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: Health & Hospital Committee Meeting
October 18, 2022

The following reports were received and filed:  

• Alternative Health Intervention & Response: 
  • This report is the result of Commissioner Degnen’s resolution that last year focused on establishing for suburban Cook County  a mobile crisis team to respond to mental health crisis with trained mental health specialist. 
  • Commissioner Degnen at the meeting noted that establishment of the team for this year will need to be delayed sometime in 2023. The task force activity working on this project are expanding usage of the 988-emergency number and facing issues with the workforce and hospital capacity for care.   
• Covid 19/ Contract Tracing Update: 
  • CCDPH expecting a surge of COVID 19 in Nov. Concern about low rates of vaccinations and will be working over next months to increase levels of vaccination.
• Cook County Health System Strategic Plan 
  • Review of Strategic plan generated questions regarding the changing of the Health System’s mission statement.  What was emphasized is that the team was committed to a shorter mission statement maintaining the wording "regardless of the ability to pay" and adding the word "access".  
• Cook County Health: Mental Health Services Quarterly Report
  • Reports from Health System’s Department of Behavioral Health & Psychiatry; Cermak Health Services; Juvenile Temporary Detention Center Health Services (JTDC); Cook Department of Public Health
  • A common theme with each of these agency reports is a marked increase in need for mental health services. Discussion focused on numbers of juveniles confined in their rooms which presenter while did not have data felt that few were being confined to their rooms. 
  • The Cook County Department of Public Health did report training of 145 suburban law enforcement over 3 months in usage of naloxone and have documented through this training were able to reverse 20 overdoses.
• Behavioral Services Quarterly Report: Office of Chief Judge
  • Instituted with ARPR monies a collaborative program focused on youth diversion from criminal justice system. 
  • Pilot program demonstrated of 135 youth with gun charges 79% completed the outlined treatment program with charges dropped. 
• Cook County State’s Attorney Office & Cook County Sheriff’s Office: Behavioral Health Services Report:
  • Both agencies reported on working to expand community mental health services. The State’s Attorney Office reported that there were significant lower number in the pool for diversion coupled with community agencies that they partner with facing backlog of referrals. 

Items to watch in the future:

• Capacity for the expansion of mental health services 

Observer:  Susan Avila

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 of Directors Committee Meetings
Health & Hospital Committee
November 2, 2021

Cook County Department of Public Health [CCDPH]:

• Public Health officials gave their monthly update on Covid-19 status and issues.  They reported that 98% of the CC Care Team has been vaccinated, and they are in the midst of preparing for the rollout of the Pfizer vaccinations for 5-11 year olds. Frontline efforts will be at schools and medical providers’ offices. CCDPH has established between 150-200 partners to give vaccinations.  CVS, Walgreens, and the smaller federally funded Health Centers are among that number.
• The Health Department is beginning to incorporate the census 2020 data into its Covid data – they now have 2020 census data on population by race and ethnicity and reported that with this incorporation, case rates for whites have increased, Hispanics has decreased, and there is no change for the African American community.  
• The State has agreed to extend its county grant for contact tracing into 2022.
• When asked about the reason that the undocumented have a hesitancy to take the vaccine, the answers given was:  1. No health care provider 2. Many are very young and didn’t qualify initially  

Mental Health Initiatives/Statistics - Quarterly Reports from Cook County Offices

• The Cook County Board of Commissioners passed a resolution a number of months ago requiring that all County offices dealing with mental health patients, detainees, etc. provide a quarterly report on their actions and activities regarding mental health services. 
• Eight offices provided their quarterly report at this meeting. Those reporting were: CC Health, CC Department of Public Health, Cermac Health Center, Juvenile Temporary Detention Center, Sheriff’s Office, Chief Judges Office, Office of Veterans Affairs, State's Attorney Office. and the Office of the Public Defender.
• One provided a verbal report. There does not appear to be a standard format for providing information the board is interested in receiving.  However, the program is new
• Not all of the offices provide mental health services.  For example, the Public Defender’s office provides information to their lawyers for their clients.  Others are referral only.

Observer:  Diane Edmundson

Cook County Board of Commissioners 
Health & Hospitals System Committee Meeting
March 16, 2021

Following two public comments urging that additional vaccination sites be set up in the western and southern suburbs, coincidentally, the presentations by both the Department of Emergency Management & Regional Security and the Department of Public Health (“DPH”) focused on the criteria that has been used in establishing County-sponsored vaccination sites in the suburbs and how this is changing.  Both Departments acknowledged the need to provide more vaccination opportunities in the southern and western suburbs and said that they expect, with the promised increase in vaccination doses, to be able to do so.

• Executive Director of Emergency Management William Barnes explained that the County started by looking at large sites in order to be able to get as many shots in arms as possible.  Convention Centers were looked to, such as the one in Tinley Park.  Began rethinking as heard from communities wanting their own sites, as well as the Federal and State governments now also wanting to be involved.
• Currently looking at large commercial sites, such as big box stores, which are located all over the County and are very flexible (can use large or small areas as required), have lots of parking, generally are easy to locate, and often accessible by public transportation (all key factors).
• But also looking at other alternatives:  know that while about 40% of people happy to go to large sites, the rest prefer smaller sites.
• CEO of Cook County Health Israel Rocha, Jr. said that currently there are more people wanting the vaccine than those needing more education about it.  He touted the number of contacts from residents to the vaccine web site, www.vaccine.cookcountyil.gov, and the vaccine hotline, 1-833-308-1988.
• Dr. Kran Joshi reported that 18% of suburban residents have received at least 1 vaccine shot and 9% have received 2. 
• A Mobile Vaccination Strategy is in place to help reach more places, with a pilot successfully conducted in Maywood recently.  More are scheduled.
• Dr. Rachel Rubin reported that the DPH finally has a significant workforce in place to do contact tracing.
• DPH presented its 1st quarter report (Item 21-0798) which focused on its grants of $5 million to 42 community organizations to help educate and vaccinate people and of $1 million to 5 worker centers to help reach temporary workers over the 6-month period from Dec. thru May.  With more funds coming, DPH expects to continue the efforts through the end of 2021.

DPH also told the Commissioners that it had received reaccreditation in Feb. for the next 5 years.

Priscilla Mims, Observer

Cook County Board of Commissioners - Committee Meetings  
December 16, 2020

Zoning and Building Committee:

• Commissioners Britton and K. Morrison have revised their proposed Tenant and Landlord Ordinance with input from the parties concerned.  This ordinance would give tenants in Cook County suburbs more protections from evictions, payments, and other tenant issues.  Several thousand comments were submitted to Board members, both in favor of and against the original ordinance.  Because this latest iteration of the ordinance was just completed and Board members and the public should have time to review it, the vote on this was delayed until the January Zoning and Building Committee meeting. The new (2nd) substitute ordinance (Agenda Item 20-3562) is over 21 pages long.  Meeting observers did not have access to the substitute during this meeting.

Rules Committee:

• Commissioners Deer and Moore proposed adding Juneteenth as a 14th paid holiday for all Cook County employees.  This ordinance (Agenda Item 20-3460) commemorates Black American freedom.  There was not a cost analysis presented that this observer could see.  All commissioners spoke in favor of the ordinance and it passed in this committee.
• An archive ordinance (Agenda Item 20-3950) will provide for all Cook County offices’ and departments’ historical records dating to 1876 to be formally archived. A Manager of Archives (hired from DuSable Museum) will coordinate this preservation of history of Cook County.

Finance Committee:

• An Ordinance (Agenda Item 20-4357) which included edits to the Independent Forecasting Commission Ordinance passed.  This will “better serve the purpose of this commission,” according to sponsor Comm. Anaya.  This commission analyzes new revenue streams proposed by Board members and the President.  There was no mention if this includes the Hospital System.

Health and Hospitals Committee:
The 3rd and 4th quarter reports were presented  by the Cook County Department of Public Health (CCDPH). 

• The 3rd quarter report addressed COVID cases, violations & mitigations, and inspections of businesses violating COVID “rules” such as indoor dining and congregate settings.  Over 200 locations have been cited and are listed on the CCDPH website.  Among the current rules are the following for Cook County:  no indoor dining, retail at 25% capacity, no sports events—games or spectators, restricted visitation at long term facilities.
• The 4th quarter report presentation covered flu/COVID combination concerns, vaccine distrust, challenges in vaccinating Cook County communities, logistics of vaccinating, and strategy. 

There were many questions and comments from commissioners.  Points brought up include the following: 

• Flu vaccination rate in Cook County is less than 50% (less in Black communities) and the CCDPH wants to use public service announcements to get higher rates of vaccination. 
• Challenges to vaccinating for COVID mentioned were myths surrounding the vaccine, distrust of vaccine, unclear support from the state, limited resources, and defining critical populations when the vaccine is limited.  The current strategy of vaccination for Cook County is health care workers are the first to be vaccinated; County is partnering with CVS, clinics, etc. to distribute the vaccine; tracking and monitoring who has gotten the vaccine will be done.  It will take 4-5 weeks to get hospital workers vaccinated.  Comm. Deer asked if there will be mandatory vaccinations for Cook County Health workers.  Answer will be sent later. Dr. Joshi stated that even after a person is vaccinated there will still be a necessity to mask as it is unclear if the virus can still be spread from that person.
• Both quarterly reports were voted on and passed. 

Legislation and Intergovernmental Relations Committee:

• An Ordinance (Agenda Item 20-4415) transferred special purpose funds to the County Clerk’s office due to the consolidation of the Clerk and Recorder of Deeds offices and cleared up references to the Recorder office (which no longer exists) .  Discussion centered on how many Recorder employees will be hired in Clerk’s office.  This issue of guaranteeing that employees would have jobs in the new consolidated office was decided by the CC States Attorney office—that the Board cannot interfere in these types of hiring decisions.  Comm. Johnson still desired that all the employees have guaranteed jobs—perhaps elsewhere in county government— in order to keep a job and health care. Forty-five have been retained so far.  There was a big discrepancy between what the SEIU (union representing those workers) and the Clerk’s office say regarding hires.  SEIU has brought a notice to strike in court.  This strike would be all SEIU employees in the County.  However, the court has enjoined that some essential workers are not allowed to strike. 

Follow Up Items: 

• Tenant/Landlord Ordinance (Agenda Item 20-3562) at January meeting
• Board of Review hearing in near future
• Hiring between Clerk’s office and now-defunct Recorder office
• COVID vaccination procedures and results

Observer:  Karin Hribar                                                   Meeting(s) length total: 5 1/2 hours