MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS AND JOHNSON COUNTY BOARD OF HEALTH:
MARCH 31, 2005
Vice-Chairperson Mike Lehman called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 4:35 p.m. Members present were: Pat Harney, Mike Lehman, Terrence Neuzil, and Rod Sullivan; absent: Sally Stutsman.
Board of Health members present were: Pamela Willard, RN, MS; Maureen A. Connolly, MD; and Paul Deaton; absent: Kelley Donham, DVM, MS; and Donna Henn.
DISCUSSION: JOHNSON COUNTY PUBLIC HEALTH AND JOHNSON COUNTY BOARD OF HEALTH ACTIVITIES, DUTIES AND RESPONSIBILITIES
Public Health Director Ralph Wilmoth presented the Johnson County Public Health Department Annual Report. Wilmoth said that if they look at the reports from year to year the changes are visible in the different programs.
Board of Health Chairperson Pamela Willard asked what is happening with the new Health and Human Services building. Harney said that they are planning a building in the block north of the Administration Building. Negotiations are underway with 2 property owners and letters have been sent to others. The building will have plenty of space for the future growth of Public Health, DHS, and MH/DD, and Veteran Affairs. Harney said that they hope to begin the building within a couple of years but it depends on how property acquisition proceeds. R. Sullivan said that the Board has talked about speeding the acquisition process up. Neuzil said that by FY 06 there will be $4 million saved for the project. Wilmoth asked if outside assistance has been acquired to move the condemnation process along. Harney said that it hasn’t yet materialized, but White has scheduled an executive session to update the Board on the process. Neuzil asked if Wilmoth has shared with his Board what he needs in the new facility. Wilmoth said that the original estimation for a building was $4 million and now it is at $10 or 11 million. Wilmoth said that the last set of drawings included Juvenile Justice also. Harney explained that Juvenile Justice could be moved out later when a Court Services building is built, which would free up more space in the Health and Human Services Building. Neuzil said that his biggest concern is that they think ahead so that they don’t make a building that is too small in a few years. R. Sullivan said that he thinks that the public will support building an adequate space.
Lehman said that the Health Department has done a good job with personnel, hiring people using grant funding. He asked if it is a problem attracting employees to jobs that are grant funded. Wilmoth said that all offer letters state that positions are subject to continued grant funding. He said that often times new grants come in as some are ending. Wilmoth said that since he has been the Director, they have not had to let someone go because of a discontinuation of grant funds. Wilmoth said that the University attracts many highly qualified people in the public policy and health arenas, but they move a lot. They have a little bit of turnover fairly regularly so that if a need were to come up they wouldn’t fill a position. Wilmoth said that they just advertised for a 30 hour a week vacancy and received 30 applications.
Pamela Willard said that they don’t have Free Medical Clinic, Visiting Nurses Association, or Elder Services dollars in their budget. She asked if the Board would like the Board of Health to manage those dollars. Lehman said that the Board looks at dollars, but the Board of Health has the medical expertise. Lehman asked if the Board is adequately funding the agencies. R. Sullivan said that block grants are always a debate between the Board. He said that there isn’t oversight of the block grants like there is with departmental budgets. R. Sullivan said that he feels more comfortable with those block grants that have Public Health oversight. Neuzil said that the question is whether or not to put the money in the Public Health budget. He said that discretionary money is going to get more and more difficult due to Jail overcrowding. R. Sullivan suggested the Board of Health think about public education to let people know that programs like Free Medical Clinic, VNA, and Elder Services are part of the goals of the Health Department. Willard said that it is always an issue to make the department known for what it does.
Willard said that they are starting to discuss addressing the issue of access to health care in the community. She said that due to the large hospital in the area people think that there isn’t a need for health care in the community, but there is. Willard said that they’ve discussed having a proclamation explaining that the Johnson County Board of Health thinks that there should be better access to health care. They’ve also discussed dealing with the issue on a more active level by having meetings with CEO level people of the local hospitals. R. Sullivan said that the Public Health Department and Board of Health have been more activist lately. Wilmoth said that the department is more engaged in local community based activities than they have been in the past. Harney said that one of the local underused resources is the Veterans Administration Hospital. Wilmoth said that the Veterans Administration would tell that they’ve been overwhelmed because a lot of people that previously were able to receive other care, now can’t, and are using their veteran benefits.
Wilmoth said that he has recently met with representatives from the University of Iowa Hospitals and Clinics, and the CEO of Mercy, to discuss health care access. He said that the dilemma the Health Department gets into is that they don’t do sick care. He said that when someone needs sick care they are referred. If they have Medicaid the Health Department is able to find a provider for them. If there are children with Hawkeye, they are able to find them services. If the individual has an insurance plan that has a high deductible or doesn’t cover services well, sometimes they could get the care but can’t afford the out of pocket expense that goes with it, there is no benefit to find them care. He said that some patients that they see don’t qualify for any programs and don’t have insurance, so they need to have cash money. If they had cash money they could get care. Wilmoth learned through the meetings that the University now has a sliding scale fee that goes down to zero. He said that he also discussed with them how the physical system of UIHC can be prohibitive. Wilmoth said that all of the representatives were interested in the notion that care is always cheaper if people are seen at the first onset of systems, rather than seeing them in the emergency room later. Wilmoth said that Mercy’s Urgent Care function is a little cheaper than the emergency room, but still not as cheap as going to see a doctor.
Neuzil asked if there are any other organizations that the Public Health Department would want to have oversight on. He explained that during May, the Board will be doing strategic planning and block grants are going to be a large part of the discussion. Wilmoth said that VNA, Elder Services, and Free Medical Clinic are part of the Public Health Department services. Neuzil said that it is going to be very difficult in the next couple of years to come up with the same type of funding that the Board currently does. Harney said in the Board’s strategic planning he would like to discuss the amount of services block grant agencies are providing versus how much they are spending on administrative costs. Harney said that the Health Department does a good job watching the agencies that they work with, but there are other agencies that are top heavy compared to the services that they provide to the community. Neuzil said that MECCA could also fall under Public Health. Wilmoth said that they aren’t going to do substance abuse intervention, but it is clearly a public health issue. Wilmoth said that it would also be logical that MECCA be funded through DHS. Willard said that if early prevention programs were put into the schools, there would be less problems in jails later. The Board agreed.
The Boards discussed issues with alcohol in the community at length. Wilmoth said that it would really help the community if the Iowa City City Council would raise the legal age to enter a bar to 21. Wilmoth said that this issue is not an issue all over the State; it’s more of an issue in University communities. Harney added that tobacco is an issue as well. The Board of Health agreed.
R. Sullivan said that he has heard anecdotes of people who go to the Free Medical Clinic and have insurance. Board of Health Member Maureen Connolly, MD, said that the majority of their patients don’t have insurance. She said that they have seen an increasing number of elderly people with Medicare that only covers hospital bills. There has been an increasing number of immigrants who don’t qualify for services until they’ve been in the country for at least five years. There has also been a large increase in the people who’ve been recently laid off and don’t have insurance. Connolly said that their numbers are drastically increasing every year.
Adjourned at 5:55 p.m.
Attest: Tom Slockett, Auditor
By Casie Kadlec, Recording Secretary