Karuk Tribe – Health Board Meeting

June 11, 2009 – Meeting Minutes

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

Present:

Arch Super, Chairman

Florrine Super, Secretary (late - 3:05 pm)

Roy Arwood, Member at Large

Florence Conrad, Member at Large (late -3:11 pm)

Sonny Davis, Member at Large

Verna Reece, Member at Large

Bud Johnson, Member at Large

Absent:

Leaf Hillman, Vice-Chairman

Leeon Hillman, Treasurer

Quorum is established.

Health Mission statement was read aloud by Sonny Davis, Member at Large.

Agenda:

Bud Johnson motioned and Sonny Davis seconded to approve the agenda, 4 haa, 0 puuhara, 0 pupitihara.

Minutes of May 14, 2009:

Verna Reece motioned and Sonny Davis seconded to approve the minutes, 3 haa, 0 puuhara, 1 pupitihara (Verna Reece).

Guests:

1. Pam Ames, 2010 Census:

Pam introduced herself as Pam Aimes as a member of the US Census Bureau. She is present to introduce census 2010 and recognize that the Tribe and the US Census have a unique government to government relationship. She would like to announce that the census information is really important and there only shows 833 counted Native Americans in this area. She understands that there are several more members than that, but that is an example of uncounted Native Americans and with a better working relationship both entities will be able to collect accurate data and share that information.

She would like to obtain create a collaborative working relationship and bring a liaison on board that will assist in facilitating working together. She would like a contact person to work closely with, to send and forward information to, regarding census work.

There are only ten questions in the census this coming year. This is a change as there used to be quite a large questionnaire. There is a new check list for Native Americans to ensure there is a more accurate count of Native Americans. The method used for self identification has changed as well. Small changes such as naming the head of household is an example of how the US Census questionnaire has changed; noting a Native American as head of household will count the entire household as Native American.

Mike wanted to know if the Tribe would have access to the information. Pam explained that she and nor her organization will share names and addresses period, however there are data sheets that are done and they release general data summaries. They could also provide customized data information and there are over 50 surveys that are done annually that may be accessed.

She works out of Chico CA and covers several counties. She is available to work more cooperatively and as time allows.

Arch believes that it is appropriate to work with the Enrollment Committee who conducts the Tribal Census. He will take the information she has brought and forward that to them to identify who would work with Pam.

Old Business:

None at this time.

New Business:

None at this time.

Director Reports:

1.) Daniel Pratt, TANF Director:

Daniel reviewed his written report with the Board. He explained the definition of “pending clients” means that the staff is still identifying paperwork needs and the client has not been officially named as a TANF client.

Daniel has action items to present for approval. He and the TANF staff have completed the TANF policies and procedures and would like to seek approved of them. The policies work hand in hand with the TANF plan including how clients enroll into the program and all the processes involved to appealing a denial.

On the Federal update, there is a passage in a section which is carryover funding for TANF. Basic assistance was considered food, shelter, clothing and other basics including administrative fees. Now, the re-wording includes that the funding may be used in other areas of the program. This is good for the Karuk Tribe.

Previously, with ACF the requirement to have purchases over $5,000 to be prior approval and that wasn’t done. There to be a request for approval to purchase if it was over $5,000. He received the verbal okay for the expenditures that he had over that amount but finally received the documented approval.

He has received the state funding that was needed to order to operate. There has not been a December reimbursement and it is still pending. The case count was received and reported correctly. Daniel thanked Cecilia for her work and the other staff members as well. There is training next month and he will be requesting out of state travel. Daniel, Alfonso, Anthony, Janelle, and Lisa will attend. The training is beneficial and it is provided by UC Davis. He was working with the Hoopa Tribe to bring UC Davis onsite for the training; however, it is cheaper to travel to the training for the staff to Shelton Washington. Daniel requested approval of the training. Daniel explained that all the case managers need the training and there is no lapse in services. Daniel explained that this training is a national training and moving forward he will rotate trainings.

Florrine motioned and Verna seconded to approve travel for TANF staff and Florence Conrad to Sheldon, Washington, 5 haa, 0 puuhara, 1 pupitihara (Florence Conrad).

Daniel has not received the MOU between the Karuk TANF program and Siskiyou County. He will continue to wait for the signed MOU to be returned and forward to Erin for processing once it is received.

The TANF policies procedures were tabled to Thursday for final approval. The next staff monthly meeting is in Happy Camp on July 10, 2009.

Florrine Super motioned and Florence Conrad seconded to approve Daniel’s report, 6 haa, 0 puuhara, 0 pupitihara.

2.) Mike Edwards, Behavioral Health Director:

Mike reviewed his written report with the board. His department has seen about 400 clients. The program has drafted the policies and procedures in compliance with the upcoming behavioral health accreditation. The policies were distributed about ten days ago for the Council to review and he would like to see them approved tonight. The Karuk Child and Family Services plan was approved and now the policies and procedures are now being presented to go along with the plan. Arch asked if any internal committees have reviewed the documents. Mike explained that Barbara Norman, April Attebury, Stephanie Dolan and he did review the documents.

Florence announced that the Council members that sit on thee committee work on these policies and procedures continually.

Florence Conrad motioned and Verna Reece seconded to approve the Karuk Child and Services Policies and Procedures, 6 haa, 0 puuhara, 0 pupitihara.

Mike explained that Kim Dodge will be completing parenting classes in Orleans soon. The classes that were offered in the Yreka area were successful and the group is happy to complete sessions in each community.

As of today the DUI license has not been approved in Yreka. Arch asked if it would be beneficial to have staff and Council meet with the licensing agency in Sacramento to determine what the delay in licensing is. Joe explained that there shouldn’t be a hold on this any further as they were waiting on an address and now that that has been received the licensing should go through.

Mike would like to change the department name and he will bring that back to the Council for formal approval. They would like to rename their department “Child and Family Services” as the name “Behavioral Health” seems to turn clients away.

Mike asked the Council for permission to provide insurance for the bike-a-thon during the reunion. With the reunion being planned for the River Park location, the bike-a-thon will not have space to complete child safety in collaboration with the CHP. Mike has sought permission to use the Happy Camp Elementary School parking area, but will be required to provide insurance prior to the event.

Alvis Johnson motioned and Florrine Super seconded to provide the insurance policy for the bike-a-thon event to be held during the reunion, 6 haa, 0 puuhara, 0 pupitihara.

Verna Reece motioned and Florrine Super seconded to approve Mike’s report, 6 haa, 0 puuhara, 0 pupitihara.

3.) Karen Daniels, DQMCH:

Karen distributed more policies for the Health Board to review. Karen reviewed her written report with the board. She has been diligently working on accreditation processes for the upcoming accreditation. There have been several inspections and YR clinic has been working very hard on cleaning up their facility. On Monday AAAHC has called and they have accepted the application. They will be here in August. They are looking at August 10^th and they will be sending two surveyors. They will review Yreka and Happy Camp and not travel to Orleans. In a day and half the traveling will be too much. They will be reviewing reports. She is attempting to get a midlevel provider for Orleans as well as credentialing for Yreka. She is also going to work on peer reviews and they are almost complete. The board report was submitted early because she was on travel. Her budget update wasn’t included as she was gone however she knows that it was right on track. Her computer crashed but Eric and Chad worked on getting her back up.

Karen provided the Nursing policies and several others tonight to seek approval of along with the policies that were already included in the packets. She is presented, Verbal Order, Release of Information – general, Information Management Training, The Reconciling of Medication across the Continuum of Care, Verification of Patient Identification and Surgical Site, Inactive Record Storage, Credentialing and Privileging Policy and Procedures (Barbara include the policy names from the packet).

Florence Conrad motioned and Alvis Johnson seconded to approve the policies, 6 haa, 0 puuhara, 0 pupitihara.

Florrine asked if Karen will provide accreditation training on AAAHC. Karen said that she would if the Council could pick a time that would work for them. The Council will add it as a topic to their planning session.

Alvis Johnson motioned and Florrine Super seconded to approve Karen’s report, 6 haa, 0 puuhara, 0 pupitihara.

4.) Patti White, Database Administrator:

Patti updated the board on her report. She announced that Happy Camp and Orleans is one week behind. Yreka is about two weeks behind. In April and May there were 29 documented requests for technical support. The workload reports were provided to the board. The numbers were down from April to March and a contributing factor was the last week in April closed all facilities for onsite EHR set up. Starting in July, Judy and Dr. Burns are going to go live with EHR. Some providers seem a bit reluctant to use the new electronic means of charting, but overall the support staff has taken the process and has really begun working with it. She is sure there will be challenges but things are moving along nicely. On June 18^th Phil Church and an onsite engineer will be here to meet with the generator committee. The Blue Shield Grant is to be spent by September 30^th and has been obligated toward the generator project. Vickie questioned this as it was her opinion that the funding was to be used toward IT needs, but was corrected, noting that the expenditure was allowable.

Her one action item is on behalf of the Yreka clinic. Michelle Charlesworth will need training on Medical Records related to EHR. This will also provide training on reporting and general data information collection. The training is July 13-16, 2009 in Albuquerque, NM.

Alvis Johnson motioned and Roy Arwood seconded to approve out of state travel for Michelle Charlesworth to Albuquerque NM July 13-16, 2009, 6 haa, 0 puuhara, 0 pupitihara.

Verna Reece motioned and Sonny Davis seconded to approve Patti’s report 6 haa, 0 puuhara, 0 pupitihara.

5.) Eric Cutright, IT Director:

Eric provided a request for approval of procurement for 7 computers. The new laptops will be for Council Members and the staff listed on his procurement.

Florence Conrad motioned and Florrine Super seconded to approve procurement and allow the purchase of the computers, 6 haa, 0 puuhara, 0 pupitihara.

Eric then presented a request to purchase software for the Yreka clinic provider. The software allows providers to speak into the computer and their notes appear on the page. The reason this software is so expensive is because it has an extensive medical library. He will use the Yreka facility as a test site and if proven to be effective, useful and cost efficient then he will evaluate the use in the other facilities.

Florence Conrad motioned and Florrine Super seconded to approve procurement and allow the purchase of medical IT software in the amount of $2,222, 6 haa, 0 puuhara, 0 pupitihara.

There is stimulus money for broadband connection along the river. There is a group of individuals around the County and from the Tribe that are attending meetings regarding the additional service to the area and funding to receive the service. Siskiyou Telephone was in attendance at one of their broadband meetings which will be useful if they choose to collaborate.

Verna Reece motioned and Florence Conrad seconded to approve Eric’s report, 6 haa, 0 puuhara, 0 pupitihara.

6.) Vickie Walden, Dental Office Manager:

Vickie apologized for not having her report done on time. Pat Doak and Donita Hill attended training and those reports were provided to the Board to review.

Dr. Madkins schedule for leave in July will be July 2-9, 2009. Dr. Bardonner was able to schedule appropriately to provide limited service availability in the Yreka facility since there is no dentist here.

The Bright Smiles Program saw 17 children in collaboration with the Family Resource Center and Nikki Hokanson. There are a few more that may come in. The Bright Smiles program is a two year program and they will participate next year as well. The next report will include several months for the visit count as she hasn’t provided the numbers for three months. She does off hand know that the numbers are increasing. She will be watching the California budget to see how the patient load will be affected with the slated cut of adult denti-cal. She has some concerns over the budgets. The State IHP is concerning as it shows a couple line items with very low funding, and she will attempt to evaluate what can be completed and working on budget restrictions to ensure the best service possible. Vickie believes that the Native American dental lab is very low and she believes that the Karuk Tribe is the only tribe that doesn’t make Native Americans pay for outside lab work. She announced that the dental lab line item for Native Americans has a remaining balance of a little over $1,500 while the non Native American lab line has approximately $14,000.

Vickie will send an email regarding a planning session on Non Native American and Native American dental lab to ensure all staff is prepared to review this.

Verna Reece motioned and Roy Arwood seconded to approve Vickie’s report, 6 haa, 0 puuhara, 0 pupitihara.

7.) Lessie Aubrey, EDHHS:
Lessie is present to review her report with the Health Board. Lessie distributed the CRIHB advisor for the board to review.

At the Self Governance conference the Health Directors decided to put together questions for the reduction in MediCal and DentiCal services for the health program.

Lessie provided an update on the budgets for this fiscal year. The third party budget is 20.62% used. Lessie is reviewing the 3^rd party budget as several line items are overspent. She then reviewed the patient assistance program benefits announcing the thousands of dollars saved in medications for the patients in the communities.

Phil Church has contacted Lessie with information that IHS has funding for painting for the clinic facilities. She then announced that there will be two youth workers onsite that may do a lot of pre facility work. Florence would like the community room and the kitchen painted and the designs posted back on the wall for the Orleans DNR main room.

Verna Reece motioned and Roy Arwood seconded to approve Lessie’s report, 6 haa, 0 puuhara, 0 pupitihara.

Closed Session:

Consensus: to table review of the DUI program to Thursday’s planning meeting.

Consensus: to table CHS request to Thursday’s planning meeting.

Consensus: to table loan request from Tribal Member # 0390 to Thursday’s planning meeting.

Consensus: to have Tribal Member # 0361 to work with the Education Coordinator on complaints regarding graduation ceremony.

Verna Reece motioned and Florence Conrad seconded to approve the newsletter and forward for printing, 6 haa, 0 puuhara, 0 pupitihara.

Arch Super excused himself from the meeting.

Florrine Super excused herself from the meeting

Florence Conrad motioned and Sonny Davis seconded to submit a letter to DOJ, 3 haa, 0 puuhara, 1 pupitihara (Roy Arwood).

Florence Conrad motioned and Verna Reece seconded to approve travel for Leaf Hillman to Sacramento CA, March 9-13, 2009 4 haa, 0 puuhara, 0 pupitihara.

Consensus: to table request from employee # 5091 to Thursday’s planning meeting.

Roy Arwood motioned and Sonny Davis seconded to approve credentialing and privileging of Dr. Goodwin 4 haa, 0 puuhara, 0 pupitihara.

Florence Conrad motioned and Verna Reece seconded to adjourn the meeting at 6:36 PM.

Respectfully submitted,

______________________________

Arch Super, Chairman

______________________________
Alvis Johnson, Member at Large

Recording Secretary, Barbara Snider