speaker for the ban represented the 40,000 members of the Friends of the Chicago River.  All speakers referenced studies supporting their positions.
• Having received additional information, which affected the wording of the proposed Ordinance after being placed on the agenda, the Committee stated that they would be deferring a vote on the Ban until the March Board Meeting. The Board accepted item 23-5769 Ban on Coal Tar Sealants, then accepted new wording for the proposed ban and finally deferred item 23-5769 as substituted.
• Deferral was requested by the sponsor of the Ban due to unexpected consequences on some industries and further substitution may be made to the wording before it is brought again before the committee.  The vote approved the deferral. The Committee adjourned immediately at 5:00pm

What to watch for in the next meetings:  

• Coal Tar Ban Ordinance
• Paid Leave Ordinance
• Sauk Village Court Lease
• Board of Review technology migration

​Observers:  Karin Hribar and Victoria Cerenich (Environment and Sustainability Committee)

Cook County Board of Commissioners
Health and Hospitals Committee Meeting
February 27, 2024                        1 hr. meeting

Dr. Erik Mikaitis, Interim CEO of CCH and Dr. Rami Doukky, Chair of Cardiology & Interim Director of Heart Institute at CCH presented Health Disparities Semi Annual Report, June 2023-December 2023. The slide show from this presentation is available online at
 cook-county.legistar.com/calendar.aspx. Look on the Attachments for this meeting’s entry.

The Heart Institute is developing its scope of care from prevention to critical care. CMS shows the heart failure rate of readmission within 30 days which is better than the national average, in the 10th percentile. Com. Trevor noted that is especially impressive since they see patients further along in the disease. The statistic indicates good care. In 2023, the American Heart Association awarded them twice with Gold Plus recognition in heart care. These start the list of recent accomplishments at the Heart Institute.

Outpatient services expanded, including outpatient cardiology care and palliative care. Three new clinics have been added. They have introduced the CardioMES, a pulmonary care tool that transmits data every night relative to pulmonary pressure.  A team can intervene and contact patient; decreased need for readmission when in use has been proven here. 

Access to testing and timeliness of results have increased.  Comprehensive ECHO lab has been accredited by a national organization.  Cardiac CT and Cardiac MRI have been introduced. Cardiac PET will be added in Fall, 2024.   Referrals for services are now coming from UChgo Medicine. Patients are now being sent to CCH because of the services and care available, rather than solely as the resource for uninsured patients. Connections with other hospitals are being developed.

 A list of less invasive procedures introduced since 2021 was given. Minimally invasive procedures have helped grow cardiology services. A steady increase of 10% yr. is expected. These are examples of access to a higher standard of care now available to patients. 
Examples: 
-Transcatheter Aortic Valve Replacement (TAVR).  Prior practice would have been to send the patient elsewhere for this or perform open heart surgery with all its risks. 45 cases have been performed.  This TAVR option provides access to an equitable standard of care, with less time in hospital, less cost, less morbidity, reduced risk of adverse events.  
-Left Atrial Appendage Occlusion (Watchman). This is superior to blood thinners which are associated with bleeding.
-Trans Catheter Mitral Care (MitraClip).  This clip is used for leaking valve which if left untreated can lead to heart failure.  It is especially valuable for patients who are not candidates for open heart surgery.  Introduced in 2023, 20 procedures have been performed so far.

A new clinic program, Heart Disease in Women, will be opening will opening in Fall, 2024.
24-0403 was received and filed.

Slide show of presentation is available online in Attachments for Meeting Details.

Observer: Carolyn Cosentino

Cook County Board of Commissioners Health and Hospitals Committee
​Public Hearing
​February 27, 2024                                         Meeting Length: 1 hr. 25 min. 

Dr. R. Garza CCH Board of Directors Chair introduced Brian Barton and Dr. Greg Vaughn. They were representing the firm Spencer Stuart, which is conducting the search process and were present to hear priorities and address questions. Many of the points of concern, they stated, had also been expressed to them by the Cook County Health (CCH) Board.  Commissioners agreed on these and many others.

The discussion included the following points of concern:

• The 9% of agency hires is a financial burden and discouraging to employees who see agency coworkers earning higher salaries. Staffing is a responsibility and must be seen by next CEO as an important priority.
• Susan Avala, representing 7th Dist. Health Task Force, stated concerns over turnover in leadership, need for staffing using fulltime employees so they have sufficient training to address medical needs of clients.
• Diane Palmer, SCIU union, pointed to the financial burden of agency workforce; CEO needs to recognize the needs represented by unfilled positions. Staffing goes beyond doctors and nurses. 
• Experience in public health systems is needed, showing a commitment to it.  Concern about the position as a steppingstone was repeated by many.  
• Prioritizing mental health/ behavioral health services is needed. Treatment is an important tool in many cases when police have become the only available option. 
• Christina Terell, mental health specialist at Cermak facility echoed this concern noting overreliance on agency workers has negative impact on workload for rest of staff.
• Julia Jacobs, for 25 yr. a mental health worker, stated new CEO must value developing technology so that patients have access to tools.
• Understand value of flexibility to address quickly shifting needs we confront. 
•  Understand systems interface with functions of others in Cook County
• Importance of equity needs in disinvested communities must be recognized 
• Background in business administration of healthcare is useful

 The following information is a portion of what commissioners were told when they asked about the process.

• The process generally takes 5-6 months from start to finish.  Discussions with CCH Board have begun. 
• Vaughn stated confidentiality is very important for candidates in the process.
• Asked what happens if you feel you don’t have the ideal candidate among the ones interviewed, Mr. Barton stated we want to bring. you the top candidate. If necessary, we relaunch the search. We are here until you are satisfied with the final candidate.

Observer : Carolyn Cosentiino