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County Board of Health/Board of Supervisors Meeting E ~ CITY OF DUBUQUE, IOWA MEMORANDUM December 2, 1999 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: County Board of Health/Board of Supervisors Meeting As directed by City Council, Public Health Specialist Mary Rose Corrigan and I met with the Dubuque County Board of Health to discuss the dissolution of the City of Dubuque Board of Health and to provide for a smooth transition. A task force was formed by County Board of Health Chairperson Dr. John Viner. The members are: Dr. Viner, County Health Department Director Paul Buss, Mary Rose and Visiting Nurses Association Director Barb Moran. Julie McMahon, former VNA Director and now with the Iowa Department of Public Health will be asked to provide technical assistance. The goal is to have a plan in place by March 1, 2000. MCVM/j Attachment cc: Barry Lindahl, Corporation Counsel Tim Moerman, Assistant City Manager Mary Rose Corrigan, Public Health Specialist Attachment #4 ~ CITY OF DUBUQUE, IOWA MEMORANDUM November 18, 1999 TO: Michael C. Van Milligen, ~i~ M~nager \~\,\l/' Mary Rose Corrigan"} RN, Public Health Specialist FROM: SUBJECT: County Board of Health/Board of Supervisors Meeting INTRODUCTION This memo provides information summarizing the meeting on November 16, 1999 that we attended with the County Board of Health and County Board of Supervisors regarding the dissolution of the City Board of Health. BACKGROUND At the October 18, 1999 City Council meeting, staff was directed to meet with County Board of Health officials to discuss the City Board of Health dissolution and provide for a smooth transition. Present at this November 16, 1999 meeting were County Board of Health members, Dr. John Viner, MD, Chair, Nick Goodmann, and Susan Hellart, Board of Supervisors Donna Smith, Jim Waller and Alan Manternach, along with several Dubuque VNA Board members, Barb Moran of the Visiting Nurse Association, Mary Pat Breitfelder, Hillcrest Family Services, and Rod Tokheim of Mercy Medical Center. DISCUSSION Several public health programs and topics were discussed including childhood immunizations and communicable disease follow-up. It was agreed that prioritization for funding various public health activities should be a Board of Health function. The Healthy Dubuque Steering Committee is willing to provide data and information regarding public health programs and activities, but do not feel comfortable in selecting the funding priorities for the community. Mike Van Milligen explained that it is the City's intent to continue performing functions in the Health Services Department that are not Board of Health responsibilities, including such things as animal control, food inspections, nuisance control, etc. The activities that are in question are those Board of Health responsibilities of communicable disease follow-up, community assessment and health planning, swimming pool inspections, and the immunization audit. It was discussed that the current swimming pool inspection program is through a contract with the City Board of Health and continuation of this program would require a State contract with the County Board of Health and a subsequent agreement with the City to perform this function. The City would like to continue playing a role in the community assessment and health planning activity. Mike Van Milligen also made it clear that the City Council does not intend to fund any County Board of Health activities. The City Health Services Department's current budget of $400,000 per year will continue to fund its own health department activities. Dr. John Viner suggested that a task force be formed to work on a plan to assure that the Board of Health responsibilities can be performed and that a prioritization process be developed. It was suggested that Julie McMahon of the Iowa Department of Public Health be solicited to provide technical assistance to the task force. Rod Tokheim stated that although the Healthy Dubuque Steering Committee does not feel comfortable setting the priorities for the Board of Health, he would provide assistance to the task force in terms of working out a time line and planning for the City Board of Health dissolution and transition of activities. It was agreed that the task force would consist of Dr. John Viner, Paul Buss, Mary Rose Corrigan, and Barb Moran. The goal is to have a plan in place by March 1, 2000 so that the County Health Plan can be submitted to the Iowa Department of Public Health by its due date on April 1, 2000. After the task force meets in early December with the County Board of Health, I will inform you of their time line and plan for the transition. MRC/cj (', City Manager's Office 50 West 13th Street Dubuque. Iowa 52001-4864 (319) 589-4110 (319) 589-4149 FAX DUB~ .~~~ October 14, 1999 Dr, John Viner, MD, Chair Dubuque County Board of Health c/o Dubuque Internal Medicine 1515 Delhi Dubuque IA 52001 Dear Dr. Viner: ~Tb8.. "? ' . '",", "", ?,:' " ,:,,~I>. ""=h~i='=~m~~~'t:"o:v~~~':':ol health to one for the entire county. This includes assuring that essential public health services such as health planning, communicable disease investigation and swimming pool/spa inspections for Dubuque city and county residents continue. r'-""'\ \ ' -, :_'-'/f':::::, ::'" ---',":~_,_':.:-:";':, _ - " ',' - ," - Public H~~lltl ~p~l~;MJrY Rose. c;orri9.anan.~t,"_i.,\....wJtIt"~j~' of~. todi$C....thedJaaotuti9A-of'..~_.~,..~f the County Board of . Health is agreeable, please let us know when your next meeting is, or when it is convenient for the board to discuss this issue with us. I was contacted by Dubuque County Board of Supervisor Jim Waller, and he asked that the County Board of Health invite the Board of Supervisors to this meeting. I look forward to our discussion. . <~ J\ 0\.\J\ ~ "r.' t \:\J'V ,,, \.-Jl\.. Sincerely I M Michael C. Van Milligen City Manager MCVM/cj cc: Dubuque County Board of Supervisors Paul Buss, County Health Department Manager Mary Rose Corrigan, RN, Public Health Specialist (-": Service People Integrity Responsibility Inno\'ation Teamwork NOV-24-99 WED 01:02 PM DUBUQUE CO AUDITOR FAX NO. 3195894478 p, 02 MINUTES OF MEETING OF DUBUQUE COUNTY BOARD OF SUPERVISORS November I U, 1999 MEMBERS PRESENT: Donna Smith; Alan Manternach, Jim Waller MEM BERS OF BOARD OF HEALTII PRESENT: Dr. John Viner, Nick Goodmanl1, Sue HeBert CITY COUNCIL MEMBER PRESENT: Ann Michalski STAFF PRESENT: Dr. Paul Buss, Jan Hess OTHEI~S PRESENT: City Manager Mike Van MilIigen, Tom & Jane Uehler, Mary Rose Corrigan, Mary Pat Brcitfcldcr, Steve Baumhovcr, Tom Larson, Kay frommelt, Jackie Koontz, Craig Reebcr, Barb Moran, Sue QuinlJen, Ann Michalski, Rod Tokheim, Peg Hudson 'j'he meeting of the Dubuque County Board of Health was called to order at 7 p.m. by Chairperson Dr. John Viner in the North Courtroom, Dubuque Cmmty Courthouse. Mr. Goodmanll moved, Ms. Hcllclt seconded, carried unanimously to approve the minutes or tho meeting or October 20, 1999. Ms. Hcl1crt moved, Mr, C':roodmann seconded, carried unanimously to approve the county clalms for the Board of Health for October, 1999. Dr. Buss explain that the Board of Health has seen this plat previously, He located the subdivision on ,1 map and explained that the ClIo-cnt plat is Phase 2 and includes 9 lots.. He said it is a final plat and that there will be centralized water and individual septic tanks. Tom Larson of Buesing & Associates, distributed results of percolation tests. Dr. Buss pointed out wells on the map, Mr. Goodmann moved, Ms, Hellert seconded, carried unanimously to approve the Plat of Survey of Lots 21-29 inclusive and Lot D of Southern Hills Subdivision as comprised of Lot C ofthc Southern Hills Subdivision. Dr. Buss explained that the next plat on the agend,l is located along the Mississippi River, accessed by a dead end county road that the Tom and Jane Delnel' have improved to le~\(.l to the existing subdivision. Ms, Heller recalled th.1l the Board ofHe.llth had already heard about the idea for the proposed suhdivi!>ion, Mr, Uelner said that he is providing access for an existing 1 NOV-24-99 WED 01:03 PM DUBUQUE CO AUDITOR FAX NO. 3195894478 P. 03 stlbdivision. Ms. Hellert clarifieu that this is tldjacent to an existing subdivision. Mr. Dehler explained tlmt he is adding G lots to the existing subdivision. He added that he is planning to reshapo some oftlle existing lots anu to add 6 more Jots to the subdivision. Mr. Goodmunl1 ,lsked ,lbout the unbuitdable area near the pond, which is controlled by protective covenants and the walkway easement. Ms. Hellert asked about screening. Mr. Larson explained that there arc existing trees which screen. Mr. GoodmallJl asked about the number ofl()lS; Mr. Larson said additional lots were Lots 20,21, 22, 24, 26 and 27. lIe said that other lots are reshaped. Dr. Viner ask,ed what has been built so far; Mr. Uell1er pointed out the sites of two homes. Mr. Uclncr said that one well is in, the road is improved, and street lights are in. Dr. Buss tlskcd about additionallightillg; Mr. Uclncr said that covenants require low wattage y,lrd lights. Ms. Smith asked if wells available for public lIse for fire fighting. Mr. Dehler said that there arc two-inch water mains and 3 hydrants. Dr. Buss commented on the problem of water prC'ssure with those hy<lrants and said that fire departments would h,we to bring water. Mr. lklncr s,lid that there is also water from the pond. Ms. Hellert said that she is concerned about accessibility for fire protection and school buses in areas that arc inaccessible, causing additional public expense. Mr. Uelncr said there is .1Jrcady a bus turnaround 311d that access for emergency services for the existing homes is much bctLcr than it was. Ms. lIcllcrt said this is a broad area needs to be addressed in the future. Mr. GoodmauJl asked about zoning; DelneT said already zoned residential. Ms. Hellert said that the 30.year old zoning ordinance is irrelevant and that there arc thOlls.mds of acres with residential zoning ~Ilready existing because ofit. Ms. IIcllcrt. moved, Mr, Goodmann seconded, carried unanimously to approve the preliminary plat ofGnmd River Bluffs.tt2 Subdivision. T90N. R2E, Peru Township. Ms. Hellert commented in conjunction with plats, that the geological survey is finally finished, showing pOrollS blufH; and limestone, protected by clay. She said that she had read that when the elay is removed, there could be a problem and said that these issues need to be addressed in a new ordinance. Ms. Smith asked if gCl)logical maps are available to the Board; Dr. Buss said that they me available in th~ office. Ms. Hellert requcsted that this issue be addressed. Dr. Viner asked about the subdivision 2 NOV-24-99 WED 01:03 PM DUBUQUE CO AUDITOR FAX NO, 3195894478 p, 04 moratorium idea. Ms. IleUert said tlnlt there is much that has to be addressed and changed. Ms. Smith ,1sked ahout revised regulations. Dr. Buss said thilt the Board of Health has adopted reviseu Auministrativc Rules from the Department of Natuml Resources, which will result in less disturbance ofland with alterni:ltive wastewater systems. Chairperson Smith convened the Dubuquo County Board of Supervisors. Dr. VincI' wdeo111cd the Board of Supervisors, City Council member, City Manager and Public Health Specialist. Mike Van Milligen, City Manager, explained that the Dllbuquc City Council had directed him to represent them (1t this meeting and rererred to his letter of October 14, 1999 to the COllnLy Board ofHeallh. Dr. Viner silid that he understood that the City Board ofHeaJth, i.e., City COllncil, is 110t allxio11S to continue and said that this is not an issue casily resolved. Mr. Van Milligen saiu that at its August goal-setting session the City Council discussed eliminating the Airport Commission and the City Board of Health and asked for.these issues 10 be on COllllCil agenda in October. He said that there was gcneral consensus from the Counci 1 that they wanted to eliminate Board of Health and votcd to ask the Mmlager to meet with the County Board of Health to talk about a smooth transition. He said that the Council has also discussed continuing to perfonll functic.ms that arc not specific Hoard of llcalth functions with a 400,000 budget including animal control and rc~lallrallt inspection. He asked the County Board of11calth for consideration that the city Public JIcnlth Specialist continue to serve on Healthy Dubuque 2010 [or planning [unctions. He said that the City also has two ccrtified swimming pool inspectors and has an interest ill conlinuing swimming pool inspections. Mr. Van MilligCll referenced a lctter from Dr. Ross M'ldden conccmed about the subsiuy that Medical Associates provides [or communicable disease Iollow-up. Dr. Viner asked ifthc City inspects pools in County'? Mr. Van Milligen said that the City inspectors do that now. Ms. Corrigan said that the inspections are done with a 28-E contractual agreement with the State. Dr. Buss said that the County Board of Health hali talked ,thout restaurant inspections. But the iowa Dept of Agriculture wanted the county to have a full-time clerical person to do nothing but that. He said that the State continues to do restaurant inspections outside the city of Dubuque. 3 NOV-24-99 WED 01:04 PM DUBUQUE CO AUDITOR FAX NO. 3195894478 p, 05 Me. Van Milligen said lhal the City performs the inspections in a direct relationship with the Slate, not as a noard of Health fUllction. Dr. Viner - asked if the City could do that for the County. Ms. Corrigan Raid that they have that option, but don't have stan: She said that the City also has the potential to inspect funeral homes and tatoo parlors, but doesn't have the Sblfr. Mr. Waller asked if the City inspects anybody with a food license? Ms, Corrigan said yes, even temporary licenses. Ms. Hellert asked how ofLen; Ms. Corrigan said that is dependent upon risk assessment, but at least annually. Ms. Hellert how oIlen docs the state the state does inspections. Dr. Buss said at least once a year, but jfthere are deficiencies, follow-up is done, Dr. Viner said that he is looking for efficiencies in Public Health Nursing. Ms. CorrigiUl said th:lt Dr. Madden's letter pointed Ollt thut the City and County don't have the iufrastructure to deal with outbreaks of communicable disease. She said that this sprig, a major employer paid some of cost of Tuberculosis outbreak. Dr. Buss asked jf a bill-back to employers could be built illto a county ordinance. Mr. Van Milligen asked if this work is contracted to the Visiting Nurse Association. Dr. Buss said that is limited and that the VNA does not do waterbomc disease; he explained that the County lIcalth Deparlment does lhat. Ms. llellert said there is trcmendous increase in number of cases and at the same time a decrease in dollars from federal government, and that at some point it can't be absorbed. Dr. Viner commented that each visit is now more expensive; so limited monies mean rew~r visits. Ms. Hellert said that every year the money in grants is either stagnant or less while health care cost escalates. She said that the result is telling very ill people we can't help them. She said there is a need to set priorities. Mr. Waller said that the COLmty can't pick up every decrease in federal funding. Ms. Hellert !mid that it is 110t a viable option to invite people to come here and 110t get sick. Ms. Corrigan said that the state~maJ1(hlted plmming process walks through asseSS1l1Cllt and planning. Mr. Waller said that Washington did Balanced Budget Act of 1997 and shoved costs down to the property tax payer. Ms. Smith said that sOl11e of the state dollars that flow through the County .md City went to the Healthy 2000 Committee. She said that was meant to be counlywide planning effort that looked at the delivery system and how to meet needs. She !;aid that now the County has a single contract for first time; before that city und county both contracted with VNA for communicable disease follow-up, immunization, and llursing. She said .then the VNA opted out of medicare. She asked whether the (lVer $1.5 miJiiol1 accumulated and in the Foundation flmd wa~ from the delivery ofho.1l1h care. She said the VNA discontinued using United Way money when they went into the Finley system. She said that now it is predicted that home health care 4 NOV-24-99 WED 01:05 PM DUBUQUE CO AUDITOR FAX NO. 3195894478 P. 06 billing through medicare will be built into hospital service. Ms. Smith said that the $125,000 in county proeprty tax money has been there for LIse when no other payer is available. She ask ed the COlmty Board ofHcalth what is coming back. She said that the Board of Supervisors did approve an increase in rates for public health nursing which will cut service. She asked ifthe community is left with the question of the City Council not l11eeting twice a year on this component.. Mr. Van Milligen suid that the city hasn't served the function of Board of Health and that other large cities don't havc boards of health. Ms. Smith said that the City Council, Board of Supervisors and County Board oflleahh had a meeting several years ago about combining the function because City taxpayers pay twice as it stands. Ms. Corrigan said that was in 1989. Ms. Corrigan added that the VNA did sexually lnll1smiUcd disease follow.up until the Dubuque Racing Association grant ran out. Me. Waller said that the VNA volulltarily left the United Way where they had received $30-40,000 per year. Ms. Moran said th,lt was a very difficult decision because of the creation of the VNA foundation. Ms. Moran said that the Foundation money is in a blind trust and that the VNA can only draw intcrcsteach year and then a maximum of$50,000 annually from the trust principle if the organization is in deficiL She said that the $170,000 in interest from tbe foundation disqualified the VNA [rom United Way f\mdillg. She said that the trust was never meant to be operating money; she said that in the current situation, the VNA is having to draw down on the principle. Ms. SmUh said that the VNA wanted to have 11 specific fund raiser in lieu of United Way funding, and couldn't draw interest from the foundation is they had received money from the United Way. Ms. Smith asked how many counties the VNA is serving in. Ms. Moran said 8 counties for maternal child health, but all other programs mostly in Dubuque. Mr. Waller clarified that Ms. Corrigan's position at the Cily would remain with the Mr. VUIl MiIligen said th,\t it would so that the City could continue to be involved in planning, and the City would continue its ordinances in the areas of nuisances, animal control, lead paint, restaurant inspections, pool inspections. He said that the work Ms. Con-igan CtUTently docs with cOlllmunicable disease would become the responsibility of the County Board ofHeaHh, along with the questions Dr. Madden is raising. Dr. Viner said that the county Board of Health has 110 capacity to do that now. Ms. Smith suggesting going out to bid for the service. Ms. Corrigan said that there is no money in it. Ms. Smith said that it would he ,\ componcnt in the delivery system. Ms. Corrigan 5 NOV-24-99 WED 01:05 PM DUBUQUE CO AUDITOR FAX NO. 3195894478 P. 07 said th.\t insurance doesn't cover that follow up, and ifit is billed to the public health nursing grant, it would consume tbe money. She said that Tri-State Occupational Health is folJowing up with 30 people they arc 110t getting paid for and that the VNA a similar load. Dr. Buss said that would be a necessary component of the system. Ms. Smith said that there is ,m ohligation to address th~lt issue countywide. Dr. Buss said that the county will have to spend 10 times more than it is spcnding now jfthnt's the highest priority. Ms. Hellort said that immutlizatiol1 is also a high priority. Ms. Smith mentioned the lcderal early periodic scrcaning, diagnosis & treatment that is outside Medicaid and can provide service.. Ms. Peg Huuson said that is offered to who is Medicaid eligible but that there is not enough money to pay for it. Dr. Viner said that the best dollars are spent on immunization and that n(~cds to be pursued with vigor, even if it means cutting back on another program. Mr. Vall Milligen emphasized the need to prioritize because there won't be enough money to go ,lrolmd and somebody has to decide how to allocatc it and said that the County Bmlrd of Health has to set priorities. Dr. Vincr said that the COl1l1ty Board of Health has worl\ed with Healthy Dubuque 2000 and questioned the relationship between the Board of Health and that Committee. Mr. Waller emphasized that everybody must work together. Ms. Hellert said that as a taxpayer. she doesn't like to see planning so far removed from the taxpayer, three steps away f)'om elected officials. She said that Healthy Dubuque 2000 must be advisory to the Board of Health. Ms. Corrigan said that the health consultant for Healthy Dubuque 2010 does the data gathering, showing where DLlbuque County ranks in the various disease categories and the Committee does continuous assessment. She said that the Healthy Dubuque 2010 Web Site provides Lhat data for everybody's planning needs. Mr. Rod Tokhcim said that currently Healthy Dubuque 2010 is uncomfortable with its relutionsllip to official health planning bodies. He said that private sources are "on hold", and that the volunteers on the committee do not wish to be seen as usurpers. He said that some of the budgct lor Healthy Dubuquc 2010 is coming frol11 the budget at Mercy Medical Ccnter. and that the group is waiting for the County Board of Health to establish its roles. Ms. Hellert asked if the City's ::lCtiOll is this a done deal and .\sked if the City abandon its role. She asked ifthe County Board of Health has any choice in the matter. Mr. Van Milligcl1 said that he w~s directed was to consult wilh the County Board of 6 NOV-24-99 WED 01:06 PM DUBUQUE CO AUDITOR FAX NO, 3195894478 p, 08 .. Health about the transition. He said that the City COLlncil wants assurances that core public health functions will be mct. Dr. Viner asked nbout the time linc. Dr. Buss said that the Assessment document is due to the State April 1 and that much of work has been done. Dr. Buss said that Healthy Duhu4UC 2010 and the hospitals have contributed greatly. He said that the Board of Health needs to set priorities for what will be done. Ms. Corrigan said that much of the data has been gathered. Ms. Smith asked if immunizations are being done by the VNA, both rural and urban. Mr. Tokhcim said that there is a need start looking at the source of funds. He said that the State of Iowa is going to privati:!c, giving (15 (Ul example the Hawk-J program. He said that the COlmly BO:ll1.t of He,lUh needs to improve participation in the llawk-] program. Mr. Waller said that there is a contract with Operation: New View to recruit people into it. Ms. Kay Frommelt said that nobody has done a good job of setting priorities, going far buyond immunizations to overall health. She said that an example is Maternal Child visits. She said that hospilals do the 1irst one but there is tremendous need for people that fall through cracks. She said th~re .tre also tremendous problems with the elderly. Dr. Viller SHid that the volunteer board is glad to do their part and suggested that a Task Force for the new sct- up nc~ds to look at data and sources of income. He said that the Board of I !ealth will need to have all in order by March 1. Mr. Goodmanll asked if Healthy Dubuque 2010 will be the Tasl~ Force. Dr. Viner said lhat is to be determined. Ms. Smith askcd ahoul the health system in s('.hools and whether it is coordinated. Ms. Corrigan said that immunizations have to be done before school. She said tbere arc clinics in schools and that maternal health is with the hospitals. Ms. Frommelt said that the needs are growing dramatically and that the schools, the VNA ilnd everybody else is understaffed. She mentioned at-risk students and lice progrilll1s in the schools. She said it is most helpful to have to do preventive health care ill the home. She said th~lt the community doesn't know how dramatic the need is in Dubuque. Ms. Koontz said that there are tremendl)lIS needs with the elderly population and said that currently volunteers arc working with a small number of patients because fLlnding js not there. She said that people who W<lnl to continuo to stay in own homes, and that the alternative is more expensive care in nursing homes. Ms. Smith asked about the elderly w,liver. Ms. Moran said th,lt only applies to cerlain qualitied people and that the VNA has tried to get ,'\5 m,my as possible eligible but the paymcllt mechanism also doesn't pay what it cosis to provide services, and the VNA loses mOl'cy on each hour of service provided. Mr. Mantcrnach said that thero are increased needs when the economy is rohust and 7 NOV-24-99 WED 01:07 PM DUBUQUE CO AUDITOR FAX NO. 3195894478 P. 09 wondered what will happen if the economy goes sour. He sclid we are fairly wealthy and probably have the ability to fund more services, but other poor counties cannot afford it. He said that the federal government has shirked their responsibility when services are 110t provided nationwide. Mr. Waller said it is ironic that the richest country in the world doesn't care for children ~lI1d the eJderly. Ms. Helleit said it is a consumer-driven culture and the County has resources and pointed out the subdivisions approved earlier 011 the agenda at the same time the Board is talking about children not immunized. Mr. WaJ]er said that property tax is not intended for such lIse and that help is needed from the state and federal governments.. Ms. Mantemach said that all that new growth is subject Lo tux increment fInancing.. Ms. Smith said that she doubted that there would be a person who wonlon't recommend uSlng taxes for immunization and prevention of sexually transmitted disease. Mr. Manternach agreed, but asked about the elderly. Mr. Manternach said that the Board of Supervisors needs priorities, with dollars attached to each priority. Dr/ Viner asked for volunteers for the Task Force. Mr. GoodmUlll1 a::;ked what responsibility will county take over. Mr. Van Milligcn said the: city is not performing functions now except for some communicable disec\se f{lJlow~up out ofnccessity because nobody else will do it and referred to Dr. Madden's letter. Ms. Corrjgan said that there could be a full-time communicable disease follow.up nurse busy in county. Ms. Frommelt asked if the County do more than the City did because it wasn't good enough. Mr. Waller stressed the meed eliminate duplication and save money and to set priorities. Ms. Hellert said that the Board of Health needs somebody from the City, YNA,llcalthy Dubuqne 2010 and 5 members of the Board of Health to set priorities with dollar amounts ;lltached for the Board of Stlpervisors. Mr. Van MHligell said that he and Ms. Corrigan would participate but that the City isn't going to spend money beyond what it is currently spending. He added that if there is no Board of lIealth, there is not a function. Mr. Vcm Milligen added that there is only onc large city in Iowa with a Board of HeaJth. Hc said that most counties have contracted nursing services, not provided directly. Ms. Corrigan said that counties still staff some functions. M~. Hellert asked for numbers showing the percentage of people in the City of Dubuque and the percentage of property taxes collected in the City of Dubuquc and thc balance of the 8 NOV-24-99 WED 01:08 PM DUBUQUE CO AUDITOR FAX NO. 3195894478 P. 10 .. County.. Ms. Smith said that the money from the low" Dep:utment of Public Health is divided. Ms. Smith asked why the VNA doesn't serve people in the City of Dubuque with tho county propclty tax monies and asked why that was carved out.. Ms. HeIlert said that she was totally mmt7.cd that City of Dubuque had a non.functional BOotrd of Health. Ms. Frommelt said that most people have no idea that City Council is the City Board of Health. Ms. Smith suggested a public health clinic. Mr. Wallcr asked where the moncy would come from. Ms. Smith asked about the contract between City and the VNA. Ms. COlTigan said that is fllnded only with the grant from the Iowa Department of Public Health. Ms. Frommelt s:lid that people served are on the VNA sliding fee scale. She added that the VNA Foundation rnonics are restricted so the VNA doesn't hnve to go out of business. Dr. Viner said that the Board of Health is soliciting membership on a Tusk Force from Healthy Dubuque 2010, County Health and the VNA Ms. Mary pat Breit[cldcr suggested that Hillcrest Family Services be represented as the provider o1'thc WIC progmm. MS.llellclt suggested somebody from the school systems. Mr. Tokhcim suggested representation fr()1TI Healthy Dubuque 2010. Ms. Bellert asked if there is a core group; Mr. Tokhcim said there is a steering committee. Mr. Hellert stressed that the Task Force be advisory and include Healthy Dubu'-l\.IC, the VNA and the City staff. Mr. Tokheim said that Healthy Dubuque is comfortable with getting information, but uncomfortable with financial issues. Mr. Van Milligcn suggested Julie McMahon fro111 State Dcpt of PuhlicHeClllh to work with the group. Dr. Viner agreed that Ms. McMahon would h,we the perspective of other like- sized cities. Dr. Buss said it is interesting to look at like-sized cities and what they spend. He said that Linn County seems to furthest ahend. Ms. Corrigon said that she has that information; Mr. WntIer asked for cost intbnn.\!iol1. Ms. Moran said that Linn, Scott and Johnson County health directors have volunteered to facilitate a task force for the County Board ofheallh.. Mr. Tokhcim said tlH\t he would be more C0l11fo11ablc with the facilitator coming from Stelte of Jowa. He said it would bc..useful to talk to other counties but he was 110t comfortable with their models because they arc grossly expensive. Dr. Buss said that Ms. McMahon will have infol111ation from other counties at the state level; Mr. Waller suggested that cost infonm\tion also be obtained.. 9 NOV-24-99 WED 01:08 PM DUBUQUE CO AUDITOR FAX NO. 3195894478 P. 11 ol Dr. Viner tlskcd about who on is on the Healthy Dubuque Committee. M... Tokheim said a number of people represent constituencies including the hospitals, education, other health care providers, the elderly. Dr, Viner solid the Board ofHeallh needs nucleus group with perhaps lone person from llcalthy Dubuque. Dr. Buss suggested a member of the Board of Supervisors for funding issues. Mr. Manternach disagreed, saving that one Board Member docs not represent funding; Mr. W..llcr agreed. Mr. Goodmann said that lhc City Board of Heallh is a moot pont; Mr. Van MilligOll said ht: hoped to have Ms. Corrigan participate in the transition. . Mr. Goodmann said th::lt the community is not gaining any economics; Mr. Van MilIigell agreed. Ms. Smith asked lflherc lU'e any funding sources exclusive to the City. Mr. Tokheim recommended a gOClI-settillg process that Healthy Dubuque can feed into. Ms. Hellert said that she wanted specific infonm\tion about monies available. Mr. Tokheim suggested that Julie McMahon facilitate the planning process.. Ms, Smith askt:d if there would be any money fi'om the City; Mr. VCln Milligcn said that other cities are not providing money. Dr. Viner asked inhere are any other issues. Ms. Smith said that the County's budget process is in January. Mr. Waller asked for some idea of money for the budget but didn't think it will be finished. He said that the Board of Supervisors can always do budget amendment at later time. Mr. Van Milligen said that the County must have had an expeck1tion of change when dividing health and zoning. Mr. Waller said that there was no expectation of a change this dmstic; it was a matter of work load. Mr. Waller suggested coming up with priorities and some idea of cost 101' the budget season.. Mr. Vun MilligCll asked when the Committee would be appointed. Mr. Tokhcim volunteered Art Roche and himself to work with the Board of Health as an education process to set priorities Dr. Vincr agreed thut would be helpful. Ms. HcIlerl moved, Mr. Goodmanll seconded. carried unanimously to create a Task Force for blending City of Dubuque ,lnd Dubuque County Board of Health Functions including Paul Buss, Mary Rose Corrigan, Barb Moran and Julie McMahon. with the assistance of Rod Tokheim and Alt Roche to assist with facilitation. The next meeting was set for Dccernbel' 8. 10 NOV-24-99 WED 01:09 PM DUBUQUE CO AUDITOR FAX NO, 3195894478 p, 12 ot Mr. Waller moved, Ms. smith seconded, carried to (ldjoum the Board of Supervisors (It 8:45 p.m. There was discllssion about the format for next meeting. Ms. Hellert requested information about available funding and a copy of the letter from Dr. Madden. Mr. GoodrnUllll raised queslions of assessment of needs required by Iowa Department of Public Health due by Aprill, 2000, and and Healthy Dubuque 2010's role in it. lle said that he attended the last mc~ting of that Steering Committee and there was frustration because Dr. Buss was not in attendance and the group did 110t have direction. There was consensus that Dr. Buss confer with Julie McMahon and Rod Tokhcim to ascertain role of Board of Health and Health Officer in the required assessment, and to instruct Dr. BliSS to work with Healthy Dubuque 2010 to complete the document for review, cOl1sideration and approval of the Board of Health. Dr. Viner adjourned the Board of Health meeting at 9 p.m. Minutes taken by Jan Hess 11