Karuk Tribe - Health Board Meeting
Meeting Minutes – February 12, 2009
Meeting called to order at 1:00 PM, by Arch Super,
Chairman
Present:
Arch Super, Chairman
Leaf Hillman, Vice-Chairman-late
-3:30 PM
Florrine Super, Secretary-late-1:16
PM
Robert Goodwin, Member
Florence Conrad, Member-late-1:12
PM
Roy Arwood, Member
Verna Reece, Member
Alvis Johnson, Member
Absent:
Leeon Hillman,
Treasurer-absent-excused
Agenda:
Roy Arwood motioned and
Florence Conrad seconded to approve the agenda with changes, 5 haa, 0 puuhara,
0 pupitihara.
Minutes of January 8, 2009:
Florence Conrad motioned
and Robert Goodwin seconded to approve minutes of January 8, 2009 with
corrections, 6 haa, 0 puuhara, 0 pupitihara.
Old Business: none
at this time.
Director Reports:
1.) Daniel Pratt, TANF Director:
Daniel reported that he has
been working very hard. They have fifteen total cases currently and additional
cases pending. Daniel is collaborating with Hoopa Valley TANF and UC Davis for
training. There has been a misplacement of an MOU. Laura questioned that until
there were stimulus packages and they will not come through for State funding
until the stimulus comes through. Daniel explained that at his State Travel
TANF meeting there should be some federal funding that can be allocated, not
new funding, but what is already obligated. This will work with TANF, CalWORKs,
and other Social Service program. Daniel was assured that Tribal TANF dollars
were going to be fine. The staff is doing wonderful. He would like to request
that one position in Yreka. There is an individual that is going to be on leave
and he would like to have an additional case assistant and eliminate the
secretary position. This request was moved to closed session.
Daniel would like to have a
Council member attend the next quarterly meeting. This would help in attempting
to attend further TANF funding to be allocated.
Florrine would like to attend
the County meetings with Anthony Ballard and Maria Miranda when those meetings
are set. Anthony and Maria shall notify Florrine of those meetings.
Leaf motioned and Florrine
seconded to approve Daniel’s report, 6 haa, 0 puuhara, 0 pupitihara.
2.) Mike Edwards, Behavioral Health Director:
Mike is present tonight to
review his written report with the Board. He is planning a parenting class in
Yreka on February 20th. As soon as this class is concluded he will
offer the classes in
Leaf Hillman motioned and
Florrine Super seconded to approve the addition of a Verizon blackberry for Kim
Dodge, 7 haa, 0 puuhara, 0 pupitihara.
Florrine asked for an update
on AIR. Mike did not have a current update but did recall that it was being
under spent. Lessie has met with Toby Reuze and she is preparing to train both
Tanya and Mace to work on increasing their numbers. Laura explained that when
the switch from CAIR to AIR happened the staff wasn’t sure on how to bill and
did not complete much billing. Now that the staff is working on back billing
Lessie anticipates some revenue generation as the staff does provide services
that are billable. Florrine asked what services were now billable. Lessie found
that the Tribe can bill for DUI classes and counseling, but no residential
treatment.
Mike presented an application
to the State for DUI certification. This agreement will allow for the DUI
program to charge individuals that are enrolled in the program. There were
several corrections to the document that the Council would like incorporated.
They would like the entire document typed and cross check the spelling of the
Karuk Tribe, Council Members, and have accurate numbers listed for contacts.
Robert Goodwin motioned
and Alvis Johnson seconded to approve agreement 09-A-014 with changes 7 haa, 0
puuhara, 0 pupitihara
Florrine Super motioned
and Verna Reece seconded to approve Mike’s report, 7 haa, 0 puuhara, 0
pupitihara.
3.) Vickie Walden, Dental Office Manager:
Vickie is present tonight to
review her report. She has no action items to her report, but is available if
any Council members have questions.
Vickie introduced Dr.
Bardonner and his discussion topics for orthopedics and inpatient pediatric
services.
Vickie went on to explain
that for orthodontic services some patients are sent to Hoopa and are very
rarely accepted. Dr. Pfeiffer used to complete evaluations and consultations,
but his office has been sold and the new dentist at that location may not be
interested in this same type of agreement for the Tribes patients. Vickie
announced that CHS dollars are dwindling and review what is feasible for the
necessary services of oral surgery and direct care is very important.
Dr. Bardonner had Vickie run
an analysis of fifty patients that were sent to the pedio-dontist and review of
their care. He would like to review the possibility of partnering with
providers to provide direct care to the Tribes patients, and generate revenue
based on the need for services and the lack of providers in the local area. Dr.
Bardonner went on to explain that there would be payment discussions on what is
feasible and also what will work with offices including hospitals as some
patients may need inpatient services. Lessie asked if there would be dental
surgeries done at the facilities. Dr. Bardonner explained that an on staff dentist
can use local anesthetics and the current staff may use hospitals with
agreements in place. Laura asked for a cost analysis displaying what services
are going to be offered and what the costs would be. Dr. Bardonner explained
that he does not have that yet, but in his experience, he has seen 50% downward
in costs from referring out. Dr. Bardonner doesn’t expect to have higher
staffing but he believes that the payment for services with this new position
would be paid by the CHS line item, and overall saving the CHS budget money,
the health program money and providing more services to patients.
Leaf supports the idea of
reviewing options with the hospital and the accessibility of care but he is
wondering how that information can be evaluated prior to opening up services to
determine if the concept is feasible. Vickie believes that the staff may pull
information from the RPMS system to determine what patients have been referred
out and how much money the CHS budget has obligated to the patient services. This
information will assist the staff in determining the feasibility of the idea.
Vickie will work with the
staff on the project and have further planning meetings regarding the topic.
Lessie, Vickie and Dr.
Bardonner announced that there were several discussions on adult Denti-Cal.
Arnold Schwarzenegger would like to cut this from the
Vickie explained that an
action plan would be implemented, including seeing more patients. Dr. Bardonner
did explain that he would like to see more children and provide services
increasing productivity. For funding it would be a little less funding as the
patients are Native American, but with a good plan, it should work well and
hopefully the Karuk Tribe will not receive a dramatic change in revenue.
Restricting dental procedures in regards to services that are covered under grants
may save funding. Asking Non-Native Americans to pay 50% of their sliding fee
would assist in obtaining the funding that is needed as well. All options to
prepare for the possible loss in Denti-Cal revenue is being evaluated at this
time.
Laura asked about the
stimulus package that is going to be signed and inquired if the staff is
reviewing the option of what the Medicaid section is going to cover. If this
suggested cut is included in that option then it may mean that President Elect
Obama has incorporated funding in the stimulus to assist through Medicaid which
operates with Denti-Cal.
The staff has not yet
reviewed the stimulus package to determine what will be included for health
programs across the nation.
Vickie has also asked that
Nikki Hokanson RDH to get involved with parenting classes and also have a
person assigned to work with
Florrine Super motioned
and Leaf Hillman seconded to approve Vickie’s report, 7 haa, 0 puuhara, 0
pupitihara.
4.) Patti White, Database Administrator:
Not present, written report
provided.
Florrine Super motioned
and Robert Goodwin seconded to approve Patti’s report, 7 haa, 0 puuhara, 0
pupitihara.
5.) Eric Cutright, IT Director:
Eric is present to review his
written report with the Health Board and also seek approval of action items.
Eric requested approval of
procurement for a server to support the TANF software program. Eric worked with
Daniel on the quotes and needs of the TANF program including funding in the
budget.
Robert Goodwin motioned
and Florrine Super seconded to approve procurement and allow the purchase of a
server from IBM, 7 haa, 0 puuhara, 0 pupitihara.
Eric moved his copier
agreement to next Thursday for review since Erin Hillman did not sign off on it.
Eric announced that the Yreka
facility recently had phone updates and the old system that was removed may be
sold. The equipment is not useful in our environment currently, and will most
likely end up housed in archives. There is a company that is interested in
purchasing the equipment.
Eric explained that the new
phone system in
There are still issues with
internet connectivity for the new facility in
Robert Goodwin motioned
and Alvis Johnson seconded to approve Eric’s report, 7 haa, 0 puuhara, 0
pupitihara.
6.) Toni Lynn Downey, PHN:
Toni is present to provide
her report to the Health Board. She has had some recent staff vacancies. She
has been able to increase home visits and she is working on ideas on how to
increase home visits across the program. She announced that she is happy with
the services that are offered by the CHR and Elder’s workers in
She is working with Vickie
Simmons on diabetic eye exams and foot exams. Toni will attempt to move the eye
machine to each location to have all diabetic patients in each area receive
services or have the opportunity for services.
The CHP had completed car
seat safety in the local area. There were several car seats distributed and the
community benefited from the collaboration.
She attended safety officer
training and provided her training report on infection control courses that she
attended.
She is working with Erin
Hillman on a collaborative agreement with Hoopa regarding some defibulator
machines.
Toni would like to have the
Elder’s worker position changed to a CHR position in the Yreka area. She would
like to have the public health portion work better and be incorporated into all
the position descriptions within her program. Florrine agrees that the qualifications
of the CHR’s are beneficial to both Elder’s and persons receiving CHR services
but would like to keep it as an Elder’s worker to demonstrate the Council’s
commitment to the Elders in each community. The CHR position is titled that way
based on the medical skills necessary but there is nothing barring the Elders
workers from receiving the same types of training and qualifications as the
CHR’s. CHR training is done by IHS. Toni would like to also have a lot of good
training to all staff on drawing blood, diabetic training and some chronic
disease training.
Leaf believes that this is a
good idea and he isn’t concerned with the details, but would like this worked
out and ensure that it provides flexibility in working with the issues and
especially health related issues. Leaf explained that the two positions should
not be eliminated but he does support what she would like to do to serve the
community. The position descriptions have been kept separate and she didn’t
understand why this was done that way, but Leaf believes that it is a good idea
to have some cross training. Mike Edwards would like to have the Social Workers
trained as well due to the high volume of transports and likely staff that need
to participate. Dr. Burns believes that the providers could perform the
training that is needed.
Verna Reece motioned and
Florrine Super seconded to approve flying the position as an Elders Worker/CHR,
6 haa, 0 puuhara, 1 pupitihara (Robert Goodwin).
Verna Reece motioned and
Robert Goodwin seconded to approve Toni’s report, 7 haa, 0 puuhara, 0
pupitihara.
7.) Karen Daniels, DQMCH:
Karen is present to review
her written report with the Health Board. She reviewed her schedule while in
the office and noted the meetings she has been attending. She has been working
with Vicki Simmons completing auditing and monitoring of the diabetic program.
She explained that she has been acquiring knowledge of her new position and
hoping to use her information to assist her in doing a good job in the Quality
Management Department. She attached the Compliance & HIPPA meeting minutes
for the Council to review.
Verna Reece motioned and
Florrine Super seconded to approve Karen’s report, 6 haa, 0 puuhara, 0
pupitihara.
8.) Dr. Burns, Medical Director:
Dr. Burns announced that
Dr. Burns explained that the Veteran’s
Association is now not interested in the Karuk Tribe working with the VA and
Dr. Burns revised the Pharmacy
& Therapeutics Committee. The new tasks of the committee will include a
central oversight body of all the medications that are used at all three
clinics. The reports of the P & T Committee are given to the pharmacy
consultant as well.
Verna Reece motioned and
Robert Goodwin seconded to approve Dr. Burns report, 6 haa, 0 puuhara, 0
pupitihara (Leaf Hillman absent for vote).
9.) Lessie Aubrey, EDHHS:
Lessie thanked the Health
Board for allowing the Yreka staff to not attend this meeting and also to have
the meeting moved up to 1 PM due to weather.
Arch needs to register for
travel to the Annual Tribal Leaders Consultation Conference by February 17,
2009. She would also like to request that someone be designated as the
representative having voting authority while at the conference.
Leaf Hillman motioned and
Robert Goodwin seconded to approve Arch having voting authority as the
representative at the upcoming conference, 6 haa, 0 puuhara, 1 pupitihara
(Florrine Super).
Lessie went on to explain
that there has been miscommunication with HRSA in the past. She drafted a
letter on the grant and is also paying a consultant out of technical assistance
funding from HRSA to come onsite and provide some assistance on understanding
the grant and its requirements related to the Karuk Tribe.
Lessie went on to explain all
the services that she will be working with and as resources allow. Robert asked
if these were reimbursable services. The HRSA grant dictates what services will
be offered in the community based on their granting and what was drafted in the
original application. A requirement is to respond to how to offer after-hours
care. Laura has reviewed Lessie’s response to HRSA and justification on how to
meet requirements and does agree that it is accurate and well written.
Lessie has a shaded area that
is based on how to identify the patient population. A clinic visit must be
established in order to maintain services and have clients counted as the target
population.
Elsa asked how it gets around
to the community that the Tribe has the HRSA grant and that all services must
be provided to community members, free of charge, based on having the grant.
Alan Dyar provided a letter to the students and staff of the
Robert Goodwin motioned
and Leaf Hillman to approve the HRSA grant letter that Lessie drafted regarding terms and conditions of NGA, 7 haa,
0 puuhara, 0 pupitihara.
The Council asked that Lessie
follow up on the letter regarding HRSA that Alan Dyar had sent with inaccurate
information.
Lessie provided information
on procedures for national data collection. She reviewed the handout of information
including how organizations can become affiliated with the process and how
Leaf Hillman motioned and
Robert Goodwin seconded to approve Lessie’s report, 7 haa, 0 puuhara, 0
pupitihara.
Non-Health Employee’s:
1.) April Attebury, Tribal Court Administrator:
April presented resolution 09-R-017
with is the Inter Tribal CASA for approval. She is requesting that the Tribal
Council support the inter-tribal CASA program and it’s forming. Hoopa’s
resolution and Yurok’s resolution are both in supporting the project. An office
will be in the
Florence Conrad motioned
and Florrine Super seconded to approve resolution 09-R-017 supporting
intertribal casa, 6 haa, 1 puuhara (Verna Reece), 0 pupitihara.
Florence Conrad motioned
and Alvis Johnson seconded to appoint Florrine Super as an alternate and approve
resolution 09-R-018, 6 haa, 0 puuhara, 1 pupitihara (Florrine Super).
Informational:
1.)
Closed Session:
Alvis Johnson motioned and
Roy Arwood seconded to approve resolution 09-R-016 enrolling six (6) members, 5
haa, 0 puuhara, 0 pupitihara.
Consensus: to table CHS
case #197 to Thursday.
Consensus: for Tribal
Member # 1421 to discuss options of delinquency with the TERO Commission and to
also refer him to the KTHA board to discuss further options.
Alvis Johnson motioned and
Florence Conrad seconded to approve contract 09-C-036, 5 haa, 1 puuhara (Verna
Reece), 1 pupitihara.
Consensus: to table
recommendations of inductees to the CRIHB hall of fame. Lessie will provide the
list of nominees to the Council for their recommendation.
Informational: The EDHHS
would like to request better communication between herself and the Board.
Consensus: to deny a loan
request from Tribal Member # D00696.
Consensus: to deny a loan
request from Tribal Member # 390.
Consensus: to table loan
request from Tribal Member # 1392 to Thursday.
Consensus: to table
assistance request from Tribal Member # 1494 to Thursday.
Consensus: to allow staffing
recommendation with review of the position in three months.
Verna Reece motioned and
Robert Goodwin seconded to approve Washington DC travel for Florrine Super
February 15, 2009, 6 haa, 0 puuhara, 0 pupitihara.
Robert Goodwin excused himself from the meeting.
Florrine Super motioned
and Florence Conrad seconded to declare the Member at Large position vacant
effective Monday, 16th, 2009 and notify the Election Committee of
legal options and proceed as the constitution states with an appointment, 6
haa, 0 puuhara, 0 pupitihara.
Robert Goodwin and Leaf Hillman entered the meeting.
Arch Super excused himself from the meeting.
Robert Goodwin motioned
and Alvis Johnson seconded to approve contract 09-C-034 between the Karuk Tribe
and Stephanie Dolan, 6 haa, 0 puuhara, 0 pupitihara.
Robert Goodwin motioned
and Alvis Johnson seconded to approve contract 09-C-035 between Dave Wrobleski
and the Karuk Tribe, 6 haa, 0 puuhara, 0 pupitihara.
Florence Conrad motioned
and Robert Goodwin seconded to approve out of state travel for Bill Tripp and Erin
Hillman to Washington DC, February 23-27, 2009, 6 haa, 0 puuhara, 0 pupitihara.
Next meeting date: March 5, 2009 in Happy Camp, CA. at
3 PM.
Verna Reece motioned and
Alvis Johnson seconded to adjourn meeting at 6:28 PM, 6 haa, 0 puuhara, 0
pupitihara.
Respectfully Submitted,
_______________________________
Arch Super, Chairman
_______________________________
Leaf Hillman, Vice-Chairman
Recording Secretary, Barbara Snider