CC Board Budget Hearings Continue - Nursing Shortages, Shakman Compliance, Failures to Respond to Inspector General Reports among the Issues Raised

Cook County Board Finance Committee Meetings on the Budget
October 25, 2022

Cook County Health (“CCH”) – Presented by CCH CEO Israel Rocha. Jr.

• Addressing Payroll expenses, particularly for nurses, has been devasting for the System and remains its top priority.  Agency contract rates have declined but still historically high. President Preckwinkle has approved the System's new Retention and Recruitment Plan.
• COVID has led to the wide-spread adoption of telehealth and telemedicine.
•  The System's new Change Institute priorities are cancer, stroke, diabetes, behavioral health and mental health. Food and housing insecurity programs will be added and expanded.
• Provident Hospital - $5 million has been budgeted for early conversations with institutions that are interested in partnering and funding a new Provident Hospital.
• The System has already served close to 2,400 undocumented people aged 42 and up; and the CCH Foundation has supplied needed clothing, diapers, etc. for the newly arrived undocumented persons.

Commissioner Questions:
Miller:  Addressing the issue of the new Change Institute, said that she was pleased to see more focus on "preventive vs reactionary" care, and noted the increase of 44 new positions in this new Department.  She particularly asked for goals and metrics from each of the Institute's funding sources [ARPA, Grants, County] and any other new programs using ARPA and County funding.

CEO Rocha responded to a question about the behavior health goals using ARPA funding stating that there are two big categories:

• External:  The System will create an organization to expand the safety net for the Behavioral Health community and its services to secure in the long term all elements of Behavioral Health needs.  Will use impact funds to do an analysis of the current community safety net.
• Internal:   The System will expand "trauma informed" outpatient therapy and will create a 16-bed inpatient unit and crisis stabilization unit.

Responding to Miller's inquiry and support for more emphasis on equity and inclusion across the System's services, Rocha said that he is hiring a Chief Equity Inclusion Officer, and two Associate Inclusion Officers - one responsible to/for the System and one to/for the Public Health Department.

Next came Miller's question on the Juvenile Justice Care Coordination Program to be funded by ARPA.  Two Care Coordinators will be hired for reentry and transition stabilization.

When asked about the ongoing long-time issue of low patient satisfaction ratings, Rocha noted that the HIV Core Center has a great reputation and rhetorically asked "how can we use its experience?"

Degnan:  Wants the system to communicate more broadly that CCH is a safe home for reproductive health.  Said that a specific brochure is needed focusing on the System's services.  Rocha responded that he would send her the communication tools currently in use.

Anaya:  Responding to Anaya's concern about the length of the hiring process, Rocha said that the System has hired 350 individuals in the last 150 days and that turnover is at its lowest level in 18-20 months.

Several other Commissioners noted that their questions had been covered by previous colleagues and also commended CEO Rocha on his command of the System's needs and his vision for CCH.

Assessor’s Office -– Presented by Assessor Fritz Kaegi

• The biggest news is that the office expects to be found in “substantial compliance” with Shakman by mid-November.
• Assessor Kaegi next noted that the North suburban counties’ reassessment will be completed by the end of the year, and the office is waiting for the Board of Review to be in a position to accept the data.  
• 2023 priorities includes a new implementation phase of the Tyler technology system to ensure an on-time assessment cycle; the office needs to continue to maintain in parallel the old main frame system until the Board of Review transfers to Tyler; and it will implement new tools for tracking exemptions.  Expects March 2023 assessment data transfer to be on time.
• To date in 2022, hired 31 employees to fill vacancies due to retirements - 25% of new hires are customer service positions, and added strategic hires to build capacity in HR and Legal.  The office is not using temporary help; is hiring data science and evaluation majors, and also hiring from real estate schools. 
• Commissioner Gainer wants to work with the Assessor’s office to reset outstanding taxes on scavenger sale properties to zero thereby helping properties to be sold and neighboring properties to maintain their values.  She also wants to work with the FHA to change the rules so that Land Bank developers can get access to the FHA uniform appraisal data base and qualify for FHA loans.     

Carrying over from the meeting with the Assessor earlier, court oversight of the offices of the Clerk of the Circuit Court and the County Clerk under the Shakman cases (which prohibit political considerations regarding most County personnel) was raised during these two meetings.  

• Circuit Court Clerk Iris Martinez said she has been working closely with the court-appointed administrator, and expects her office to be found in “substantial compliance” with Shakman by November, 2022!  
• Cook County Clerk Karen Yarbrough criticized Shakman oversight of her office as not being necessary, and she has filed to end such supervision, expecting it to also end in November.  

Commissioner Sean Morrison focused on the failure of some County departments to respond to remedial recommendations, as required by County ordinances, during the meeting with the Inspector General.  
Following are more details from these meetings, along with the one with the Treasurer, who announced that she is expecting to receive the information for the 2nd installment property tax bills by November 11.  If so, she said she would have bills posted on her web site and available for downloading and payment by November 15.  
Treasurer -  Presented by Treasurer Maria Pappas 

• By posting the 2nd installment property tax bills on the Treasurer’s web site (hopefully by Nov. 15), this will facilitate payment prior to the end of 2022 for those wishing to take a deduction for property taxes on their 2022 income tax returns.
• Only 5% of the Treasurer’s budget is financed by taxpayer dollars.
• Says her workforce comes into the office - no working from home.
• Quickly went through her slide presentation, focusing on the many studies published by her office, included the latest one, the Sales in Error, which Comm. Gainer praised.  All of the studies are available on the web site, https://www.cookcountytreasurer.com/. 

Office of the Independent Inspector General -– Presented by Acting IIG Steven Cyranoski

• Responding to Comm. Morrison’s questions, Acting IIG explained that if an investigation results in remedial recommendations, the applicable department has 45 days to respond, with the ability to request 30 more days under County ordinances.  The department does not have to accept the recommendations, and Mr. Cyranoski said that there may be good reasons for not accepting.  In each quarterly report from the IIG, at the end there is a list of cases for which no response has been received.  These quarterly reports are submitted to the Board, which in turn can refer for further consideration by the Litigation Subcommittee.  Comm. Suffredin noted that the League of Women Voters has pointed out these failures to respond.
• When the open slots for the IIG and the Deputy IIG are filled, the office will have 19 FTEs, same as authorized for 2022.
• Over the last 5 years, there has been an 85% increase in number of complaints.  Have been able to handle because of the high quality of the personnel in the office and increased use of technology.
• 85% to 90% of the IIG’s recommendations have been adopted. 
• In response to Comm. Suffredin’s questions, Mr. Cyranowski explained that there are 2 investigators assigned full time pursuant to the intergovernmental agreement to provide inspector general services to the Metropolitan Water Reclamation District (“MWRD”).  The current agreement ends mid-2023.  The MWRD has gone to Springfield to obtain legislation that would authorize the MWRD to have its own IG in-house.  In anticipation of this happening, the current budget adjustment (called an “appropriation transfer”) has been reduced from $650,000 in 2022 to $250,000 in 2023.  Part of transfer is also due to the work the IG does for the Forest Preserve.

Clerk of the Circuit Court - Presented by Circuit Court Clerk Iris Y. Martinez

• Has hired more than 150 people to fill open spots this past year.  Currently there are 280 entry level union vacancies, many due to 200 promotions.  Cross training is now being provided so clerks can staff Criminal or Civil courtrooms as necessary.
• 2023 budget includes 30 more FTEs so that every court can be staffed to meet the needs of the new SAFE-T Act and the expected increase in the hours when domestic violence orders of protection can be obtained.  A pilot for extended hours is currently running through early Nov.
• Hopes to be fully integrated into the Odyssey system by the end of the year, reducing reliance on the County’s mainframe.
• Has launched a new call center for 200 different languages to make information more readily available.
• Overall, the budget has increased by 2%.
• In response to a question from Comm. Miller, Clerk Martinez said that the court documents can identify the number of continuances, but not the reason.  Comm Miller and Daley emphasized that they need a report on who is requesting continuances in order to understand (and potentially tackle) the issue of defendants being held in the jail for long periods of time.

County Clerk - Presented by Clerk Karen Yarbrough

• To help alleviate the critical need for Election Judges for the Nov. 8 election, the office reached out to retired military and had 2,000 respond.  More judges are still needed for the 1,439 precincts (which need 5 judges each).
• Early voting and vote-by-mail ballots accounted for 40.1% in the June primary.
• Said that Cook County is recognized nationally for its cyber-security for voting.
• Said that the bulk of revenues from this office is from the recording of deeds area.  A new cashiering system should be rolled out in 2023.  There is a help desk now for recordings.
• Land records from 1871-1974 will be digitalized.

Observers:  Diane Edmundson and Priscilla Mims