MINUTES
DUKES COUNTY HEALTH COUNCIL
October 27, 2005 Meeting
West Tisbury Public Safety Building
CALL TO ORDER
Treasurer Terry Appenzellar, acting on behalf of Cindy Mitchell, called the meeting to order at 7:36am. A quorum was not present. Attendees included: Terry Appenzellar, Judie Flanders, Olga Church, Linda Swanson, Susan Wasserman, Jo Ann Murphy, Dr. Ilene Klein, Matt Poole, Tad Crawford, Dr Patrick Donegan, Nancy Gilfoy, Cathy Brennan and Mary Jane O’Connor-Ropp. Also present were Sarah Kuh, member ex officio, guest Dedie Wieler, and Deborah H. Potter, executive assistant to the county manager to record minutes.
NEXT MEETING:
Treasurer Terry Appenzellar reminded members that the date of the next meeting is November 17th, one week earlier than normal due to Thanksgiving.
MINUTES:
The minutes of the September 29th were reviewed and deferred for acceptance due to a lack of a quorum.
PRESENTATION OF VHCAP BUDGET:
Terry Appenzellar turned the floor over to Sarah Kuh for a presentation of the VHCAP FY07 budget. Sarah Kuh explained that the County has asked each department to submit their Draft Budget requests for FY07 by the end of October. In the past two years, the budget was restricted to the same amount as previously allotted. This year Department Heads were asked to submit budgets based on actual needs.
Sarah explained that her budget from the County covers two basic areas. Salaries and Operational Expenses and the NY Avenue Building were the VHCAP is based. Although each department has been asked to fully budget for anticipated needs, the expectation is that the figures will be adjusted downward before receiving final approval. Additionally, the County’s contribution covers only a portion of VHCAP’s full budget of $200,000.
Considering those factors, Sarah prepared a budget requesting $89,969.20 for the Access Program and $6,500.00 for the NY Ave. Property for a total of $96,469.20 from the County.
Changes in the Health Care Access budget included (from Sarah’s handout):
- Health Access Coordinator (Sarah Kuh’s position): Proposed increase reflects an increase from 25 to 30 per week. Sarah currently works 30 hours; 5 hours are paid through a grant to Island Health inc. (IHI) which ends April 30, 2006. Per County instructions there are no COLA increases in the FY2007 department budget requests; if possible the County will grant COLA’s under the supplemental budget.
- Administrative Assistant (Carole Seale’s position): Proposed increase reflects an increase from 10 to 18 hours a week. Carol works 18 hours; 10 hours are currently paid by the County, the rest comes from grants.
- Personnel Expenses are based on County furnished formulas, except for health insurance, which is for one family policy, based on projected costs.
- Telephone and Internet: The $800 request would fund approximately one-third of annual expense.
- In-State Travel: $530.00 funds four of the fifteen off-island meetings per year that are attended for various purposes.
- Office Supplies: $1,000 covers approximately one-third of the total expense
- Postage: $1,000 would cover most of annual expense
- PO Box Rental: $44 covers the annual cost of the PO Box.
Changes in the NY Avenue budget (from Sarah’s handout) are designed to accurately reflect costs related to the property:
- Electric: $1,000 covers annual expense.
- Fuel Oil: $800 covers annual expense.
- Water utilities: $350 covers annual expense.
- Repairs/Maintenance of Building: $2,000 provides for the addition of a second air conditioning unit and the replacement of a rotting window and frame at the rear of the building.
- Misc. Contractual: $600 provides for a janitor so the VHCAP staff does not have to do their own cleaning.
- Comp. Building Insurance: $850 is projected expense for FY2007.
- General Liability Insurance: $900 is projected expense for FY2007.
Terry Appenzellar asked if there were any questions and Tad Crawford asked Sarah how are the balances of the staff salaries funded. Sarah explained that a substantial amount is paid through the Rural Outreach Grant. The rest is paid through a variety of other grants including a Blue Cross grant which expires in 2007 and through another grant through Elder services. VHCAP is going to be in a position soon, with the expiration of many of these grants, of not being able to maintain existing staff positions and in May of 2006 she may have to reduce staff hours due to a lack of funding. This would provide a serious blow to providing services.
She explained that it is at times extremely difficult to prepare/maintain budgets because of the mix of funding resources.
Tad Crawford then asked if the Hospital’s Determination of Need has been approved? Because one of the provisions included the support of 3 community projects. However, the Determination has not been approved as of yet.
Terry Appenzellar then redirected the conversation back to the specifics of Sarah’s budget and asked if there were any further questions on the proposal. With no other questions and reiterating the need for action Terry asked the group if there was a consensus of the members present to support the VHCAP budget as presented. All members present voted in the affirmative.
Sarah returned to Tad’s question about the Hospital and elaborated that she is going to be requesting help from the Hospital for staff salaries regarding the Determination of Need because our Health Care Access program is one of only five statewide that operate with Hospital support. She continued by stating that helping people enroll in health care programs can directly relate to an increase in revenue. If you take, for example, just the number of pregnant women, over 70 last year, that were enrolled the increase in revenue from the patients will normally cover the associated staff expenses. Then there are other areas were services are also provided: surgery, in-patient care, prescription assistance and other services as well. The Hospital is already
referring people to VHCAP for help and they are pleased to be a point of contact for many of the patient services.
Jane Cleare asked Sarah if she had done any contingency planning for the possibility of the dissolution of the County. Sarah responded that they have begun doing some long range planning but not specifically related to the County because it is unlikely that will happen any time soon if at all. However she has been working with Pat __________, on a pro bono basis, trying to identify a variety of ways of addressing ongoing sustainability and funding issues.
Terry suggested that Sarah be added to the agenda in January for an update on the progress of this work.
TREASURER’S REPORT:
Terry Appenzellar continued with the Treasurers report which she stated was pretty straightforward. The DCHC expenses are primarily related to the use of Carole Seales administrative services and some advertising for DCHC functions.
There were no questions and no action was taken on the report due to a lack of a quorum.
FY06 budget was approved last meeting and the budget was disbursed across the various committees as previously recommended and approved. Dr. Klein asked who was chairing the Public Health Committee and Terry replied that the Coordinating Committee was aware that Dr. Klein was looking to participate in that group but they were still evaluating if a separate or special committee was needed so that is still pending.
Terry then addressed the FY07 budget and advised that a 10% across the board increase was requested. Because the committee has not had time to review the proposed budget, the distributions to the various committees was not defined. She further advised that the County had no problem with the redistribution of funds from one fund to another as long as it did not involve salaries. Although this budget is what we are requesting, there is no guarantee that the increase will be approved.
Terry asked if there were any questions and there were none. Due to a lack of a quorum, budget submission approved by a consensus of members voting in the affirmative with no dissenting votes.
HEALTH COUNCIL COMMITTEE/PROGRAM REPORTS AND UPDATES:
- UMASS Clerkship Planning Group Report: Olga Church reported that today’s MV Times will have a very detailed article about the UMASS clerkship. There were five students: three 1st year medical students and two 1st year graduate nurse students. There were here from October 4th through October 18th and provided a comprehensive power-point presentation before they departed on their findings during their stay. They focused on Mental Health and Substance Abuse issues while also participating in medical rounds and contributing at the Island Health Clinic.
The committee is reviewing their findings and there were several members of the general public at their presentation. A full committee report on their findings will be presented to the DCHC at a later date. Sarah Kuh asked Olga Church is she could just summarize some of the findings. Olga replied that there wasn’t anything new or unexpected but that the students did make suggestions to implement one universal screening tool that would be useful in determining early intervention, the creation of an Island wide directory of resources, and for the creation of a High-School community services program in the Mental Health and Substance Abuse areas. Deide Weiler remarked that the student’s
observations were astute and confirmed a lot of information that was already suspected or known. Olga continued by commenting on how next year she is going to request that the presentation be taped and then aired on the local TV station. Dr. Klein wanted to know if Olga could email everyone the findings and she replied yes but after a short discussion it was determined that she will email the report to Deborah Potter for posting on the website.
MVCS update: Unfortunately Susan Wasserman had to depart the meeting earlier and an update for MVCS was delayed until next meeting.
- Other Committee Reports: None
- General Announcements and Updates:
Dr. Klein advised that the first meeting of the consultants and the RHNPG would occur next Friday, November 4th. Karen Travers and her consulting firm were selected and they are National experts in the field. In addition to the consultants the meeting will be attended by Ronnie Rohr from the State Committee and Neva Flaherty from Congressman Delahunt’s office. The agenda has not been set yet but the meeting should be very productive. Someone inquired where the meeting would be held and Dr. Klein said at the South side Conference Room.
Review, Discussion and Approval of Integrated Workplan:
Terry Appenzellar continued the meeting by addressing concerns with the DCHC Final Draft of Integrated Workplan as expressed by Paddy Moore via an earlier email. Recommended revisions include:
Goal 1: Concern was expressed with identifying Coordinating Committee as final authority on certain objectives/activities when it should be the DCHC. There are some instances when a committee is given the authority to make decisions without the DCHC approval so this distinction should be made clear for each item. Dr. Klein suggested that the CC should go back and redefine the distinctions between the two regarding the different objectives and then present the changes at the next meeting to make sure everyone understands the distinctions. Tad Crawford advised for new members that the Coordinating Committee is not viewed as an executive committee and the DCHC bylaws clearly state that the CC is not the final decision making authority but that the entire DCHC was. All committees report directly back to the DCHC.
Goal 2: Recommended change to formatting of goal to: Foster and promote the organizational support and collaboration needed to develop an integrated primary care system. Dr. Klein remarked that made more sense and the goal would need to be reviewed as some of the items had already been completed. Terry Appenzellar deferred that for the next meeting.
Goal 3: Recommended change of removing other agencies from the “Responsible Committee/Person” list to Results/Outcomes section as other agencies are not directly involved with the final decisions of the DCHC per se. They are often consulted for their opinions however; the DCHC remains the final responsible agency and has no authority to make other “members” responsible for outcomes.
Additionally, a recommendation to change Objective 3C to the following:
i. Complete and disseminate the final Health Report
ii. Review elder age-specific data of the MV Health Report
iii. Review and integrate use of other data.
Goal 4: Recommended change to the Responsible Committee to include the working group and the committee chairs.
Goal 5: Judie Flanders has replaced Kath Rose as responsible person.
Terry Appenzellar advised that took care of all the changes recommended by Paddy Moore and asked if there were any other questions or comments. With no questions or further comments made, Terry asked the members present to recommend the acceptance of the changes as described. With a consensus of the members present, all changes were approved with no dissenting votes.
Adjournment
With no additional business to discuss the meeting was adjourned by Terry Appenzellar at 8:40 a.m.
Respectfully submitted,
Deborah Holtzer Potter
| 
