Chairman’s & Budget Request Presentation Meeting: June 15, 2022

Chairman’s & Budget Request Presentation Meeting: June 15, 2022

Indian River County Hospital District Conference Room/ Zoom
June 15, 2022
10:00 AM

TRUSTEES: Marybeth Cunningham Karen Deigl
Ann Marie McCrystal Barb Bodnar

ZOOM: Samantha Mesena Marie Andress
Allen Jones

STAFF: Ann Marie Suriano Dawn Carboni
Kate Voss Jennifer Peshke, Esq.
Jennifer Frederick

ATTENDEES: Vicki Soule Robin Curby
William Winns Andrea Fedock
Pedro Bernabe

Convene Meeting – Marybeth Cunningham, Chairwoman

Mrs. Cunningham convened the meeting of the IRCHD Board of Trustees at 10:00 AM by welcoming those participating via Zoom and in person.

Audit Findings- Marybeth Cunningham, Chairwoman

Ms. Cunningham stated that this matter has to do with Phoenix Rising and a copy of the audit report Ms. Carboni prepared was provided to the Trustees for their review prior to todays discussion. She explained that District staff and Ms. Peshke also met with Pedro from Phoenix Rising to discuss the audit finding, and asked that the staff prepare a recommendation for the Trustees to consider relative to future funding. She then asked that Ms. Suriano provide some background information on this and discuss next steps. Ms. Suriano addressed the board and stated that a few months ago the District was served a subpoena duces tecum from the Florida Department of Law Enforcement (“FLDLE”) which requested records relative to the payments the District made to Phoenix Rising, for substance abuse treatment. The District complied with the request and were asked not to disclose the existence of the investigation with anyone other than District staff and legal counsel. Subsequently Ms. Carboni conducted her own internal audit of Phoenix Rising, as she has been doing with all the funded organizations, and created a report of those findings. In follow up discussions with the investigator from FLDLE ,who disclosed some of their findings from the investigation, many of those same items of concern were discovered within Ms. Carboni’s audit report. She further explained that the FLDLE has decided to not pursue any criminal charges due to the large number of resources it would take to bring the case to trial. Therefore, the investigation has been closed and the District is free to disclose the existence of the same to the Trustees. She then explained that based off the Audit findings it was decided that Phoenix Rising was in breach of their current funding agreement and Ms. Peshke prepared written notice of the same, which was delivered to Mr. Bernabe for his immediate attention. There has been a subsequent meeting with District staff, Ms. Peshke, and Mr. Bernabe and he was provided a detailed list of items that would need to be provided in order to cure the breach of the funding agreement. This is to provide assurance that the funds the District has provided them, are going to direct patient care. Therefore, Ms. Carboni and Ms. Frederick will be conducting a second review visit in the next week, to review documentation requested which include a full financial disclosure, access to their bank and payroll records, and access to IRCHD patient treatment records to verify that patients billed to the District were actually provided services. Lastly, Ms. Suriano stated that District staff is recommending that funding to Phoenix Rising be suspended beginning July 1, until they are able to cure the breach of the funding agreement. There was Trustee discussion and many were displeased with the fact that they were not aware there had been an investigation pending with Phoenix Rising. Ms. Peshke explained that this matter was discussed at great length due to the District’s staff concern of the Trustees not being aware. However, she spoke to the prosecutor overseeing the investigation and he firmly stated that this matter was not to be discussed with the board or in a pubic setting until the investigation was complete. There was further Trustee discussion and they were in agreement that funding should be suspended immediately, not July 1, pending the additional revie to cure the defult. Ms. Bodnar made the motion to suspend funding immediately pending the audit findings, which was seconded by Ms. Deigl. The motion carried unanimously. Additionally, Ms. Deigl made a motion to amend the May disbursement amount, less the Phoenix Rising reimbursement check. The motion was seconded by Mrs. McCrystal and carried unanimously.

Approval of District Employee COLA- Allen Jones, Treasure

Mr. Jones stated that he prepared a recommendation for the Trustees to review and consider prior to todays discussion. Therefore, he made a motion that District staff be given a one-time cost of living adjustment increase of 5.9% effective July 1, which was seconded by Ms. Deigl for discussion. Ms. Bodnar questioned how Mr. Jones arrived at the 5.9% figure. Mr. Jones stated he based his recommendation off of the Social Security cost of living increase which was 5.9%. Ms. Bodnar stated that based on her research of other county organizations she feels 5.9% is too high and would be more comfortable at 3% or 3.5%. Ms. Deigl also felt that the number was a bit high and would be more comfortable around 4%. Ms. Bodnar made an amended motion to approve a COLA of 3.5%. There was no second to the motion and it died. Mr. Jones and Mrs. McCrystal felt that, given the current financial climate, 5.9% was a fair number and approving a lower number would be insignificant in any savings to the tax payer. They also felt this was a good way to show appreciation to staff. After further Trustee discussion Ms. Deigl made an an amended motion to approve a COLA of 4% which was seconded by Ms. Cunningham. The motion carried 3-2 with Mr. Jones and Mrs. McCrystal in opposition.

FY 22-23 Funding Request Presentations

New Horizons- William Wims, CEO

Mr. Wims addressed the board and stated that their funding request has increased by 5% which is to help cover the cost of some of their services and the improvements they have made to the programs. One major improvement is that they have hired additional case managers which has helped provide additional support to their clients. He then explained that the funds requested will be used to provide psychiatric medical services, case management and outpatient therapy services, and injection clinic visits. There was further discussion surrounding the new request for funding concerning the injection clinic and the cost per service for the injections. He explained that the injection clinic provides a slow-release form of medication allowing a client, having problems, to avoid missing dosages or forgetting to take their medication daily. He also discussed their issues with recruiting therapists and that they rely heavily on their psychiatric nurse practitioner who is qualified to treat clients with mental health issues. There was Trustee discussion and it was agreed that New Horizons increased funding was fairly small and a reasonable request, to support the much-needed services they are providing to the community.

TCCH- Vicki Soule, CEO

Ms. Soule began by introducing Heather Miranda as the new Executive Vice President at TCCH, who is in charge of operations. Also present for todays discussion was Andrea Fedock who is the CFO. Ms. Soule stated that she would begin their presentation by reviewing their semi-annual report. She explained that volumes have increased in all service areas from last year, and the demand for services is almost overwhelming. Therefore, they are looking to expand their Oslo Road location but have encountered some obstacles along the way with zoning and county issues. Next, she discussed their expansion with pediatrics services and have hired two new pediatricians. They have also been able to hire additional nurse practitioners, but the physicians who oversee them have become overwhelmed by the work and she is trying to find a happy medium for all the practitioners. She further stated that their patient population has become more stressed and negative due to the current social factors affecting them which include homelessness, inflation and chronic illness. She maintains that TCCH is committed to providing the care and filling the gaps for this population, regardless of the many challenges they continue to face. She then addressed where she sees their organization heading in the next five years. She explained that technology will play a huge roll in their growth and how they deliver care. They would also like to focus their efforts on training opportunities for students which could help with recruitment of healthcare workers. Lastly, she discussed that TCCH may come before the Trustees before fiscal year end to request additional funding to support a shortfall they are experiencing in providing healthcare services. One of the main issues they are facing is the push back on the 340B pharmacy program and lack of affordable prescriptions.

Next, she provided the Trustee with a review of the FY 22-23 funding request. The total increase to the funding request from last year was $307,480, which is due partly to increased cost per service, and the addition of the new optometry program. Ms. Soule explained the details of the optometry program and what services would be offered to patients, which include a comprehensive exam for adults and children, and with discounted eye glasses. There was further discussion surrounding the increased cost per service for a primary care visit. Ms. Soule then discussed the request for funding concerning behavioral health services which had decreased. She explained that many of the patients who visit TCCH for behavioral health services have insurance but have high deductibles or co-pays. This leads to the patient having a large outstanding balance owed for services which they are unable to pay. Ms. Soule stated that she would like to discuss in the future how the District may be able to help assist in paying off some of that debt owed to TCCH. There was further Trustee discussion surrounding how they could help support the population who has insurance but are faced with high deductibles or co-pays, and unable to afford their visits.

Public Comment & Adjourn

Mrs. Cunningham asked for public comment and there was none. The meeting was adjourned at 11:30 AM