MINUTES
OTHERS: Budget Dept.: Kate Carrano, Leslie Bennett, Robert Kopenhaver, Fran Piskorowski, Meredith Waltman; CBAC: George Hosey; Health Dept.: Dr. Adel, Irv Cohen, Patsy Yang-Lewis, Mary Landrigan; Board of Health: Doug Aspros; C.E.’s Office: Ingrid Bent, Susan Tapper, Bill Randolph; Board of Elections: Commissioner Sunderland, Commissioner LaFayette; Dept. of Community Mental Health: Commissioner Friedman; BOL: Chris Chang, Sally Schecter, Robert Boland, Tina Seckerson
Chairman Wishnie called the meeting to order at 9:10 a.m.
DISCUSSION: (There is a cassette tape on file for more detailed information)
2000 PROPOSED BUDGET: BOARD OF ELECTIONS:
· The Department is requesting funds to purchase two high speed printers. Currently they only have one high speed printer. They have made great strides in overcoming potential Y2K problems by implementing a new voter registration system that has streamlined workflow and increased productivity. They would like to continue their progress by utilizing technology to produce maps, “poll roster books”, election canvass reports without outsourcing and doing the work themselves. The printers will help them reach this goal. These printers will be able to run all night and help prevent overtime issues. They intend to raise revenue by producing the poll roster books at a cost to the villages in Westchester that conduct their elections in March. They also intend on raising funds and reducing operating costs by producing annual election canvass books in-house. The cost of the printers is approximately $8300.
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· The Board of Elections is requesting 2 additional personnel (Grade 12 – Program Managers) to help with supervision of their staff of 36 because of added work responsibilities due to new voter registration system. The department is taking on some responsibilities that data processing used to do.
· The plan is to cut down on outsourcing services and do more in-house. Punch Card ballots will always be outsourced because of the size and stock of the cards.
2000 PROPOSED BUDGET: HEALTH DEPARTMENT:
· Dr. Adel began by stating that he feels that a portion of the tobacco settlement money should be used toward an aggressive campaign against smoking, which would be an investment in the future.
· Surveillance program: Until 1985 the Department of Health operated a surveillance program in response to encephalitis in the County. With no return of the encephalitis and with the onset of Lyme Disease it was easy to transition the funds towards surveillance of misquitoes into the Lyme Program. The point of the Surveillance Program is to get early warnings about increased breeding and presence of mosquitoes by setting up the counting of mosquitoes in various areas by using rather sophisticated tracking mechanisms. They concentrate on areas where standing water exists and at sewer and main systems to see fi there is any breeding going on. The program includes establishing inspections of standing water bodies trying to get municipalities to cooperate vigorously in moving sources of standing water and getting municipalities to treat their STP’s and keeping track of counts and determine whether or not there is significant change. The control aspect is somewhat more extensive and difficult. It is their hope and expectation that the state will recognize that this is a regional problem and not a county problem. Counties cannot be left to their own devices to deal with a problem that crosses county borders and even crosses state borders. Dr. Adel stated that it is important to have local legislative support and push to get the state to recognize its responsibility to provide adequate financing of control measures. Spraying costs alone were $1.5 million, if you add in overtime costs and personnel expenses it would probably come close to $2.5 million. The money came from savings within the department.
· Although he feels the Board of Health belongs in the center of the County, Dr. Adel stated that the staff has settled into the New Rochelle location. There is increased travel time, but the building works and the parking situation has been resolved reasonably well.
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· Of the 8 positions abolished, 2 were physicians at the neighborhood health centers. Several years ago the delivery of medical care began to change whereby managed care became a reality and them mandated managed care became a reality. Many children with Medicaid were rolled into managed change as a requirement of the state. As that occurred the volume of care that the county has to deliver to children began to fall because they were now being pulled into the HMO’s. That decline in service load was accompanied by a substantial decline in revenue because the Medicaid population was our source of income to cover the non-pay patients. That began to dry up and with the reduction in volume it was thought that the appropriate response from the department and the county was to begin to reduce the staff of the services that were being offered. Over the past several years six well baby satellites in Westchester have been closed as well as the Eastchester District Office, the Mount Kisco District Office, the Well Baby Clinic in White Plains and the Yonkers Pediatric Treatment Center. When the Pediatric Treatment Center was closed, the patient population shifted into St. Joseph’s which was an available provider located right across the street. St. Joseph’s was viewed as a more ideal location for the children because they were capable of providing coverage 24 hours a day, seven days a week. In this year’s budget (1999) they envisioned further reductions in services by the planned closure of the Pediatric Treatment Center in Rye/Port Chester. Because of the shrinking load of children that they were responsible for and because Open Door opened a clinic directly across the street from the Rye/Port Chester District Office, it was quite clear that they were now going to become a duplicate source of services. With the advent of Child Health Plus it became clear that they were able to offer a much better care level to the children than the county could provide. Dr. Adel stated that they have been negotiating with Open Door for sometime and it is their understanding that Open Door is planning to double their capacity, it is an ongoing process.
· Neighborhood Health Centers: A long term issue that needs to be resolved is the importance of having good data and accurate cost reporting procedures that permit them to verify for the taxpayers that every penny is being spent as intended.
· Concerns that need to be planned for so they don’t go unmet: From a broad viewpoint Dr. Adel stated that what they’re learning is that when you ask the public about its health concerns a major problem is transportation to the doctors and hospitals as well as unemployment which prevents people from being able to afford health insurance. People are talking about social issues that continge on the communities health very directly. We are going to have to start thinking more and more in terms of the social determinants of health rather than the medical ones.
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2000 PROPOSED BUDGET: COMMUNITY MENTAL HEALTH:
· Tax levy has gone down $75,000. In addition, Commission Friedman stated that they have absorbed $40,000 of expenditures to the Mental Health Association (for an assistance program) that had been in the Miscellaneous Budget prior to this year.
· Commissioner Friedman stated that there are several issues he sees as being hopeful for the future. First, there are ever-increasing break throughs on the use of new, better, dramatically less harmful side effect profile drugs. They have been very successful with depression and successful in bi-polar disorder. They are being to get the same level of success, albeit a beginning, in schizophrenia and other psychotic disorders. The drugs that have come out within the last five years are revolution compared to what existed before. They don’t bring with it the side effects that can be very serious. Every day there are new discussions of what will be the next generation in each of these areas. These will be more expensive medications when they first come out. The bi-product is that more and more people will get healthier and healthier and their work will shift ever more from the acute area to the more rehabilitative area. As patients get better the two areas that they need help with is jobs and housing.
· The Commissioner was asked to comment on the recent announcement by the governor that he wants to put more money into centralized hospitals and his concern about the number of beds available for mentally sick people. Commissioner Friedman responded that the Governor’s announcement has three major components. One of the components is a statement that for the first time in the last thirty years, the available number of beds that are being budget for the State Office of Mental Health (directly run facilities by the state, i.e. Rockland Psychiatric Center) will not be shown as decreased, as they have been by around 500 per year in the last few years. From its high point in the early 60’s this is a system that had at one point 93,000 individuals in those facilities. We now have more facilities. By not shutting any beds they have not yet proposed the shutting of any campuses. There is an incredible amount of money that goes into supporting everyone of these state campuses. The facilities now have 200-400 patients each whereas they used to have 4,000 patients each. He stated that it is time for some of the campuses to be closed.
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· 35 positions in trust accounts: The Commissioner stated that this is a deliberate decision by his department to aggressively pursue as many state and federal grants as they can which allows them as a department to have dramatically fewer tax levies, general operating budgets supporting employees than they had year by year. He said this growth will continue as they seek both state and very large federal grants.
· Commissioner Friedman stated that a major issue, which is now part of federal employee health insurance and is legalized in about 20 states, but not in New York, is parody. Parody means that mental health insurance coverage is the same as physical health insurance coverage. He stated that this will be a major political issue in the near future.
ADJOURNMENT:
There being no further items for discussion, on motion of Legislator Young, seconded by Legislator Carsky, the meeting was adjourned at 10:15