MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
NOVEMBER 25, 1997
TABLE OF CONTENTS
Chairperson Stutsman called the Johnson County Board of Supervisors to order
in the Johnson County Administration Building at 8:59 a.m. Members present were:
Charles Duffy, Jonathan Jordahl, Stephen Lacina, and Sally Stutsman; absent:
Joseph Bolkcom.
Stutsman: First thing, that isn't on the agenda, but I'd just like to add is this is Karen's last day, and Karen has been some temporary help that we've had in the Board's Office. She's done a fantastic job and we're going to miss her, but she's going to go back to school, so thank you for your help, Karen.
Lacina: Yes thank you.
Board Employee Karen Lienau: Thank you.
Stutsman: Review of formal minutes for November 18th.
Lacina: No additions.
Stutsman: Look OK? OK, we'll put those on for approval in the formal minutes, or formal meeting.
Stutsman: Business from Graham Dameron, Director of Department of Public Health regarding funding for the pertussis outbreak. Morning Graham.
Lacina: Morning.
Director of Public Health Graham Dameron: Good morning. With me today is Jim Martinek, the Chairperson of the Board of Health and Diane Joslyn, a member of the Board of Health, and Kot Flora, our Disease Prevention Manager with the department. The purpose of us being here today is to discuss and hopefully for you to consider acting on a Board of Health action that we had a special meeting last Thursday. The Board approved the hiring of additional personnel for the pertussis outbreak, but we need additional funds from you to cover the expenditure for this additional personnel. We'll eventually need an amendment in our FY 98 Board of Health budget, probably the one in May would be the most appropriate and I'll explain a little bit later. The department's been coping with this outbreak since July. The department's utilized the Disease Prevention and Administration Division resources that have been available or readily available, that is the Public Health Nurse, the Disease Prevention Manager, Kot, and the clerks, and the secretaries in the front office. We've also been able to have a work study student and hired a Disease Prevention Specialist on a temporary basis, specifically for the outbreak, and have had volunteers also to assist us. But the department cannot continue to divert the resources that are necessary for this outbreak and because of its intense labor that is necessary to control it, at this point in time I'd like to have Kot give you an update regarding that and answer some questions regarding pertussis or whooping cough.
Disease Prevention Manager Kot Flora: I'll just join you up here, Graham. I'm going to give you, keep one for myself, some information that we've put together a couple of weeks ago about pertussis and the only change in this handout is the case numbers. We have approximately 90 cases of pertussis now, and we have about 30 suspect cases, meaning that they haven't fit the case definition yet. But we felt that it was important for you to understand a little bit about the disease in order to consider this request. Pertussis is what you probably recall as whooping cough. It's a bacterial disease that a lot of people are surprised that we're seeing a resurgence of this disease. But what's happened is that in 1949, vaccine against pertussis was starting to be used universally, everywhere in the U.S. So if you were an infant around that time or after that, you would have received the vaccine. If you were older than that, you may have already had pertussis or you may have just been too old to receive the vaccine. The vaccine is only used in people from 2 months of age through 7 years of age. So none of us can receive the vaccine at this point in time. It's not licensed to administer to people who are 7 years of age or older. So what happened was that most of the population for a good number of years were protected because there was enough natural infection circulating that everybody was getting a little boost all the time. You'd be exposed to someone who had a mild case of pertussis, and so your immunity would be boosted through that process and it was fairly constant. But as the years have gone by and we've been more reliant on the vaccine to produce protection or immunity, we've been seeing nationally and actually internationally, an increase in numbers of cases of pertussis. The vaccine itself is only 70 to 80% effective when it's being given, and so that's something that surprises a lot of people, they presume that it's 100%, and there aren't that many things that are 100% effective and pertussis vaccine is only 70 to 80% effective. Then you receive your last booster when you go to kindergarten generally, so by age 15 or 17, you really have no immunity left because of the vaccine and we don't have enough natural infection circulating to give those little boosts to your immunity, so essentially, the entire adult population is susceptible to pertussis. With that sort of as ground work, that's why we are seeing an increase in cases of pertussis. There are some countries where it's really what we consider endemic, meaning it's just something that occurs all the time. That has not been true certainly not in Johnson County or in Iowa. Historically our number of cases over the past few years has been either 0 to 2 cases per year. So obviously at this point in this year looking at 90 cases at a minimum, we're going to have more than that, is extraordinary. But there was a nationwide outbreak last year and people travel. It's a respiratory spread disease, it's transmittable. If someone with pertussis coughs and you're within 3 feet of that person, you can breath the organism in and you can be infected with and ill with the disease. Then the symptoms are mild enough for the first couple of weeks when you're infectious, you're just going to exhibit a few symptoms like a runny nose, watery eyes, like mild cold type symptoms. But at that point, you can transmit the disease. So if you're singing, if you're coughing, just occasional coughing, you can transmit the disease before you even really feel very ill. Then the disease progresses to kind of a nasty cough that gets worse and becomes spasmodic. Then you're infectious for the first 3 weeks of cough. So if you add the initial 2 weeks plus 3 weeks, you're infectious for 5 weeks unless the disease is detected and you're put on antibiotics. So you can see that there's a huge opportunity for spreading this disease around, and there's a very lengthy period of time in which that can be done and a very susceptible population. So that's why we are experiencing what we're experiencing here. I think I'll stop with that and Graham...
Dameron: Well, the local Boards of Health under the Chapter 139 are responsible for reporting the disease and also under the Administrative Code of the Department of Public Health on a particular reporting form. Now, I know that people have said this is a lot of paperwork. Well it is to some degree a lot of paperwork, but it's really more of an investigative paperwork. I kind of equate this with an investigator on a robbery or anything else. It takes an intensive amount and Kot was talking about the communicability time frame and they have to investigate for a substantial amount of time. You might talk to them a little bit about how much, what is involved in that reporting.
Flora: OK. When we receive a report from the laboratory, from the University Hygienic Lab that we have a case, we have to do an interview of that case. What we do is we go back to that 5- or 6-week period of time that they would have been infectious and ask them where they've been, who they've been around, what sort of setting they've been in. So if they go to church, or if they go to Sunday school classes, who do you sit next to routinely. How big is the table, how big is the office, if you were playing on some sort of team, is it an indoor sport, outdoor sport, etc. It goes on and on. Did you have people over for dinner? What are your activities? If you think back to where you've been over a 6- to 8-week period of time you can imagine the task. This is a very active community and people certainly interact with an awful lot of people. The children who have had pertussis are on all sorts of teams, go to Sunday school, go obviously to school, they're in soccer, they're in dance, it goes on. So when we receive a list of those folks, we compare it to the infectious period. Then we contact those people who they've been around while they were infectious and make specific recommendations to those people. So it's very labor intensive, it's a whole lot more than filling out a piece of paper. We consult with the schools that they attend. If it's in a club, we certainly spend a lot of time talking to the leaders of those organizations to explain risks. There are a lot of questions and we've always tried very hard to answer any questions posed to us. So it's, people are afraid of this disease and we've had 5 percent of the cases hospitalized at this point. Of those hospitalizations, 4 of those people have been under the age of one. This disease is very critical in a person who is less than one year of age. The mortality rates are highest in that age group because they have the least amount of protection from the disease and also people who have any respiratory, any chronic illness, any respiratory illness or disease, are also at high risk. So we've had people hospitalized from one month of age to 64 years of age, but the cluster is in the infant age group. So we really try to identify those folks at highest risk and it's our responsibility to notify those folks so that they can be put on preventive antibiotics. So that hopefully, I know we're seeing an increased number of cases, but we're preventing a tremendous number of cases by doing this investigative work. If we didn't do it, you would guarantee that this outbreak would continue indefinitely.
Lacina: You're working off the State Hygienic Labs lists?
Flora: Yes.
Lacina: OK. We don't just submit a culture to the State Hygienic Lab. That has to be done through a doctor. So we're following up to see to it that they're getting medication. So like the doctors aren't prescribing medication?
Flora: We are often times referring people to their physicians to be cultured for this illness.
Lacina: So then what list are you working off of?
Flora: Well then the doctor's office will culture the person, it's a nasal pherengial swab, they'll swab the person, they'll send the specimen, often times to the Hygienic Lab, and then we receive the results and we work with the physician's office to get that information about that case, permission to contact the case. But then the doctor's office does not go back and do that lengthy interview and identify contacts of that case. That's our responsibility.
Lacina: But can't you do this, well first of all where do you get that initial contact? When you make a referral to the doctor? How do you know that the individual has it? Where are you getting these...
Flora: We... Through the interview of the person they may have been exposed by. It's this whole series of interviews where, say I have pertussis and I get interviewed and I talk about who I've been around and then we contact those folks and we say, it's by letter, because there are so many people that we physically cannot make the phone calls. But we say you have been exposed to someone with pertussis. If you have these symptoms, we recommend that you go to your physician and be tested for pertussis. If you do not have these symptoms, we recommend that you contact your physician and be put on preventive antibiotics.
Lacina: So a student at one of the high schools then in a class will have every one of his classmates in theory contacted.
Flora: Not necessarily because through the interview process that we do, we determine whether the contact was close enough to warrant antibiotic use. Because we have to balance that recommendation with not wanting to over-recommend the use of antibiotics, and so we really... That's why we go into that lengthy interview process, to try to figure out who is at most highest risk so we're not just wholesale saying everybody go on antibiotics. Then how many times do you recommend they go on antibiotics if you have a number of cases. So we really look at the individual exposure and make those recommendations. So you could have in a high school situation, you could have a teacher, a series of teachers, because kids have what, 4, 5, or 6 teachers in a day. Some of those teachers may receive the recommendation from us that they go on antibiotics. Others will not. It has to do with what sort of interaction they have with the student. If it's a laboratory setting and you're all bending over a lab table or you're working around a small desk, then it's a higher risk than someone who, for example, the distance between you and I would not be considered a very high risk, if you stayed where you were and I stayed where I was. So we really get down to specific identification of type of exposure. This is part of the protocol set forth by the State Health Department, and by the Centers for Disease Control. It's really a protocol that we're expected to follow and we do try to individualize those recommendations.
Lacina: OK. The, and I scanned the minutes perhaps faster than I should have, but you're requesting how many people? The equivalent of 2 1/2?
Dameron: 2.4, Steve.
Lacina: OK, and the total cost in your budget would be how much?
Dameron: Well, if we went to the maximum amount, through June, it would be $37,128.
Lacina: But on an annual basis, what would be the cost in your budget?
Dameron: The annual basis of this?
Lacina: Are you saying the 36, you're amortizing?
Dameron: I'm just asking for the 6 months.
Lacina: OK, so then after 6 months, this will disappear? These are temporary positions?
Dameron: Yes. Actually I want to try to do this before the end of the 6 months, but I don't know how long the outbreak will go. I will know much more in May if we need to go on, or if we need to back off the amount that I already have got.
Lacina: Do you anticipate having these people on line the first of January or sooner then?
Dameron: Well, I want to try to...
Lacina: 3,600 is based on what time period I guess I'm asking. 6 months...
Dameron: Yes. I'm trying to get this pretty much in place by January. We'll start the, we'd like to start the process now because some of this takes some time to get the people and etc. But we'd like to have them on board on the first of January. If we can sooner, that would be good.
Lacina: So on an annual basis, it would be around $72,000.
Dameron: Yes, but I don't know where this is going to end, but I don't anticipate that. I can't predict that at the moment, Steve, but that's what we would need if it continues the way we've been working.
Jordahl: I was a little confused. I attended the Board of Health meeting last week and I was a little bit confused by the idea that you have some people that are now doing these functions as a work study student and I'm not sure exactly what the configuration of staff is, but as I recall, the discussion there was the idea of adding basically a half-time slot to the existing functions but a half-time slot doesn't cost $37,000 so I'm not tracking with this.
Dameron: Well let me explain this a bit. I recommended we have additional funds to employ 2 full-time Disease Prevention Specialists and a part-time clerk position. At the current time, we had had a work study student who left yesterday. So that was a half-time person that we just were fortunate to have somebody who is mastering in epidemiology and she worked in very well with this. We have a temporary person, who is a Disease Prevention Specialist, who happens to be an RN as well. She's on money that I've tried to absorb for this month as much as I can. So that's the... so we really have one and 1/2 persons technically on board at the present time. I've asked for another ˝-time person to bring this up to 2 full-time positions, and a clerk, which would be about a 4/10s position.
Stutsman: Will you have any money in your budget to pay for these?
Dameron: Well let me also tell you which is I think good news for you to some extent. The Board of Health the last regular meeting approved a budget amendment for FY 98, and I'm asking for $29,000 less in tax funds from that, due to the changes. So those funds could be used for this program, or project, the $29,000.
Lacina: In the handout that you gave us, you gave the scenario of the increased rates. So in 95 we had zero cases, in 96 we had 2, then I'm a little confused on the August and September reports. Do we have 45 total cases now? Or is it 45 plus an additional 29 in August? Is there double counting on that?
Flora: No, that's at the time this was printed we had...
Lacina: 74.
Flora: 74 cases.
Stutsman: Now you say there's 90.
Flora: There are closer to 90 cases. We're receiving anywhere from 6 cases reported daily to one to 6 cases, it depends on the day.
Stutsman: These are documented pertussis cases. These are actual pertussis.
Flora: Correct, correct.
Lacina: How serious in terms of how many hospitalized cases do we have? Because there are different levels.
Flora: 5.
Lacina: We have 5 hospitalized. OK. I'm experienced with this because 2 of my brothers and I were hospitalized as kids with it and it can be severe if it hits you, but also if it's a mild case, it is similar to a bad cold.
Flora: Which can be a problem in a way, it's kind of strange, but with those mild cases, those folks are not necessarily going to go to the doctor.
Lacina: And they should...
Flora: And they won't know that they are spreading pertussis.
Lacina: But that's also some of the increase in a tighter level, or resistance levels of other individuals as this shedding takes place and they are somewhat self-immunized. I guess one of the problems I'm having is spending the equivalent of $72,000 a year for paperwork. I don't mean to be insulting because I know the survey's important to prevent this within the schools, but one of the elementaries right now has notification posted on a door. The school has been exposed to a communicable disease. Well it's chicken pox, and it's very dangerous that hasn't had it. I would think there would be a way of doing mail out surveys, or having information at the principal's office for those, and alerting them, rather than finding an individual with the case and then checking everyone that was within 6 or 7 feet of them to notify them that they may be exposed.
Flora: Well, that wouldn't work because you would, the only way we can be responsible in determining who is at highest risk is by going through that lengthy interview. If we did it any other way such as just putting out a news release to the County and saying hey, we have an outbreak of pertussis in Johnson County so if you're considering coming here, you'd better go on antibiotics indefinitely. That would be...
Lacina: Well I don't think anybody would recommend everybody just go on...
Flora: No, but you know that would be one, if everyone complied with that, then that would be one way to handle it, but so there's that, then some people think that might be a reasonable approach, but certainly with our requirements for following up, we have to balance over-notification and under-notification to do the job to prevent this disease from spreading, as much as we physically can. Without having that interview process, it wouldn't be done. It would have to be a notification, a general notification. Some folks have been, they're diagnosed at the very end of their infectious periods, so we would not recommend antibiotics to people who had that exposure. So it gets very complicated to figure out any way other than the detailed interview as to who is at risk of disease from that exposure and who's not.
Lacina: But looking at the (inaudible) periods. By the time the person is diagnosed, they've already gone through the viral shedding, and by the time you get to the other individuals, they are in, according to the timetable, they in fact have the disease.
Flora: Well you can, some people can, are diagnosed much earlier in the disease process than the 21st day of cough.
Jordahl: Kot, you said earlier that you are following a protocol from the CDC and the State Department of Health. If I understand that correctly, that means in order to discharge your job according to those guidelines, you must follow this procedure. Is this optional?
Flora: No, I don't consider it optional.
Lacina: Protocol is well, OK but it is not a mandate from the State for this.
Flora: Yes it is.
Stutsman: Well according to chapter 139, you said earlier that we are required when there's an outbreak to follow certain procedures.
Flora: There are certain diseases that have to be reported by law, this is one of them, TB is one of a bunch of them.
Lacina: OK, there's a difference in the reporting and going through these surveys. How long does it take for this survey to take place of an individual.
Flora: Depends on how active the person is, and how long, where they are in the disease process. But anywhere from 45 minutes to an hour and 15 minutes I would say, for one case.
Jordahl: I think the point...
Flora: For that one interview. But can we go back. Because with the mandate for reporting, they're not just saying tell us how many cases you have of pertussis. They're saying you shall report to us in the format we require. So that's what we do and the format they require both nationally and the State certainly follows the National Centers for Disease Control and Prevention guidelines, is this extensive interview, the Centers for Disease Control investigative team were here, was here for a week. I'm sure you're aware of that. One reason that they were invited here was to go over our protocols. To let us know if there was something that we were doing that we needed to do differently, something that we weren't doing that we should be doing. They reviewed every control measure that we have implemented and felt it was all appropriate. I asked them, are there any ways we can reduce the workload? Because believe me, we would much prefer that we not be putting the amount of resources into this that has taken since August. We much would prefer to resolve this outbreak as quickly as possible, protect those at-risk people, which is our role, and get this completed so we can get back to doing the other work that we do that's still out there, TB, hepatitis, all sorts of things. They said no, you let up and you will guarantee that his outbreak will last longer. So we are following mandated protocols and the reporting in the format that we're complying with is required.
Jordahl: Yes, I think it's, as I was wanting to say earlier, the point of this is to protect public health. This is the key core function of the Department of Health. We have people at risk, we have a disease spreading, you talk about contagiousness Steve, I think even though an initial case may be identified only toward the end of the course of the disease as it becomes serious and they say, my gosh, I'm whooping, therefore I have whooping cough. As you follow this chain of contact, those contacts will be spread throughout that 5 or 6 week period, some of them being very recent. Those people, not only having been exposed, but as a result of the exposure and then coming down with the disease, would then themselves become carriers and spread this thing by sort of algebraic functions. This thing would just explode. The idea of the staff being out there these numbers of hours following these interviews is to intercept that process, to get ahead of this curve, and to get people on antibiotics, so that I assume then they become less contagious and ultimately not contagious and stop the outbreak. That's the point of this. If in the professional judgment both of the CDC and of our own staff that this is what we need to do to act responsibly to protect public health, I don't understand disputing that I guess. It's important to ask questions about costs, and I respect that, that's important to do, but I think what we've heard is that basically we're required to do this and this is what it's going to cost, we're going to try and do it at a minimum level.
Dameron: Actually this is not exactly what it's going to cost, it's going to cost me a little bit more in the terms of the copying, the postage, and that sort of thing which I'm going to absorb. We'll just have to try and work out something else, but I'm only asking for the people, to try to help for that, because that's the most critical need that I have. I also wanted to tell you that our Board of Health meeting scheduled for December 8th, I've got on the agenda a request from the State Health Department for some funds. I provided Pat a copy of that. It's never been tried. I don't have much faith that we'll see much of the funding from there, but I think it's worth attempting to apply for. They're talking about emergency situations and I felt that this might be a need here, under the Chapter 137 local Boards of Health, which is presumably supposed to have a fund reserved for this purpose, which I'm sure they don't.
Lacina: Well and I understand that while Jonathan's always quick to jump on me, I really don't have a position, but I do have a lot of questions. I guess when I think about students that have already been ill, pulled out of their classes for another hour and the fact that we're kind of behind the curve on a lot of these things, many times an epidemic will come in, hit, the flu, and then quickly goes away. If the response isn't very, very fast, it's going to run its natural course and we're still behind the curve on the information side. So I guess I have questions, is what I have that I would like to have resolved. One of the questions, I guess, if in fact it's in your budget, and you have the authority to put these positions in, and you said you had a budget amendment coming in with an excess $29,000 so you're only looking for the difference from the 29 to the 36? So basically what you're doing is telling us that in May you're going to need a budget amendment.
Dameron: For this amount because I'd already made that other request. So that money's back to you, Steve.
Lacina: Oh, I see what you're saying.
Dameron: OK. I don't know that I'll need all this. I just say that might be the end point if we go the full amount. I'll know much more in May when the budget amendment comes around where we are.
Stutsman: But you're just telling us where you're at.
Dameron: I'm telling you where I would like the authority to go ahead on the assumption that you'll consider this in May, frankly. Because otherwise, I don't want to go down the road here and say, whoops, I'm out of money, folks, I can't do that.
Lacina: But as you get closer, you may need to amend your expense side by around 30 to 40 thousand dollar range, depending on where we're at then.
Dameron: That's correct.
Lacina: I don't have a problem with that.
Stutsman: Well I guess I don't either. I feel that this is for the public good. I think that we would be more remiss in ignoring this and not dealing with this, and doing what we need to do to get this under control, rather than going ahead with what we need to do. I guess I would encourage you to try to get this out of your budget as much as possible, looking at what's ahead for the next 6 months in your budget and just keep that in mind.
Dameron: Well, I will certainly try to be a good steward for the tax funds, but at the same time, I don't usually come to you and ask if I don't need some help. At this point, I think we do.
Lacina: Your answers were very good, it obviously shows that you've done your homework and that you're knowledgeable on this and you've satisfied my questions.
Duffy: Yes. Sally, would it be all right if I say something?
Stutsman: Yes, quickly.
Duffy: Childhood diseases, I had some of those when I was very young and I almost died.
Dameron: From whooping cough?
Duffy: Well I probably had that too, but that's the first thing I do, I get rid of the word pertussis and call it whooping cough because people don't know what that word is. Judging by the information that you gave me, Kot, it's more serious in the ages 1 to 5 and it can result in death, and after that, hardly anybody dies, but could I ask about the vaccines?
Flora: Sure.
Duffy: Do vaccines, some vaccines, even if a person had whooping cough, if you vaccinate them, it wouldn't be as serious as if you didn't.
Flora: Correct.
Duffy: It's kind of... So I'll probably ask you a question here, it might be a stupid question, not comparing animals to human beings, but I've been a farmer all my life.
Flora: Uh-huh, I don't know if I can answer this one. I know what you're going to ask.
Duffy: But, are the vaccines live cultures, semi-live, or killed cultures?
Flora: Well, this is a killed vaccine, the pertussis.
Duffy: I'm glad to hear you say that, because a semi-live or live and some person that wasn't vaccinated sitting next to someone else, could (inaudible) it.
Dameron: Attenuate it.
Duffy: That's right. So that's the question that I'd like to know and I don't have any problem.
Stutsman: Well and I think dealing with things like this are the consequences of a growing, expanding County and that's what we're dealing with. People are transient...
Dameron: We're a very fluid County as well. People go to Russia and to Europe, and part of it's...
Stutsman: And although there may not be a lot of deaths, there are a lot of other things that we have to take into consideration. People missing work to deal with sick children or themselves sick. So that all enters into what happens when you have an outbreak like this.
Dameron: CDC was very explicit in saying that they felt that we were doing a good job in relationship to the number of infant cases that we do have. They were pleased to see that.
Lacina: I think the schools require the DPT shots for anyone going into the elementary schools, but what we fail to realize that in our culture, 1/4th of the Business Masters Program at Iowa are non-American. A lot of those countries don't require this. So we can be somewhat lulled into thinking that we're immune to a disease and then if we drop our guard, it can come right back very quickly and very deadly so...
Stutsman: Well thank you for coming in.
Dameron: Yes.
Stutsman: Please keep us informed about what's happening and...
Dameron: OK, thank you. I don't mean to be self-serving, but I think this is what we're here for and we're happy to be here, but we occasionally need some additional help, so thanks.
Jordahl: Uh-huh.
DEPUTY AUDITOR LYNNETTE HULTMAN: OCTOBER CASH FLOW ANALYSIS
Stutsman: Thank you. Business from the County Auditor, Lynnette? You have information for us about cash flow analysis for October. Good morning.
Deputy Auditor Lynnette Hultman: I've got the monthly cash flow reports for you. I think what I'll do is if we can just get back to the department pages, we'll go through the departments. The green and white. Expenditures, for accounts payable, we've paid 18 out of 52 weeks, and payroll, we've paid 9 out of 26. So both of those are at 35%. So that's the target that I used in highlighting some of the ones that are above 35. Board of Health as Graham talked about, they're going to be coming in with a budget amendment. They've got revenues exceeding the expenditures for this first budget amendment.
Duffy: But I could have asked if they're not over 3%, which doesn't seem like that's kind of where it talked about, but they do have a large budget.
Hultman: Uh-huh.
Lacina: Well and they're at 41% on revenues. So the revenues are way over.
Duffy: The revenues go into the General Fund, so...
Hultman: Department 11, Recorder. I talked to Deborah a little bit and I think she's going to be making a budget amendment request for some additional personnel also to deal with the vital statistics. Department 20, Block Grants. All the Block Grant departments, 20, 21, 23, those can be ahead of schedule just because of the timing of the block grant payments. Any of the monthly payments, we've made 5 payments. In the ones that are quarterly, we've made 2 payments. So those are a little bit ahead of schedule there. Veterans Affairs. Again, we've discussed this one, the payroll is above average. Some of the dues, director-transportation, meals, lodging, those things are ahead of schedule. So we definitely need to keep an eye on that one. Department 22, insurance, those are annual premiums, so there's no problem there. 27, Juvenile Justice. I'm going to talk to Brandon a little bit today. Apparently we just had a lot more kids in detention.
Stutsman: I think they're coming in next week...
Hultman: So yes...
Stutsman: ... to talk about it. Because it is a real problem.
Hultman: I talked to Carol yesterday too, and she said that they were going to be coming in for discussion on that, too. She said they've been averaging maybe one child or less in detention, and she said this last month we have 6 in detention for the month.
Lacina: Compounded by, we had this discussion when we discussed moving them out of the Courthouse if there would be a concern in the future about cash flowing in that budget. Unfortunately she has no control over the crimes committed by the juveniles. A problem is a problem.
Hultman: Yes. Let's see, what else do we have. On page 3, SIH Consortium Trust, this is a special fund, it's funded through donations. We've had some increased donation. So that will be a budget amendment coming up too, but again, the revenues and expenditures will match on that one. We budgeted 500 in donations and already we've received 972. So... and Rebecca said there would be, they were expecting even more donations there. So...
Lacina: But it's a very small amount in regard to $500 in the...
Hultman: Right. Any questions on expenditures? That's all I had to cover there.
Lacina: We are authorized 24 cents for mileage within the County is that right?
Hultman: Correct.
Lacina: What happens if somebody exceeds that and pays more?
Hultman: To my knowledge we don't. If they turn in a claim with more than that on it, we call them and say we only pay 24 cents.
Lacina: It won't be paid, OK, thank you.
Hultman: OK, moving on to revenues then. Ambulance is a little bit below the average. One of their big lines is their call fees. That was below the average for this point in the year so we'll keep an eye on that one too. Information Services, they have received payments from the Clerk of Court and the Assessors for data processing fees. Those usually come in later in the spring or the last quarter of the year, so that's not unusual there. SEATS, State Transit Assistance and some of the transportation contracts were below average there. We'll keep eyes on those. It's not too alarming at this point either. Those are probably just timing things also, but we'll keep an eye on that in the future months. The next 3, Departments 20, Block Grants, Emergency Medical Services, and CORDLAP, all 3 of those are one-time annual payments and those usually are received December, January, about half way through the year. Human Services, Department 45, again they have some State reimbursements, but I think their expenditures were below. A lot of their State reimbursements are after the fact, and their expenditures are only at 29%. So that doesn't look too unusual. Juvenile Justice, this one we get reimbursed after we hit a certain dollar amount in expenditures and attorney fees. Unfortunately, all of our expenditures in this area are for detention, which aren't reimbursable. So I'm guessing we probably won't end up receiving too much of that reimbursement.
Lacina: Do you, did we get that last year?
Hultman: No.
Lacina: Then instead of budgeting $10,000, we probably, in the next budget should be more realistic.
Hultman: Yes, it was at 30, and we backed it clear off to 10, so it might be a good idea just to back it off more.
Stutsman: We're still not even reaching that.
Hultman: Right.
Stutsman: Maybe that's something we can talk to Carol about too, and see what she thinks.
Hultman: Yes.
Stutsman: OK.
Hultman: Auditor/Elections. We haven't received the reimbursements for the school and city elections. Those should be coming in the next few months I would guess. Second page, Secondary Roads, again they have some State payments that are like one annual payment that we haven't received yet. Law enforcement and prosecutor forfeiture proceeds, there's no real way of predicting those, so those are just, we get them when we get them. Reservoir Roads is interest, so it's all timing of when the CDs come due. I guess that's...
Lacina: But overall in summary then on our revenues side, we are actually at 45%, normally 33. So we look very good in the revenues side and on the expenditure side, some rising up, Lynnette. How do you feel about that.
Stutsman: Is it at 33?
Hultman: Yes. That's the grand total. Again on the grand totals that includes everything on these reports, and not everything on these are County funds. We've got the Assessors and 911 and Disaster Services. So as far as the grand total, that doesn't mean grand total for the County. That just means the grand total of the whole report. Overall, the...
Lacina: Yes, if we're normally at 33, and we're at 33 in expenditures, a number of those, there are some delayed, but some of them were up-fronted as well so that's not too bad.
Hultman: Uh-huh, yes. The ones, I've started to get some requests for budget amendments and of course Health Department, they came in, they've got more revenues at this point than expenditures. The Recorder's Office I know is going to discuss a budget amendment request. Juvenile Justice, that will be an additional one, I'm sure. And Veterans Affairs, I guess that's a question at this point in time, too, since they're running above average.
Stutsman: I didn't, after we talked last month, I was to sit down with Leo and I didn't do that, so I'll make a point to do that for sure.
Hultman: I know he knows where his budget's at and everything, but it might be a good idea to...
Stutsman: Yes, just to be reminded.
Hultman: Yes.
Lacina: Well as always you do a wonderful job. You do a great report.
Stutsman: I agree too, Lynnette. This is so helpful. Thank you for putting that together.
Hultman: Yes, if you have any questions on these individual reports, don't be afraid to ask.
Jordahl: The idea that there's a grand total here that doesn't reflect necessarily all County funds. Do we have a total that does reflect just County funds?
Hultman: I don't know, I could figure it out, but not right now.
Jordahl: It might be useful to have at some point.
Hultman: Yes.
Stutsman: I wonder if that could be included in next month's report. Just to, so we do have a clear picture of where we were just at with the County.
Hultman: Uh-huh. Sure.
Stutsman: OK.
Duffy: If I could echo what Sally and Steve just said, I always did like this spreadsheet. I think I say this every time, but it kind of keeps us informed as to how the County is doing, and the departments money-wise. It really, not disbursements, but also, it's a very simple document, and anybody from the public if they wanted to look at one of these, it's very easy to read and it's just a good document. There's no doubt about that.
Stutsman: Any other questions? Anything else on that from the County Auditor's Office?
Hultman: Nothing else.
Stutsman: OK, all right, thank you.
Hultman: Uh-huh, thanks.
DISCUSSION: PROCEDURE FOR HIRING SEATS DIRECTOR
Stutsman: Business from the Board of Supervisors, procedure for hiring SEATS Director. I put this on. The applications for SEATS Directors are all in, so we need to decide how we're going to proceed from here. I guess my suggestion is we maybe come up with as we have from the past our top 3 or 4 candidates and then we can begin scheduling interviews. So looking at calendars I wonder if we could have those completed, the top 2 or 3 names from every Supervisor by maybe Monday December 1st.
Lacina: Well I would encourage us to move quickly. I have a sense the City is kind of waiting to see what we're going to do in terms of a Director and our SEATS negotiations and has just been dragging on and on. Is there reason we couldn't do it by the first?
Stutsman: Well that really leaves just today and tomorrow. If that's OK with the Board to come up with 3...
Jordahl: Does Joe have his list too?
Stutsman: Yes. He does. I mentioned it to him before he left. So he does have his names.
Jordahl: Is he aiming at a December first decision on that?
Stutsman: To get the names?
Jordahl: Yes.
Stutsman: Yes, right. He already... right.
Lacina: We could delay it until Tuesday if it would be easier.
Stutsman: Well why don't we do it on the 2nd?
Lacina: OK.
Stutsman: Just have everybody get their names to Carol by the 2nd and then maybe look at interviewing, the following week is going to be a busy week because we're going to be doing HR interviews. Charlie you were going to be gone some?
Lacina: The first week.
Duffy: On the 2nd and third.
Stutsman: Oh, OK. How does the Board feel about when you would like to schedule interviews?
Lacina: Well we're free Thursday. We have our zoning meeting that night right?
Jordahl: Yes.
Stutsman: Yes we do.
Lacina: So if we are going to interview... are we interviewing the top 3 then? OK.
Stutsman: I would say there aren't that many applicants, so I think maybe if we limit it to 3 then that would be a good pool to go from.
Jordahl: It would be nice to have some time to digest the HR interviews too though. It might be good to do something about that on Thursday and maybe not start the SEATS process until a day later.
Stutsman: Are you looking at Friday?
Jordahl: Yes.
Lacina: I would rather not do it Friday.
Stutsman: Yes and I can't do it Friday either.
Lacina: Could we do it Thursday afternoon starting at 1:00 if it's subject to the applicants being available.
Stutsman: I would either say that or maybe Monday the 15th.
Jordahl: I think Steve raises a good point about the status of the SEATS contract.
Stutsman: Uh-huh. Well why don't we tentatively plan on Thursday afternoon starting at 1:00.
Duffy: That's the...
Stutsman: The 11th.
Duffy: The 11th, OK.
Stutsman: So if everybody could get their 3 names as quickly to Carol and then she'll...
Duffy: Start at 1:00.
Stutsman: Start at 1:00.
Lacina: Then we've got a 6:00 zoning so...
Stutsman: Then everybody can kind of plan their schedule. Then we had questions put together for the last set of interviews for the SEATS Director. Do we want to use those again? Maybe I could have Carol circulate those questions again and if there are any additions then we can put those on.
Lacina: Sounds good.
Stutsman: OK. Any other comments about the SEATS Director?
Lacina: Just real quick Sally there was a letter which we received from Heritage pertaining to a contract in reports and funding. Did you have a chance to take a look at that?
Stutsman: Right, and that's been taken care of.
Lacina: That's resolved? Thank you very much.
Stutsman: Burnell took care of that. We're all right there. Reports from the Board of Supervisors, Jonathan, do you have a report this morning?
Jordahl: Well I think the most interesting thing in the past week since we haven't met since a week ago was just last night I attended a meeting of the what was that calling it self now... The Council on Child Abuse and Neglect, which is an organization that had existed in the past in Johnson County and had passed out of existence it wasn't exactly clear at that meeting why. But there was a gentleman there from the State level that was part of the decision making process from the Governor's Council on Child Abuse to actually decide how the funds are distributed and he said that other counties are getting funds to do this but Johnson County isn't even applying for these funds because we don't have an active council here. So basically last night they geared that back up and I think there's hope there that they're going to be...
Stutsman: Were there quite a few people at that meeting?
Jordahl: Actually given the way these meetings and forums in Room A in the Public Library tend to run I would say there was a pretty fair number. I would say we had maybe 25 people.
Stutsman: Good.
Jordahl: We broke into small groups to discuss what major issues were. The speaker, Mr. Randy Alexander, Dr. Randy Alexander from the University Hospitals, a pediatrician, said that really the biggest issue is getting at the attitude of men. Probably while those attitudes are an informative place and suggested that such things as having men go in and talk to junior high level boys maybe in athletic arenas or practice or something like that trying to find forums where men can sort of act to get a new model of what male behavior is going is an important part of this picture, it's not the whole picture by any means. A lot of focus was put on childcare and other issues related to family, stability and taking the stress off of families. But it's a pretty big question so I was... I'm glad to see that happening. The 3 of us attended the Iowa State Association of Counties meeting the last 3 days of last week which is why we had 2 meetings on Tuesday last week.
Stutsman: All of us attended.
Jordahl: All of us, did I say that? Yes.
Stutsman: I thought you said 3.
Lacina: You said 3.
Jordahl: Oh, I apologize for that. I meant 3 days, I had that idea that we were there for 3 days. Not 3 members. Yes, last week. Looked at a lot of different topics. One entire day was spent I think very productively looking at issues related to our new Human Resources position. It was quite a nice piece of coincidence for us, that they had a speaker who dealt with a lot of labor negotiation issues and his focus was mediation as opposed to litigation. There are ways of resolving what in many cases seem to be really difficult or almost impossible to resolve in employment situations by a process of looking at what do people want, getting them to sit down together and talk and reducing the cost of resolving a problem. So I was excited to listen to that, maybe others want to report on other aspects of that meeting. I chaired my first meeting of the Mental Health/Mental Retardation/Developmental Disabilities/Brain Injury Planning Council on Tuesday and I'm really glad that we have the support of the CPC Director Craig Mosher and Linda Severson of Johnson County Council of Governments to help to set those agendas and make sure that issues are discussed in a timely way. I mostly had to make sure the discussion didn't get led astray off of the agenda which is something I felt myself up to so I was glad for all of the support. I'll leave it off there.
Stutsman: OK Charlie do you have any reports?
Duffy: It was interesting last week when we went up to the Association of County meetings. So I won't really escalate on that too much because Sally and I too have an appointment. One of the things though, Steve Lacina, indeed they have this silent auction, and he ended up with a lot of things that he actually bid over with the rest of the people there the same as last year. But I didn't realize that we wouldn't get out of the place till around 9:00. It's quite a lengthy process to pay for those things. I bid on a couple of them, but I got overbid. That's for the county employees' children too, it's a fund so that they can afford to go to college, it goes into that fund. Thanks Steve for doing that. Festival of Trees was good again this year. I think Sally you'd probably have more to say about that. I stopped up there on Saturday. I attended the Secondary Roads collective bargaining meeting. I thought we had a pretty good meeting, that will be coming up later on. Senior Center on December 3rd is going to have a meeting pertaining to the senior citizens and from what I've been hearing as far as Social Security is concerned, there could be suggested cuts on Social Security, a lot of dollars and limitations on what, as you get older what you could use Social Security, Medicare and Medicaid for and higher taxes on the Social Security payments that you receive so that will be at the Senior Center on the 3rd of December. Harold Stager who has probably held every position that there is on the AARP will help with this meeting. I belong to that organization, it's a good organization. There's a couple more here but that will be it. Thank you.
Stutsman: Busy time. Steve?
Lacina: I served on the selection committee last year for the kids,
the auction goes... The money goes for kids for County employees around the
State. I think we had 5 kids last year out of 100 some, 4.0 students. This one
young woman was involved in about everything, cross country, 4.0, plus worked 20
hours a week at the local Wal-Mart with a single parent family. Just was an
outstanding young woman and just had a very professional résumé and I'm just
sure will go far. So this auction goes for that. I will be wearing T-shirts from
about every County in the State. But I go along and I tend to prop some of the
bids up so I ended up with some $3 T-shirts and then a couple of things that
went a little higher than I probably should have, but it was fun. We're having a
cash flow problem at the Mental Health Center and it might be wise for us to
have Craig Mosher come in and talk. Other counties are not reimbursing us for
their clients that are out-of-county and after we try to pursue the bill of
course we have to up front the money and it's causing the Mental Health Center
some problems so we may want to discuss that. At some of our Supervisor meetings
drop the ball on some of these other counties. They need to pay up. Also we all
want to acknowledge that we've all I think received documents from Mr. Shaw, he
put together a lengthy packet of material and we have gotten that. Then also
while at ISAC because of deregulation in the power industry there will be what
is known as power wheeling where an individual can open an office, buy futures
in power and then go out and sell it to different counties. I did sit down with
one Supervisor from Linn County, we were just brainstorming about the idea of
putting together Linn, Johnson, Cedar Rapids, Iowa City, Coralville, the school
districts and major users in the counties as a consortium to go and negotiate
with the power companies. It would be Mid-America down here and IES up there to
give us a little more power rather than just having them come to us and bid us
as individual customers. There are some consultants in Cedar Rapids that
potentially might do this at no cost, but anyway that's something that we may
take a look at. It may fly, it may not fly, but it's worth taking a look at. So
I'll... And Sally is aware of this too, we'll be following up on that. That's
all I have thanks.
REPORTS (STUTSMAN): ATTENDED ISAC CONFERENCE; AND SERVED ON TASK FORCE TO STUDY IOWA PLAN
Stutsman: Good reports. I too attended the ISAC meeting and it was I think one of the better ISAC meetings as far as a good variety of topics and a lot of information exchanged. I also was in Des Moines on Monday and Tuesday to serve on the task force looking at the Iowa plan. It was basically an informational meeting the first couple of sessions just to kind of bring everybody up to speed what's going on with the State and their plans to turn over child welfare funding to a managed care agency. Lots of good discussion. It's an excellent task force and I think we can look forward to some good options coming out of that meeting. So we'll be meeting again a couple more times in December and then present a report to the legislature but I will keep the Board and interested people in the community updated on what's going on with that because that's going to really have a profound effect on counties especially if we more towards local governments of child welfare funding.
Jordahl: Sally can I ask a question about that, is this basically a foregone conclusion that it's going to be turned over to managed care or is one of the options not doing that?
Stutsman: Well one of the options is not doing that. One of the options is turning it over to a managed care entity much like the Mental Health program and funding is currently being done. There's all kinds of varieties on that option. Another option would be turning it over to a consortium of providers who would be the managed care entity that would provide a consortium in the State. Another option would be de-linking the child welfare funds from the current managed care plan that would be completely separate from managed care. Then the other option is just turn it over to local governing bodies who do the managed care format but have the governments on a local level. But that's interesting too, because all 99 counties have different levels of the decategorization because that's kind of the process that they would follow, the decategorization. Johnson and Linn who have been in decategorization are pretty well up to speed on that local governance end of it but you get other counties that have just turned over to decategorization and they're not anywhere near ready to take over that. So there's lots of options, lots of things to think about, lots of things to throw out on the table so it's going to be an interesting process.
Jordahl: Well I'm glad you're in there.
Stutsman: Lots of things to think about and profound impact on what's happening with kids in the State of Iowa. Inquiries and reports from the public? Business from the County Attorney. Pat we had you scheduled for an executive session. I notice Mike and Bev are here from Senior Dining to talk about their contract. I wonder if we can move to that and maybe put the executive session a little later.
Recessed at 10:01; reconvened at 10:10.
Motion by Duffy, second by Lacina, to enter Executive Session at 10:11 a.m. to discuss collective bargaining strategy for the Secondary Roads Department under section 20.17(3), Code of Iowa: "negotiating sessions, strategy meetings of public employees... shall be exempt from the provisions of chapter 21 (Official Meetings Open to the Public)." Roll call: aye: Jordahl, Stutsman, Lacina, Duffy; absent: Bolkcom.
Recessed at 10:11; reconvened as an executive session at 10:16 a.m.
Motion by Lacina, second by Duffy, to leave Executive Session at 10:58 a.m. Roll call: aye: Jordahl, Stutsman, Lacina, Duffy; absent: Bolkcom.
Adjourned at 10:58
Attest: Tom Slockett, Auditor
By Casie Parkins, Recording Secretary