Karuk Tribe – Annual Health Board
Meeting
December 4, 2008 – Meeting Minutes
Meeting called to order at 3:12 pm by Arch Super,
Chairman
Present:
Arch Super, Chairman
Florrine Super, Secretary (6
PM)
Leeon Hillman, Treasurer
(3:44 PM)
Roy Arwood, Member
Alvis “Bud” Johnson, Member
Verna Reece, Member
Robert Goodwin, Member
Absent:
Leaf Hillman, Vice-Chairman
(excused)
The Health Mission Statement was read aloud by Arch
Super, Chairman
Agenda:
Robert Goodwin motioned
and Verna Reece seconded to approve the agenda with changes, 5 haa, 0 puuhara,
0 pupitihara.
Minutes of November 6, 2008:
Alvis Johnson motioned and
Robert Goodwin seconded to approve the minutes of November 6, 2008, 4 haa, 0
puuhara, 1 pupitihara (Verna Reece).
Director Reports:
1.)
Dr. Hanst is present to
provide his annual report to the Health Board. He reviewed department updates,
GPRA activities and progress of the Yreka clinic.
There were two clinic
positions eliminated during the budget shortfall this fiscal year. He has not
heard a lot of complaints so he believes that this is not a drastic change for
the patients.
Amy has gone back to administrative
work one day a week at the Yreka clinic, mainly concentrating her focus on EHR.
Dr. Hanst explained that the intern PA works within the community providing
health education.
The GPRA indicators are being
reviewed for updates. December is the month for the annual patient satisfaction
survey for the facilities and once that is complete the information will be
shared with the board.
The annual report distributed
for FY08 includes information on the patient population including, but not
limited to, 113 new patients in the fourth quarter, breakdown of demographics
(80% Native American 20% Non Native American), health disparities over long
term, FY08 has a higher workload than FY08, the new FNP is doing great and her orthopedic
experience is great and useful in the clinic. Currently the clinic is staffed at
a 2.6 equivalent of providers, supported with two medical assistants. They will
most likely be back to seek additional nursing support staff with the increase
in patients. The Medical Director position for Yreka is being advertised
currently. The Yreka clinic is now using EHR for vitals and basic patient
information. This is a very new process and it was originally slated for
implementation at the
Leeon Hillman arrived at 3:44 PM
Arch has heard concerns over
the schedule of the Elder’s worker for Yreka. Flo Lopez reported that this will
be discussed on Monday.
Arch questioned the parking
availability of the patient parking at the Yreka clinic other sites have
patient parking. Lessie explained that the employees were assigned parking at
one time, with consideration given to patients of the facility. She will review
the parking situation. Dr. Hanst will also send that information out to his staff.
Verna Reece motioned and
Robert Goodwin seconded to approve Dr. Hanst’s report, 6 haa, 0 puuhara, 0
pupitihara.
2.) Daniel Pratt, TANF Director:
Daniel is not present, but
Elsa Goodwin is present to distribute his report and seek approval for an action
item. Elsa Goodwin is the new TANF Administrative Assistant of the TANF
program.
Robert asked if Eagle Suns
has been set up and scheduled. Eric understands that it isn’t up and running
and Daniel was going to contact them. It is understood that the TANF program
will be using TERO’s server but if that isn’t compatible then Eric would like
to purchase a separate server for the program. They have enough funding for
their technical needs.
Elsa’s action item for
approval is procurement for office supplies that will be needed to begin operating
TANF in Happy Camp.
Verna Reece motioned and
Alvis Johnson seconded to approve procurement and allow the purchase of office
equipment from Quill in the amount of $2,874.66, 6 haa, 0 puuhara, 0
pupitihara.
Robert Goodwin motioned
and Leeon Hillman seconded to approve Daniel’s report, 6 haa, 0 puuhara, 0
pupitihara.
3.) Michael Willett,
Dr. Willett is present to
provide his report to the Health Board. He thanked the Health Board for
inviting him to report on the
IHS is attempting to
emphasize preventative care to assist in the overall health care of patients.
Dr. Willett believes in preventative care and hopes that the community realizes
the benefits.
Dr. Willett was pleased to
see Dr. Hanst report on the facility visits and care provided. The report
generated was more realistic displaying the patient population. He also
explained that the
The computer and telephone
systems have had several issues in the past, but lately they are working very
well. Within the last year there have
been tremendous improvements to communication from the
The future goals for the
Arch questioned what method was used in
Verna Reece motioned and
Robert Goodwin seconded to approve Dr. Willett’s report, 6 haa, 0 puuhara, 0
pupitihara.
4.) Mike Edwards, Behavioral Health Director:
Mike is present to review his
report with the Health Board. Mike explained that his department is finally
fully staffed after several positions were left vacant due to employee’s
applying for positions within the TANF Program.
The Title IVE agreement is
still a work in progress. There is a meeting on the 8th with Region
IX and the State Department of Social Services. They will review the Tribal
Welfare Plan and once all revisions are reviewed then it will hopefully be
approved.
The Yav Pa Anav group had
their last meeting on November 18th. The large group will meet
quarterly moving forward and the providers will meet as needed. Mike provided
patient count updates for the LSCW in Yreka, noting that the patient visit
count is higher now than it has been in years. She is doing a fantastic job and
the patients seem to be receptive to her.
The parenting classes that were
held in Yreka that were co-sponsored by the Yreka facility and the Yreka Family
Resource Center turned out well and they are hoping to have more classes. They
would like to hold the next round of classes at the KTHA community room for
more participation with Native American children and parents. When the classes are
scheduled there will be further advertisement to include non Indians as well.
An IHS visit for
environmental and safety was conducted at the Yreka site. The major problem for
the Yreka facility is the air exchanging system. IHS explained that they had
funding for the repairs and explained that the facility may have the system
repaired and IHS will pay for this. There is a lot of staff that participate on
community committees and with that participation Mike believes that this
assists in providing collaboration and acceptance in the community of the
services that the Tribe offers. The County has begun getting staff involved
more than they ever have previously.
This year there were two
tribal homes certified as foster homes. This has not been accomplished in years
past, so this is something that the Tribe should be very proud of.
Goals for FY09 include
pulling resources and working well together to learn and achieve better
services for patients and clients.
Robert Goodwin motioned
and Leeon Hillman seconded to approve Mike’s report, 6 haa, 0 puuhara, 0
pupitihara.
5.) Vickie Walden, Dental Office Manager:
Vickie is present to review
her report with the Health Board. She explained that the dental staff is
heavily involved in the community. They perform dental cavity reviews and would
like to do fluoride varnishes for children. The Tribal Head Start program,
specifically Donna Goodwin-Sanchez, works closely with the dental program to
create dental education or increase access to dental care. There is a new
dental hygienist for the Yreka facility and she is working very well.
The dental program completed two performance improvement projects this last
fiscal year.
The budgets were reviewed
monthly and they did not have a shortfall all fiscal year. Staff continued
their certifications and no licenses were lapsed due to not complying with
licensing requirements.
Vickie reviewed the staffing
changes and updates with the Health Board. She provided an overview of each visit
and what the count was for those visits.
Vickie explained the diabetic
population and the care that they need. The importance versus the care that is
done and recommended was tracked as a performance improvement report. The
dental health of the patients improved, but education with the medical
providers and outreach staff must be done to educate patients on continued
dental treatment.
The Hoopa Tribe phoned and
they wish to donate a panorex x-ray machine if the Karuk Tribe will share the
cost of installation of their new machine. This is an excellent opportunity for
the Happy Camp dental office to receive upgraded equipment.
Arch inquired about the
courier service for dental baker lab and the recent decision to use different
lab services. Vickie will refer that question for Dr. Bardonner to answer as
the Dental Director.
Alvis Johnson motioned and
Robert Goodwin seconded to approve Vickie’s report, 7 haa, 0 puuhara, 0
pupitihara.
6.) Patti White, Database Administrator:
Patti provided copies of an
OSHPD workforce development letter. Patti had each site application prepared
and listed but explained that the clinic scores are low. The behavioral health
program scored higher which means that this can be applied to them; this
program will cover part of the physicians’ student loans if approved and allow
the health program to use this as a recruitment and retention perk for seeking
providers.
Leeon Hillman motioned and
Florence Conrad seconded to approve the applications and send them to the
Statewide Health Planning and Development, 7 haa, 0 puuhara, 0 pupitihara.
Patti’s annual report is
included in the packet and includes the 2008 goals. The accomplishments for
FY08 are training and reduction in costs. Patti has continued to increase the
RPMS user manual library and they are available for use and review by
employees. The onsite set up has been changed from January to April of 2009 for
EHR training.
The Blue Shield grant was
used to purchase a copier for the business office. There has been a lot more
communication between the front office and the data entry clerks over the last
year, which creates a better flow in insurance billing. The flow of patients
and paperwork is working better each year, and the staff is open to trying new
options for information processing.
Communication with IT has
been fine. She has worked very closely with Eric Cutright and Chris Kleeman
this past year. Hiring Chad Tiraterra and sharing an office with him has been
very nice. He has been a great asset to the department.
Patti’s 2009 goals are to
provide further training to the health program staff, seek funding for
projects, and continue to administer the Blue Shield grant. Patti received word
that the health program received $80,000 for a generator for the Happy Camp
Complex. This is still short approximately $40,000. Laura Mayton explained that
she would like to have Phil Church’s explanation of assisting in payment for
the generator in writing as there are things that have been billed that haven’t
been paid for by IHS although similar statements of assisting in payment were
made.
Florence Conrad motioned
and Leeon Hillman seconded to approve Patti’s report, 7 haa, 0 puuhara, 0
pupitihara.
7.) Eric Cutright, IT Director:
Eric would first like to have
his monthly report reviewed and then will move on to his annual report. He has
one action item from his regular board report. It is with AT&T for connecting
the Yreka TANF office to the Karuk Network. The cost is for two years starting
January 2009 to January 2011 with the total cost being $6,694. Eric provided
procurement and it was sole source as AT&T is the only local provider. This
will be spent from the TANF budget.
Leeon Hillman motioned and
Alvis Johnson seconded to approve agreement 09-A-011 between the Karuk Tribe
and AT&T, 7 haa, 0 puuhara, 0 pupitihara.
The new phone service was
finally installed in
Eric continues to work closely
with the TANF staff on ordering for program use any related IT items. He has been working with Daniel on ordering IT
supplies and he is hoping to have the TANF staff operational within the next
week.
Eric reviewed the agreement
changes that are being made with staffing and billing for positions related to
KTHA and KCDC and the IT department. One IT staff member will be working with
KTHA mainly to allow a more efficient flow of tasks and IT needs being met.
Eric explained the pros of having KTHA on a similar working pattern as the
Karuk Tribe’s network and services that are provided here. Eric explained that
KTHA only used services when they had really no other choice as they had to be
billed. With this new contract the staff will be able to work cooperatively
together.
Eric reviewed his annual
report with the board. Solutions that were done before he arrived within in the
last 8 months have been more permanent fixes and less temporary fixes. Eric
believes that the IT department is meeting several needs of the Tribe,
including the health program. He would like to eventually provide training to
staff on computer use, but will begin that once the programs have time.
Laura Mayton said that the
finance office appreciates Eric’s work and his demeanor when working with IT
issues. Since Eric has been taken on staff, the Tribe has been operating a
little smoother, and when issues arise, Eric handles them very professionally.
Florence Conrad motioned
and Robert Goodwin seconded to approve Eric’s report, 7 haa, 0 puuhara, 0
pupitihara.
8.) Lessie Aubrey, Executive Director of Health &
Human Services:
Robert Goodwin congratulated
Lessie on her recent selection to the position of Executive Director of Health
Human Services for the Karuk Tribe. She thanked the Council for the
opportunity.
She went on to explain her
annual report with the Health Board and wanted to explain how concerned she is
with the Health Program and its development.
CMS was supposed to conduct a
review and they have not done it yet. She is working on the policy and
procedure manuals and would like them completed as soon as possible. The
manuals create an opportunity to work well together and have an answer at hand
for staff that have questions.
Lessie explained that the
State Indian Health Program review has recently had a staff member resign,
which was the person who has conducted the Tribe’s reviews for years. She is
unsure of who will conduct reviews now, but she is sure the Tribe will do fine.
Staff changes were reviewed
with the Health Board with the conclusion that times change and employees
change, but change seems to be the one consistent trend.
The IHS billing Indian
beneficiaries issue has not had any follow-up discussions. Lessie will follow
the topic closely to ensure the health program and the board has the most
current information if any should arise.
GAP insurance coverage is
going to be reviewed to determine if the Tribe should purchase the insurance
coverage for the employee’s.
Lessie explained that the
HRSA third year grant wants outreach and transportation services to the target
population. Also, after hours care and urgent care was noted, but it is not
outlined how that was gonna be met. Lessie would like to have a HRSA
facilitator brought in to assist in training. Lessie would like to have the
HRSA budget revised to pay for services if HRSA are requiring them. Lessie
explained that when she contacted HRSA for an explanation she was referred to
reading material and she will be completing that reading over the next couple
weeks.
December is peer review and
evaluation time so she hopes to have them completed on time.
Florence Conrad motioned
and Robert Goodwin seconded to approve Lessie’s report, 7 haa, 0 puuhara, 0
pupitihara.
9.) Toni Downey, PHN:
Toni provided an overview of
her tasks within the last month. She is working with all the staff and making
contacts with other staff. She provided information on the facilities and the
budgets she is responsible for. Toni did the flu vaccines for the staff at
Happy Camp at no cost and also made contacts with the County and IHS since she
has been onboard.
Toni presented a travel
request for safety and infection control training. She is the Tribe’s safety
and infection control officer and would like to understand her role.
Florence Conrad motioned
and Robert Goodwin seconded to approve out of state travel for Toni Downey to
Albuquerque NM, January 2009, 7 haa, 0 puuhara, 0 pupitihara.
Toni explained that there are
new laws that regarding persons that use intravenous needles no longer
disposing of their used needles in the trash. The County recently received a
grant for containers for the sharps. She would like to work cooperatively with
the County and attempt to obtain a container for the Happy Camp community.
Florence Conrad motioned
and Leeon Hillman seconded to approve Toni’s report, 7 haa, 0 puuhara, 0
pupitihara.
10.) Flo Lopez, Elder’s Director:
Flo thanked the Council for
allowing her to continue her CPR training. She would eventually like to train
the Administrative offices and Council members as well. Flo would also like to
announce that the Elder’s staff does not need to have access to RPMS. She
doesn’t find the packages in RPMS to be useful for her or her staff and really
doesn’t need access.
Flo explained that there was
one ramp project that was done and it was only done partially. Flo explained
that it is not safe and really needs to be completed. The discussion was moved
to closed session.
Leeon Hillman motioned and
Robert Goodwin seconded to approve Flo’s report, 7 haa, 0 puuhara, 0
pupitihara.
11.) Suzanna Hardenburger, Business Office Manager:
Not present, report provided.
Florence Conrad motioned
and Leeon Hillman seconded to approve Suzanna’s report, 7 haa, 0 puuhara, 0
pupitihara.
12.) Joe Snapp, Substance & Alcohol Abuse Program:
Not present, report provided.
Florence Conrad motioned
and Robert Goodwin seconded to approve Joe’s report, 7 haa, 0 puuhara, 0 pupitihara.
13.) Martha Schrock, former EDHHS:
Not present, report provided.
Florence Conrad motioned
and Robert Goodwin seconded to approve Martha’s report, 7 haa, 0 puuhara, 0
pupitihara.
14.) Dr. Burns, Medical Director:
The national VA and IHS signed
a memo stating that they would share resources wherever possible. Yreka has 800
VA clients and their only service is a traveling van. Margo Kerrigan and others
participated in a teleconference meeting announcing that there should be a VA
facility in Yreka. They would like to do a shared services agreement between
the VA and the Karuk Tribe. The VA
explained that they need primary care services for approximately 400 patients
and mental health services for approximately 140 patients. The good news is
that this would bring additional patients to the Yreka clinic and that it is a
shared quality facility including similar goals for servicing patients. The VA
could either pay the Karuk Tribe for a provider or provide one. They also said
that the Indian patients would have access to their VA services. They would
transport our Indian patients to their appointments and services that the VA
has. Dr. Burns of course does not have the complete information but he believes
that this would save the CHS budget. Dr. Burns would like to have himself,
Lessie and a team of individuals from Yreka attend the Feather River Tribe to
see how this process works, since they have this type of set up there.
Arch asked if the current staff
would be able to handle the additional patients. Dr. Burns believes that the
staff could do this with the reports he has seen, identifying an additional 7
patients a day and mental health having 2 more patients a day. Dr. Burns
believes that there are options that may work. He believes that with the
historical level of patients being seen would mean that the providers would
have to see more patients and that may be an issue, but workable.
Dr. Burns provided an update
on his crisis intervention training that he has completed. He has already
trained the Happy Camp staff and will be training the Yreka staff very soon.
The training costs several hundred dollars but him training the staff saves the
Tribe money.
Performance Improvement is
important to the Karuk Tribe and he reviewed the projects such as GPRA
indicators that the health program developed into performance improvement
reports. As much as possible the Karuk Health Program had the performance
improvement projects match the national GPRA indicators to ensure that the
staff was being fully utilized and meeting the needs of clients as well as
national standards. The health program did very well with the diabetic needs
and did score low in other areas. The staff reviewed obstacles in data
collections and began to increase the method in which they collect data. By
doing this it was identified that the clinics did provide several services to
patients and clients, but were not collecting the data correctly. This has
since been resolved and the numbers show the care actually provided.
The pandemic flu is still an
ongoing project. He and other staff will begin meeting to start the process of coordinating
a local emergency response plan. This would assist in meeting the community
needs as well as meeting national standards of having an emergency preparedness
plan.
The expansion of telemedicine
has been large within the last couple of years. The amount of equipment used by
the facilities has enabled the providers to seek outside assistance for
patients that is much needed and provides necessary services.
The employee’s completed the
employee satisfaction survey for 2008. The outcome is attached to his report. Overall
the employee’s in the health program were neutral to satisfied in their jobs.
They felt that they had good relationships with their peers and clients. They
appreciated the Tribe’s support in family relationships. The negative comments
were with monetary issues and communication with their supervisors.
Challenges for the health
program are currently, enlarging the revenue stream, continue to seek grant
funding and increasing the patient base, as well as, improving efficiency. It
is hard to measure productivity of providers but a measuring tool can be done
with the new GUI package in RPMS. Dr. Burns believes that providing raises and
monetary compensation should be considered even in an economic challenging
time. Dr. Burns believes that there should always be two doctors in the health system,
because if there isn’t at least one then the doors to the facilities would have
to be closed due to oversight requirements.
Dr. Burns explained that
every year he is strongly convinced that the healthy foods and diet of Native
Americans was correct, and that Kari Norgaard and Ron Reed worked hard on and
identified. He is more and more convinced that the outcome of health for Native
Americans in the past was increasingly better than the health of Native
Americans in this time. He values the history of information.
Florence Conrad motioned
and Florrine Super seconded to approve Dr. Burns’ report, 8 haa, 0 puuhara, 0
pupitihara.
Closed Session:
Robert Goodwin motioned and
Alvis Johnson seconded to pay for mileage and perdiem for three months, with
monthly report from employee #4761 on his attendance of the Board of
Supervisors meetings, 6 haa, 1 puuhara (Roy Arwood), 0 pupitihara.
Florrine Super arrived at 6 PM
Consensus: to deny loan
request from Tribal Member due to low funding and restricted resources.
Consensus: to deny request
to purchase equipment from the Tribe.
Roy Arwood motioned and
Robert Goodwin approved to pay for charges not to exceed $150 for employee # 4696
for not cancelling hotel reservations based on family emergency, 8 haa, 0
puuhara, 0 pupitihara.
Consensus: for the
Chairman to speak to contracted employee regarding recent reports of behavior.
Robert Goodwin motioned
and Florence Conrad seconded to approve travel for Florrine Super to Eureka CA.,
December 4, 2008, 8 haa, 0 puuhara, 0 pupitihara.
Consensus: for Florrine to
submit stipend request for meeting with Elder’s Worker.
Next meeting date: January 11, 2009
Florence Conrad motioned
and Robert Goodwin seconded to adjourn meeting at 8:15 PM, 8 haa, 0 puuhara, 0
pupitihara.
Respectfully Submitted,
________________________________
Arch Super, Chairman
Recording Secretary, Barbara Snider