Board of Health

Skokie Board of Health December 12, 2013 Present Absent Excused Mr. Abbasi Dr. Prince Ms. Bromberg Dr. Gaynes Dr, Drachler Dr. Sood Mr. Gordon Mr. Jones Ms. Nickisch Duggan Dr. Topousian Dr. Kaplan Dr. Luka Dr. Gaynes Ms. Urbanus Dr. Polin Dr. Herwitz Dr. Usman Dr. Usman Ms. Langguth Dr. Veis Ms. Varma Mr. Nidetz Dr. Williams Mr. Pandya Guests Dr. Plotkin Ussman Abbasi Deborah Grodinsky Dr. Counard, Director of Health David Clough, Staff Shelley Wax, Staff Call to Order - The meeting was called to order at 7:31 p.m. Approval of Minutes – One question in the November minutes was incorrectly attributed to Dr. Plotkin. The question will be corrected and attributed to Dr. Polin. The minutes of the previous meeting were approved with this correction. Erie Evanston/Skokie Family Health Center Avery Hart MD FACP spoke about the new Erie Evanston/Skokie Family Health Center. The presentation included an overview of Erie Family Health Center’s mission statement, history of the Evanston/Skokie site, and sources of funding for the Evanston/Skokie site which includes a large Federal Grant and private donors. Dr. Hart highlighted Erie’s focus on community involvement, cultural sensitivity and provision of services regardless of patient ability to pay. Plans for eventual expansion and staff and service hour increases were also reviewed. Erie’s amenities include mental health services, a pediatric dental clinic, and a community room with a working kitchen to teach patients suffering from diabetes and hypertension about healthy cooking. Dr. Hart’s report of the initial demographic experience is roughly one third Latino, one third African American and Asian and one third white. Assyrians are the largest immigrant group that has begun to utilize the clinic from Skokie. Dr. Hart hopes to penetrate more immigrant groups in Skokie. Currently about twice as many patients coming to the clinic are from Evanston than Skokie, but Dr. Hart hopes to have a more equal balance in the future. Dr. Veis asked if the clinic takes all comers. Dr. Hart stated that by mission the clinic takes all patients regardless of ability to pay. The majority of patients are either Medicaid eligible or uninsured. They do accept private insurance though they are not attempting to actively compete with the private sector. Ms. Grodinsky asked if people make appointments or just walk in. Dr. Hart reports that they want to be viewed as a regular doctor’s office rather than a walk in clinic so patients must make appointments. If someone walks in and there is an available appointment they can have it but that is not the model of the clinic. Ms. Wax asked if they needed care on the same day if they would have to go to the ER. Dr. Hart replied that he carries a pager and would triage after hour calls like any other doctors office. Mr. Pandya asked if someone visiting from out of state could be seen without insurance and how much they would be charged. Dr. Hart stated that they could make an appointment and be seen like anyone else. If anyone who may be eligible for insurance comes in they will be screened and assisted with enrolling in whatever form of insurance they qualify for. However, if they do not qualify for any insurance they are charged a sliding scale fee depending on their household size and income. Mr. Pandya asked whose income would be considered if they were a tourist visiting from out of town. Dr. Hart stated that he did know the answer and would have to differ to the business office. Dr. Counard asked what the minimum amount they would charge is. Dr. Hart reported that the fee for the initial visit would be $30 at the bottom of the sliding scale. This fee includes all labs, diagnostic tests and other referrals that would come about in that visit. However, nothing goes to collections by policy. If people have to come in for multiple visits in the first month it will cost half the price of the initial visit. Generally speaking patients want to pay something and they have not met much resistance to the fee. Dr. Herwitz asked if they had any imaging services on site or if all diagnostics were done by referral. Dr. Hart clarified that Erie provides primary care but that specialty care is not provided on site. Both North Shore and St Francis have signed contracts to use Erie’s financial screening to govern what they are charged for specialty referrals at the hospital. So imaging services would be done at one of the hospitals but would be covered under the comprehensive fee the patient paid to see their Doctor at Erie. Dr. Plotkin asked what percentage of patients are over 50 and clarified that this was regarding hearing testing. Dr. Hart clarified that they refer audiology and ENT issues to the hospital. Dr. Plotkin asked if they did hearing screenings at Erie. Dr. Hart stated that they screen children and do some adults but not as many as he would like at the recommended age for testing. Mr. Pandya added that the Village of Skokie Health Department provides adult hearing screenings. Dr. Drachler thanked Dr. Hart and acknowledged the support of North Shore, the Village of Skokie and the City of Evanston in making Erie possible. He also pointed out the #1 issue in the community health plan was access to health care and that Erie had filled that gap. Dr. Hart then took everyone on a tour of the facility. Dr. Pandya asked if there were plans for a pharmacy to be opened in the facility. Dr. Hart stated that they ran into the issue of clients receiving affordable services at Erie and then facing sticker shock at the pharmacy. Sliding scale patients with no insurance can find that medications cost over $100 in a regular pharmacy. Erie has a number of programs they have developed to address this issue. Erie provides certain supplies and medications such as diabetes test strips, STI treatments, and contraceptives on site sold at cost. They also have the 340B program which allows them to purchase a range of vital medication that are prohibitively expensive and put them in local pharmacies to be sold to their patients for between $9 and $12. Lastly, they have contracts with three pharmaceutical companies that allow them to accept Erie’s financial screening as their own to provide cheap or no cost medicines to clients. Dr. Drachler asked if the affordable care act would affect the Erie clinics client base. Dr. Hart responded that more people would be insured but that would not make a significant dent in the uninsured population. To qualify for Medicaid under the affordable care act you must be a citizen or have had a green card for five years so the immigrant population alone will be a large enough uninsured group that needs their services. #442342 Chair’s Report Dr. Drachler reviewed the plan for each Board member to give personal statements for Ms. Langguth and asked that she prepare a statement for next month’s meeting. Director’s Monthly Report Dr. Counard presented the November monthly report (attached). The highlights included: Beekeeping Regulation Presentation to Board of Trustees On November 4th the Board of Trustees passed an ordinance regulation backyard bee keeping. The ordinance requires bee keepers to obtain a permit from the Village and obtain consent from residents of neighboring properties. Animal Control will be responsible for enforcing all bee keeping regulations. Community Shelter Plan CHUG completed Skokie’s Community Shelter Plan in collaboration with Health, Human Services, Fire, Police and Public Works. The plan addresses what would happen if many individuals were displaced during a major disaster. Training Notes Our rodent control officer was send to New York for the premier national training on control of rat population. Mr. Neditz asked if a place had been identified to house individuals for the community shelter plan. Dr. Counard reported that the Weber Center had been selected. Dr. Williams asked if the Weber Center has generators and Dr. Counard responded that the lack of generators was one of the main concerns and generators would be cost prohibitive. Dr. Williams and Mr. Veis discussed other potential facilities including Niles North High School and Oakton Community College. Dr. Counard offered that the Fire Chief could possibly give a presentation on the Community Shelter plan and the full reasoning behind the selection of the Weber Center. She also stressed that this is an initial outline and there will be further discussions and developments on this issue. Dr. Williams expressed interest in getting involved with the Community Shelter Plan. Community Health Plan Initiatives Updates • Access to Healthcare – – Dr. Drachler and Dr. Counard highlighted the success of opening the Erie Family Health Center to address this issue. • Obesity Prevention – Dr. Drachler shared an article on preventing obesity that linked smoking during pregnancy, excessive gestational weight gain, breast feeding for less than 12 months and less than 12 hours of sleep per day during infancy to risk of weight gain for the child. He also shared on article on how the lack of revenue for obesity treatments is leading to a lack of attention to the issue from the medical community. Dr. Drachler then explained how breast feeding helps set the child’s metabolism for later in life. Ms. Abbasi asked if Skokie had taken any steps towards a Village wide weight loss goal. Dr. Counard responded that nothing like that was on the horizon at the moment but encouraged her to forward any information she might have. Dr. Drachler highlighted problems we have had with documenting data due to back lash about shaming obese individuals by publishing data about weight. A discussion ensued about collecting aggregate data to track progress without singling out individuals and inciting parental backlash. #442342  Further discussions of individual motivation, potential exercise and diet programs and risk factors and treatments for obesity followed. Mr. Abbasi suggested that a subcommittee could be formed to discuss this issue and come up with possible solutions. Dr. Drachler stated that until we have baseline data new programs are unlikely to be funded due to lack of measurable progress. • Tobacco Use Prevention – Dr. Drachler shared an article on smoke free campus policies incorporating e-cigarettes into their language. Dr. Counard highlighted upcoming anti-tobacco ads that will be running in Skokie and the upcoming presentation by Dr. Williams geared towards healthcare providers. Dr. Williams encouraged all health care providers to bring all medical staff to the trainings. • Healthy Environment – Dr. Drachler noted that in February the Solid Waste Agency of Northern Cook County (SWANCC) will be coming to discuss their recycling program with the board. Old Business Dr. Drachler mentioned that Libertyville has rejected backyard chickens in their community. New Business Dr. Drachler brought up the issue of legalized medical marijuana and asked if Skokie has prepared for how this will be distributed under new regulations. Dr. Counard reported that she does not believe the Board of Trustees has looked at this issue. Dr. Drachler suggests that it should be brought to their attention. Dr. Counard announced that John Lockerby will be the new Village Manager and she will present the Board of Healths concerns to him when she first meets with him in January. Adjournment The meeting adjourned at approximately 9:08 p.m. #442342