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

Cook County Board of Commissioners Committee Meetings
September 18, 2024 

Finance Committee

• Meeting reconvened from July 31, 2024. Motion to Receive and File FY 2025 Preliminary Forecast Report Period 12/1/20203-11/30/2024 from Dept of Budget and Management Services was made by Com. Lowry and seconded by Com. Britton. Passed with unanimous aye vote.   Meeting Length: 41 Seconds.
• Finance Committee.  Motions were made by Com. Lowry and seconded by Com Britton for 2 resolutions addressing uses of ARPA funding. Both passed.  Healthy Community Program Initiative (24-2908) includes guidelines amending the subrecipient agreement with Il Public Health Institute to increase funding by $8M from current agreement. Also approved was Resolution to Authorize the Use of Mortgage Foreclosure Mediation Special Purpose Fund to Support the Mortgage Foreclosure Mediation Program (24-4131). Com Trevor made the motion and Com Britton seconded the financial reports be received and filed from Comptroller and CCH. The 8-month Comptroller report (24-4901) showed a net favorable budget variance to the General Fund of $148.9M. The State Revenues Update through July 31, 2024, shows the state owes $139.5M to the County. Cook County Health CFO Pam Cassara reported $110M favorable balance for the first 8 months of 2024(24-4901) 
• The Health Fund showed a favorable net budget variance $76.3 M. 
• Meeting Length:  14 min.

Transportation Committee.

• Supt. Killen was present to explain all contracts and extensions to Transportation Commtt.  Supt. Killen provided an explanation for the proposed ALPR system. Resolution 24-4292 authorized the approval of Automatic License Plate Reader (ALPR) to permit installation on county roadways; it can identify make, color, and license plate information on vehicles to assist local law enforcement and Sheriff’s Office in crimes such as child endangerment and missing persons. Personal information is not included. State regulations exist regarding lawful use of images and information.          
• ​Meeting Length 13 min.

Observer: Carolyn Cosentino

Cook County Board Of Commissioners Committee Meetings
September 17, 2024

AUDIT COMMITTEE
Although not on the Asset Committee agenda, at its September 19 meeting, the board approved a Professional Consulting Service contract with Iron Mountain Information Management to develop a materials and records storage assessment, implementation plan, and digital files/digitization.  The contract is for $1.2 million and the duration 16 months until 1/31/26.
Auditor, Mary Modelski, reported that several items from the 1st quarter were closed and that during the second quarter progress is being made with the "employment reimbursement process" and with the Clerk of the Court "traffic citations".  She went into more detail on the recommendation to Consolidate the Grant RFP Process stating that a stakeholder process was established in August to work on centralizing the grant management system.                                                                                                     
#24-3722 - the ARPA Fixed site emergency shelter report for people experiencing homelessness.   Two hotels are in the process of being purchased to house the homeless.  ARPA monies were used to provide a 30-year loan which will come due in 2053.  The Audit Department recommended the monitoring process needs to be improved and defined for the long term.   Comm. Daley asked that the Audit Department add this specific ARPA project to its regular auditing schedule.  Currently, it does not follow up on ARPA grants
#24-3681 - The Audit Department conducted an audit of the Work Order System in the Facilities Management Custodial Services Section.  It specifically recommended that the work order system be defined:  what it is and what it covers or not. Three recommendations were made: Under policies and procedures, how staff is assigned; Under standards, spell what specifics to help with efficiency; and get better metrics from its “Famous Compute System”, specifically regarding staff shortages.
#24-3949 - ARPA Hyperfocal and In-Home Vaccination and Vaccination Incentive Program.  The COVID vaccination incentive program of the gift cards received scathing criticism from several commissioners.  12,000 $100 cards were purchased and 8,000 distributed.  Blackhawk, the card vendor reduced the value of the card each month it wasn’t used by $6.00.  There was no contract but an emergency purchase order, and the Chief Counsel has demanded a reimbursement, not just on the remaining balance but the entire purchase order amount.

LEGISLATIVE & INTERGOVERNMENTAL COMMITTEE
During a very short meeting, the committee approved the appointment of Patricia N. Jjemba to the Juvenile Temporary Detention Center Advisory Board, and approved a resolution offered by Commissioner Gordon to request that the IL General Assembly approve SB3948, an amendment to the missing persons identification act to streamline processes to allow an agency to more quickly attempt to obtain the missing person’s DNA; would require, rather than allow, law enforcement to collect additional information such as fingerprints and biological samples; and provides that a waiting period may not be observed before accepting a missing person report.
Commission Gordon also requested and received approval of her request to Urge Congress to approve the “Protect our Letter Carriers Act (H.R.7629) to enhance postal workers safety.

HEALTH & HOSPITAL SYSTEM COMMITTEE
#24-4143 – Birthday Health Screening Program. The members approved the amended resolution calling for an annual prostate and mammogram health screen at Cook County Health locations – which would be free to those without insurance or other coverages.  Cook County Health’s, Dr. Fagan, noted that black males have a 60% higher mortality rate than white males, and over 16% of CC residents are age 65 or older. 
SEMI-ANNUAL BEHAVIORAL HEALTH REPORTS
Office of Behavioral Health – Department of Public Health:   Both the Jail and the Juvenile Detention Center are increasing developing individual behavioral health treatment plans.  70% of those in the JDC are receiving therapy.  The jail is housing more individuals charged with more serious offenses; therefore, an increased number are also receiving mental and drug therapy.  Naloxone is used extensively and being more broadly distributed even after discharge.
Public Defender’s Office:  It was noted by the presenter that the Defender’s office is not a treatment provider, but does assist in identifying needs and getting help.  It will soon launch a community assist center to provide case management and clinical services as well as putting together treatment plans.  Several new mental health clinicians have recently been hired bringing the total to six.  The Office made 104 referrals in the last quarter which is on par with previous quarters.
Circuit Court:  Established guidelines in 2015 based on evidence-based data.  In its Problem-Solving Courts, Probation Officers work with collaborative, community-based services on a team basis.  Accountability is part of the program.  The presenter noted that Narcan is now available at all public libraries.
States Attorney:   Used this reporting period to highlight the issue of Petitions for Firearm Restraining Orders.  A petition is usually filed by a family member.  The Petitioner must be at least 18 years old.  The petition leads to a Writ of Detention Examination for an emergency court order to bring the individual in question to the hospital for examination.  Every effort is made to have the writ brought to a judge on the day the petition was received.
Sheriff’s Office:  The presenter talked about the Sheriff’s Smart and Thrive drug and mental health treatment center.  Participation requires a court order.  At the center during the last period, 1,000 males and 300 females participated.  The Sheriff’s office also has a community-based re-entry program.

Observer - Diane Edmundson

Cook County Board Finance Committee’s Mid-Year Budget Meetings
July 31, 2024

Following the death of Cook County Commissioner Dennis Deer (D-2nd Dist), the Democratic Party ward committee persons whose wards include part or all of the 2nd District, met and elected Michael Scott.  He will serve as the 2nd District Commissioner until December, when the winner of the November election will take office for the remaining 2 years of the term.  Commissioner Scott joined the Finance Committee for this last day of mid-year budget hearings.  

Following are some of the highlights of the meetings with the (1) State’s Attorney, (2) Chief Judge, (3) Inspector General, (4) Secretary to the Board of Commissioners, (5) Head of the Veterans Assistance Commission, and (6) Public Defender.

Meeting with State’s Attorney Kimberly Foxx

• After several years of a significant number of unfilled positions, SA Foxx reported that the office has a net increase of 40 employees so far, with 75 new graduates expected to join after successfully passing the bar exam.  This is the highest “class” in years, more than the classes from the last 2 years combined.  There has also been a 30% drop in resignations as compared to last year.
• SA Foxx attributed the turnaround in hiring and retention in part to the increase in salaries recently approved by the Board after a compensation study completed late last year.  
• Also helpful, said SA Foxx, is the office’s participation in the County’s retention bonus program this past year.  
• Finally, there is the increase in the hiring of support staff which results in the attorneys being able to spend less time on administrative work and more time on legal work.  
• SA Foxx would like to see the office continue to add to the number of support staff and technology positions, saying that in most offices there are 2 support staff per attorney, while in the SA office, it is the opposite.
• SA Foxx was asked about a recent Sun-Times story about the lack of government corruption cases brought by the SA office.  SA Foxx said the office does have a public corruption unit, but that the US Attorney’s office, which has traditionally brought most of the corruption cases in this area, has far more resources, including the use of the FBI for investigations.
• The SA office received $2.4 M in federal American Rescue Plan (ARPA) dollars for the office’s gun crimes strategy unit.  SA Foxx said that the unit was started in 2017 by putting assistant state’s attorneys in police districts which had the most gun incidents.  ARPA has allowed expansion.  SA Foxx thinks the office will be able to sustain the efforts through other funding sources once the ARPA dollars run out.
• SA Foxx said that the Pre-Trial Fairness Act, which went into effect in Sept. 2023, has had a smooth roll-out in her office.

Meeting with the office of the Chief Judge Timothy Evans

• Chief Judge Evans also had good news on the hiring front, with 23% fewer vacancies at this point as compared to last year.  He attributed the improvement to the office’s use of a new hiring system platform called Jazz HR, which prospective employees find easier to use.
• The Chief Judge reported that the program to resolve eviction cases has helped 55,000 tenants, as well as small landlords, and has been honored nationally.  
• The latest Restorative Justice Community Court has just opened in Commissioner Miller’s 4th District.  The Chief Judge said he is considering adding 4 more such courts, 3 in this next fiscal year in the 5th, 14th, and 16th Commissioner districts.
• The Chief Judge said that the pilot for extending the hours of the Domestic Violence Court for protective orders has shown him that there is a need to have the court operate 24/7.  He plans to talk to the other County officials who provide support to see if and when this can be accomplished.
• One remaining impact of Covid is the continued use of hybrid and remote hearings and other court proceedings, which the Chief Judge said offers a number of advantages. For example, witnesses can appear remotely, making it easier to get their participation.
• The Chief Judge’s web site has a number of statistics posted, including for the implementation of the Pre-Trial Fairness Act, which eliminated cash bail in Sept. 2023.  Among other things: (a) in 18% of the criminal cases, the State’s Attorney files for detention of the accused, which is granted 60% of the time; (b) of those defendants released (whether it be on their own reconnaissance or on electronic monitoring), 88% come back to court for future proceedings on time; (c) 87% of the time, the defendants who have been released pending trial are not charged with any new offenses.  Of those released, only 1% are accused of violent offenses that occur during that release.  See https://www.cookcountycourt.org/court-reports-statistics. 
• There has been much discussion with the Board in the past on the Juvenile Temporary Detention Center (“JTDC”), and this continued at this meeting.  Chief Judge Evans said that the contracts approved by the Board with Chapin Hall of the University of Chicago to identify best practices regarding juveniles accused of crimes are on track.  They are looking at creating assessment centers where youths would first be sent and then, when appropriate, the young people could be sent to a center of care that would house 10 to 20 youths, in lieu of the JTDC (which currently houses 210).  The Chief Judge wants to do a pilot program, and he has identified both an assessment center and center of care for young women, and he hopes to have one for young men soon.  
• Commissioner Kevin Morrison was very critical of the JTDC Superintendent for not knowing how many juveniles at the JTDC have identified themselves as LGBTQ.  The Superintendent said that there are opportunities for the youths to self-identify if they wish, but his concern is the safety of all those in his care, regardless of identity.  Comm. Morrison is concerned that LGBTQ juveniles are not getting the care they need, remembering the abuse that he endured in school.  After some testy exchanges, the two agreed to meet separately and discuss further, and Comm. Lowry asked to be included in that discussion.

Meeting with Inspector General Tirrell Paxton

• Under budget for the 6 mos. of fiscal year   $1,024,314 out of budgeted $1,078,193; will stay within budget rest of year
• 19 FTE budgeted; 3 vacancies—working currently to fill them
• Intergovernmental agreement with MWRD involves a payback, so a wash in budget

Meeting with Secretary to the Board Lynne Turner

• Challenges in retaining and filling vacancies (due to burn out, family responsibilities)
• 13 FTE budgeted; 9 filled, 4 vacancies (improved from the beginning of this fiscal year)
• New board room is expected to be done by Dec. 2024, but everyone needs training on using the technology, etc. so won’t be used for a while
• The room will have ADA accessibility , closed caption on video, electronic voting (have to be in the room to use it), QR code for agendas instead of print

Meeting with Veterans Assistance Commission Head Elizabeth Soto

• 11 budgeted FTE, 8 vacant
• Mainly provides emergency aid for veterans—$270,000 to 1,287 veterans so far this year 
• Under budget mainly because of hiring issues
• Grant funding from Federal government coming along well
• Commissioner Trevor and others want more satellite offices in home districts using current commissioner offices—many veterans have difficulty getting to VAC office near Stroger campus

Meeting with Public Defender Sharone R. Mitchell, Jr.

• Just under budget on YTD spent 95%—$44,588,108
• Wants lower caseloads for attorneys—still too high compared to national standards
• 828 FTE budgeted with 694 filled; 60 more will be filled by year end
• New computerized case load management system
• Have classes of newly graduated lawyers going through training in PD office to work there once they have passed the bar exam 
• Some grants have lapsed due to not getting the programming organized; Freedom Defense Center (in Austin) grant was successful; this helps integrate and support accused into programs to help with housing, work, health, etc.
• Challenges include case load amount, space issues, technology issues, hiring process issues
• Current programs being funded by ARPA should be sustainable after 2026 when ARPA ends

Observers:  Priscilla Mims and Karin Hribar

Cook County Board of Commissioners Committee Meetings  
July 24, 2024

Finance Committee

• Carrianne Carallis, Director of Research, Operations and Innovation, outlined the new process to review and revise performance management goals and measures. The objective will  be to align the measures with the stated mission of the department in the budget book.  They are going to start with the Economic Development Department and plan to review all departments under the President by the end of the fiscal year.  Then they hope that the elected offices will also participate.   Commissioner Gainer said they should address the measures in Human Resources since money is being spent to improve the process.   Deloitte is consulting with that department.   Commissioner Daley said the elected offices should be included, especially focusing on the technology programs such as in the Court system.  Commissioner Miller asked if there were standards for the Justice Advisory Council grantee reviews.  She also asked if ARPA has standards for performance evaluation.   The ARPA reporting requirements focus more on finances.   
• The County’s Fitch bond rating has improved from AA- to AA.   This will help with the impending issuance of sales tax revenue bonds.

Criminal Justice Committee

• One of the public speakers was Carlos Ballesteros, a reporter for Injustice Watch, who has been investigating the high number of deaths at the jail and urged the Commissioners to hold a hearing on the issue.
• The Commissioners recommended for full Board approval the purchase of a helicopter for the Sheriff’s Office for $11.3M. Currently, the Sherriff shares one helicopter with Chicago.   Chicago has 4 additional helicopters.   There was a lot of discussion about the cost of the helicopter’s ongoing maintenance, fuel, and pilot costs. The pilot can be a civilian and would be accompanied by two tactical officers.    There will be an additional request for money in the budget for those items.   Jason Hernandez of the Sheriff’s Office explained that they have to know the model of the helicopter to be purchased in order to calculate the other costs.  They anticipate it will be $3.1M/year. A helicopter reduces the need for high speed car chases, facilitates searches in wooded areas, and can be used for patrol and other emergencies.   It will be delivered in second quarter 2025.

Health and Hospitals Committee

• LaMar Hasbrouch, M.D. reported that they are tracking four difference communicable diseases: Covid, H5N1 (bird flu), Mpox, and West Nile Virus.   Incidences of Covid are still low in Cook County but Dr. Hasbrouch explained that the variants change and so those people who are more vulnerable should get another vaccine this fall.  
• The agency has five points of surveillance of standing water for West Nile Virus throughout the County.  There has been one case this year.   They have a program called Fight the Bite, educating schools and other groups to protect themselves against mosquito bites and eliminate standing water.

Asset Management Committee

• The department is working with vendors to install electric vehicle charging stations in suburban Cook County. The vendors will charge for the service.  There was discussion about the two power levels of the charging stations and where they would be placed.   Commissioner Moore asked that some should be put in his district as there currently are very few and that they should be the higher- level charging station that requires a shorter time for the charge, as residents would not be able leave their cars for a long period of time.     Commissioner Degnen recommended that more charging stations be put in the County buildings to facilitate the County fleet being converted to electric vehicles.

Audit Committee

• The RSM US LLP audit manager presented the report of the  comprehensive financial audit for the County.   It was a clean audit.   There were reporting errors discovered and the relevant departments accepted the findings and put in additional controls.    He stated that the workman’s compensation liability for the County is $1.3B.  Commissioner Gainer asked if he could break down the components of the pension liability increase to headcount, recent salary increases, and investment income/loss.   The auditor did not have that specific information, but thought the County analysts could provide it to the Commissioners.
• A previous finding of insufficient monitoring of systems access for employees that moved to another department or were terminated was discussed.  The controls were better in this audit.    Commissioner Anaya asked more questions about how the controls were improved.   Currently a paper form has to be completed by the supervisor and there is a 90 day completion deadline, which the Commissioner commented was too long especially for a terminated employee.

Contract Compliance Committee

• Director Mandeville reported on the current lawsuits in other states that are challenging MWBE programs and the potential effects on the County’s program.  Her department is working to help MWBE and all smaller vendors learn how to navigate doing business with the County.  They are making informational webinars open to all vendors.  The County needs to address how to make it easier for any small business to participate, such as breaking down contract amounts into smaller units.

Emergency Management & Regional Security Committee

• The executive director, Ted Berger, explained the updated multi-jurisdictional hazard mitigation plan.  125 municipalities and agencies are participating including the Forest Preserve and the MWRD.  The group cooperates in dealing with issues such as the recent flooding in the County.

Observer:  Kathleen Graffam