WAYS AND MEANS COMMITTEE REVIEW OF THE 2014 TENTATIVE BUDGET
HEALTH DEPARTMENTS P.M. – SEPTEMBER 16, 2013
DAVID H. KNAPP, CHAIRMAN
MEMBERS PRESENT: Mr. Jordan, Mr. May, Mr. Holmquist, Ms. Williams, Mrs. Ervin
MEMBERS ABSENT: Mr. Kilmartin
ALSO PRESENT: Chairman McMahon, Mr. Dudzinski, Mr. Plochocki, Mr. Liedka, Mr. Ryan; also see attached
Chairman Knapp reconvened the meeting at 1:04 p.m.
PUBLIC HEALTH: Dr. Cynthia Morrow, Commissioner; Ellen Wilson, Fiscal Officer
Dr. Morrow stated there will be three requests during the presentation including the creation of two grant funded positions in Public Health to support new grant work, the creation of two funded positions in MEO for better alignment and supervision of staff (will be associated with two unfunded – net flat in terms of number of positions), and lastly the CIP in Facilities has two Health Department projects which are Vital Statics and the east side of 9th floor.
Dr. Morrow:
 
 
 
- Grants are a best estimate of what will happen in 2014
 
- All admin costs for Special Children Services are in Public Health budget; SCS budget is service budget only
- Overall budget up $132,000 - Public Health (excluding grants) is down $537,000 gross and down $563,000 local
- Request for 5 additional grant funded positions (several new grants)
 
- Down in interdepartmental charges
 
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Developing strategic plan for National Accreditation; $12,000 request for accreditation fee – it’s been clear at a national level that if Health Dept. is not accredited, then won’t get grant funding; $11 million in grants so it’s essential
 
- HIV Counseling and Treatment should be HIV Counseling and Testing as they do not offer direct care for HIV
 
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New grant of $75,000; projected return of investment about $5 million - preventing up to 11 cases by identifying someone, educating them, reducing their viral load (return on invest based on national stats and applied to local stats)
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Significant threat from budgetary standpoint – drug shortages
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Late last year drug shortage with first line therapy against TB; now facing drastic shortage in solution to test for TB
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Getting calls from fire depts, correctional facilities saying they don’t have the solution; they cannot operate if they are not testing their people; another way to test is a blood test but extraordinarily more expensive
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County was prepared with 3 month advanced supply; shortage should resolve by Oct. 15th
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Additional demands – threat to public health if cannot test for TB and threat to budget when cannot predict national shortages
 
 
 
 
 
 
- Tree of Health: basis of CHA which will be available on the website
- Demographics to learn about Onondaga County (all sorts of data points) - educational status of community
- Will be interactive when fully operational; roots are demographics and priority areas in branches
- An example of things they are doing – way to communicate risk factors and health indicators to constituents
Mr. Holmquist requested a list of all the positions funded and vacant. Dr. Morrow responded yes and stated in terms of Public Health there are 236 funded positions (half are grant funded). Mr. Holmquist requested a list of positions that are unfunded, and a list of positions that are newly funded for the 2014 budget. Mr. Holmquist asked if the department has any Administrative Interns. Dr. Morrow responded that they have had them recently but none right now; there is a grant (if they receive funding for) that will require one. Mr. Holmquist asked if there are any other plans other than the possible grant funded position. Dr. Morrow replied there may be a second grant funded but no operational at this point. Mr. Holmquist asked if the Legislature has a list of employees that are on the department’s roster in the 101 or 103 that are physically located in other departments. Dr. Morrow responded that they took care of the transfers last year. In this year’s budget when they get to the Center, there is a Building Maintenance Supervisor who has been on the 101 but is located at the Center; the position will be transferred to the Facilities budget. Mr. Holmquist asked if that was the only one. Mr. Morgan commented that when he started, this was an issue the Comptroller’s office looked into and made recommendations for (regarding letters of distribution and handling charges between the departments). There was a piece of legislation Mr. Morgan was involved in that corrected a lot of that. The money was put in the department where the person worked, and if they are benefiting a different department, then they were charged interdepartmentally. In the 2013 budget, they fixed all the other items in terms of transferring people to the right department. Dr. Morrow stated they do have a hybrid; Contract Compliance Officer for Correctional Health. Mr. Morgan commented that is a unique situation, but in general those have been cleaned up. Mr. Holmquist requested a list of any other positions they may find; any situations like this. Dr. Morrow replied those are the only ones she can think of but she will let them know. Mr. Holmquist requested a list of positions that were requested versus what the County Executive approved. Did you ask for more and get less or ask for less and get more? Dr. Morrow responded that she can get that list but cannot think of any right now. Mr. Holmquist requested any changes presented in the Health budget from a roster perspective.
Mr. Jordan asked why the fees for services line for the MEO was up $67,000. In fiscal year 2013 it was $230,780 and the projection is $297,280 for 2014. Dr. Morrow responded it is a separate budget but it is all related to the Oneida County contract. Mr. Jordan stated there was a decrease of $53,000 in revenue for pool inspections and asked if they are not inspecting pools. Dr. Morrow stated last year there was a request from the Consumer Product Safety Commission, and they are two year inspections. They were incorporated into last year, and assuming they would like the Health Department to do it again, they will add it in 2015. It was a two year inspection fee, and the Health Department did them all in the first year. Dr. Morrow responded to Mr. Jordan that they will not be doing any more pool inspections in 2014 because of the cycling. The department does their own inspections as part of Public Health Law, but this was a request from the Consumer Product Safety Commission for the department to do them at a fee. Dr. Morrow agreed with Mr. Jordan that these are public pools. Mr. Jordan asked if there were any funding changes for other inspections like tanning salons. Dr. Morrow replied no; they are status quo for other regulatory inspections. Mr. Jordan asked if those are funded through other levels of government or local dollars. Dr. Morrow responded for anything that is required by State Law, the department receives 36% state aid reimbursement for it. Mr. Jordan asked why travel and training is at $156,000. Mrs. Messe answered that they have a number of field staff so there is routine mileage and parking paid out of that account.
Mr. Liedka asked if accreditation is something they have to go through every now and again or once. Dr. Morrow responded it’s every five years, and the charges are spread out over a number of years. Chairman Knapp asked if there is any funding source or grants for that. Dr. Morrow replied the NYSHD and the NYS Association of County Health Officials have talked about it but nothing yet they can apply for. If it becomes available, they will certainly apply for it.
Mr. Plochocki asked about the Lead Poisoning Control Program. Dr. Morrow’s responses:
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Have independent evaluation by Maxwell to look at all the programs and categorize by different levels of mandates
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This is highest level of mandate; required by Public Health Law to do case management of a child who has an elevated level; the good thing about the program is that it is grant funded
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Lead numbers are going down; numbers of highest danger have significantly decreased; as the levels have lowered, there are more children identified at lower levels; can get a trend analysis
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Targets by Public Health Law, Health Care providers and pediatricians are required to test around ages 1 to 2; all results are put in registry so the Health Department can get all the results
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WIC Clinic does test and there is a door to door outreach; also done different outreach efforts depending on target; if concerned about physicians not following the state law, then they will send reminders
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It’s about targeting – couple years ago, designated the highest risk zip codes; more aggressive outreach in those areas; haven’t decreased outreach but have made it more targeted
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Physicians test one and two; compliance drops at age 2; detailing and working with physicians is key
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Work closely with Community Development – homeowners or landlords will be informed of resources available in community at County and City level
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By law have to do case management so if child has elevated blood level, then the department has to ensure they are not being continuously exposed; work with housing authorities to find a different area for the child
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Close relationship with all lead partners in community; support in Community Development as well
Mr. Ryan asked what the zip codes are that are higher. Mr. Ryan stated that Dr. Morrow referenced a specific neighborhood which is in his district, and said there are a lot of people in that specific neighborhood that need help. Dr. Morrow responded that she can get the list.
Dr. Morrow responded to Mrs. Ervin that the incinerator monitoring will be included in the budget; 100% local.
Ms. Williams stated Dr. Morrow mentioned additional funding for gonorrhea cases, and asked if there is a targeted area for gonorrhea cases or are they all over. Dr. Morrow stated they received notification of support in June but have not heard anything since, but she will let the Legislature know when they get it. Dr. Morrow said that the increased cases are almost exclusively in the city and are almost exclusively among African Americans between the ages of 15 and 24. They know where the disease is occurring so the challenge is getting behavioral change that would accompany risk prevention. They are hoping with the funding they can have targeted educational messages that resonate with people being disproportionately affected by gonorrhea.
Dr. Morrow answered Chairman Knapp that the contractual expenses under line 695700 for $32,000 is the SPCA. Chairman Knapp asked about line 694080 because it has gone up dramatically in the past. Dr. Morrow responded there are many things included but part of it is aerial spraying and part is an increase in translation services; seen the increase with more refugees resettling in the community as the department has been more active with improving their health care. Mrs. Messe commented that under Physician Services they’ve been able to cover the Medical Director with grant funding. There will still be a need for the Medical Director if the grant funding goes away so they still budget for that contract. Chairman Knapp requested a breakdown of that line. Dr. Morrow responded absolutely. Dr. Morrow replied to Chairman Knapp that they do rent facilities. Chairman Knapp requested a breakdown of facilities that are rented. Dr. Morrow responded their primaries are 501 E. Fayette (Healthy Families) and 375 W. Onondaga (WIC). Chairman Knapp stated he’s aware that software is constantly evolving and increasing, and asked if the department is picking up new software as there is an increase in software or is that part of electronic medical records. Dr. Morrow answered that they do not have electronic medical records. Total Content Management is for scanning everything in Vital Statistics which has a lot of software licenses involved with it, and Pier Place licenses which is the database that allows the department to communicate with health care providers. A lot of those licenses are offset by grants. Dr. Morrow replied to Chairman Knapp that the grants are going up. Chairman Knapp asked if the department was losing anyone because of a lost grant. Dr. Morrow responded no. If there is a good match and grant funding is going down in that area, then they try to see if there is a fit someplace else. They try to move a person from one grant to another when possible. Dr. Morrow stated last year there were a lot of problems with grants, and there were positions lost but in 2014 fortunately they are not in that same position. Chairman Knapp asked if the Social Worker and Research Tech have an effective date of October 8th. Dr. Morrow answered yes because that is when the grant starts. The money will be in 2013 which is why they would like those two positions on adoption of the budget so they can be filled and start working. Mr. Morgan replied to Chairman Knapp that the grant funding starts this year. Dr. Morrow said one grant is effective 9/30 and the other on 10/1.
Chairman Knapp asked Dr. Morrow to walk the Legislature through the process of what happens when someone passes away in regards to death certificates.
Dr. Morrow:
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Someone passes away; within 72 hours a death certificate (DC) must be filled and filed - state requirement
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Vital Statistics centralized County - few within NYS; sub-registrars throughout the County to decrease load and provide services to community so they don’t’ have to come here
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Funeral Directors have to file DC with sub-registrar, then sub-registrar files with County
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County has 7-10 business days to get it back to Funeral Director to give to family
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Aware there are concerns; other communities are more automated; trying to improve and be automated
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Had training this year; also recently changed the functions of office to streamline; complaint – investigate right away
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Example: sub-registrar moved offices and put DC in safe, didn’t send to County; post office returned a few DC’s to sender even though the address was correct
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Some DCs go beyond the time given - will find out about it and investigate why
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Sub-registrars – village and town clerks; making sure have access for community
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First 72 hours – Funeral Director has to get the DC signed by the Physician and filed with the sub-registrar
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Funeral Director or hospital to get process started – depends on situation; unexpected death is ME; hospital death typically hospital fills out; community expected death - 92 yr old w/heart lung disease, then Funeral Director is primary
Chairman Knapp stated the Funeral Director takes the DC to the County or sub-registrar for formal processing, and the sub-registrar does not issue anything but facilitate getting the DC to the County. What does the office of Vital Statistics do when they receive it? Dr. Morrow responded they file the DC with the NYSHD, but before filing, they review it to make sure there are no obvious errors. Chairman Knapp asked after they file it with the state, does the County send something back to the Funeral Director. Dr. Morrow replied the Funeral Director will get official copies that they can give to the families. Chairman Knapp commented that seems to be where the disconnect and concern is; the time period after coming in from the sub-registrar when it has to be processed and copies sent back.
Mr. Holmquist stated this came to the attention of the Legislature about two months ago. There was a meeting with the executive board members of the Funeral Directors Association for Onondaga County along with Chairman McMahon, Chairman Knapp and Mr. Holmquist. The board members were frustrated, and said they had been working on this for two years with no resolution. They did studies, worked to the extent they could with the department, with the executive team, with the bureau, and they said the last place they could go to for any resolution would be the County Legislature. They said the average wait time for death certificates is two weeks or longer. They stated the department they work with is not efficient or easy to work with. They told the Legislature they want resolution by the third Thursday in October. Their last request is to get everyone in the room (including Dr. Morrow, the Health Department, the Bureau, the County Executive’s team, the County Legislature, all the Funeral Director’s in the County), and have a dialogue to get to the root of these issues as they see it. Dr. Morrow responded she appreciates that. Dr. Morrow stated that Mr. Liedka asked to meet with her, and they tried to address the issues presented to Mr. Liedka at the time. Dr. Morrow said the department has had a good relationship with Patty Knight over the last several years and is surprised at what was said. Dr. Morrow is not sure what Mr. Holmquist is referring to about not getting resolution but would certainly like to hear more about it. Customer service is the most important thing they do, and they have to hear what the concerns are. Dr. Morrow wished she had known about this before it hit the Legislature level to avert that. Mr. Holmquist commented it was members of the executive committee who were meeting with them and speaking for the board. Dr. Morrow stated they will have to get to the root of this, and they are more than happy to identify anything. The Health Department has done time studies, and it is important to respond to the concerns. Dr. Morrow is not sure that the data being presented is reflective of the data the department has, so that is where they will need to see where the disconnect is. Dr. Morrow stated this is her plug for capital improvement at Vital Statistics because some physical capital improvement could improve things. Mr. Holmquist said they are claiming family after family come in, the Funeral Director’s have deadlines with the state, and they need the death certificate to get the work done. Dr. Morrow welcomes the details.
Mr. Liedka stated this was brought to his attention a few months ago, and he was told about three instances. Mr. Liedka was not aware of any meeting or any of the information that has surfaced since that meeting. Mr. Liedka met with Dr. Morrow and her staff, looked into the three instances, found the reasons why they happened, and since that meeting, Dr. Morrow has implemented some training as well as scanning of documents (to get more current). There are efficiencies that need to be addressed there, and some other issues that are not proper to discuss during this forum. This other information came forward in the last three days to Mr. Liedka’s attention. Mr. Liedka is a little discouraged that the communication has not been good. There was an opportunity to address this a few months ago, and now it is rearing its ugly head with all this new information. Mr. Liedka was only aware of three cases, so if he knew there was more, he may have approached it differently. Now that they are aware there is more, Dr. Morrow has offered to meet with them. Mr. Liedka would like to have a civil discussion, not just people throwing daggers because what he brought to Dr. Morrow’s attention, she has looked into and addressed. Mr. Liedka would like specifics, dates and all the information. Mr. Liedka said that in this business eighty percent is talk and twenty percent is reality. Let’s get the reality on the table and address the problem. Mr. Liedka said he was the middle man but should be cut out, and everyone should get in a room. Mr. Liedka stated he does not want hearsay. Mr. Liedka would like specific instances. The Funeral Directors have a business to run, and the last thing they want to worry about is a death certificate. Mr. Liedka said as Health Chair he would have liked to have been part of the conversation.
Chairman McMahon commented that any organization will have numerous concerns. The one in their grasp to fix is the turn times. The death certificates are taking in the two to three week range which they were told is much longer than the counties surrounding Onondaga County. Chairman McMahon stated Onondaga County likes to be a leader not at the back of the bus. The executives have a lot of different things they would like addressed but this is one the County has the best shot at success for. Dr. Morrow agreed.
Mr. Holmquist agrees with Mr. Liedka that the County Legislature is a middle man. The board wants dialogue with everyone who has a vested interest in the room so that it can be fully vetted. The communication has broken down because the Funeral Directors are very frustrated and feel they have no resolution currently.
Chairman Knapp stated they will get some dates together to see if they can get everyone in the room.
SPECIAL CHILDREN’S SERVICE: Dr. Cynthia Morrow, Commissioner
 
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Any child in the US with developmental delay is legally entitled to a full developmental assessment; if identified to have developmental delay, then next step is provision of services – budget pays for the provision of services
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Whole budget down $3.3 mil - 7.5%; unfortunately a local increase of $424,000 primarily because of a decrease in revenue and other complicated factors
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Early Intervention – significant shift at NYSDH level in administration: in the past, local counties were responsible for paying the bills upfront, then seeking reimbursement; state took over as fiscal agent as of April 2013
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Today, Onondaga County is responsible for paying for whatever is not covered by third party insurance including Medicaid, then the County gets 49% reimbursement from state
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Because cost shifted w/state doing first pass, there’s a dramatic decrease in overall costs; revenues associated also
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Good news – have not lost any providers despite the huge challenges they face with getting reimbursed; nor has any child had disrupted services; some providers struggled to meet payroll but no services were interrupted
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Why local share is up – PreK increases in expenditures and summer programs
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Easy budget – no control over; get billed for children that qualify for services and pay those bills; relatively flat budget
CENTER FOR FORENSIC SCIENCES: Dr. Cynthia Morrow, Commissioner
 
 
- Decrease in funded positions - transfer of Building Maintenance Supervisor to Facilities
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Regional approach with Oneida contract; most of the changes are related to the Oneida contract – no local costs
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Only position changes – requesting Senior Forensic Investigator and Senior Forensic Autopsy Technician: think this is a better organization structure; in terms of cost it will be an increase of $4,500
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Will unfund the vacant positions when the people are promoted – these will provide better services and afford physicians time to do what they need to do
Mr. Holmquist congratulated the department on national accreditation. Mr. Holmquist requested a list of positions that are funded and vacant. Dr. Morrow responded a lot of the center and forensic lab positions are 1, 2 and 3, so they will see two vacants for every one filled for promotional purposes. Mr. Holmquist requested a list of positions that are unfunded, and a list of each position that is newly funded in the 2014 budget. Mr. Morgan replied they will get the same information for this budget as asked for during Public Health. Mr. Holmquist asked if there are any Administrative Interns working currently, and are there any plans for 2014. Mr. Morgan responded no, but they will confirm that. Mr. Holmquist asked if there are any employees on the 101 or 103 located in a different department. Mr. Morgan said no. Mr. Holmquist requested any differences in the budget request relative to what the County Executive approved; any changes in what was asked for, and what they are presenting.
Chairman Knapp stated the contract for Oneida was exciting and shows the long term sustainability of the center. Chairman Knapp asked if the contracted money from Oneida is covering everything the County is doing. Dr. Morrow responded yes. This year they were not able to fill all the positions, but all the costs that were incurred were reconciled. The reconciliation process will ensure that Onondaga County isn’t subsidizing Oneida County. It has worked out beautifully. Dr. Morrow answered Chairman Knapp that with the increase in volume, they needed to hire another Pathologist. That was not a create, but a fund and unfund. Whatever positions needed to execute this contract are being paid for by Oneida County. Chairman Knapp asked if they are talking to anyone else. Dr. Morrow is not aware that they are talking to anyone else but they do have other contracts; they are comprehensive but not like the contract with Oneida County. They have comprehensive contracts with Cayuga, Madison and Oswego. They also have as needed contracts with Broome, Jefferson, Seneca, St. Lawrence and Tompkins. Those counties (with as needed contracts) have their own system or coroner but if they need assistance they will ask. Chairman Knapp asked how comprehensive the contracts with the other counties mentioned are (Cayuga, Madison and Oswego). Dr. Morrow replied they offer autopsy services for any case that requires an autopsy. Dr. Morrow agreed with Chairman Knapp that they do not do any forensic investigation except with Oneida County.
Ms. Rooney commented that Oneida County is very pleased with the arrangement, and the executive’s office is as well. Ms. Rooney stated they are working with Oneida County to try to put into place a multiyear contract. It would continue to be 100% cost reimbursable but gives the County something that has assurances going down the road so they can continue to have the staff.
Chairman Knapp asked about the specifics concerning line 692150 in the amount of $65,000. Mrs. Messe responded it is for the firearms section of the laboratory; comparison microscope system. Dr. Morrow commented it is expensive to keep up with supplies. Dr. Morrow agreed with Chairman Knapp that it is for a new piece of equipment.
Chairman McMahon commented that there was a public complaint against the Forensic Center by SPD, and their complaint was unfounded. Chairman McMahon congratulated them on that. Chairman McMahon was disappointed in SPD but was glad the truth got out there.
The meeting was adjourned at 2:32 p.m.
Respectfully submitted,
Jamie M. McNamara, Assistant Clerk
Onondaga County Legislature |
