Board members of the Cook County Health and Hospitals System came up with about $12.4 million in proposed reductions to the FY2018 executive budget recommendation in October — the target was $27 million.

Over the course of the presenation, commissioners asked Dr. Jay Shannon, CEO of the health and hospitals system, and other board members what else could be cut from the system during the department’s presentation.

Shannon said that more cuts would be detrimental to services and providing quality care, something the county prides itself on. Of the proposed cuts, none included eliminating vacant positions, something commissioners have urged many departments to do as they look to fill a $200 million hole in the budget.

A starting point could be cutting the full $27 million from the system’s budget, said Commissioner Jeffrey Tobolski, D-McCook, and maybe more. That figure is partly from the penny-an-ounce sweetened beverage tax which sunsets on Dec. 1. Not filling or cutting open positions could also help reduce the budget, commissioners suggested.

Alexandra Normington, director of media for the system, said Wednesday that there is a turnover adjustment factored in to the budget to account for vacant positions. By not filling them, the system has few options to make sure that the quality of care is not affected but the most cost effective is filling the position, versus using overtime or agency staff. .

Though none of the commissioners want to close clinics or curb services for people, all facets of the system are still on the table. That includes the closure of a child sex abuse clinic, Char Rivette, executive director of the Children’s Advocacy Center, said last week.

That possibility is “absurd,” she said because the clinic — a satellite clinic housed at the Chicago Children’s Advocacy Center staffed by child abuse clinicians from Stroger Hospital — does the sexual abuse investigations for Chicago.

“The children would be losing all of these resources,” Rivette said. “I get that they have to figure out the budget, but when it comes down to child abuse, it’s required of us to investigate that crime and ensure the public is safe. That, in the hierarchy of needs, is most important. It’s the government’s responsibility to protect the children.”

Normington said Wednesday the clinic would not close, but services will be transferred to Stroger Hospital.

Shannon cautioned against cutting positions, saying that advancements in care over the past few years are because of the system’s staff and their commitment to “helping the people we serve.” Tobolski and others brought up the cuts other departments face, namely the state’s attorneys and public defenders offices, and said it was time to make tough choices.

“It’s a circle of no one wanting to pull the trigger and say let’s go,” Tobolski said. “This isn’t about trying to pick your pocket, it’s about asking you to take some difficult steps to help us.”