Karuk Tribe - Health Board Meeting

January 8, 2009 – Meeting Minutes

Meeting called to order at 3:04 PM, by Arch Super, Chairman

Present:

Arch Super, Chairman

Florrine Super, Secretary

Leeon Hillman, Treasurer-late-3:11 pm

Florence Conrad, Member

Alvis “Bud” Johnson, Member

Robert Goodwin, Member-late-3:11 pm

Roy Arwood, Member

Verna Reece, Member

Absent:

Leaf Hillman, Vice-Chairman-travel-excused

Roy Arwood read the health mission statement.

Agenda:

Florrine Super motioned and Leeon Hillman seconded to approve the agenda with changes, 7 haa, 0 puuhara, 0 pupitihara.

Meeting Minutes of December 4, 2008:

Florence Conrad motioned and Robert Goodwin seconded to approve the minutes of December 4, 2008, 6 haa, 0 puuhara, 1 pupitihara (Florrine Super).

Guests:

1.) Dr. Willett:

Dr. Willett introduced Dr. Jessica VanArsdale and Terry Supahan. Dr. VanArsdale is a physician and heading a project called the National Children’s Study and Your Community. It is an ambitious undertaking that will over a span of approximately 20 years. This project will involve the Orleans clinic because it is done by County and Orleans serves patients and clients within Humboldt County. Dr. Willett will be involved and is very excited to be involved in the project.

This is a study done by the National Institute of Health (NIH). Humboldt County was selected to enroll children including prenatal children (pregnant mothers). The study will be competitive in funding but they are seeking a proposal with local organizations to verify the feasibility of the study. The group is focused on obtaining community collaboration to ensure that the local County takes a step forward to complete the research and keep the study locally done.

Jessica and Terry showed a video to the Health Board which provided an overview of the research study, including the goals and the challenges that today’s children face and how this new study will compare the health data across environmental influences on health and development as well as natural health changes children.

Dr. VanArsdale has invited all three tribe’s in the County that serve Native Americans to participate in supporting the program and being involved. UIHS is recommending the project and are forwarding the recommendation to their board for formal approval as well as K’maw. As community member’s and board members, no matter what is said the community has to decide if they are going to participate, so the failure would be up to the community members and their willingness to participate. Terry would recommend this to his children personally so he hopes that other community members become involved and participate as well. NCIDC and Vector are the only non profit facilities on the coast. The Board’s of NCIDC and Vector are concerned over prevention and making communities healthier; this study will work hand in hand with those concerns. Terry’s dream is to have the open communication between tribe’s and the communities that would encourage working together and making a difference in the communities’ health.

Lessie commented that it seemed simple when she reviewed the material but during the presentation this became more confusing. The data collection is during pregnancy and at birth. This would have storage of specimens and this leads to several different questions. The data won’t be analyzed right away but they can go back and check the samples and determine what an exposure could be, so storage of specimens over time is needed. However, the first portion of this project is community input and the possibility of conducting this project locally.

People would be hired as part of a research team that is trained in obtaining blood samples. As with outreach teams they would receive additional team assistance based on the need to collect specimens or data for the project. Dr. Burns explained that a big concern is with accreditation. There would be additional work as the KTHP is not a “research” program. The health program would have to review a different set of standards based on adding research to the services offered by the Orleans clinic.

Bob asked if there was some work done on reimbursements for the Karuk Tribal Health Program being involved in this type of service. Jessica explained that yes, there is reimbursements based on office visits. The other option would be data collection with staffing to coordinate when a woman is onsite. The program has a goal of 1,000 samples according to the demographics of the County. She would like to get 80-100 children from Humboldt County. Dr. Willitt explained that this would be approximately 6-7 children for the Orleans clinic.

Patti questioned minors participating. Jessica explained that no minors would be accepted or eligible unless they are pregnant and all applicable laws would apply to minors receiving care while pregnant.

Bob asked if there was a draft letter of support that they have brought with them. Terry explained that there was a presentation done to determine if Tribe’s were interested.

Terry really wants Tribe’s to be invited to participate both Board members to accept this project but tribal membership to become involved. Jessica believes that this will change medicine over time and develop a more comprehensive data base for information sharing and prevention work. Terry and Jessica will work with Lessie to draft a support letter on behalf of the Tribe and bring that back for formal approval by the Board.

Director Reports:

1.) Daniel Pratt, TANF Director:

Daniel is present to review his written report with the Health Board. He explained that it has been a busy week for the month of December. As of today, the TANF program is fully operational in the TAS system. The MOU’s were previously approved, but the County’s both sent back their suggested changes. These MOU’s are regarding case transfers. In Happy Camp there are four cases, in Orleans there are two, and in Yreka five cases. The federal funding should be eligible for drawn down due to the clients being taken on. The new clients on County rolls will have to discontinue for January and will start under the Tribal TANF program as of February 1^st. Also, once the MOU’s are signed and returned then the County’s they then will identify eligible clients and forward that information to the Tribe in order to make contact with possible clients. Daniel anticipates the County’s to transfer cases right away once the MOU’s are finalized and signed.

The staff has gone above and beyond to get cases and he was anticipating only receiving one client, however, they received eleven cases.

Consensus: to re-approve the final draft of the TANF MOU’s with Siskiyou and Humboldt Counties.

Daniel believes that if he doesn’t hear back by tomorrow then he will check with Freeman to determine where the State funding is. The funding that is obligated so far will be found and he recommends accessing federal funding as a last resort as the federal funding is allowed to be carried over.

Suggestions for changes to the TANF application and forms will be done and presented back on Thursday. Daniel will also be completing the policies and procedures and will present those back for formal approval.

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

Florence thanked Daniel and his staff for getting the program up and running. She believes that this program will benefit Tribal Members and the work they have done to begin the program is appreciated.

2.) Mike Edwards, Behavioral Health Director:

Mike is present to review his written report with the Health Board. The Title IVE has basically been completed. The staff including, Stephanie Dolan believe that they have a document that is ready for final approval. The document has been submitted to Region IX and they are waiting to hear back.

A time study was suggested for the month of December. The staff had completed time studies for the months of September and November, but they were mock surveys and they are recommending another one be done for the month of December. Mike will work on this.

Mike provided an overview of the new staff that was taken on board to replace the vacancies left by staff changing positions. They all have full schedules and are doing well transitioning into their communities and working with their clients.

April is present in the capacity of the Yav Pa Anav Circles of Care grant. The first advisory body meeting was today to accomplish their plan. The first team meeting is a requirement and it is scheduled for February 1^st, 2008. The team members would be Chuck Lent, Holly Hensher, Mike Edwards, Robert Attebury, April Attebury and Jennifer Goodwin. April is seeking approval for Holly to attend the meeting in February which is in Portland Oregon.

Florence Conrad motioned and Florrine Super seconded to approve Holly Hensher’s travel to Portland OR February 1, 2009, 7 haa, 0 puuhara, 0 pupitihara.

There is funding in the HRSA budget to hire a consultant. The contract has been reviewed and the number is 09-C-014, with Dr. Sue.

Bob asked whose concept it was to include forming a 501(c)(3) non-profit organization as noted in the plan. April explained that it is a feasibility study for the addition of a 501(c)(3) status and that it isn’t actually the forming of the status. This topic will be moved to closed session.

They did receive the Title IVB agreement. This funding is used for finger prints, out of home placement, and other necessary items for children while they are in placement transition.

Florence Conrad motioned and Leeon Hillman seconded to approve Mike’s report, 7 haa, 0 puuhara, 0 pupitihara.

3.) Vickie Walden, RDA:

Not present, written report provided.

Florence Conrad motioned and Leeon Hillman seconded to approve Vickie’s report, 7 haa, 0 puuhara, 0 pupitihara.

4.) Patti White, Database Administrator:

Patti is present and she has a couple action items to present along with her report. She would like to have a contract for a pharmacy consultant approved for the Health Program. The contract is 09-C-013 between Denise Vermilyea LLC and the Karuk Tribe.

Florence Conrad motioned and Verna Reece seconded to approve contract 09-C-013 between Denise Vermilyea LLC and the Karuk Tribe, 7 haa, 0 puuhara, 0 pupitihara.

Leeon Hillman motioned and Roy Arwood seconded to approve resolution 09-R-003, 7 haa, 0 puuhara, 0 pupitihara.

Patti requested approval of a Business Associate Agreement with Denise as well. The agreement was sent to Erin and Laura for review, but they had not reviewed it. Patti still needs it approved by the Council prior to any work being done by Denise. The Business Associate agreement is a requirement by HIPAA.

Leeon Hillman motioned and Roy Arwood seconded to approve the Business Associate Agreement between Denise Vermilyea LLC and the Karuk Tribe, 7 haa, 0 puuhara, 0 pupitihara.

Erin will be setting a meeting between Laura, Toni Lynn, Patti and others to determine what funding will be needed to receive a generator that will provide enough power at the Administrative complex.

Leeon Hillman motioned and Roy Arwood seconded to approve Patti’s report, 7 haa, 0 puuhara, 0 pupitihara.

5.) Eric Cutright,

Eric is present to review his written report with the Health Board. Eric explained that the month of December has been focused on working with TANF program and their staff. There have been quite a few work orders completed and they continue to work diligently on assisting the staff.

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

6.) Toni Lynn Downey, PHN:

Toni provided an update to her report. Toni complimented Flo for her efforts in delivering food baskets to the Elder’s during the Holiday months. Flo really took the imitative in working with the community and making sure several people received a food basket.

Toni has action items for the board tonight. She presented a grant application in the amount of $2,000 that is geared toward children and physical activity in the Happy Camp area. The resolution number is 09-R-002. Florence would like all children at all locations to be considered when writing grants for this type of activity.

Leeon Hillman motioned and Florrine Super seconded to approve resolution 09-R-002 authorizing submission of the grant application to General Mills , 6 haa, 0 puuhara, 1 pupitihara (Florence Conrad).

Toni would like to go to Infection Control training and IHS has offered to pay for the course and the Tribe would only have to pay for the travel and perdiem costs. Infection Control training would allow her to fully understand her position responsibilities as the Infection Control Officer for the health program.

Robert Goodwin motioned and Leeon Hillman seconded to approve travel for Toni Lynn Downey to infection control training in Albuquerque NM, 7 haa, 0 puuhara, 0 pupitihara.

Robert Goodwin motioned and Leeon Hillman seconded to approve Toni’s report, 7 haa, 0 puuhara, 0 pupitihara.

7.) Suzanna Hardenburger, Business Office Manager:

Suzanna is present to review her written report with the Health Board. Suzanna announced that with the notation in Patti’s report about the data entry being behind, she then announced that this creates a lag in billing. Of course, the data entry staff will catch up and then that will allow the billing department to catch up. Suzanna would like approval to write-off some claims that are on the books that cannot be billed to the patient due to granting guidelines, and the grant funding has now ended.

Roy Arwood motioned and Leeon Hillman seconded to write of the billing owing $1,400, 7 haa, 0 puuhara, 0 pupitihara.

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

8.) Lessie Aubrey, EDHHS:

Before Lessie could begin her report, Florence apologized to Toni Lynn for putting her on the spot about the grant application she was presenting. Toni Lynn did not draft the proposal and was presenting it for Hester so she may have not been able to answer all the questions regarding it. Florence did not want to offend Toni Lynn, but would like to remind staff in general to complete grants that include downriver communities as well as the other communities. She was not attempting to be negative and may have come across that way. She would like her apology reflected in the minutes.

Lessie presented an externship affiliation agreement between Abdill Career College, Inc. and the Karuk Medical Clinic in Yreka. The agreement number is 09-A-012 to accept a student to complete 180 externship hours in the Yreka clinic as a medical assistant including phlebotomy.

Robert Goodwin motioned and Roy Arwood seconded to approve agreement 09-A-012 between Abdill Career College Inc and the Karuk Tribe, 7 haa, 0 puuhara, 0 pupitihara.

Lessie explained that Phil Church was present to do a walk-thru of the Orleans facility. He has offered to paint the Orleans and Happy Camp clinics and have new floors installed at the Orleans facility. He also mentioned checking into the Orleans generator for necessary repairs. Phil Church has been receiving several items that Laura Mayton has sent for repayment from IHS which leads Laura believe that IHS has extra funding this year. She has not received reimbursement from IHS but she believes that if Phil has expressed the approval to assist the health program then there must be funding to cover those costs.

Robert motioned and Leeon seconded to move forward with painting and flooring anticipating reimbursement from IHS, 7 haa, 0 puuhara, 0 pupitihara.

The position description attached to Lessie’s report was moved to closed session.

Lessie found a consultant to provide a 4-5 hour course for providers on coding. The instructor is a member of the National Association of Community Health Clinics and she is going to provide training on E&M coding and CPT coding to the providers. Usually coders will participate in the training as well and there may be CEU’s offered for the course.

While on training, Lessie made some contacts and one in particular she would like to have come to Happy Camp to assist in training the Tribe on the HRSA grant. Lessie’s contact explained that the Tribe is unique as the Tribe has different funding sources and has obligations to those funders as well as HRSA. In general, most places only receive HRSA funding, so they are only having to meet their requirements, it is difficult to decipher which regulations to work within and still maintain compliance in other areas. Lessie is working on determining if HRSA will pay for the consultant to come in and provide training as well as the availability of the consultant.

Another meeting with the Veterans Association found that there wasn’t much development to their program as they aren’t up and running. Lessie would like to meet on the 26 or 27 of January for discussions and questions on the program to receive a full explanation of expectations.

Lessie thanked Erin, Toni Lynn, Dr. Burns and the outreach department as they did a lot of work toward meeting the needs of the community with the recent winter warning. The Elder’s workers and outreach staff did a very great job during the winter storms.

The Manager’s Meeting only had the local managers as the weather was too bad for travel. The Manager’s will go back to their ACQI Committee meetings monthly to have a better flow of process. The Manager’s meetings will be quarterly. The Managers would now like to talk about accreditation updates, points of interest, programs making a difference, have closed session, and staff updates. If the Council has any other topics that they believe the Manager’s should be covering Lessie is interested in them sharing that information.

The Youth Treatment Center for California is making progress and it seems that there has been property identified. Margo Kerrigan recently forwarded information on each property location that was considered and the pros and cons of each location. Lessie will continue to follow this to ensure that the facility is placed in a realistic location that serves the population.

On January 14^th there is a meeting in Sacramento, CA regarding the diabetic grant and Lessie will be taking Vickie Simmons as she works very closely with it. Lessie will let Karen Daniels talk about the policies and procedures since she is going to be handling this moving forward.

Some physicians have been contacting the Tribe for employment. Dr. Burns even has been excited to receive some contacts. Lessie will attempt to get a couple different physicians as this only helps the program to keep an open line of communication and assist in recruitment.

There is a CRIHB meeting on January 22, 2009. The program directors may stay but some directors leave. Roy explained that some directors choose to stay, but it is up to them and if Lessie would like to stay she may, but it is entirely up to her.

The renewal for the SAMSHA grant is due March 2, 2009.

There is a little Medical Records coverage issue in the Yreka clinic but Lessie will continue to work on this as she does with other staffing coverage questions and tasks.

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

9.) Karen Daniels, DQMCH:

Karen did not submit a written report as she is new and has taken the DQMCH position just recently. Lessie has suggested that Karen Daniels attend travel for training on AAAHC in March 5-8, 2009 to Atlanta Georgia. Karen will now head the department on accreditation and she believes that the training will assist her in understanding her responsibilities.

Robert Goodwin motioned and Leeon Hillman seconded to approve travel for Karen Daniels to Atlanta GA March 5-8, 2009, 7 haa, 0 puuhara, 0 pupitihara.

The Performance Improvement group is now the ACQI Committee again and they will need to have a Council Member sit on that committee if they are available. Roy will attend the ACQI Committee meetings as a member.

Robert Goodwin motioned and Leeon Hillman seconded to appoint Roy on the ACQI Committee, 7 haa, 0 puuhara, 0 pupitihara.

Lessie’s report contained several health program policies and procedures that need approved. Karen followed along while suggestions for changes and updates were noted by Bob Goodwin. Lessie would like to table the C&P Policy.

Robert had suggestions for the disciplinary action policy under procedures he believes that limiting action to suspension under section one may lead to some complications. Having the policy say that disciplinary action up to termination would be best to ensure that the health program may decide which action is best and not limit them.

Also under policy for Notification of AAAHC, noting that the EDHHS should notify AAAHC of changes and if that person unavailable then the DQMCH is required to do it. Outlining that both positions may do it, but in what order only ensures that the health program is clear on whose responsibility it is.

Robert Goodwin motioned and Florence Conrad seconded to approve the policies and procedures with changes and corrections, 7 haa, 0 puuhara, 0 pupitihara.

Robert congratulated Karen on her new position.

Roy Arwood motioned and Leeon Hillman seconded to approve Karen’s report, 7 haa, 0 puuhara, 0 pupitihara.

Closed Session:

Lessie will write Dr. Bardonner a letter regarding CHS patient.

Robert Goodwin motioned and Leeon Hillman seconded to approve agreement 09-A-010 with the stipulation that April, Mike and Laura Mayton draft policy to ensure that there be a process for internal review prior to selection of such cases. Also the policy shall outline priorities to ensure they are followed including a yearly update on clients, 7 haa, 0 puuhara, 0 pupitihara.

Robert Goodwin motioned and Leeon Hillman seconded to approve contract 09-C-014 between contractor and the Karuk Tribe, with the removal of the concept to achieve a 501(c)(3) status and include language of a tribally chartered 501(c)(3) status in the contract, 7 haa, 0 puuhara, 0 pupitihara.

Consensus: to refer Tribal Member # 0390 to CHS.

Robert Goodwin motioned and Roy Arwood seconded to re-hire employee # 0338 and have the EDHHS supervise the position, 7 haa, 0 puuhara, 0 pupitihara.

Robert Goodwin motioned and Florence Conrad seconded to approve the Orleans Janitor position description 6 haa, 0 puuhara, 1 pupitihara (Roy Arwood).

Consensus: for the EDHHS to discuss a rotating schedule with staff to travel for the Health Board meetings to ensure their facility is working closely with the board and other directors.

Florence Conrad motioned and Verna Reece seconded to approve employee # 0988 a $.50 hourly increase, 7 haa, 0 puuhara, 0 pupitihara.

Directive: to employee # 4959, to no longer correspond with officials at BIA without the Chairman being involved or reviewing the correspondence prior to submission.

Robert Goodwin motioned and Leeon Hillman seconded to approve providing $100 to Tribal Member # 0043 for assistance in setting up office space, 7 haa, 0 puuhara, 0 pupitihara.

Robert Goodwin motioned and Florence Seconded to approve travel for Arch Super, Florrine Super and April Attebury to Hoopa for NTCC meeting, 6 haa, 0 puuhara, 1 pupitihara (Florrine Super).

Robert Goodwin motioned and Florence Conrad seconded to approve travel for Arch Super to Susanville for a CATG meeting on January 6, 2009, 6 haa, 0 puuhara, 1 pupitihara (Florrine Super).

Robert Goodwin motioned and Alvis Johnson seconded to approve Florence’s travel to Sacramento CA February 3-4, 2009, 6 haa, 0 puuhara, 1 pupitihara (Florence Conrad).

Consensus: for the Maintenance Supervisor to change the combination codes at the People’s Center.

Consensus: for HR to provide Tribal Member #1032 a key to the Panamnik Center for basket classes.

Next Meeting Date: February 12, 2009 at 3 PM in Happy Camp, CA.

Robert Goodwin motioned and Leeon Hillman seconded to adjourn meeting at 9:23 PM, 7 haa, 0 puuhara, 0 pupitihara.

Respectfully Submitted,

________________________________
Arch Super, Chairman

Recording Secretary, Barbara Snider