CHICAGO — Facing an imminent takeover of its large and financially troubled Public Health Bureau, Cook County, Ill. Board President Todd Stroger has named a health care consultant to replace interim bureau chief operating officer Thomas Glaser, who was given a new position. Glaser, the county’s long-serving chief financial officer, was moved into the bureau’s COO post last February. While praising Glaser’s financial skill, health bureau chief Robert Simon, who Stroger appointed to the position last March, said he wants a top aide with health care experience. Consultant David R. Small, 56, currently works for the Houston-based firm D. Peterson & Associates.Glaser was the county’s CFO for 11 years during the tenure of Stroger’s father, John, and served as president of the Government Finance Officers Association from May 2006 to June 2007. Glaser will now serve as associate director of contracts, purchasing, and auditing for the health bureau, and his salary will drop to $165,000 from $225,000. Todd Stroger named his own finance team after his election earlier this year.The move comes just weeks before an independent board is likely to take over control of the financially troubled bureau, which accounts for a third of the county’s total budget. The board, whose members will likely be appointed before Christmas or in the first weeks of January, could herald another shake-up among the bureau’s top managers. “With the board coming in, [Small] might not have a job,” said Commissioner Joan Murphy, vice chair of the board task force for hospital governance. “That’s all their decision — they’re going to be looking at everyone and at every contract.” She added that a national search for a new COO was launched several months ago.Simon, who has held the chief position since March, has said publicly he would leave as soon as an independent board took over. Stroger would appoint the members of the new board and it’s possible that the full county Board of Commissioners would retain voting power over the health system’s budget, said Murphy. The bureau has been at the center of a long and contentious debate over how to fix Cook County’s budget, which faces a $239 million deficit going into fiscal 2008. The system includes three hospitals and 26 clinics with an $850 million budget that in fiscal 2007 suffered from a $70 million shortfall. The deficit was largely due to an ongoing annual decline in federal matching dollars, chronically low patient collections, and an ineffective billing system. The health system lost approximately $158 million between 2002 and 2005.In May, at the request of U.S. Sen. Richard J. Durbin, D-Ill., Stroger appointed a 10-member blue ribbon health committee to review the system, which largely serves uninsured and underinsured patients. The committee returned to the county board in October with a 40-page report that was highly critical and recommended the independent board takeover, similar to other public health systems across the country. The committee said it could not even determine the true size of the system’s shortfall because of varying financial reports. Speaking to board commissioners Tuesday, Small, the new chief operating officer, said he was willing to take a lower salary than Glaser’s — $200,000 instead of $225,000 — and that he would sign only a one-year contract with renewal upon board approval. He also said he was aware of the fragility of his new position with a new management team likely taking over soon.

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