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 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

Cook County Board Finance Committee Mid-Year Budget Hearings
​July 30, 2024

9:30 am Cook County Treasurer - Maria Pappas and staff
Highlights:

• 70% of all tax bills have been paid as of today with a due date of Aug. 1
• Each cycle about 200,000 pins are not paid on time
• Overall there is a 98% collection rate countywide 
• There are those pins that are chronically delinquent - many are vacant land - an example was given that Ford Heights has 1400 pins that have not paid in 30 years
• The tax system needs to be changed and she has a Policy Group that is working with Springfield to see what changes can be made.
• Her office has done several studies that can be accessed on their website that are about the problems with the present tax structure. She encouraged everyone to read her studies.
• Many taxpayers do not understand the system or the exemptions. She has a Refund Project that will refund about 10,000 individuals this year. 
• Interest on late payments has been reduced from 18% to 9% (she took credit for this) and now has implemented a payment plan process for those who cannot pay all at once. 
• The office does outreach to all communities and has information available in a multitude of languages. 
• At the tax sale approximately 54,000 pins are offered and about 7,000 are actually sold. Most of those will end up being redeemed. 
• Setting up an AI unit that she hopes will be used to analyze date. Needs to assemble a team that will be able to mine the data

10am Cook County Sheriff - Tom Dart and staff
Highlights:

• Slowed civilian hiring to make budget
• Taking away more guns from those with revoked FOID cards.
• Doesn’t like to ticket for vehicle equipment problems. Likes to work with owners to repair the vehicles instead.
• 80% of inmates in some type of program. EX. Dog training program helps with aggression control. Agribusiness program for learning about a business. 
• Comm. Britton asked about dealing with Mental Health (MH) issues. Sheriff stated that about 40% of inmates have MH issues. Cermak deals with those who have severe issues but they didn’t have the capacity to deal with everyone so he started his own program. Talked about a possible day program at the Boot Camp for those with low level MH issues but concerns with funding and not sure if this is continuing. 
• Comm. Britton also asked about why with the jail population down there has not been a reduction in the budget for salaries - fewer personnel needed. Sheriff stated that they are still short staffed (240 positions open) and the reason the budget is not down is because of the salary increases approved by the CC Board.
• Comm. Anaya asked about licensure of those on staff working with the MI and about insurance coverage for services rendered. Sheriff stated that staff was in appropriate roles and that while services may be covered by Medicaid the sheriff does not have the ability to bill. All billing is done by Cermak. 
• Anaya also asked about Electronic Monitoring. Sheriff state that there are about 1400 now on his EM program. The number has been slowing decreasing. Any violations due to a change in the law now go to a judge who makes a determination but the judges “do not violate very many”. 
• Comm. Quezada had questions about the Co-Responder model for MH calls and questioned the Sheriff’s Treatment Response Teams (TRT) for MH calls. The Sheriff stated that getting trained professionals to respond to calls with officers proved to be too expensive so their teams use tablets that can connect someone in crisis to a MH professional. The program has resulted in a decrease in calls from some households. The sheriff also said he is tired of hearing about programs that are all talk and no action - he wants to get the right people to the door and thinks they are doing that pretty well.
• Quezada also asked about the number of inmates housed elsewhere and the cost to the county. The Sheriff stated that there are 27 inmates in other jails right now - not for capacity reasons but for safety reasons - and there is about $500,000 budget for that with about $200,000 spent to date. 
• Comm. Stamps raised the concern that the facility is not conducive to rehab for young people and wanted to know if they do research on best practices and how do they track success. Sheriff Dart said he is always looking for new ideas and success is measured by the number that do not return and the number that continue after release with the services they get connected with while in his custody. She also suggested that he consider an apprentice program with Chicago Public Schools to encourage employment at the Jail and that could help with the employment situation. Dart liked that idea. 
• There were more questions about billing for services, MH treatment for jail personnel as well as for the inmates, technology updates and the new helicopter. Sheriff said he would provide metrics on the helicopter use and the ongoing cost of housing and maintaining the helicopter. 

12:17pm Cook County Clerk - Cedric Giles and staff
Highlights:

• Now have a GPS tracking system for all election equipment in November
• New voter check-in system for November that will allow voters to update their signatures
• Sample ballots will be posted on their website
• The Recording Division has a new cashier system and they are in the process of digitalizing all records from 1871-1974.
• Commissioners were excited about the Pilot Program of partnering with the township offices for access to records of the Clerks office. Trial is running in Palatine and it may expand although no plans as of now. Also questions about using the City-Key card as an ID which at present is not okay. 

1:09 Cook County Health - Pamela Cassara, CFO, and staff
Highlights:

• CCH is presently in a favorable financial position
• 25% of the ARPA funds that CCH were allocated have been distributed and are on track to have all the funds allocated by the end of the year
• Comm. Trevor asked if CCH had the capacity to take on new patients with the present staffing shortages. Hiring is a top priority with nursing at the top of the list.
• Reproductive Health Issues - At Stroger the nursery is being removed so that they can increase capacity since newborns are now in the rooms with their moms and the nursery is no longer needed. 
• Migrant Health Services - fluctuating need as the numbers change. Can ramp up rapidly if necessary. Are providing health assessments and immunizations. 
• New outpatient facility will be opening in Bronzeville that will include Behavioral Health services.
• Comm. Stamps asked about the marketing of CCH services so that the communities know about where clinics are and what services are available. Stated that some facilities need to be upgraded (Austin Clinic). Also asked about relationship with nursing programs and asked why there was not a “direct hire” program with local high schools and colleges. CCH indicated that there is is a strong connection with the Malcolm X College nursing program. 
• Touted “My Birthday Health Program” that promotes early detection screenings for prostate and breast cancer.

3:31pm - Board of Review - Commissioners Steele, Rogers, and Cardenas
Highlights:

• 2023 Tax bills went out on time this year
• IT has been upgraded and a patch to the mainframe is no longer needed.
• Processed 246,000 appeals (some include multiple pin numbers) with a 46.9% decrease in their assessment.
• 45,000 PTAB cases covered
• Have open positions and recruiting is a challenge - hiring process is a long process.
• Comm. Cardenas emphasized that the mission of Board of Review is to correct assessments - focus primarily on residential properties - not their fault that taxes are increasing.
• Comm. Degnan wanted to know about having separate budgets for each of the Commissioners office which led to confusing discussion of how the BOR allocates their finances and other resources. Per the Budget Director in 2025 budgets will be separated for non-personnel budgets. 
• Comm. Anaya asked about the outreach process to let people know that there is an appeal process and how to do it. BOR says they are doing outreach and asked the CC Commissioners to help with the outreach. 
• Dispute over the assessing, appeal and tax process is ongoing and not new. President’s office is doing a study to determine the best process according to Comm. Steele. 
• A lot of concern expressed over the amount of OT and what that does relate to. Is it the type of work or the number of appeals or something else. Comm. Britton said they need to know so that they can allocate resources appropriately. 
• Comm. Britton also wants to know why there is such a discrepancy in the number of appeals that come from various areas in Cook County - stated that he sees this as an equity issue. Further expressed desire that all involved (Assessor, BOR, and anyone else necessary) get together and work out all these data, communication, equipment etc. issues that seem to be causing a lot of contention. 
• Comm. Kevin Morrison reviewed all BOR minutes for past few years and asked that the BOR commissioners figure out how to get along. 
• There is now a process for pre-filing an appeal so appeals can now be filed anytime and anywhere in Cook County. Comm. Stamps asked for clarification and how this is being communicated to the residents of Cook County. BOR says they don’t have a communications budget so the efforts are minimal.
• Comm. Rogers says there have to be concerted efforts to get the numbers right in the beginning so there is less need to appeal. Comm. Steele said the appeal rate in Cook County is 33%.

Observer: Cynthia Schilsky

Cook County Board Committee Meetings
April 16 and 17, 2024

The following are key items from the Committee Meetings:

Finance Committee:
Resolution to redirect $70 M (out of $100 M in the Disaster Response & Recovery Fund) from new arrival health care to reimbursing Chicago for food service for new arrivals (Item 24-2103)

• Approved after significant discussion with the caveat that any modification to the grant agreement with Chicago (such as change in vendors or use of the funds) would have to come back to the Board for approval.  
• Normally, the Chief Financial Officer and the Director of the Emergency Management and Regional Security (DEMRS) would be able to approve such changes as long as the purpose fell within the scope of the resolution:  “food service or other new arrival operating costs throughout calendar year 2024.”  
• Commissioners Bridget Gainer, Sean Morrison, and Donna Miller led the call for the greater oversight by the Board given the great interest the public has in these expenditures.

Public Comment

• The lone commenter pointed out the settlements on the agenda for Freedom of Information Act Violations.  The commenter urged that such settlement payments come out of the applicable department/official’s budget.
• The following settlements were on this agenda (and approved):  $5,500 for the Sheriff’s Office; $31,500 and $29,500 and $41,537 for the State’s Attorney’s Office.

Comptroller’s Report (Item 24-2587) for 1st quarter of 2024

• $140 M favorable balance for the General Fund
• $37 M favorable balance for the Health Fund (cash basis)
• $126 M favorable balance for the Health Fund on an accrual basis

Legislation & Intergovernment Relations Committee
Approved amendment of Ethics Ordinance (Item 24-2057)

• Modified language to prohibit only County officials who are candidates for the upcoming election from using County funds for newsletters, brochures, public service announcements or advertisements up to 60 days prior to the election.
• Previously, the prohibition applied to all County officials, not just those running in the upcoming election.

Health & Hospitals Committee
Heard a report from Dr. Lamar Hasbrouck, Chief Operating Officer of the Department of Public Health (Item 23-3815)

• Up to 64 cases of measles state-wide; 58 in Chicago and 2 in Suburban Cook; most of which related to migrant shelters.  Doing a lot of education on both measles and need for vaccinations in general.  
• Currently low transmission for Covid-19, both within Cook County and nationally.  Says now endemic (that is, present), as opposed to epidemic (spreading widely).
• Provided some information about Long Covid, which defined as either new or recurring symptoms 4 weeks after initial infection.  Most often seen 3 months after initial infection.  Most common after the first infection.  Symptoms do seem to be decreasing over time.  Much more study is needed.

Technology Committee
All County Officials provided reports on their major technology projects from Sept. 2023 thru March 2024.  However, written reports/presentations were not posted for the Board of Review or the State’s Attorney, though they did report at the meeting.  A few items of note:

• Bureau of Technology reported on the Integrated Property Tax System, saying the overall schedule appears to be back on track.  Hoping to go live with the automated tax bill by October 18, which suggests that the 2nd installment of the property taxes will not be sent out prior to then.
• The Board of Review has migrated from the main frame and data sharing with the Assessor is working.
• The Clerk’s office reported that the new recording system, which was done in house (!) went live in March of 2024.  
• The Clerk of the Court’s office reported that the case management system is off the main frame, though still looking up history from the main frame.  Expect to be completely off by July.
• The Chief Judge’s office expects to be completely off the main frame by December at the latest, but hopes earlier.  All courtrooms are now ready for hybrid proceedings.  A new web site was just launched.

Observer:  Priscilla Mims

Cook County Board of Commissioners
Committee Meetings
March 12, 2024

Health and Hospitals Committee. 1 pm
Vaccine Preventable Disease was the focus of the report from CCH. Dr. LaMar Hasbrouck, COO, made the presentation.  Boost Up Cook County has been the program title for the past year.  This year’s title is The Gift of Booster. Since currently school age children have the lowest vaccine rate in decades, immunizations awareness campaign is reaching out in a variety of ways and in multiple languages.  30 priority zip codes have been identified; outreach does extend beyond them. The goal for measles vaccines is 94%; there are concerns when it is under 90%. Shelters now have needs.  Some support is provided for efforts in Chicago and the CDC is also involved. Comm. Stamps moved and Comm. Lowry seconded approval of Item 24-1372. It was approved by the Committee.  Report can be viewed on the Legistar site for this meeting. Meeting adjourned at 1:45.

Environment and Sustainability Committee. 1:30 pm
A change in language to the Coal Tar Ban Ordinance was explained by Com Trevor to be a change from “asphalt based surfaces “ to “asphalt paved surfaces.” Committee Chair Degnan explained the item has been under discussion over months, that Com Trevor had spoken with business owners, lobbyists, and others. Details were explained in response to comments and questions from commissioners. A motion was made by Commissioner Trevor, seconded by Vice Chairwoman Morita, to accept as substituted and amended in the errata 23-5769. It passed in committee. Meeting began at 1:47pm and adjourned at 2:17pm.

Observer:  Carolyn Cosentino