Karuk Tribe of
Annual Health Meeting
November 08, 2007 – Meeting Minutes
Meeting called to order at 3:11 PM by Arch Super,
Chairman
Present:
Arch Super, Chairman
Florrine Secretary, Secretary
Leeon Hillman, Treasurer (3:31
PM)
Robert Goodwin, Member at
Large (6:01 PM)
Roy Arwood, Member at Large
Sonny Davis, Member at Large
Alvis Johnson, Member at
Large
Absent:
Leaf Hillman, Vice-Chairman (conflicting
meeting / excused)
The Health
Agenda:
Florrine Super motioned
and Leeon Hillman seconded to approve the agenda, 5 haa, 0 puuhara, 0
pupitihara.
Minutes of October 11, 2007:
Florrine Super motioned
and Leeon Hillman seconded to approve the minutes of October 11, 2007, 5 haa, 0
puuhara, 0 pupitihara.
Guests:
Formally she was involved in
this type of work in another location and would like to return to doing this
work that she loves in this community.
Arch mentioned that there is
limited space currently and possibly
Martha has reviewed the
proposal and she is putting it on the Managers Meeting agenda for avenues of
discussion and collaboration. Bud suggested having it presented to Housing too.
Old Business:
None at this time.
Director Reports:
1. Dr. Steve Burns, Medical Director:
Dr. Burns provided his report
to the Health Board and explained that his summary report provides a detailed
list of the goals and standards to update the board on projects that the Health
Program is working on.
On the medical aspect Dr.
Burns highlighted the fact that there have been strides made on GPRA. The
federal government wanted to see the progress of health care across the nation,
and currently KTHP is monitoring 21 GPRA indicators.
David Eisenberg, Karen
Daniels and others have chosen areas to really focus on, including, Ha1c,
diabetic eye exams, flu vaccine, and immunizations. There have been extreme
improvements in the indicators reaching or excelling the national goal. Dr.
Burns explained that if there is focus on the indicators they really rise.
The health program continues
to monitor performance improvement activities. Some examples of their projects
include colonoscopies and blood pressure control.
A new doctor was hired in
Yreka and he is a welcomed addition that provides strong leadership.
The loss of x-ray capability for
the Happy Camp Community was a loss of service, but will be re-established
soon.
Pay for performance is
coming, and that means that the funding received will be upon successful and
beneficial performance provided to patients.
CMS has mandated that pay for
performance be in effect in 2001, but IHS is working on this and serving as a
buffer until truly implemented across the nation. If the HRSA funding is not
received, then in his opinion there must be funding sought to continue the GPRA
nurse to keep someone on board controlling and monitoring the GPRA indicators.
Arch asked if the GPRA coordinator is still on staff. Karen Daniels is the GPRA
nurse and will remain on staff, but there is still no word on the HRSA grant in
which she is paid from.
Continuing down the road to
EHR this will assist in documenting and assisting in performance.
A pandemic flu plan will be
drafted and approved in December to dove-tail with what Erin Hillman is doing
in the Tribal Emergency plan.
Moving from JCAHO to AAAHC is
good and needs to continue. Lessie is working on the switch in accrediting
bodies.
Dr. Burns will be meeting
with Dr. Tom Carlton on Kari Naargard’s documented reports regarding the
diabetic alterations of the diet for Native Americans in this area.
Dr. Burns is having some communication
with possible person for physical therapy services in the local area.
CHS spending on medications
is always a challenge due to the high cost of drugs across the nation, but it
is monitored as effectively as possible.
Martha is continuing to work
with other organizations promoting wellness for Tribal people as well as other
community members.
The current performance
improvement activities of the Health Program include mental health, substance
abuse, eligibility worker activities, medical records reports, blood pressures,
child immunizations, dental sealants, fluoride RXS, HPV, Patient ID, and the Employee
satisfaction survey. These various performance reports aren’t completed, but
will be done, and striving for improvement is key.
The flu clinic offered
services to the community and completed more vaccines in two hours than the
Public Health department did in three communities in a whole season. Karen and
David will be asked to provide a news brief to the paper on it.
Roy Arwood motioned and
Florrine Super seconded to approve Dr. Burns’ report, 5 haa, 0 puuhara, 1
pupitihara (
2. Suzanna Hardenburger, Business Office Manager:
Suzanna explained that she
provided several revisions to her department upon her new position as the
Business Office Manager to increase communication. The restructuring has
successes and failures but they are overall pleased with the outcomes. The
office space is nicely remolded and working well for space.
Suzanna updated the Health
Board on effective communication and working with each other.
She has tried to encourage
staff to attend training and position specific training. She would like the
staff to have more mental health training to beef up that aspect of the billing
office and coding specific.
Suzanna explained
clearinghouse billing processes and she will be further investigating this in
the future. She will be drafting some policies and procedures and updating the
office as necessary. All staff members are being cross-trained to work with
each other and in different aspects of the billing office.
The age report shows 120+
days at $96,000 and this is the lowest it has ever been. That is due to the
staff working hard on denials and re-submitting claims. There are also
additional receivables being received.
Florrine Super motioned
and Roy Arwood seconded to approve Suzanna’s report, 6 haa, 0 puuhara, 0
pupitihara.
3. Lessie Aubrey, DQMCH:
Lessie explained that her
report is late due to computer issues. She further explained that in November
of last year it was discussed to switch from JCAHO to AAAHC. Norlyn and Lessie have
received training on the new accreditation body, and there are minor changes in
the accreditation bodies, but she believes that the switch is definitely
possible with little disruption. There are some standards that need more
in-depth details and other standards that need less reporting than what JCAHO
required.
The State IHP visited and KTHP
received good scoring. The Health Program is reviewed by the State and
periodically receives suggestions, but does well.
The Pharmacy Consultant
visits are done quarterly and when applying for a pharmacy license then it may
not be necessary on tribal land. Lessie explained the hesitation in applying as
the time frames are lag, and the communication isn’t well with any licensing
and certification places do to the lack of requirements on tribal lands.
Accreditation issues are
handled at the Managers Meetings now and CQI only handles performance
improvement reports.
There are a few standards for
substance and alcohol abuse specific items that may be used to move toward
increasing communication and getting their departments accredited.
Lessie assisted Hester in
writing the five year plan in the HRSA grant.
Notice of name changes and
location of the clinic have been sent to CLIA, Board of Pharmacy and the State
Clinic Licensing and Certifications. She will be exploring this possibility of
moving to exempt status since the facility is on tribal land.
Lessie attends every staff
meeting at the clinics which provides her the opportunity to train staff on
standards.
The strategic planning
session has been scheduled December 10, 2007 at 9:30 am.
Lessie is nominating the
Health Program for an award at the upcoming employee awards ceremony for the
Tribe. She explained that not only the clinics, but the whole health program
because the clinic move was due to a lot of teamwork met those needs and worked
together.
Lessie noted her goals for the
upcoming year in her report. She would like to set a date to move to AAAHC and
several others.
Florence Conrad motioned
and Alvis Johnson seconded to approve Lessie’s report, 6 haa, 0 puuhara, 0
pupitihara.
4. Joe Snapp, Substance & Alcohol Abuse Program:
Joe pointed out that he was
the only staff member on board two years ago that worked specifically on
substance and alcohol abuse and now the need is so large that there are several
staff members on board in this field. Joe does feel that there is a need to
have more staff in the field assisting clients. He’s feeling the crunch of the
lack in knowing if there is enough staff from the HRSA grant to sustain the
program. There are other grants available, but it is a timely process.
There is no data from
Joe is still working on the
DUI certification for the Tribe. He is having Barbara Norman work on it, and
the contact assured Joe that she is sending him the correct forms to be
completed to move his process along. It has been approved on the County level
and still attempting to be done at the State level.
Joe explained the high demand
of social workers to meet the communities’ needs with mental health services
and family interventional services. He would like to see more staffing to
assist in the demand of needs.
Dr. Burns questioned what the
family resource center is doing regarding mental health services, as he has
read that they were funded to incorporate services in the communities.
Carrie Davis explained that
the
Sonny
5. Martha Schrock, EDHHS:
Martha explained that the
managers really had the opportunity to work on their goals and identify their
successes over the past year. Martha provided an overview of her report. She
identified areas of communication that needed improvement and now she has
fostered that and definitely sees improvement with the inclusion of the
behavioral health aspect of the Tribe to the entire Health Program.
The communication bridge
created with the programs is working really well. The 2008 goals will be to
continue development of the Title IV E agreement and staff training, develop
training and certification of Karuk Tribal foster homes and foster parents,
develop MOU’s with Remi Vista and KTHA, develop social service billing system,
and coordinate social services and behavioral health under a director that will
answer to the Executive Director. These are attainable goals and Martha
believes that the Health Program is on track to achieve them.
A dentist was interviewed
this past Monday. There were some interview cancellations, but one interview
was successful. If no confirmation is received by tomorrow regarding the
cancellations there may be an offer submitted to the interviewee that was
interested in the position. However, the staff is really hesitant to miss
opportunities.
Martha reviewed the clinical
goals submitted by their sites. Orleans goals include improve quality of
preventative health care, improve quality of chronic health care, integrate
behavioral health into daily operation of the clinic, emphasize patient
education, improve consistency of medical records, act as first site within the
Karuk Clinic system to convert to the electronic medical records, and stabilize
medical staffing. Dr. Willett has begun the work toward their clinical goals
and has been working closely with outreach staff to meet his incorporating
goals with social services to the patients in their area, really taking the
lead to service his community.
The Happy Camp clinic goals
are to give the best patient care possible, to treat every patient with the
same respect and sensitivity, to foster respect, job satisfaction, and team
spirit among staff and to increase community awareness and participation in
their own healthcare.
Dr. Burns announced there is
a grand opening of the Karuk Community Health Clinic November 19th
at Noon. It will be at the Gym and he would like everyone to attend to view the
new facility that the Tribal Council had remolded to resolve the facility
location issues.
Roy Arwood motioned and Sonny
Davis seconded to approve Martha’s report, 6 haa, 0 puuhara, 0 pupitihara.
6. Chris Kleeman, IT Manager:
Chris is present tonight and he
updated the Health Board providing a summary of the IT Department.
Unmet needs were listed in
which he also included his 2008 goals. His goal overall for the IT department
is to provide for the entire Tribes communication needs with a focus on
maintaining services to key programs. Continue to integrate the entire Tribe
into one heterogeneous network with redundant connections to key facilities.
Minimize costs in technology by exploring new services and making use of
standards based on software and hardware as well as making use of open
technology such as Linux.
Chris is working on the
Administration / Housing building in Yreka and is experiencing delays by the
phone company. He is hoping to ease the error with equipment to use hardware to
the get the building up and running smoother however, it isn’t completed yet.
The phone system needs set up
soon and there are phones ready for installation, but it hasn’t been hooked up.
The phones are in his office. Chris apologized to employees and staff for
having outbursts during stressful times.
Roy Arwood motioned and
Leeon Hillman seconded to approve Chris’ report, 6 haa, 0 puuhara, 0
pupitihara.
7. David Eisenberg, PHN:
David is present tonight to
review his report with the Health Board.
David provided his safety
report for the Health Board. He summarized his reports for the Health Board on
safety, infection control and GPRA. There are ongoing challenges for snow
removal at the Happy Camp complex. The security really isn’t an issue. Hazardous
materials space is needed but it will be figured out. All the fire drills have
been completed and the emergency drills will be done shortly.
The drive by flu clinic has
submitted a press release to the newspaper.
David would like to address
the facilities management. There is an area of concern. In Happy Camp there are
operational issues if there is the loss of power during the fall seasons. If
the system goes down, with limited access to the back up system then there are major
concerns for the flow of operations. David is concerned that the loss of power
is terrible, but the loss of vaccines due to power outages is terrible.
David handed out a summary
from Karen Daniels as the GPRA nurse. She is funded from the HRSA grant and to
date has not received word on funding from HRSA.
Florence Conrad motioned
and Florrine Super seconded to approve David’s report, 6 haa, 0 puuhara, 0
pupitihara.
The turkey trot is November
17, 2007 at 10 AM in Yreka rain or shine.
8. Patti White, Database Administrator:
Patti is present to review
her written report with the Council. Her regular report has updates on the
changes to RPMS and new server additions.
Patti has received EHR
updates and explained progress for the facilities. There are continued efforts
to increase the packages needed in RPMS to ensure that it works well and is
ready for the move to EHR.
The clinic workload reports
are attached. The numbers show that facilities are down a little, but that was
due to the move and loss of open time for the Happy Camp clinic. There are
graphs attached to demonstrate the comparison.
Patti updated the Council on
the HRSA determination for loan repayment services for the providers. The
“designation” status was lapsed for Happy Camp and Yreka was too difficult and
the
Patti explained that the 2008
goals for the IT department will include; continue to provide tools for RPMS
users to better do their jobs, find resources and funding sources for EHR,
administer the Blue Cross of California Grant, work with Martha on the HPSA
designation, update job descriptions to meet EHR requirements, promote
communication between front office and data entry to capture needed patient
information, annual HIPAA security training, continue to work closely and keep
communications open with the entire IT department to improve in area of
computer technology, work with dental program and set up PCC+ for dental,
continue to work on challenges and unmet needs and to set up RPMS back up to
run automatically.
Leeon Hillman motioned and
Sonny Davis seconded to approve Patti’s report, 6 haa, 0 puuhara, 0 pupitihara.
9. Vickie Walden, RDA:
Vickie provided her annual
report and her monthly report for the Health Board to review. Dr. Madkins
vacation is scheduled from December 4th to January 23rd.
Vickie reviewed her annual
report for the Health Board explaining the dental departments’ challenges,
activities and 2008 goals for the upcoming year. An ongoing challenge for the
dental program is the lack of providers for the amount of patients needing
service in the communities. Across the nation the shortage in adequate
insurance coverage for dental services leaves the facility over booked and
needing the correct amount of staffing to control the needs.
Vickie explained that the 35
root canals done outside to other facilities is also a factor in the spending
in the CHS budget. That is contributed to the time it takes to complete them,
the staff needed to do them and the scheduling that needs blocked out when they
need to be done.
Florence Conrad motioned
and Leeon Hillman seconded to approve Vickie’s report, 6 haa, 0 puuhara, 0
pupitihara.
Closed Session:
Consensus: to table
request from Tribal Member # 2113 to Wednesday.
Consensus: to table
Barbara Norman’s request for resolution to Wednesday.
Robert Goodwin motioned
and Florrine Super seconded to uphold CHS denial for case # 182 and pay $164.67
from third party, 7 haa, 0 puuhara, 0 pupitihara.
Roy Arwood motioned and
Robert Goodwin seconded to uphold CHS denial for case # 180 and pay the $102.93
from third party, 7 haa, 0 puuhara, 0 pupitihara.
Roy motioned and Sonny
seconded to approve the staffing reporting revisions per EDHHS outline
presented, 7 haa, 0 puuhara, 0 pupitihara.
Consensus: for the EDHHS to
provide an updated IT position description at the Wednesday meeting.
Florence Conrad motioned
and Roy Arwood seconded to approve travel for Arch Super, Florrine Super and
Vina Smith to Marine Highlands for language course, 3 haa, 4 puuhara (Sonny
Davis, Alvis Johnson, Leeon Hillman, Robert Goodwin), 1 pupitihara (Florrine
Super).
Florence Conrad motioned
and Alvis Johnson seconded to approve DSL installation fee for Council Member 6
haa, 0 puuhara, 1 pupitihara (Florrine Super).
Next meeting date: December 13, 2007 at 3 PM in Happy
Florence Conrad motioned
and Florrine Super seconded to adjourn meeting at 8:56 PM, 7 haa, 0 puuhara, 0
pupitihara.
Respectfully Submitted,
_____________________________
Arch Super, Chairman
Recording Secretary, Barbara Snider