Cook County Board of Commissioners 
Health & Hospitals System Committee Meeting
March 16, 2021

Following two public comments urging that additional vaccination sites be set up in the western and southern suburbs, coincidentally, the presentations by both the Department of Emergency Management & Regional Security and the Department of Public Health (“DPH”) focused on the criteria that has been used in establishing County-sponsored vaccination sites in the suburbs and how this is changing.  Both Departments acknowledged the need to provide more vaccination opportunities in the southern and western suburbs and said that they expect, with the promised increase in vaccination doses, to be able to do so.

• Executive Director of Emergency Management William Barnes explained that the County started by looking at large sites in order to be able to get as many shots in arms as possible.  Convention Centers were looked to, such as the one in Tinley Park.  Began rethinking as heard from communities wanting their own sites, as well as the Federal and State governments now also wanting to be involved.
• Currently looking at large commercial sites, such as big box stores, which are located all over the County and are very flexible (can use large or small areas as required), have lots of parking, generally are easy to locate, and often accessible by public transportation (all key factors).
• But also looking at other alternatives:  know that while about 40% of people happy to go to large sites, the rest prefer smaller sites.
• CEO of Cook County Health Israel Rocha, Jr. said that currently there are more people wanting the vaccine than those needing more education about it.  He touted the number of contacts from residents to the vaccine web site, www.vaccine.cookcountyil.gov, and the vaccine hotline, 1-833-308-1988.
• Dr. Kran Joshi reported that 18% of suburban residents have received at least 1 vaccine shot and 9% have received 2. 
• A Mobile Vaccination Strategy is in place to help reach more places, with a pilot successfully conducted in Maywood recently.  More are scheduled.
• Dr. Rachel Rubin reported that the DPH finally has a significant workforce in place to do contact tracing.
• DPH presented its 1st quarter report (Item 21-0798) which focused on its grants of $5 million to 42 community organizations to help educate and vaccinate people and of $1 million to 5 worker centers to help reach temporary workers over the 6-month period from Dec. thru May.  With more funds coming, DPH expects to continue the efforts through the end of 2021.

DPH also told the Commissioners that it had received reaccreditation in Feb. for the next 5 years.

Priscilla Mims, Observer

Cook County Board of Commissioners Committee Meetings 
February 24, 2021

Cook County Health and Hospital  Committee 

• In a public hearing, CEO Israel Rocha, of Cook County Health and Hospital System, and Dr. Rachel Ruben, of the Cook County Department of Public Health, gave updates on the COVID vaccine program.  Information included website improvements for scheduling vaccines, locations to get vaccinated, the distribution of vaccine system, and current numbers of those vaccinated in Cook County.  There are 11 large and 145 small vaccine locations in Cook County.  These include major sites in Tinley Park, Triton College and newly opened New Trier High School.  There is also a partnership with Walgreens, Osco Drug, and Mariano’s Grocery pharmacy.  The call center receives about 12,000 calls per day.  In the last month about 105,000 residents have been vaccinated with at least one dose.
• Cook County Commissioners’ questions and concerns were addressed. Regarding Chicago residents using Cook County locations:  this is a reciprocal arrangement designed to quickly vaccinate as many people as possible; about 30% of Chicagoans and 30% of suburban residents have been vaccinated by the other entity.
• Numerous  programs and outreach have been developed to encourage minorities and other hesitant residents to take the vaccine.  About half of these communities are not inclined to be vaccinated.  There is no charge to anyone for vaccines and tests, but insurance companies may be charged an administration fee.  Group 1c (those 16-64 years of age with co-morbidities) will likely be added mid-to late March in Cook County.
• In other business, the committee passed a Resolution to Assess Needs and Improve the Quality and Effectiveness of Behavioral Health Care Provided by Cook County Government (21-1189).  A 2015 study found that behavioral health visits to emergency departments (ED) in Illinois are the largest growth category of ED visits.

Finance Committee Meeting--

• Cook County CFO Amar Rizki gave an overview of the property tax levy levied by Cook County government.  The base levy has not changed since 1994 ($720,000,000).  That and other revenue sources make a total of $784,214,215 for the 2021 budget.  Because of the tough budget year (COVID and business closures), two of seven categories will not be funded this year—Corporate and Capital.

Finance Subcommittee on Litigation 

• Regarding the Inspector General’s recommendations for the Board of Review:  the issues related to Shakman-type practices have not been resolved by the Board of Review.  There will be a special meeting next week to discuss these problems.  It is not known if this will be a public meeting.

Observer -  Karin Hribar

Cook County Board & Finance Committee Meetings
November 24, 2020

The Board

• Unanimously passed the $6.9 billion budget, as amended (Agenda Item 20-4595).
• Unanimously passed an amendment to the Property Tax Relief Ordinance which provides that late fees will not be assessed for any payments of the 1st installment of the property tax bill, still due by March 2, that are made on or before May 3; and that late fees will not be assessed for any payments of the 2nd installment, still due by Aug. 2, that are made on or before Oct.1.  This amendment is in recognition of the pandemic and the financial toll it has taken on many residents and businesses (Agenda Item 20-5643).

The Board met immediately after the Finance Committee, which passed 19 amendments unanimously to amend the budget.  Many of these amendments were “technical” in that they simply made budget neutral changes to reflect either corrections to the Executive Budget or to reflect new information since the Executive Budget was presented in mid-October.  The following changes were the most substantive:

• As a result of identifying additional revenues from the State, 48 positions were restored to the Chief Judge’s budget, including positions in the Adult Probation Department, and 41 positions were restored to the Juvenile Temporary Detention Center (also under the Chief Judge).
• Funding to continue to operate the Morton East Clinic under the Cook County Health's (CCH) budget was found by making some adjustments to other line items in that budget.  Commissioner Anaya, one of the sponsors, stressed that this Clinic has been a vital health center for the high school and the surrounding community, and is an entry point for other CCH services.  Commissioner Anaya emphasized that there should not be a single model for providing health care within the County, but that different models are needed for different communities.  Key is to engage the public in each community to find out what their needs and preferences are.  Many of the other Commissioners thanked Commissioner Anaya and Commissioner Aguilar, the other sponsor, for finding the money to keep this clinic open.  During the public comments at the various hearings on the budget, this was among the issues raised the most often by those seeking its continuation.

Following the budget passage at the Board meeting, some of the comments included:

• President Preckwinkle stressed that the 2021 budget, which contains no new taxes or fees, was possible because of many years of hard work and hard votes by the Board.  The Administration and Board have stuck to a long-term financial plan, rather than look to one-time solutions.
• Commissioner Sean Morrison cited the past actions which included extra payments to the Pension Fund of $2 B (which led to a higher bond rating for the County;) the increase in the Fund Balance over the past years from $30 M to $479 M, which allowed this year’s budget to be balanced by taking some money from that Fund Balance; and the Board’s funding of technology which has allowed the County departments to continue operating remotely during this pandemic.
• Commissioner Kevin Morrison reminded everyone that the Administration presented a balanced budget after having to close a $400 M deficit.

Observer:  Priscilla MIms

Cook County Finance Committee Departmental Budget Hearings
November 4, 2020

Cook County Health (CCH)

Proposed 2021 Budget - $3,387B                             Proposed FTES for 2021 - 6743
2020 Budget Amount -  $2,824 Billion                   2020 Budget FTEs - 6601
Difference - Increase of $653M (20%)                     Difference - Increase of 142
​
Highlights of Presentation and Questions:

• The increase in the 2021 budget is primarily due to the increase in County Care membership which affects both revenue and expenses and the staff increase for the County Jail due to Covid-19 requirements. Layoff’s occurred in the summer of 2020 to reduce the year’s deficit. Any additional union job cuts will likely result in filling openings in other areas.
• The increase in the 2021 FTE's is due to Covid-19 requirements at the jail, managed care, and hiring 91 permanent employees to replace Agency temporary hires.  . Commissioner Degnan asked that the projected savings by bringing agency positions in house be tracked to include not only compensation but benefits.  
• County Care Revenues for 2021 projected at $2.2 billion due to increased enrollment due to Covid-19 and employer layoffs.
• Overtime costs are expected to come down from a 9% of payroll high in 2020 to 6% in 2021.  And Commissioner Suffredin highlighted the System’s focus on improving the “prior authorization process” to reduce denials and thereby increase revenues.
• During this four-hour meeting, there were surprisingly few questions about budget numbers.  Most of the Commissioners were very concerned about service impact to their constituents.  There is only one service elimination.  The in-patient pediatrics which averages a little over 2 patients per day is suspended for fiscal year 2021.  Originally, CCH said it would be eliminated, but has now changed to suspended, likely due to internal and external pressures.  Interim CEO Carey and Interim Budget Chief Gibson held their ground on the necessity for and the reasoning behind service cuts.  
• Most of the questions were about clinical care especially mental health services and the consolidation of south side’s two ambulatory clinics into the Provident Clinic affecting approximately 9,000 patients.  
• Interim CEO Carey gave a clarion call that something has to be done about charity care stating that CCH cannot continue to absorb the more than $312 million in charity care costs [$320 in 2020 due to COVID and people staying home].
• The reversal of the Affordable Care Act was also a topic  In its budget presentation, the System estimated a loss of approximately $600 million annually in County Care capitation revenue, another at least $100 million annually from other Managed Care providers, and an increase of $700 million annually in uncompensated care costs.  
• Regarding the public’s concern about the Morton School Clinic, Carey said the System is very close to closing on an agreement to transfer services.  And the Lurie Partnership is taking over the services at the Child Advocate Center.  
• All Physical Therapy services will be centered in space developed in Harrison Square, which is the name now given to the old Stroger Hospital Building.
• Of the approximately 5,000 inmates at Cermak, it is estimated that 2,000 are listed as having mental health issues.  Very little discussion on the COVID-19 contact tracing but a hearing has been requested I believe by Commissioner Suffredin on this issue.
• An unknown for 2021 is the potential impact on the CCH System if Mercy Hospital closes for both regular and charity care patients.

Observer – Diane Edmundson                                                     Length of Meeting - 4 hours

Cook County Board Committee Meetings
October 21, 2020 - Committee Meetings were held from 9:30am-2:30pm

Items of Interest: 
Health & Hospital Committee: 

• The 2020 2nd Quarter Report for the Public Health Department was submitted. In the report it was reported that there have been 70,000 Covid19 cases and 2000 deaths attributed to Covid19. The positivity rate is 7% and trending up in all age groups. Disparities were noted due to structural racism. Federal policy has generated fear among the undocumented, making them reluctant to seek medical help.  County level risk metrics were blue in August but now back to orange.  The CC Health System has responded to 10,000 requests from the public. CCH is partnering with other agencies to expand rapid testing for Covid in coming weeks. They are also staffing up for increased contact tracing.

Legislation & Intergovernmental Relations Committee
Agenda Item 20-4191 - Final Report on Merger of Recorder of Deeds Office with the Office of the County Clerk

• During the meeting there was an extensive discussion on the transfer of jobs from the Recorder of Deeds Office to the office of the County Clerk.  Union representatives were present to object to the fact that employees of the Recorder’s office were being forced to reapply for jobs with the Clerk. Their collective bargaining unit, along with their jobs, will be terminated on November 30 when these two offices merge. The union objects that Recorder employees must compete with outside applicants for the positions that will now be within the Clerk’s office. Many employees have a good deal of experience/seniority and feel that they are being unjustly treated.
• Several commissioners expressed surprise that the merger was not proceeding as seamlessly as they had believed. The HR representative reminded the commissioners that the merger was  complicated by Shakman and by Covid. Also, the positions of the two agencies are not a simple “apples to apples” process when it comes to hiring. She did make a commitment that those who were hired by the Clerk would not lose their seniority or their salary. Approximately 20-25 jobs will be cut. It was hoped that these could be absorbed by attrition/early retirement. 
• Clerk Yarborough has requested a legal opinion from the States Attorney. Commissioner Suffredin recommended deferring action on the ordinance until this opinion is obtained.
• The report on the Clerk’s office assuming duties of the Recorder was accepted with no discussion at the October 22 Board meeting.                          

Cook County Board Of Commissioners Meeting
October 22, 2020          Meeting Length - 3 hours 15 minutes

Key Items Addressed by the Board: 
Agenda Item 20-4204    
Mr. Israel Rocha, candidate for the Cook County Hospital’s CEO position,
        received the blessing of the Cook County Board on October 22, 2020. His 
        offer package included a base salary of $650,000 plus a 10% performance-
        based annual bonus opportunity. The industry’s standard severance package
        of one year was reduced to 20 weeks.  CCH Board President officially intro-
        duced Mr. Rocha, though he had met most of the 17 Commissioners prior to
        this meeting. While taking longer than the expected six months to identify
        and vet the final candidate, it appears that the Cook County Board and the
        Hospital Board are in strong agreement that they have found the right person.
        Mr. Rocha has experience in all of the responsibility areas he will assume as
        CEO, including: Public Health, A Managed Health Care Plan, Forensic Medi-
        cine and an Ambulatory Care Network.
In his remarks, Mr. Rocha said that he wants to create a leading model of care
        for Cook County.  He offered the following six goals toward that end:
        1. Operate a safe and clinically sound system of care
        2. Responsive to patients’ needs
        3. Take bold steps by breaking barriers to achieve equity and inclusion
        4. Ensure fiscal and financial resilience
        5. Be known as the employer of choice and the provider of choice
        6. Be known as a leader in the advancement of medicine as a human right.

Agenda Item 20-3562    The Board voted a substitute for the Proposed Landlord Tenant Ordinance
        and then discharged it from the Finance Committee and referred it to the
        Zoning & Building Committee. This ordinance is meant to establish the same
        rights for all renters and tenants throughout suburban Cook County as those
        currently enjoyed by citizens of Chicago, Evanston, and Mt. Prospect.

Agenda Item 20-4872    A resolution was passed stating the Clerk of the Court should collect $150 on
        all mortgage foreclosure filings to be used to support a plan to save residents
        from eviction and mortgage foreclosures. The Illinois Supreme Court authorized
        the collection. Passed unanimously.

Agenda Item 20-4814    The Board unanimously passed a resolution to forgive loans made by the 
        County under the program established to deal with Covid. The County can use
        CARES money from the federal government as long as it is done before the end
        of December.

Agenda Item 20-3431    The Board approved appointment of Joseph M. Harrington to the CCH Board.

Agenda Item 20-4202    The Board passed an ordinance by President Preckwinkle to establish a 
        Property Assessed Clean Energy Program & Area. It is to finance the acqui-
        sition, construction, installation or modification of energy projects. 

Agenda Item 20-4684    The Cook County Board honored Dorothy Brown on her retirement from 20years of service as the Clerk of the Circuit Court. 

Commissioners praised the Coronavirus report (9-30-20) as a great resource. The distribution 
of funds was broken down into four areas: 1) direct costs, 2) workplace redesign, 3) economic
development and 4) grants to local governments (due by October 31).

Observers: Georgia Gebhardt and Diane Edmundson                   

Cook County Board of Commissioners Meeting -  Sept. 24, 2020​

Key Items Addressed by the Board:                      

• 20-4302  Extending Disaster Proclamation through Dec. 31, 2020. Motion made by Com. Daley and seconded by Com Suffredin.  Com Daley stated Pres. Preckwinkle has continued to hold conference calls with department heads and staff to answer questions of commissioners and provide requested information.  Com Suffredin affirmed the prudence of the extension in light of continuing need to access resources to address the recession and Covid19; he stated no abuse of power has occurred.  Com Britton stated it is necessary for county to be “nimble” in its responses. Com. Morrisson questioned why technology could not allow us to operate without this extension. Another concern was that not enough meetings were held to address Covid19.  Commissioners are receiving monthly statements from the Budget Director. Passed.  Aye-13  No-3. Present-1

Moved by Com. Suffredin, seconded by Com Britton, and approved to take up out of order the recommendations of Legislative and Intergovernmental Regulations Committee the 3 items below. Then moved by Suffredin and Britton to concur with the recommendations of that committee.

• 20-3428 Appoint Raul Garza as Director to Cook County Health Board for a 4 yr term.  Approved
• 20-3433 Appoint Robert Currie as Director to Cook County Health Board for a 4 yr term. Approved.
• 20-0016  Approve as Substitute Proposed Amendment to Office of Inspector General.  This included a new provision requested by the LWVCC to have quarterly reports from the IG Office submitted as Board agenda to receive and file or refer to Litigation Subcommittee. It also includes clarification on minimum qualifications for the IG position and allows the president with approval from the Board to reappoint the existing IG for a 2 yr term. It adds a requirement that before the IG would issue a written public statement regarding an investigation that found inefficient or wasteful management, the IG must first submit this to the affected department and allow the department to provide a written comment within 10 days to be issued (and any response by the IG) with the written public statement. Passed.
  

• 20-4289 Re-appointment of Patrick Blanchard for 2-yr term as Inspector General. Moved by Com Suffredin and second by Com. Britton.  Commissioners expressed support of past work of IG Blanchard.  Passed.
  
• 20-4259 Proposed Cook County Health (CCH) Preliminary Budget FY2021. Move to approve by Com. Deere and seconded by Com. Arroyo. One question was whether this was supposed to go first to committee.  It was explained that the purpose of the document is to see the hospital budget for substantive issues, format. The budget can be discussed after it has been received by the President’s office. The CCH budget becomes part of the Cook County budget to be defended by CCH later in the budget process. Debra Carrie, Interim CEO, spoke to a question of the dollar value of the budget.  She stated the tax allocation for 2021 would increase $40 million over 2020 allocation, making it $123 million for FY2021. Approved.

Other item of note:

• Clarification was made regarding roll call votes and voice votes in virtual meetings.  Per the Open Meetings Act, all actions require roll call votes.  Motions for referral of items can be voice votes since the actual action takes place in committees.

Observer:  Carolyn Cosentino                                        Length of Meeting 3 hr 32 min