Cook County Board Of Commissioners
Health & Hospitals Committee Meeting
October 17, 2023

The Public Health Department: presented both a verbal and written 3rd Quarter Report which is also being presented to the Cook County Health Board on Friday, October 27, 2023 and will be available to the public after the meeting.

• Presentations were made on SDI treatments and diseases, targeting campaigns for colleges, and public relations campaigns for individuals to increase knowledge and where to go for help. CC Public Health has a communicable disease unit that excludes Chicago, Evanston, Oak Park, Skokie, and Stickney Township which have their own public health departments.  The program engages in surveillance, investigation, interviews, partner services, education, and support.
• Gonorrhea, Chlamydia, Syphilis, HIV, and Monkey Pox are the main SID's targeted for treatment and reporting statistics.  The current marketing campaign slogan is:  "Don't guess, get a test".  Mail back test kits are now available from CCH. The public should check the website for specifics.
• Also discussed was the youth tobacco seller ordinance passed in July of 2023, which consists of compliance check and required signage.  Starting this fall, CCDPH in partnership with the CC Sheriff's office is conducting random, unannounced inspections where flavored tobacco products are sold in unincorporated Cook County.  
• Opioid Epidemic:  Resolution #23-5053 Treatment not Trauma carried with enthusiastic concurrence.  At this time, there are vending machines for Narcon in the emergency rooms at Stroger, Provident, and the Austin Clinic.  Plans are to expand availably to CC court houses, and a new methadone clinic is opening at the Austin Health Center in January of 2024.   ARPA monies are the source funding.  
• All ambulatory clinics have or will soon have an embedded mental health professional to provide services on location.
• At Cermac, recovery coaches help ensure a three times better success for inmates with a drug and/or mental health problem.  The jail currently has a 2,400 caseload.
• County Care follows members and provides services for mental health and drug addiction.  The system monitors a combination of opioids and certain other drugs which has already stopped "a lot" of prescriptions and overdoses.
• CCDPH will do an assessment of where in Cook County communities methadone clinics can be successful.
• CCDPH's Dr. Joshi said that the department is looking at how CCH can be more trauma informed.  When asked what phone number can be given to drug users that want help but are not critical, Dr. Joshi said to call the Behavior Health Hot Line at 833-626-4244.  He also said that the 988 help number the county is installing is not ready but will eventually be available.
• Dr. Joshi then announced that CCH is convening a Behavioral Health Summit for early 2024.  More information to follow.

​The Joint Finance and CCH Health Meeting to discuss the use of contract staff rather than permanent hires was called to order and after 4-5 public speakers [union employees] was recessed at 4:45 p.m. with a reconvened date and time to be announced.
 
​Observer:  Diane Edmundson

Cook County Board Finance Committee – Mid-Year Budget Hearings
July 26, 2023 –

Cook County Health  - Israel Rocha, CEO.    
2024 Preliminary Budget:  $4,034.9 Billion Revenue

Mr. Rocha began by stating that Strategic Plan mission is to compete head on with any health care system in the world.  The primary issues discussed during the two-hour hearing were:

• Dental Care             -   Nurses Hiring & Reduction of Agency staff       
• Abortion Care        -    Asylum Seekers and the Undocumented

Dental Care

• CCH currently has six clinics outfitted to provide dental care.  Blue Island is the latest at a cost of $236,000 for space preparation and equipment.  The issue is finding staff to provide the dental services at all the locations.  Mr. Rocha said the System is look at options and may start sharing staff.   

Abortion Care

• Commissioner Britton asked about out of state patients seeking abortion care.  Mr. Rocha said that the CCH has seen an increase in services needed, particularly with complications.

Hiring & Reduction of Agency Nursing Staff

• Mr. Rocha noted that year to date, 800 hires have been made, and turnover is down.  The System’s 6.1% turnover is lower than the industry average, but he noted that the average age of the workforce is 51 years. The number of current vacancies is 2,314.  When asked about when the use of agency nurses would be reduced, Mr. Rocha talked about the HR’s recruitment efforts for nurses including the very successful job fairs with same-day conditional offers, signing and retention bonuses, and the increased emphasis of benefits such as pension, health, personal leave, and full tuition coverage after one year of service.  
• Later in the discussion, Commissioner Gainer said that the CCH will always have to rely on agency help, particularly for nurses.  Her point is that a realistic number should be set each year for needed agency help to which budget numbers can be assigned.  

Asylum Seekers and the Undocumented

• As a reminder, the System serves all residents of Cook County regardless of their citizenship or ability to pay.  The influx of Asylum Seekers over the last 6-8 months has resulted in unbudgeted expenses.   Belmont Cragin is the entry point for health care screenings.  Mr. Rocha said that the cost to date has been about $1-$1.5 million per month, but total costs for 2023 are projected at $26 million. Commissioner Morrison asked if the cost of the Asylum Seekers and the Undocumented could be separated for future budgets.  Mr. Rocha said that patients are not asked if they are in the US legally to avoid a chilling effect. on seeking care.  Some of the undocumented cost is covered by Medicaid and the rest falls under the Charity Care expenses line.
• Overall, commissioners were very complimentary of Mr. Rocha’s leadership and progress.  Commissioner Miller said that CCH has gone from being a model of reactive care to a model of preventive care.

Observer:  Diane Edmundson

Cook County Board of Commissioners Committee Meetings
July 19, 2023

​Legislation & Intergovernmental Relations Committee

• Item 23-3320   Recommended for approval  The Committee approved an amendment to the Inspector General selection ordinance  which required a bipartisan committee of equal number of Commissioners from different parties.   Since there is only one Republican commissioner now, the ordinance had to be changed.    The change was that if there is not enough representation of both parties, the President can appoint another commissioner.  
• Item 23-3719  Recommended for approval   Amends the ordinance covering sick leave to add that it may be taken for mental health issues.

Finance Committee

• Item 23-3116  Deferred  The item was for the approval of the use of $20 M in ARPA funds to assist suburban Cook County residents pay water bills. Money could go to pay directly for a person’s water bill. The plan was to use  CEDA (The Community and Economic Development Association) as they currently help individuals with their water bills.    CEDA is about to lose its federal funding.   The funding would also go to help a municipality  with a high-water burden. That program is to be managed by Elevate, a private company.   Elevate would need to negotiate with the municipality to ensure that the funds would go to pay for water, that fees and rates would be modified for residents, and that resident water would not be turned off.  At this point it is not known which suburbs would participate and what the conditions would be.  Commissioner Daley asked what suburbs would be targeted and what reports would there be.  Commissioner Degnen suggested a smaller amount be authorized to initiate the programs and when more details were available, more money could be given.  Since there were so many unknowns the item was deferred.
• The second part of Item 23-2116 was authorization of $1.24M to implement a Community Information Exchange Program to share client profiles among healthcare and social services.   This would allow more holistic care to an individual and build connections among providers.

Transportation Committee

• Item 23-3259. Recommended for receiving and filing. This was a report on  a pilot program in South Cook, The Fair Transit Program, that is subsidizing fares on Metra and Pace to encourage the use of public transportation in the south region.   The Metra Electric has seen ridership return to pre-Covid levels.   The Commissioners approved the continuation of the pilot. 

Health & Hospitals Committee

• Behavioral Services Reports from CCH, Sheriff, Office of the Chief Judge, State’s Attorney, and Public Defender were reviewed.   The Committee recommended for receiving and filing.      
• Much of the conversation focused on substance abuse programs.  CCH is finding that recovery coaches who continue a relationship with a patient after they leave the hospital have shown to help the patient stay clean.    They are also implementing emergence naloxone vending machines in neighborhoods, where residents can get this to help with overdoses.  
• The Sheriff’s office reported that the jail does individual assessments on new inmates and it has its own substance abuse programs that are offered to the inmates.   They also give released prisoners naloxone if indicated.  

Asset Management Committee 

• Item 23-3313 Recommended for approval  This contract contained several capital projects. 
• Earl Manning, Director of the Office of Capital Planning and Policy ,  has established a pre-qualified program for small minority firms to make it easier for them to participate in smaller projects.    The businesses do not have to submit the paperwork for each potential job as in the past.

Contract Compliance Committee

• Item  23-0820 Recommended for receiving and filing.   This was the annual diversity report.    Nicole Mandeville, Director of Compliance, reported on the past 4 years of county spending on contracts.   32% of contracts in 2022 went to M/W/DBE  owned companies.

Audit Committee

• Items 23-3381 & 23-3378  Recommended for receiving and filing   Outside Audit of Cook County for fiscal year 2022.  The auditors did see errors in accounting entries for CC and CCH which required adjustments for the financial statements.  There were weaknesses in the controls on the Oracle accounting system such as not deleting terminated users. The auditor recommended allowing more time to close the books at year end to find needed corrections.  
• Item 23-3382  Recommended for receiving and filing   Report on Federal Awards There were  findings of non-compliance with Federal Grant Awards requirements.   Commissioners Degnen and Daley noted this was more than usual.     Commissioner Degnen will be meeting with the department to discuss improvements in process.

Observer - Kathleen Graffam

Cook County Board Finance Committee
Mid-Year Budget Review Meetings on July 25, 2023

Budget Overview

• Revenue will decline next fiscal year because the State has changed the statutes on sharing the Personal Property Tax (part of the corporate income tax) and Cook County will see a change from $133M this year to $75M next year.
• Sales tax will remain level
• Income from County Care at CCH will decline because participants have to go through Medicaid redetermination post Covid and it is projected there will be less members.
• Labor costs will increase $27M  and IT costs will increase $20M next year.

Cook County Health (CCH)

• FY 24 will have a shortfall of $3M due to the redetermination and increased labor costs. The union agreements included retroactive COLAs.
• Asylum seekers medical costs have been $26M this year.
• CCH has managed $265M of ARPA funds in 70 programs.  They provide monthly reports on the programs to the Board.  There is a sustainable working groups looking at how to continue the programs after 2026 and the end of ARPA funds.

Office of the President

• Cook County reporting of ARPA funds is good according to Results for America.
• $281M of medical debt of individuals has been paid by Cook County.
• $110M has been spent for reducing gun violence.  Cook County is working with the City and the State on this issue.
• Technical help has been provided to 13,000 small businesses.
• Commissioner Sean Morrison asked for more detailed reporting on the medical debt elimination—how are recipients chosen, which hospitals and locales.
• Commissioner Gainer asked if HR hiring process is improving.  Ms. Turner said that was being reported in the Performance Management website.

Chief Judge - Tim Evans

• The court system now has a permanent hybrid process.
• The courts will need more employees to support the Safe-T act for night and weekend shifts.
• Judge Evans explained the operation of the restorative justice program and its success in decreased recidivism of its participants compared to people who go through the regular court system.
• Commissioner Gainer asked for more reporting on the residents in the Juvenile Detention Center, particularly in education.   There have been reports that special needs students are not being accommodated.

Sheriff - Tom Dart

• The jail will be within budget for FY 2023.
• Sheriff Dart explained why there was a need for a new helicopter, particularly for use in carjackings.
• The sheriff office provides back up for many suburban police departments. They are the only police in Ford Heights, Dalton, and Harvey.
• The office implemented a mental health incident support program.   Responders are trained on de-escalation procedures and provided a tablet that they can use when dealing with a mental health crisis.   The tablet connects them with a mental health expert to help them deal with the issue.  This has been implemented with 15 communities.

​Observer:  Kathleen Graffam

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

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

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

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

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

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

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

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

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

Observer - Priscilla Mims

Cook County Board of Commissioners Committee Meetings
May 24, 2023

Legislation and Intergovernmental Relations Committee

• After testimony and much discussion, commissioners voted yes to the proposal (23-2311) to amend the ordinance regarding tobacco dealers and eliminating the sale of flavored (including menthol) nicotine products. The substitution allows time for notification.  Among concerns noted were reports of products laced with fentanyl, marketing to minors, impact in unincorporated Cook County, need for alignment of policies and hope for state policy. Motion was made by Com. Miller, seconded by Com. Lowry, and was passed.  
• Commissioners also voted to recommend for approval of Ethan’s Law (23-2695) which would require gun owners to secure guns.
• Presentations and extensive discussion went on regarding Agenda Item 23-1387, a resolution to request a meeting by this committee to discuss Asian American and MENA Data Collection and Language Access Hearing. It was approved.  The key question at the starting point is what we are doing now regarding current employees, forms, job applications, and services to the public. Information from LA county and best practices are being sought. 11 presentations were given by entities reporting. Federal Government will be updating race and ethnicity categories for data collection; this could impact standardization. Several different translation tools in use were cited with cautions regarding limitations of translations. 

Human Relations Committee

• Voted to defer action on Agenda Item 23-2279 regarding amending the Human Rights Ordinance to include no discrimination related to exercise of bodily autonomy.

Health and Hospitals Committee 

• ​Covid updates (23-0469) from Cook County Health and Cook County Department of Public Health - . Dr L Hasbrook stated the Covid case count continues to decline, that testing at home does impact local collection of data. Just under 20% (approximately 16, 000) of Cook County is up to date with latest booster and there are over one million shots in arms. 2 points currently being emphasized in public information: The Public Health emergency is ending while the concern is not over since the virus is here to stay. 
• Regarding MPox, the increase is by a couple dozen in Chicago and +3 suburbs. Among people vaccinated the infection is less severe. Information for the pubic will be updated for social media, publicity, and PRIDE Chicago. Having an adequate amount of vaccines available and medical countermeasures for those infected are part of what is being done. 

Committee meetings adjourned at 4:31.

Observer - Carolyn Cosentino