COMMITTEE ON BUDGET AND APPROPRIATIONS

MINUTES-JULY 9, 1997

1:00 P.M.

B & A MEMBERS: Swanson, Wishnie, LaMotte, Darcy, Delfino, Young, Abinanti

OTHERS: C.E.’s Office: Gina Angiulo-IGR, Bob Wolff; Personnel: Betty Wallace-Deputy; Labor Relations-Mike Wittenberg; Budget: Joe Phelan-Director, Robert Kopenhaver; CBAC: George Hosey, Barbara Strauss; LWV: Jo Brill, Amy Paulin; Health Dept: Dr. Adel-Commissioner, Patsy Yang- Lewis, Karen Kelly, Ira Cohen; Mt. Vernon Neighborhood Health Center: Carole Morris-CEO, David Ford, Steven Horowitz; Greenburgh Neighborhood Health Center: Carolyn George-Executive Director; BOL: Legislator Bronz, Legislator Stewart-Cousins, Legislator Carsky, Dan Rodriguez, Robert J. Boland-Budget Analyst, Glenn Guzi- Program Specialist, Tina Seckerson-Secretary to Committee

Co-Chairs Swanson and Wishnie called the meeting to order at 1:00 p.m.

DISCUSSION: (There is a cassette tape on file for more detailed information)

23. COUNTY EXECUTIVE: Proposed legislation which would authorize the withdrawal of the Westchester County Department of Health from the operation of the Greenburgh Neighborhood Health Center. (6/16/97)

• Dr. Adel stated that the Greenburgh Neighborhood Health Center is a critical component of the health care network in Westchester and has been providing a much needed service. He explained that if the Center remains tied to the County it will be virtually impossible for them to survive basically because the County is bound by rules and regulations which do not apply in private sector. If the Greenburgh Center is bound by those rules it cannot survive in the competitive atmosphere of health centers. He further stated that he is pessimistic about the County’s ability to continue to support the center and believes that if they are not allowed to be independent there will be a dramatic decrease in revenue which will seriously affect their ability to survive.

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• Carolyn George, Executive Director of the Greenburgh Neighborhood Health Center explained that the center was started by a small group of people who formed a task force comprised of local government and community people to provide health care to people in the community. From that grew the Greenburgh Neighborhood Health Center. The Center has had a board from the beginning which makes decisions for it. The board assessed changes in the health care field and felt that the center was becoming increasingly uncompetitive in a competitive environment. Ms. George further explained that the center is a provider for Medicare and Medicaid and networks with area hospitals (i.e. St. Agnes, White Plains Hospital and WCMC). One problem which needs to be addressed is the fill vacancies immediately, which is not something they are able to do while under County control. She stated that the center needs to be able to spread its wings and be able to grow in order to survive in this market.
• Mr. Wishnie stated that he had several questions he would like answered during the discussion such as:

1. The total cost of the Greenburgh Neighborhood Health Center to the County.
2. What will happen to the employees being laid off and their vested interests?
3. How did the process evolve with regard to the relationship with Mt. Vernon and was the process opened up to other participants?

• Ms. George stated that after much discussion the Greenburgh Neighborhood Health Center Board made a decision to form a joint venture with Mt. Vernon. She stated that they were approached by various hospitals, some of whom wanted to absorb the health center. They also looked at the other health centers and the decision was made by the Board to go with Mt. Vernon. Mr. Wishnie asked if there was an RFP process. Ms. George stated there was not as the Board felt there was no need for it.
• The Greenburgh Neighborhood Health Center is slated to receive $1.2 million from the County annually through 1998.
• Ms. Wallace stated that Personnel is attempting to place the 41 employees that would be laid off. Of the 41 people slated to be laid off, 19 have "bumping" rights. Dr. Adel assured the Committee that the Greenburgh Neighborhood Health Center has made a commitment to offer positions to those County employees at the Center slated to be laid off when the Center goes independent.

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• Mrs. Stewart-Cousins inquired as to the difference in compensation for employees when the Center is spun-off. Ms. George stated that she did not have the figures in front of her but traditionally the salaries in the independent health centers are lower.
• Mrs. Stewart-Cousins asked if there will be a benefit package. Ms. George replied that there would be, although it may be structured differently than the current one.
• Mrs. Swanson asked if the Center goes independent, if any provisions have been made to keep those employees who may be eligible for early retirement on the County payroll until the window of opportunity is available. Mr. Wittenberg replied that the County has made a commitment to keep people on payroll until first early retirement window comes up. 6 of the 41 employees to be laid off are eligible for early retirement.
• Mrs. Stewart-Cousins stated her concern with regard to the elimination of health related positions. Ms. George stated that 58 positions are slated to be eliminated. The infrastructure of the new entity will have to be developed, using current vacancies as well as changing titles. There is a need to fill different types of positions (i.e. bookkeepers, accountants, etc.) Karen Kelly stated that the proposed staffing structure will be about the same size.
• Ms. George stated that the joint venture is based upon the economy scale. One major plus networking with Mount Vernon is the computer system. Greenburgh will hook onto Mt. Vernon’s system which will allow them to expand their capability. This will require Greenburgh purchase some additional hardware and software although not to the extent they would have to if not joined with Mt. Vernon. Dr. Adel stated that Mt. Vernon has been through this process and Greenburgh stands only to gain from their experience and expertise.
• Mr. Wishnie asked what the financial arrangement will be between Greenburgh and Mt. Vernon. Dr. Adel stated there is no financial commitment from Greenburgh to Mt. Vernon. Mrs. Bronz asked that the concept of "freestanding" be explained. Ms. George explained that a freestanding health center is one that is run by the local community. Greenburgh is currently the only non-freestanding center in the County. Mrs. Swanson asked if there is any financial set-up where Mt. Vernon will be paid by Greenburgh after the spin-off. Dr. Adel replied that there will be a small transition fee for which there is a management contract in the amount of $70,000. He further stated that this is the full extent of exchange of any money to Mount Vernon by Greenburgh. He reminded the Committee that there is a commitment by the County to Greenburgh for $1.2 million for next year.

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• Mrs. Swanson stated that the Committee previously requested audits of health centers. Ms. Yang-Lewis stated that KPMG Peat Marwick study on methodology done. At that time it was suggested that the Bennett Kielson audit be held off for one year pending putting the new methodology in place.
• Mr. Boland indicated that based on the terms of the contract the County would be obligated to give a $1.2 million contribution to Greenburgh. It was stated that for 1996 it should not be obligated because there was a surplus. Dr. Adel stated that it may not be necessary in 1996 but it will definitely be necessary in 1997. Mr. Phelan stated that based on the current numbers Greenburgh will need full level of contribution for 1997.
• Mrs. LaMotte asked if Greenburgh has a mission statement as they go forward. Dr. Adel stated that as a recipient of 330 & 340 federal grants their mission statement is defined.
• Mrs. Swanson asked if after the sin-off Greenburgh will stay in the same catchment are and serve the same people. Ms. George replied that they will.
• The doctors associated with the Greenburgh Neighborhood Health Center currently have privileges in White Plains Hospital and St. Agnes Hospital and no changes in this area are foreseen.
• Mr. Delfino asked if there are signed affiliation agreements with these hospitals. Ms. George stated there are and they also have an agreement with WCMC for lab work and a pre-natal agreement with St. Agnes.
• Ms. Kelly stated that the license (Certificate of Need) is granted contingent on staying in the location and serving that population.
• Mrs. Stewart-Cousins asked for more specifics as to who will be employed (i.e. the element of staffing in the new agency. Ms. George stated that those people with bumping rights will bump into the Health Department. The process has already started wherein 4-5 employees have moved to Health Department. Mr. Wittenberg stated that every title abolished from the County payroll will be created in the new arrangement.
• Mr. Wishnie asked if those whose jobs are to be abolished are a minority population. Ms. George stated that the people in the entry level positions are basically of the minority population while the others are multicultural and multiracial.

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• Mr. Wishnie went on to say that the only privatization done by the County thus far has been at the hospital (food service), and those people were minorities and now the county is being sued. He asked if this is the same type of situation. Dr. Adel responded that while it is a legitimate concern, he had to take issue with classifying this as privatization. He reiterated that everyone will be offered an opportunity to remain employed, the staff will actually be larger. He said that if the Center goes down 60 people will be totally without jobs.
• Mr. Delfino noted that the Greenburgh Neighborhood Health Center Board has already made a decision to join with Mt. Vernon, the County will contribute $1.2 million for each of 1997 and 1998, and wondered if the County will have any say as to how the $1.2 million is to be used. Dr. Adel stated that the private entity will decide the use of the money.
• Mr. Boland requested a breakdown of the cash subsidy the County has given the Greenburgh Neighborhood Health Center for the last five years.
• Mr. Abinanti stressed his concern that people are already leaving the Center’s employ before the spin-off. He requested a list of comparable vs. lesser salary & benefits. He asked, what does it do to the quality of care if most employees there leave? Dr. Adel stated that it is appropriate to be concerned, and although the salary scale may be different, the first priority was to assure people of employment. Mr. Abinanti requested for a projection of 1st year personnel costs. Mr. Wishnie stated that it is safe to say personnel costs will be lower but marketplace will prevail and they will be able to survive in a competitive marketplace which they cannot do now.
• Mrs. Stewart-Cousins stated that she would like to know who the new staff will be. She said she knows what is going to be taken away but would like to know what will be coming in. Ms. Kelly stated that there will be a different staffing structure that will meet needs of the independent entity. Mrs. Bronz stated that there will be a parallel for staff that is being replaced, it just won’t be under a county title.
• Mr. Abinanti stressed his concern that the new Board will consist of 40% from Mt. Vernon (51% will be from the local community served). He stated that according to the agreement numerous, important decisions will need a 75% vote of the Board and wondered how that will be accomplished given the make-up of the Board.

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• Ms. Morris explained that currently the Greenburgh Neighborhood Health Center Board is 50% operator of center while the County is the other half. With this agreement, the County is going to give up their half to allow Greenburgh to take over 100% operation. Mt. Vernon has no financial interest in this venture and is interested purely in helping the Greenburgh Center survive. She noted that not all of the Mt. Vernon Health Board members are from Mt. Vernon. This matter is time sensitive as the federal grant and state approval would have to be renegotiated if the legislation is not approved in July.
• The Mt. Vernon Neighborhood Health Center has affiliations with various local hospitals (i.e. Mt. Vernon, St. John’s, St. Joseph’s).
• Mr. Delfino asked for assurance that the patients of the Greenburgh Center will continue to go to St. Agnes and White Plains Hospitals. Ms. George stated that the patients have the right to choose the hospital they want to go to. The doctors at the Center have rights at St. Agnes and White Plains Hospitals and some privileges at WCMC. Ms. George stated that the goal of the Center is to continue to serve the community. Dr. Adel stated that the best interest of the organization is to make hospitalization convenient. Mr. Abinanti inquired as to what plan Mt. Vernon is Center is affiliated with now (HMO’s)? Ms. Morris responded they are affiliated with Community Choice. Ms. George stated that Greenburgh is affiliated with Community Choice and Health Source. Mr. Abinanti stated that it is his understanding that the agreement with Health Source is with the County, not the Center. Ms. Yang-Lewis stated that the County currently serves as intermediary and when Greenburgh spins off they will contract with Health Source directly.
• Mr. Abinanti asked if there is a procedure by which each party can terminate the agreement. There is a termination agreement although Greenburgh would have to pay Mt. Vernon ($100,000) for "lost opportunity". Mt. Vernon gave up its opportunity to apply for primary care privileges in Greenburgh to help Greenburgh survive independently.
• Mrs. Swanson asked where in the expenditures is the $100,000 that was added? Mr. Phelan stated that it is not being expended against one particular line item, it is last instance funding against shortfalls (it’s the subsidy piece; deficit financing). Mr. Boland stated that it was the Board’s assumption that the $100,000 was put in to increase expenditures and instead it was put into subsidy.

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• Mr. Abinanti asked if the state will issue more than one Certificate of Need for a particular catchment area? It was responded that the only way Mt. Vernon could get into this catchment area is through Greenburgh.
• Mr. Abinanti asked what the Center’s plan for relocation is when the present lease expires. Mr. Wishnie stated that the Certificate of Need requires that they have to be located within Greenburgh (catchment area). Ms. George stated that they have been on the look-out for another location, in the catchment area, for the last 5 years.
• Mrs. Carsky stated that according to the agreement ex-officio members will have a vote - something she has never heard of. Ms. Morris stated that in this case the ex-officio members refer to the Mt. Vernon representatives on the Board.
• The Committee questioned whether this agreement had been signed off on by the County attorney’s office. The response was that the agreement is strictly between the two parties (Mt. Vernon & Greenburgh). Ms. Yang-Lewis stated that the County Attorney’s Office reviewed the agreement and did not find any liabilities for the County. The Committee asked that this opinion be put in writing. Ms. Yang-Lewis stated that they will provide same.
• Mr. Phelan stated that this agreement now does not bind the County to the $1.2 million contribution for 1998. Ms. Swanson stated that the audits are still a necessary piece in this matter.
• Mr. Wishnie stated that once the Committee’s questions have been answered they will make every effort to take care of this item. The Committee agreed to discuss this matter again at their meeting on Monday, July 14th.

On motion of Legislator Abinanti, seconded by Legislator Swanson, the motion to go into Executive Session at 3:02 p.m. to discuss litigation presently pending in federal court, Absolu vs. County of Westchester, was carried by a vote of 7-0. Mr. Abinanti requested only Legislators be in the room at this time.

On motion of Legislator Swanson, seconded by Legislator Abinanti, the motion to come out of Executive Session was carried at 3:05 p.m.

Mr. Abinanti requested a memo be sent to the County Attorney with regard to the above-referenced case asking the following:

• Has the County of Westchester appeared on this case?
• If so, by what counsel?
• If outside counsel, has approval been granted? and, if so how without the approval of the Board?

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There being no further items for discussion, on motion of Legislator Delfino, seconded by Legislator Abinanti, the meeting was adjourned at 3:15 p.m.