LANE COUNTY BUDGET COMMITTEE
May 8, 2008
Harris Hall Main Floor
Chair David Crowell presided with Budget Committee members Scott Bartlett, Bill Dwyer, Bill Fleenor, Bobby Green, Sr., Alice Kaseberg, Tony McCown, and Peter Sorenson present. Denis Hijmans and Faye Stewart were excused. County Administrator Jeff Spartz, Budget/Financial Planning Manager Dave Garnick and Recording Secretary Melissa Zimmer were also present.
I. CALL MEETING TO ORDER
II. COMMITTEE BUSINESS
Approval of Minutes of April 29, 2008
MOTION: to approve the minutes of April 29, 2008.
Green MOVED, Fleenor SECONDED.
Crowell reminded the committee about the way they question staff. He said when they have questions either by written form, e-mail or phone call, the protocol is to send the questions to budget staff. He said it allows budget staff to organize and clarify the questions. He added that it provides a record of the questions and it makes sure responses get back to all the committee members. He said there was an issue about retaining e-mails on the five citizen members.
Teresa Wilson, County Counsel, explained that if the budget committee members are engaging in an e-mail conversation about budget committee business, that document is likely a public record. She indicated that they haven’t had clean court decisions. She said for the purpose of transparency of government, they need to assume that e-mail communication is a public record. She said if they get a public records request, they will be asked to provide a copy. She said they should be prudent in using language carefully. With regard to how many people on e-mails constitute a meeting, she said the law hadn’t caught up with the 21st century. She thought there are greater risks that they were conducting a public meeting electronically. She noted the Attorney General’s public records manual explains it in his comments. He said if the members weigh in a short time period about a discussion and deliberation is taking place that is close to a public meetings law problem. She said if they are engaging in e-mail about budget committee business, they should include the management analysts and they will be able to keep records and make available the e-mails as part of the budget material distributed and the public has the chance to see it. She indicated that was the transparency of government. She added that e-mails about public business are public records. She encouraged the committee to include the management analysts and involve all the committees’ members so everyone has the same level of information to work with as they make their decisions.
Sorenson asked if Public Records Law required people or governments to keep records.
Wilson said that every custodian of a public record must respond to a public records request. She added the government also has a responsibility.
III. OVERVIEW OF TOPIC FOR EVENING:
HEALTH & EMERGENCY MANAGEMENT.
With regard to Public Health, Spartz commented that it had been a struggle to prepare the budget. He said they learned under state law they have to provide the minimum service, otherwise the state will declare the programs inadequate and they will step in and operate it themselves and bill the County. He said they came to the conclusion that having the state bill the County would be more expensive than doing it themselves. He said they found enough money to provide a minimum level of Public Health services. He indicated that they will be down field nurses and they will have fewer people becoming eligible for application to the Oregon Health Plan and early pre-natal care. He said they will have a problem monitoring TB cases. He added that they will not have flu clinics for residences and the immunization clinics will close. He said they won’t have as good of monitoring for sexually transmitted diseases and they will have a greater risk of people spreading HIV infections. He indicated the Federal Qualified Health Clinic has been able to increase the number of patients it is bringing through. He added that they have been able to move Lane County Mental Health Services under their billing ability. He said they have now transitioned from full-time professional management at the Community Health Center and they are now the largest provider for low income individuals in the County. He added there will be a transition to electronic medical records this fall that will help operate more efficiently and provide better patient care. He noted that they will have 1300 less patients in Mental Health receiving services.
With regard to Emergency Management and Emergency Services, Spartz indicated the Sheriff has been able to put together a minimal configuration to provide the service but on a skeletal basis.
VI. HEALTH & EMERGENCY MANAGEMENT
Tom Turner, Under Sheriff, recalled the Budget Committee received a letter on April 25 that discussed the restructure of the organization. He said they are facing a new renewal budget and they made things work a little different. He gave a fiscal report regarding Emergency Management (copy in file). He said this is within the general fund monies and already allocated to the Sheriff’s Office. He noted the services are state mandated.
Linda Cook, Emergency Manager, said she is supervised by the Sheriff, but her service is countywide. She provides service to all of Lane County. She indicated the two most important laws for Emergency Management are the Robert T. Stafford Act, and the Homeland Security Act of 2002. She said the laws provide special emergency powers to federal agencies so they can bring special assistance to other agencies when they incur a local disaster.
Cook noted Oregon Revised Statutes, Chapter 401 underlines that counties must have an Emergency Management Program and in establishing an Emergency Management Program they are to have an emergency program manager who shall have responsibility for the organization, administration and operation of such agency subject to the direction and control of the County. She added Lane Manual, Chapter 54 is a reflection of the Emergency Operations Plan that shows who is in charge. She indicated Emergency Management’s role in terms of the legal issues is to make sure that Lane County stays compliant with federal and state laws and they manage risk by having plans and procedures in place.
Cook reported that Lane County has had 14 federally declared disasters since 1975. She said they weren’t able to handle it with their own resources. She indicated that Lane County has a disaster every year bringing together police, fire and Public Works. She noted the County is the agency that all cities have to go through in order to declare a disaster. She indicated that a city is not able to contact the state directly if they run out of resources. She noted the definition of an emergency or disaster means an incident has occurred that is so large that the local first responder agencies cannot handle it, they invoke mutual aid and ask for help and to access additional resources.
Cook explained that communications and warnings are some of the most important aspects of the Emergency Management Program. She said they have to let people know if there is an impending emergency. She indicated they do that though the Emergency Alert System that breaks through televisions and radios with the warning. She added that it gets tested every week and every other month by the Sheriff’s Office to make sure staff is always up to date on the activation. She said they also have the Community Emergency Notification System for which Lane County is a paying partner and it is a reverse 911 system. She noted the government would call the citizens in a particular area to let them know about an emergency.
Cook reiterated that the Emergency Management Program is mandated and hazards do pose a real threat to Lane County. She added the Emergency Manager has a broad set of responsibilities and the heavy reliance they have on community partnerships.
John Miller, Sheriff’s Office, said he is in charge of Search and Rescue. He said a search is an emergency and it is a mix of science and art. He stated that Lane County’s program is known as one of the most highly regarded programs in the northwest. He noted the program consists of ten subgroups and each has their own special set of skills. He added there are over 200 volunteers and they are managed under the Sheriff. He said they have 4,600 square miles to cover. He noted that land missions are 60 percent of their load with water missions at 40 percent. He noted they have had close to 115 missions over the past four years. He indicated that they have more than 200 trained volunteers who donate an average of 20,000 hour per year. He added at $18.04 an hour, it equates to $360,800. He indicated that there is one FTE per ORS 401.560 and it is a state mandated service. He noted Lane County is the second most active County in the state for Search and Rescue. He commented that this is a job that can’t be managed as an ancillary duty. He said that Search and Rescue is potentially a high risk and high liability function. He added that it is an immediate response life or death service to the public and visitors to Lane County. He added that Search and Rescue fits the Board’s service priority guidelines for priority one, two and three. He indicated that one FTE provides a program that covers 24 hours per day, 7 days per week, 365 days per year with 200 volunteers. He commented that the volunteers and the program are a win-win situation for Lane County. He added that Lane County can’t afford not to have the program.
Mental Health & Community Health Centers
Rob Rockstroh, Health and Human Services, reported that under general health services, one of the big issues they are working on is the integration of Mental Health in the Community Health Centers. He said it is important to stabilize the primary care part of the system with some Mental Health monies. He said there is an advantage to having integrated services for behavior health and primary care. He said they have a new management team working with the Community Health Center. He noted that the Federally Qualified Health Center has been the most successful safety net clinic in Lane County. He said they have grown in four years to over 10,000 clients per year. He recalled last October they officially included Lane County Mental Health Services under the scope of the Community Health Center. He indicated that they need the money from the Mental Health billings to stabilize the Community Health Center. He said they receive a higher payment for Medicaid patients and people in poverty. He said they want people on Medicaid to subsidize the people who have the inability to pay. He commented that the biggest issue they have is stabilizing the funding to make sure it keeps going forward, as it has the best potential for growth.
Al Levine, Mental Health, explained that Mental Health is losing over $1 million of its general fund. He said the general fund was originally from a series of serial levies. He said they have to eliminate a part of the funding. He said with Mental Health and the Community Health Center, they can integrate mental health and primary care. He commented that people with mental illness have a 25 year shorter lifespan than the general population because of the physical health conditions that accompany mental illness. He said it gives them an opportunity to stabilize the finances of the Community Health Center and for Lane County Mental Health. He recalled that Lane County Mental Health went through a large reduction in staff in 2003/2004 as a result of a decrease in state funding. He said they had lost about one-third of their staff.. He said they are able to mitigate a portion of the reduction with one-time funding but it is not without a loss to the citizens. He said they may be looking at additional reductions next year. He recalled the money was used to fund the psychiatric hospital that was highly successful. He said they faced budget reductions in 2003/2004 and due to cuts in the Oregon Health Plan, they were forced to close the Lane County Psychiatric Hospital. He said because of the reductions, they will not be able to get funding out to the private non-profit subcontracting agencies. He added with the carry forward they have had over the last few years, they were able to fund many of the Mental Health agencies that served the entire County. He added that allowed them to continue to serve more individuals who did not have the Oregon Health Plan. He said they will have to reduce by $400,000 the amount of money to get to the provider agencies for indigent care. He said that means unless a patient has the Oregon Health Plan, if they are indigent they have to be at imminent risk for hospitalization in order to be served. He added that Lane County Mental Health will continue to provide services to indigent clients but it would take that level of severity to serve patients. He said the County is statutorily responsible for the costs of inpatient care for indigent clients who are hospitalized psychiatrically on emergency holds. He said in the past year Lane County has had to pay for over 1,500 hospital bed days for indigent clients. He said they spent over $1 million in the last year on inpatient care. He commented when they reduce their ability to serve indigent clients on an outpatient setting, they are increasing their exposure for the financial risk for in- patient care.
Levine reported that Lane County serves over 1,300 adults annually. He said they provide for than 160 protective service investigations for individuals who have alleged to be abused or neglected who are in the mental health system. He said they are serving 450 children annually and Lane County is responsible for the care and coordination for the 75 high intensity children that are receiving services in the County.
Levine noted the only money left in the general fund is money that funds the transition team and that is critical money because it maintains their partnership with Peace Health. He said Peace Health and the County are planning on expansion of the transition team to be able to serve more individuals, taking people out of the emergency room and preventing them from inpatient care at the emergency room level. He said the statute requires Lane County to pay for inpatient care. He noted that reduced funding to subcontractor providers will increase the number of indigent inpatient admissions. He said there will be about 1,300 less indigent citizens that will receive services and that will include untreated mentally ill individuals who will be encountering police, corrections and the courts.
Karen Gillette, Public Health, said three programs are generated by the general fund: health services for high risk pregnant women and infants; the women, infant and children nutrition program, and communicable disease control.
Gillette explained that Lane County Public Health protects and improves community health and well being by preventing disease and keeping surveillance over chronic conditions, impacting social and economic and environmental factors. She said they interact with treatment programs, hospitals, private clinics, government and fire and EMS. She recalled in 2007, they handled 1,836 reportable communicable diseases. She noted they performed about 1,672 TB skin tests, and three-quarters were actually at the homeless shelter. She said this year they had a reduction with the collection of health statistics and they are down to one office assistant. She noted in 2007, they issued 9,840 birth certificates and 18,861 death certificates. She said in 2007 they received 10,400 calls and referrals were given. She said Environmental Health inspected 2,500 licensed facilities.
Gillette commented that if the Board relinquished the Public Health authority, they said the state could provide the services, but they would have to relinquish the services to the state and at that level they would deem what is necessary to maintain community health at that level and they would turn around and bill the County for the costs. She added they would lose the ability to leverage millions of state and federal dollars and other grants. She said they made a commitment to the community for healthy babies and healthy communities and if they relinquish the Public Health authority, that effort will go away. She stated they have a 24/7 responsibility for responding to any Public Health events. She said if they maintain the reduced level as proposed, they looked at what it would mean at the service level and they adjusted staffing. She said the concern they have is their ability to respond to a Public Health event at the reduced level.
With regard to mandated services, Gillette said they had to make a decision on what they were going to let go. She said even though they fit the Public Health circle around maternal child health and the prenatal program, they want to make sure they are providing the mandated services. She said they want to be above the minimum level, but they have to stay at the minimum level.
Gillette said they have been giving flu shot clinics, but they won’t be able to do that anymore. She added they will be providing flu shots in the annex building by appointment but they won’t be having flu clinics in the rural areas. She said they are going to look at the nurse home visiting program and their ability to do as many home visits for the rural area as they can. She indicated that they get about one in three that are appropriate referrals. She added with the proposed reduced levels, they will be able to visit one in five women who will get a referral. She noted with the reduction they would see 300 fewer high risk women, teens and medical fragile infants.
With regard to WIC, Gillette reported that they currently provide health assessments, nutrition counseling classes and food vouchers to 7,706 clients per month. She said when they first put this document together, they had a waiting list of 194 from two weeks ago. She added in the past two weeks with budget discussions and layoff letters going out, the wait list has jumped to 824 for Eugene and Springfield. She said they are trying to find ways to stay open in the rural offices because the show rates are good and they are able to provide classes. She said if the case load goes down, the federal dollars are impacted.
With regard to communicable disease, Gillette indicated that limiting disease outbreak is a core function of Public Health. She noted with their new set up they will be down to three nurses. She said when an outbreak occurs they will not be able to manage the event without assistance. She said they discontinued all TB skin testing at the homeless shelter. She indicated they will go over to the shelter and offer education about the symptoms of TB. She said they are concerned about people getting their flu shots as a preventative measure. She said when they look at the reduction of staff on the nurse side and community service workers, they are facing 30 percent fewer general immunizations for children and adults. She said they are ceasing the clinics and they won’t continue the traditional walk in clinics. She indicated they are closing their moderate complexity lab. She said they had a part-time lab tech. She stated it is required for them to do the sexually transmitted disease clinic as mandated in the state support funding for Public Health, but it isn’t required that they run a lab. She said with rural services, the communicable disease staff did work with delegate agencies. She commented that the Oregon Health Division provides technical support, money and mandates. She indicated they are a partner with them in all programs. She said with a $605,000 cut they have to do the minimum
V. PUBLIC COMMENT
George Baitinger, III, Eugene, said he is a volunteer with Lane County Search and Rescue. He said the County takes a central responsibility for SAR. He stated with the cuts in timber funds, he is afraid the County would stop SAR.
Laura Hammond, Eugene, said Lane County’s Public Health system has sustained years of budget and staff reductions to almost an unsustainable point. She commented that ensuring Public Health programs is not the just right thing to do, it is the economically responsible thing to do. She stated that investing in Public Health saves lives and money in the future. She said programs like WIC saves three times their cost by preventing low birth weight babies. She added that ensuring immunizations like measles, mumps and rubella saves over $16 in direct medical cost for every dollar spent. She commented that they are not safe when pregnant women do not get the care they need or when children go hungry or left with few resources and no support. She stated it is important they don’t lose site of their charge to protect and promote the health of all people in Lane County. She urged the committee to ensure that Public Health services remain in tact.
Jennifer Jordan, Eugene, said she works for Lane County Public Health. She expressed her concern about the proposed cuts to Public Health. She said Public Health’s authority is to preserve, protect and promote the health of all people in Lane County. She said they analyze local population level health data to identify the greatest risk to community health and implement interventions to prevent poor health. She said the data indicates that Lane County has a high rate of fetal infant mortality. She said cutting core public health programs that provide essential assistance to the most vulnerable women and babies in the County will only increase the crisis. She said they can’t make cuts to WIC which currently serves over 40 percent of pregnant women across the County, nor could they consider further cuts to their maternity case management nurse staff. She commented that the budget cannot bear further reduction.
Larry Dunlap, Eugene, stated that he is an emergency physician. He thought these trying times are an opportunity to review the many functions of County government with an eye to long term value. He said matters of health and the betterment of children is the foremost goal. He commented that programs serving pregnant women are essential to ensure that the young can get assistance. He said they remain vulnerable to infections when they eliminate the ability to respond to sudden outbreaks. He said the County must have the capacity to meet the contagious threats. He commented that jails cure almost no one, pot holes slow them down and most people eat animals once a day. He said community health pays dividends for generations. He asked not to cut the Health Department budget.
Brian Johnson, Eugene, said he is the preparedness coordinator for Lane County Public Health. He said while they discuss maintaining a minimum level of Public Health, it is important to maintain Public Health services locally. He said when they have the authority locally, the voice of the community is how they determine the important health priorities for the community. He said there are important priorities that come down from the state driven by good practices. He said it is a statewide picture of the health priorities. He said Public Health is driven by prevention. He indicated that the work they do reduces costs in the future. He said it is a good investment and casting a wide net assures the broader health of the community. He said Lane County is the only government locally who has the authority to provide this service. He said that Linda Cook from Emergency Management serves Lane County and many of the city governments in the community.
Kendra Morrigan, Eugene, said she is a Public Health nurse. She stated she has a dread of what lies ahead. She has been on contract with Willamette Family Treatment Services as a Public Health nurse and they serve 300 women and families per year. She commented that it is a high risk population that has been underserved. She said they have lack of access to medical care. She said the holes and gaps will be left in the community and they don’t know what lies ahead. She added as the prison population grows and more children are affected by substance abuse and domestic violence, they have a crisis. She commented that most middle class Americans have no idea of the conditions of families who live in Lane County. She said they get families connected to services . She said they have to keep the services they have and grow Public Health. She thought Public Health could be a leader for what they need to do in the future. She added that they need to think about how to provide services and information to people so their lives can change.
VI. NEXT MEETING
Jennifer Inman, Budget Analyst, distributed information for the next meeting.
The meeting was adjourned at 8:15 p.m.