Karuk Tribe of California

Health Board Meeting Minutes

June 8, 2005

Happy Camp

 

Ayukii,

 

The meeting was called to order at 5:00 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

Alvis Johnson, Member

 

Absent

Robert Grant, Member – excused.

 

Robert Goodwin read the Health Mission Statement aloud.

 

Approval of the Agenda for June 8, 2005

Leaf Hillman moved and Leeon Hillman seconded to approve the Agenda for June 8, 2005.  7 haa, 0 puuhara, 0 pupitihara.

 

Approval of Minutes for April 14, 2005 and May 12, 2005

Robert Goodwin moved and Leaf Hillman seconded to approve the Minutes for April 14, 2005 and May 12, 2005.  7 haa, 0 puuhara, 0 pupitihara.

 

Guests:

1.) Michael Weahkee, CRIHB

Mr. Weahkee is currently the Director of Family and Community Health Services for CRIHB. He is present to give a presentation on what services CRIHB offers. Roy and Florrine are members of the voting body representing Karuk, as KTOC is Associate Members of CRIHB. He presented copies of contract books, and the financial status of CRIHB. He explained that they are dedicated to the interests of rural communities.

 

He presented a report on the expenditures of CRIHB. Their majority of funding is from IHS, but CRIHB does receive grants and State funding.  A snapshot of CRIHB’s budget proves that CRIHB has been relatively stable over the last ten years. The IHS budget has remained stable at flat but he explained that he has seen growth within CRIHB.

 

He presented the programs that are currently in their forefront and also presented the services that CRIHB could offer to KTOC. He explained that they could help KTOC with Peer Reviews and auditing, also several of their programs are established with teams of individuals that work directly on them. Some programs that CRIHB has, which KTOC has also, is a Diabetic Program, Nutrition Program, Safety Program, Head Start Program and several others.

Behavioral Health is new with the SAMHSA grant. They were awarded 17.4 million dollars to provide substance abuse resources. All of the KTOC providers have been credentialed and now they are working on getting clients in.

 

Karuk has been an Associate Member for years, but they have the opportunity to advance into full members. There is talk right now in the development of a DEW structure; it will be driven by an active user status. This was a request from other Associate Member Tribes that felt they were getting more than they put in.  Currently there are three levels of membership. Full member can have 100% of their funding through CRIHB. Area Office Function Contractor, they pass only the area office functions through CRIHB. Basically, Associate Members choose what shares they want to go through CRIHB.

 

He thanked the Council for their time. And Larry thanked Michael Weahkee, for coming and doing a presentation for them. Larry stated that they should use CRIHB more, and he supports their continued involvement with CRIHB. He added that there will be CRIHB attendees at the Health Fair, being held during the Karuk Tribal Reunion.  

 

2.) Laura Mayton:

Laura introduced Laura Croy-Olivas. She is the newest employee in the fiscal office, and she wanted to introduce her to the Council and welcome her aboard.  

 

3.) Julie and Rick:

Julie and Rick introduced themselves as the new grant writers for the Tribe. Julie will work full time and Rick is going to work part time. They both come from Federal funding background and bring experience to grant writing. They are already working on several projects, and are extremely busy.  

 

Leaf introduced Leo Carpenter. He is the new Director for the People’s Center in Happy Camp. Larry commented that Leo did a terrific job giving a guided tour to the CRIHB personnel while they were here.  

 

3.) Lisa Aubrey:

Lisa stated that she is having a problem getting HIP applications completed. She would like the Council to donate a $100 gift certificate to Wal-Mart, so that there is incentive to get some applications completed and sent in. Bob suggested doing two $50 gift certificates.

 

Robert Goodwin moved and Leaf Hillman seconded to purchase two $50 gift certificates for the LIHEAP program for incentive prizes.  7 haa, 0 puuhara, 0 pupitihara.

 

Old Business:

None currently.

 

Director Reports:

1.) David Eisenberg, PHN

David thanked the Council for their continued support in allowing flexibility for employees who also volunteer for the Happy Camp Volunteer Ambulance.

 

David stated that the EAPC grant has gone well this year and is anticipated to close this month.

 

After research for an Exercise policy that was originally wrote for KTOC, David found it and it was not approved for several years. He is now requesting that the policy be reaffirmed by the Council and entered back into active status. It happens that the new Physician and Dentist in Yreka want to continue their exercise program that they currently do, but KTOC does not have a policy that addresses the issue.  Arch asked if this is specific to the Health Program staff or if it was for the entire organization. David explained that it could be used for the whole organization if that is what the Council chooses to do.  

 

Robert Goodwin moved and Florrine Super seconded to re-approve the exercise policy.  7 haa, 0 puuhara, 0 pupitihara.

 

Florrine asked if David may be able to help with transportation for Tribal Members that need transportation to the Karuk Tribal Reunion. David explained that they no longer have transportation services but he will check with Sheila Robinson about the situation. He confirmed no promises of transportation being made.

 

Leeon Hillman moved and Robert Goodwin seconded to approve David’s report.  7 haa, 0 puuhara, 0 pupitihara.

 

2.) Joe Snapp, Drug and Alcohol Counselor

Joe finished the policies and procedures for the Drug and Abuse program. Arch stated that he would like the policies to go through the ACQI Committee. Lessie affirmed that presently the Health Program is not affiliated with the Social Services Program. Joe explained that as a resource he received another set of policies from a similar Tribe and used them as a template.

 

It is Larry’s understanding that awhile back the Health Program and Social Services Program were joined and both accredited by JCAHO. The ACQI committee is for JCAHO accredited processes. The Social Services program is not reviewed through this committee because they aren’t currently accredited.

 

Larry explained that the ACQI or another committee can review the policies and provide recommendations to the Council. Leaf asked why Social Services are not a part of the Health Program. Laura stated that it seemed to have evolved this way over time. Laura explained how this came about.

 

Bob explained that if they are going to eventually become accredited with Social Services/Behavioral Health then these policies may conflict with the JCAHO side of the Health Program, so to have some help reviewing them would be appropriate. A committee being formed to help Joe and his policy development will be discussed at the Wednesday meeting.

 

Joe states there is a meeting the first week of July with the County to discuss the DUI contract. Larry will attend with Joe after the contract is cleaned up and they will begin to negotiate the terms of the contract.

 

Joe has also been accepted as a CAIR provider. This means that they can get reimbursed for the services that he provides.

 

Robert Goodwin moved and Alvis Johnson seconded to approve Joe’s report.  7 haa, 0 puuhara, 0 pupitihara.

 

3.) Patti White, Database Administrator

Patti announced that interviews for the temporary data entry clerk in YR will be held on Friday. In the interim Sharon Meager will be working in YR until the new person is up to speed to do the job on their own.

 

Patti stated that at her last training she really learned a lot. She learned how to use QMAN to pull reports from RPMS. This is a very useful tool, because it allows her to pull reports for several different topics and programs.

Patti would like to request that she be allowed to be a secondary signer on the RPMS back up safety storage. According to policy the back up is to be stored at the bank, but currently it is being stored in a fire safe lock box. When the back up secured at the bank then she would like to be a signer to retrieve the data. Arch will talk with Chris to determine who the signers for the back up retrieval will be. Arch stated that Larry should be the secondary signer. Patti stated that in history Marsha was the secondary signer.

 

Florrine Super moved and Florence Conrad seconded to approve Patti’s report.  7 haa, 0 puuhara, 0 pupitihara.

 

4.) Lessie Aubrey, DQMCH

Lessie presented the revised Patient Handbook for the Council to review. They were pleased with its completion, and commented that Rosie did a terrific job. Lessie stated that Rosie is getting better all the time; Mosaic Press printed them wonderfully and she noted that this is a good local team.

 

Lessie presented HIPAA Security policies for the board’s approval. She stated that the deadline for implementation of these policies was April 15, 2005. She also has Pharmacy policies for approval. Lessie stated that the Pharmacy and Therapeutics committee thoroughly reviewed these as well as the ACQI Committee. Florrine stated that the wording change for Tribal Elders should be changed to reflect Tribal Member Elders for the Pharmacy policies under mailing of prescriptions to be clear.

 

Larry stated that there are RPMS monthly conference calls, and he would like Lessie to partake in them. They are addressing security issues.

 

Bob asked what is done with the employee satisfaction surveys when they are completed. He stated that it appears to be a lot of work and he hopes that something is done with the findings in the survey. Lessie stated that it does get worked on by the committees. The highest response from the survey was that staff wanted to know what is going on with management. The second highest response was that the staff would like training. The Pareto theory states that 80% of the problem is 20% if the solution. This is the process in which the 2005 employee satisfaction survey will be used to focus on issues identified in the survey. With this theory if the training request is focused on they could meet the goal of improving communication regarding what is going on with management.

 

Robert Goodwin moved and Leeon Hillman seconded to approve the Pain Management, HIPAA Security, and Pharmacy Policies with the Amendment.  7 haa, 0 puuhara, 0 pupitihara.

 

5.) Larry Jordan, EDHHS

Larry stated that he had a meeting with the State regarding the Title IVE Program. He, Laura, Mike Edwards, and Daniel Pratt met to discuss program options, background checks, and funding matches. Another meeting is being held July 8th to further discuss this endeavor. Foster Care is a part of Title IVE funding.

 

Larry received the IHS scholarship categories. They are asking for input regarding categories that the Tribe would like to be funded through the scholarship. For their needs they would like to see fields related to substance abuse, social services, medical and nursing funded. If the Council has any input they should send it to him, and the deadline is June 30th. Florrine announced that there are people at the CRIHB office that will help students fill out their applications for funding also.

 

Dr. Burns announced that Dr. Solus will start on June 13th, and his wife is the Dentist who will be starting the same day. They are originally from Yreka and are excited to be moving back to the area.

 

Dr. Burns would like to do some advertising in regards to announcing this to the community. It would be a good thing to share with the community, because Dr. Solus is very interested in reaching out to the community. This would also be a good opportunity to announce to the community that they have a stable and consistent physician at the Yreka clinic, and that they are dedicated. Dr. Burns and Larry are going to work on the announcement to the newspapers.

 

Florrine stated that she would like an invitation to the bi-annual health meeting next time. She was present last time, but she wasn’t invited this time. The group apologized because they were busy and overlooked it.

 

Leaf Hillman moved and Florence Conrad seconded to approve Larry’s report.  7 haa, 0 puuhara, 0 pupitihara.

 

6.) Vickie Walden, RDA

Vickie presented her report to the Council and explained what she was going to present at the Health Fair. Vickie has chosen to do dental imprints for the children that participate in the Health Fair. This dental imprint also extracts DNA. In the event a child is lost or stolen the parents will have this valuable tool for law enforcement if they need it.

 

She also announced that she has a dental staff meeting on June 23, 2005 from 9:30-3:30. If anyone would like to attend they should just let her know and she’ll send them an agenda.

 

Dr. Madkins will be out next week and there will be signs posted at the HC clinic to announce the closure. Changes in the fee schedule will be coming, as Dr. Weaver and Vickie have revised the fees to update them. The RDA positions are currently being flown.

 

7.) Mike DeHart, Pharmacist

Pharmacy sales report. For the month of May, Mike was gone one week on vacation. The pharmacy was open for fifteen days. Sales are up. Third party is everything that is not Tribal.  Mike explained that Medi-Cal will pay what they want to, although they are billing for the full amount and hoping for maximum reimbursement.

 

Dr. Burns explained the pros and cons of the EAPC grant. He explained that the EAPC grant allows patients to obtain medications where they would not normally receive them due to lack of funding. However, after six months of being stable on their medications the grant ends and the patients are off their needed medications.

 

Laura stated that last year the patients were getting a three month supply and they ended up going in the hole, this year however they’re going to come out in the good. She explained that it seems the providers closely monitored their prescribing guidelines in order to maximize this year’s grant funding.

 

Mike explained that he can now use the 330B pricing for the general public. This allows him to pass the federally reduced rate for drugs to the general public, and doesn’t require that he keeps two stocks of medication.

 

Laura stated that at this point in time for the average Medi-Cal billing it appears they’re going to come out in the dark. Mike explained that he estimates recouping $100,000 in billing. This is not the number that they anticipated and needed. Mike attributed a major problem with the back billing to be TARS. There are a lot of guidelines to qualify for a TAR and previously these weren’t being followed, so the pharmacy can’t get reimbursed for these. Bob asked if they can prevent the TAR problem in the future. Dr. Burns explained a new form implemented for allowing a non-covered drug to be dispensed to the patient. Now there is a process in place for doing TARS and following guidelines.

 

Roy questioned the appeals process for Medi-Cal. Mike stated that there is a three level appeal process. Roy stated that someone who understands how to begin the appeal and see it through begin working on this. Roy and Mike will work together to begin to formulate this process. Larry will also be involved in this to find out if they can try to appeal even though Mike has explained that the problem regarding unnecessary drugs and TARS is going to be a problem.

 

Mike also stated that he needs help in the pharmacy. He stated that he filled an enormous amount of medications in three days and this is not safe.

 

Florence Conrad moved and Alvis Johnson seconded to approve Mike’s report.  7 haa, 0 puuhara, 0 pupitihara.

 

8.) Dr. Steven Burns

Dr. Burns does not have an official report to present, he explained that he was previously on the agenda to allow for more communication between the board and the Medical Director, however with Larry Jordan he doesn’t anticipate a hindrance in communication.  

 

Dr. Burns updated the group on the provider productivity reports that are presented in the Health Manager’s Meeting monthly. Roy questioned quality vs. quantity, and how the group monitors if quality of service is being monitored along with quantity of patients and revenue. Dr. Burns explained that there are established benchmarks in the Nation for visits that should occur with an average healthcare provider. He stated that 250 patients a month for providers is a good average and they need to maximize the providers that they have.

 

Leaf Hillman moved and Leeon Hillman seconded to approve Dr. Burns’ report.  6 haa, 1 puuhara (Robert Goodwin), 0 pupitihara.

 

Requests:

The purchase of T-shirts for the basketweavers gathering will be further discussed at the Wednesday meeting.

 

Informational:

CRIHB is going to ask for further funding and Roy asked how much the Council thought they could provide. Roy has a meeting next Thursday to discuss this.

 

The TURTLE health plan meets next week as well. Dr. Burns declined to sit on their board, because they changed from a Medi-Cal HMO to more of a commercial insurance company. Dr. Burns explained that they are also having trouble getting provider contracts. This indicates that there may be some unstableness within Turtle.

 

The Head Start program within CRIHB is excellent, and this should be discussed tomorrow if Michael has gotten enough information from Jim Crouch.

 

Leaf would also like to look at the nutrition program advances from CRIHB. Larry explained that there is a grant through the state that may provide them with information on nutrition.

 

 

 

Committee Reports:

Florence stated that there was an ICWA meeting on Tuesday. They went over the closed session items, and they have a high case load. YR currently has about seventeen cases. They are getting ready to send a case to Tribal Court. Florrine and Florence will be attending the State ICWA conference at the end of this month.

 

Florrine stated that she has been working on the Tribal Reunion business; she will be working on the agenda this week. She does need someone to go pick up tents by the 22nd.

 

Closed Session

 

Consensus:  To table the loan request from Tribal Member #31 to the Wednesday meeting.

 

Leaf Hillman moved and Robert Goodwin seconded to uphold the denial for CHS Case #143 and approve payment in the amount of $75.62.  6 haa, 0 puuhara, 0 pupitihara (Florrine Super not present for voting).

 

Consensus:  Anna Myers will contact patient that went directly to Health Board for denial from CHS as the patient did not contact her as directed by the Health Board.

 

Consensus:  For Leo Carpenter to meet with Sara to discuss revisions to his Contract to increase his time and bring it back to the Wednesday meeting for review.

 

Leaf Hillman moved and Robert Goodwin seconded to accept job description changes for Finance Assistant/Accounts Payable Manager, Finance Assistant/Payroll, Finance Assistant/Travel, A/P & Filing, Finance Assistant- A/R, A/P, & Vehicles.  7 haa, 0 puuhara, 0 pupitihara.

 

Leaf Hillman moved and Robert Goodwin seconded to approve merit increases ranging from to $0.25 to $0.50 for the Finance Staff.  7 haa, 0 puuhara, 0 pupitihara.

 

Directive:  For Arch, Larry, and Sara to address inappropriate behavior of employees.

 

Consensus:  For the Committee to handle the complaint and employee behavior and report back to the Council.  Florence will bring it up at their next meeting which is next Thursday.

 

Announcement:  The CASA Planning Meeting has been re-scheduled for October 10, 2005.

 

Consensus:  To table the loan request from Tribal Member #2484 to the Wednesday meeting.

 

Next Meeting Date:  July 14, 2005 at 5 PM in Happy Camp.

 

Leaf Hillman moved and Roy Arwood seconded to adjourn the meeting at 10:09 PM.  7 haa, 0 puuhara, 0 pupitihara.

 

Yootva,

 

 

________________________________

Arch Super, Chairman

 

Recording Secretary, Barbara Snider