IN THIS ISSUE: Healthy City - Healthy Nation How Much Lead is in Your Drinking Water? Navigating HIPPA in the Workplace
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August 2019
ILLINOIS MUNICIPAL LEAGUE REVIEW
IN THIS ISSUE:
Healthy City — Healthy Nation
How Much Lead is in Your
Drinking Water?
Navigating HIPPA in the
Workplace
B ILLINOIS MUNICIPAL REVIEW | AUGUST 2019
ILLINOIS MUNICIPAL LEAGUE REVIEW
PAGE 13
3 FROM THE EDITOR’S DESK Advocacy Update:
9 MUNICIPAL CALENDAR How Much Lead is in
13 ADVOCACY UPDATE How Much Lead is in Your Drinking Water? Your Drinking Water?
17 LEGAL BRIEF Tuberculosis Sanitariums
18 AWARDS & GRANTS
Feature Articles
19 RISK MANAGEMENT Navigating HIPAA in the Workplace 5 Healthy City — Healthy Nation
24 FUN IN ILLINOIS! August 2019 Festivals Rethink the Role of Local
Government in Improving our
28 PROFESSIONAL SERVICES DIRECTORY
Nation’s Helath
21 Mental Breakdown
What Happens When a City Shuts
EDITOR IN CHIEF MANAGING EDITOR Down Mental Health Clinics
Brad Cole Rebecca Turner
Volume 98, No 8, August 2019. Total number 1,126.
26 Municipal Golf Courses
(ssn 0019-2139)
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PAGE 26
Municipal Golf Courses:
What it Takes to Survive
and Thrive
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 1
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2 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019
FROM THE OFFICERS OF THE
EDITOR ’ S DESK ILLINOIS MUNICIPAL LEAGUE
The six best doctors in the world are sunlight, rest, exercise, diet, self con-
fidence and friends. Maintain them in all stages and enjoy a healthy life. P R E S I DE N T
Steve Jobs (1955 - 2011) Mayor Michael J. Inman, Macomb
Co-founder of Apple Inc. F I R ST V I C E P R E S I DE N T
Mayor Leon Rockingham, Jr., North Chicago
It’s the best day of the year — #CityHallSelfie Day is August 15. S ECON D V I C E P R E S I DE N T
Sponsored by Engaging Local Government Leaders (ELGL) and in its Mayor Ricky J. Gottman, Vandalia
fourth year, this is your chance to showcase your local government love. E X EC U T I V E DI R EC TOR
To participate, take a picture of yourself in front of your city hall and Brad Cole, Former Mayor, Carbondale
post the picture on social media with the hashtag #CityHallSelfie. There
will be trophies, recognition and prizes for the people and organizations
V I C E P R E S I DE N TS
Mayor Richard H. Veenstra, Addison
that show the most pride and creativity on the big day. Be sure to tag Mayor Richard Irvin, Aurora
Illinois Municipal League with your Illinois City Hall Selfie by using @ Village President Greg Szymanski, Beecher
IllinoisMunicipalLeague or #IML. Mayor Michael Chamberlain, Belvidere
Mayor John Michael Henry, Carbondale
Village President Charles E. Tokar, Chicago Ridge
The Will County Governmental League (WCGL) has announced the
Mayor Kevin B. Hutchinson, Columbia
election of officers for 2019. President: Greg Szymanski, Village President, Mayor Aaron Shepley, Crystal Lake
Village of Beecher; Vice President: Steve Streit, Mayor, City of Lockport; Mayor Julie Moore Wolfe, Decatur
Secretary/Treasurer: John Noak, Village President, Village of Romeoville. Mayor Teresa Kernc, Diamond
Mayor Liandro Arellano, Jr., Dixon
Mayor Reggie Freeman, East Moline
The Illinois City/County Management Association (ILCMA) has Mayor Mark Kupsky, Fairview Heights
announced the election of officers who will serve the association for Mayor John Pritchard, Galesburg
2019-2020. President: Ray Rummel, Manager, Village of Elk Grove Village President Mike McCormick, Godfrey
Village; President-Elect: Ken Terrinoni, Administrator, Boone County; Village President Rodney S. Craig, Hanover Park
Mayor Andy Ezard, Jacksonville
Vice-President: Drew Irvin, Manager, Village of Lake Bluff; Secretary-
Mayor Timothy D. Gover, Mattoon
Treasurer: Dorothy David, Manager, City of Champaign. Town President Chris Koos, Normal
Mayor Jim Ardis, Peoria
IN MEMORIAM Mayor Scott J. Harl, Peru
Nicholas B. Blase, the former Mayor of the Village of Niles, passed away Mayor Robert Hausler, Plano
Mayor Kyle Moore, Quincy
on June 17, 2019, at the age of 91. Blase served as Mayor of Niles for over
Village President Rick Reinbold, Richton Park
48 years, beginning his first term in 1961. Blase served as a vice president Village President Catherine Adduci, River Forest
on the Illinois Municipal League Board of Directors for many years. Mayor Thomas McNamara, Rockford
Village President Dale B. Adams, Rockton
Mayor Richard H. Hill, Round Lake Beach
Mayor Jim Langfelder, Springfield
IML RISK MANAGEMENT ASSOCIATION BOARD OF DIRECTORS Mayor Gary W. Manier, Washington
Mayor Tom Jordan, West Frankfort
C H AIRM A N
Village President Trevor Clatfelter, Sherman PAST P R E S I DE N TS
Village President Karen Darch, Barrington
V IC E CHA IRM A N
Mayor Mark W. Eckert, Belleville
Mayor Hal Patton, Edwardsville
Mayor Roger C. Claar, Bolingbrook
B OA RD MEM BERS Mayor Gerald E. Daugherty, Mascoutah
Mayor Kathy Carroll-Duda, Geneseo Mayor Gerald R. Bennett, Palos Hills
Mayor Steve Frattini, Herrin
Village President Sean Widener, Mahomet
Village President Glenn Ryback, Wadsworth
Village President Eileen Phipps, Wayne
M A NAGIN G DIRECTO R
Brad Cole, Former Mayor, Carbondale
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 3
Join us for great food, speakers, entertainment, and more!
State Treasurer Michael Frerichs
Hosts Local Officials Day at the Illinois State Fair
Saturday, August 17 All local officials are invited to attend this event.
11:30 a.m. - 1 p.m.
Program starts at 12 p.m. For questions, contact:
THanners@illinoistreasurer.gov or 217.558.3709
RSVP at LocalOfficialsDay19.eventbrite.com
for event tickets no later than August 9. Generously sponsored by:
Township Officials of Illinois, Illinois Municipal
League, Illinois Association of County Board
Illinois State Fairgrounds, Director’s Lawn Members, and the United Counties Council
801 East Sangamon Avenue, Springfield, Il of Illinois.
Different by CHOICE
& leading the way in Risk Management
Contact us for a quote at
(217) 525-1220 or online at
imlrma.org
4 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019
Healthy City —
Healthy Nation
Rethinking the Role of Local
Government in Improving
Our Nation’s Health
B Y L A W R E N C E J . M O R R I S S E Y, F O R M E R M AY O R , C I T Y O F R O C K F O R D ( 2 0 0 5 - 2 0 1 7 )
“You’re running an insurance company — and you’re going worse moving forward. If we didn’t address the issue, we
broke.” Those were sobering words coming from the City faced the prospect of our health fund devouring our general
of Rockford’s health insurance consultant during my first fund, threatening our ability to finance our core operations.
month in office.
Mayors and council members get elected on issues like
Health insurance was nowhere on the list of pressing issues improving public safety, growing jobs and fixing potholes.
during my campaign for mayor in 2005. But as I began my We may even take on challenges like improving public
first term and our city prepared for labor negotiations with education, reducing poverty and ending homelessness.
each of our three major unions, we faced an unavoidable These issues, not healthcare or health insurance, are the
challenge. typical issues that get discussed at council meetings,
during election debates and state of the city speeches. We
The city had been masking the true cost of healthcare have historically left healthcare to the states, the federal
by running a deficit in our health fund that had grown government or the private sector.
to over $3 million. As a self-insured employer with an
annual healthcare spend of over $16 million, we had grown But the financial viability of our health fund forced me
accustomed to double-digit increases in annual spending. to pay close attention. And while I knew the issue was
We were financially under water and things looked even important, I had no idea that following this path would
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 5
provoke a fundamental shift in how I While state and federal leaders became aware of during my time
defined my job as mayor. debate who pays for healthcare, like in office. My goal is to highlight the
many of our most difficult challenges, opportunities mayors, city council
Let me share with you a perspective state and federal bureaucracies are members and other local government
that took me the better part of simply too far removed from the officials have to improve the health of
12 years to develop — the job of actual work necessary to improve their communities.
running a city is the job of creating health outcomes.
a healthy city. Whether we want A CITY’S WORK IS
to admit it or not, we are in the To rely on state or federal HEALTHCARE WORK
healthcare business — literally. I just governments to improve the health
While our city’s role as a self-
wish I had realized this in my first of our citizens is like waiting on
insured payer introduced me to our
term instead of my last. them to pick up curbside trash or
healthcare role, I now view our direct
fix potholes. We can hope they do
operations the same way.
LOCAL LEADERS ARE it, but the trash will keep piling up
CLOSEST TO THE PROBLEM and the potholes will go unfilled.
Our public works, community
While we’ve waited on them to fix
Coming into office, I would have development and enforcement
the problem, our citizens have gotten
assumed that state and federal functions serve a primary role in
sicker and costs have skyrocketed,
leaders were rightly charged with designing, building and maintaining
while pharmaceutical companies and
fixing healthcare. My experience in a healthy physical environment for
insurers have gotten rich.
office has convinced me otherwise. our citizens. High quality roads and
I now see the engagement of bridges, sidewalks and pathways,
The examples that follow provide
local government leaders as the parks and recreational facilities
details and illustrations of
only real chance for improving a and sanitary sewer and stormwater
approaches we worked on or I
fundamentally broken system. systems provide an essential
911 Calls are Healthcare Calls
If they don’t know it before they medical emergency. Their ability more police agencies across Illinois
take office, a new city council to quickly respond to medical are requiring Crisis Intervention
member soon learns that the emergencies can literally mean the Training for their officers.3 In fact,
vast majority of fire service calls difference between life and death. county jails now provide mental
are actually medical calls. Out of That’s why police agencies are now health services as a core component
approximately 29,000 calls in 2018 being called on to respond to the of their work.
to Rockford’s 911 Center, 21,000 national crisis of Opioid Overdose
of those calls were for medical Deaths (OOD). In Illinois, Cook County Jail isn’t
emergencies requiring transport just the largest institution providing
to an emergency room, according In response to the OOD crisis, law mental health services in the state,
to Rockford’s Fire Chief Derek enforcement agencies are being it’s the largest in the nation.4 In 44
Bergsten. Fire service personnel are required to carry the opioid reversal states across the nation, jails or
a predominant frontline healthcare antidote naloxone (Narcan®), a prisons care for more mentally ill
provider in most communities. life-saving resuscitative drug people than hospitals.5 That’s why
intervention previously only mental health training has become
It’s no different for law enforcement administered by emergency medical a requirement for Cook County
officers, who often arrive first on the personnel1 Moreover, one in 10 police corrections officers.6
scene for an automobile accident, department calls involve a mental
drug overdose or other traumatic health crisis.2 This is why more and
6 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019
foundation for a healthy and
prosperous community.
We also permit and monitor both
public and private sector properties.
Whether approving the construction
of an industrial building, residential
home, restaurant or retail shop; or
enforcing property maintenance
standards, environmental regulations
By the end of 2015, the City of Rockford had become the first
or stormwater regulations, the
community in the nation to reach the “functional zero” definition
standards we set and manage for for ending veteran homelessness.
others also foster the community
we become. But our health impact
involves much more. revenue streams to reward our Housing and Urban Development
contributions to a collaborative and (HUD) Region V. That’s where I
THE SOCIAL DETERMINANTS accountable continuum of care. learned of common sense population
OF HEALTH health management strategies that
In a general sense, just about APPLYING POPULATION were working in much larger cities
everything we do in local government HEALTH MANAGEMENT TO like New Orleans. If they could
can be viewed as impacting MUNICIPAL CHALLENGES — do it there, I started to believe
community health. But our impact on VETERAN HOMELESSNESS, that we could do the same. We
an individual’s health outcome goes MOBILE INTEGRATED ultimately found success like they
well beyond a general influence. HEALTH & CANCER did — taking a complex, intractable
TREATMENT & SURVIVAL and impersonal problem like
Research over the last decade by the homelessness, and making it smaller,
World Health Organization indicates ENDING VETERAN HOMELESSNESS manageable and extremely personal.
that the place where someone On behalf of the City of Rockford, in
lives, and the conditions in which late 2014, I accepted the Whitehouse The first step was identifying every
they grow, live, work and age, has a Challenge to End Veteran single homeless veteran by name.
greater influence on health outcomes Homelessness.9 By the end of 2015, The City of Rockford Human Services
than the medical care they receive.7 we had become the first community Department, which leads the
In fact, medical care accounts for in the nation to reach the “Functional Community Action Agency for Boone
only 10% to 20% of health outcomes, Zero” definition for ending Veteran and Winnebago Counties, served
with 60% or more now attributed to Homelessness.10 as the backbone agency for the
socioeconomic and environmental effort. That took a lot of work by our
factors known as the Social To be perfectly honest, I was a local teams with great help by the
Determinants of Health.8 skeptic and reluctant at first to take Veteran’s Administration. This initial
on this challenge. We had been work gave visibility and personality
This research challenges us to rethink working on homelessness my entire to the challenge. It became possible
our roles, redefine our responsibilities time in office — and long before I was to end veteran homelessness as soon
and explore new opportunities to elected. We seemed to be making as we had an actual list with names
connect our work with traditional little progress. What, I thought, on it.
hospital systems and care providers. would be different now? But with
We have an incredible opportunity some prodding that we could do it, Each month we worked the list with
to work as part of a new, proactive and promises that things could be our community partners that were
and holistic approach. As some of the different, I took the pledge. members of our Community Action
examples that follow also illustrate, Agency Continuum of Care. During
moving beyond the traditional I followed up the pledge with my these private, Health Insurance
reactive and symptomatic approach personal participation in training Portability and Accountability Act
also offers the opportunity for new offered by U.S. Department of (HIPAA)-compliant meetings, case
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 7
MUNICIPAL CALENDAR managers, social workers and other partners would share
AUGUST
SUN MON TUE
JULY
WED THU FRI SAT
SUN MON TUE WED THU FRI SAT
SUN MON TUE
SEPTEMBER
WED THU FRI SAT
details on outreach and problem solving efforts for each
1 2 3 4 5 6 1 2 3 1 2 3 4 5 6 7
veteran on the list. Our Human Services staff also reported
7 8 9 10 11 12 13 4 5 6 7 8 9 10 8 9 10 11 12 13 14
14 15 16 17 18 19 20 11 12 13 14 15 16 17 15 16 17 18 19 20 21 on the aggregate results at our monthly city management
21 22 23 24 25 26 27 22 23 24 25 26 27 28
28 29 30 31
18
25
19
26
20
27
21
28
22
29
23
30
24
31
29 30 meetings, which we called RockStat.11
While the list grew over the course of the year, by
AUGUST 2019 December of 2015, we had housed more than 100 veterans
and became the first in the nation to achieve Functional
Zero.12 For a community like ours that has been beaten up,
NOTE: For purposes of this calendar, it is assumed the fiscal
left out and forgotten by many, I can’t tell you how much
year begins May 1, as it does in most municipalities. Some pride there was knowing that despite our challenges, we
municipalities, however, may have adopted a date different had done our part to serve our nation’s veterans.
from May 1 for the beginning of their fiscal year. (65 ILCS
5/1-1-2(5).) If so, this calendar must be adjusted to reflect MOBILE INTEGRATED HEALTH/
that specific fiscal year. COMMUNITY PARAMEDIC PROGRAM
In December 2015, the City of Rockford Fire Department
On or before the first day of August, a report of delinquent
special assessments and special taxes is to be made by the became the first municipal fire department in Illinois licensed
collector. (65 ILCS 5/9-2-82) to provide Mobile Integrated Health (MIH) by the Illinois
Department of Public Health. This means that for the first
On or before March 1 with regard to data collected during time, the city could get paid to do preventive care at a
July through December of the previous calendar year and citizen’s home instead of waiting for an emergency call with
by August 1 with regard to data collected during January the only option being an ambulance transport.
through June of each calendar year, every law enforcement
agency is required to submit racial profiling information
and other data required to be collected from traffic stops “We’ve had some incredible success reducing 911 calls,
to the Illinois Department of Transportation. (625 ILCS 5/11- reducing inpatient hospital admissions, and lowering
212(d)) healthcare costs,” states Rockford Fire Chief Derek
Bergsten. “While the model is still new, we’ve seen some
Between August 1 and September 15, nominations for the great results and have entered into contracts with managed
board of trustees of the Illinois Municipal Retirement Fund
care insurance companies to help patients — our citizens —
are to be made. (40 ILCS 5/7-175(a)) NOTE: Cities and
with their care.”
villages with a population over 5,000 are automatically
subject to the Act. However, participation is not mandatory
for any municipality that attains a population of over 5,000 The challenge of dealing with so-called “super utilizers” or
after having provided Social Security coverage for its “frequent fliers” is a challenge faced by fire departments
employees. Each participating municipality may nominate and EMS professionals across the country. Working in
and vote for the four executive trustees who are part of the partnership with insurance companies, hospital systems
eight-member board. (40 ILCS 5/7-174(b)(1))
and other medical providers they can address chronic
health conditions, mental health and substance abuse
In counties having a population of less than 1 million, the
collector of the municipality shall, at any time after August problems and other social support needs of the citizens
15 in each year, publish an advertisement that a return they serve.
will be made to the general officer of the county having
authority to receive state and county taxes of all unpaid The MIH program starts, however, the same way the city
special assessments and installments. (65 ILCS 5/9-2-84) worked to end veteran homelessness — building the list
Publication of the advertisement must be made not more
of individuals who would benefit most from targeted
than 30 days or less than 15 days in advance of the date for
interventions of MIH paramedics.
judgment. Return of delinquent special assessments shall
be made five days prior to the date fixed for application for
judgment. (65 ILCS 5/9-2-85) For Rockford, that began by working with Swedish American
Hospital to identify so-called “super users” who were
frequently calling 911 and driving up emergency room
(ER) visits and hospital stays. The results so far have been
impressive, according to Chief Bergsten.
8 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019“In our pilot effort with Swedish place teaching family members program will result in less trauma,
American Hospital, we saw a 40% how to use naloxone to revive their better care to the patient with lower
reduction in hospital inpatient family member. We are also there cost to taxpayers.”
admissions with just 10 patients,” to connect the patient to drug
stated Chief Bergsten. treatment at Rosecrance, if they are IMPROVING CANCER TREATMENT
ready to take that step.” OUTCOMES AT THE UNIVERSITY
As a result of that early success, OF ILLINOIS CANCER CENTER
Swedish American funded the “The Rockford Fire Department is an Embracing the Social Determinants
community paramedic program innovative group,” states Rosecrance of Health to improve outcomes is a
another two years and the President Dave Gomel. “They’re not core component of the approach at
latest data received for 2018 just first responders to someone the Cancer Center of the University
has demonstrated even more that’s had an overdose. They’re of Illinois (UIC) College of Medicine
impressive results. community leaders who want to stop in Chicago. Partnering with mayors,
the overdose from occurring in the other local governments and
“Our current program saw an 85% first place.”13 community hospital systems, Dr.
decrease in readmissions. Once the Robert Winn hopes to improve
patients were released from the The city’s partnership with Rosecrance detection, treatment and survival
hospital, we have been able to keep got a boost when the Illinois rates for cancer patients.
them at home,” stated Chief Bergsten.
Rockford Fire is also working with
the insurance company, Humana, to
help care for their Medicare Managed
Care patients and with local mental
health and substance abuse provider,
Rosecrance, to reduce Opioid
Overdose Deaths.
While it’s still early, the partnership
with Humana has also had some
As much as hard science and research in the area of genetics and
great results, according to Chief
DNA is leading the way to innovative cancer cures, Dr. Robert
Bergsten. “We have been told that
Winn emphasizes that equal emphasis must be placed on what
we have a much higher rate of
he calls ZNA - with the Z representing a patient’s zip code.
patient engagement than traditional
case managers, which we expect to
result in better patient outcomes and
fewer hospital admissions.” Department of Public Health (IDPH) As much as hard science and
recently approved a pilot program research in the area of genetics and
As for the opioid efforts, the City that allows Rockford paramedics to DNA is leading the way to innovative
of Rockford has partnered with transport a patient suffering a mental cancer cures, Dr. Robert Winn
Rosecrance, the Winnebago County health crisis to the organization’s emphasizes that equal emphasis
Health Department and other short-term triage program. must be placed on what he calls ZNA
community partners to address the — with the Z representing a patient’s
crisis. The goal is to keep an addict “In the past, all we could do for zip code. While Dr. Winn supports
alive and help them access treatment someone suffering a mental health the Precision Medicine movement14
when they are ready. crisis was to send them to the ER and leading to treatments that are
a potential hospital admission or have most likely to help patients based
“Within 48 hours of an overdose law enforcement arrest them and take on a genetic understanding of an
incident, our Mobile Integrated them to the county jail,” according to individual patient, he advocates for
Health Managers are back at the Chief Bergsten. For someone suffering a similar level of precision around an
home where the overdose took from mental illness, we believe this individual patient’s social needs.
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 9“Most of the work we were focused to understand how the Social As part of their work to become a
on had to do with taking care of the Determinants of Health impacts each nationally certified cancer center, Dr.
person’s DNA — all the drugs are patient. It does no good to prescribe Winn and his team are now reaching
developed around the genetics of potentially life-saving medications out to areas outside of Cook County
the person,” states Dr. Winn. “Then it if a patient is unable to consistently from where a considerable number
dawned on me that the vast majority get that prescription filled and of their patients are referred. They
of issues are outside of the genetic consistently take the medication. are reaching out to mayors like
issues — the environmental issues, Peru Mayor Scott Harl to build local
how one responds to stress, the foods “That’s why we need other partners partnerships in what is considered
that we eat. It became very clear to help us serve our patients,” the UI Cancer Center’s catchment
that the zip code or neighborhood states Winn. “We want to share area. This includes Livingston,
the person was associated with was data with local leaders who can Grundy and LaSalle Counties.
a much stronger indicator of their help us drive the interventions
overall health and, interestingly, their and engage the patients that will Winn believes that the approach of
overall life expectancy.” benefit from our help. This has been connecting and engaging effectively
a critical missing piece.” with patients, through the assistance
Understanding the unique social of local government and community
needs of each patient is a key Winn employs strategies like those leaders, ensures that breakthrough
to early diagnosis and effective utilized by the City of Rockford in cancer treatments can be delivered
treatment. “Place and space where achieving Functional Zero for Veteran to the individuals who need them.
you live really matters to your overall Homelessness. Their teams build
health,” according to Winn. To patient lists, utilize social workers “We’re focused on our local
improve outcomes, Winn points to and case managers and refer to communities — the challenges they
the need of identifying and engaging community partners and networks face and the screenings, care and
those that can benefit from care and to make sure a patient’s social needs cures they need,” states Winn. “We
connecting with local government are being met. want to move medicine to a point
leaders who know their communities where a person’s health and quality
best and who may already have front “It’s not as sexy as a new miracle of life in the face of cancer is not
line personnel who can help engage drug, but probably as effective, if not determined by their zip code.”16
those in need. more,” states Winn.
THE ROLE OF THE LOCAL
Dr. Winn attributes his unique Dr. Winn’s approach is so important GOVERNMENT EMPLOYER:
perspective to the other role he plays that it is embedded into the UIC BUILDING A HEALTHY
with the UIC College of Medicine. As Cancer Center’s efforts to achieve WORKFORCE & PUSHING
Vice Chancellor for Community-Based designation as a National Institute BACK AGAINST BIG PHARMA
Practice, Dr. Winn is responsible for of Health (NIH) from the National
“You are running an insurance
a 13-site Federally Qualified Health Cancer Institute (NCI).
company,” our consultant, Mr.
Center network known as the UI
Brauns stated. “You need to start
Health Mile Square, which serves “We were invited by the NIH to
acting like it.”
Medicare and Medicaid patients in one compete for designation because
of Chicago’s poorest communities. of our unique approach — we focus
While bargaining for additional
on health disparities, we have a
contributions to the cost of the plan
“Every single day we are in some hospital, clinics and a full suite of
from union members helped in the
of the most challenged, most colleges that serve marginalized
short run, the biggest driver of our
underserved and most under- communities, and we have strong
rising costs was the poor health of
resourced neighborhoods. We are ties with those communities.”15
our people, including a steady rise in
fighting that fight to bridge the gap
the number of our members suffering
and reduce disparities.” The UIC Cancer Center approach has
from chronic, avoidable disease. We
lead us to their current work building
had to do more.
To improve outcomes for our Mile partnerships with multiple local
Square patients, clinicians work governments in the collar counties.
10 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019Pushing Back Against Big Pharma
When two infants on our city’s the fix is in — that’s the short has received from average citizens
health plan suffered from a life- answer.18 But I’m proud to say that demonstrates the need for local
threatening infantile spasm cities like Rockford are pushing government leaders to take on the
condition in 2015, thankfully, there back. battle to improve health outcomes
was a drug available called Acthar and reform healthcare systems.
that was effective in treating The City of Rockford has filed a
the condition. In 2001, that drug class action lawsuit against the Cities can hold the medical,
cost approximately $40/vile. drug manufacturer as well as pharmaceutical and insurance
Unfortunately for our taxpayers, the pharmacy benefits manager industries accountable through
when the infants on our health plan alleging an illegal conspiracy to strategic litigation and effective
needed the medicine, the drug had raise the price of Acthar in violation lobbying. But we have to work
risen to over $40,000/vile — an of antitrust laws. While the smart and work together to ensure
increase of 100,000%. litigation is still ongoing, the city the best outcomes. That’s why I am
won an important early battle as personally advocating for mayors to
Why has the maker of the drug, the defendants’ motions to dismiss take ownership over improving our
Malinckrodt, raised the price so the lawsuit were denied.19 nation’s health.
much? If you happened to catch
Lawrence J. Morrissey
the 60 Minutes story, you know my Whatever happens with the litigation, Former Mayor, City of Rockford (2005-2017)
answer to that question — because the tremendous support the city
By my second term in office, we had opportunity. We followed this up with conditions, build patient lists, and
introduced a number of wellness a formal Request for Proposal (RFP). proactively drive engagement at
related activities and incentives the health center to address each
including offering a discount to our “We knew that running a health patient’s individual health needs.17
employees who participated in an center was a big step, so we took
annual biometric screening and other our time, ran an extensive and The results since opening the health
wellness related activities. But despite open process, and involved council center in 2014 have been very
those efforts, and some individual members,” stated Ryan Brauns. positive with the city showing over
success stories, we were not improving “Selecting a non-local vendor to $11 million in cumulative savings and
health outcomes across our employee operate the health center was a a return on investment of over 3:1.
population. That’s when our healthcare significant political concern for some, Beyond the financial savings, the city
consultant, Ryan Brauns, convinced me but it also gave the local hospital has seen continued improvement in
that we should look into operating our systems comfort knowing that our the baseline health of their members.
own employee health center. clinicians did not have any referral
bias and would refer patients to “The health center has helped the
OPERATING AN EMPLOYER- any provider covered under the city city reduce annual increases in health
SPONSORED HEALTH CENTER health plan.” trend and turn around a health
While the original idea of running our fund deficit into a surplus,” stated
own health center seemed extreme, The city’s chosen vendor, Marathon Mr. Brauns. “We’ve also seen that
as I looked at how much we were Health, operates health centers for an employer can do more than just
spending on primary care and the both public and private employers finance disease and injury. Employers
poor outcomes we had, I warmed across the country, providing like the City of Rockford are
up to the idea. We went through evidence-based clinical care and showing that they can prevent and
a long process with a Request for total population health management reverse disease and support a more
Interest (RFI) first, which was a great services. They work to identify productive and enjoyable career for
way to learn and understand the patients with chronic health their people.”
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 11Healthy employees are more dealing with the opioid epidemic 4
See www.motherjones.com/crime-justice/2019/01/
chicagos-jail-is-the-one-of-the-countys-biggest-
productive and more prepared to or the outrageous increases in mental-health-care-providers-heres-a-look-inside.
serve. This is particularly true in intense prescription drug costs, mayors and Ibid.
5
6
Ibid.
occupations like fire and police, but it other local government leaders have 7
www.who.int/social_determinants/sdh_definition/
is also true for every other employee. an incredible opportunity to drive the en.
8
National Academy of Science, Social Determinants of
Our local governments experience loss national healthcare debate. Health 101, Sanne Magnan, October 9, 2017, nam.edu/
social-determinants-of-health-101-for-health-care-
when employees miss time from work
five-plus-five.
due to injury or illness of oneself or a Instead of just dealing with the 9
https://www.usich.gov/solutions/collaborative-
leadership/mayors-challenge.
family member, when we are not at our backend consequences of poor 10
Functional zero is reached when the number
best in serving our citizens and, sadly, health, we have a unique opportunity of veterans experiencing homelessness within a
community is less than the average number of
when poor health of our employees to become part of front-end veterans being connected with permanent housing
results in on-the-job injuries to our healthcare interventions. The benefit each month. www.hudexchange.info/onecpd/
assets/File/SNAPS-In-Focus-Ending-Veteran-
employees or to third parties. is more effective outcomes, lower Homelessness-and-What-it-Means-for-Zero-2016-
costs and access to new resources. Communities.pdf.
11
Built for Zero, Community Solutions Case
Being proactive also requires Study:Rockford Illinois: Ending and Sustaning an End
close monitoring of health related There is simply no reason why we to Veteran Homelessness www.community.solutions/
sites/default/files/built_for_zero_case_study_-_
operations. Our human resource can’t add healthcare to our agenda. rockford.pdf.
professionals and outside healthcare In fact, as I’ve discussed in this 12
Rockford, IL Becomes first Zero: 2016 Community
to Reach Functional Zero for Veteran Homelessness,
consultants and partners play article, so much of what we do Adam Gibbs, December 18, 2015
a major role in monitoring our already impacts healthcare, it really www.community.solutions/blog/rockford-il-
becomes-first-zero-2016-community-reach-
healthcare related operations. The isn’t a new agenda item as much as it functional-zero-veteran-homelessness.
over $16 million spent annually is a new perspective on our work. We
13
See https://vimeo.com/user18209692/
review/339609332/9996c1be26
on healthcare includes medical are on the front lines, we are closest 14
https://www.cancer.gov/about-cancer/treatment/
types/precision-medicine
spending, pharmaceutical spending, to the problems and we are too 15
https://today.uic.edu/building-capacity-for-cancer-
as well as working with health numerous and too important to sit on research-through-nci-designation
16
Ibid.
insurance companies, pharmaceutical the sidelines. 17
In the interest of full disclosure, I became such a
benefits managers, excess insurers stong believer in our City’s healthcare work and the
work of Marathon Health, that after leaving office in
and a variety of other health related 1
See www.researchgate.net/
2017, I joined Marathon Health as Vice President of
publication/326329045_Naloxone_Administration_
vendors and programs. by_Law_Enforcement_Officers_in_Illinois_A_
Government Relations and Vice President of Sales.
18
https://www.cbsnews.com/news/the-problem-
Policy_Analysis.
with-prescription-drug-prices/
2
See www.rrstar.com/opinion/20171103/their-view-
Perhaps nowhere is this responsibility police-on-front-lines-of-mental-health-crises-need-
19
https://www.rrstar.com/news/20190125/rockfords-
lawsuit-against-drug-company-moves-forward
more obvious and more important more-training?template=ampart).
3
See rosecrance.org/cti2012.
than when dealing with the high cost
of prescription drugs.
Lawrence J. Morrissey, J.D., is Vice President of Government Relations and
Vice President of Sales Midwest Region for Marathon Health. He served as
CONCLUSION Mayor in the City of Rockford from 2005 to 2017. Contact Mr. Morrissey at
(815) 540-3354 or morrissey.larry@gmail.com.
Whether taking care of our
employees and our citizens, or
12 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019E D U C AT E .
A DVO C AT E .
ADVOCACY UPDATE E M P OW E R .
How Much Lead is in Your
Drinking Water?
The Safe Drinking Water Act has reduced
the maximum allowable lead content in
drinking water
E XC E R PT E D F R O M T H E U. S . E N V I R O N M E N TA L P R OT EC T I O N AG E N C Y W E B S I T E , E PA .G OV
HOW LEAD GETS INTO DRINKING WATER A number of factors are involved in the extent to which lead
enters the water, including:
Lead can enter drinking water when plumbing materials
that contain lead corrode, especially where the water has
high acidity or low mineral content that corrodes pipes • the chemistry of the water (acidity and alkalinity) and
and fixtures. The most common sources of lead in drinking the types and amounts of minerals in the water,
water are lead pipes, faucets and fixtures. In homes with • the amount of lead the water comes into contact with,
lead pipes that connect the home to the water main, also
• the temperature of the water,
known as lead service lines, these pipes are typically the
most significant source of lead in the water. Lead pipes • the amount of wear in the pipes,
are more likely to be found in older cities and homes built • how long the water stays in pipes, and
before 1986. Among homes without lead service lines, the
• the presence of protective scales or coatings inside the
most common problem is with brass or chrome-plated brass
plumbing materials.
faucets and plumbing with lead solder.
To address corrosion of lead and copper into drinking water,
The Safe Drinking Water Act (SDWA) has reduced the
the U.S. Environmental Protection Agency (EPA) issued
maximum allowable lead content — that is, content that is
the Lead and Copper Rule (LCR) under the authority of the
considered “lead-free” — to be a weighted average of 0.25%
SDWA. One requirement of the LCR is corrosion control
calculated across the wetted surfaces of pipes, pipe fittings,
treatment to prevent lead and copper from contaminating
plumbing fittings and fixtures and 0.2% for solder and flux.
drinking water. Corrosion control treatment means utilities
must make drinking water less corrosive to the materials it
Corrosion is a dissolving or wearing away of metal caused
comes into contact with on its way to consumers’ taps.
by a chemical reaction between water and your plumbing.
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 13effects of lead occur at lower bones along with calcium. During
exposure levels in children than in pregnancy, lead is released from
adults. A dose of lead that would bones as maternal calcium and
have little effect on an adult can is used to help form the bones of
have a significant effect on a child. In the fetus. This is particularly true
children, low levels of exposure have if a woman does not have enough
been linked to damage to the central dietary calcium. Lead can also cross
and peripheral nervous system, the placental barrier exposing the
learning disabilities, shorter stature, fetus to lead. This can result in
impaired hearing and impaired serious effects to the mother and her
formation and function of blood cells. developing fetus, including:
The Centers for Disease Control and
• Reduced growth of the fetus
Prevention (CDC) recommends that
public health actions be initiated • Premature birth
when the level of lead in a child’s • Lead can also be transmitted
blood is five micrograms per deciliter through breast milk.
or more.
HEALTH EFFECTS OF ADULTS
EXPOSURES TO LEAD It is important to recognize all the Lead is also harmful to adults. Adults
IN DRINKING WATER ways a child can be exposed to lead. exposed to lead can suffer from:
Children are exposed to lead in paint,
The health effects information • Cardiovascular effects, increased
dust, soil, air and food, as well as
included here is not intended to blood pressure and incidence of
drinking water. If the level of lead
catalog all possible health effects for hypertension
in a child’s blood is at or above the
lead. Rather, it is intended to let you • Decreased kidney function
CDC action level of five micrograms
know about the most significant and
per deciliter, it may be due to lead • Reproductive problems (in both
probable health effects associated
exposures from a combination of men and women)
with lead in drinking water.
sources. EPA estimates that drinking
water can make up 20% or more
IS THERE A SAFE LEVEL OF CAN I SHOWER IN LEAD-
of a person’s total exposure to
LEAD IN DRINKING WATER? CONTAMINATED WATER?
lead. Infants who consume mostly
The SDWA requires EPA to determine Yes. Bathing and showering should
mixed formula can receive 40% to
the level of contaminants in drinking be safe for you and your children,
60% of their exposure to lead from
water at which no adverse health even if the water contains lead over
drinking water.
effects are likely to occur with an EPA’s action level. Human skin does
adequate margin of safety. These not absorb lead in water.
CHILDREN
non-enforceable health goals, based
Even low levels of lead in the blood
solely on possible health risks, are This information applies to most
of children can result in:
called maximum contaminant level situations and to a large majority
goals (MCLGs). EPA has set the • Behavior and learning problems
of the population, but individual
maximum contaminant level goal • Lower IQ and hyperactivity circumstances may vary. Some
for lead in drinking water at zero situations, such as cases involving
• Slowed growth
because lead is a toxic metal that highly corrosive water, may require
can be harmful to human health • Hearing problems
additional recommendations or
even at low exposure levels. Lead is • Anemia more stringent actions. Your local
persistent, and it can bio accumulate In rare cases, ingestion of lead can water authority is always your first
in the body over time. cause seizures, coma and even death. source for testing and identifying
lead contamination in your tap
Young children, infants and fetuses water. Many public water authorities
PREGNANT WOMEN
are particularly vulnerable to lead have websites that include data on
Lead can accumulate in our bodies
because the physical and behavioral drinking water quality, including
over time, where it is stored in
14 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019results of lead testing. Links to a Consumer Confidence Report materials containing lead. Since
such data can be found on the (CCR) for their customers by July you cannot see, taste or smell lead
EPA Consumer Confidence Report 1 of each year. Contact your water dissolved in water, testing is the only
website at epa.gov/ccr. utility if you’d like to receive a copy sure way of telling whether there are
of their latest report. If your water harmful quantities of lead in your
WHAT YOU CAN DO comes from a household well or drinking water. A list of certified
Find out if lead is in your other private water supply, check laboratories are available from
drinking water. with your health department, or with your state or local drinking water
any nearby water utilities that use authority. Testing costs between
ground water, for information on $20 and $100. Contact your water
FIRST, LEARN MORE ABOUT THE contaminants of concern in your area. supplier as they may have useful
WATER COMING INTO YOUR HOME information, including whether the
EPA requires all community water SECOND, YOU CAN HAVE YOUR service connector used in your home
systems to prepare and deliver an WATER TESTED FOR LEAD or area is made of lead.
annual water quality report called Homes may have internal plumbing
EPA and the Centers for Disease Control and Prevention (CDC) agree that there is no known safe level of lead in a child’s
blood. Lead is harmful to health, especially for children.
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 152019 Lead REDUCE YOUR EXPOSURE TO LEAD • Taking further steps to
Legislation in IN DRINKING WATER AT HOME
• Use only cold water for drinking,
optimize their corrosion control
treatment (for water systems
serving 50,000 people that
Illinois
cooking and making baby
formula. Boiling water does not have not fully optimized their
remove lead from water. corrosion control).
Senator Heather Steans (D-Chicago)
• Regularly clean your faucet’s • Educating the public about lead
is a leader and advocate for the in drinking water and actions
screen (also known as
removal of lead service lines consumers can take to reduce
and has worked closely with the an aerator).
their exposure to lead.
Illinois Municipal League (IML) on • Consider using a water filter
a solution to what everyone has certified to remove lead and • Replacing the portions of lead
agreed is a real problem in some
know when it’s time to replace service lines (lines that connect
communities in Illinois. With the distribution mains to customers)
the filter.
intention of taking all communities under the water system’s control.
into consideration, IML has • Before drinking, flush your pipes
respectfully opposed the option by running your tap, taking a EPA issued the Lead and Copper Rule
of a one-size-fits-all approach shower, doing laundry or a load
promoted by some more aggressive in 1991 and revised the regulation in
of dishes. 2000 and 2007. States may set more
environmentalist groups whose
solutions could financially cripple • Contact your water system stringent drinking water regulations
many municipalities and citizens, to learn more about sources than EPA.
communities are already at a of lead and removing lead
tipping point economically. service lines. HOW EPA REQUIRES
No group is more aware of this STATES AND PUBLIC WATER
issue than IML, precisely because DRINKING WATER SYSTEMS TO PROTECT
we represent the interests of all REQUIREMENTS FOR LEAD DRINKING WATER
1,298 cities, villages and towns Because lead contamination The SDWA requires EPA to establish
in Illinois. We do not take this of drinking water often results and enforce standards that public
public health issue lightly, and as from corrosion of the plumbing
a matter of that insightfulness, we drinking water systems must
materials belonging to water system
have worked with Senator Steans follow. EPA delegates primary
customers, EPA established a
and other key legislators on this enforcement responsibility (also
treatment technique rather than an
legislation to incorporate state called primacy) for public water
revenues for any lead service line MCL for lead. A treatment technique systems to states and tribes if they
replacement approach. is an enforceable procedure or level meet certain requirements.
of technological performance that
Due to IML’s advocacy efforts,
water systems must follow to ensure
Senator Steans agreed to not EPA requires all community water
control of a contaminant.
pass legislation out of the Senate systems to prepare and deliver an
without any accompanying revenue. annual water quality report called a
This year’s capital bill did not The treatment technique regulation Consumer Confidence Report (CCR)
include funding for lead service for lead (the Lead and Copper Rule) for their customers.
line replacement, and consequently requires water systems to control
the initiative did not advance in the corrosivity of the water. The EPA’s Public Notification Rule
the General Assembly during this regulation also requires systems to requires public water systems to alert
spring session. Similar legislation is
collect tap samples from sites served you if there is a problem with your
expected to be filed again in 2020 drinking water.
by the system that are more likely to
and IML looks forward to effectively
tackling this issue in a fair and have plumbing materials containing For more information about these
equitable manner for our members. lead. If more than 10% of tap water requirements please see www.
samples exceed the lead action epa.gov/dwreginfo/primacy-
If you have questions regarding level of 15 parts per billion, then enforcement-responsibility-public-
legislation, please contact water systems are required to take water-systems.
IMLLegislation@iml.org. additional actions including:
16 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019E D U C AT E .
A DVO C AT E .
LEGAL BRIEF E M P OW E R .
Tuberculosis Sanitariums
and Related Illinois Municipal Code
Provisions are a Thing of the Past
BY I L L I N O I S M U N I C I PA L L E AG U E L EG A L STA F F
The Illinois Municipal Code contains numerous provisions Similarly, Article 11, Division 25 provides for the corporate
detailing the grant of authority, or restriction thereof, authorities of cities to establish and maintain hospitals
that belongs to municipalities. These provisions address for the segregation or treatment of inhabitants of the city
a myriad of topics that range from the organization and suffering from any contagious or communicable disease.
forms of municipalities, to cultural activities, airports, flood Division 25 has also been in the Illinois Municipal Code since
control drainage and zoning. Many provisions in the Illinois 1961 and hasn’t been amended since 1989.
Municipal Code date back to the inception of the Code
and are no longer necessary or relevant to the operation According to a legislative liaison from IDPH, “Illinois has no
of municipalities. licensed tuberculosis sanitariums” and “there are currently
no contagious disease hospitals in Illinois.”
The Illinois Municipal League (IML) recently sent a letter to
Dr. Ngozi Ezike, Director of the Illinois Department of Public Consequently, there is no need to maintain Division 29,
Health (IDPH), encouraging her support in our advocacy regarding municipal tuberculosis sanitariums, nor Division
efforts to repeal two outdated and obsolete portions 25, regarding contagious disease hospitals, in the Illinois
of the Illinois Municipal Code regarding City and Village Municipal Code. It is our contention that if there ever
Tuberculosis Sanitariums (65 ILCS 5/11-29-1 et seq.) and becomes a need for a program to care for and treat
Contagious Disease Hospitals (65 ILCS 5/11-25-1 et seq.). persons afflicted with tuberculosis or any other contagious
or communicable disease, local hospitals and the IDPH will
Article 11, Division 29 provides for the corporate be utilized.
authorities of cities and villages to establish and maintain
a program for the care and treatment of persons The Illinois General Assembly continues to add to the Illinois
afflicted with tuberculosis, the authority to levy taxes Municipal Code every year, with little regard to the outdated
for the establishment of a tuberculosis sanitarium fund, mandates that are already enacted. Seeking the repeal of
appointment of a board of directors that maintains the these unnecessary provisions in the Illinois Municipal Code is
program for the care of treatment of persons afflicted with one of many ways IML works to keep the Code relevant and
tuberculosis and the discontinuance of public tuberculosis understandable for Illinois’ public officials.
sanitariums, among other provisions. Division 29 has been
in the Illinois Municipal Code in some form since 1961 and If you have questions regarding legal issues, please contact
IMLLegal@iml.org.
hasn’t been amended since 1992.
AUGUST 2019 | ILLINOIS MUNICIPAL REVIEW 17AWARDS & GRANTS
AWARD OPPORTUNITIES
ALL-AMERICA CITY AWARD
The 2020 All-America City theme is “enhancing
health and well-being through civic engagement.”
The 2020 All-America City Award is focused
on celebrating examples of civic engagement
practices that advance health and well-being in
local communities. For information on applying,
please visit www.nationalcivicleague.org/america-
city-award/how-to-apply/.
to Lewis University in support
AWARD WINNERS of its Lewis Innovation Hub. An
independent panel of judges
USCM ANNOUNCES AWARDS Mayor John Noak of Romeoville,
selected recipients of the Wells second from right, accepting the
During their 87th Annual Meeting, the United States Fargo Foundation-funded grants CommunityWINS® award.
Conference of Mayors (USCM) honored two Illinois from 136 applicants representing
municipalities. small, medium, large and metropolitan cities. The
Hanover Park Recognized for Climate Initiative CommunityWINS® Grant Program recognizes non-profits
The Village of Hanover Park completed an initiative of and cities that drive neighborhood stabilization, economic
Mayor Rodney S. Craig to increase the number of solar development and job creation. Mayor Noak was recognized
installation permits. The initiative took quick, bold steps for his efforts in the Lewis Innovation Hub Partnership.
to encourage solar energy growth and remove obstacles
to solar development in the ILCMA ANNOUNCES AWARD WINNERS
community. The initiative At its annual conference held in June, the Illinois City/
sought to revamp the County Management Association (ILCMA) honored three
permitting process, evaluate members with ILCMA Service Awards. Bob Kiely, who retired
any zoning issues that impede as manager for the City of Lake Forest in February 2019,
solar installation, streamline received the Robert B. Morris Lifetime Achievement Award.
and expedite the inspection This award is presented to a retired individual who has had
process, give residents Mayor Rodney S. Craig of Hanover an exemplary career in local government management and
resources to solar installers Park, second from right, accepting has served no less than 20 years in local government, at
the Climate Initiative award.
and increase community least eight of those in Illinois.
engagement by letting them Steve Vinezeano, Manager, Village of Niles, received the
know that Hanover Park was “open for solar business.” special award for Service to the Community.
As a result of the initiative, 55 solar installation permits Dorothy David, Manager, City of Champaign, received the
were issued and are expected to generate 136,192 kilowatt special award for Service to the Association.
hours annually, saving the equivalent of 308 metric tons of
CO2 per year. Lowell Crow, Manager, City of Freeport, received the special
award for Service to the Profession.
The initiative was completed with existing funds from
the current budget, with no additional funding needed to GRANTS
achieve the goals.
GRANTFINDER
Romeoville Recognized for Economic Development Initiative GrantFinder provides IML members with access to an
The Village of Romeoville and Mayor John Noak were online searchable database of thousands of federal,
honored with the CommunityWINS® top award in the state, foundation and corporate grants available
small city category for economic development initiatives. to Illinois communities. Visit iml.org/grantfinder to
In addition to the recognition, a $75,000 grant was award get started.
18 ILLINOIS MUNICIPAL REVIEW | AUGUST 2019You can also read
