Cook County Commissioners - Board and Committee Meetings
July 27, 29 and 30, 2020

Key items passed by the Board:

• “Justice for Black Lives” Resolution.  The substitute non-binding resolution calls on monies for policing and incarceration to be redirected to public services, not administered by law enforcement, which will promote community health and public safety, particularly in Black and Brown communities most impacted by violence and incarceration.  Such services to include housing, health care, mental health, restorative justice, job creation, public transport, eviction/foreclosure, and increasing opportunities for Minority-owned and Women-owned business enterprises.  Passed with 15 votes; Commissioner Aguilar voted present and Commissioner Sean Morrison voted no, both expressing concern with the idea that the resolution calls for defunding the police.  Commissioners voting in favor say that this lays out priorities for reducing crime and promoting opportunities through these other means.  The upcoming 2021 budget (which will be considered in October and November) will offer the first opportunity for the Commissioners to start to carry out the resolution. (Agenda Item 20-2867)
• Resolution to utilize $82 million of money County received under the CARES Act to aid economic recovery from COVID-19.  (Agenda Item 20-3229)  See the Observer Report for the Special Board Meeting on July 16 for details of the distribution.

Other Items of Interest Discussed in Committees:
Finance Committee:

• County’s Use of CARES Act funds:  CFO Ammar Rizki reported that the $429 million has been allocated for (1) County’s operational costs (46%), (2) County’s direct costs incurred  (23%), (3) spurs for economic development across the County (19%, the Resolution described above), and (4) $51 M for eligible costs incurred by suburban municipalities (12%, as described in the Observer Report for the July 16 Special Board Meeting).  New guidance comes out regularly from the U.S. Treasury as to how these monies can be spent.  Mr. Rizki said that with $300 M in lost revenues to the County, it is critical that now County can use the CARES money to cover some salary and benefit costs.  However, Mr. Rizki said that CARES Act money can only be used to cover hazard pay for those employees directly dealing with COVID positive people (health care workers and correctional officers in the Jail).  So hazard pay provided to other people will not be covered, based on current information.  Mr. Rizki stressed that with many people predicting a spike in COVID cases in the fall, the County needs to conserve some of these funds to cover future costs.
• To date, 439 staff members have tested positive for COVID-19.
• So far, no monies have been allocated to township governments, which have other options.
• Mr. Rizki receives a weekly report of which municipalities have requested monies under the $51 M allocation by the County and will share with the Commissioners so they can make sure municipalities in their districts are applying for that money.
• Cook County Health has received $59 million of CARES Act funding in May in addition to the above as a health care provider. 

Audit Committee:

• Clean audits received for both the County as a whole and Cook County Health (“CCH”) for fiscal year 2019.  County has a Fund Balance that would cover 2 months of expenses, which is considered what is necessary.  (Agenda Items 20-2685, 2687)
• Auditor stated that CCH’s receivables tend to be risky, but thinks there are sufficient reserves to cover delinquencies.  Liabilities include $477 M of claims to County Care for outside (“foreign”) providers, $236M which are identified and the rest based on management estimates of what claims will be submitted after the fiscal year for care provided during the fiscal year.  Comm. Miller asked for breakdown of these “foreign” claims so they will know where people are going for care outside of CCH’s facilities.  Comm. Morrison wants to know dollar amount not collected due to mistakes; this goes beyond scope of this audit.  Andrea Gibson, CCH interim chief business officer, will be setting up meetings with the Commissioners.  She said that CCH is now catching out-of-network people and so not providing service under County Care.  Also, CCH is making sure getting pre-authorizations required by other insurers.
• Clean audit for Clerk of the Circuit Court, except that fees not disbursed in timely manner as required under Illinois Clerks of the Courts Act. (Agenda Item 20-2653)

Legislation & Intergovernmental Relations Committee:

• Review of the Final Recommended Plan for consolidating the Recorder of Deeds functions into the Office of the County Clerk.  Estimated cost savings during 2021 is $1.1 M, and annual savings thereafter over next 3 years estimated at $6 M.  Expect reductions in positions down to 79 for recorder’s work due to streamlining and broadening of work done by an employee.  Savings also due to moving Clerk’s Vital Records area from Daley Center pedway to Recorder’s office on main floor and moving Clerk’s offices on 14th floor of 69 W. Washington to Recorder’s administrative offices in County building. (Agenda Item 20-2745)  Next review by Commissioners of this consolidation will be in the proposed budget submitted in October.

Items to watch for at next Committee meetings, likely during the week of Sept. 21:

• Agenda Item 20-3562: Proposed “Residential Tenant & Landlord Ordinance,” which was referred to the Finance Committee.  Co-sponsor Britton said that this is modeled on the Chicago and Evanston ordinances.  Would spell out tenant and landlord rights and obligations.
• Agenda Item 20-3482:  Proposed resolution requesting hearings every month of the Criminal Justice Committee with the Sheriff and senior staff to discuss the operation of the Jail and Police Department (responsible for unincorporated areas plus some suburban towns under inter-government agreements).  Referred to Criminal Justice Committee.
• Agenda Item 20-3435:  Proposed resolution supporting the Illinois NAACP State Conference and Illinois Association of Chiefs of Police Ten Shared Principles.  Referred to Law Enforcement Committee.
• Commissioners Deer and Moore each submitted separate proposals to add Juneteenth as a County holiday, which were withdrawn.  The Commissioners said they would work to add this holiday without putting an added expense to the budget.

Note:  The Cook County Board and most of the Board Committees are not scheduled to meet again until week of Sept. 21, though Commissioner Suffredin wanted the public to know that everyone is still working and Commissioners continue meeting virtually in small groups (so as not to violate the Open Meetings Act) each Sunday with key County personnel.

Observer - Priscilla Mims

Cook County Board Of Commissioners’ Finance Committee
       Midyear Budget Hearings - July 21, 2020

Cook County Health - Debra Cary
Revenues as of May 31, 2020: General information from report available on Legistar 

• Medicaid Expansion up 21% from $798 million budgeted to $965 million actual            
• Patient Fee Revenue down 21% from $332 budgeted to $262 actual

Expenses: 

• $1,665 billion actual versus $1,303 billion budget = 28% higher 

Holdback Target:  Reported as N/A 

Highlights of Presentation and Discussion::

• As of 7-21, $154 million Cares Act monies have been received plus another $40 million for COVID-19 contact tracing.
• 70 positions were eliminated and another 200 agency positions identified to bring in house as a cost savings.
• Charity and unpaid care continues at 42% to date but expected to rise.
• Commission Daley stressed that the System has to reverse the large percentage of County Care MCO patients using other providers.
• System is expanding use of Telehealth but it is not considered to be an expense saver.
• Stand alone, ambulatory dialysis services at Provident to open in late 2020.
• Patient numbers are slowly rising at the hospitals and community centers as accommodations are made for social distancing.
• Cary said System needs to be prepared for COVID-19 resurgence and continued extra services at the Jail.
• Artificial intelligence being used to reduce claims rejection by ensuring pre-approval is received.  This new approach is operational for radiology and underway for oncology.  Next 2-3 months will provide more information on success.
• It is expected that the County will use tax dollars in the amount of $82 million to help offset Jail and Public Health Expenses and will pick up another $30 million In pension costs.
• Commission Sean Morrison asked for value of denials and billing errors for years 2018-19.  Also wants capital funding expectations from Cook County CFO.
• Projecting a $187 million deficit for 2021 due to personnel, overtime, and pharmacy costs.
• The new Medicare enrollment plan, More Care, is expected to help increase Medicare revenues by $7.4 million.
• Provident Hospital rebuild on hold until new CEO in place.
• CCH Board President expects CEO search to produce 1-2 finalists in the next few weeks.

Independent Inspector General -– Patrick Blanchard
Revenues – N/A
Expenses - $1,043 million YTD budgeted vs $882,545 actual.  Down 15.3%
Holdback Target:   $120,824.  met.
FY 2021 Budget Target:    $1,726,849

Information of Interest

• Did not hire 2 investigators as part of his hold back target and another new hire will start in August.
• Provides services to Cook County, Forest Preserve, and the MWRD.  Exceptions: States Attorney, Chief Justice, and Clerk of the Court
• Used Micro-Soft Teams to good advantage and will incorporate in future operations.  May save on space.
• Noted that since its inception the IG office has consistently had its staff reduced from a high of 20 to the current number of 14 including 2 MWRD investigators.  Blanchard is now doing the complaint triage work previously handled by his deputy who left and has not been replaced.
• Complaints are up about 25% from 2019.  Projecting 800 for 2020 [includes MWRD].
• With the projected cuts in the 2021 budget, Blanchard does not expect his office can be prepared to provide the coverage needed.
• Produces 60 OIG summary reports a year and receives 350 inquires/complaints.
• The OIG has one full-time harassment investigator who is busy but not “crushed” with work.

Public Administrator -– Louis Apostol
Revenues – Up $539,328 or 82.9%.  YTD Budget $650,000 vs YTD Actual $1,189,328
Expenses -  Down $7,129 or 1.07%.  YTD Budget $666,922 vs YTD Actual $658,922
Holdback -   No.
Fiscal 2021 Budget Target:   $1,259,749.    2020 Budget is $1,344,605

Information of Interest

• In explanation of the holdback:  “The office will have generated over $2,865,112 in fees, interest, court costs, and funds for unknown heirs.  Our 2020 budget is $1,344,605.  At the close of Q3 2020, the fees alone will have generated $1,169,933 to the county treasurer.  This office estimates a year-end total of $1,827,331 in revenue which represents $527,331 over the expense amount appropriated for FY 2020.”
• The office assists the public in administering probate estates when a CC resident passes away without family to manage the liquidation and distribution of his/her assets.  It also aids the public and the Medical Examiner’s Office in location of family for unclaimed remains and homes that would otherwise be abandoned.
• The office has a staff of 15 plus the Public Administrator who is a 1099 employee.

Secretary to the Board of Commissioners - Matthew DeLeon       
Revenues:  N/A
Expenses:  Down $90,636 or 10%.   YTD Budget is $932,617 vs YTD Actual of $84,981
Holdback:   $112,707.  Met.
Fiscal 2021 Budget Target:  $1,745,747

Information of Interest​

• A new Manager of Archives has been hired, and the Secretary intends to bring an Ordinance governing the archives in the fall.
• January 2021 is the 190th Birthday of the County for which the board has instituted a flag design contest for the students of the county.  The contest deadline has been extended to September 2020, and the semi-finalists will be picked in October.  The presentation of the flag is projected for spring/summer 2021.
• The Secretary stated that the Board is not likely to be coming back to the conference room any time soon.
• Sims reminded the Board and the Secretary that the current board room needs to be made ADA accessible.  
• Secretary hopes to significantly expand the conference room in addition to making it ADA accessible when resources are available.

Cook County Sheriff - Tom Dart
Revenue: $6,797,999
Expenses:$284,937,121
Holdback:$25,413,144
Target Holdback;$38,884,424

Sheriff Dart appeared early and ran late at the Midyear Budget Hearings. Some Commissioners called it “extra innings” and other baseball analogies. But the Sheriff had much to say and the Commissioners had many questions. His session ran approximately 2 hours and 40 minutes. Although there was some repetition, the Sheriff and the Commissioners are very concerned as his department might be facing $90 million in cuts from his current $600 million budget.

Some Highlights from the Sheriff’s Remarks:

•  The Sheriff began his remarks by stating he was perfectly “on budget’ until March when Covid hit.
• In March, due to Covid, he had to hire new people  (he said about 200) to open up , clean and staff long closed divisions in order to spread out the population. He also tests each detainee upon entry and quarantines them for 2 weeks. All of this has increased his need for personnel costs, including overtime.
• He also has 1000 more people on Electronic Monitoring (EM) as judges are trying to not put more people in the jail.  His jail population is about 4900, and his EM population is about 3300, both are up from
• He also has about 500 Illinois Dept. of Corrections’ inmates who have been sentenced, but are not being placed in prisons, due to Covid. On the positive side he has freed up some sheriff’s deputies who have not been serving evictions. But as the courts reopen, these deputies may go back to those duties.
• The Sheriff also talked at length about the other duties he has taken on recently. He named 3 South Suburbs that his police have been working with in a supplemental capacity (Dolton, Harvey, and Riverdale). He has also been supplementing the CPD on the West and South sides of Chicago during the protests.
• In addition he runs many mental health programs, mentoring programs for youth, job training programs, and opioid addiction treatment programs both in and out of the jail. He has trained his officers in crisis intervention and in the use of naloxone treatments, he said. For these reasons he will be having trouble cutting his budget.

Some Highlights from the Commissioners’ Questions and Comments:

• Many Commissioners congratulated him and asked detailed questions about testing, distancing and tracing. He said that as of July 20 he had only 16 cases that were positive, 10 of which came in that way. All detainees are tested upon entry and isolated for 2 weeks, no matter what the test results may be.
• Commissioner Suffredin asked for a list of all of the programs that sheriff’s deputies are involved with and the costs of each. The Sheriff said he would get that information.
• Commissioner Anaya asked about how the Sheriff planned to cut $90 million from his budget. He mentioned 3 ways: 

1. He hoped to cut staff through attrition. But he warned the board not to be too generous in the next          union contract talks since he is not part of those negotiations.
2. Branch courts could be closed (like Bridgeview and Rolling Meadows). He would then need to staff less officers in the court houses.
3. He could cut all transportation from the jail to the outlying courts for simple hearings that take 1 or 2 minutes. These could be done remotely. He would save the transportation costs for trials, plea bargaining, sentencing, etc.

• Commissioner Johnson asked about administrative costs. The Sheriff said a full review took place a few years ago in order to cut these. It was unclear if more could be cut. The Commissioner also asked for a list of school related programs that the deputies are involved with and their costs, such as those at Proviso and Richards high schools.

Observers - Diane Edmundson and Jan Goldberg 

Cook County Board -  Health & Hospital Committee Meeting
February 26, 2020

Meeting Report 
The CC Health & Hospital Committee had two items on its agenda:

Agenda Item 20-1118 went through two substitute iterations with the final dated February 24, 2020 and contains major amendment changes to the 2008 Health and Hospitalts System Enabling Ordinance that established the independence of the Hospital System from the County President and Board and set up the mechanism for appointing an independent board.   The chair of the committee, Dennis Deer, was not in attendance nor were Commissioners Moore and Tobolski.  Commissioner Arroyo, Vice-Chair, ran the meeting. 

• All commissioners in attendance strongly supported the need for a viable and vibrant county public health care system and it was reflected in each of their remarks.
• Agenda Item 20-1118 was passed out of Committee with the only exception to a unanimous vote being Alma Anaya who voted "present".  Her comments are below as are selected other commissioners:
• Larry Suffredin:  Led off the discussion by stating that he strongly supports the amendments and considers them to allow for "re-balancing" of the relationship between the Cook County and System Boards as well as ensuring collaboration on executive hiring, financial, strategic planning, and labor relations issues.  He offered that the Cook County Board is the Health Board for the County; and he pointed to the large increase in uncompensated care; the two highly critical Inspector General reports; and the increased number of grievances and arbitration cases as reason for the need to re-balance.  
• Sean Morrison:  Stated he often communicated belief that the problem lies with the executive team.
• Bridget Gainer:  Stated that outward collaboration as well as between the Hospital and the CC Board is needed.
• John Daley:  Strongly supportive and stated that nearby U of I Hospital and Rush Hospital are both expanding their ambulatory centers and that the HHS System needs more help from them.
• Alma Anaya:  Stated she does not believe the amendments solves the root cause issues.  She advocates creating a process such as a task force to identify, dissect, and address the problems - particularly financial.  Wants to review and then change rather than "jumping the gun" with the proposed amendments. 

Agenda Item 20-1229 was deferred without discussion.  It would require top executive compensation and severance package approval by the President and County Board and because the matter is also covered in 20-1118, it may be withdrawn

Public testimony

• ​Dr. Lindsay Ray Murray, Health & Medicine Policy Research Group.  Stated that the System cannot cut its way out of its financial deficits.  Called for a blue ribbon commission from a cross-section of health care professionals and experts to thoroughly explore the issues and make recommendations before approving changes to the 2008 enabling ordinance.  H&M Policy Research Group is a member of the nominating committee that provides HHS board nominations to President Preckwinkle for her and the CC Board approval.
• Laurence Msall, Civic Federation.  His main objection is that 20-1118 gives the county board say over the selection and compensation of the CEO.  He said that he has heard of no explanation on how the proposed changes will correct the System’s financial problems. The Civic Federation is also a member on the nominating committee for HHS board nominations.
• Susan Avila, Collaborative Health Equity.  She is also on the H & M Policy Board and worked at Stroger for a number of years.  She stated that there was not enough information before the changes were proposed and is for a comprehensive analysis of the problems and at what works best (Best Practices approach).
• Mr. George Blakemore also spoke and is in favor of more County Board involvement.

Significant Amendment changes included in Agenda Item 20-1118

• The System Board will no longer have sole authority to hire the CEO, or interim CEO, or fix the compensation.  Henceforth, it will recommend, subject to the advice and consent of the Cook County Board and the President’s departments on development of its three-year strategic plan as well as its operational and policy strategy. 
• Requires the Hospital System Board to direct its CEO to collaborate with President Preckwinkle and her departments on development of the strategic plan as well as its operational and policy strategy.
• Increased HHS board membership from 11 to 12 – The twelfth member will be hired by and reports directly to President Preckwinkle and will serve the same 4-year term as the other directors.  This appointee and the CC Board appointee, currently Dennis Deer, cannot serve as chair of the HHS Board.
• Allows the System Board to recommend instead of fix compensation of employees and provides that the compensation must be in line with the county board’s budget appropriation.
• Gives more responsibility to the Cook County Human Relations Bureau in handling grievance issues.
• Provides that the HHS board shall meet 12 times a year.
• Specifically states that the Cook County Board does not delegate Home Rule Authority to the System board.​
  
• Sets a threshold for county approval for capital expenditures at above $150,000 with monthly reporting of such expenditures of $5,000 to $150,000.

Diane Edmundson - Observer

Cook County Board of Commissioners Meeting
January 16, 2020

Items of Interest Considered by the Board:

• An amendment to the Medical Examiner Ordinance that includes the elimination of the Medical Examiner Advisory Committee was referred to the Legislative and Intergovernmental Relations Committee. The Medical Examiner office is performing well relative to 2012 when there were a series of burial scandals and overcrowded coolers.  The office rarely has unclaimed cases over 90 days, and disposition of deceased persons is orderly and dignified.  Coms. Kevin Morrison and Daley were very complimentary of the high standard of performance.  (Agenda Item 20-0626)
• The Performance Management Ordinance Amendment was referred back to the Finance Committee to make sure that Cook County Health was included. (Agenda Item 20-1076)
• All the transportation expenditures were passed with many of the projects exceeding the Women and Minority Owned Business requirements.
• Com. Bridget Degnen asked what kind of cars the Sheriff was leasing, and wanted to make sure that whenever possible, the selection is hybrid cars, not full emission.  She is very interested in encouraging the County to become more sustainable. (Agenda Item 20-0018)
• The Cannabis ordinances were all passed with Coms. Silvestri, Degnen, Moore, and Sean Morrison voting present, in all cases regarding cannabis. 
• Com. Suffredin will revise the amendments to the Ordinance on the General Powers of the System Board to ensure that severance payments for Cook County Health (CCH) employees are in line with Illinois state law.  Comm. Suffredin discovered that there are several CCH employees with severances promised in excess of what is allowed by law.  All commissioners were added as co-sponsors and the item was referred to the Health and Hospitals Committee.  (Agenda Item 20-1229)

 Amy Little, observer