OFFICE OF THE PRESIDENT – LEGAL AND GOVERNMENT AFFAIS

LAURA LECHOWICZ FELICIONE

SPECIAL LEGAL COUNSEL
69 W. Washington, Blvd., Suite 1415 ⚫ Chicago, Illinois 60602 ⚫ (312) 603-6371

MEMORANDUM
TONI PRECKWINKLE
PRESIDENT
To: Honorable Cook County Board of Commissioners
Cook County Board
of Commissioners
From: Laura Lechowicz Felicione, Special Legal Counsel
BRANDON JOHNSON
1st District Subject: Proposed Substitute Amendment to Cook County Health and Hospitals
System Ordinance
DENNIS DEER
2nd District
Date: February 24, 2020
BILL LOWRY
3rd District The proposed substitute amendments to the CCCHHS ordinance provide for independent
governance; however, the amendments will also provide for enhanced collaboration on
STANLEY MOORE various operational initiatives that impact County policy and appropriations, including but
4th District
not limited to, human resources and labor issues, financial matters, operational initiatives,
DEBORAH SIMS
capital improvements, performance benchmarking, uncompensated care policy and the
5th District CCHHS legislative agenda. It is intended that enhanced collaboration will result in a more
unified policy agenda as well as improved operational efficiencies, enhanced transparency
DONNA MILLER and improved patient care.
6th District

The proposed substitute was drafted following consideration and input from the System
ALMA E. ANAYA
7th District
Board, civic and healthcare organizations and labor; please note, the Chicago Federation of
Labor has indicated that they no longer object to the enabling ordinance changes provided
LUIS ARROYO, JR. in this substitute.
8th District

Noted below please find a bullet point summary of changes by category. In addition,
PETER N. SILVESTRI
Attachment A to this memo highlights the sections further modified in the substitute from
9th District
the original amendment.
BRIDGET GAINER
10th District Mission and Policy Changes

JOHN P. DALEY
• Ensures that CCHHS, its leadership and System Board cooperate with the Office of the
11th District
Cook County Board President and its various Bureau Chiefs on operational matters,
BRIDGET DEGNEN uncompensated care policies, determining appropriate benchmarking and reporting
12th District (including but not limited to revenue and finance enhancements, operational and quality
improvements and expenditure authority), strategic plans and the legislative policy agenda
LARRY SUFFREDIN for CCHHS to ensure efficiency across County operations.
13th District

SCOTT R. BRITTON 1
14th District

KEVIN B. MORRISON
15th District

JEFFREY R. TOBOLSKI
16th District

SEAN M. MORRISON
17th District
 • Requires CCHHS policies on direct access programs to ensure uninsured residents’
access to quality health care to be determined in consultation with the President or the
President’s designee; said policies are subject to the approval of the President and County
Board acting in its official capacity as well as the Board of Health. .
• Promotes consultation and collaboration between the System Board and the County
Board.

Nominating Committee

• Modifies the Nominating Committee from 14 to 13 representatives, replacing MCHC with the Illinois Health
and Hospitals Association and removing Suburban Primary Healthcare Council as they are an agency funded
by the County.

System Board Modifications

• Increases System Board Membership to 12 from 11 and provides the President with a Direct Appointment
who will be an employee of the County.
• The President’s Direct Appointment will be subject to the same qualifications as the remaining System Board
members and the appointment will require the advice and consent of the County Board.
• Modifies the System Board and System Board Committee structure. Provides that no fewer than 12
meetings shall be held annually; standing committee meetings shall be called by the various committee
chairs and that committee meetings shall called as determined by the System Board of Committee Chairs.
• Allows System Board to recommend instead of fix compensation of employees and provides that the
compensation must be in line with the County Board Budget appropriation. This language is line with the
County’s Code under State law which indicates that the Board of Commissioners approves salary.
• Requires the CEO appointment to be subject to the advice and Consent of the Board and consult with the
Board on performance benchmarking for the CEO. The Board of Commissioners will not approve the job
description or the performance evaluation; these responsibilities will remain with the System Board.
• Requires the System Board to direct CEO collaboration with the President and the President’s departments
on operational and policy issues.
• Accounts for the roles of the System Board and Cook County Bureau of Human Resources in labor
negotiation and strategy.
• Sets the timing of budget proposal submission to the Chief Financial Officer and Budget Director and aligns
capital improvement requirements on real property with the Procurement threshold and requires
additional reporting to Asset Management and Finance.
• Provides that the delegation of authority to the System Board from the Board shall not be considered a
grant of home rule authority.

CEO Responsibilities

• Work with the Office or the President and his or her designees to collaborate on various operational
initiatives that impact County policy and appropriations, including but not limited to, human resource and
labor issues, financial matters, operational initiatives, address capital needs, determine benchmarking, set
uncompensated care policies and determine the CCHHS legislative agenda.
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• Provide input to the Cook County Bureau of Human Resources in Cook County Bureau of Human Resources
negotiation of management rights and work rules for CCHHS.
• Meet monthly with the Cook County Board President and his/her designees regarding CCHHS operations
and collaborate with the Office of the President and his/her Bureau Chiefs on various operational initiatives
that impact County policy and appropriations, including but not limited to, human resource and labor issues,
financial matters, operational issues, informational technology issues, address capital needs, determine
benchmarking, set uncompensated care policies and determine the CCHHS legislative agenda.

Finance Related Changes

• Allow a representative of the County Board President and the Cook County Chief Financial Officer or his/her
designee shall assist the System Board in developing the Strategic and Financial Plan.
• Requires CCHHS to submit a balanced Preliminary Budget with expenditures matching the revenue
estimates for the fiscal year; provides opportunity for CCHHS to ask for additional revenue which is subject
to County Board approval.
• Expands managerial and financial oversite by permitting the County Board to recommend in consultation
with CCHHS management or the System Board to implement management related changes based upon the
recommendations of any management audit initiated by the County Board. Should CCHHS fail to implement
the recommendations, CCHHS shall explain its position to the Health and Hospitals Committee.
• Requires CCHHS to submit proposed budget to the Cook County Chief Financial Officer and Budget Director
at a minimum of two weeks in advance of the presentation to the System Board.

HR Related Functions

• Requires the CEO or Interim CEO appointment to be approved by the Board of Commissioners. Creates a
process to re-initiate recruitment should the Board of Commissioners not approve the appointment.
• The System Board shall provide a copy of the job description for the CEO in advance of recruitment as well
as share the performance measures utilized by the System Board to evaluate the CEO’s performance.
• The recommended salary, termination, term, severance and any contract bonus provisions negotiated by
the System Board for the CEO shall be subject to the review and approval of the County Board.
• Expands the collaborative and operational role of Cook County Bureau of Human Resources (BHR) in
working with CCHHS to ensure operational and budgetary efficiency, as well as efficiency and uniformity in
human resource functions and polices.
• Provides collaboration with Cook County BHR and provides for human resource policies to be approved by
System Board and Chief of Cook County BHR.
• Requires that any recommended salary, termination, term, severance and any contract bonus provision or
compensation policies negotiated by the System Board for Direct Appointments of the System Board or CEO
to be subject to the review and approval of the County Board.
• Addresses the significant role of BHR Labor in the negotiation of collective bargaining and authorizes Cook
County BHR to address and deliver bargaining agreement training and settle or resolve bargaining unit
employee contract or disciplinary employment related disputes and grievances at the applicable step.
• Permits BHR to implement Employee Appeals Board Decisions and to investigate and recommend discipline
should CCHHS management fail to implement labor directives, grievance resolutions and settlements.

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 Should you have any questions or comments, please do not hesitate to contact me or Chief of Staff, Lanetta
Haynes Turner directly.

cc: Honorable Toni Preckwinkle, President

Lanetta Haynes Turner, Chief of Staff
ATTACHMENT A

Substitute Changes as of February 24, 2020

Sec. 38-71(a)(6) – Modified to reference correct statutory citation.

Sec. 38-71(c) – Provides that CCHHS will cooperate with the Board of Commissioners, the President and the
President’s various Departments on various CCHHS matters. Added the County Board of Commissioners per
requests from the Board of Commissioners.

Sec. 38-71(d) – Added language to address the benefits of cooperation and consultation and referenced the ongoing
independent authority of the System Board except where otherwise provided in the Article as well as adds reference to
the County Board acting in its official capacity as well as the Board of Public Health.

Sec. 38-72 – Modified definition of Cook County Health and request of CCHHS.

Sec. 38-73(a) - Changed the effective date of the increase of one member to the System Board to February 27, 2020.
(Original Item provided for the change to occur on February 15, 2020)

Sec. 38-74 (a)(1) and (9) – Modified the original amendment to include language in subsection (a)(1) and move
remaining amended language to new (a)(9).

Sec. 38-74 (a)(7) - Modified reference to Employment Plan in lieu of Supplemental Relief Order.

Sec. 38-74 (a)(8) - Modified to reference correct statutory citation.

Sec. 38-75(b)(1) – Replaced MCHC with the Illinois Health and Hospital Association

Sec. 38-75(d) – Requires the President’s direct appointment to be approved by the Board of Commissioners.

Sec. 38-76 - Changed the effective date of the increase of one member to the System Board to February 27, 2020 and
created a section for the President’s Direct Appointment which requires the advice and consent of the County Board.
Places the President’s direct appointment on a four year term like other System Board members and said appointee is
subject to the same background qualifications. Provides that the Ex Officio member and the direct appointment
member may not be the Chairperson.

Sec. 38-76(g) – Subjects the President’s direct appointment to the same removal process as the remaining System
Board members and also permits the President to remove his/her direct appointment at any time.

Sec. 38-77(a) – Subjects the President’s direct appointment to the same qualifications as the remaining System Board
members.
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Sec. 38-78(a) – Provides that the System Board will continue to annually select their Chairperson.

Sec. 38-78(b) -Deletes reference to the frequency of committee meetings to be determined

By the System Board as this is addressed in Sec. 38-79.

Sec. 38-79(b) - Allows the frequency of committee meetings to be determined by the System
Board.

Sec. 38-79(e) - Corrects reference citation to Open Meetings Act.

Sec. 38-80(c) – Removed reference to County Board approving the performance evaluation of the CEO and added
that the CEO’s performance will be reviewed in 6 month intervals in the Cook County Health and Hospitals
Committee.

Sec. 38-80(j) – Accounted for dollar value in quarterly reporting to not include improvements, etc… under $5,000 as
such dollar value falls in a Direct Pay category.

Sec. 38-80(q)- Correct statutory citation.

Sec. 38-81(b) – Provides that if the CEO the appointment is not approved by the Board of Commissioners, a new
search shall be conducted by the System Board. If the compensation package is not approved by the County Board,
the System Board must renegotiate the compensation package and if unsuccessful, a new search shall be conducted by
the System Board. Also provides that the job description and performance measures be provided to the County Board
instead of the County Board approving.

Sec. 38-81(c)(6) – Clarifies that the CEO shall participate in labor negotiations with Cook County Bureau of Human
Resources in regards to negotiating management rights.

Sec. 38-81(d) and (e) – Changed language from “report” to “meet” in (d) and modified reporting in (e).

Sec. 38-83(d)(3) – The balanced budget issues if further addressed to note that the revenue estimates may include
requested appropriations from the County Board which will be subject to County Board approval.

Sec. 38-84(b)- Addresses reference to Employment Plan and Supplemental Policies.

Sec. 38-84(c) – Provides that CCHHS may participate in negotiations with the Cook County Bureau of Human
Resources in regard to negotiating management rights and work rules.

Sec. 38-84(d) – Includes language that the Chief of the Bureau of Human Resources or designee, will discuss the
implications of grievance decisions with CCHHS Human Resources and addresses when Cook County Bureau of
Human Resources becomes involved in the grievance process.

Sec. 38-84(e) – Modifies labor language to provide that CCHHS shall not enter into agreements with unions,
verbal or written that amend or modify the terms of existing collective bargaining agreements and/or
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practices without consulting the Bureau of Human Resources Labor Relations Division. Removes the
previous language that indicated that CCHHS shall not engage the union officials (President, Delegates, Business
agents, or any non-County employee without consulting with the Bureau of Human Resources Labor Relations
Division.

Sec. 38-84(f) – Added that the training programs implemented by the Bureau of Human Resources will be reviewed
with CCHHS Human Resources Department prior to implementing said training.

Sec. 38-84(g) - Added underline.

Sec. 38-84(i) - Addressed appeal rights.

Sec. 38-84(j)- Replaces System Board with CCHHS in reference to disciplinary hearings.

Sec. 38-86 (d) - Corrects statutory citation.

Sec. 38-88(a)3) – Allows the County Board to initiate a management audit of CCHHS a deemed advisable instead of
“at least every year.”

Sec. 38-88(a)(4) – Allows that any reorganization of the System Board financial accounts by the County Board will
be in keeping with best practices adopted by the Professional Accounting Standards Board.

Sec. 38-88(a)(5) – Allows the County Board to recommend management related changes(instead of implement) as a
result of an audit and calls for a hearing should CCHHS or System Board fail to implement recommended changes
pursuant to audit findings.

Sec. 38-159 – Included County Board, functioning as itself and the Cook County Board of Health in Direct Access
policy approval.