Cook County Board Finance Committee - July 24, 2018 
Midyear Budget Hearing - Day 2 - Morning Session

 I arrived right at 9AM for the hearings and there were 2 commissioners present (Suffredin and Morrison) other than Chariman Daley. Seven more arrived by 9:30AM and 3 more by 11AM. Absent for the entire morning session were Commissioners Goslin, Gainer, Butler, and Fritchey.  Commissioner Sims asked everyone the core mission of his or her department and if there was any waste to cut. She did this even when both questions were answered in the original presentation. Commissioner Morrison asked everyone what new taxes they would propose, if any. Most took no stand on this issue.

Board of Review (BoR): I came in just as their presentation was wrapping up, but  I heard all of the questions.

• Their budget is only 1% of the whole county’s budget so any increase in personnel should be considered, according to the 3 BoR Commissioners present (Patlak, Rogers, and Cabonargi).
• Their biggest problem was losing experienced analysts in the past year. They would like 11 new ones.
• Their staff picked up 16,00 extra overtime hours in the past year and were not given more money for this. This was equal to 13 FTE’s.
• Most of the hearing was about community events called workshops in which the tax appeals  process was explained to the public. Many commissioners participated in these events. Also the B of R said it was a good way for staff to see the properties that were being discussed. More appeals are to be expected this year.

The Assessor: This presentation and Q and A session was extremely short. It lasted maybe 15 minutes.

• Assessor Berrios said he would have no trouble keeping within his budget this year due to new technology. This has helped to eliminate positions that became unnecessary.
• Commissioners seemed focused on Senior exemptions and the process that it entails. Ways of simplifying the process were mentioned.

Cook County Health and Hospitals System (CCHHS): A short report was given to each commissioner.

• Dr. Shannon said that no new revenues would be requested this year or for FY 2019. They will live within their budget mainly due to the fact that they now have 330,000 new patients enrolled in County Care (up from 270,000). Most new patients come with Medicaid funds which includes federal reimbursement for now.
• They have been able to solve any deficit spending by renegotiating contracts with vendors.
• Some of their proudest achievements other than the above include getting Cermak hospital out from under its consent decree (this is the jail hospital at Cook County Jail), a technology award for having all patient records electronically filed, and for expanding its charity care (care to those with no insurance at all). 
• In addition, the future looks to be one of 5-6% growth for a number of reasons. They expect more community centered clinics, especially those that deal with dialysis and dental care, and they have taken on the mental health services for kids in the JTDC (juvenile detention).
• They also hope to get to the underlying causes of bad health such as poor diet, housing and lack of job opportunity. He did not say exactly how a health care system would manage those issues, but he is working to obtain grants to study these issues.
• He is working on a better system of bill collection to alleviate previous problems.
• Comm. Boykin asked about the issue of gun violence as a health epidemic and what CCHHS was doing about it. Dr. Shannon listed many solutions. He said that he agreed with the commissioner and cited last weekend’s shooting statistics: 20 of 35 shooting victims were taken to Stroger.
• He said that in the case of a juvenile detainee, CCHHS was linking services he was getting while incarcerated with those out in the community once he was released.
• CCHHS is expanding its care under Mental and Behavioral issues in order to treat the whole person. This would include linking that patient with substance abuse programs and programs for depression or anxiety.
• CCHHS is working with Westside United and Rush Hospital in order to improve health in several west side neighborhoods.

At one point the hearing got a bit controversial as Commissioner Moore asked about a lawsuit against a doctor in a malpractice case. States Attorney Kim Foxx, who was on deck to speak next, answered that this matter was in litigation and could not be discussed in open hearing. Chairman Daley stifled any more conversation on this issue.

State’s Attorney:  Presentation was given by Cook County States Attorney Kim Foxx.

• Ms. Foxx said that this past year has been tough because last summer she missed an entire hiring cycle. Most of her new hires come in the summer after new grads finish law school and the bar exam. She was down in staff since her office did not have enough money to hire last summer. This summer is better and she is trying to live within her current budget.
• In FY 2019 she would like $1.97M more to hire 20 FTE’s.
• On civil cases she needs more experienced lawyers since she represents every county employee who needs defending. The conviction integrity unit has only 5 attorneys and 268 new cases came in this year. Her attorneys have 2-4x the amount of cases recommended by the American Bar Association.
• The SA Office also has attorneys working with the Chicago Police Department (CPD)  on intelligence gathering in the Englewood and Harrison districts in order to solve gun crimes. Training CPD and suburban police chiefs in how to gather evidence can save money if there are less faulty convictions.
• Comm. Suffredin commended her for doing a good job. 
• Ms. Foxx appealed to simple math often. Hiring outside counsel, she said would cost anywhere from $300 to $500 per hour on civil cases. Her attorneys cost about $90 per hour.

The Public Defender (PD): Presentation given by Cook County Public Defender Amy Campanell. She put up a big poster board with her core mission and with a list of some of the duties performed by her office.

• Ms. Campanelli  said that in FY2018 positions that were vacant for a long time were slowly being filled and that she was on target to live within her current budget.
• She wanted more staff in FY 2019  especially to start a mental health unit, but did not give a specific price tag unless asked.  She said that she had asked for this several years in a row . She now had a business plan worked up in which she would use student interns who were psychology or social work majors at local universities to help. Their assistance would be at no cost to the county. Early psych evaluations can also speed up the disposition of many cases. Comm. Deer asked her how much a mental health unit would cost the county. She said that she could do it for a mere $225,000. This would save money at trial since many psych professionals testify at a cost of $500 per hour.
• She also noted that now the PD is on call for arrestees in every police district in Chicago. She even gave out the PD phone number several times. A recent survey of 120 arrestees showed that 22 were released because the arrests should never have happened. This saves the county money. PD’s helped this to happen.
• She has also asked for more grant money to employ social workers and more lawyers to work with detainees awaiting trial who might be in danger of losing custody of their children.

Observer - Jan Goldberg

Cook County Board of Commissioners and Committee Meetings - April 25, 2018
                                       Meeting Length - 4 hours, including breaks. Committee meetings started at 10am.

FINANCE COMMITTEE MEETING
The Finance Committee, which met from 10:09am to 11:40am, spent considerable time grilling the Cook County Health and Hospitals System (CCHHS) CFO about the $174 million in denials in 2016 and 2017 as reported in the Inspector General’s (IG) 4/13/18 quarterly report for 1Q 2018. 

• Commissioners, Boykin, Daley, Gainer and Morrison asked most of the questions in trying to determine what led to the loss of $174 million - $108 million in 2016 and $66 million in 2017. Boykin referenced the report stating that denials can be attributed to scheduling, patient registration, coding errors, physician and nurses, inadequate and inaccurate coding. He noted that 1/3 was written off because of untimely filed medical bills. 
• In response to Comm. Gainer’s question, the HHS CFO said yes – the $174 million was lost due to missed collection deadlines and clerical error. 
• The Finance Committee talked briefly about another topic, but then Comm. Gainer asked about the CCHHS collection rate. The CCHHS CFO responded that the charges are different from billing and different from collections. Typically, patient collectibles are 30% or a $50 million loss on $175 million in charges.
• In response to questions, it was revealed that there had been about 1,200 patients treated for gunshot wounds at a cost of $35,000 per patient. However, it was unknown what percentage was covered by insurance. 
• It was clarified that the $174 million written off was separate from uninsured. $317 million that was written off for charity care. 
• Comm. Boykin expressed frustration with the responses he received. Comm. Suffredin stepped in, stating that the CCHHS CFO came to the meeting prepared to address the monthly report – not the IG report. He suggested a special meeting to address the IG report be scheduled. 

Comm. Daley wrapped up the Finance Committee meeting stating that they need clarity on the $174 million in losses. 

ZONING AND BUILDING COMMITTEE MEETING
Next the Zoning Committee met from 11:40 am to 12:50 pm. They passed a bunch of recommendations. 

BOARD OF COMMISSIONERS MEETING
Pres. Preckwinkle called the meeting to order at 11:54 am, then went into recess at 12:26 pm; reconvened at 1:08 pm and adjourned at about 2:08 pm. 

• Regarding 18-3099 a lease agreement for CCHHS, a question was asked about the expenditure of $1.5 to $2 million to lease space rather than incorporate it in the new building. It appears to be a bonding issue, which limits the capitalization plan. It was noted that the rent will be $23/SF with 79 free parking spaces, which is $2 less than market comps in the Medical District around Stroger. Staff felt it was the best deal in the newly renovated space. 
• There was also reference to the Inspector General’s report on CCHHS billing issues at the Board meeting, that had been previously referred to in the Finance Committee meeting. 

Items to Watch for in the Future

• Special hearing on the $174 million in CCHHS denial of billing by insurance companies.

Other Comments or Observations

• Several members from the Illinois Committee of Blind Vendors spoke during public comment. They referenced the “Blind Lives Matter” movement, that the unemployment rate for people who are blind is 70%, as well as an Enterprise Program for the Blind (a training program). They referenced the Blind Vendors Act. (I found reference to the BVA in the 1/17/18 Board meeting materials where it was referred to the Asset Management Committee’s 2/7/2018 meeting, which appears to have been cancelled. There does not appear to have been another meeting.)
• They mentioned that blind vendors have the right of first refusal on federal and state property and are looking for commission-free opportunities and partnerships like they have with state and federal. They advocated for the commissioners to vote in favor of the Blind Vendors Act of Cook County.

​Observer - Peggy Pissarreck                      

Cook County Board of Commissioners Meeting – July 19, 2017   
   
Significant Decisions Made:  

• A proposal by Commissioner Garcia to prohibit law firms handling property assessment appeals from contributing to election funds for any candidate for Assessor was referred to the Finance Committee. (Agenda Item 17-4188)
• Passage of the new witness slip ordinance -  Authorization to speak will only be granted to individuals who have submitted in writing their name, address, subject matter, etc. 24 hours in advance of the meeting. (Agenda Item 17-3293) Commissioner Suffredin publicly thanked the League of Women Voters and the Better Government Association for their support of this amendment to the rules of organization.
• After extensive discussion and testimony of twenty south suburban mayors and presidents, seeking repeal of a requirement that all contractors working on Class 8 projects have a certified U. S. Department of Labor Apprenticeship Program, the revised ordinance passed with a 9 to 6 vote.  The communities promised to work with the Board to revise the issue. (Agenda Item 17-4339)
• An amendment to the Cook County Property Tax Assessment Classes returning small Bed & Breakfasts with no more than six rooms to Class 212.  Two years ago the Assessor’s office had changed their classification to Commercial which dramatically increased their property taxes.  Testimony indicated that owners live in all of the affected B&Bs as their personal homes. (Agenda Item 17-3303)

Significant topics  discussed:

• The Comptroller and his staff reported on some of the finances of the County.  Sales tax receipts are down about $5m from projections and not likely to be recouped.  This was attributed to online sales.  The Clerk of the Court receipts are down about $1.4m due to a decrease in the number of tickets issued.
• Comm. Boykin questioned Dr. Shannon, Cook County Health and Hospitals CEO, about increased costs to Stroger Hospital because of all the murders and gun violence.  This was followed by a discussion of how Dr. Shannon made the ten percent cuts to his budget as ordered by President Preckwinkle.  He indicated he cut 3 physicians, 21 nurses, and also cut contract usage and other related actions. He indicated that he had vacancies in other areas of the hospital and most of the laid off staff would be able to find other positions.  This led to a discussion of vacant, funded positions that he still can use, and Commissioner Boykin questioning if all vacant position in the county are eliminated and all hiring is frozen “is there a need for a layoff”.  The discussion ended there.
• There was also a discussion questioning if the Comptroller’s staff still has to drive to Springfield to pick up the multi-million dollar checks from the State.  He answered Yes, but they are still trying to achieve electronic transfer and eliminate the driving.

Other observations:

• The meeting lasted until 6:30 p.m.  This observer left at four p.m.  The actual Board Meeting with the pledge and prayer began about two thirty in the afternoon having been preceded by several committee meetings.  It was a “survival of the fittest" meeting.

Observer - Syvia Tillman                                    Meeting lasted:  9:30 a.m. until after 6:30 p.m.  

Cook County Board of Commissioners Meeting - May 10, 2017                               

Significant Decisions Made:  

• The Patriot Acres Special Use proposal to establish an organic materials recycling facility to convert landscape trimmings and food scraps into high quality compost in Des Plaines was approved with several additional conditions imposed.  The vote was 13 yeas and 2 nos from Comm. Goslin and Morrison.  Comm. Silvestri recused himself from discussion and voting and Comm. Schneider was absent. (Agenda Item ​17-2310)
• Accepted a grant from IDHA of $250,000 to be used for maintenance and demolition of abandoned property. (Agenda Item 17-3106)
• Comm. Boykin's Resolution urging suburban communities to consider adopting and working  constructively with  Chicago neighborhoods was approved. (Agenda Item 17-3227)
• Reappointment of Cook County Health and Hospitals System (CCHHS) Board members Hill Hammock, Mary Driscoll,  Robert Reiter.

Significant Topics Discussed and/or Referred to Committee: 

• Comptroller’s Report  -  The State of Illinois owes Cook County $105 million dollars - including money from 2016. County did recently receive a $40 million payment for 2017.  The Board discussed the possibility  of getting paid interest from the state under The Prompt Payment Act.
• Commission Suffredin introduced an ordinance allowing for the electronic filing of witness slips by the public on all issues that come before the Cook County Board and the Committees of the Board The ordinance was referred to the Rules Committee to be voted on at June 7 meeting. (Agenda Item 17-3293)

Other Testimony: 

• During CCHHS reports, Dr. Shannon was asked about what can be done about the gun violence problems.  His comments focused on the desperation in the communities and the need for jobs, education, other societal determinants of health and the need to improve the economics of the community.

Other Comments or Observations:

• The lengthy meeting was a result of the large number of individuals who testified on the Patriot Acres proposal. 

Observer: Syvia Tillman                                         Meeting Length:  5 hours including committee meetings

Cook County Board of Commissioners Board Meeting - April 12, 2017

At the end of the Finance Committee that preceded the Board Meeting, a report from the Cook County Health and Hospitals System (CCHHS) CFO stated that the state owes $45 million to the county for FY16.  There is a match that the county makes to the state that is required to meet the federal match and CCHHS makes expedited payments to the state in order to get the money back from the federal government. The money is actually driven down by the CFO and hand delivered to the state office in order to prevent the continued delay from the state regarding not yet receiving the match money from the county!  

Comm. Boykin asked Dr. Jay Shannon, CCHHS CEO, to explain the status of the gun violence reduction study being done by CCHHS.  Dr. Shannon said that the study continues, but preliminary results show major stresses on families and communities are similar to the stresses that researchers are finding with children in Syria!  Trauma Informed Care is showing that the trauma of living in a continued state of stress leads to chronic behavioral problems and ultimately to physical disease.  He described it as a cascading problem.  CCHHS is targeting community based care which will offer social and mental health support in the affected communities. The goal is for CCHHS to get into the community,  and better results will occur.  Comm. Steele suggested looking at mental health awareness.  Comm. Sims then offered her own experience of visiting with families and educating families about resources available.  Dr. Shannon explained that almost anything can be accomplished if the resources are available. Comm. Sims then said that she thought they all would agree to find a way and she suggested that the Dept of Human Services should take the lead. There are other models in the country where communities have put through referendums to tax the affected community in order to financially support the needed services. 

During Public Comment two women from the violence impacted communities provided emotional testimony and one stated that she was with the Warriors on the Watch. They described needed services and support for neighborhoods filled with liquor stores and abandoned houses. They expressed anger about guns and gangs and kids dying in the street. They asked for work “in our communities, so we don’t have to duck and die."  One called out Comm. Sims and said she is in the suburbs, not the west side.  Both were verbally supported by comments from Mr. George Blakemore.

Significant Issues Discussed and/or Action Taken:

• The Administrative Office of IL Courts (AOIC) is paying the county for probation officers (including juvenile), but slowly. Cook County is owed over $30 million and  the costs are about $3.7 million/month. 
• There was discussion from the interim director of Homeland Security (the last director was removed by Preckwinkle in November), regarding a grant from federal Homeland Security. Comm. Suffredin questioned the rules and budgeting of the grant.  He referred to a grant from last year, poorly managed, that resulted in the county having to come up with a significant amount of money to make the grant whole.  Homeland Security will monitor the new grant closely and will supply quarterly reports.
• Monitoring of the merger of the offices of the County Clerk/Recorder of Deeds was moved to the legislative committee. 
• Comm. Boykin’s resolution urging suburban-neighborhood innovation partnerships  is being expanded and will be reintroduced next month. (Agenda Item 17-2736)
• John Yonan, Superintendent, Dept of Transportation and Highways, answered questions from Comm. Suffredin regarding the request for $1,120,000 for 1.1 miles of road in Palatine that divides the oldest Forest Preserve in Cook County.  As the original request dates back to 7/12/2005, Superintendent Yonan explained that the bid includes an environmental and engineering study, which were never done. As I live within 5 miles of this forest preserve and understand the sensitivity of the area, I was very interested in the discussion.  The forest preserve is in Comm. Goslin’s district. He asked no questions.
• Approved a contract request from the Public Defender for the Safer Foundation that provides confirmation reports to judges that defendants are safe to be released.  Safer Foundation verifies information regarding defendants with low bonds and gives confidence to the judges. This is in collaboration with the MacArthur Foundation, the Justice Advisory Council and the Public Defender Office, to provide services for individuals with low bonds who have remained in jail for extended periods due to failure to post bond.
• Approved as substituted the $36m technology contract for Office of the Clerk of the Circuit Court of Cook County - Dorothy Brown’s office - that includes money for outside oversight of the contract. 

 
Observer - Laura Davis                                                              Meeting:   9:45 to 12:45