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 of Commissioners Committee Meetings
June 28, 2023

The Commissioners had a full day of Committee meetings filled with much substance. Highlights below include

• Approval of the 12-week paid parental leave for offices under the President (not for employees who work for the other County Elected Officials)
• Differing views about the conditions inside the Juvenile Temporary Detention Center
• Updates on the status of revenues vs. expenses for this fiscal year and on the long-term revenue forecast
• Update on what the different County offices are doing with respect to domestic violence cases

12-week paid parental leave

• The Finance Committee voted to direct the Bureau of Human Resources to put together a policy for paid parental leave for 12 weeks.  To qualify, the employee must have been full-time for at least 12 months and must be a birth parent, non-birthing biological parent, intended parent of a gestational surrogacy, parent of adopted child, or foster parent placed with a foster child of 17 or younger.  Employees will be limited to 1 such leave per 12 months.  
• Commissioner Degnen, the principal sponsor along with President Preckwinkle, explained that the policy would for now only cover employees under the offices of the President.  Each other Elected County Official must take their own steps to adopt such a policy.  Commissioner Degnen said the Board can and should encourage such steps by assuring the Electeds that the Board would make sure the money was there to cover the costs of such a policy.
• Commissioner Gainer said that she had left the City of Chicago’s employment years ago because it had no such policy.  She expects that having such a policy now at Cook County will enable many good employees to remain at the County.  
• Commissioner Kevin Morrison stressed that people who opt to take this leave should know there will be no retributions as a result - particularly that they will not miss out on promotions.
• Commissioner Miller emphasized that this policy should assist in improving the significant maternal mortality and morbidity rates that the Commissioners heard about the previous day by allowing birth mothers to have the time to obtain the care they need.  Commissioner Miller also said that this policy was another plus for attracting and retaining good workers at Cook County (again referencing yesterday’s meetings where they heard about the challenges of hiring).
• The Board approved this item (#23-3117) at the Board meeting on June 29.

Conditions at the Juvenile Temporary Detention Center (“JTDC”)

• The Audit Committee held a hearing to discuss Equip for Equality’s report on conditions inside the JTDC, which is under the authority of the Cook County Chief Judge.  The Chief Judge did not speak, but was present throughout.  
• Equip for Equality (“EFE”) is the private not-for-profit legal advocacy organization designated by the Governor to operate the federally mandated Protection and Advocacy (“P&A”) System for people with disabilities in Illinois.  EFE conducted observations and interviews with staff and detainees at the JTDC and the Chicago Public School that operates there from late 2021 thru early 2023.  The full report can be found at https://www.equipforequality.org/files/jtdc_report.pdf
• EFE recommends ending the practice of isolating youths and the use of a “holding” pod for those who either act up in the school or refuse to go to school.  EFE also recommends the end of the policy of having youths in the holding pod sit “on the wall” while they are given packets of work and utilize overturned chairs as desks, all the while not being able to talk to anyone.
• JTDC Superintendent Dixon and other supervisory JTDC staff stated there was no such “policy,” but admitted that this practice is used.  Supt. Dixon explained that this is used to prevent harm to others, as well as for the youths themselves.  There are serious gang issues within the JTDC, and the youth detained there are generally accused of serious crimes, including murder and attempted murder.  
• EFE is particularly focused on those detained in the JTDC who have special needs and the failure to accommodate that in the school.  However, Supt. Dixon explained that the staff are not advised by the Chicago Public Schools (“CPS”) as to when any of the youth there have special needs.  The prior memorandum of understanding between CPS and the JTDC lapsed a long time ago and a new one is just now being negotiated which presumably would provide for such information to be given to the JTDC.

Current Fiscal Year and Long-Term Revenue Forecast

• The Comptroller reported to the Finance Committee that both the General Fund and Health Enterprise Fund have positive balances due to revenues exceeding expenses:  $162 M for the General Fund and $108 M for the Health Fund.
• Dean Constantinou, Deputy Chief Financial Officer, presented the quarterly update on the long-term revenue forecast developed by the County’s Independent Revenue Forecast Commission.  The forecast is for slow economic growth into 2024, which should have a positive impact on revenues, particularly the sales tax which, as of April, is projected to be 1.3% over budget.  As a result of projected small surpluses going forward over the next 5 years, the County’s Fund Balance should continue to be above the maximum desired under the County’s policy, resulting in additional funds being available.
• The forecast is also for revenues to exceed expenses in the Health Fund going forward.  County Care membership is expected to peak in June and then drop off.  After November of 2024, the forecast is for membership to remain flat.

Domestic Violence

• The Criminal Justice Committee heard from representatives from the offices of the State’s Attorney, Sheriff, Chief Judge, and Clerk of the Circuit Court on what is going on with respect to domestic violence cases.  The Public Defender was not available.  Prior to the meeting, Commissioner Anaya, the sponsor of the item (23-2711) calling for the hearing, had met with each office explaining what she wanted covered.
• The State’s Attorney’s representative talked about the Domestic Violence Mental Health Court pilot that started in February.  The focus is on familial conflicts with outpatient and inpatient treatment for both defendants and victims.  So far, there have been 50 cases and 5 graduates. 
• The State’s Attorney is recommending (1) technology upgrades to the domestic violence court at 555 W. Harrison, (2) creation of a shared screening data base among agencies, and (3) the elimination of paper communications.  
• The Clerk of the Court’s representative reiterated the need for a single system among the criminal justice offices, and said that there is one that all offices have access to:  the Clerk of the Court’s Case Management System.  What needs to be done now is make sure all offices are trained on using it.  The representative explained that each office still needed its own system to manage its work load – other offices, for example, should not have access to the State Attorney’s case management system.  
• Honorable Judy Rice, the Acting Presiding Judge of the Domestic Violence Court, reported that there are 1500 new cases each month, both criminal and civil.  There are monthly meetings among all the entities (DV advocacy, Sheriff, Clerk of the Court, State’s Attorney, DV Judges, etc.) and the Chief Judge’s office supports increased staffing for all.  Since the pilot program for “After Hours” Domestic Violence Court (9 pm to 3 am on weeknights and 1 pm to 6 pm on weekends) there have been 543 cases.

​Observer: Priscilla Mims

Cook County Board of Commissioners Committee Meetings 
May 24, 2023

Veteran’s Affairs Committee

• Chair Morita and the Veteran’s Committee heard testimony related to the new Veterans Affairs of Cook County Commission. Two veterans described the challenges when they attempted to access services. First, Cook County did not initially have VSO’s (Veteran Service Officers) to facilitate the cases presented. Secondly, budgeting was far from adequate. For example, Lake County, which has many fewer veterans, was receiving $5 million while Cook County, with the largest veteran population, had a budget of $1 million. 
• Director Love from the Cook County Department of Veterans Affairs testified that they were well aware of these problems and that there has been one VSO hired with three more to come. She stated that they were aware of the need for satellite offices, so that veterans could more easily make use of the services. With the new ordinance, employees of the VACCC will have the same benefits as other Cook County employees. In addition, the director will be able to speak directly about the agency, rather than going through the CC Department of Veterans Affairs. The ordinance was approved that would enable the VACCC to operate independently, now that the IGA is no longer in effect.

​Finance Committee

• The Cook County Comptroller reported that the general fund was +$115 million and that the CC Health Fund had a favorable balance of $22 million. Receivables from the State were $314 million for Medicare and AOIC. 
• Commissioner Sean Morrison asked how much is the State of Illinois in arrears to Cook County. The comptroller replied that items such as grants are historically slow. However, State medicaid payments are less than one month. Commissioner Morrison expressed concern that the State might be “sitting on our money.” Comptroller said that they had no mechanism to track how grants move through the system. 
• A spokesperson for Cook County Health stated that they had no concerns about the State. She said they were currently working to find funding for the recent influx in immigrants from the border. 
• All items for approval passed unanimously and a final vote will occur at the Cook County Board Meeting.

​
Transportation Committee: 

• Agenda Item 23-0342- A Motion was put forward to receive and file the Cook County Bicycle Plan, whose goal is to advance the bicycle infrastructure in the county. One goal is to connect existing gaps between the county and the Forest Preserve system. Commissioner Trevor suggested that there are some suburbs that need to remove physical barriers that inhibit free flow of bicycles. Motion was approved on a voice vote.

Technology & Innovation Committee

• Joe Gallo, former mayor of Rolling Meadows, spoke in support of the Illinois Smart City & Region Association. This organization helps to create a roadmap for digital transformation. He would like to see the ISCRA work closely with municipalities to improve services. Commissioner Britton echoed his approval, stating that the association saves money and is needed to improve service to citizens throughout the county. Commissioner Trevor asked for concrete examples of the association’s work. Gallo said that one example would be the impact on First Responders. Innovative ideas contribute to enhancing public safety and to reducing crimes. A commissioner whose district lies within the city of Chicago asked if the association was working with the city. He said no. Chicago is a different sort of challenge on a scale that the ISCRA would find hard to meet. However, it would certainly be possible for neighborhoods to become involved. 
• All motions put before the committee were approved unanimously by a voice vote and final vote will be at the Cook county Board meeting.

​Observer: Georgia Gebhardt

Cook County Board of Commissioners Committee Meetings
May 24, 2023

Legislation and Intergovernmental Relations Committee

• After testimony and much discussion, commissioners voted yes to the proposal (23-2311) to amend the ordinance regarding tobacco dealers and eliminating the sale of flavored (including menthol) nicotine products. The substitution allows time for notification.  Among concerns noted were reports of products laced with fentanyl, marketing to minors, impact in unincorporated Cook County, need for alignment of policies and hope for state policy. Motion was made by Com. Miller, seconded by Com. Lowry, and was passed.  
• Commissioners also voted to recommend for approval of Ethan’s Law (23-2695) which would require gun owners to secure guns.
• Presentations and extensive discussion went on regarding Agenda Item 23-1387, a resolution to request a meeting by this committee to discuss Asian American and MENA Data Collection and Language Access Hearing. It was approved.  The key question at the starting point is what we are doing now regarding current employees, forms, job applications, and services to the public. Information from LA county and best practices are being sought. 11 presentations were given by entities reporting. Federal Government will be updating race and ethnicity categories for data collection; this could impact standardization. Several different translation tools in use were cited with cautions regarding limitations of translations. 

Human Relations Committee

• Voted to defer action on Agenda Item 23-2279 regarding amending the Human Rights Ordinance to include no discrimination related to exercise of bodily autonomy.

Health and Hospitals Committee 

• ​Covid updates (23-0469) from Cook County Health and Cook County Department of Public Health - . Dr L Hasbrook stated the Covid case count continues to decline, that testing at home does impact local collection of data. Just under 20% (approximately 16, 000) of Cook County is up to date with latest booster and there are over one million shots in arms. 2 points currently being emphasized in public information: The Public Health emergency is ending while the concern is not over since the virus is here to stay. 
• Regarding MPox, the increase is by a couple dozen in Chicago and +3 suburbs. Among people vaccinated the infection is less severe. Information for the pubic will be updated for social media, publicity, and PRIDE Chicago. Having an adequate amount of vaccines available and medical countermeasures for those infected are part of what is being done. 

Committee meetings adjourned at 4:31.

Observer - Carolyn Cosentino

Cook County Board of Commissioners Committee Meetings      
Wednesday, April 26, 2023

Finance Committee:

• Comptroller Laurence Wilson presented the January Revenue report for Cook County Health (CCH), which was mostly on budget and the 2022 year end report which had no significant variances. 
• State of Illinois is frequently late on reimbursement to CCH. 
• About $1billion will be spent on immigrant health; the question is “Who Pays?” —County, State, Federal governments? 
• In addition all Medicaid recipients need to reapply (redetermination).  About 1 million more residents are on Medicaid now than before the pandemic due to expanded program and not being required to re-enroll during that time.  There will be a monthly rolling basis of redetermination with letters going to current Medicaid recipients. It is expected that County Care (the Cook County insurance program) will lose members and thus money due to fewer being qualified.

Audit Committee:

• Auditor Mary Modelski gave an update of Open Recommendations from the Auditor’s Office to various departments regarding large projects and department practices. 
• Human Resources Dept. disagreed with many recommendations, particularly with on-boarding new employees and  trainings, and so declined to follow them.  The Auditor can recommend, but not require these to be followed.  It would be up to the Cook County Commissioners to follow-up/change rules, etc.

Environment and Sustainability Committee:

• A resolution calling for further federal action and accountability in connection with Norfolk Southern Corporation’s Operations (Agenda Item 23-1939) was passed in committee.  This relates to the recent derailing in Ohio which released toxic materials.  The sponsor, Commissioner Quezada wanted “to demonstrate solidarity with Ohio and ensure safety of rail systems.”

Technology and Innovation Committee:

• The Technology Department presented updates on several large projects. 
• The IPTS Property Tax Project (which has been a source of controversy and blame) will “go live” in October or November if the property tax bills go out on time.  There will still be two separate systems (Assessor and Board of Review) but with an interface so that the same data is seen by both departments.  The future goal is for both these offices to be on the same system (Odyssey or Tyler) and off the main frame computer which is about 40 years old. 
• Getting off the main frame system is the main goal for the Technology Department for numerous County depts.
• The Criminal Justice BUS computer system works and has been ready to go.  This system computerizes the CJ data and information for easier access and reliability.  However, it was noted that paper carbon copies are still being used.  The solution (BUS System) is there; but not all departments are using it.

Observer - Karin Hribar

Cook County Board of Commissioners - Committee and Board Meetings
March 15 and 16, 2023

Finance Committee   March 15

• The Comptroller gave a report.  (#23-1270) The state of Illinois owes Cook County $318 million. Commissioner Sean Morrison noted that  the State is slow to distribute sales tax revenue from the Local Government Distribution Fund.  Commissioner Brittan recommended organizing a lobbying effort with the State to improve the distribution. 
• Dean Consentino of the Independent Revenue Forecasting Commission gave a long term forecast of Cook County revenue and expenses in the General Fund.   It is projected that there will be sustained slow economic growth.  The projected inflation could impact sales tax revenue. While the  revenue will grow less over the next five years, the expenses will increase at a higher rate.    In the Health Fund, the Medicaid re-determination will  decrease the number of recipients, increasing the costs to the Health System.  Their projections did not include continuing the current programs being funded by ARPA funds.  
• Cannabis tax revenue goes to the Equity Fund.   

Contract Compliance Committee-  March 15

• Agenda Item 23-0936 - Nicole Mandeville, Director of Contract Compliance, presented the proposed changes to the Minority and Women Business Enterprise (MWBE) section of the Procurement Ordinance.  They are to extend the ordinance until 3/31/28 and change how the net worth of a woman business owner’s wealth would be calculated.   Some illiquid assets would no longer be counted.  After initial certification, the business would have to confirm its financial condition  and submit tax returns.   They would not have to be certified every year. The changes came from a disparity study that is done every five years.  Public speaker Mary Kay Moynihan, Women’s Owned Construction Group, expressed concern the ordinance might be challenged once some current cases at the Supreme Court are settled.  Ms. Mandeville  and the Contract Compliance lawyer, Laura Lechowitz stated that the goals in the ordinance are legally defensible.   MWBE goals are set for each individual contract. 
• The Committee recommended approval.  The Board of Commissioners approved.

Technology & Innovation Committee  March 15

• Agenda Item 23-1334 The Chief Information Officer’s annual report was recommended to be received and filed.  There was no discussion, but committee members had met individually with the CIO.
• The Board of Commissioners voted to receive and file.

Legislation and InterGovernmental Relations Committee March 15

• The Committee met with Sukemeke Watkins and Lizbeth Leanos of the lobbying team from the Office of the President.   They reviewed various bills that the County is supporting at the State and Federal levels  and discussed arrangements for the County lobbying day in Springfield. 

Cook County Board of Commissioners Meeting
March 16     10:30 AM to 1:10 PM

The Board of Commissioners approved previous Committee recommendations with little discussion.  Several public speakers complained about the steep increases in property taxes in the Pilsen area.  Commissioner Anaya has organized programs on how to appeal the taxes and request exemptions.

The Board honored Secretary of State Jessie White on his retirement.   Most of the Commissioners spoke to his service to the County and State and his Jessie White Tumblers Program which has served 18,000 kids over 65 years.

Board Action:

• Agenda Item 23-1606   The Board approved  ARPA funds to subsidize installation of solar technology for residents.
• Agenda Item 23-1609  The Board approved ARPA funds for the Housing Authority of Cook County and the Justice Advisory Council to aid people getting out of prison in obtaining housing.
• Agenda Item 23-1647  The Board referred the Report on Major Technology Projects to the Technology Committee.

Observer:   Kathi Graffam