Karuk Tribe of California – Health Board Meeting

July 10, 2008 – Meeting Minutes

Meeting called to order at 3:00 PM by Arch Super, Chairman

Present:

Arch Super, Chairman

Florrine Super, Secretary

Leeon Hillman, Treasurer (3:42)

Florence Conrad, Member at Large (3:15)

Roy Arwood, Member at Large

Alvis Johnson, Member at Large

Sonny Davis, Member at Large

Robert Goodwin, Member at Large (3:16)

Absent:

Leaf Hillman, Vice-Chairman (excused)

Health Mission Statement read aloud by Florrine Super, Council Secretary.

Approval of Health Board meeting minutes of June 11, 2008:

Florrine Super motioned and Alvis Johnson seconded to approve the regular board meeting minutes of June 11, 2008, 5 haa, 0 puuhara, 0 pupitihara.

Agenda:

Florrine Super motioned and Roy Arwood seconded to approve the agenda with additions, 5 haa, 0 puuhara, 0 pupitihara.

Guests:

1.) Kari Norgaard, UC Berkeley:

Not present.

2.) Nancy Kilmer, Community Member: (3:15 – 3:25)

Nancy is present to provide information to the Council regarding a therapeutic painting option. She has a master’s degree in Fine Arts and a teaching credential. She was injured and during recovery of her injury she explored creative art relief. Presence painting was discovered and it includes painting free of structure. Having no instruction on what to paint, just open and clean canvas has proven to be therapeutic for clients. It is also used to offset old wounds and past harms to people both emotionally and psychologically.

Nancy provided general information regarding the fees for other similar classes and further information for offering the classes in Happy Camp. The cost would be $25 per adult with a 7-10 size class.

She would like to provide information to the Health Board on this avenue of therapy and like to partner with the Karuk Tribal Health Program to provide this type of service or announce that it is being worked on and offered soon in the community.

Arch explained that he will have staff contact her if there are any further questions, and thanked her for attending the meeting.

Old Business: None at this time.

Director Reports:

1.) Vickie Walden, RDA: (3:26 - 3:28)

Vickie provided her written report and is present to provide verbal updates to that report. She provided a new register balance of the CHS line item dental and has no other updates. The new balance for dental CHS line item is $9,589.53 for the remaining of this fiscal year. Vickie has met with the new Dental Director in Yreka clinic; Dr. Bardonner to bring him up to speed on the dental program. They have done some planning and are continuing to move forward with developments of the dental department while monitoring expenditures.

Florence Conrad motioned and Sonny Davis seconded to approve Vickie’s written report, 6 haa, 0 puuhara, 0 pupitihara.

2.) Mike Edwards, Behavioral Health Director: (3:28 – 3:34)

Mike provided his written report and is present to provide a verbal update to his report. He has an additional action item to his written report. He explained that Joe had previously presented a purchase request for the Council to approve, but it was not included in the minutes. This leaves finance with no notice to pay the invoice based on the amount being over $2,000 and their internal requirements of Council approval. Barbara explained that it was most likely not approved if it wasn’t in the minutes showing approval. Mike is now seeking Council approval to pay the invoice.

Robert Goodwin motioned and Florrine Super seconded to approve the purchase of DUI class supplies in the amount of $2,590.75, 6 haa, 0 puuhara, 0 pupitihara.

The Health Board would like to discuss the opening of DUI classes and the certification that was obtained. An update should be sent to the Council regarding the classes and the planned availability. Florence questioned the psychiatrist for Orleans as noted as a new service to the clients in Orleans. She would like to know the name of the psychiatrist and have a little information on that person. Mike is unsure of the person, but will find out who it is and forward that information once he receives it.

Florence Conrad motioned and Sonny Davis seconded to approve Mike’s written report, 7 haa, 0 puuhara, 0 pupitihara.

3.) Patti White, Database Administrator: (3:37 PM)

Patti is present to review her written with the Health Board.

Florence Conrad motioned and Sonny Davis seconded to approve Patti’s written report, 7 haa, 0 puuhara, 0 pupitihara.

4.) Eric Cutright, IT Director: (3:38 – 3:45)

Eric is present to review his written report to the Health Board. Eric explained that the implementation of the People’s Center online gift shop is fast upon us. The inventory needs to be photographed and a caption assigned to each item and will be uploaded to their website soon. He will be training the staff on how to maintain their inventory and uploads to allow them to maintain their system once it goes online.

Florence Conrad motioned and Sonny Davis seconded to approve Eric’s written report, 7 haa, 0 puuhara, 0 pupitihara.

Leeon Hillman, Treasurer arrived at 3:42 PM.

5.) David Eisenberg, PHN:

Davis is not present, but provided his written report for the Health Board to review.

Roy Arwood motioned and Florrine Super seconded to approve David’s written report, 7 haa, 0 puuhara, 0 pupitihara.

6.) Daniel Pratt, TANF Director: (3:44 – 3:53 PM)

Daniel is present to review his written report with the Health Board. He summarized his TANF data explaining that the State is willing to accept the Tribal Census data as explained by the contract that the Tribe entered into with HSU to perform the clarification. Daniel has responded to questions that the State has had and a meeting has been set with the State for Tuesday in Sacramento. Daniel believes that there was a question of tribal sovereignty, but the Federal government says that no entity is questioning the Karuk Tribe’s sovereignty but seeking clarification. Daniel is unsure of this statement.

The new case load approval from the State is 262 which is a $2 million budget bringing the Karuk Tribe TANF program up and running. This number is including Humboldt County.

If the Health Board would like to challenge the 262 case load number and have the Federal Government review what the State and the Karuk Tribe are disagreeing on, the timeline for the Feds to provide a review and recommendation of a case load number may take up to six (6) more weeks.

The Health Board has additional questions and clarification that they would like to seek and due to this they asked that the remainder of Daniel’s report be moved to closed session.

Sonny Davis motioned and Leeon Hillman seconded to approve Daniel’s written report, 7 haa, 0 puuhara 0 pupitihara.

7.) Lessie Aubrey, DQMCH: (3:55 – 4:01 PM)

Lessie is present to review her written report with the Health Board.

Lessie has one action item; it is to seek approval of the Performance Improvement Plan. The plan is similar to last years, but it includes minor changes and updates including external and internal customers. The revised policy will include the language necessary to maintain accreditation, but with AAAHC not JCAHO in accordance with the approval to switch accreditation bodies for the Health Program.

Robert questioned the approval process for policies for the Compliance and HIPAA Committee. Lessie explained that the policies will be revised and approved by this Committee when regulations and rules change to ensure the utmost compliance is met for the program. Robert would like to know if the Committee recommendations will be then presented to the ACQI Committee and forwarded to the Health Board for final approval in accordance policy and procedure for previous years. Lessie confirmed that this process still takes place. Robert concluded that last sentence regarding approvals does not read that way, or maybe it is a grammar issue. Lessie explained the process and the overall organizations performance improvement plan with other policies that the Health Program has.

Leeon Hillman motioned and Roy Arwood seconded to approve the Karuk Tribe’s Organizational Performance Improvement Plan, 7 haa, 0 puuhara, 0 pupitihara.

Lessie provided an overview of the performance improvement reports that are attached to her report. She explained that the outcomes of the projects should be reviewed by the Health Board and if there are any questions she is available to work with them.

Leeon Hillman motioned and Florrine Super seconded to approve Lessie’s written report, 7 haa, 0 puuhara, 0 pupitihara.

8.) Martha Schrock, EDHHS: (4:02 – 4:22)

Martha is present to provide highlights of her report for the Health Board.

Martha has received miniature individual strategic plans and will be working on incorporating each department into an overall health program strategic plan creating a five year plan.

The notice of the reduction from Medicare/MediCal was sent to all providers that have CMS billing, but to date the reduction has not taken the action in the reduction of payment for services. Medicare is still delayed with this implementation of a 10.6% rate reduction. MediCal has approved their $3 reduction per visit payment but have not begun their reduction yet. In order to keep billing smoothly MediCal will go back and reduce their rates and implement a monetary correction due to not reducing their payments effective July 1^st.

Babbie did a power point presentation at the Title VI Conference. The Karuk Tribe was showcased at this conference and Babbie did a wonderful job representing the Karuk Tribe.

Martha invited the Happy Camp Family Resource Center to be a guest speaker at the Health Managers meeting to become communicative of services offered in the community and resourceful for each other in those services.

Chuck has noted in his report that he would like some cross training between substance and alcohol abuse with mental health to better serve patients or clients. In particular, it is difficult to have men obtain treatment due to the stigma of behavior health treatment. Often men are willing to enter into drug and alcohol counseling, but avoid therapy.

Margo Kerrigan has sent notified to Tribal Leaders and Tribal/Urban Health Program Directors of site deficiencies and is now moving in to the “due diligence phase” on two different sites. In the North, a 23-acre parcel zoned for government use has been identified and for Butte County a site is being reviewed. This progression of a Youth Regional Treatment Center is a priority and this letter demonstrates some set backs for IHS in providing the much needed services for the youth of California.

Martha has one action item. She would like to seek approval of an agreement with Oregon Health Service University to obtain PA’s or PA students to participate in clinic experiences under the direct supervision of Dr. Hanst. This will provide a service to the physician assistants by providing them with training and experience, but also provide a service to our clients with Dr. Hanst supervising.

Upon review of the agreement it was noticed that no number was assigned, but the agreement had been approved internally and signed according to procedure. Barbara will obtain the number from Erin Hillman who assigns the agreement numbers.

Robert Goodwin motioned and Alvis Johnson seconded to approve agreement 08-A-017 between KTOC and Oregon Health and Service University, 7 haa, 0 puuhara, 0 pupitihara.

Florence Conrad motioned and Robert Goodwin seconded to approve Martha’s report, 7 haa, 0 puuhara, 0 pupitihara.

Non Health Employees:

1.) Erin Hillman, DAPC:

No show.

2.) Sami Difuntorum, KTHA Director: (4:22 – 4:49)

Sami is present and distributed information for the Council to review regarding the 2008 Indian Housing Plan. Specifically Sami would like to point out correspondence received from Karen Barnette, of HUD. Karen received the KTHA approved 2008 IHP but notified Sami that the included three Model Activities were unacceptable to HUD. Sami spoke with HUD and was advised that if KTHA does not remove the ineligible activities form the IHP then they will receive a technical deficiency letter. This means not receiving funding until the issue is resolved.

Other model activities that have been allowable have been a remodel of the house to a daycare center in KTHA of Happy Camp. The renovation of Headway was another. Those two items are examples of acceptable model activities, but the implementation of culture classes, feasibility of constructing a gas station and mini mart, and funds to support government functions is unallowable.

Sami will need to revise the plan for presentation to HUD, but will need approval from the Council of the plan. She would like to seek clarification on what the Council would like to submit based on their recommendations and the response from HUD.

The Council will discuss this further in closed session and send a response to Sami as soon as possible.

Closed Session: (6:47 – 8:42)

Robert Goodwin motioned Florence Conrad seconded to amend policy 10-105-013 CHS Residency Requirements, 7 haa, 0 puuhara, 0 pupitihara.

Florence Conrad motioned and Alvis Johnson seconded to approve agreement 08-A-016 between KTOC and Gary Wade, 7 haa, 0 puuhara, 0 pupitihara.

Robert Goodwin motioned and Leeon Hillman seconded to approve Clinic Provider letter to all providers effective immediately, 7 haa, 0 puuhara, 0 pupitihara.

Consensus: to table loan request from Tribal Member # 390 to the Wednesday Planning Meeting.

Consensus: to table loan request from Tribal Member # 982 to the Wednesday Planning Meeting.

Consensus: to table loan request from Tribal Member # 493 to the Wednesday Planning Meeting.

Consensus: to table request from employee # 0033 to the Wednesday Planning Meeting. Employee shall provide further information regarding alternate resources and funding needs to assist client in receiving care.

Robert Goodwin motioned and Florence Conrad seconded to approve travel of Arch Super and Daniel Pratt to Washington DC, July 23-26, 2008 for ACF Summit, 6 haa, 0 puuhara, 1 pupitihara (Florrine Super).

Employee # 6868 provided his tasks and activities update to the Health Board. It is understood that both the Health Board and employee are frustrated with the outcome of the program and the lack of progression. However, better communication of activities both daily and monthly shall be provided to clear any mis-communication of responsibilities and tasks moving forward.

Consensus: to table review and priority of tribal attorney’s to the Wednesday Planning Meeting.

Informational: inspection of program resulted in deficiencies and a corrective action plan will be implemented effective immediately.

Leeon Hillman excused himself at 7:49 PM

Consensus: to set a meeting with all grant writers of the Tribe outlining what grants are done, who administers them, and who is responsible for them. Active versus continual grants shall be noted including timelines of submittals or estimated funding schedules. Attendees shall be the Grant writers, DNR grant writers, health program personnel involved in grant writing, CFO and DAPC. The Council will meet with the group at a management team meeting and view all spread sheets of information and determine scheduling, responsibility and grant management based on information. Meeting shall be set for August either the third or fourth Monday.

Leeon Hillman re-entered the meeting at 8:09 PM.

Leeon Hillman motioned and Florence Conrad seconded to approve the letter to Dennis Wittelsey clarifying responsibility of contact and allowable costs based on approved assignments.

Florrine Super motioned and Florence Conrad seconded to approve travel for Hector Garcia and Arch Super to the Trust Consortium meeting on July 14, 2008, to Sacramento, CA. 7 haa, 0 puuhara, 0 pupitihara.

Robert Goodwin motioned and Leeon Hillman seconded to lower monthly payments to $25 per month and defer delinquent owing amount for six months for Tribal Member # 744, 7 haa, 0 puuhara, 0 pupitihara.

Directive: to employee # 8900 & housing director to meet July 11, 2008 to determine allowable model activities and inclusion of revisions to necessary model activities through writing, demonstrating the necessary impacts of the KTHA community through employment experience and self esteem building from training. If it is still undetermined of HUD approval then a formal request shall be made of the allowable model activities and forwarded in written form to the Council moving forward.

Council directive: to KTHA to order and install mirrors at Headway.

Consensus: for employee # 3146 to determine possible conflict between employee # 2966 and KTOC and the perception of ethical behavior. To determine reason for lack of reporting to board oversight committee of program and to follow up on employee # 4811 assignment to meet with Siskiyou County Behavior Health.

Consensus: to table possible Head Start travel to the Wednesday Planning Meeting.

Consensus: for Executive Assistant to contact IC of Six Rivers to confirm meeting with the Council at the upcoming Wednesday Planning Meeting.

Consensus: to sponsor employee # 9253 for 2008 Big Foot event, no monetary assistance is requested or noted and if they should arise employee shall re-present to the Council.

Consensus: to invite CRIHB to meet with the Council regarding membership to the D. Hostler fund and seek a clarification of the outcome from last years membership.

Next Meeting Date: August 14, 2008 at 3 PM in Happy Camp, CA.

Robert Goodwin motioned and Florence Conrad seconded to adjourn meeting at 8:42 PM, 7 haa, 0 puuhara, 0 pupitihara.

Respectfully Submitted,

_____________________________

Arch Super, Chairman

Recording Secretary, Barbara Snider