Health Services FY19 Budget PresentationCopyrighted
February 8, 2018
City of Dubuque Public Hearings # 6.
IT EM T IT LE:Health Services FY2019 Budget Presentation
SUM MARY:
SUGGEST ED DISPOSIT ION:
ATTACHMENTS:
Description Type
FY19 Health Servic es Budget Recommendation Supporting Documentation
-141-
Health Services
-142-
This page intentionally left blank.
-143-
HEALTH SERVICES DEPARTMENT
Budget Highlights
FY 2017
Actual
FY 2018
Budget
FY 2019
Requested
% Change
From FY 2018
Budget
Employee Expense 445,294 488,592 475,793 (2.6)%
Supplies and Services 336,951 312,460 303,494 (2.9)%
Machinery and Equipment 12,895 1,125 2,935 160.9 %
Total 795,140 802,177 782,222 (2.5)%
Operating Revenue 316,163 311,602 312,656 0.3 %
State Grant 13,047 8,806 10,500 19.2 %
Total 329,210 320,408 323,156 0.9 %
Property Tax Support 465,930 481,769 459,066 (22,703)
Percent Increase (Decrease)(4.7)%
Personnel - Authorized FTE 5.58 5.58 5.58
Improvement Package Summary
1 of 5
This improvement package would increase the two 30-hour per week part-time Animal Control Officers to
full-time at 40 hours per week. This would improve Animal Control staffing by 33%, providing more morning,
evening and weekend coverage and timelier follow-up on current animal control incidents and complaints.
The added coverage will reduce the amount of calls the Police will need to respond to, increase the number
of impounded animals and their subsequent revenue, and provide more prompt and efficient service to
citizens. This increase in staffing would also provide more coverage for when Animal Control staff is in
training, City business, or for personal time. In addition, now that pets are allowed on trails and in
some parks, Animal Control will provide enforcement for pets in these areas in conjunction with
park patrol. Currently, when one of the Animal Control Officers requires time off, coverage hours are
decreased, since neither part-time Animal Control Officer can go above 29 hours per week or 1,508 hours
per year.
Also, when Animal control is not on-duty, i.e., evenings, nights, weekends, holidays, training, etc., Police
cover animal emergencies and complaints. This amounts to significant time and expenditure for the Police
Department.
Police Animal Calls
FY12: 767 FY14: 854 FY16: 647
FY13: 717 FY15: 569 FY17: 525
Current staffing levels do not allow any time for community outreach and education on animal control and
responsible pet ownership issues. Increasing the Animal Control officers’ hours would allow them to meet
with and provide education to neighborhood associations, civic organizations, schools and animal
organizations, etc.
-144-
In addition, the amount of dogs and cats licensed in the city has steadily increased since FY94 This does
not account for unlicensed pets, which the American Veterinarian Medical Association estimates 32% of the
households owning 1.69 dogs and 27.3% owning 2.19 cats. For the City of Dubuque’s 22,560 households,
this translates to 12,200 dogs and 13,488 cats. Recent and proposed annexations have also added travel
time and coverage ability.
Fiscal Year Animal Licenses
Sold Fiscal Year Animal Licenses
Sold
FY94 6,495 FY06 7,683
FY95 7,050 FY07 7,990
FY96 6,900 FY08 8,675
FY97 7,110 FY09 8,370
FY98 7,333 FY10 8,190
FY99 7,147 FY11 9,055
FY00 7,294 FY12 9,341
FY01 7,792 FY13 9,437
FY02 8,005 FY14 9,486
FY03 7,574 FY15 9,897
FY04 8,036 FY16 10,091
FY05 6,293 FY17 10,086
-145-
This improvement package also includes an increase in fuel (+$586) and vehicle maintenance (+$330). In
addition, it is expected that animal impoundments fees would increase (+$3,000), court fines (+$5,000) and
cat licenses (+$2,000) and dog licenses (+$3,000) due to enforcement and outreach.
Related Cost:$82,497 Tax Funds Recurring Recommend - No
Related Revenue:$13,000 Animal Fees/Fines Recurring
Net Cost:$69,497
Property Tax Impact:$0.0278 0.26%
Activity: Animal Control
2 of 5
This improvement package would provide funds to replace the portable printers used by the Sanitarians that
were purchased by grant funds. Sanitarians must have portable printers while working outside of the office
while conducting food service/hotel inspections. The inspections are recorded in the computer on-site and
wireless portable printers allow a report to be generated on-site for the food service/hotel operator. This
avoids having to print the report at the office and then mail it to the food establishment after the inspector
leaves.
Related Cost:$600 Tax Funds Non-Recurring Recommend - Yes
Property Tax Impact:$0.0002 —%
Activity: Health Inspection
3 of 5
This improvement package would provide funds to purchase personal body-worn video cameras for Animal
Control officers. These funds would provide the department with two units that would equip each officer with
his/her own personal unit. Costs include purchasing the cameras and accessories. The Police Department
will provide the video storage. Units are estimated at $550 each with an estimated five-year life span for.
Body-worn cameras are becoming a necessity in today's enforcement environment. Officer-worn cameras
provide objective documentation of encounters, ensuring efficient and accurate information; and also offers
additional officer safety while aiding in accountability for all persons involved and mitigating liability in the
event of erroneous claims made against officers. These cameras have served the Police Department well
and they believe Animal Control would benefit from their use.
Related Cost:$1,100 Tax Funds Non-Recurring Recommend - Yes
Property Tax Impact:$0.0004 —%
Activity: Animal Control
4 of 5
This improvement package would provide funds for an additional staff member to attend the Green and
Healthy Homes Initiative leadership conferences and seminars. The Lead and Healthy Homes Program
now leads the Green and Healthy Homes Initiative (GHHI) process which was previously facilitated by the
Community Foundation of Greater Dubuque. GHHI conducts leadership conferences and seminars annually
in various locations and as a GHHI city, staff can benefit from obtaining technical assistance, grant and
funding opportunities, and GHHI community leadership skills by attending these seminars and conferences.
Although GHHI offers one scholarship per community, it does not cover all expenses and allows for only one
staff to attend. With new staff in both the advocate and inspector roles, sending a minimum of two
participants would improve GHHI work with both the Lead and Healthy Homes Program and the Bee Branch
Healthy Homes Program.
-146-
Related Cost:$1,195 Tax Funds Recurring Recommend - Yes
Property Tax Impact:$0.0005 —%
Activity: Community Health
5 of 5
This improvement package would provide funds for purchase of a stand-up, adjustable height desk unit for
Animal Control officers. A stand-up, adjustable height desk unit will enable Animal Control officers to stand
while working at their computer doing report inputting and licensing enforcement work. This is especially
important for employees who spend a majority of their time in a vehicle and/or sitting at their desk.
Related Cost:$425 Tax Funds Non-Recurring Recommend - Yes
Property Tax Impact:$0.0002 —%
Activity: Animal Control
Significant Line Items
Employee Expense
1. FY 2019 employee expense reflects a 1.5% wage package increase.
2. The Iowa Public Employee Retirement System (IPERS) City contribution increased from 8.93% in FY
2018 to 9.44% in FY 2019. This resulted in an increase of City IPERS expense of $1,733 in Health
Services. The employee contribution increased from 5.95% in FY 2018 to 6.29% in FY 2019.
3. The City portion of health insurance expense decreased from $1,325 in FY 2018 to $1,193 in FY 2019
per month per contract which results in annual savings of -$5,564 or -10.00%.
4. Sick leave payout decreased from $4,618 in FY 2018 to $4,097 in FY 2019.
5. Overtime expense is unchanged from $1,500 in FY 2018 to $1,500 in FY 2019. FY 2017 actual was
$1,189.
Supplies & Services
6. Court Costs and Record Fees decreased from $25,500 in FY 2018 to $23,595 in FY 2019 based on FY
2017 actual $23,595. Beginning January 1, 2016, the court requires the $85 filing fee for municipal
infractions to be paid up front by the City. The Court then enters judgment, and if a defendant if found
guilty, the defendant will pay a fine plus $85 in court costs and the Court will distribute the fine portion
and reimburse the City for the filing fee that was paid up front by the City. If a defendant is found not
guilty, the City will pay for the court costs using the $85 filing fee paid upfront instead of deducting the
$85 from the City's judgments, which was the process done by the Court previous to January 1, 2016.
Departments that file municipal infractions must budget the upfront filing fee and a portion of the amount
is reimbursed to the department going forward. The offsetting revenue is budgeted in Iowa District Court
Fines and is $28,192 in FY 2019 . Due to time delay of reimbursements, the revenue received is greater
than the expense.
7. Payments to Other Agencies decreased from $177,860 in FY 2018 to $158,691 in FY 2019. The FY
2019 Humane Society contracted budget is $129,271. These contracted services for animal control are
expenses that the City would have within its organization regardless of who provides the services. In
addition, there is $0 budgeted for the Crescent Community Health Center for rent of the wellness center
at the renovated Engine House and $25,000 budgeted for Crescent Community Health Center operating
expenses (which had a 10% reduction in FY 2018 which was removed in FY 2019). There is also $4,420
-147-
budgeted for the Visiting Nurse Association to provide medical case management of lead poisoned
children, which is funded by the Iowa Department of Public Health grant.
8. Bill Collection Services decreased from $46,845 in FY 2018 to $46,238 in FY 2019 based on FY 2017
actual $46,238. This line item represents the amount paid to PetData Services for pet licensing.
Machinery & Equipment
9. Equipment replacement items include ($2,935):
Administration
(1) Smart Phone $405
Inspections
(1) Smart Phone $405
Recommended Improvement Packages 2,125
Total $2,935
Revenue
10. Dog and cat license revenue decreased from $162,700 in FY 2018 to $161,023 in FY 2019 based on FY
2017 actual of $160,500.
11. Business license revenue decreased from $101,095 in FY 2018 to $97,000 in FY 2019 based on FY
2017 actual of $96,949.
12. Iowa District Court Fines increased from $21,675 in FY 2018 to $28,192 in FY 2019. FY 2017 actual
was $28,202. This revenue represents the reimbursement of the cost of Court Costs and Record Fees
for municipal infractions fee paid up front by the City and then reimbursed to the City by the Court. Due
to time delay of reimbursements, the revenue received is greater than the expense. A majority of the
municipal infractions filed by Health Services are for failure to license a pet.
Miscellaneous
13. The Animal Control activity is 61.4% self-supporting in FY 2019 versus 61.6% self-supporting in FY
2018.
14. The Inspection of Food Establishments activity is 52.6% self-supporting in FY 2019 versus 52.1% self-
supporting in FY 2018.
-148-
This page intentionally left blank.
-149-
PUBLIC HEALTH
Public Health provides an effective service to protect, maintain and promote the physical and
environmental health and well-being of the citizens of the community.
SUCCESS IS ABOUT PLANNING, PARTNERSHIPS AND PEOPLE
LEADING TO OUTCOMES
-150-
PUBLIC HEALTH
The Health Department is supported by 5.58 full-time equivalent employees, which accounts for
60.83% of the department expense as seen below. Overall, the departments’ expenses are expected to
decrease by (2.49)% in FY 2019 compared to FY 2018.
Expenditures by Category by Fiscal Year
-151-
PUBLIC HEALTH
Administration/Community Health
Overview
Community Health provides assessment, assurance
and policy development, to address public health
problems and issues in the community. The Health
Services Department works with the Dubuque County
Board of Health to carry out public health core
functions and essential services necessary for an
effective public health system. Although the primary
responsibility of the Public Health Specialist, all Health
Services Department staff contribute to community
health activities.
Evaluate/Review/Update
Ordinances enforced by
Health Department:
Animal
Noise
Nuisance
Sewer Connection
Refuse Storage
Food
Administration plans, budgets, coordinates and supervises the various activities of the Health
Services Department and participates in public health assessment, assurance, and policy
development for the community, often working with partner organizations. Its prime
responsibility is to plan programs and develop policies based on the community health needs
assessment and emerging health issues and emergencies as required, respond to health
related complaints and requests in a professional manner.
Health Administration/Community Health Funding Summary
FY 2017 Actual FY 2018 Budget FY 2019 Requested
Expenditures $259,156 $261,993 $244,079
Resources $20,328 $9,769 $12,207
Health Administration/Community Health Position Summary
FY 2019
Public Health Specialist 1.00
Public Health Intern 0.14
Secretary 1.00
Total Full-Time Equivalent Employees 2.14
Highlights of the Past Year
EPA PM Advance Plan and activities for Air Quality PM 2.5 level reduction and
continued with EPA Air Quality education grant with University of Iowa
Updated Animal Control Ordinance
Advisor for City Employee Wellness Committee
Attended National League of Cities Green and Healthy Homes Workshop
-152-
PUBLIC HEALTH
Future Initiatives
Further developed SOCRATA dashboard for Public Health data and outcomes
Facilitate refinement of FOG program, policies, and procedures
Performance Measures
Community Health- Activity Statement
Maintain and enhance factors that contribute to the public health and welfare of the citizens of
Dubuque.
Goal: Financially Responsible, High Performance Organization
Outcome #1: Provide, maintain, and educate on measures to prevent and control the
spread of infections, communicable and environmental diseases and threats.
Prepare for, respond to, and recover from public health emergencies and problems.
Work cooperatively with community health partners to prevent and control the spread of infections,
communicable and environmental diseases and conditions.
Build and maintain collaborative relationships with community partners that support public health
assessment, planning and program implementation.
• Seasonal health and emerging disease information
provided to local media upon request
• Participated in the Integrated Pest Management
Program (IPM) Task Force which included drafting an
IPM plan for the City.
• Planning for Iowa Mission of Mercy Clinic.
Participating in preparedness training and drills ensure that in the event of a public health emergency
all participating partners are familiar with their agencies role and implementation of the public health
preparedness plan is tested.
• Participate in the Dubuque County
Health Care, Executive Committee
Member
• County Public Health Preparedness
exercise being scheduled/planned for
2017 in conjunction with Emergency
Management, Planned and executed
City Management Team Emergency
Operations Center (EOC) exercise.
Exercise also held with Airport, Public
Health, and EMS.
-153-
PUBLIC HEALTH
Outcome #2: Assure accessibility and quality of primary care and population-based
health services
Crescent Community Health Center
celebrated its 10th anniversary October 2016.
See link for video.
• 6,263 patients served; 58% of these patients from the 52001 ZIP code which includes all of
the Washington and North End neighborhoods
• 824 were children
• 48% have incomes at or below 100% of the federal poverty level
• 33% had no insurance
• Dental Visits: 9,723 (up from 9,112 in FY15)
• Medical Visits: 9,097 (Up from 7,370 in FY14)
Outcome #3: Reduce the incidence of environmental health hazards in residential living
environments
Did You Know?
The Public Health
Specialist and
Healthy Homes staff
are providing local
health and social
agencies and
providers with
Healthy Homes
program information
and education.
• Partner with the Bee Branch Healthy Homes Program for implementation of the HUD
Natural Disaster Resiliency grant.
• Assisted with presentation to Dubuque Board of Realtors
-154-
PUBLIC HEALTH
Outcome #4: Mobilize community partnerships to identify and investigate public health
problems and emerging issues
• Bi-hospital infection control committee member
• Dubuque County Wellness Coalition, Co-Chair
• Air Quality Task Force
• GHHI Resource Group
• University of Iowa College of Public Health Board of Advisors
• Dubuque County Health Care Preparedness Coalition
• Dubuque Opioid Response Task Force
Health Services Department
maintains agreements:
IDIA- Food Inspections
IDPH- Swimming pool, tanning,
tattoo inspections
IDPH/Dubuque County Board of
Health- Childhood Lead Poisoning
Prevention Program, Annual
Dubuque Regional Humane
Society- Annual
Dubuque VNA- Childhood Lead
Poisoning and Healthy Homes
Services
Crescent Community Health
Center - Health Care Access
Did you know? The Dubuque County Health
Preparedness Coalition meets regularly to assess and
plan for public health emergencies. Recent
accomplishments include: completion of IDPH
Preparedness capabilities, review and update of the
Preparedness Plan.
Environmental Health
Overview
Environmental Health promotes a safe and healthy environment by assuring sanitary
conditions and practices in accordance with municipal public health and environmental
ordinances, codes and regulations.
The Environmental Health Activity:
• Responds to resident weed, garbage, and nuisance complaints
• Inspects public swimming pools and spas
• Provides information on indoor air quality and other environmental issues
• Inspects tanning and tattoo facilities
• Assures food safety through inspection and licensing of food and food service
establishments, temporary food stands and mobile food units.
-155-
PUBLIC HEALTH
Food Inspection/Environmental Health Funding Summary
10017300
FY 2017 Actual FY 2018 Budget FY 2019 Requested
Expenditures $198,657 $231,106 $220,732
Resources $114,471 $120,389 $116,070
Food Inspection/Environmental Health Position Summary
FY 2019
Environmental Sanitarian 2.00
Total Full-Time Equivalent Employees 2.00
Highlights of the Past Year
Training and orientation of an additional Environmental Sanitarian which replaced
Environmental Sanitarian who is now the Bee Branch Healthy Homes Coordinator.
FDA modified the National Voluntary Retail Food Protection Standards. All Standards
will need review, updating, and completion.
Future Initiatives
• Complete cycle of the FDA National Voluntary Retail Food Protection Standards
• Go fully digital on field inspections
• Education and training for new sanitarian
• Continue data collection of bedbug incidence and conduct enforcement for hotels along
with targeted education and enforcement.
-156-
PUBLIC HEALTH
Performance Measures
Environmental Health - Activity Statement
Promote a safe and healthy environment by assuring sanitary conditions and practices in accordance
with municipal public health and environmental ordinances, codes and regulations.
Goal: Environmental Integrity
Outcome #1: Assure safe and sanitary non-residential swimming pools and spas, tattoo
and tanning facilities by providing a minimum of one inspection per year within
Dubuque Country under a contractual agreement with the Dubuque County Board of
Health and the Iowa Department of Public Health (IDPH).
Enforce environmental health rules and regulations.
All facilities inspected a minimum of once per year per IDPH contract:
• Pools/Spas: 45
• Tanning facilities: 10
• Tattoo parlors: 27
A sampling of rooms at
each facility are inspected
bi-annually in accordance
with the state regulations
• Tanning operator certification exams administered: 8
• Pool/Spas closed for “Unsanitary Conditions”: 0
• 100% of tanning operators maintaining/meeting training
requirements
Did You Know?
Public swimming pools and spas are inspected for both water quality and safety measures
annually.
Outcome #2: All school lunch programs, licensed food service establishments, mobile
unit/pushcarts, temporary food service establishment, retail food establishments,
Hotels, motels and bed & breakfast inns are inspected and licensed through a contract
with Iowa Department of Inspections & Appeals.
Ongoing, regular and follow-up inspections of food establishments protect the public from food borne
illness and outbreaks.
• Food Inspections Conducted: 535
• Outstanding past due inspections: 141
• Complaint Inspections: 40
• Temporary food stand licenses issued: 135
• New establishment/change of ownership licenses
issued: 45
-157-
PUBLIC HEALTH
A total of 403 food establishments are inspected on a risk-based system. Of these, 257 are
inspected annually.
• Number of active Certified Food Protection Managers: 299
• Hotel Complaints: 8
Working with the Building Services Department, the Environmental Sanitarian requires all food
facilities to meet Food Code requirements prior to issuance of alcohol and food licenses.
Did You Know?
In order to obtain a new food establishment or food service establishment license, a plan
review packet must be submitted and approved.
• Facility must pass inspection
• Policies and procedures along with trained staff must be in place
Outcome #3: Alleviate overgrown weeds, improper garbage/refuse storage and
disposal and other public nuisances through code enforcement
• Nuisance citations issued: 7
• Nuisance violations corrected by hired
contractor: 52
• Nuisance complaints: 366
Outcome #4: Provide information, education, and assistance on environmental health
risks and Healthy Homes principles.
The Health Services Department provides current information on new and recurring environmental
health issues such as radon, bed bugs, mold, rodents, vermin, etc.
Did you know?
Environmental health staff maintains the most current information available on the Health
Services Department website. Bedbug information is the most frequent request for
environmental health topics.
-158-
PUBLIC HEALTH
Animal Control
Overview
Animal Control enforces the City Animal Ordinance which provides for licensing of all cats and
dogs, the prohibition of dogs and cats running at-large within the city, inoculation of all dogs
and cats against rabies, investigation of animal bites and assurance of proper rabies
confinement, prohibition of harboring a vicious or potentially vicious animal or dangerous
animal and prohibition of animals causing serious disturbance or nuisance.
Animal Control Funding Summary
10017200 FY 2017 Actual FY 2018 Budget FY 2019 Requested
Expenditures $336,786 $309,078 $317,411
Resources $194,411 $190,250 $194,879
Animal Control Position Summary
FY 2019
Animal Control Officer 1.44
Total Full-Time Equivalent Employees 1.44
Highlights of the Past Year
• Implemented pets in parks enforcement procedure
• Updated pet license enforcement procedure and tactics
• Updated Animal Control ordinance
Future Initiatives
• Evaluate pets in parks enforcement procedure
• New Animal Control Officer education and training
• Review Humane Society Contract reporting and trends
-159-
PUBLIC HEALTH
Performance Measures
Animal Control - Activity Statement
Protect the public health by abating and investigating animal nuisances, preventing the spread of
rabies and providing information regarding animals to citizens.
Outcome #1: To respond to and abate the problems and nuisances of dogs and cats
within the city limits by impounding stray dogs and cats, investigating complaints
regarding barking dogs and animals roaming at large and other animal nuisances, and
live-trapping dogs and cats.
Enforcement of the Animal Control Ordinance promotes responsible pet
ownership and provides city residents with guidance for living with and among
pets.
• Animal Control officers responded to 1,073 complaints
• Police Department responded to 525 complaints during times Animal
Control Officers are not on duty
• 48 citations were issued for violations of the Animal Control ordinance.
Outcome #2: To control the spread of rabies among animals and between animals and
humans
By assuring accurate and rapid investigation of animal bite incidents, assuring the rabies
observation of animal bite incidents, assuring the rabies observation of biting dogs and cats by
a licensed veterinarian, apprehending and ordering the laboratory diagnosis of biting, wild and
non-domesticated animals for rabies, enforcing the rabies immunization and licensing of all
dogs and cats within the city.
• 10,086 Pet Licenses Sold
• 1,532 Citations for Failure to License Pet
-160-
PUBLIC HEALTH
Outcome #3: Assess and evaluate animal bites, injuries and attacks for determining
potentially vicious and vicious animal declarations.
The City Animal Control Ordinance addresses several aspects of responsible pet ownership such as
rabies vaccination, licensure, leash laws, running at large, vicious and nuisance issues.
• 18 Animals (that have bitten) surrendered to Animal Control, which is down from 21 in
FY16
• 138 Animal Bites
• 2 Vicious/Potentially Vicious Declarations
Did You Know?
• Per the Iowa Department of Public Health, there were 12 cases of animal rabies
reported in Iowa in 2015-most commonly found in bats and skunks.
• Approximately 4.5 million dog bites occur each year in the US.
Outcome #4: To respond to the problems and nuisances of wild animals within the city
by: providing citizens with possible abatement methods and consultants and
suggesting ways to discourage animals from habitation; and attempting to capture of
wild animals suspecting potential rabies exposure.
Wild animal trappers must be certified by the IDNR. A list of certified trappers is maintained by
the Health Services Department. Currently 4 certified animal trappers do business in the city
of Dubuque.
Did you know?
In the state of Iowa, rabies was
diagnosed in 3 dogs and 1 cat in 2015.
-161-
Recommended Operating Revenue Budget - Department Total
17 - HEALTH SERVICES
Fund Account Account Title
FY16 Actual
Revenue
FY17 Actual
Revenue
FY18 Adopted
Budget
FY19 Recomm'd
Budget
100 42105 BUSINESS LICENSES 101,095 96,949 101,095 97,000
100 42120 DOG LICENSES 115,351 117,023 117,658 117,023
100 42125 CAT LICENSES 44,596 43,477 45,042 44,000
100 42169 TANNING TATTOO LICENSES 5,186 3,276 5,186 4,221
100 42235 REFUSE HAULING PERMITS 675 650 675 650
100 42325 SWIMMING POOL INSP. FEES 8,989 8,087 8,989 8,500
100 42330 ANIMAL IMPOUNDMENT FEES 7,320 6,540 7,320 6,600
42 - LICENSES AND PERMITS 283,212 276,002 285,965 277,994
100 45701 STATE GRANTS 7,915 8,354 6,454 5,807
100 45771 FED PASS THRU STATE GRANT 2,352 4,693 2,352 4,693
45 - STATE GRANTS 10,267 13,047 8,806 10,500
100 51987 WEED CUTTING CHARGES 2,799 4,132 2,799 4,017
51 - CHARGES FOR SERVICES 2,799 4,132 2,799 4,017
100 53102 PRIVATE PARTICIPANT 0 3,163 0 0
100 53403 IA DISTRICT COURT FINES 19,204 28,202 21,675 28,192
100 53605 MISCELLANEOUS REVENUE 0 100 0 100
100 53610 INSURANCE CLAIMS 2,475 382 0 382
100 53620 REIMBURSEMENTS-GENERAL 1,188 4,183 1,163 1,971
53 - MISCELLANEOUS 22,867 32,867 22,838 30,645
17 - HEALTH SERVICES TOTAL 319,145 326,048 320,408 323,156
-162-
Recommended Operating Expenditure Budget - Department Total
17 - HEALTH SERVICES
Fund Account Account Title
FY16 Actual
Expense
FY17 Actual
Expense
FY18 Adopted
Budget
FY 19 Recomm'd
Budget
100 61010 FULL-TIME EMPLOYEES 251,296 245,428 277,546 272,938
100 61020 PART-TIME EMPLOYEES 69,673 73,039 77,723 75,970
100 61030 SEASONAL EMPLOYEES 1,703 4,037 3,285 3,334
290 61030 SEASONAL EMPLOYEES 48 0 0 0
100 61050 OVERTIME PAY 1,821 1,189 1,500 1,500
100 61091 SICK LEAVE PAYOFF 4,599 4,599 4,618 4,097
290 61091 SICK LEAVE PAYOFF 502 502 0 0
100 61310 IPERS 28,910 28,890 32,153 33,394
100 61320 SOCIAL SECURITY 23,783 24,059 27,898 27,374
290 61320 SOCIAL SECURITY 42 39 0 0
100 61410 HEALTH INSURANCE 56,480 55,650 55,650 50,086
100 61415 WORKMENS' COMPENSATION 7,823 7,518 7,662 6,772
100 61416 LIFE INSURANCE 239 217 557 328
100 61660 EMPLOYEE PHYSICALS 419 128 0 0
61 - WAGES AND BENEFITS 447,338 445,295 488,592 475,793
100 62010 OFFICE SUPPLIES 871 523 938 614
100 62011 UNIFORM PURCHASES 295 514 691 1,259
100 62030 POSTAGE AND SHIPPING 2,711 7,875 2,710 7,249
100 62033 HAND TOOLS/EQUIPMENT 0 0 150 0
100 62061 DP EQUIP. MAINT CONTRACTS 7,343 7,594 7,895 8,054
100 62063 SAFETY RELATED SUPPLIES 0 0 350 100
100 62065 LAB SUPPLIES 0 0 100 100
100 62067 ANIMAL CONTROL SUPPLIES 147 158 150 500
100 62090 PRINTING & BINDING 2,475 1,614 2,856 2,524
100 62110 COPYING/REPRODUCTION 977 2,282 977 2,282
100 62130 LEGAL NOTICES & ADS 136 698 139 698
100 62170 SUBSCRIPTIONS-BOOKS-MAPS 47 0 136 320
100 62190 DUES & MEMBERSHIPS 695 1,245 1,130 1,355
100 62204 REFUNDS 208 0 0 0
100 62206 PROPERTY INSURANCE 167 141 145 0
100 62208 GENERAL LIABILITY INSURAN 3,586 3,608 3,791 3,437
100 62230 COURT COSTS & RECORD FEES 0 23,595 25,500 23,595
100 62310 TRAVEL-CONFERENCES 1,708 4,685 6,501 7,700
100 62320 TRAVEL-CITY BUSINESS 43 1,354 244 319
100 62340 MILEAGE/LOCAL TRANSP 0 167 265 285
100 62360 EDUCATION & TRAINING 4,782 6,770 9,642 8,703
100 62421 TELEPHONE 3,714 3,686 3,768 2,964
100 62436 RENTAL OF SPACE 2,154 2,304 2,304 2,304
100 62511 FUEL, MOTOR VEHICLE 2,721 2,381 2,721 2,428
100 62521 MOTOR VEHICLE MAINT.1,845 8,092 1,150 1,629
100 62528 MOTOR VEH. MAINT. OUTSOUR 848 990 1,265 1,010
100 62614 EQUIP MAINT CONTRACT 689 688 703 688
100 62663 SOFTWARE LICENSE EXP 125 154 129 153
100 62667 INTERNET SERVICES 318 241 720 481
100 62668 PROGRAM EQUIP/SUPPLIES 645 507 500 507
100 62671 MISC OPERATING SUPPLIES 0 2,740 0 100
100 62683 FIELD OPERATIONS SUPPLIES 765 182 780 182
100 62716 CONSULTANT SERVICES 3,223 5,120 3,288 5,120
-163-
Recommended Operating Expenditure Budget - Department Total
17 - HEALTH SERVICES
Fund Account Account Title
FY16 Actual
Expense
FY17 Actual
Expense
FY18 Adopted
Budget
FY 19 Recomm'd
Budget
100 62725 BILL COLLECTION SERVICES 45,926 46,238 46,845 46,238
100 62727 FINANCIAL SERVICE FEES 1,462 1,421 1,491 1,421
100 62732 TEMP HELPCONTRACT SERV.0 0 1,004 4,869
100 62736 CATERING SERVICES 0 260 225 225
100 62761 PAY TO OTHER AGENCY 200,149 194,214 177,860 158,691
100 62779 SURVEY / PLAT 0 0 250 0
100 62780 HAULING SERVICES 1,286 1,021 1,312 1,500
100 62781 LAWN CARE SERVICES 1,799 3,890 1,835 3,890
62 - SUPPLIES AND SERVICES 293,860 336,952 312,460 303,494
100 71118 PROJECTOR/CAMERA 0 0 0 1,100
100 71122 PRINTER 0 0 0 600
100 71124 MICRO-COMPUTER 112 0 0 0
100 71211 DESKS/CHAIRS 0 3,734 0 425
100 71310 AUTO/JEEP REPLACEMENT 0 8,250 0 0
100 72418 TELEPHONE RELATED 1,029 910 1,125 810
71 - EQUIPMENT 1,141 12,894 1,125 2,935
17 - HEALTH SERVICES TOTAL 742,339 795,141 802,177 782,222
-164-
Recommended Expenditure Budget Report by Activity & Funding Source
17 - HEALTH SERVICES
HEALTH SERVICES ADMINISTR- 17100
FUNDING SOURCE: CABLE TV
Account FY17 Actual Expense FY18 Adopted Budget FY19 Recomm'd Budget
EQUIPMENT 346 —405
SUPPLIES AND SERVICES 33,960 36,367 14,803
WAGES AND BENEFITS 132,619 129,806 131,126
HEALTH SERVICES ADMINISTR 166,925 166,173 146,334
ANIMAL CONTROL - 17200
FUNDING SOURCE: GENERAL
Account FY17 Actual Expense FY18 Adopted Budget FY19 Recomm'd Budget
EQUIPMENT 8,469 750 1,525
SUPPLIES AND SERVICES 241,516 215,965 225,358
WAGES AND BENEFITS 86,802 92,363 90,528
ANIMAL CONTROL 336,786 309,078 317,411
INSP. - FOOD ESTBLMNTS - 17300
FUNDING SOURCE: GENERAL
Account FY17 Actual Expense FY18 Adopted Budget FY19 Recomm'd Budget
EQUIPMENT 4,080 375 1,005
SUPPLIES AND SERVICES 26,653 26,764 28,699
WAGES AND BENEFITS 167,923 203,967 191,028
INSP. - FOOD ESTBLMNTS 198,657 231,106 220,732
COMMUNITY HEALTH SERV. - 17400
FUNDING SOURCE: GENERAL
Account FY17 Actual Expense FY18 Adopted Budget FY19 Recomm'd Budget
SUPPLIES AND SERVICES 23,654 26,900 27,409
WAGES AND BENEFITS 57,950 62,456 63,111
COMMUNITY HEALTH SERV.81,604 89,356 90,520
LEAD PAINT PROGRAM - 17500
FUNDING SOURCE: GENERAL
Account FY17 Actual Expense FY18 Adopted Budget FY19 Recomm'd Budget
SUPPLIES AND SERVICES 11,168 6,464 7,225
LEAD PAINT PROGRAM 11,168 6,464 7,225
HEALTH SERVICES TOTAL $795,139.79 $802,177.00 $782,222.00
-165-
C I T Y O F D U B U Q U E , I O W A
DEPARTMENT DETAIL - PERSONNEL COMPLEMENT
17 HEALTH SERVICES DEPARTMENT
FY 2017 FY 2018 FY 2019
FD JC WP-GR JOB CLASS FTE BUDGET FTE BUDGET FTE BUDGET
61010 Full Time Employee Expense
100 7700 GE-37 PUBLIC HEALTH SPECIALIST 1.00 91,796 1.00 93,274 1.00 94,676
100 7500 GE-32 ENVIRONMENTAL SANITARIAN 2.00 128,563 2.00 137,554 2.00 129,313
100 7375 GE-27 ENVIRON.SANITARIAN ASST 0.00 0 0.00 0 0.00 0
100 225 GE-25 SECRETARY 1.00 44,970 1.00 46,718 1.00 48,949
TOTAL FULL TIME EMPLOYEES 4.00 265,329 4.00 277,546 4.00 272,938
61020 Part Time Employee Expense
100 7400 GE-29 ANIMAL CONTROL OFFICER 1.44 72,827 1.44 77,723 1.44 75,970
TOTAL PART TIME EMPLOYEES 1.44 72,827 1.44 77,723 1.44 75,970
61030 Seasonal Employee Expense
100 PUBLIC HEALTH INTERN 0.14 3,297 0.14 3,285 0.14 3,334
TOTAL SEASONAL EMPLOYEES 0.14 3,297 0.14 3,285 0.14 3,334
TOTAL HEALTH SERVICES 5.58 341,453 5.58 358,554 5.58 352,242
-166-
CITY OF DUBUQUE, IOWA
ACTIVITY PERSONNEL COMPLEMENT SUMMARY
FY 2017 FY 2018 FY 2019
ACCT FD JC WP-GR POSITION CLASS FTE BUDGET FTE BUDGET FTE BUDGET
Health Services Administration-General Fund
10017100 61010 100 225 GE-25 SECRETARY 1.00 $44,970 1.00 $46,718 1.00 $48,949
10017100 61010 100 7700 GE-37 PUBLIC HEALTH SPECIALIST 0.50 $45,898 0.50 $46,637 0.50 $47,338
Total 1.50 $90,868 1.50 $93,355 1.50 $96,287
Community Health Services - FT General Fund
10017400 61010 100 7700 GE-37 PUBLIC HEALTH SPECIALIST 0.50 $45,898 0.50 $46,637 0.50 $47,338
Total 0.50 $45,898 0.50 $46,637 0.50 $47,338
Community Health Services - Seasonal General Fund
10017400 61030 100 PUBLIC HEALTH INTERN 0.14 $3,297 0.14 $3,285 0.14 $3,334
Total 0.14 $3,297 0.14 $3,285 0.14 $3,334
Inspection of Food Est./Environmental
10017300 61010 100 7500 GE-32 ENVIRONMENTAL SANITARIAN 2.00 $128,563 2.00 $137,554 2.00 $129,313
Total 2.00 $128,563 2.00 $137,554 2.00 $129,313
Animal Control-PT
10017200 61020 100 7400 GE-29 ANIMAL CONTROLOFFICER 1.44 $72,827 1.44 $77,723 1.44 $75,970
Total 1.44 $72,827 1.44 $77,723 1.44 $75,970
TOTAL HEALTH SERVICES DEPT.5.58 $341,453 5.58 $358,554 5.58 $352,242
2017 Impact
6,437 Patients Served
by the numbers
18,764 Clinic Visits
10,780
Dental Visits
11,845
Website Visitors
60% of patients with
hypertension now have
controlled blood pressure
40% are covered by
Medicaid
49% of adults
are uninsured
50% of children
are uninsured
92% of tobacco users
participated in counseling
to reduce use
74% of of patients with
out of range BMI received
and participated in a
specialized care plan
7,984
Medical Visits
1,699
children
409 age
65 and older
2,448
Women
1,880
Men
204
Veterans
2017 Impact
growth & developmentfuture
Last year was one of substantial growth and development for Crescent
Community Health Center. The Board of Directors, along with Administration,
focused on aligning strategic objectives with identified needs within the
community. Program development consisted of:
Addition of on-site
behavioral health &
substance abuse services.
Development of a community health
worker program targeted for the Marshall
Island community.
Continued growth of the Stonehill
satellite dental clinic enhancing oral
healthcare for the elderly
population.
Expansion of the clinical
pharmacy program allowing for
greater access to affordable
medications.
An increased need for services prompted by changes enacted
with the Affordable Care Act has Crescent forecasted to see 8,543
patients by the year 2021. This reflects a 41% penetration rate of
the total low income population within our service area and a
10% growth over the next 4 years.
The implementation of value-based contracts with the managed
care companies will strengthen Crescent's financial position by
allowing for reimbursement based both on attribution and
performance in quality of care metrics.
funding
Funding for Crescent supports
patients and patient services,
allowing us to carry out our
mission of providing high-
quality, respectful and
affordable medical and dental
care to improve the health and
well-being of our community.
Our financial solvency allows
us to grow our services in a
reliable and responsible
manner. The following pie
graphs are a brief overview of
our finances from November
1, 2016 to October 31, 2017.
Revenue Composition 2017
Expenses 2017
Patient Service Revenue:
Medical
Patient Service Revenue:
Dental
340B Drug Revenue
330 Federal Grant
Unrestricted Donors
Salaries & Benefits
MIT Expenses
Depreciation
Contract Pharmacy & Pharmaceuticals
Rent
Others
Realized/Unrealized Gains
& Interest from Community
Foundation
2%
9%2%
22%
23%
16%
26%
16.5%
2.9%
8.6%
6.8%
3.6%61.7%
2017 net income
Revenue $6,489,174.94
Expenses $5,829,616.00
Net Income $659,558.94
Health Services Department
FY 2018-19 Budget Presentation
Health Department Activities
COMMUNITY HEALTH
•Planning
•Public Health
Preparedness
•Community Partnerships
•Wellness Coalition
•Health Care Access
•Lead Poisoning
Prevention
•Communicable Disease
ENVIRONMENTAL HEALTH
•Food Inspections
•Nuisance Enforcement
•Swimming Pool
Inspections
•Tattoo/Tanning
Inspections
•Vector /Rodent Control
•Healthy Homes
ANIMAL CONTROL
•Ordinance Enforcement
o Nuisance
o Bites
o At large
o Dangerous Animals
•Rabies control
o Licensing
•Cruelty/Neglect
•Pets in Parks
0
1
2
3
4
5
6
7
8
City of Dubuque Lead Poisoning
and
El
e
v
a
t
e
d
B
l
o
o
d
L
e
v
e
l
%
Animal Control
1516 1536 1417
1134 1153 1096 1187 1073
FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17
Complaints
Animal Control Citations Issued
1184 1197 1101
1489
1153 1037
1318
1532
FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY 17
License Citations
11
21
33
73
47
72
48 48
FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY 17
Other Citations
7990 8675 8370 8190
9055 9341 9437 9486 9897 10091 10086
FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17
Pet Licenses Sold
State Code Animal Violations
(Investigated by Animal Control and Police)
FY14 FY14
FY15 FY15
FY16 FY16FY17
FY17
0
10
20
30
40
50
60
Animals left in Vehicles Neglect / Cruelty to
Animals
86
99
81
104
117
91 98
109
38 30
19 27 18
29 25 28
0 4 3 3 1 4 5 1
FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17
Animal Bites
Dog Bites Cat Bites Other Bites
Improvement Package
Environmental Health: Food Inspection
•2 Sanitarians
•FDA standards
•Inspections digital
•Follow-up on violations
•Newsletter
Food Inspection App
Food Inspection
16
22
20
9
12
20
2
4
6
0
2
6
FY15 FY16 FY17
NEW CHANGE OWNERSHIP REMODEL FOOD TRUCK
441
46
2017 IowaSic Line
Illness Complaint Calls Outbreaks Detected
5
11
1
0
2016 2017
City of Dubuque Foodborne
Illness Complaints
Complaints Verified Illness
Hotel/Pool/Tattoo/Tanning Inspections
•Hotels: 28
•Pools: 34
•Tattoo Est: 7
•Tanning Est: 14
•Total: 83
Nuisance Control
7
13
8
13
9 12 13
8 8
11
2
6
1 3
54
36 38
34
23
5
2017 Nuisance Complaints
Garbage/Junk/Nusiance Grass/Weed
Total= 294
2
8 10
25
12
18
7
18
6 10
5 55
78
44
32
54
17
7
1
2016 Nuisance Complaints
Garbage/Junk/Nuisance Grass/Weed
Total= 364
0 2 6 7
17 19
38
70
FY14 FY15 FY16 FY17
Nuisance Enforcement
Citations Hired Contractor
0
20
40
60
80
100
120
Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec
Nuisance & Food Inspections 2017
Food Inspections Nuisance
New Employee Education
•Prior to Inspecting Food Establishment Independently:
o 34 Online Classes (44hours)
o 25 Joint Inspections
o 5 Days Training in Des Moines
•Foodborne Illness Investigation Training:
o 8 Online Classes
•Pools, Tanning & Tattoo Training:
o 5 Days Training in Des Moines
•Ongoing Education:
o Received a $3,000 Grant for Training (2018)
Air Quality
Patient Income & Poverty
0
10
20
30
40
50
60
<100%101-150%151-200%>200%UNK
2008
2009
2010
2016
4009
5376
6001 6069
6377
5711 5750
6228 6263 6437
8057
3500
4500
5500
6500
7500
8500
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2020
Crescent Patients
Opioid/ Substance Abuse
•Dubuque Opioid Response Team
Narcan training
Advocacy-state legislation
Healthcare provider education
Community education
Mental Health
•Dubuque County
•East Central
Region
•Access to
care/services