Karuk Tribe of California
Health Board Meeting Minutes
October 6, 2005
Happy Camp, California
Ayukii,
The meeting was called to order at 5:08 PM by Arch Super, Chairman.
Roll Call
Present
Arch Super, Chairman
Leaf Hillman, Vice Chairman
Leeon Hillman, Treasurer
Roy Arwood, Member
Florence Conrad, Member – 5:53 PM
Robert Goodwin, Member
Robert Grant, Member
Alvis Johnson, Member
Absent
Florrine Super, Secretary - excused
Quorum is established.
The Health Mission Statement was read aloud by Roy Arwood.
Approval of the Agenda for October 6, 2005
Robert Goodwin moved and Leaf Hillman seconded to approve the Agenda for October 6, 2005. 6 haa, 0 puuhara, 0 puuhara.
1) Approval of the Minutes on September 8, 2005
Leaf Hillman moved and Alvis Johnson seconded to approve the Minutes for September 8, 2005. 6 haa, 0 puuhara, 0 pupitihara.
2) Guests
Laura Mayton: She states the vehicles from the Karuk Building Center have been transferred to the Maintenance Department after the closing of the store. She would like permission to pay off the Ford truck from Ishpook Leasing and then lease it to Indirect.
Leaf Hillman moved and Robert Goodwin seconded to approve the pay off of the Ford in the amount of $7,000 from Ishpook Leasing. 6 haa, 0 puuhara, 0 pupitihara.
3) Old Business
Arch asked about the vehicle detailing. Sara states she is still working on it.
4) Larry Jordan, Executive Director of HHS
Larry was present to review his written report.
He gave a brief update on the Medicaid Administrative match program and how it will be implemented. He received approval to do the initial letter of intent and there has been a conference call since then and some meetings to discuss how this will work. MAA is what they call the program to help reimburse for Medicaid functions performed by the Tribe in getting individuals signed up for Medi-Cal. They will be able to recoup some costs of the new Transporter they just added back into the budget by tracking time used to transport Medi-Cal patients to medical/dental appointments. There is also a time survey to be done for others that transport Medi-Cal clients; they are still working on ways to implement a tracking system for this purpose. Laura Olivas will be helping with this and being the Fiscal lead on this project.
He distributed an updated position description for the Social Services Department for a Social Services Administrative Assistant. This was previously the Social Services Receptionist/Billing Clerk position that Mary Matchett holds. This reflects the current duties being handled by this position accurately. Most of the new duties are related to the CAIR Program.
Robert Goodwin moved and Leaf Hillman seconded to approve the revised position description for the Social Services Administrative Assistant. 6 haa, 0 puuhara, 0 pupitihara.
November 14, 2005 in Eureka will be the meeting to go over the results of the IHS Facilities Master Plan site visit that was done in August. It will begin at 1 PM at the UIHS Clinic if they wish to attend.
He has a request from CRIHB for the Darrell Hostler Fund. The amount is $7,000 each year that the Tribe has contributed in the past. It covers a portion of CRIHB Administrative Staff Salaries as well as advocating for California Health issues. The contribution is paid from Third Party and is included in the budget.
Leaf Hillman moved and Roy Arwood seconded to approve the contribution to the Darrell Hostler Fund at CRIHB. 6 haa, 0 puuhara, 0 pupitihara.
He states they are gearing up for JCAHO Review in 2006 and as a part of that process Lessie has made some assignments to the Staff. She has divided the various chapters of policies and he has been designated the Leadership Standards to review. The sub-committee is Larry Jordan, Arch Super, Laura Mayton, Robert Goodwin, and Dr. Weaver. They need to meet and then review the standards to ensure they are in compliance with them and if they are not discuss how they can be. He went over the other sections of the standards to let them know what they are. There are no other Council Members included on the committees but if so, he will notify them. Management of Human Resources will be Barbara Snider, Sara Spence, Lessie Aubrey, and Larry Jordan.
He again updated them on the Region 9 Group that Margo Kerrigan notified him about that has been having conference calls to address possibly helping a Tribe with a project. It is a networking project to bring together several different Tribes. He had thought about the dam removal project being used and Leaf was recommended to work with him but Leaf was not in the office during the last conference call. Leaf states they now have a public health issue with the toxic algae in the River and it may be a very health related project for them to work on. Margo saw the Tribe’s Newsletter and felt they were doing good things and that the Tribe would be a good addition to the group that they would like to use as pilot group. There are over 20 different agencies that participate in these conference calls so is a very diverse group of individuals. The conference calls are the third Wednesday of the month.
He would like to discuss the clinic issue and states they are still pursuing acquiring the HCHS Building through a transfer agreement. They hope to have a meeting once they have received a determination from the CRIHB attorney stating it will work.
Dr. Burns feels that the building is worth retaining and renovating to suit their needs. He was present and briefly addressed the Council regarding his thoughts. His first thought is regarding the square footage estimates that were based on Yreka are about 1,000 square feet short due to the ER, ambulance access, and X-Ray needs that Happy Camp has that Yreka doesn’t. He also states that they are able to move a lot of patients through the current clinic. He has a suggestion that he would like to see the current clinic renovated as it stands and then a Wellness Center added on to it with a Physical Therapy Department and warm water exercise pool rather than tearing it down and rebuilding. He feels they could locate a Physical Therapy Assistant to come to Happy Camp to serve the needs of the Happy Camp and Orleans communities. They can do everything that a PT can do with the exception of the initial assessment. It would be a very valuable addition to the services they already provide. Then at a later date they could possibly rebuild the Clinic with additional funds. He also states that there was some discussion about having the ambulance/fire department at the same location which would be beneficial as well.
Leaf feels those are great ideas and it would be a good idea to pursue if they can identify funding. Dr. Burns would like to have the staff very involved in the planning to ensure it addresses all of their needs. He states a basic PT Department would not be very expensive of an addition. Leaf asked if they have identified any numbers regarding how many PT referrals are done or how much is spent on that service. It is hard because they do not order it often due to the distance that must be traveled to obtain the services. He can do some research and report back to them. They can forward this information on to Rick and Julie so they know possibly what they may be looking for funding for as well.
Blue Cross has donated $35 Million to be distributed in a similar fashion to the Clinic Renovation Funds that were available previously. They can apply for up to $250,000 that could be used for this purpose.
David states he has contacted the CRIHB lawyer four to five times since the last meeting and there is still no result. HCHS has entertained an opinion from their attorney that there are some barriers to a transfer due to modifications that would need to be made to the Articles of Incorporation before it could be done to the Fire Department as their primary service is not health care, but the Tribe’s is so it may be simpler.
Florence Conrad arrived at 5:53 PM.
Leaf Hillman moved and Robert Goodwin seconded to approve Larry’s report. 7 haa, 0 puuhara, 0 pupitihara.
5) David Eisenberg, PHN
David was present to review his report with the Council.
He presented an agreement with Happy Camp Elementary School to allow the students the ability to use the Tribe as an alternate site for them to gather in case of an evacuation at the School, the High School already has this agreement in place with the Tribe.
Consensus: To allow the Elementary School to gather at the Tribe in case of an evacuation at the School.
He states that the company that provided them with the ophthalmology equipment in Orleans has received a grant to update that equipment at no cost to the Tribe and he is in the process of doing this. David states that Dr. Willett and Alissa know how to run the equipment and the more they do it, the better they will get at it. Their goal is to have all of the diabetics and elders done first, then other Orleans patients and then move it to Happy Camp to do the same in that community, then move it back and start over again.
He also requested approval of five policies; Bomb Threat, Oxygen, Product Recall, Child Passenger Protection, and TB Exposure Plan. They were reviewed by ACQI and only slight changes have been made. He states there will be several more coming to them for approval as it is that time of year.
Bob asked about the evacuation procedures for the Bomb Threat policy and if that is what they will say on the intercom or if this is guidance about what they will say on the intercom. David states they can use their common sense; the policy is just fall-back in case they forget what they are supposed to do. Arch suggests they learn to do the bomb announcement in Karuk Language.
Robert Goodwin moved and Leeon Hillman seconded to approve the Bomb Threat, Oxygen, Product Recall, Child Passenger Protection, and TB Exposure Plan polices. 7 haa, 0 puuhara, 0 pupitihara.
He also distributed CHS Levels of Care that were reviewed, updated, and approved yesterday at the Annual Managed Care Meeting. These will be the Levels of Care for FY 2006. They currently are covering everything in Level I and Level II. They have changed item K) that oxygen must be re-certified annually, and Q) is OB/GYN devices were added as a covered item. They also clarified physical therapy/massage therapy services and how they are authorized and how many visits you can have; maximum of 10 visits per referral, with a maximum of 2 referrals per episode, further referrals for the same episode must be approved by Managed Care. They have not changed the coverage, only updated the wording to make it clearer.
Florence asked why acupuncture is only allowed for pain as it is beneficial for other ailments as well. If the Council would like they can either remove that restriction or revisit it to determine why it was only allowed for pain.
Consensus: For the Managed Care Committee to revisit the acupuncture coverage to determine if it can be beneficial for more than pain only.
Robert Goodwin moved and Florence Conrad seconded to approve covering through Level II of the CHS Levels of Care for FY 2006. 7 haa, 0 puuhara, 0 pupitihara.
Leeon Hillman moved and Florence Conrad seconded to approve David’s report. 7 haa, 0 puuhara, 0 pupitihara.
6) Patti White, Database Administrator
She distributed copies of the policies that she was requested to bring to the meeting as Lessie is away on travel.
They are Nutritional Assessment, Opening and Closing of Dental Clinic, Performance Evaluations, Ambulatory Patient Care Personnel Identification Policy, Daily Visit Sheet, Patient Records Information Management, Management of Information, and Filing Systems. The changes from yesterday’s meeting are written on them and Barbara and Lessie will update them on the computer when they return from travel.
Florence Conrad moved and Robert Goodwin seconded to approve the Nutritional Assessment, Opening and Closing of Dental Clinic, Performance Evaluations, Ambulatory Patient Care Personnel Identification Policy, Daily Visit Sheet, Patient Records Information Management, Management of Information, and Filing Systems policies. 7 haa, 0 puuhara, 0 pupitihara.
Robert Goodwin moved and Leaf Hillman seconded to approve Patti’s report. 7 haa, 0 puuhara, 0 pupitihara.
7) Vickie Walden, Senior RDA
Vickie states she has nothing to add to her written report. She did state that Dr. Madkins will be out from December 19, 2005 through January 23, 2006. They will begin recruitment next week for both the Dentist and the Dental Hygienist for Yreka that was included year two of the HRSA Grant.
Robert Goodwin asked about dental appointments and when they can call in to make appointments. Vickie states that they are exploring the possibility of only accepting appointments on a certain day to avoid the problems they are having with scheduling. She did not think it had taken effect yet, and it would only affect Yreka. Bob asked if they are going to be able to adequately serve their Native American patients with the implementation of the HRSA Grant and the expanded access it requires. Vickie states she had that concern and can do some evaluation for them to show how many Native American versus Non-Indian patients they are seeing. Patients on a treatment plan are not losing their appointments, they continue to receive treatment. There may be a slight problem with the scheduling due to the fact that they do not know the patient population.
Laura asked if maybe they should revise their HRSA Grant to hire another Dentist or a portion of a Dentist instead of a Hygienist for Yreka to handle the demand. Dr. Burns states it may be a good business opportunity to increase revenues. Larry states that this may require more thought before they make a decision. Bob also suggests possibly looking into additional funding to again expand Dental in Yreka. Larry states they just received $175,000 to expand Happy Camp Dental from IHS. Laura states they could also coordinate expanded hours as they do not have enough operatories to still be able to provide more services for Yreka. Dr. Burns asked if the rumor that Redding Rancheria will be closing their Dental Clinic is true. She states she called and has found out that yes, they are reducing to ½ days already and will be closing. This is increasing their workload also. Yreka continues to be the only Medi-Cal provider for Dental at this time. Dr. Carlson has agreed to be the “Emergency” Dentist to see the walk-ins and emergencies and they are trying to do what they can. Last week Dr. Carlson pulled 18 teeth before Wednesday. There needs to be a planning meeting of the staff with input from Council.
Leeon Hillman moved and Roy Arwood seconded to approve Vickie’s report. 7 haa, 0 puuhara, 0 pupitihara.
8) Lessie Aubrey, DQMCH
Written report only, on travel to Chicago.
Florence Conrad moved and Roy Arwood seconded to approve Lessie’s report. 7 haa, 0 puuhara, 0 pupitihara.
9) Joe Snapp, Drug and Alcohol Counselor
Joe states he has been out all of September for carpal tunnel surgery so he does not have a report. He came back to work yesterday.
10) Requests
Sara Spence: Sara requested approval of more revised position descriptions implementing the JCAHO measurable terms and reflecting current duties. They are for Clinic Dentist, Dental Director, Medical Coder/Business Office Manager, Dental Hygienist, HC Custodian, HCHS Custodian, Orleans Custodian, Dental Office Manager/Senior RDA, Clinic Physician, Medical Director/Clinic Physician, Yreka Dental Clinic Coordinator/RDA, Accounts Receivable Clerk, and Billing Clerk.
There was lengthy discussion regarding the salary ranges and what they actually mean and when and how they should be adjusted.
Leaf Hillman moved and Robert Goodwin seconded to approve the position descriptions for Clinic Dentist, Dental Director, Medical Coder/Business Office Manager, Dental Hygienist, HC Custodian, HCHS Custodian, Orleans Custodian, Dental Office Manager/Senior RDA, Clinic Physician, Medical Director/Clinic Physician, Yreka Dental Clinic Coordinator/RDA, Accounts Receivable Clerk, and Billing Clerk. 7 haa, 0 puuhara, 0 pupitihara.
11) Informational
None at this time.
12) Committee Reports
Roy Arwood: He states that they recently had a conference call for the Turtle Health Plan and announced the start of Turtle Health Insurance Solutions that will provide Worker’s Compensation and Health Insurance coverage for Tribes. Sara states Andy has contacted her to discuss this and she has hesitations about signing on or changing coverage to a company that has not been financially stable for a long period of time. Blue Lake will be the first Tribe to have coverage through them and their plan will start January 1, 2006. The Council seems to feel the same and wants to see how it goes before making any changes.
Closed Session from 7:54 PM to 11:40 PM
Robert Goodwin moved and Leaf Hillman seconded to approve Resolution 05-R-124 enrolling seven members into The Karuk Tribe of California. 7 haa, 0 puuhara, 0 pupitihara.
Robert Goodwin moved to uphold the CHS denial and pay $8.00 from Third Party. 5 haa, 0 puuhara, 2 pupitihara (Florence Conrad and Robert Grant).
Leaf Hillman moved and Leeon Hillman seconded to uphold the CHS denial and pay $100 from Third Party. 7 haa, 0 puuhara, 0 pupitihara.
Leaf Hillman moved and Leeon Hillman seconded to credential and privilege Dr. Donald Solus and credential Nicole Hokanson. 7 haa, 0 puuhara, 0 pupitihara.
NOTE: Robert Grant’s name was not included on the acknowledgement of credentialing page, Health Board Requests that this not be a trend.
Request: For Dr. Burns to meet with Larry Jordan and Laura Mayton to discuss the productivity level of the Yreka Clinic.
Consensus: To require the Medical Director to report directly to the Tribal Council/Health Board. This is to be discussed with the EDHHS by the Tribal Chairman and to be carried out as soon as possible to allow a simpler process for allowing recommendations to move forward. Decisions/recommendations from the Medical Director regarding the Health Program should be discussed with the EDHHS before coming to the Council/Health Board.
Robert Goodwin moved and Leaf Hillman seconded to approve Contract 05-C-001 with Barbara Norman, Attorney at Law in the amount of $87,000. 7 haa, 0 puuhara, 0 pupitihara.
Robert Goodwin moved and Leaf Hillman seconded to approve the Administrative Assistant and Administrative Receptionist position description revisions. 7 haa, 0 puuhara, 0 pupitihara.
Consensus: To accept the resignation of the CASA Program Manager and cancel any travel arrangements that were made if they are through the Tribe.
A meeting was set for November 3, 2005 at 10 AM with Stephanie Dolan to review the community comments on the Constitution Revisions.
October 25, 2005 at 10 AM was set to evaluate the EDHHS, the ICWA Meeting will be re-scheduled.
Robert Goodwin moved and Roy Arwood seconded to approve $2,995 for a slip-in tank for dump truck to be used for water abatement from Affordable Equipment in Grants Pass, Oregon. It is a 3,000 gallon tank with a 3 by 3 gas powered pump and a spray bar. Funding will come from either State Indian Health, Automotive, or Cal Trans Fund for road Maintenance at Ranch. 7 haa, 0 puuhara, 0 pupitihara.
Robert Goodwin moved and Roy Arwood seconded to approve the Mushroom MOU with the US Forest Service with updated diagram for stem cutting. 7 haa, 0 puuhara, 0 pupitihara.
Consensus: To accept the Settlement Agreement as reviewed tonight and sign the document Tuesday for submission to the Court to have a Court Order issued for Temporary Relief.
Consensus: To not approve travel to the funeral.
Consensus: To deny the request for financial assistance for legal fees and see if there is any more that Barbara can do for the Tribal Member.
There was a vote held to appoint one individual to the Housing Committee. There were 3 votes for Sheila Robinson, 1 vote for Scott Quinn, 1 vote for Roy Arwood, and 1 pupitihara (Leaf Hillman).
Consensus: To draft a letter responding to the Yreka Tribal Member’s concerns.
Next Meeting Date: November 10, 2005 at 5 PM in Happy Camp
Meeting adjourned at 11:46 PM.
Yootva,
_______________________________________
Arch Super, Chairman
Recording Secretary, Sara Spence