Cook County Board of Commissioners Meeting
December 14, 2023

Board Action:
The first hour of the meeting was devoted to the Consent Agenda and to public speakers. 

When ready for the business of the meeting Comm. Daley asked that a vote be taken to consider an item from the Third New Items Agenda, Agenda Item #24-0583, out of order. The motion to do so was approved and the amended Paid Leave Ordinance was moved for consideration. 

• Comm. Sean Morrison asked several questions about how violations of the ordinance would be handled. He wanted to know what happens when a complaint is filed. Complaints are handled by the Board of Human Rights and Ethics. A representative from that board explained that the rules for how the ordinance would be handled still need to be drafted and cannot be drafted until the Ordinance is approved. It is expected that the Rules will be finalized by February and then approved by the Board of Human Rights and Ethics.  Then the rules will come to the Board of Commissioners for its approval. 
• Comm. Miller wanted to understand the difference between the County ordinance and the legislation as approved by the State. Home Rule communities can opt out of the County ordinance but will need to be in compliance with State Law, so in essence they are the same. She asked that outreach is undertaken so that employers will know what they need to do to be in compliance with the new legislation. 
• Comm. Trevor was concerned with the time frame for instituting this legislation as it takes effect on 1/1/24. She too felt there needs to be more outreach so the employers and employees understand the legislation. Discussion of this agenda item continued for about an hour after which a vote for approval was taken. The vote was 16 ayes with Comm. Lowry voting present due to a Conflict of Interest. 

Comm. Degnan raised an issue with Agenda Item #24-0029, a contract with LexisNexis. She stated a concern that vendors should not be able to collect data that they can then bundle and sell. She asked that language be included in contracts to ensure prohibition of this process. Tanya Anthoney, CFO, said that they are developing a strategy with the Bureau of Technology, the Procurement Department, and the States Attorney’s Office to strengthen the language in this type of contract. 

Comm. Quezada questioned a contract extension, requested by the Chief Judge, with a company for radio frequency electronic monitoring (EM). (Agenda Item #24-0009) He indicated that there are more problems with this type of EM equipment than with GPS monitoring. A representative from the Chief Judge’s office stated that of the 1700 persons in their EM program about 200-400 use the radio frequency equipment. The 7 month extension is being requested so they can complete the RFP process for a new vendor that began in July of 2022. Testing of the equipment takes a long time. This item was deferred after questions from Comm. Anaya and Comm. Stamps were not answered to their satisfaction.  

Most remaining items on the agenda were bundled by department and approved with no discussion. All the items in the 5 sets of New Items were done at once with some items being referred to committee and some items being approved. Meeting lasted 3 hours and 40 minutes.

Previously on December 12 and 13 a number of the Board Committees met, and among the items of interest dealt with are the following:

December 12
Health and Hospitals Committee
Dr. Hasbrouck, COO of the Cook County Department of Public Health, presented the Quarterly COVID and Infectious Disease Update. Highlights of the presentation:

• In October 2023 there were 5 cases of measles, the first since 2017. All cases were in unvaccinated persons and contact tracing was done to contain the outbreak. Over 300 contacts were identified and of those, 88 people were deemed to be at risk and monitored for 21 days. No further cases were reported.
• COVID and Flu are both showing slight increases in number of cases. Waste water contamination is also increasing and is being done for both COVID and the Flu. 
• The majority of those hospitalized with COVID are over 65 years old. COVID vaccine is now considered to be a seasonal vaccine like the Flu vaccine. 
• There have been no new cases of MPox since July in Cook County. 

There was also a presentation about the Good Food Purchasing Program, that provided an update on the implementation and progress of this program since it began in 2018. ARPA funds are to be used to assess the progress of the program in expanding access to healthy foods throughout Cook County as well as changing the food procurement processes within Cook County Government. 

December 13
Finance Committee 
A public speaker expressed concern that a budget amendment was approved during the budget process adding 4 people to the staff of the Board of Review (BoR). He stated that the amendment process did not allow for rebuttal from the public. He stated that the BoR needs to be reined in.

• Lawrence Wilson, CC Comptroller since 2013 will be retiring as of Dec. 31. Several commissioners acknowledged his good work and he made a few comments.
• All business on the agenda was approved without discussion.

Finance Sub-Committee on Litigation 
All business including the Inspector General (IG) 3rd Quarter Report was conducted in closed session and the IG report was voted on to Receive and File when the committee returned to open session. No public discussion. 

Transportation Committee
Jennifer Killen, Superintendent, Department of Transportation and Highways, gave a presentation about 2 programs that will use ARPA funds for various projects. 

• Stormwater Management Project - partnering with the Metropolitan Water Reclamation District (MWRD) to deal with urban flooding. The funds will be used for technical assistance for those communities that lack municipal capacity, with equity at the forefront of the grants. Over 100 known drainage problems have been identified, and projects were selected based on readiness to proceed and the likelihood that the investment will improve the problems. 26 projects will receive funds with 6 in unincorporated Cook County. $20M is available and $18,775,000 has been granted with a reserve in case it is needed. Under this item, 8 grants to municipalities in Suburban Cook of under $1 M each are recognized as having been granted for a total just under $6 M.  (Agenda Item 23-5643)
• Invest in Cook Expansion Program - These ARPA funds ($25M) will be used for infrastructure projects that are not eligible for Motor Fuel Funds. Over 300 applications were received.. The Board previously approved grants to Chicago totaling 13.5M for 19 projects. This item is acknowledging that 23 entities in Suburban Cook County are receiving approximately $8.4M in separate grants under $1 M each for 23 projects. The total granted, including the amount previously approved for Chicago, is around $23.245M, with again some in reserve if needed. (Agenda Item 23-5644)

All items on the agenda were approved with no questions. It was noted that the Dept. of Transportation had met with each Commissioner about the ARPA funds distribution.

Asset Management Committee
Two items provoked discussion

• A resolution for acquisition of a building to be converted into a mail order robotic pharmacy in Countryside for $2.7M. This property was identified after looking for property for many years. The pharmacy was previously housed at Oak Forest Hospital and then at Stroger Hospital but more space is needed. Comm. Morrison had questions about the cost of renovating the building for its stated purpose. The estimate for renovation was given as about $8.5M. An RFP will be used for new robotics equipment. It will be a 24/7 operation employing about 70 people. (Agenda Item 23-5618)
• A Proposed Lease Agreement for property at 439-493 31st St. in Chicago that would be taking over a lease from Howard Brown Health in property that they have never occupied. Cook County Health would like to relocate outpatient services from Provident to this space so they can expand in-patient areas in Provident. Several commissioners expressed their concern that this was coming before them without any previous outreach from Asset Management, but it seems that email had been sent to at least some of the commissioners about this proposal. In person contact was requested. After much discussion about cost and need for this space, it was approved with 2 commissioners voting no on this item. (Agenda Item 23-5619)

Observer - Cynthia Schilsky

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