Karuk Tribe of California

Health Board Meeting

April 13, 2006

*Minutes*

Meeting called to order at 5:05 PM, by Leaf Hillman, Vice-Chairman

Present:

Leaf Hillman, Vice-Chairman

Robert Grant, Member at Large

Florrine Super, Council Secretary

Leeon Hillman, Council Treasurer

Robert Goodwin, Member at Large

Florence Conrad, Member at Large

Absent:

Arch Super, Chairman (excused/travel)

Alvis Johnson, Member at Large (excused/travel)

Roy Arwood, Member at Large (excused/travel)

Quorum is established.

Agenda of April 13, 2006:

Bob motioned and Florrine seconded to approve agenda with changes, 5 haa, 0 puuhara, 0 pupitihara.

Minutes of March 9, 2006:

Leeon motioned and Florrine seconded to approve minutes of March 9,2006, 4 haa, 0 puuhara, 1 pupitihara (Florence Conrad).

Guests:

1.) Phillip Albers, Jr., Language Program Assistant:

Phillip is present to request approval for the language ANA continuation grant application. He explained that the continuation is standard, and all required personnel have reviewed it as well.

Leeon motioned and Florrine seconded to approve resolution 06-R-31 ANA continuation grant, 5 haa, 0 puuhara, 0 pupitihara.

Old Business:

None at this time.

Directors Report:

1.) Patti White, Database Administrator:

Patti’s written report was submitted, but she is unavailable as she is on travel.

Florence motioned and Leeon seconded to approve Patti’s written report, 5 haa, 0 puuhara, 0 pupitihara.

2.) Vickie Walden, Dental Office Manager:

Vickie is present to review her written report, and stated that she doesn’t have any action items. She updated the Health Board explaining that she is requesting bids for the Happy Camp dental remodel, but it appears to be sole source. She will bring further information to the Health Board as it becomes available.

Florrine motioned and Leeon seconded to approve Vickie’s written report, 5 haa, 0 puuhara, 0 pupitihara.

Leaf questioned the status on training requirements for her staff and the previous discussion to have all dental staff attend training in Lake Tahoe. Vickie explained that four employees will be attending the Tahoe conference to obtain their CEU’s and the remainder will be present in the clinics. The closure of the dental facilities will not be needed as they will have adequate staffing.

3.) Lessie Aubrey, DQMCH:

Lessie is present to review her report and distribute it for the Health Board to review. She distributed ACQI committee meeting minutes, and reports that were available.

Lessie stated that she recently traveled to the IHS Directors meeting, attended Compliance training and traveled to Eureka to attend the IHS facility master plan meeting. She explained that through data submitted and feasibility studies done for the health program, IHS feels that some priorities for the health program should be conducted in locations other than what KTHP has began discussing as a possibility. She asked that the Health Board review the priorities from the list that IHS compiled and then return them to her when completed. She stated that the final meeting is upcoming and it will be at that time she will need to bring the priorities of the Karuk Tribal health program. She has reviewed the priorities herself, as well as the Health Managers, but they should be selected with Health Board input. The next meeting is May 23, 2006 in Sacramento. Bob noted that he would like to have the Health Board’s input on these priorities and that feasibility studies are nice to see, but the planning and selecting of priorities will include planning from the Health Board and staff. Leaf agrees, that he would like the Health Board to review the list and have their input and ensure that IHS has correct information on the direction in which the Health Program is considering.

Lessie was approved to attend Medical Records training in Redding, but it was actually on HIPAA as the presenter was unable to attend. She stated that the speaker was really good, and it may be useful to have him come to the Tribe to train all staff. Lessie stated that the training she received on HIPAA was slightly different than what she previously received training on, so she will contact IHS regarding differences.

Lessie stated that looking into the future it was suggested to being downsizing. She explained that the suggestion would be to ensure positions within the health program are offered to individuals already employed with the Health Program. She would like to suggest that when positions become available that the Health Program allow for efficient staff to transfer into the position. Florrine clarified that Laura Mayton suggested that it would be best as staff leave or resign that the Health Board review if the position is necessary, or could be filled by existing staff. Leaf agrees with reviewing the positions prior to allowing staff to transfer into the position as a priority would be to ensure that adequately trained staff be moved into positions.

Bob and Leaf would like to review the status of provider productivity issues that were previously brought to the forefront. The end of the timeframe for increasing productivity is in May and according to the timeline set, this is due to be revisited.

May 8^th, 2006 at 5:30 PM was set to have the follow up meeting regarding productivity.

Lessie announced that HRSA has signed the contract for an accreditation body and it is confirmed that they have signed with JCAHO. HRSA will pay for our upcoming JCAHO survey.

Lessie presented a resolution request from CRIHB. This resolution would allow for a position to be implemented by the Tribe, and when funding is received from the SAMSHA grant CRIHB would pay for the position. The position would be for a substance and abuse counselor.

Bob clarified that KTOC would have to designate one of our staff to work toward their goals, and then at the time of funding, then CRIHB would fund and hire someone to work in our facilities. Bob asked who the supervisor would be if this person is paid through CRIHB. Bob stated that it should be defined as to the supervisor and person in which CRIHB would select.

Another concern would be that we understand who our community is and the existing priorities of our patients. CRIHB coming into the community and hiring a person to work with our patients really wouldn’t guarantee focus of care toward the goals.

Leaf stated that this sounds like an interesting topic, but it would need some clarification and he would like Lessie to follow up on this request with Joe’s input, as he is familiar with this program. Joe and Lessie will follow up on this, and Lessie will present it back at the Wednesday Planning meeting.

Lessie stated that she submitted the original HRSA health plan. She stated that HRSA did not accept it, but she revised it to meet the time frames and persons responsible that was required. Lessie noted that the health plan was already sent to HRSA.

Lessie is preparing to implement the patient satisfaction survey for 2006. It was developed by David Eisenberg and revised by the ACQI committee in which they made some revisions that she agrees with.

Lessie requested approval of the survey to go out to the patients of the Karuk Tribal Health Program.

Florence motioned and Bob seconded to approve the patient satisfaction survey for 2006 with changes, 5 haa, 0 puuhara, 0 pupitihara.

It is not clear as to the distribution of the survey at this time. Previously it was available at all clinic locations, but a bulk mail to the patient population is a possibility.

Lessie distributed conflict of interest statements for the Health Board to sign, Board members present signed them and returned them to Lessie.

Bob motioned and Florence seconded to approve Lessie’s report, 5 haa, 0 puuhara, 0 pupitihara.

4.) Joe Snapp, Alcohol & Substance Abuse:

Joe is present to review his written report with the Health Board. He would like to request approval to Tacoma Washington for MRT domestic violence training. He would like to use their materials for his men’s group and in order to use their materials you must attend their training. The dates are, May 8-11, 2006.

Florence motioned and Bob seconded to approve out of state travel for Joe Snapp to Tacoma Washington for MRT domestic violence training May 8-11, 2006 5 haa, 0 puuhara, 0 pupitihara.

Joe mentioned the Oak Knoll project. He contacted the Architect and she is going to go ahead with the plans. The process with getting a permit and zone change will cost roughly $10,000. He would like to request seeking funding for this. The committee has met regarding the project, and they will schedule another meeting to determine if people followed up on their assigned tasks.

Sue has contacted Laura Mayton, and requested more information, but was still unsure of possible funding avenues. Joe stated that he would like to have another meeting to brain storm ideas to create funding.

The next meeting hasn’t been set yet, but when it is set, he will forward the information to the Council as they may want to attend.

Joe stated that he was notified from the state regarding his application for certification and they responded that they will be scheduling a site visit. He is awaiting this, and will provide follow up on the matter when it occurs.

Joe stated that the DUI application is still at the County level and he hasn’t heard anything further. Bob suggests having Hector assist in this and work with Joe to determine the reason the application is being held.

Directive: to Hector Garcia to meet with Joe Snapp to look into the issue with the DUI application held at the County level.

Bob motioned and Florence seconded to approve Joe’s written report, 5 haa, 0 puuhara, 0 pupitihara.

5.) David Eisenberg, PHN:

Not present, written report submitted.

Bob motioned and Leeon seconded to approve David’s written report, 5 haa, 0 puuhara, 0 pupitihara.

Requests:

1.) Consensus: to not make a donation at this time to the Special Olympics, Northern California.

2.) Erin Hillman, Director of Administrative Programs & Compliance:

Erin is present to request approval for several documents. They have been through the internal process and are now prepared for Council approval.

Erin explained that there needs to be a soils engineering report which was $3,950 with Galli Group, from Medford Oregon. The topography survey for development will be provided by Jim Bray and Associates, of Yreka California. The cost for the topography is $1,200 which was the lowest bid. Both services are needed and it was thought to have been completed by the Karuk Tribe Housing Authority for a project in close proximity to the project site, but was not. This addendum will reimburse the Architect for actual costs and no cost for coordination of these services will be charged to the Tribe.

Bob motioned and Florence seconded to approve addendum one (1) to contract 06-C-013 for the cost of services for soils engineering and topography surveys for development of plans for the construction of the Yreka Community Facility in the amount of $5,200 5 haa, 0 puuhara, 0 pupitihara.

Erin explained the agreement with Plumas County. She stated that the agreement is for clinical services for early stage HIV patients. This covers roughly 5% of salary for the Yreka FNP and 5% for a Nurse.

Florence motioned and Bob seconded to approve agreement 06-A-005 with Plumas County, 5 haa, 0 puuhara, 0 pupitihara.

Florence motioned and Bob seconded to approve the MOU 06-M-001 between HCCSD and the Karuk Tribe of California for fee to trust properties, 5 haa, 0 puuhara, 0 pupitihara.

Florence motioned and Bob seconded to approve MOU 06-M-002 between the Happy Camp Sanitary District and the Karuk Tribe of California for payments in lieu of taxes, 5 haa, 0 puuhara, 0 pupitihara.

Erin also presented a MOU with the Karuk Tribe of California, IHS, and the Happy Camp Community Services District. She explained that this is to provide Indian Health Services funding to the Community Services District for replacement of 3900 linear feet of existing water mains and associated piping and appurtenances.

Florrine motioned and Leeon seconded to approve, MOU 06-M-003, between IHS, HCCSD and the Karuk Tribe of California, 5 haa, 0 puuhara, 0 pupitihara.

Erin was excited to obtain these MOU’s and agreements between the local businesses and the Karuk Tribe of California. The Council thanked Erin and applauded her efforts to obtain these MOU’s as they have been working on them for quite awhile.

3.) Laura Mayton, CFO:

Laura is present to seek approval for an additional fiscal policy, bad debt and collections for the health program; she also emailed the Council a copy. She explained that this wouldn’t affect Native Americans and the sliding fee eligible patients. The policy affects persons that can actually afford to pay their outstanding medical bills but since the Tribe has not been aggressively seeking collections they have been opting to not pay. Bob clarified that this works for auditing purposes as well.

Bob motioned and Florrine seconded to approve the health program additional billing policy Section 25.4 for bad debt and collections, 5 haa, 0 puuhara, 0 pupitihara.

Closed Session:

Consensus: for Barbara to call the Yreka MD, and explain information with him regarding request from Tribal Member. Decision as to which facility he can refer to and if the location should be considered. The mileage reimbursement request would have to be discussed at a later time, with further information after recommendations from physician.

Consensus: to refer loan request from Tribal Member #2275 to the Wednesday Planning meeting.

Bob motioned and Florence seconded to approve 06-R-36 to remove Tribal Member #3335 from Tribal Roll, 4 haa, 0 puuhara, 1 pupitihara (Florrine Super).

Consensus: for board member and Laura Mayton to review financial assistance request for higher education, from employee #CT. Consideration on entering into an agreement for a length of stay employment contingency, if further education should be considered.

Bob motioned and Leeon seconded, to uphold CHS denial and pay $295 from third party if negotiations for a reduced rate are denied, 5 haa, 0 puuhara, 0 pupitihara.

Employee concerns over conflicts in personalities and recent meeting conversations were expressed with the Health Board.

Reassurance to Employee # 1017 that the Council was advised of reaction to the directive that was issued. They will evaluate the recommendations from all persons involved and would like him to continue to provide his medical services to the community. The Health Board assured employee that ideas or suggestions for improvement may be forwarded to them, but implementation or changes will be approved and set forth by the Health Board. Also, reiteration by the health board that managerial discussions will be handled without creating distraction by including other staff members, as their priorities are to provide health care, and handle their daily duties.

Consensus: to have suggestions to improve overall health program productivity be completed by Lessie Aubrey, Laura Mayton, Barbara Snider and Erin Hillman also for them to make recommendations to the Health Board at the upcoming Wednesday planning meeting.

Consensus: Contingent that no Health Board members attend, Barbara is to contact the HCHS board to set a meeting at the earliest time possible. Laura Mayton, Erin Hillman and Barbara Snider are to attend.

Directive: To all providers that there will no longer be discussion of changing accreditation bodies to AAAHC any further at the staff level at this time.

Directive: to HR to please provide update on the recruitment of an MD for the third year HRSA grant.

Consensus: to allow Dorothy Bridenstine to complete dental billing/ data entry on Fridays in the YR facility and one day a week for employee Tara Trent to work on dental billing at the HC dental clinic.

Consensus: to send former employee Nita Still something nice for her work while employed at KTHP.

Consensus: to deny request Barbara Norman’s professional assistance for DA at this time.

Florence motioned and Bob seconded to approve resolution 06-R-40, amendment one (1) for the Election Ordinance to correct a typographical error, 5 haa, 0 puuhara, 0 pupitihara.

Consensus: To forward minutes of the meeting in which the determination of removing the Election Committee chairperson was completed. The voting of the Committee Chairperson must be done in order to break a tie, consistent with committee processes.

Bob motioned and Florence seconded to approve the Election quick reference sheet, 4 haa, 0 puuhara, 1 pupitihara (Florrine Super).

Consensus: to Arch to handle issues regarding communication and behavior with employee #3770.

Next meeting scheduled for May 11, 2006.

Bob motioned and Florence seconded to adjourn at 10:11 PM 5 haa, 0 puuhara, 0 pupitihara.

Respectfully Submitted,

_____________________________

Leaf Hillman, Vice-Chairman

Recording Secretary, Barbara Snider