A joint meeting of the Board of Estimates for the City and the Personnel and Finance Committee for the county – except the later does not have quorum. The meeting is to approve the Dane County and City of Madison Public Health Department Budget. Read on, you can read the rant about the “hobos”!
The pause the presentation by Dave Schmiedicke on the operating budget and go into the joint meeting. No quorum on the county side of things.
Rosemary Lee is registered to speak on the budget. She is fed up with the way the homeless are draining the health, safety and financial groups. She lives downtown, has for 45 years, the homeless are creating quite a disturbance, mainly because many have terrible disease of alcoholism. They mainly leave trash, human waste and everything else all over the doorways they sleep in at night and she knows a downtown developer who owns several properties who lost several employees because they got tired of cleaning up the doorways of their property that the homeless were spending the night in and they had to clean up everything, including human waste. She says it is also a safety issue. She said that yesterday during the fire truck parade one of her friends called and they were there with 8 or 10 of their family and the children were afraid of the “hobos” hanging around, the hobos were swearing, using every swear word you can think of. Including harassing some of the citizens that were there for the parade, so her friend and their little family instead of going shopping down State St. and up to Capitol Kids and then out to eat, left. All because of these “hobos” and the Madison Police Department was not there for quite a while, not until after the parade started, and those are just a few examples. Also, she thinks they are losing Monona Terrace Conventions, although Mr. McManners could not verify that for her. She lives at 111 W Wilson so she is often on Martin Luther King Blvd – women coming and going to the Monona Terrace Convention Center, she is talking about professional business women, will often stop her, point to the hobos and ask if they need to be afraid of them. She always say no and crosses her fingers. One night a woman about 28, beautiful, well dressed, asked her if she had to be afraid that any of the hobos would attack or rape her. Well that got her thinking, we don’t want guests, male or female, to our city, to have to worry about that, remember these people are going home, they are talking about it. How many conventions are we losing because we are getting a reputation that our homeless citizens are very aggressive and they are bothering ordinary citizens. She smokes, one night she had a cigarette in her hand, a homeless person asked her for one, she wouldn’t open her purse in front of him and she saw him the next day, and this is a direct quote from him, he said to his friends as I passed “There goes the f-word many-other-words-bitch that wouldn’t give me a cigarette yesterday.” Now since when am I obligated to give anyone a cigarette, especially someone I don’t want to open my purse in front of. The county has to start the ball here, especially in front of the city-county building where they all hang out. She had a meeting with a high ranking Dane County Administrator and he in essence said he wasn’t going to do anything about it. Well, the county and city together better get together and start doing something about these people that are damaging our city.
1 . Public Health is a joint venture with tax levy support divided between the City and the County based upon equalized valuation . Joint costs for 2014 total $ 10, 454, 384, net of revenues received from grants and fees . The City levy will support $4,689, 197 (44.854%) of the joint costs, and County general purpose revenues will carry the remaining $5,765,187 (55.146%).
2 . In addition to sharing the joint costs, the City of Madison will provide additional funding for community agency contracts, including $ 188, 000 for Access Community Health Center and $ 20, 000 for the Safe Communities Coalition. With these contracts, along with additional support for the continuation of the Heroin/Opiates Poisoning program ( $ 18,276), total support from the City of Madison will amount to $4,915,473 in 2014.
3 . Total City funding for the Heroin Opiates Poisoning Program amounts to $45,188, including the City’s share of the joint costs ($26,912) plus the added City – only funding ($18,276).
4 . PHMDC will continue to provide services to individuals for the control and prevention of communicable disease . However, chronic disease is now the primary cause of death and disease in the community . This will mean diversifying the skills and professional disciplines of the staff in Public Health . To do this, the 2014 budget reclasses several vacant positions . Two positions will become Public Health Planners, one with an emphasis on health policy analysis and the other on food security . A third will become a Public Health Analyst, focusing on translating data into action . This budget will also reclass a position to a Division Director, to create a division dedicated to policy, planning and the built environment
Janel Heinrich gives an overview of the budget. She is excited about the 2014 budget, it allows them to do things that they have been talking about for quite some time and allows them to continue their transformation as a public health department to provide mandated services that are important, but also work to be a better partner, collaborator in the work in the community to have a bigger imprint to work at a population level, to provide data to form decisions that help shape the environment that we live in that help shape our outcomes. That is a really critical role for public health. In 2014 they had the ability to reclassify a number of positions to create new positions to bring in different skills and professional orientations in the health department. Primarily in health policy analysis, a data analyst that is not a epidemiologist, food security and poverty expert and a division director to help lead the work as we are focusing on internal reorganization. While they are focusing their work in health services and data policy and planning. There are some innovative things, that is exciting, they have been able to partner with the city planning department to jointly fund a position to work on land use and transportation planning with public health emphasis.
Reorganization of positions
Mike Verveer asks about details on the reclasses, are all the positions currently vacant? They are all vacant, no lay offs. They have been working on opportunities to have vacant positions and not eliminate them through targets, 3% this year or 5% this would allow us to use that opportunity – there were 5 vacant positions, 2 public health nurses, 2 administrative positions and an interpretor that have been vacant for short or long terms. They used those to reclassify.
Verveer asks about the role of public health nurses evolving to analytical and data work. She says there were a couple things that happened, they are still sorting things out post merger, in doing so they realized some changes in programs to provide the same quality care, but they don’t need the same number of bodies to do these services. It is a trend nationally and internationally for public health to not work within the medical model necessarily which is providing individual case management, but to work beyond that. To work in helping change the systems and inform the policies that have an impact on health programs. Public health nurses, epidemiologists, data analysts, there is a whole host of other disciplines that public health is comprised of.
Verveer asks about fees for licensed establishments, was last year the last fee increase are there fee increases any time soon. David says that they increased and reevaluated fees last year, there is no fee increase this year.
Verveer says there is some methodology you use and your board reviews that. David says annually. Verveer says that is all cross sections of licenses that are issued by our city clerk on behalf of the whole county. David says correct.
Larry Palm says he is on the Homeless Issues Committee and we talked substantially about investments made by other agencies, but I don’t have a lot of discussion about investments made by Public Health and given our testimony here, here is curious about whether or not you believe that is a burden that is increasing or decreasing, changes in policy the in our community.
Heintich says he is correct, they have not played a big role in that conversation to date, she doesn’t know the data behind the parts of that conversation that public health could play a part in that conversation, whether that is related to medical services, coordination of care or policies. There could be a role but they don’t have the expertise in order to play a role in those conversations. She says she is not sure if that answers his question.
Palm says probably not, but it intrigues him in a different way, he would assume that human services would be working with health to work with people on chronic alcoholism or mental health or basic health issues are important. And I seen no one else more in need than someone who is homeless, why are they not receiving services.
Heinrich says that the medical services they provide are driven by mandates to provide care. That has traditinoally been related to communicable and infectious disease. That is how the operationalized their services, one of the questions they have long asked is what are the needs of this population. Their scope of practice is related to that. Some of the care or the conditions that our homeless population might have falls outside the scope of public health services and they are more associated with home health and they don’t have liability to provide those services whether it is for wounds or diabetes, they don’t have that expertise. She is not aware of the volume of the need in the community, she would like to participate in assessing that, she thinks that is a great role for public health.
Palm says that they do have employees on the neighborhood resource teams. Have they communicated to you any needs.
Heinrich says homelessness has not been the primary concern they have brought forward. Their participants on those teams.
Palm says you expressed interest, how would you you follow up with that.
Heinrich says pending approval of their budget their ability to look at the data could be a critical contribution to the conversations on homelessness.
Matt Phair asks about – with all the talk with the conference with the YWCA and the high disparities we all know about here in Madison and Dane County and he knows they did something the day after. How does the reclassification get at the equity, how does your organization play a role in that.
Heinrich says to her data is always the answer. Their ability to bring data not just about disease and death but also the factors that influence those conditions. They know in Dane County we are healty overall, we rank well, we are 12th, but the disparities are off the chart in terms of health incomes, they can be more nimble and bring the factors that influence that to the table and equity is a big theme underlying all those things. How do we better target, an example from last week, how would Owl Creek be different if public health were at the table, and that is a conversation that is worth exploring, she can’t say what the answer would be, but she thinks with their data they could help shape the environment differently. They base their decisions and drive their work from an equity framework.
Shiva Bidar-Sielaff asks about food security and the Food Council, where do you see that role of public health in helping with data and staffing of that committee because our current staffer is going to be stretched pretty thin pretty soon. There are 5 subcommittees.
Heinrich says that is a great conversation for them to participate in robustly. What they tried to do, it is not a service to any conversation or work in the community or to staff to divide and conquer they way they have. Many of the people they serve are food insecure, its a theme, through WIC, through high risk home visiting programs, do we have the expertise in house to fully participate in those conversations, not entirely, so she thinks there is opportunity for them to play a bigger role with a more robust capacity.
On-line info on restaurant inspections
Anita Weier asks about restaurant inspections, are violations available on line?
Heinrich says not currently.
Weier asks why not, she says that is pretty important data.
Heinrich says that is a great piece of data and they are working with city IT to make that possible.
Weier asks if there is an end date in mind.
Heinrich says she doesn’t have one.
Weier says that once when she checked in to this years ago, it was hard to find the information even not on-line.
Heinrich says they can access that information, more easily in the past, its all electronic now.
Weier says so the public could ask a question and get an answer on it.
Heinrich says yes.
County Budget process
John Hendrick thanks them for the joint meeting, they have another meeting at 5:30 across the street so they may have to leave, he tells them about their budget process. Contact them if you need to do so. He says it is awkward have a department with two budget processes because you never can change things, but they are willing to cooperate if there is a need. They are having a hearing on the County Executive budget on the 24th of this month. On the 29th, after the rest of the committees have had a chance to take up their areas, the Personnel and Finance Committee will be taking up the budget and that will be the most intensive time for their budget process. Then the county boar will pass the county budget on Nov. 18th. They look forward to working with them, Let them know if there are any issues, right now they do not.
There is no action to be taken at this time, they go back to their meeting.
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