Cook County Board of Commissioners Meeting
May 12, 2022

Commissioners Anaya, Miller, and Gainer questioned Cook County Health’s Chief Executive Officer Israel Rocha concerning a proposed transfer of funds and the continuing problem of filling nursing positions.  Commissioner Gainer asked CEO Rocha to report back to this Board next month on the measures being taken to improve the hiring process.  Commissioner Sims said part of the problem is due to following all the steps required under the Shakman consent order.  CEO Rocha said his staff has been working with the Office of the Independent Inspector General to see what changes could be made.

The Board approved the following:

• Appointment of current County Comptroller Lawrence L. Wilson as Acting Chief Financial Office as of June 11 to replace Ammar Rizki who is stepping down as Chief Financial Officer on June 10.  Mr. Rizki will take that same position at the Obama Foundation. (Item 22-3267)
• An amendment to the intergovernmental agreement with the Metropolitan Water Reclamation District for the County’s Office of the Independent Inspector General to continue to provide such services to the MWRD for an additional year, from May 17, 2022 to May 16, 2023. (Item 22-3020)

The Board referred to the Legislation and Intergovernmental Relations Committee:

• The proposed appointment of Dr. LaMar Hasbrouck as Chief Operating Officer of the Cook County Department of Public Health. (Item 22-3342)  Separately, the Commissioners passes a resolution honoring Dr. Rachel Rubin and Dr. Kiran Joshi for their service as Interim Co-Leads of the Department.  (Item 22-3308)
• A proposed resolution announcing a new flag for Cook County.  However, there were blanks where the name of the flag and the designers should be.  (Item 22-341)

The Board referred to the Rules Committee:

• A resolution declaring racial or other discriminatory covenants in real estate recordings to be void pursuant to the County’s Human Rights Ordinance.  The Count Clerk has said her office stands ready to process applications to eliminate such covenants from deeds. (Item 22-3150)
• Proposed changes to the “public facing rules and regulations” of the Board of Ethics Procedural Rules as a result of the change in the County’s Ethics Ordinance.  (Item 22-3155)

The Board referred to the Technology and Innovation Committee:

• An extension of the contract with Tyler Technologies for the period of April 1, 2023 thru March 31, 2026 for an additional $8.4 million for the centralized property tax system for the Assessor, Clerk, and Treasurer.  (Item 22-2917)  This system has been a source of controversy, including in the issues regarding the delays to the 2nd installment property tax bill to be sent out this year.  
• Approval of $6.3 million for a new case management system for the State’s Attorney’s office to replace the current Juvenile Justice system that is on the main frame, as well as the Adult Criminal system (not on the main frame).  When this work is completed, the State’s Attorney will no longer have any processes on the main frame.  (Item 22-1112)

The Board referred to the Litigation Finance Subcommittee the 2022 1st Quarter Inspector General’s Report.

League Observer:  Priscilla Mims

Cook County Board of Commissioners Meeting                
April 7, 2022

The Board Approved:

• Surviving Spouse Tax Abatements for surviving spouse of fallen police officers, soldiers, or rescue workers program will continue.  Rather than receiving a refund, the line item for Cook County property tax will read as zero. This change was made with the Treasurers’ Office so the individual does not have to pay the tax and then receive a refund. 20 people have been in the program and two new members have recently become part of it. (22-2649)
• Contract for technical assistance sought by Justice Advisory Council: This relates to changes in pre-trial policies, practices, and operations required under the SAFE-T Act and involves significant cross-agency planning and implementation.  Approved as amended in errata.  (22-2558 )
• HOME Investment partnership Program loans of $1.25 M to support the development of Bellwood Senior Apartments, an affordable senior housing of 80 units and $3 M to support the Chicago Heights Veterans affordable housing development of 82 units (22-2328 and 22-2378)
• The Board approved receipt of an additional $32M for Emergency Rental and Housing Assistance.  Cook County has dispersed $132M to date. Streamlined processes and cooperation between government dept. supported the success of the program.  The additional monies is from funds not used across the country and reallocated by the US Treasury Dept. (22-2738)

Other Items of Interest:

• Joint committee meeting for Finance and Technology will be held to discuss second property tax billing with concern about possible delays.  This meeting cannot be held until after technology upgrade in the Board room is completed. Without the upgrade, live-streaming would not be an option, thereby restricting public and press involvement. The work was scheduled 2 months ago.  It will be scheduled as soon as possible as all parties are aware of the urgency of questions involved. Public speakers today emphasized need for predictability and transparency (22-2803) 
• The Bureau of Human Resources filed a report concerning the salaries of elected officials in Cook County to determine appropriateness or if increases are warranted.  Deloitte Consulting Group analyzed the peer groups reflecting Cook County’s population and other variables. Their conclusion is that county elected officials’ compensation is below market rate for similar elected officials across the country, below 50th mean percentile. This was referred to Finance Committee. (22-2471)
• There are concerns about potential violations by ICE obtaining information from private data brokers across the country. A public hearing will be scheduled by the Legislative and Intergovernmental Relations Commtt. (22-2815)
• Monday, April 18, 5pm a public hearing will be help where 6 new flag designs for Cook County will be presented and discussed by their designers.

Meeting length 2hr 32min.                

​Observer: Carolyn Cosentino

Cook County Board of Commissioners Committee Meetings.
April 5, 2022

Health and Hospitals Committee

• Change Institute is monitoring 2023 Strategic plan.  Racism is a public health crisis. Life expectancy correlates with zip code. The resolution is meant to monitor Cook County Health (CCH) programs and progress in addressing disparities in health outcomes. Commissioner Moore stated this is an essential compliment to CEO Rocha’ partnership with Change Institute (22-1702)
• Funding for Covid testing and vaccines has been exhausted so providers may not be reimbursed.  CCH  and Cook County Public Health (CCPH) will continue to provide these services free; group events can still be organized. CCH locations are available across Chicago, Cook County and at Stroger and Provident hospitals.
• Illinois Department of Public Health has taken over contact tracing; will monitor high risk facilities and high risk populations.
• Covid Data is not broken down beyond county level for type of variant. Existing vaccines have been effective against the new strain of Covid, VA2, for reducing spread, hospitalizations, and deaths. Case counts are beginning to rise, much higher among unvaccinated by over 1000x.  Concerns remain over booster rate. Mask guidance for indoor settings may be revised as monitoring continues.
• Behavioral Health Report indicated that staffing shortage here and across the nation continues; this includes triage social workers for crisis calls and recovery coaches, AP RN’s for injection services.
• Cermack Health services provides service to detainees in Cook County Jail, total daily census averages 6,000. Screening intake for every inmate entering jail is made to assess and address needs.  Patient safety includes evaluation of emerging needs and suicide prevention measures. (22-2245)

Observer - Carolyn Cosentino

Cook County Board Finance Committee
Departmental Budget Hearings
Oct. 26, 2021

The meeting scheduled for 9 a.m. was held at 10:30 due to CCH scheduling issues.  It continued until 1:15 for 2 hours and 45 minutes due to commissioner questioning and compliments. 

Cook County Health - presented by CEO Israel Rocha and former Interim Budget Officer, Andrea Gibson

Proposed 2022 Budget:  $ 3.889 Billion    2021 Budget:  $3.388 Billion
Proposed 2022 FTEs:         7,560                 2021 FTEs:       6,803 

CEO Rocha’s comments
Both internal and external factors were considered in developing the 2022 budget; and while he stated that this is a conservative budget, he also stated that is has taken into consideration the importance of meeting the needs of patients, staff, and growth challenges.  Health Equity runs through all budget allocations.

2021 Accomplishments

• Mitigated COVID at CC Jail
• Established a health line for employees
• 900,000 Covid shots administered
• Established an Office of Health Equity
• County Care again received the highest recognition from the State for its coverage and options.

The COVID Pandemic impact on the 2022 budget:

• FY 2019 patient volumes were used as a baseline as all volumes were down in 20-21.
• Medicaid has been expanded to those previously considered charity care which includes undocumented seniors 65+.  And beginning in January undocumented seniors 55+ will also be covered.
• The County Care Management Program has grown beyond expectations due to the state not requiring the usual annual re-determination of Medicaid eligibility.

Other Highlights of his presentation:

• County Care now has 415,000 members which has driven up both anticipated revenues and expenses for 2022.  Focus will continue to be on increasing the use of in-house medical care vs members using outside providers.  Emphasis will be on closing service gaps, investing in the nursing staff, and increasing emergency and dialysis services at Provident.  
• Neurology, Oncology, behavioral services will all be increased offerings at Provident, Stroger, and several of the community health centers.  The ultimate goal is to offer these services at all or most of the centers.  Also reported that a new state-of-the-art health center was opened in 2021 on W. Fullerton named Belmont Cragin.
• Public Health received funding from the Center for Disease Control and the County will increase its tax allocation by $10 million each year contingent on revenue.
• Surgical rooms are being increased and modernized at both Stroger and Provident. Provident is resuming emergency ambulance runs.
• There is the potential for national recognition of Provident Hospital’s Dialysis and Renal Center.

Commissioner Questions

1. When will the vaccine for ages 5-11 be available.  Answer:  expect vaccine on hand in two weeks.  To date every suburban school has been contacted.  Emphasis will be on schools and family doctors to answer questions and vaccinate.
2. Have outstanding accounts receivables improved.  Ans:  Yes.  In 2021 to date cash collection increased by $24 million.  Also, the System is establishing a claims reserve for County Care.
3. Commissioner Miller wants to see the ambulatory care clinics much more robust and all offering life style services.  She also wants more services provided in the Southland area.
4. Anaya asked that Telehealth be expanded.
5. A question on the pandemic effects on the staff was answered this way: There were many more retirements.  The System is asking itself “how do we energize our staff?” Need more patient education. Need increased emphasis on Mental Health. Mr. Rocha stated he will be offering a new Strategic Plan at the end of 2022. 

Diane Edmundson - Observer

Committee Meetings of the Cook County Board of Commissioners
Oct 5 & 6, 2021
 
Note: all items listed below as being approved by a Committee do not become effective until the Board approves them at the Board meeting held on October 7.

October 5 Meeting Highlights:

Health and Hospitals Committee

• Agenda Item 21-0541  CCH and Public Health Dept update on Covid. Deferred  Cook County Health (CCH) established a mandate for employee vaccination or weekly testing.   As of Oct 1, 83% of the employees are fully vaccinated and 92% had one dose.
• 21-5290 Resolution declaring mental health a public health crisis.     Passed   Commissioners Amaya, Degnen, and Kevin Morrison said their constituents want more money spent on mental health services.   Commissioner Miller said American Rescue Plan Act funds should be spent on improving these services.  Commissioner Daley said that there needs to be coordination with other existing services including private hospitals.

Legislation and Intergovernmental Relations Committee

• 21-5410 Ordinance to codify the existence, duties and appointments for the Commission on Women’s Issues.     Passed    The Commission was formed in 1995 by resolution. The purpose of this action was to put it into the County ordinances.  
  
• 21-0565  Proposed resolution to celebrate Indigenous People’s Day and Reconciliation Day                                                                                           Deferred     There were several public speakers in favor and against the proposed resolution.    One point often raised by the public speakers and the Commissioners was though it is important to recognize the wrongs done to Indigenous People, there was no reason to take away a day that honors the contributions of the Italian Americans.   The State of Illinois has named the last Monday of September as Indigenous Peoples Day. Several Commissioners thanked Commissioner Johnson for initiating the process and resulting difficult conversations that were illuminating.

October 6 Meeting Highlights

Finance Committee

• 21-5258  Calling for a review and recommendation regarding elected officials’ compensation.  Passed.  Comm. Suffredin proposed to initiate a process to engage an economist and an outside compensation consultant to review the compensation of Cook County officials and compare it to other counties.  The last review was in 2000. The committee would prepare a report on the comparison and recommend salaries to the Commissioners.  The report would be prepared by February of 2022.  The Commissioners would then decide if any action was needed. Any such increase would be effective in the next fiscal year in 2023 after the election for the offices.  The Clerk of the Court would be excepted since it isn’t up for election until Nov. 2024.
  
• 21-4303 Proposed amendment to the Procurement Code.     Deferred to Nov Mtg.  It would require that the Chief Procurement Officer shall make every effort to have at least one woman and one African American or Hispanic  on any evaluation committee for an RFQ or RFP.  
  
• 21-4102   Approval of Unarmed Security Contract for the Juvenile Detention Center (JDT)  Passed      11 Aye  4 present   Commissioner Sean Morrison No  Leonard Dixon of the JDT  reported that supplemental guards were needed at the facility because they are currently experiencing a 23% absentee rate.  He is recommending a three-year contract with Monterrey Security Consultants to provide 22 officers.   The JDT has 400 FTEs in security staff and currently 100 vacancies.  The standard absence had been 10-15%.  The vacancies are due to COVID, retirement, FMLA, injuries, and difficulty in hiring.   The JDT brought in a psychologist to help the staff with the stress of the job.  He anticipates that it will take them 3 years to rebuild to full staff.   The JDT can have an average of 200 detainees. Comm. Sean Morrison had previously asked to see the contracts and supporting documents and had not received them.   He was concerned that the vendor could commit to handling all the requirements. Comm. Daley asked for a follow up report on how the JDT was reducing the absentee rate.

Technology Committee

• 21-5079   Chief Technology Officer’s major project report.       Deferred to the November meeting  
• The Clerk of Court technology officer reported that they were making progress on the Odyssey system, that allows electronic access to court documents and dates.  Initially, Judge Evans delayed the Court from implementing the system.   He has since given approval for Phase 1 and 2 to be implemented.   The traffic court is in the last phase and will be implemented by the end of the year.
• The completion of the Integrated Tax Processing System will be delayed until September of 2024.    Comm. Sean Morrison referred to a letter that all the Commissioners received from Treasurer Pappas with concerns about the project.   The vendor is Tyler Information Systems and they were originally contracted in 2015 with a completion date of 2019.  The contract was performance based and Tyler has not been paid for implementation projects since 2017 although the implementation is continuing.   They are also contracted for ongoing licensing and maintenance of the system.     Comm. Sean Morrison said Tyler’s performance is disappointing. Comm. Kevin Morrison said he may call a special meeting to address the issues.   Since it is a contract issue, the committee would have to meet in executive session.

Observed by: Kathi Graffam                                           Time: 7 hours total

Cook County Board Finance Committee Mid Year Budget Hearings​
July 20, 2021
Presentations - Office of the Cook County Treasurer and Cook County Health

Highlights of Presentations:

Treasurer

• The office is currently under budget with regard to expenses, but expects to come in at budget by year-end.
• The office has received $4.9 million over budgeted revenues thus far, mainly due to higher than expected people paying delinquent taxes
• Purchased two vans to re-purpose customer service employees to enable them to serve taxpayers in their communities rather than in the CC building.
• Also go to community events at churches, festivals, etc. to assist taxpayers with tax related issues.
• Treasurer touted the studies done by her staff and noted that she is hiring to establish a kind of "think tank" section in her office to conduct more studies, concentrating on the inequities within the tax system.
•  The office has a staff of 58 employees.  Continued concentration will be in technology hiring.

Cook County Health

• .  In total, Cook County Health (CCH) currently has $2.4 M more in revenues than expenses.
• .  There are 1,284 vacancies among the 6,802 budgeted positions.
• .  Most of the questions centered around Covid and the Delta variant, which will not be reported here.  There was emphasis on providing guidance to suburban school districts.  CEO Rocha said that for now they are waiting for the CDC to provide guidance.  If necessary, the CC Public Health Department will step in to do so.
• .  Commissioner Degnan asked about grant funding and the potential to increase it.  CEO Rocha responded that for a public hospital system we do a good job, but the goal is to have "extraordinary" results.  CCH will be making investments to develop an institute for grant funding.
• .  Commission Sean Morrison asked if CCH has established a dollar value for requested 2022 funds from the county.  Answer:  not yet, but should have by the August preliminary budget presentation.
• .  He also asked about efforts to improve the revenue cycle.  CEO Rocha stated that a new Chief Revenue Officer is now in place and noted that through the first quarter of 2021 revenue retrieval has increased to 30% and can be expected to move to the mid-30's by year end.  Interim Budget Director Gibson noted that the System is looking at non-direct patient care to improve.
• . In March 2021, a "patient homecoming" project was launched to promote the return of patients to the ambulatory care centers.  He stated he is very excited about the progress to date.
• . Daley asked about outreach to retired nurses.  CCH noted that a few came back for the mass vaccine sites and that the system is definitely open to more coming back to the system.

Observed by:  Diane Edmundson         

Cook County Board - Health and Hospitals Committee Meeting
April 13, 2021

Cook County Health (CCH) has been working hard to get people vaccinated.  The following improvements to the system were cited

1. 5 mass vaccination centers opened including the new site in Matteson which is the largest and is in an abandoned Target store.
2. 13 PODS (point of distribution) sites opened to target school personnel.
3. Worked with 145 organizations for other sites
4. Changes made to improve the vaccination website including adding a waiting room. 1.4 million people have scheduled through the site.
5. Expanding hours for the telephone hotline for scheduling appointments for non computer users. Hours are M-F 7am-10p and Sunday 8am-10p. Average of  30,000 to 50,000 calls per day. When new shipments arrive calls can exceed 100,000 per day
6. CCH is committed to equity and has identified 32 communities needing attention and will be doing temporary priority PODS 
7. Current limiting factor is still supply but the sites are capable of a ⅓ surge if supplies increase.
8. Paramedics will be making visits to vaccinate homebound people 
9. Organizations can request pop up sites
10. There will be drive through sites opening now that the weather is improving.
11. Research indicates that the most hesitant to be vaccinated are 18-34 year olds. A My Shot campaign has trusted voices for this demographic recommending shots.

In addition to vaccinations, the CCH Contact Tracing initiative now has 187 tracers and 63 investigators. 90% of newly identified Covid patients are contacted and 71% responded. Funds are available to help quarantining patients with food, home supplies and lost income.

The number of new cases is rising but they can still keep up for now.
The BinaxNow rapid antigen test is in use.

The meeting had been delayed while CCH CEO Israel Rocha, and Drs Joshi and Rubin from the Cook County Department of Public Health, and Mr Barnes were handling the problems caused by the temporary hold on Johnson & Johnson vaccines.  All patients who were to receive the J&J vaccine will be offered either the Pfizer or Moderna vaccine.  Anyone with a scheduled appointment can still be vaccinated. Only 27,000 J&J vaccines have been given in suburban Cook County and no issues with blood clots have been reported.

Several commissioners spoke - some had questions but most were just complimentary comments.

Observed by: Lisa Slankard                                           Length of Meeting - 1 hour