Karuk Tribe of California

Health Board Meeting

December 8, 2005

*Minutes*

Meeting called to order by Vice-Chairman, Leaf Hillman at 5:10 PM

Roll Call:

Leeon Hillman, Member at Large

Roy Arwood, Member at Large

Robert Grant, Member at Large

Robert Goodwin, Member at Large

Absent:

Alvis Johnson, Member at Large

Arch Super, Chairperson

Florrine Super, Secretary

Florence Conrad, Member at Large

The Health Mission Statement was read aloud by Robert Goodwin.

Approval of Agenda for December 8, 2005:

Robert motioned and Leeon seconded to approve agenda with changes, 4 haa, 0 puuhara, 0 pupitihara.

Approval of minutes of November 10, 2005:

Bob stated that page 4 of 8, under Requests, second sentence, there is an error. It states that Leaf will meet with Leaf. This should be corrected to state, that Leaf will meet with Scott.

Robert motioned and Leeon seconded to approve minutes with changes, 4 haa, 0 puuhara, 0 pupitihara

Guests:

Dr. Burns:

Dr. Burns thanked the Council for allowing him to address them with something very important to the Happy Camp Volunteer Ambulance, Happy Camp community and the Health clinics.

Dr. Burns introduced Doreen Mitchell, Medical Assistant from HCHS. He stated that Doreen is a Tribal Member and an asset to the Health Program and was selected from across the Nation to receive recognition for her outstanding accomplishments within her profession and the community. She was awarded the winner of the National Non Physician Health Professionals grand prize which is an all expense paid week vacation for two to the Caymon Islands. Doreen was also presented with $1,000 from Cherokee to purchase merchandise from their line along with a feature in the 2006 Cherokee calendar.

Doreen thanked the community for being a part of her enjoyment. She also thanked her husband and co-workers for being supportive and a joy to work with.

Robert Goodwin suggested forwarding this accomplishment to the local newspaper, as the staff, and Council are proud of her.

Sara will contact the local newspaper to arrange an acknowledgement of Doreen’s award.

Sandi Tripp:

Not present.

Old Business:

None.

Directors Reports:

1.) Joe Snapp, Alcohol and Substance Abuse Program:

Joe provided his written report to the Council. He requested an update regarding the DUI project. Joe explained that he put a lot of time into this project, and would like to know the follow up. Bob sated that he hasn’t received anything further, and would like his guidance regarding this.

Larry will contact Barbara Norman regarding this, and follow up.

Joe also requested $400 to apply for State Certification for his program. He has completed the application, but will need to send the check along with it. Bob asked if this was an annual fee, and Joe explained that it is not, it is a one time fee. The program will be granted the ability to bill Medi-Cal if it becomes certified.

This will be addressed at the Wednesday meeting. Joe will provide the application to the Council prior to their Wednesday meeting. The Council agrees to provide the funding, but will look into what program will be charged on Wednesday.

Bob motioned and Leeon seconded to approve Joe’s written report, 4 haa, 0 puuhara, 0 pupitihara.

2.) Larry Jordan, Executive Director of Health & Human Services:

At December’s health board meeting the proposal for a resolution in support of CRIHB to allow for an engineering position, was tabled for more information. Larry announced that CRIHB was prepared to attend tonight’s meeting to provide that update, but were unable to make it. They have asked to be added to the meeting agenda in January to present their information.  

CRIHB has sent a request for a data sharing agreement. This does not require funding, however the agreement to be a collaborator for this project. The data collected is compiled in a document, in which provides data specific to Karuk needs; it is used for several different aspects of programs including the grant program, Social Services and others. There are other projects compiled similar to this, but CRIHB is specific to the California Area.

The agreement states that KTOC will share information and will provide data to CRIHB in which they need to include in these documents. Larry is asking approval to sign the agreement, and return it to CRIHB. The project is funded by the Epidemiology Program.

Bob stated that normally these requests are passed through Erin Hillman’s office first.

Leaf reiterated that this will have to go through the regular review process, and it will be re-discussed on Wednesday. This will require a resolution as well.

Leaf asked if there are additional copies of the CRIHB document containing data that other departments can utilize. Larry stated that this was distributed to all health managers, in electronic format, and he will send each Council member and Hector Garcia an electronic version of the data report as well.

Larry stated that the Health Facilities Master Plan is complete, but it does not include data specific to non Native Americans that use our health facilities. This can be completed by IHS, but the cost is roughly $18,000. Larry stated that he doesn’t believe we need the second planning document.  Dr. Burns stated that he concurs with Larry, in that the data can be extracted at a later time, if the need arises.

Larry stated that the Pharmacist has resigned effective December 16^th, 2005. However the pharmacy is closing December 9^th until further notice. There are three potential candidates at this time for the position.

Leaf asked Mike if he would be available to assist during a transition period. Mike stated that he would be available to a certain point. He has not taken other employment, but it is a matter of logistics.

Larry expressed his appreciation for Mike’s efforts. Stating that Mike came to the Karuk Pharmacy on the ground floor and Larry thanked Mike publicly for his efforts.

Dr. Burns questioned the plan of going back to the system in place prior to the pharmacy opening. Previously the medications were delivered via courier from a contracted pharmacy, and issued purchase orders for payment through CHS. The appropriate step would be to go back under CHS. Direct care was limited before, and clinic stock was available. Dr. Burns presumes we will go back to this process.

Leaf stated that personally he would assume this would be done, however he is unclear of the steps that are going to be implemented. He confirmed that the procedures should be re-discussed with guidance from staff.

This discussion will be moved to the Wednesday meeting. Mike agreed stating that several patients have phoned or came in questioning the process after he leaves.

The outreach and communication will have to be discussed as this is short notice, including discussion of the charging policies.

The discussion of the pharmacy procedures will be set for Noon on Wednesday so Dr. Burns may attend without hindering patient care time.

Bob stated that he hopes staff are getting together prior to Wednesday to allow for input and discussion. Larry stated that this is a work in progress, as this situation has recently occurred. Bob stated that he would like to have recommendations brought to them, and not discussions. So he recommends that Larry get with health staff, including Dr. Burns, and bring the recommendations back to the Council.  

Larry stated that the committee created to address the Yreka Clinic productivity issue, has reached their conclusions and a plan of action. Larry outlined that a resolution has been created to increase productivity, including bringing their patient visits to meet the benchmark set for other physicians, mass marketing, and evaluations over time of the operating hours. The time line to evaluate the plan after implementation is six months. During the meeting with Larry and the Yreka staff, comments regarding the Tribe’s public image were discussed. The clinic staff concluded that with better communication of the services, and with positive advertisement of the Yreka clinic, this would allow for a higher understanding from the community of what services KTHP offers. Discussion over a Communication Director position also took place at this meeting, and the staff feels that this would be beneficial for the health clinic as well as the Tribe.

Dr. North has agreed to work with KSYC regarding marketing promotion for ½ hour every other Saturday. Also the providers will be advertised in the local Newspapers introducing themselves and services at the Yreka clinic. Larry requests approval of the budget for this effort, it is roughly $1,000 to get started.

Bob questioned if this funding would come from Third Party. Leaf asked if the committee formed by the Council has reviewed these recommendations, and if the committee has reviewed the budget set for the $1,000. Larry stated no, that the committee hasn’t reviewed it; however David Eisenberg was at the meeting participating in these discussions. Larry further explained that if approved the funding would include two days radio time and newspaper advertising.  This will be done by existing staff, and will not create another position. Robert Grant stated that there is also free broadcasting on Channel 4.

Leeon motioned and Roy seconded to approve $1,000 funding from Third Party for the Yreka clinic marketing budget, 4 haa, 0 puuhara, 0 pupitihara.

Larry stated that he had a meeting with the HCHS board on November 16^th 2005. At the meeting the HCHS board voted to pay half of the legal bill for Barbara Kashmir’s legal opinion. HCHS also voted to have a second legal opinion of their own completed. However, they will begin the paperwork for the transfer. Larry stated that the HCHS board would also like to help the fire department, although he hasn’t seen anything regarding that in writing.

Larry stated that he would like to have David Eisenberg present to discuss this further on Wednesday as he may have more updated information.

Larry announced that the small ambulatory grant, was denied as our user population does not qualify us for the grant.

Larry and Rick are working on State funding from Well point, in which could provide up to $250,000 to clinics such as KTHP, to renovate facilities. One requirement is that there is a five year lease, if the facility is not owned. There is a letter of intent from HCHS that we may use as a means to provide documentation of the intention for the HCHS clinic transfer to the Tribe.

Larry stated that he would like to attend the IHS Annual Meeting, being held in Phoenix Arizona. This meeting is a part of his training plan, and he will receive Continuing Education Units.

Bob motioned and Leeon seconded to approve out of state travel to Phoenix AZ January 29- February 3, 2006, for Larry Jordan to attend the IHS annual meeting, 4 haa, 0 puuhara, 0 pupitihara.

Larry presented a request for Babbie Peterson to attend training specific to her program, and the funding would come from Third Party, as her program does not contain enough funding for training and travel. The training is in Cabazon California, and is a Title VI Training and Technical Assistance Field Forum.

Bob motioned and Leeon seconded to approve out of state travel for Babbie Peterson to Cabazon California January 10-12 2006, 4 haa, 0 puuhara, 0 pupitihara.

Larry provided funding information on the annual distribution from IHS. This funding is for annual routine maintenance for IHS facilities. The funding is provided, by providing a list of what the funding was previously spent on. The funding received from IHS is $17,880.

This is added to the IHS compact, with the requirements. The signature requirement should be changed to the Chairperson or Vice-Chairperson, as IHS is continually inserting the Executive Director’s signature request.

Bob motioned and Leeon seconded to approve the funding plan for annual routine maintenance provided by IHS, 4 haa, 0 puuhara, 0 pupitihara.

Leaf questioned the update on a revised health plan, and business plan required by HRSA. He asked if this was a new requirement or a reminder for the Council of the former requirement. Larry stated that this is not a new requirement. He is working on completing these documents and the deadline for completion is February 3^rd, 2006.

Bob motioned and Leeon seconded to approve Larry’s written report, 4 haa, 0 puuhara, 0 pupitihara.

3.) Patricia White, Database Administrator:
Patti stated that YR data entry is still running two weeks behind. She has intervened with the chart flow to help rectify the issue. Data Entry is to be done within two days of the patient visit, and she is actively working on the issue with the YR staff.

She noted that mainly her report is informational.

Patti asked if the Council liked having the graphs attached to her report. Leaf stated that they are useful in combination with the data. Patti will send her entire report to Sara, as some pages have only been being sent hardcopy.

Bob motioned and Leeon seconded to approve Patti’s written report 4 haa, 0 puuhara, 0 pupitihara.

4.) Vickie Walden, Dental Clinic Office Manager:

Vickie stated that she has two policies to present for approval. They have been approved by the ACQI Committee, at their regular meeting. Vickie stated that these policies were implemented in reaction to findings from Alette Thompson the JCAHO Mock Surveyor.

Infection Control policy and procedures, and sterilization and disinfection of patient care items and clinical contact surfaces will have policy numbers assigned by Lessie at a later time. But she is asking for approval of these policies tonight.  

Leaf questioned how the screenings are completed for latex sensitivity. Vickie explained that this is completed by the adult health questionnaire and communication of allergies by patients to their healthcare personnel. This is part of the patient assessment procedures.

Bob motioned and Leeon seconded to approve with spelling corrections and changes the Work Related Medical Condition and Hand Hygiene policy and the Sterilization and Disinfection of Patient Care items and Clinical Contact Surfaces 4 haa, 0 puuhara, 0 pupitihara.

Leaf questioned the current status of a dentist coming down one day every two weeks to cover HC dental clinic for emergencies. This will be set soon, but Dr. Carlson is the primary dentist who sees the walk in patients in the YR clinic. In the case of an emergency situation in HC Vickie has close communication with the other dentists in YR, to get services along with a good triage system.

Roy motioned and Leeon seconded to approve Vickie’s written report, 4 haa, 0 puuhara, 0 pupitihara.

5.) David Eisenberg, PHN:

David was not present, written report provided.

Robert asked if the CHR’s are still doing transporting as there was recently a transporter hired for the YR clinic. The Council confirmed that the transporter position was not filled at the time of the data being pulled. Bob stated that it would be interesting to get the follow up generator with propane as a continuous power supply is needed for Administration.

Bob stated that Barbara will send a note to David asking him for an update on the comment in his report regarding the suggestion to have a propane back up generator.

Patti did note that if the power is out then all health facilities and the finance department will shut down as Chris has all the systems routed through the KTOC server. Bob stated that a little more information on the suggestion of a different back up system should be done. The note will go to Chris too, for more information on what they plan on doing.

Bob motioned and Roy seconded to approve David’s written report 4 haa, 0 puuhara, 0 pupitihara.

6.) Lessie Aubrey, DQMCH:

Lessie has provided a written report, and has no action items. She is on the agenda for closed session to complete Credentialing and Privileging. She asked the Council if they had any questions for her.

Bob asked the expected dates for the upcoming Leadership follow up meeting. Barbara stated that she set December 15^th 1:00 PM – 3:00 PM with Lessie. Bob stated that as the first meeting reviewing the Leadership standards was concluded, it was decided to have some follow up on the standards and an overview provided.

Lessie stated that there are nine functional chapters in the JCAHO manual. She stated that in the Leadership chapter she included board members, the CFO and the EDHHS. She stated that in the case of the surveyors coming unannounced then some staff may not be present and further communication was needed. She added that previously she had funding set for board training; however she no longer has the time to work as closely with them as she needs. Bob noted that he agrees, adding that the board is not provided with enough adequate training time to get them orientated on the different programs and functions of those programs.

The Council affirms that they will be available for the meeting time.  

Roy motioned and Leeon seconded to approve Lessie’s written report, 4 haa, 0 puuhara, 0 pupitihara.

Requests:

Hector presented the Tribal Court Administrative Clerk position. Leaf would like to table this until the Wednesday meeting, and Barbara shall notify April of her requested presence for the meeting, to discuss the matter. If she is available for the meeting it will be put on the agenda, however if she isn’t available to attend then it will not be on the agenda.

Hector also requested approval for out of State travel to Portland OR, for December 13^th 2005; there is no hotel or lodging needed. This meeting is in regards to two state legislation bills that are being presented. Leaf stated that it is important to attend, but upon his return his written brief on this shall be done. Bob stated that it would be interesting to hear the challenges, or changes that are taking place.

Roy motioned and Leeon seconded to approve travel for Hector Garcia to Portland Oregon, on December 13^th, 2005 4 haa, 0 puuhara, 0 pupitihara.

Informational:

None.

Committee Reports:

None.

Closed Session:

Tribal Member #1690 will discuss request further with CHS and follow approved policies and procedures.

Bob motioned and Leeon seconded contingent upon the speech therapist’s review and confirmation of the benefits of this service to the patient. The recommendation for Case #156 approval of the initial evaluation,  4 haa, 0 puuhara, and 0 pupitihara after review of the initial speech therapist evaluation, the remainder, 10 visits, will be covered.

Roy motioned and Leeon seconded to uphold CHS denial for Case # 159 and pay $118.00 from Third Party, 4 haa, 0 puuhara, 0 pupitihara.

Larry will follow up on the snow removal, and trash pick up for the Foster Family house in Yreka.

Larry will contact employee and discuss lost paperwork and get back to Robert Grant.

Bob stated that it is nice to get recognition from the Council in regards to employee achievements. Employee’s that provide a positive role model for children, and have done remarkable in their achievements should be acknowledged. Larry will draft a letter for Arch to sign.

Consensus: To appoint Barbara North to the medical staff and approve credentialing her and privileging.

Discussion over the detrimental public image of the Tribe has become overwhelmingly overlooked. Past presumptions and present presumptions regarding the Tribe has become discouraging and portrays the wrong image to the County and the inlaying communities. Discussion over a Communications Director position needs to be considered and discussed with the CFO. As this topic is a pressing issue for the image of the Tribe.

Mining lawsuit, information has been leaked out, and members of the community are informing the public via internet, concluding their version of details. However, it is important to note that the information may not be divulged until December 20^th.

Bob motioned and Leeon seconded to make available up to $30,000 to purchase the boat that Leaf has researched contingent on the 50%-50% split with DNR, and in cooperation with Ishpuk Leasing 4 haa, 0 puuhara, 0 pupitihara.                                                                                                        

Robert motioned and Bob seconded to adjourn meeting at 9:24 PM, 4 haa, 0 puuhara, 0 pupitihara.

Next meeting January 12, 2005

Yootva,

______________________________

Leaf Hillman, Vice-Chairman

Recording Secretary, Barbara Snider