May 20 Regular Monthly Meeting: March 17, 2022
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
March 17, 2022 @ 4:00 PM
TRUSTEES: Karen Deigl Allen Jones
Ann Marie McCrystal Kerry Bartlett
Marybeth Cunningham Barb Bodnar
STAFF: Kate Voss Jennifer Frederick
Jennifer Peshke, Esq. Ann Marie Suriano
ATTENDEES: Cecelia Stalnaker Karissa Bolden
Liz Bruner Samantha Messina
Carrie Lester Irene Caldwell
Nate Bruckner Meredith Egan
Kip Jacoby Chief David Currey
Convene Meeting – Marybeth Cunningham, Chair
Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM by welcoming those in attendance and via Zoom. Reverend Bingham provided the invocation and Ms. Bartlett led the group in the Pledge of Allegiance.
Consent Agenda- Marybeth Cunningham, Chair
Mrs. Cunningham asked for a motion to approve the chairman’s meeting minutes dated February 16, the regular monthly meeting minutes dated February 17, and a March disbursement of $659,629.02. Mrs. Bodnar made the motion which was seconded by Ms. Deigl. The motion carried unanimously.
Mrs. Cunningham stated that the District is completing its Strategic Planning activities and is entering into the budget cycle for the fiscal year 2022-2023. As always, the focus of the board is to help support the healthcare needs of the community. She also voiced her thoughts and prayers for the people of Ukraine.
District Counsel Report – Jennifer Peshke, Esq.
Ms. Peshke provided her report and stated that progress has been made on the amended easement agreements with CCIRH and the VNA. All parties have come to a conceptual agreement and she is hopeful that this matter will be finalized in the next few months. Further, based on conversations at yesterday’s Chairman’s meeting, Mrs. Peshke has been instructed to prepare a memo outlining the process and requirements needing to be met in order for the District to sell any of its land. She will present the same to the Trustees next month for further discussion.
Financial Statement Review- Allen Jones, Treasurer
Mr. Jones stated that the District remains in sound financial position. As of February 28, the District had $15.2 million in cash and investments, less the spending just approved. This leaves about $14.5 million left in the accounts. For the balance of the fiscal year, the District has projected remaining budgeted expenses of $8.4 million. This suggests there will be about $6.1 million remaining in funds at the end of the fiscal year, with additional tax revenues of $1 million yet to be received. Next Mr. Jones stated that the District’s investments with WaterWalker have yielded very low returns this fiscal year and year to date the interest income is less than $3,500. This is a reflection of the zero interest rate policies of the Federal Reserve. However, the policy is now ending, though it is likely to take several months before short-term rates reach 1% and will not likely happen this fiscal year. In addition, WaterWalker is no longer able to provide FDIC guaranteed investments. However, the District’s investments are still very high in quality and meet Florida statute requirements, but they are not government guaranteed. With all these factors in mind, he is recommending the Trustees consider an alternative investment method for some of the funds. He explained that there is a program oﬀered by the U.S. Government called Treasury Direct. The District can open an account and invest directly without fees in U.S. Treasury securities. As of today, rates for Treasuries that mature in one year are over 1%, and maturities of two years over 2%. Mr. Jones recommends the District allocate, initially, $2 million to this program, dividing the funds equally between the one-year and two-year maturities. In the next 24 months, he predicts the District will receive over $20,000 annually from the two-year note and another $10,000 from the one-year maturity. He further stated that it appears the returns on the $2 million will significantly exceed what the District will earn with the approximate average balance of $6 million in the current investment plan. Further, the Trustees are able to evaluate the results and potentially use them for even shorter maturities in the future, as a way to more eﬀectively get a return on the high cash positions. The Trustees agreed with Mr. Jones’s recommendation and he and Mrs. Suriano plan to discuss the same with WaterWalker as soon as possible.
Executive Director Report- Ann Marie Suriano, Executive Director
Mrs. Suriano stated she prepared a written report which was included with the meeting packet materials for the Trustees’ review. In addition to her report, she provided an update concerning the Gifford Health Center. She indicated that Ms. Voss attends the Gifford Health Council meetings monthly and reports back on the same. The GHC has seen an increase in pediatric visits and are converting the old We Care office space, into further pediatric clinic rooms. Additionally, TCCH has hired a bilingual behavioral health practitioner to work at the center four days a week, which will be a welcomed addition for the patients. She informed the Trustees that she and Mrs. Peshke will meet next week to have further follow-up discussions concerning the Verizon wireless cellphone tower. They will come back to the Trustees next month with follow-up options for consideration.
Funded Agencies Semi-Annual Reports-
CCIRH Mental Health IOP- Karissa Bolden, Clinical Manager Outpatient Services & Cecelia Stalnaker, Inpatient Clinical Services Manager
Ms. Bolden addressed the board and stated that the IOP is currently at capacity and they have just enrolled 2 additional students for treatment. There have been 15 discharges from the program and 10 of those successfully completed their treatment, and the average length of stay for those completions was 11.9 weeks. She then discussed some challenges that they have experienced in implementing the program, which included transportation issues and language barriers. Also, many of the students are frequently absent from school, which has also posed challenges in their success of completing the program. However, they continue to address those issues and have partnered with SRA for assistance with transportation. Additionally, they continue to work with parents of the students to provide extra support when needed. Another roadblock has been the national and local shortage of mental health providers. She then provided a review of the services and programs provided in the IOP which included psychiatric evaluations; family workshops; individualized treatment planning; and substance abuse recovery. Next, Ms. Stalnaker discussed the types of issues patients are struggling with which include self-harm, severe anxiety, OCD, and substance abuse. They are also seeing an increase in younger adolescent patients needing further or inpatient, intervention. She stated that they believe that over the next five years, there will be an increased need for mental health services for young adults and a growing need for services for adolescents on an outpatient level.
Mrs. Cunningham asked if there were any questions from the other funders of this program who were also present at today’s meeting. Mr. Pickering stated that, after a review of their financials, he is concerned that they will not have enough funds to finish the fiscal year. Mr. Fuller, CFO of CCIRH, stated that there are funds from the District which have yet to be expended which will allow them to continue the operations for the remainder of the fiscal year without incident. Ms. Egan from the United Way asked about the typical age range of patients that are seen and what is their main referral source to receive these patients. Ms. Bolden indicated that, currently, females ages 13-14 make up most of their patient population, but there are a few clients age 16 and 17. Additionally, their main referral sources typically come from the CCIRH Behavioral Health Center and the IRC School District. However, they also receive referrals from the Mental Health Association and New Horizons.
Senior Resource Association- Liz Bruner, VP Philanthropy
Ms. Bruner began her presentation with a review of the Emergency Meals on Wheels (“EMoW”) program. The program provides a daily lunch and wellness visit by a trained SRA volunteer or staff member to homebound seniors who have been discharged from a healthcare facility within the last 30 days. She explained that it is a short-term program provided at no cost to the senior to assist with recovery and help prevent re-admittance to a healthcare center or hospital. Over the last six months, 63 seniors were served a total of 1,463 emergency meals. Of the 56 participants, 13 requested the continuation of meal deliveries for the second 14-day period for a total of 28 days. Additionally, 90% of those were not re-admitted to a hospital or healthcare facility. Most of the clients served in EMoW are through referrals from CCIRH. Next, she provided a review of the Public Guardian Program. She stated that since acquiring the Public Guardian Program four years ago, SRA continues to raise awareness within the community, encouraging referrals from families and friends of vulnerable seniors as well as professional referral sources. The program served 31 wards, exceeding its projected goal of 25 wards by July 2021. Of the 31 active wards, five are deceased, one was discharged, five are petitioned by the court, and one was referred by the court. SRA continues to manage the affairs of the deceased individuals and serve those waiting for assignment by the court. She further explained that with a large population of seniors living in Indian River County, there is high demand for Public Guardian services. Taking that into consideration, their current goal is 35 wards by July 2022. SRA continues to actively promote awareness of our Public Guardian Program, to help those most vulnerable residents in the community.
Substance Awareness Center IRC- Carrie Maynard-Lester, Executive Director
Ms. Lester addressed the board and stated that she would be providing them with an update concerning the five programs the District funds at SAC. She began her presentation by discussing the Peer Recovery Assistance and Outreach Programs. She stated there is such an importance in utilizing peer support and that it helps engage and retain clients into a life of recovery. Those peers help provide support in the program but also conduct assertive outreach within the community. She reviewed data associated with this and stated that they are also working collaboratively with the CCIRH, BHC, and IRC jail for further outreach support. She then discussed the medication-assisted treatment and Narcan training that has been offered and the positive impact it has made on the clients. Next, she discussed the intake assessment which is a comprehensive assessment of adults and youth who are referred to SAC for services. She explained that having the funds to support the qualified assessor has helped streamline this very cumbersome process. A total of 93 adults and 27 adolescents were assessed using the ASAM Continuum and Prevention Assessment Tool. She then discussed the Teen Intervene program which is a prevention program for youth who have been identified as engaging in health risk behaviors, including substance use. She explained that this is for clients who may not have yet developed a substance abuse brain disorder but still need a high level of intervention treatment. Lastly, she discussed the CRAFT program which is a new program to a population in our community that is often overlooked. The program is specifically for families with loved ones who have substance use and or co-occurring disorders. It is a skills-based program that impacts families in multiple areas of their lives, including self-care, pleasurable activities, problem-solving, and goal setting. It also addresses their loved one’s resistance to change and helps teach families behavioral and motivational strategies for interacting with their loved ones. Ms. Lester explained that she was unable to start the program at its original start date due to some organizational issues, but she is excited to now be able to offer the program to the community. Next, she provided an update on the Acupuncture Day Treatment program. She explained that they offer auricular acupuncture, which is done to the ear and is found to be effective in treating acute and post-acute withdrawal. The acupuncture provider also provides other stress-relieving techniques for use outside the treatment setting. Lastly, she spoke about some organizational transitions that happened within the center specifically with the staff. She stated that the SAC has had to rebuild its staff and there have been efforts within its current strategic planning process in working to obtain and retain its employees.
Presentation of Agreed-Upon Procedures FY 19-20- Kip Jacoby, CPA
Mr. Jacoby provided a review of the District’s agreed-upon procedures for fiscal year 19-20. He explained that seven of the District funded agencies were reviewed and he provided a summary of the findings. In many cases, minor issues were discovered such as only one proof of residency document provided, or undocumented exceptions made in the notes section on the portal. Overall, they were pleased with the review outcomes and feel that the database has helped in maintaining the requirements outlined in the policy and procedure manual. There was Trustee discussion surrounding the matter of the District requesting funds back from the agencies who were found to have exceptions from this report. Ms. Suriano stated that the District has not requested reimbursement for many years. There was also a question as to whether there was a policy in place that outlines a threshold amount, that would require an agency to pay back the District, should they meet that amount. Mr. Jacboy stated that he personally believes that the patients served were truly indigent and that many of the exceptions were due to lack of documentation or notations. It was further discussed that District staff has found some issues with the current policy and procedures and would like a chance to bring those forth to the Trustees for further discussion.
Mr. Pickering addressed the board and stated that he was disappointed that a Trustee was not appointed by the Governor to fill vacant seat 7 and that there is a potential to have a completely different board next year after the November election. With that in mind, he encouraged the board to utilize their large capital balance to fund further programs to make a meaningful impact on the community over the next nine months. The meeting was adjourned at 6:00 PM