Meetings of the Cook County Board of Commissioners Health & Hospitals Committee
June 27, 2023

The Cook County Health & Hospitals Committee held a public hearing to examine maternal health morbidity and mortality rates, particularly with regard to Black and Latino mothers.  Earlier, the Committee held a regular meeting to deal with business, which included a presentation on the Department of Public Health’s strategic plan and an update from Cook County Health’s senior staff on the hiring situation.

Hearing on Maternal Morbidity and Mortality (Item #23-2260)

• Congresswoman Robin Kelly (IL, 2nd Dist) spoke first and said that 84% of maternal deaths are preventable!  Moreover, maternal deaths are continuing to rise.  Rep. Kelly applauded Illinois for being the first state to extend post-partum coverage under Medicaid.  She said that currently 36 states have such coverage for 12 months.
• Illinois State Rep Mary Flowers (31st Dist) told the Committee that a bill she sponsored that is sitting on Governor Pritzker’s desk to sign would help train doctors to do intubations during childbirth. (HB2820)
• Dr. Lamar Hasbrouck, COO of the Cook County Department of Public Health, explained that pregnancy-related mortality includes deaths during pregnancy and up to 1-year after delivery.  The term “maternal morbidity” refers to illnesses caused or exacerbated by pregnancy and childbirth.  The statistics for suburban Cook County are consistent with what Rep. Kelly reported:  morbidity rates went up during the years 2016-2020, with Black mothers having a 60% higher rate than White.  He said that currently they don’t know why.  With regard to mortality, overall from 2015-19, there were 24.4 pregnancy-related deaths per 100,000 live births; but for Blacks the numbers were 56.6 deaths per 100,000 live births.
• Cook County Public Health had some maternal and child programming that it wants to expand.  It wants to improve the quality and coordination of maternal care after delivery.  The Department is exploring collaborative approaches with Harris County (that includes Houston) and Wayne County (that includes Detroit).
• The Chief Medical Officer for County Care said that it has a “Brighter Beginnings” program that provides monetary rewards for mothers who come in for pre-natal and post-natal care.  Approximately 79% of the deliveries County Care handled were by mothers in disproportionately impacted zip codes. 
• Midwife Carrie Elizabeth Stewart urged that the focus for improving the situation be on healthcare deserts in the County, particularly the South Suburbs. 

Earlier Meeting
Report from Cook County Health (CCH) Senior Staff on operations (Item #23-0202, which was deferred to allow for subsequent reports)

• Dr. Israel Rocha, CCH CEO, and Valerie Amos, Human Resources head, presented a report on the hiring situation, starting by putting CCH’s experience in perspective with national.  
• The national turnover of nurses is 25.9%, while CCH’s is half that.
• The industry average for # of days to hire is 90.  Currently, CCH’s is 91, about half what it took last year.  
• Overall, CCH has 2,200 vacancies, but since December, it has actually had a  gain of 115 net hires (total external hires of 422 minus 287 separations).  
• CCH is also doing planning by analyzing how many employees will be eligible to retire (50 years or older and 30 or more years of service).
• Efficiencies in the hiring process have occurred, saving an estimated 7,023 hours of staff time this year.  For example, because the same questions should be asked during interviews, the questions are now automated.  Hiring fairs have proved to be a good tool  There have been 36 with over 1,000 attendees and 293 have accepted contingent offers there and then.
• A representative of SEIU Local 73 spoke during the public comment period, taking issue with a statement she said CCH had made that the large number of vacancies was due to lack of applicants.  She provided statistics about the number of applicants.  She said that while the time it takes to hire has improved, it still takes 102 days.  She said that the union wants to partner with CCH to reduce the number of contract hires.
• Commissioner Gainer suggested that the CCH Human Relations work with the County’s to help the County reduce the time to capture hiring information – CCH can do it in about 3 weeks vs. the 90 days the Bureau of Human Relations says it takes it.
• Commissioner Degnan was told that the majority of the positions fall under the Shakman requirements, but that CCH regularly reviews to make sure the employment plan procedures remain necessary and CCH works with the County’s Inspector General to modify if appropriate.
• Commissioner Trevor asked CCH to seek information on the number of days it takes competitors to hire.

Department of Public Health Strategic Plan for 2023-25 (Item #23-1562, which was approved)
Dr. Hasbrouck explained that this is composed of 5 elements:

• Strategic communications
• Community partnerships and collaboration
• Workforce and workplace
• Infrastructure and operations
• Integration and systems alignment

As part of the implementation, the intention is to identify metrics that matter and provide quarterly updates.  In response to Commissioner Morita’s question, Dr. Hasbrouck said that the Department meets almost monthly to coordinate with the other public health departments in Cook County, including Chicago, Evanston, Oak Park, and Skokie.

Observer - Priscilla Mims

Cook County Board of Commissioners Committee Meetings
June 28, 2023

The Commissioners had a full day of Committee meetings filled with much substance. Highlights below include

• Approval of the 12-week paid parental leave for offices under the President (not for employees who work for the other County Elected Officials)
• Differing views about the conditions inside the Juvenile Temporary Detention Center
• Updates on the status of revenues vs. expenses for this fiscal year and on the long-term revenue forecast
• Update on what the different County offices are doing with respect to domestic violence cases

12-week paid parental leave

• The Finance Committee voted to direct the Bureau of Human Resources to put together a policy for paid parental leave for 12 weeks.  To qualify, the employee must have been full-time for at least 12 months and must be a birth parent, non-birthing biological parent, intended parent of a gestational surrogacy, parent of adopted child, or foster parent placed with a foster child of 17 or younger.  Employees will be limited to 1 such leave per 12 months.  
• Commissioner Degnen, the principal sponsor along with President Preckwinkle, explained that the policy would for now only cover employees under the offices of the President.  Each other Elected County Official must take their own steps to adopt such a policy.  Commissioner Degnen said the Board can and should encourage such steps by assuring the Electeds that the Board would make sure the money was there to cover the costs of such a policy.
• Commissioner Gainer said that she had left the City of Chicago’s employment years ago because it had no such policy.  She expects that having such a policy now at Cook County will enable many good employees to remain at the County.  
• Commissioner Kevin Morrison stressed that people who opt to take this leave should know there will be no retributions as a result - particularly that they will not miss out on promotions.
• Commissioner Miller emphasized that this policy should assist in improving the significant maternal mortality and morbidity rates that the Commissioners heard about the previous day by allowing birth mothers to have the time to obtain the care they need.  Commissioner Miller also said that this policy was another plus for attracting and retaining good workers at Cook County (again referencing yesterday’s meetings where they heard about the challenges of hiring).
• The Board approved this item (#23-3117) at the Board meeting on June 29.

Conditions at the Juvenile Temporary Detention Center (“JTDC”)

• The Audit Committee held a hearing to discuss Equip for Equality’s report on conditions inside the JTDC, which is under the authority of the Cook County Chief Judge.  The Chief Judge did not speak, but was present throughout.  
• Equip for Equality (“EFE”) is the private not-for-profit legal advocacy organization designated by the Governor to operate the federally mandated Protection and Advocacy (“P&A”) System for people with disabilities in Illinois.  EFE conducted observations and interviews with staff and detainees at the JTDC and the Chicago Public School that operates there from late 2021 thru early 2023.  The full report can be found at https://www.equipforequality.org/files/jtdc_report.pdf
• EFE recommends ending the practice of isolating youths and the use of a “holding” pod for those who either act up in the school or refuse to go to school.  EFE also recommends the end of the policy of having youths in the holding pod sit “on the wall” while they are given packets of work and utilize overturned chairs as desks, all the while not being able to talk to anyone.
• JTDC Superintendent Dixon and other supervisory JTDC staff stated there was no such “policy,” but admitted that this practice is used.  Supt. Dixon explained that this is used to prevent harm to others, as well as for the youths themselves.  There are serious gang issues within the JTDC, and the youth detained there are generally accused of serious crimes, including murder and attempted murder.  
• EFE is particularly focused on those detained in the JTDC who have special needs and the failure to accommodate that in the school.  However, Supt. Dixon explained that the staff are not advised by the Chicago Public Schools (“CPS”) as to when any of the youth there have special needs.  The prior memorandum of understanding between CPS and the JTDC lapsed a long time ago and a new one is just now being negotiated which presumably would provide for such information to be given to the JTDC.

Current Fiscal Year and Long-Term Revenue Forecast

• The Comptroller reported to the Finance Committee that both the General Fund and Health Enterprise Fund have positive balances due to revenues exceeding expenses:  $162 M for the General Fund and $108 M for the Health Fund.
• Dean Constantinou, Deputy Chief Financial Officer, presented the quarterly update on the long-term revenue forecast developed by the County’s Independent Revenue Forecast Commission.  The forecast is for slow economic growth into 2024, which should have a positive impact on revenues, particularly the sales tax which, as of April, is projected to be 1.3% over budget.  As a result of projected small surpluses going forward over the next 5 years, the County’s Fund Balance should continue to be above the maximum desired under the County’s policy, resulting in additional funds being available.
• The forecast is also for revenues to exceed expenses in the Health Fund going forward.  County Care membership is expected to peak in June and then drop off.  After November of 2024, the forecast is for membership to remain flat.

Domestic Violence

• The Criminal Justice Committee heard from representatives from the offices of the State’s Attorney, Sheriff, Chief Judge, and Clerk of the Circuit Court on what is going on with respect to domestic violence cases.  The Public Defender was not available.  Prior to the meeting, Commissioner Anaya, the sponsor of the item (23-2711) calling for the hearing, had met with each office explaining what she wanted covered.
• The State’s Attorney’s representative talked about the Domestic Violence Mental Health Court pilot that started in February.  The focus is on familial conflicts with outpatient and inpatient treatment for both defendants and victims.  So far, there have been 50 cases and 5 graduates. 
• The State’s Attorney is recommending (1) technology upgrades to the domestic violence court at 555 W. Harrison, (2) creation of a shared screening data base among agencies, and (3) the elimination of paper communications.  
• The Clerk of the Court’s representative reiterated the need for a single system among the criminal justice offices, and said that there is one that all offices have access to:  the Clerk of the Court’s Case Management System.  What needs to be done now is make sure all offices are trained on using it.  The representative explained that each office still needed its own system to manage its work load – other offices, for example, should not have access to the State Attorney’s case management system.  
• Honorable Judy Rice, the Acting Presiding Judge of the Domestic Violence Court, reported that there are 1500 new cases each month, both criminal and civil.  There are monthly meetings among all the entities (DV advocacy, Sheriff, Clerk of the Court, State’s Attorney, DV Judges, etc.) and the Chief Judge’s office supports increased staffing for all.  Since the pilot program for “After Hours” Domestic Violence Court (9 pm to 3 am on weeknights and 1 pm to 6 pm on weekends) there have been 543 cases.

​Observer: Priscilla Mims