May 18 Regular Monthly Meeting: April 20, 2023
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
April 20, 2023 @ 4:00 PM
TRUSTEES: Karen Deigl William Cooney, M.D.
Marybeth Cunningham Kerry Bartlett
Michael Kint Barb Bodnar
ABSENT: Paul Westcott
STAFF: Kate Voss Dawn Carboni
Ann Marie Suriano Jennifer Peshke, Esq.
ZOOM: Allen Jones Vicki Soule
Anne Posey Marie Andress
ATTENDEES: Wes Sammons Chuck Bradley
Robin Curby Meredith Egan
Thomas Nikolic Karissa Bolden
Warren Fuller Cecelia Stalnaker
Convene Meeting, Invocation, Pledge & Consent Agenda– Marybeth Cunningham, Chair
Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM. Pastor George Pellington, First Methodist Church provided the invocation and Ms. Bartlett led the group in the Pledge of Allegiance. Ms. Cunningham asked for a motion to approve the March meeting minutes and an April disbursement of $1,093,857.78. Ms. Bodnar made the motion to approve which was seconded by Ms. Deigl. The motion carried unanimously.
Chairmans Report- Marybeth Cunningham, Chair
Ms. Cunningham stated that on April 6th the board of Trustees met for a strategic planning session to review the current plan and get the newly elected Trustees up to date with the strategic priorities and initiatives. She further explained that at the meeting it was announced that Dawn Carboni, the District internal audit and data analyst had submitted her resignation effective April 28th, and would be leaving the District for another position. Ms. Cunningham recognized Ms. Carboni for the work she accomplished in creating a new audit process for the District and thanked her for her time and efforts. It was also announced that Ms. Suriano had informed the board of her early retirement after 17 years as the Executive Director . Therefore the Trustees approved a process to move forward with the hiring of an HR recruiter to find suitable candidates for her replacement. Ms. Suriano plans to stay on as a full time employee until July 31st, to help facilitate the FY 23-24 initial budget process, and will continue after on a part time basis for another 6 months during the transition with the new Executive Director.
District Counsel Report- Jennifer Peshke, Esq.
Ms. Peshke stated that the District had begun its budget funding cycle and will meet with any new agencies that is requesting funding for the 23-24 fiscal year. She is also actively following the current legislative session for bills related to Hospital Districts and specifically HB 199, and will bring forth information when necessary. She also discussed the matter concerning the VNA’s notice to vacate the HSB, which has now been extended until the end of June. Additionally, the Cleveland Clinic did send representatives to tour of the HSB, but have made no formal offer to purchase or lease the premises. She also continues to work on the matter concerning the District property at 82nd Ave and 12th street, also referred to as parcel C within the lease agreement with Cleveland Clinic. At this time Cleveland Clinic is not willing to voluntarily release the parcel from the agreement but is open to further discussions with the District, concerning its future use. Lastly, she is working with Ms. Cunningham to ensure that the process of hiring a new Executive Director remains open and transparent.
Financial Statement Review- Michael Kint, Treasurer
Mr. Kint provided his treasurers report and stated that the District continues to be in a strong financial position. He stated that the District has received 93% of the budgeted tax revenue, which is up about 2% from last month, and the District reserves are healthy as well. After six months of the fiscal year, the District is well under budget, especially concerning program expenses. He then discussed a matter with Whole Family Health Center, and their medication assistance program. He stated that the program is reimbursed semiannually and their first payment was processed this month for $63,579. He noted that their total annual budget was $45,000, and processing this payment put them over budget for that line item. However, District staff has had conversations with WFHC about the increased amount and learned that there have been significant changes to the 340B pharmacy program, with many fewer pharmacies participating. Therefore WFHC, who continues to receive 340B pharmaceuticals, has borne the weight of increased patient load. Ms. Andress reported that they expect their next reimbursement request six months from now, to be significantly larger than then $63,579, and has requested that the District reallocate dollars from WFHC’s medical services and behavioral health line items, to cover these increased medication assistance costs. There was Trustee discussion and the Trustees were in favor of the reallocation. This item will continue to be monitored by District staff and any additional action needed will be brought before the board. Lastly, Mr. Kint informed the board that he and Ms. Suriano have crafted draft proposal language for the Hospital District’s Investment Policy and the creation of a Finance and Audit Committee. They plan to bring the same before the Board for review, input, and changes in May or June. Lastly, he informed the Trustees that one of the Districts treasury bills in the ladder investment account at Deep Blue, has matured. He explained that these laddered investments are designed to be cashed in at maturity and transferred to the District operating account to pay expenses. However, at this time, those funds are not needed. Therefore, Ms. Suriano spoke to the advisors at Deep Blue and determined the best course of action was transfer those funds into the Preferred Deposit Pool, which is currently paying 4.6% interest.
Executive Director Report- Ann Marie Suriano, Executive Director
Ms. Suriano provided her report and stated that she spoke with county attorney Dylan Reingold in a follow up to Mr. Westcott report to the board that he addressed the County Commissioners concerning the pending distribution of the Opioid settlement dollars. Currently Mr. Reingold is preparing a proposed spending plan for the commissioner’s consideration. The main priority for funding would be to support diversion courts within Indian River County. Additionally, by the end of September the county will have received $437,600 in settlement funds, and further incremental deposits thereafter. She mentioned that the Sheriff’s office and the Mental Health Association were also requesting funds to help further their efforts to fight opioid abuse. She then provided the Trustees with an update concerning HB 199 and its partner SB 620 which specifies that conduct by certain public officers & employees is deemed conflict of interest; and requires ethics training for elected local officers of independent special districts. She stated that SB 620 has passed through its final committee and continues to move closer to adoption, and has placed a call to FASD and their representatives who are following this legislative session to ask for further clarification on this bill and the potential impact it may have on the District Trustees. There was further discussion and it was clarified that if the bill is adopted, its effective date would be July 1, 2023.
Funded Agency Semi Annual Report –
Camp Haven- Chuck Bradley, Executive Director
Mr. Bradley addressed the board and discussed how Camp Haven is utilizing the District funding. He explained that the Substance Awareness Center conducts the testing at least once a month for all residents and twice and month for those in recovery. To date they have conducted 116 drug/alcohol tests on 24 residents. He explained that based on the data provided, there is a pass rate of 71% which is slightly below the target rate of 75%. In addition, those in recovery had a failed rate of 43% and compared to the others at 10%, or 4.3% higher. He explained that these results highlight the struggle to maintain sobriety and the need for continued counseling and therapy. It is also important to note that 8 or 57% of those in recovery passed their testing. Next, he discussed the collaborative partnerships they have formed with Dynamic Life Recovery. He explained that many times they receive applicants who are better suited for the program at Dynamic Life Recovery. He also discussed the need for detox services in Indian River County, which would provide a better continuum of care for individuals suffering from substance abuse disorders. He also discussed the need for affordable housing and that there are residents who are eligible to leave Camp Haven but cannot do so, due to the fact that they cannot find an affordable place to live. Lastly, he stated that while drug/alcohol testing is a tool and doesn’t prevent relapse, it is crucial in maintaining the programs integrity.
CCIRH Mental Health IOP & ED BH Integration – Karissa Bolden, Clinical Manager Outpatient Services & Cecelia Stalnaker, LMHC
Ms. Bolden began their presentation by discussing the Mental Health Intensive Outpatient Program (“IOP”). She stated that they have expanded the program to include adults 18+. They have been receiving referrals from the community and are now at capacity for the adult IOP and have also added outpatient dialectical behavioral therapy (“DBT”) groups which helps serves individuals who may not meet criteria for IOP. The group meets once a week for one hour, and the groups are separated between middle school and high school. They have also increased additional individual therapy and family therapy services, to meet the needs of the community. They are also expanding their efforts within the community and are actively involved in the communities that care initiative and are working to better develop their community partnerships. Next, she reviewed pre/post treatment data and stated that the IOP has served 73 patients from the community with an average length of participation of 9.30 weeks. In many areas, they are seeing a decrease in symptoms which shows that the programs are benefiting the clients. She also reviewed patient feedback and post treatment survey results. Lastly, she discussed next steps for the program which included identify gaps in outpatient BH services and developing a plan to fill those gaps whether internally or in collaboration with other agencies. Additionally, they are working to increase overall billable service hours, through offering more services and keeping programs full. Lastly, they are working to develop/re-establish strategic parentships to improve coordination of care with other service providers throughout Indian River County.
Next, Ms. Stalnaker provided an update concerning the behavioral health integration at the CCIRH emergency department. She stated that the program is providing behavioral health services, assessments, education and referrals at the ED 24/7/365. The program consists of a licensed mental health clinician that perform level of care/crisis assessments, assist with triage and transfer of the behavioral health and substance use disorder patients. They also utilize a BH Integration team, which consists of psychiatrists, rapid BH response RN’s, BH Technicians, and medical providers. The intent is to improve the efficiency, treatment, and care provided to behavioral health and substance use patients, educate caregivers on behavioral health and substance use diagnoses and trauma-informed care, and improve safety for the patient and the caregivers in the emergency department. Next, she reviewed the outcome measures for the program and stated that the BH integration team saw 847 patients, and 88% of those patients received a psychiatric consult. 100% of those patients received an assessment from the rapid behavioral response nurse, which helps better identify what issues the patient is experiencing. She then provided a review of their current staffing and explained that they are utilizing 3.7 FTE’s out of the available 5, and are looking to hire additional staff. She further explained that the average wait times for BH patients following medical clearance has reduced drastically down from 5 hours to 1.5 hours. Next, she reviewed data concerning the disposition of BH patients and stated that 66% were admitted to the BHC and 25% were admitted to the hospital for additional medical treatment. Another statistic to note was that 7% of the patients were able to have their Baker Act lifted and be able to seek alternative treatment methods. Lastly, she discussed the discharge recommendations for patients and stated 62% of the patients have been compliant with the discharge recommendations after discharge from the ED.
Mr. Fuller, CFO at CCIRH addressed the board and provided an update concerning the financials for both programs. He began by reviewing the financials for the BH IOP and stated that at the end of the September 2022, there was $516,213 in revenue, and he discussed the various revenue sources which included Medicaid, and funding from the United Way and Indian River Community Foundation. He further stated that revenues from insurance companies exceeded their expectations and recognized the scheduling department for their work in properly billing for those services. This also allowed for a reduction in funding requested from the District by $100,000. He further explained that total expense was $514,232, which resulting in an operating income of $1,980, which was credited back to the District. Next, he reviewed the financials for the first six months of this fiscal year and stated that total revenues were $304,966, which included $171,432 of District funding. Total expense for the program were at $256,224, which provided an operating income from $48,742. Therefore, they have began to reduce their funding requests to the District over the next few months until they are at zero. Next, he reviewed the financial data relative to the BH integration at the ED. Total revenues for the program were $225,000, verses the program expense of $158,706, which resulted in an operating income of $66,294. They have also begun to reduce their funding request from the District and will continue to do so over the next few months.
New Horizons- Robin Curby, COO
Ms. Curby explained that she would be providing today’s report on behalf of William Winns, who was unable to attend. She stated that there have been many changes and challenges since they last addressed the District six months ago. Recently their board finished its strategic planning which addressed some financial challenges they have been facing, and have developed a 5-7 year outlook for the organization. One recent accomplishment was that they are began a short term residential treatment program which has been a long awaited project. They have 7 clients currently and the program is going well. Additionally, they have created a training program for their techs and it has been helpful for employee retention. They have also hired a nurse educator which was a much-needed position for the agency, but they are still facing challenges with hiring and retaining nurses. They have also hired a medical director which is a welcomed addition to the organization. Additionally, she discussed the success with their prevention programs and individual therapy services offered at the various local schools including Vero Beach and Sebastian High School, and the Freshman Learning Center, and stated that they have served 475 students in the last six months. She further explained that Storm Grove and Gifford Middle School have also requested that their services be provided at their schools, and they are working on developing a proposal to fulfill the request. Next, she discussed New Horizons involvement with mental health court and stated that they have three wrap around staff who help support the program. She explained that they are aware that the initial grant funding is set to expire and have been asked by SHFBH to submit a proposal which would outline their cost for one year of funding. Lastly, she reviewed data concerning various other programs that are offered in Indian River County. Ms. Suriano asked for an update concerning the closing of their children’s crisis unit. Ms. Curby stated that the unit is still closed due to the lack of available nurses to staff the facility and that they made attempts to utilize their available nurses from other locations to work at the center, but due to safety concerns and salary demands, it was not sustainable. Currently children are being referred to other entities throughout the Treasure Coast. They have recently hired the additional nurses needed to run the facility and they are working through onboarding and training protocols before being able to reopen the facility. Ms. Curby then introduced Thomas Nicolich who is the new CFO and would address any questions concerning their financial status of the agency. Ms. Deigl stated that the District was provided with some financial information regarding New Horizons, which she found concerning and asked how many board members currently sit on the board and what to what extent their involvement with the operations and financial situation. Ms. Curby stated that their board Chair meets weekly with she and Mr. Wimms, and it aware of the challenges they are currently experiencing. There was also discussion concerning other revenues sources they received from public entities and what their reporting process was to those agencies. Next Ms. Bartlett stated that she is a member of the Mental Health Court Task Force and questioned why a representative from New Horizons has not participated in those meetings, and has not responded to request to do the same. Ms. Curby was unaware that there was a task force and suggested that Mr. Wimms would be the person to address those requests. Lastly there was lengthy discussion concerning the financial position of New Horizons which shows them at 1.8-million-dollar loss for the current fiscal year. Thomas Nikolic addressed the board and spoke to the concern that the Trustees had concerning their financial position. There were also concerns with the fact that they had not submitted their FY 23-24 funding request to the District, and some Trustees felt that given their current financial position, they would not be willing to provide funding for the next fiscal year. Mr. Nicolich stated that the organization is working to improve the financial position through various ways and is confident that in six months they will be able to provide a positive update to the Trustees. He further stated that he requested an extension to submit the funding application and will have the same to Ms. Frederick by April 26th. The Trustees requested that Mr. Wimms be present at an upcoming budget presentation meeting to discuss their FY 23-24, and were disappointed that he was not present today to further discuss the organization. They also stressed the importance of New Horizons continuing as an organization for Indian River and the Treasure Coast.
Ms. Bartlett asked for clarification concerning the process for hiring a new Executive and if the project plan Ms. Huebner is developing would be provided to the Trustees prior to the May 4th meeting for the Trustees review and consideration. Ms. Cunningham stated that the project plan, along with the updated job description will be provided to the Trustees for review prior to their discussions on May 4th. Ms. Huebner will also be contacting each Trustee prior to the meeting to discuss the process further. Should the Trustees have any further concerns they may contact Ms. Peshke or Ms. Huebner directly.
Ms. Suriano stated that she and Mr. Westcott have been working with the Mental Health Association concerning their appropriations funding from the state and have drafted a support letter which will be sent to the various Senate and House of Representatives committee members who oversee the allocation of funding. Therefore, she notified the Trustees that those letters will be sent out by District staff in the next day or so.
There was no public comment, and the meeting was adjourned at 6:00 PM