Karuk Tribe of California
Health Board Meeting Minutes
April 8, 2004
Happy Camp, California
Ayukii,
The meeting was called to order at 5:05 PM by Arch Super, Chairman.
Roll Call
Present
Arch Super, Chairman
Leaf Hillman, Vice-Chairman
Florrine Super, Secretary
Leeon Hillman, Treasurer
Roy Arwood, Member
Florence Conrad, Member
Robert Goodwin, Member
Absent
Karen Derry, Member
Quorum is established.
Approval of the Agenda for April 8, 2004
Florence Conrad moved and Florrine Super seconded to approve the Agenda for April 8, 2004. 6 haa, 0 puuhara, 0 pupitihara.
1. Approval of the Minutes for March 11, 2004
There was a typo on page 4 of 9, first paragraph statsu needs to be changed to status. There is a motion that needs to be finished on the closed session also, Sara states she will research it and fill it in.
Leaf Hillman moved and Leeon Hillman seconded to approve the Minutes for March 11, 2004. 6 haa, 0 puuhara, 0 pupitihara.
2. Connie Reed Jeter
She states she was initially going to complain about the Pharmacy but she sees the policy has already been changed and she thanked them for that. She states that she is here due to an email she received from Greg Gehr stating that she was the reason he was not being paid for his services. She states she has never done anything to that Website that was not approved by the Council and she got it started by Greg and then it was turned over to Marty and Mike to have it finished. She states that it was then no longer under her control and it is not her fault that it was not completed properly. She states that there was a contract for his services and she came to the Health Board and asked if the remainder of that could be done under the previous contract. She understood the approval was to extend the contract to get it finished. They read the minutes and there was reference to the original contract but it was never located. They state the minutes never reflected that there was actual approval, just discussion about the project. They state that they were not blaming it on her; it was the lack of a contract and the lack of written documentation to back up the work and that was something that was lacking on their end not hers. They state they did not mean for it to appear that it was being blamed on her. They state they can discuss it in closed session with her if she would like additional information. She again thanked them for the Pharmacy.
3. David Tripp
David was present to address the Council and request continued assistance with the Jump Dance. The Tribe has supported the dance financially for ten years. Last year’s expenses were $5,987.16. This year’s dance will be July 30, 2004 to August 8, 2004. He pointed out that the $40.97 at the Store did not need to be paid by the Tribe and he is not requesting that amount.
Leaf stated this is usually funded through State Indian Health. Wes states as of today it is slated for renewal on July 1, 2004 but they do not have a final answer yet based on the Governor’s budget and the cuts that are occurring. They could fund it from discretionary if the funding does not come through.
Leaf Hillman moved and Robert Goodwin seconded to provide the same assistance for the Jump Dance with the understanding that the cost may go up slightly, not to exceed $6,000 from SIH, with discretionary as a secondary source. 6 haa, 0 puuhara, 0 pupitihara.
4. Babbie Peterson
Babbie was present to request approval of Contract 04-C-041 with the Area 1 Agency on Aging not to exceed $6,000 from Title VI C funding to provide the on site Caregiver Training April 13-22, 2004. There are 14 people signed up and they can accommodate up to 25. She is working with Lisa’s program as they cannot pay them unless they are certified. The State is going to start requiring certification also to allow them to be paid for in home care. There was discussion about the CHR’s attending. David states they can do that but there would be no transportation available during those days. Leaf suggests having one go and then doing the others in different years. They should also see if Flo and Jim can attend and then work on the CHR’s in the future.
Florence Conrad moved and Leaf Hillman seconded to approve Contract 04-C-041 with the Area 1 Agency on Aging not to exceed $6,000 from Title VI C funding to provide the on site Caregiver Training April 13-22, 2004. 6 haa, 0 puuhara, 0 pupitihara.
5. Walt Whitman
Walt was present to address the Council and request assistance with snow removal on Grayback Road. The Tribe has been involved in the past and there is an opportunity to work with two logging companies that are interested in opening the Road. John R. Woods bought the Northend Sale and will start work on April 16, 2004. John Lima is a company working in Weitchpec that would like to use the road as well. They started cutting this week and will want to use the road very soon. They contacted Tom White and indicated they would like to hire him to open the road. They would like to know if the Tribe would be interested in committing dollars to this project. There will be two Tribal Members that will go to work in the process. They think that if there is some help from the Tribe they may be able to start work as soon as Monday and it could take as little as ten to twelve days to get it open. Laura asked if the Forest Service will be putting any dollars into this since they will make money on the road deposits which are supposed to go toward the road maintenance. They have stated they don’t have dollars and cannot help.
Robert Goodwin moved and Leeon Hillman seconded to commit $3,000 of discretionary dollars toward this project. 6 haa, 0 puuhara, 0 pupitihara.
Laura suggests they contact the Forest Service and request they reimburse them a portion of that dollar amount.
6. Mike Moore
Mike was present on behalf of the Health Path Recovery Group. He states the trip to Yreka was a great success and they wanted to take the opportunity to thank them for their support. He states they may request a similar use of the vehicles in the future to keep the group going. He states that their group is a strong support group that is doing very well. He states they don’t do a 12 step program; they work on recovery and how to deal with daily stresses. They started with three people and now they sometimes have 12-15 people there.
7. Robert Goodwin
Bob was present to represent Tracy Burcell. Last year at Bigfoot Days she was able to do a Bicycle Rodeo and give away two bicycles. The Tribe donated $200 toward this last year and she would like to request assistance again. They asked David Eisenberg if he also does a rodeo and he states he does and there is nothing wrong with having two of them. If the Council would contribute $200 he could also provide some help out of his program and still have a second Rodeo.
Leaf Hillman moved and Leeon Hillman seconded to contribute $200 from discretionary toward a Bicycle Rodeo at Bigfoot Days. 5 haa, 0 puuhara, 1 pupitihara (Robert Goodwin).
8. Old Business
Sara: Committee Reports to be on Council Agenda. Need to contact the chairs to get status report and listing of expirations for seats by Council Meeting. Then start submitting their meeting minutes each month to the Council at the Council Meeting.
David E: David reviewed his results of the Elder’s Emergency Preparedness Survey that was conducted. He states it was emailed to them for their review. He does not have a solid plan at this time but suggests something along the line of having generators available that could be loaned out to Elder’s that are pre-identified as needing the most assistance. The other issue was snow removal for their driveways and how they would get that taken care of. Currently the informal system is that friends and neighbors look out for the Elders. Bob states they may just set aside a pot of money to provide services as needed rather than purchasing generators and having them sit and not be used. Another option is to work with Housing regarding a grant to have backup power professionally installed rather than a portable generator with extension cords. Florence states they can take one generator house to house to charge the freezers rather than just leaving it at someone’s house. David states he can take these options and then do a survey to see who is interested in using the services. Babbie states they already have this in place during power outages with the volunteer fire department in Orleans. They have sign up sheets at the local stores and then they take it to their home to charge their freezer. The system in Orleans is available to everyone first come, first serve and it is not only for Elders and the list gets really long once it gets started. Wes states that it sounds like they should have a couple of departments get together and brainstorm such as David’s program, Lisa Aubrey, Fred Burcell, and himself to talk about strategies to address this problem with the resources they have currently. They could do something similar to the sign up sheet focusing on Elders. The generators in Orleans were donated to them by PG&E so if they come up with a process they may be able to get equipment donated. Babbie is also working on getting the Forest Service’s generator transferred to the Orleans Elder’s Housing to help with this. Robert Super states they may want to contact Honda directly and see if they would be willing to make a donation. Disabled individuals should be assisted as well.
Leaf: Has Leaf looked into the TV for the Panamnik Center. Babbie states it is coming.
Wes: When will the opening be for the Panamnik Center. They are hoping for the second week of May. They can do it on May 13, 2004 at 3:00 PM and then have the Health Board Meeting that night in the new building. Another delay for the opening is that the cabling for the computer center is not completed as of this date. He still has to get a quote to get it done because the Orleans Community Center cannot afford the entire cost. They would like to get some eels if possible for the food.
Wes: Can Housing use the Pharmacy Courier. He does not know yet because they still have to get settled into the Pharmacy workload before they add other duties.
Wes: Are there are any minutes to send out for the Management Team. There hasn’t been a meeting recently.
Wes: Pharmacy policy revision. Lessie is working on it.
Council: Have they set up a meeting with Barbara Norman yet. Not yet.
9. Joe Snapp
Written report only, not present, no action items. Arch asked who participates in the staff meetings he references in his report. Wes states it is usually Joe, Robert, and Jesse Drake when he is available.
Florrine Super moved and Leeon Hillman seconded to approve Joe’s report. 6 haa, 0 puuhara, 0 pupitihara.
10. David Eisenberg
David was present to review his written report. His only action items are approval of the re-application for the EAPC Grant for 2004-2005 and the application for the BCEDP Mini-Grant. He states Sheila is working out great in Yreka and the Elder’s Program is moving along. He states the EAPC Tobacco Grant is a recurring grant they apply for each year and explained how the program works in the Clinics. The reimbursement rate hasn’t changed since 1988 and in past years they have made $3,000 to $4,000 on the program. Currently they are making about $1,000 from the grant. He states there are some structural things that can be done to ensure that it does not result in any cost to the Tribe. He states this is State funded and he expects the amount to stay about the same. The second grant is the Breast Cancer Early Detection Program. He states he has received this grant 5 of the 7 years he has applied. Last year he was denied due to the fact that they don’t fund projects they have funded before. His goal is to use the dollars this year to create public service announcements in Karuk with English subtitles to increase awareness about early detection of breast cancer. They have met with the funder and they think it is a great idea. He has also met with Susan Gehr and Fred Nahwooksy to obtain their input into this idea and how they can obtain the quality of media they will need for it to be well received by the public. Fred has plans to do another media project and David can contribute grant dollars into this so they can obtain two outcomes with combined funding. To have it air free on the television it goes on at 2:00 AM and they would need to look for funding to get it out at a better time. They could use these announcements in the theme of many voices – one message in other areas with the local number for breast cancer awareness.
Leeon Hillman moved and Leaf Hillman seconded to approve the EAPC Grant application for FY 2004-2005. 6 haa, 0 puuhara, 0 pupitihara.
Leaf Hillman moved and Leeon Hillman seconded to approve Resolution 04-R-022 for the BCEDP Mini Grant. 6 haa, 0 puuhara, 0 pupitihara.
Leeon Hillman moved and Robert Goodwin seconded to approve David’s report. 6 haa, 0 puuhara, 0 pupitihara.
11. Vickie Walden
Vickie was present to review her written report. She has no action items to present as the data is not all entered.
Leaf Hillman moved and Leeon Hillman seconded to approve Vickie’s report. 6 haa, 0 puuhara, 0 pupitihara.
12. Lessie Aubrey
Lessie was present to review her written report with the Council. She distributed the meeting schedule for May 13, 2004 for their records. She encourages their attendance at the meetings. She included the results and analysis of the Employee Satisfaction Survey in her report.
She requested approval of Policy 04-005-008 for missed appointments and late arrivals at the clinics. It was approved by the ACQI Committee on 9/23/03 but was never approved by the Health Board. If a patient misses three consecutive appointments they are seen on a walk in basis only. They could add a stipulation that it is only for one year or six months to not make it so strict for patients that do start showing up after they have been penalized.
Florrine Super moved and Leaf Hillman seconded to approve Policy 04-005-008 with a 6 month stipulation added. 6 haa, 0 puuhara, 0 pupitihara.
Her second request is for approval of the Verification of Patient Identification and Surgical Site Policy #06-000-001 to ensure that the patient is correctly identified and the procedure is the correct one. There are also forms associated with it that don’t require approval. There is also a Surgery Consent Form that goes along with it to obtain the proper information, verification, and consent to perform the procedure. There is an additional form for vasectomies in the event they have the capability to do them in the future. Dental will also be adding a stamp to their Dental Progress Notes to ensure proper identification as well.
Robert Goodwin moved and Florrine Super seconded to approve Policy 06-000-001. 6 haa, 0 puuhara, 0 pupitihara.
Robert asked if there should be something added to the vasectomy checklist to specify that the patient is specifically counseled on the pros and cons of the procedure. Wes states that is why there is a thirty day waiting period to allow them time to think about it and reconsider. Lessie states this is addressed on the Surgery Consent form where they discuss risks and possible complications, etc.
She had them turn to the Performance Improvement Activity for Blood Pressure Control. They found that there are a lot of patients with isolated systolic hypertension and it should be looked into. Many providers feel that patient’s blood pressure rises when they are at the clinic and they should also study their blood pressures at home in a calm environment. Their idea was to take possible patients and then train them and provide them with equipment to do the monitoring at home and then report back to the providers. Lessie would like to see this taken very seriously because it can prevent serious medical complications such as strokes and cardiac problems. Dr. Burns would also like to bring age into this study to see what that relationship is as well. The goal is to see if what the clinic staff is doing is helping with the problems. She states this is only one project and they have many others they are working on. She reviewed the current statistics with them and states they will be reviewing them every six months. She states they are tracking their ability to lower the blood pressures it is the doctor’s responsibility to track the individual patients that is why they are random checks. She provided further information into what the criteria are for selecting these projects. This is one of the GPRA Indicators that they will be rated on so that is why they selected it.
She also included the minutes from the last ACQI meeting for their information.
Robert Goodwin moved and Leeon Hillman seconded to approve Lessie’s report. 6 haa, 0 puuhara, 0 pupitihara.
Leeon Hillman excused himself at 8:03 PM.
13. Marsha Jackson
Written report only, not present, no action items.
Leaf Hillman moved and Robert Goodwin seconded to approve Marsha’s report. 6 haa, 0 puuhara, 0 pupitihara.
14. Fred Nahwooksy
Fred requested approval to submit a grant proposal to the Forest Service to produce a video/documentation/promotion of the Karuk People’s Center to promote the heritage based tourism and natural resource based art and craft industries of the Karuk Tribe and individual artists. The funding will be $12,220 from the Forest Service and $3,100 of match from the Tribe which is comprised of a portion of his contract amount and some CSD dollars. There will be four projects funded at about $10,000 each. He would like to do a 30 minute PBS quality production in the future as well.
Leaf Hillman moved and Robert Goodwin seconded to approve Resolution 04-R-023 for submission of a grant proposal to the Forest Service. 6 haa, 0 puuhara, 0 pupitihara.
15. Wes Valentine
Wes states he was at the Reno IHS meeting last week and that is why his report was not in the packets.
He states Third Party is starting to see revenue from the billing specialist and they should obtain 1.5 million this year.
He states currently the Clinics are only receiving 128K service at a cost of $18,000 which comes from the IHS Compact. To double the speed would be an increase of $2,500. This will greatly help the clinics with transferring their RPMS data for a small amount of money. If they approve he will begin negotiations for the upcoming Compact to get the speed increased.
Consensus: To move forward with doubling the cable speeds.
His next item is the replacement of the copy machine in the Orleans Clinic. The cost is $5,879 to replace the machine with a new model of the same brand they have had for ten years. The annual maintenance cost would be $867 to support the machine as well. Since this copier serves many programs it would be purchased from Ishpook Leasing and then leased back to Indirect since it is a capital purchase over $5,000.
Robert Goodwin moved and Leaf Hillman seconded to approve the purchase of a Konica copier from Coastal Business Systems in the amount of $5,879. 6 haa, 0 puuhara, 0 pupitihara.
He requested approval of Contract 04-C-043 with TASSC in the amount of up to $21,500 to be used on an as needed basis to support the RPMS server, network and OS support and training plus server upgrade and testing. This is the same vendor that IHS contracts with to write the codes for IHS and there are no other vendors with this type of capabilities.
Robert Goodwin moved and Leaf Hillman seconded to approve Contract 04-C-043 with TASSC in the amount of $21,500. 6 haa, 0 puuhara, 0 pupitihara.
He requested approval of Contract 04-C-044 with Janis Madkins, DDS who is a dentist that visited Happy Camp and is interested in working with them for two days to see how she likes the area and clinic and to see how the staff feel about working with her. The amount is $60.10 per hour, plus lodging, and a flat rate equivalent to airfare from Albuquerque, New Mexico as she will be driving.
Leaf Hillman moved and Robert Goodwin seconded to approve Contract 04-C-044 with Janis Madkins. 6 haa, 0 puuhara, 0 pupitihara.
He gave them an update on the Pharmacy’s first month of business. They filled 1,515 prescriptions and were open for 23 days. Their sales were $49,975 and their income was $45,704 even though 70% were dispensed free and they do not have a billing number for Medi-Cal. These expenses don’t include salaries and overhead but they are promising numbers.
This leaves the standing issue of the third party insurance contracts. He and Hector have been trying to contact many Tribes to obtain information and many are uncooperative. He was able to meet with the Self Governance Director at Redding Rancheria while he was in Reno and he stated that Redding has signed all of the contracts with the insurance companies as it is only a limited waiver of sovereign immunity and they only have things to gain from the contracts. At Redding the Director signs the contracts and they don’t even go to the Council. The current contracts he has pending are with Medco Health, Argus, and Prescription Solutions, Inc. If they would like to authorize him to sign them, he will do that. They are forced to sign these under duress to get the income so it is highly unlikely that any court would hear such a case and very unlikely they would ever have anything to arbitrate.
Leaf Hillman moved and Florence Conrad seconded to authorize Wes to sign all the third party insurance contracts. 6 haa, 0 puuhara, 0 pupitihara.
Arch asked if they have remedied the medications that were needed but were not on stock to be filled. Mike states they had a problem when they first opened up and now he is up to 90-95% that is in stock. Once they discover it is not in stock they add it to the inventory. Robert asked if there is a way to track the medications if someone runs out. Sharon West states they have starter packs that they can give to patients and then order the medication and they can have the medication and starter packs replaced by the next day and they are VERY pleased with the way the pharmacy is operating and serving the clinics. Wes states if anyone contacts a Council Member with a medication that is not available they need to call the Clinic and Pharmacy to have it addressed right away. If it is a true emergency CHS can also cover it at other locations. Sharon states that only being open for one month they are doing very well. Florence states that it may take some adjustment for patients that aren’t used to not having same day medications. Arch suggests that the Elder’s workers keep track of the medications to remind them of when they will run out. The clinic staff already works with the Elder’s workers for those that have problems keeping track. They can do referrals, but cannot release all of the information to get the Elder’s Worker involved.
Leaf Hillman moved and Robert Goodwin seconded to approve Wes’ report. 6 haa, 0 puuhara, 0 pupitihara.
16. Informational/Requests
None at this time.
17. Committee Reports
None at this time.
Closed Session from 8:32 PM to 10:24 PM
Meeting set for April 15, 2004 in Medford, OR with attorney. Leaf will notify them of the time and location.
Robert Goodwin moved and Leaf Hillman seconded to uphold CHS denial for Case #116 and pay the estimated $1,423 out of Third Party. 3 haa, 0 puuhara 2 pupitihara.
Leaf Hillman moved and Roy Arwood seconded to uphold CHS denial for Case #114 and pay $1,637.85 out of Third Party. 5 haa, 0 puuhara, 0 pupitihara.
Directive: For Fred Burcell to repair the podium in Council Chambers.
Directive: For Arch or Leaf to get back to employee in four business days with a decision on their request.
Consensus: To table personnel requests until Health Budget Meeting.
Directive: For Arch to take Connie’s name out of the letter that was sent to Greg Gehr.
Directive: For Wes to set up meeting within a week or two with Laura, Sami Jo, Trista, Joe, and Robert to develop a proposal to pay half of the salary for the Substance Abuse Program. Program funding ends on June 31, 2004.
Florence Conrad moved and Leaf Hillman seconded to pay $800.50 for Tribal Member #3615’s son’s funeral expenses. 5 haa, 0 puuhara, 0 pupitihara.
Consensus: To appoint Donna Goodwin-Sanchez to sit on the Election Committee. Robert Goodwin excused himself from the discussion and decision.
Consensus: To pay for Tribal Member #335’s glasses and they will make monthly payments. Robert Goodwin excused himself from the discussion and decision.
Leaf Hillman moved and Florence Conrad seconded to adjourn the meeting at 10:55 PM.
Next Meeting Date: May 13, 2004 at 5:00 PM in Orleans at the Panamnik Center.
Yootva,
_____________________________________
Arch Super, Chairman
Recording Secretary,
Sara Spence