Chairman’s Meeting: February 15, 2023

Chairman’s Meeting: February 15, 2023

Indian River County Hospital District Conference Room/ Zoom
February 15, 2023

TRUSTEES: Marybeth Cunningham Karen Deigl
Barb Bodnar Paul Westcott
Kerry Bartlett Michael Kint
William Cooney, M.D.

ZOOM: Marie Andress Lauren Meeks
Ann Marie McCrystal William Wims
Anne Posey

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

ATTENDEES: Phil Cromer Cynthia Cox
Amanda Busbin William Roller
Lisa Kahle Patty Harris
Darcy Davis Belman Andric
Karleen Russ Jax Howard
Lee Mangiapani Eric Flowers
Chriss Papayannis Vicki Soule

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.

Mental Health Court Program Update- Judge Nicole Menz.

Judge Nicole Menz introduced herself and introduced the team she brought with her today, who help oversee all matters concerning Mental Health Court (“MHC”). She also invited three graduates from the program to share their experience with participating in the program and what their lives were like today because of the help they received. All three shared about the positive impact Judge Menz and their team had on their lives, and how through the help of the program they are able to maintain productive and healthy lives. Judge Menz discussed how an individual may be placed into mental health court, and explained that many are brought in due to their encounters with law enforcement and the program is offered as a diversion in their sentencing. Some are also placed in the program due to being deemed mentally incompetent. Next Judge Menz discussed the funding structure of the program and explained that for the last several years they have received funding from the Department of Family and Children Services (“DCF”) reinvestment grant administered by the Southeast Florida Behavioral Health Network (“SFBHN”). However, that funding will cease beginning June 2023. Amanda Busbin from the SFBHN addressed the board and stated that the three-year grant which was awarded in early 2020 for the period of July 2020 – June 2023, will not be renewed. She explained that before this year there has been open opportunities to apply for grants, so the work could continue without any gaps in service, however due to funding constraints DCF has chosen to allow this year to be open only to planning grants. This decision effects Indian River County along with 15 other counties in the state of Florida including Brevard, Duval, and Miami. Therefore, the program will need to obtain additional funding to support the period of July 1- September 30, 2023. She further stated that DCF does plan on opening up solicitations for 3-year awards, but those will not be available until July 1, 2024. Judge Menz stated that the total amount to support the shortfall is $130,000. The Trustees then heard comments from Sherriff Flowers and Karleen Russ, who is the case worker for mental health court, about the importance of the program and the benefit it offers to those individuals who choose to participate. Judge Menz then provided the Trustees with an overview of the structure of the program, and stated that each participant that is referred to the program undergoes a needs assessment and then follows an individualized program plan, which typically includes medication management, substance abuse treatments, random drug screens, frequent court attendance, weekly contact with case manager, and self-help meetings, as well as transitional housing if needed. Since the inception of MHC 593 defendants have been referred to the program and 212 have successfully graduated. Felony defendants spent a minimum of 12 months in the program and misdemeanor defendants must spend a minimum of 6 months in the program. Currently the MHC has 110 active participants and the overall recidivism rate is at 7%. She then reviewed the breakdown of funding sources that support the program which include funding from Indian River County Drug Abuse Trustee Fund, Indian River County Sherriff Office and other local and state funded resources. There was also discussion the similarities and difference between mental health court and drug court. The main being that drug court is supported through fees paid by the participants, MHC collects no fees from its participants.

Next there was discussion about the need for additional personnel to help support MHC. Ms. Cunningham stated that there was a discussion surrounding this need a the Mental Health Collaborative meeting yesterday and it was stated that there needs to be a clear picture of each funding source and what areas of the program are funded by those sources, and where any additional gaps in funding may be. It was also discussed that a group should be formed to work through this issue. Judge Cox stated that the Mental Health Collaborative did form a committee that will help facilitate this. Therefore, between now and June, that committee will work on formulating an intensive plan to bring forth to the county, on how best to support and fund this program in future years. There was group discussion and it was suggested that a District Trustee patriciate as a member of that committee and Ms. Bartlett volunteered to fulfil the role. After further Trustee discussion Ms. Deigl made a motion to approve the request, which was seconded by Ms. Bodnar. The motion carried unanimously. Lastly, Judge Menz invited the Trustees to the next Mental Health Court graduation which will take place on April 11th, to see the benefit of this program first hand.

Mr. Westcott asked if the board had any interest in reaching out to the Governor’s office, by way of letter, to ask for a response as to why the funding for this program had not been renewed. Ms. Deigl stated that before any correspondence is sent, the District needs to have all the facts surrounding the program grant and its funding structure. Dr. Cromer indicated that he was in Tallahassee last week lobbying for a variety of mental health initiatives and met with the Vice Chair of Health Appropriations Committee and brought up this issue with Mental Health Court. He explained that Representative Salazar who is knowledgeable about the program was unaware that the funding was being discontinued and indicated that she would look into the matter. Ms. Cunningham asked that Dr. Cromer work with the District is finding the appropriate persons to contact to further discuss this issues. It was also decided that Ms. Voss would work to follow up with all parties to set a meeting to discuss how the approved funding would be distributed, and that the appropriate back up documentation was obtained in compliance with District funding requirements.

Health Care District of Palm Beach County- Darcy Davis, CEO & Dr. Belma Andric, CMO

Mrs. Cunningham explained that Ms. Suriano and Ms. Bartlett had a discussion with Ms. Davis several months ago as to how their District operates and their strategic planning processes. Therefore, they invited Ms. Davis to address the board as a whole and provide information and understanding to the Trustees regarding the Health Care District of Palm Beach. Ms. Davis addressed the board and provided an overview of the structure of their District. She explained that they are an independent special taxing district, with a governing board who is appointed, not elected. Their board does levy a property tax and since she became CEO 6 years ago, they have dropped their millage rate by 26%. Additionally, she discussed the transition of the District from being solely a payor for healthcare services, to a provider of healthcare services, and as stated in their mission, their District is to be the health care safety net for Palm Beach County. Next, she discussed the Districts responsibility to the community and reviewed their enabling legislation statute, which like IRCHD, provides broad language outlining their purpose, which allows flexibility to achieve their mission. She then discussed their funding structure which is made up of three areas which include property tax revenues, net revenue from healthcare payment sources, and grants. She then provided an in-depth review of the services their District provides and supports, along with the entities that they own. Currently they own and operate a 70-bed rural acute care hospital, a 120 bed long-term care skilled nursing facility, 10 Federally Qualified Heath Centers (“FQHC”), which include 3 mobile clinics. They also operate a ground ambulance program which has two ambulances that provide interfacility transportation and transports for specialized treatment. Additionally, the operate a school health program which provided staffing of nurses to nearly 170 public schools in Palm Beach County. The District currently has 1,300 dedicated and committed team members who help support all these services.

Dr. Belma Andric who serves as the Chief Medical Officer and Vice President and Executive Director of Clinic Services of the District addressed the board. She provided a detailed overview of the clinic structure and how receive provided care. She explained that all patients who present at their facilities are provided with care, regardless of their ability to pay. Their financial counselors will help determine the appropriate payor source and they also utilize a sliding fee scale. Additionally, they use an integrated care model and their quality outcomes are among the top 10% in the country among FQHC’s, and all of their efforts are based on data driven outcomes. Next, she reviewed data concerning service types and patient visits, along with quality measures and performance metrics. She also reviewed the integrated care model in greater detail showing the full picture of what the continuum of care for a patient and family looks like. There was Trustee discussion on the same and they also discussed the reimbursement method for their various areas of services. Another area of focus and measurement tool they are utilizing is social determinants of health. She also reviewed data concerning mental health and substance abuse treatment, which have both increased over the last several years. She presented a chart which outlined their addiction stabilization unit patient flow, which provided an overview of their approach to substance abuse management and treatment. There was also discussion concerning their Districts management of the counties FQHC’s. Lastly, Ms. Davis discussed the Districts next steps and initiatives, which included the replacement of one of their trauma helicopters, phase two of the transition to the electronic health records system EPIC, a behavioral health network expansion, and a community partnership school project.

Other Business

Ms. Cunningham stated that since there are three new Trustees, she suggested that the Trustees hold a meeting to review the strategic plan and set action steps to move forward with the process. The Trustees agreed and District staff will work on scheduling the same.

Ms. Peshke addressed the board and provided an update concerning the VNA vacating the Human Services Building (“HSB”) and the future use of the building. She explained that next week, Ms. Suriano and representatives from CCIRH will tour the HSB so they have a better understanding of what their potential future use of the space could be. Next, she explained that correspondence was also sent to representatives at the CCIRH concerning their future utilization of the parcel at 82nd Ave, which is currently incorporated into the lease agreement with the District. Their legal counsel indicated that they are working on a response and should have something to the District in the next few weeks. She will update the Trustees on both matters when more information becomes available.

Public Comment & Adjourn

The meeting was adjourned at 12:00 PM