Karuk Tribe – Health Board Meeting

Meeting Minutes – December 15, 2011

Annual Meeting

Meeting called to order at 3:00pm by Chairman, Russell “Buster” Attebery

Present:
Russell “Buster” Attebery, Chairman

Michael Thom, Vice-Chairman

Joseph “Jody” Waddell, Secretary/Treasurer

Dora Bernal, Member at Large

Wilverna “Verna” Reece, Member at Large

Charron “Sonny” Davis, Member at Large

Alvis “Bud” Johnson, Member at Large

Crispen McAllister, Member at Large

Absent:

Florence Conrad, Member at Large

Dora Bernal read the Mission Statement of the Karuk Tribe and Sonny Davis did the prayer.

Buster announced that with the recent wellness center proposals that have been submitted, and which will greatly affect the Yreka area. The staff has worked very hard on that proposal and he hopes to see it funded.

Agenda:

Michael Thom motioned and Bud Johnson seconded to approve the agenda, 7 haa, 0 puuhara, 0 pupitihara.

Minutes of November 3, 2011:

Corrections: Robert presented travel for the self-governance conference, which is in 2012 not 2011. Closed session: Crispen and Verna attended the CNIGA meeting.

Verna Reece motioned and Dora Bernal seconded to approve the minutes with changes, 7 haa, 0 puuhara, 0 pupitihara.

Guests:

None at this time.

Old Business:

None at this time.

Director Reports:

1.) Daniel Pratt, TANF Director:

Not present, written report provided.

Dora Bernal motioned and Sonny Davis seconded to approve Daniel’s report, 7 haa, 0 puuhara, 0 pupitihara.

2.) Mike Edwards, Children and Family Services:

Mike provided a revised report from his department. He then went on to announce that Amy Coapman has friends and family that provide donations to the Social Services offices that is in turn distributed to the children of the program. This year Amy’s mother provided a check for $100 and he is requesting that he be allowed to purchase hams and turkeys for the families that he serves.

Crispen McAllister motioned and Dora Bernal seconded to approve Mike to provide a necklace from the People’s Center up to the value of $100 with a thank you card to the individuals that are providing the donations to the Tribes children and families of Social Services, 7 haa, 0 puuhara, 0 pupitihara.

Mike then presented a resolution regarding customary adoption. The ICW Committee has approved this, and the language in the resolution is different due to the first time this being done. The resolution is 11-R-137.

Dora Bernal motioned and Michael Thom seconded to approve 11-R-137, 7 haa, 0 puuhara, 0 pupitihara.

Mike then went on to review his report. He noted that there were over 300 clients seen in the month, and within the year there have been over 5,000 contacts.

The departments Quality Improvement project will continue through the first of the year and they will evaluate if they will continue to do the same project or select a different one. The department did a project on quality improvement relating to clinic cancellations and throughout the year monitored it.

Joe Snapp is returning to work. Kristen Aubrey is doing a wonderful job and he commended her for taking on Joe’s program while maintaining her duties during his absence.

The transporter transported 82 people this month and in a year she has transported over 600 people/clients.

There has been a case transferred into Tribal Court, and he assumed it would be a Title IVE but it is not.

Verna Reece motioned and Crispen McAllister seconded to approve Mike’s report, 7 haa, 0 puuhara, 0 pupitihara.

Michael Thom noted that the Chairman attended a meeting with Sheriff Lopey and the Sheriff commended a wonderful job of the Social Services Department. Michael thanked the department for that work and the acknowledgment of local officials on the staff’s outstanding jobs.  

3.) Dr. Burns, Medical Director:

Lessie announced that Dr. Burns was having an influx of patients and may attend later. According to AAAHC he is to report on the activities of the Medical Department and Quality Management so his report covers those projects.

Dora Bernal motioned and Verna Reece seconded to approve Dr. Burns’ report, 7 haa, 0 puuhara, 0 pupitihara.

4.) Lessie Aubrey, EDHHS:

Lessie is present to review her report with the Health Board. She attended a Corporate Compliance Training that was put on by HRSA. She noted that the Government has a fraud an abuse program and they audit billing and coding of the health program to ensure compliance with federal laws. Lessie then overviewed some regulations of the compliance rules and how to fix errors when made.

Lessie then noted that the staff is provided with training and she noted that she is hoping to find some legally competent health specific lawyers to refer to in the case of an error being identified as well. She briefed what a whistleblower is and the laws that protect them from being retaliated against when notifying or reporting fraud. Lessie then went on to note that the Karuk Tribe cannot employ persons disbarred from the OIG, so this provides a level of assurance that the program is not working with persons that have been found guilty of committing fraud or abuse. The Council Members that sign the credential files with their initials verify that the persons that will be excluded from the OIG.

The Health Program also has a 340B program. There were years where the Tribe was under Indian Health Services which regulated which patients could receive the reduced fee medications to only Native Americans. Being the recipients of HRSA funding the Tribe can now provide reduced fee medications to all the patients of the health program that qualify.

Lessie outlined which programs can provide onsite review of records, explaining what compliance is and what it incorporates to protect a program from audits, fines and penalties.

She noted that the FTCA is the same as malpractice insurance within the employees’ scope of work. The Tribe is covered under IHS and also with HRSA.

The low income health endeavor is done and this assists patients that are low income and it is a bridge program. In 2014 there will be a large amount of people eligible for MediCal, so the Tribes are working on having patients enrolled to prepare for this.  

Lessie then noted that CRIHB is seeking an additional $270,000 for enrolling patients into a low income assistance program. With Verna’s attendance to CRIHB meetings she has provided information that there seems to be some confusion regarding this program and it has several reimbursement issues. Vickie Walden noted that this has been being pushed in different formats throughout the years. Lessie noted that yes, it has been and it appears to be moving toward managed care.

Lessie inquired if the Council would like set a meeting with Jim Crouch of CRIHB to discuss this. Laura Mayton noted that it doesn’t hurt to listen but there needs to be some more information provided; with the cut to the Contract Health Services budget. Laura noted that this is not the first time CRIHB has developed a similar avenue. Lessie will schedule Jim Crouch to attend, but the Council is not interested in meeting with him at this time.

Lessie then went on to explain 340B auditing that is required each year. After attending training she found that the Tribe was out of compliance. The necessary steps were taken to identify the savings and found a program that could provide the auditing and reporting service for the Tribe.

Lessie has spent some time working on the new clinic project for Happy Camp and she is hoping that this is funded, because a facility in happy camp is severely needed.

She provided a copy of the National Congress of Native Americans resolution. The resolution is stating that the Federal Government wants a direct service to Native Americans as opposed of services being operated through the individual States. She would like the Council to review this information.

Verna Reece motioned and Sonny Davis seconded to approve Lessie’s report, 7 haa, 0 puuhara, 0 pupitihara.

5.) Annie Smith, Director of Community Services:

Annie provided her report to the Council and is present to review it with them.

She has noted that she has been employed with the Tribe for one year. She thanked everyone for being so patient with her and noted that there was a lot to learn. She thanked Laura Mayton and Laura Olivas for their assistance, specifically in the compliance portion of her position.

She then provided information that the Tribe received their diabetic grant for this year. This was her first year applying for this grant and it was quite complicated.

The immunization program is doing better if she focuses on it 100% at each clinic. However, during rotation to the other clinics, then one clinic seems to drop in numbers. She will continually work on the immunization numbers, assisting the clinics as much as possible.

Flo is having emergency fire drills and is excelling at her safety officer duties.

The program received a teen prevention grant that will fund the development of a teen pregnancy prevention program in the local community. She will provide further information as they move along but she did note that they have already begun doing focus groups.

The outreach program is providing a lot of services. The Elders workers continue to work with elders that are in the early stages of developing Alzheimer’s disease or dementia. She would like the Council to consider an elders facility in Happy Camp as a long term goal. Michael noted that that was offered in Happy Camp and was unable to sustain itself. Flo noted that Yreka would be a better place and that KTHA did not allow time for that whole concept to develop. Annie noted that across the nation there is anticipation of an influx of Elders and she hopes that the Tribe is prepared.

Buster asked if there was a person that provides services to the Elders with B/P checks and well just check ups to see if there is anything the Elders are in need of, on a routine basis. Annie noted yes, but there is not enough staff to ensure that it is done frequently. She noted that Flo is providing services for emergency preparedness and CPR, so with all those activities there isn’t time for home visits. When providers provide referrals then those Elders are identified and monitored in the health system.

Jody inquired if there are services that are prioritized so elders receive some sort of checking or visits. He asked if the Elders were a higher priority than CPR classes. Flo noted that no, there is not enough time. Buster, Dora and Jody agree that the Elders are a high priority and need to be taken care of and are a priority of the Council’s. Annie will provide a recommendation to the Council regarding services.

Crispen McAllister motioned and Sonny Davis seconded to approve Annie’s report, 7 haa, 0 puuhara, 0 pupitihara.

6.) Vickie Simmons, Clinical Operations Administrator:

Vickie is present to review her report. She would like to seek approval of policies for the health program. The ACQI Committee has reviewed them and they have been signed off by the Medical Director.

Dora Bernal motioned and Michael Thom seconded to approve the policies; 20.10.12, 30.10-15, 05-001-210, 05-001-220, 05-005-225, 05-002-226, 06-004-277, 10-000-420, 11-000-420, 11-000-583, 11-009-625) as attached to her report, 7 haa, 0 puuhara, 0 pupitihara.

There were no complaints in the month of November but she has already received some for December, which she will evaluate and investigate. The complaints and incidents for the year were 6 and for incidents there were 32. The other information is the ACQI Meeting Minutes and the policies for their information, which were also attached to her report.

Michael asked that the policies be provided earlier and allow the Council time to review them. Sometimes the amount of information is overwhelming and maybe she could provide less at a time. She has to have them approved prior to accreditation so that is why they are all being done this way right now, she will attempt to streamline this moving forward.

Michael Thom motioned and Sonny Davis seconded to approve Vickie’s report, 7 haa, 0 puuhara, 0 pupitihara.

7.) Chad Tiraterra, Database Administrator:

Chad is present to review his report. He noted that RPMS has been upgraded recently to accommodate e-prescribing. Amy is now working on additional updates to ensure the program is operating smoothly.

He again provided the clinic workload reports for the Council to review.

Verna Reece motioned and Dora Bernal seconded to approve Chad’s report, 7 haa, 0 puuhara, 0 pupitihara.

8.) Eric Cutright, IT Director:

Eric is present to review his report. He has four action items in his report. 2 are agreements with KTHA and KCDC for IT services. And the other 2 for broadband will be tabled to the Orleans Council Meeting.

Eric then noted that the agreements with KTHA and KCDC have been reviewed by the KTHA staff and KCDC staff. Some IT staff is going to be moved around and brought under the Tribes umbrella with him supervising them but those programs paying for salaries to ensure they receive adequate services. Eric has discussed this with both boards.

Crispen would like to have KCDC’s agreement tabled to allow time for the Board to review it prior to the Council voting on it.

Both agreements may need to be tabled and reviewed with the boards. Eric provided the background on the previous services that were rendered to the other programs and how they work with each other and the Tribes IT Department.

Consensus: both agreements will be tabled to next week to allow the oversight boards to review and approve them first.

Eric then noted that the Zoom’s are no longer provided and the Council approved for 2 replacements to be ordered. Eric will provide a recommendation back to the Council next week on his recommendation of equipment that is similar.

He then noted that at the Planning Meeting the Smartphone’s should be upgraded to allow for insurance. His question on the insurance was to cover all Smartphone’s and the Council would like to review this because they instructed him to provide insurance on the phones that are used a lot and cost the most to replace.

Verna Reece motioned and Crispen McAllister seconded to approve Eric’s report, 7 haa, 0 puuhara, 0 pupitihara.

9.) Vickie Walden, Dental Office Manager:

Vickie introduced Dr. Shone the dental director for the Tribe. The dental staff yearly report covers that the Tribe received acknowledgement of being one of the 10 top lists of health facilities in the Nation. Dr. Bardonner has resigned. Dr. Carolyn Ash was introduced from Coos Bay, OR as the replacement for Dr. Bardonner.

Dr. Ash comes from a long line of dentists, has orthodontic experience and endodontic experience.

Dr. Shone noted that Dr. Sheppard will be here at the first of the year and will be operating out of the Happy Camp Clinic.

Crispen McAllister motioned and Jody Waddell seconded to approve Vickie’s report, 7 haa, 0 puuhara, 0 pupitihara.

10.) Suzanna Hardenburger, Business Office Manager:

Suzanna introduced herself and her position outlining what she does. She provided her annual report and the monthly report.

She continues to have issues with the data entry in Yreka and is brainstorming options on ensuring that facility stays up to date.

She is seeking the Council’s approval to send patients to collections due to uncollectable accounts. These accounts are from people that are refusing to pay for services and the medical department is unable to collect. The Tribe has never forced patients to make a mandatory payment in advance.

One of her goals is to receive funding upfront at the time of the visit.

Michael Thom motioned and Crispen McAllister seconded to approve sending patients to collections who have refused to pay, 7 haa, 0 puuhara, 0 pupitihara

Verna Reece motioned and Dora Bernal seconded to allow the write off of $4,000, 7 haa, 0 puuhara, 0 pupitihara.

Laura noted that the billing office did bring in over 1million dollars in revenue and she recognized their good work and diligent billing practices to recoup payments.

Verna Reece motioned and Jody Waddell seconded to approve Suzanna’s report, 7 haa, 0 puuhara, 0 pupitihara.

Guests, Non-Health:

1.) Dolores Voyles, Enrollment Department:

Dolores is present to seek approval from the Council to release addresses from Enrollment to KTHA. There was a suggestion to have the mailing done through the Enrollment office as done in general practice for all departments, reducing the number of people that have that confidential information.

Consensus: the mailing will be sent to Enrollment to complete for KTHA.

2.) Laura Mayton, CFO:

Laura is present to seek approval of action items. She first would like approval of resolution 11-R-141 to the OST for the Council Members to conduct business on behalf of the Tribe.

Dora Bernal motioned and Michael Thom seconded to approve resolution 11-R-141, 7 haa, 0 puuhara, 0 pupitihara.

Laura then noted that an addition to the fiscal policy is to outline a general fund and the RSTF. She believes the policy is a “no brainer” as it outlines spending what the Tribes priority is, but the GSA Beacon organization requires it.

Dora Bernal motioned and Crispen McAllister seconded to approve section 26 spending policy, 7 haa, 0 puuhara, 0 pupitihara.

Laura then sought approval of a revision to the travel policy to limit the number of checked bags allowable by staff when they travel. Exceptions can be made as presented later to the Tribal Council on a case by case basis.

Verna Reece motioned and Crispen McAllister seconded to allow only checked piece of luggage while on travel for the Tribe, 7 haa, 0 puuhara, 0 pupitihara.

Laura Mayton noted that at the RV Park there is a lady that makes a garden she would like to give her a $50 gift card for continually working in that garden and doing a great job. She cleans it, maintains it, plants it and donates the items to the RV residents every year.

Verna Reece motioned and Bud Johnson seconded to provide $50 to the nice garden lady from Council Discretionary, 7 haa, 0 puuhara, 0 pupitihara.

Then Michael asked Laura to provide information on purchasing a vehicle for the courier. Sara did procurement and through comparison the cheapest vehicle is a Ford Focus for $16,676.60.

Laura is asking for this to be purchase from Jim Wilson Ford and will be purchased through Ishpuk Leasing and payments made by Third Party.

Michael Thom motioned and Crispen McAllister seconded to approve procurement and allow the purchase of a vehicle for the courier service, from Jim Wilson Ford, in the amount of $16,676.00 from Ishpook Leasing, 7 haa, 0 puuhara, 0 pupitihara.

Anna Myers, CHS Policies:

Dora Bernal motioned and Michael Thom seconded to approve CHS policies including levels of care with the change to “l”, 7 haa, 0 puuhara, 0 pupitihara.

Informational: Tribal Member #3242 was present to provide a report in process failing within the Tribe. Their request is to have it reviewed and the Council will have the issue reviewed, specifically and identify if there is a process problem.

Consensus: Employee #4895 has several action items to present and also requests direction moving forward for the Department Committee. The Committee will be tabled to Thursday’s Planning Meeting. Roll #131 request will be tabled for TANF to review. Roll #3198 will be tabled for TANF to review.

Crispen McAllister motioned and Michael Thom seconded to approve assistance in the amount of $170.41 for Tribal Member # 2527 from LIAP Discretionary, 7 haa, 0 puuhara, 0 pupitihara.

Dora Bernal motioned and Bud Johnson seconded to allow for one nights lodging for transient that arrived at the meeting, from Council discretionary, 7 haa, 0 puuhara, 0 pupitihara.

Dora Bernal motioned and Crispen McAllister seconded to approve Dr. North’s re-appointment, 7 haa, 0 puuhara, 0 pupitihara.

Michael Thom motioned and Bud Johnson seconded to seat Tribal Member #2570 to the ICW Committee, 7 haa, 0 puuhara, 0 pupitihara.

Consensus: to table the KTHA Board seating until all information is disclosed to the Tribal Council.

Jody Waddell motioned and Bud Johnson seconded to appoint Michael Thom to the CRIHB Board after Verna Reece’s resignation, 7 haa, 0 puuhara, 0 pupitihara. (Delegates are Michael Thom, Jody Waddell and Dora Bernal as an alternate).

Michael Thom motioned and Sonny Davis seconded to approve travel to the Self-Governance Conference for Dora Bernal, Buster Attebery and Jody Waddell to New Orleans, LA May 2012, 5 haa, 0 puuhara, 2 pupitihara (Dora Bernal and Jody Waddell).

Michael Thom motioned and Sonny Davis seconded to have Dora Bernal to attend the LLC Meeting February 27, 2012 in Sacramento CA, 7 haa, 0 puuhara, 0 pupitihara.

Consensus: to deny the loan request from Tribal Member # 2645 and refer to TANF for assistance.

Consensus: to deny the loan request from Tribal Member #3155 for inconsistent paperwork and documentation.

Dora Bernal motioned and Verna Reece seconded to approve resolution 11-R-144, 7 haa, 0 puuhara, 0 pupitihara.

Request: for Barbara to schedule a follow up meeting with Sheriff Downy.

Next Meeting Date: February 9, 2012 at 3pm.

Crispen McAllister motioned and Bud Johnson seconded to adjourn the meeting at 8pm, 7 haa, 0 puuhara, 0 pupitihara.

Respectfully Submitted,

______________________________

Russell “Buster” Attebery, Chairman

Recording Secretary, Barbara Snider