Jun 19 Regular Monthly Meeting: May 18, 2023
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
May 18, 2023 @ 4:00 PM
TRUSTEES: Paul Westcott Michael Kint
Marybeth Cunningham Kerry Bartlett
ABSENT: William Cooney, M.D. Karen Deigl
STAFF: Kate Voss Jennifer Frederick
Ann Marie Suriano Jennifer Peshke, Esq.
ZOOM: Allen Jones Vicki Soule
Anne Posey Marie Andress
ATTENDEES: Mike Cianci Michael Davis
Andrea Berry Cheryl Martinez
Taylor Farnsworth Stacey Washburn
Bridgette Jerger Maria Roman
Genevieve Mallen Heather Moxley
Convene Meeting, Invocation, Pledge & Consent Agenda– Marybeth Cunningham, Chair
Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM. Pastor Anthony Onorato, of Calvary Chapel Vero Beach provided the invocation and Ms. Bartlett led the group in the Pledge of Allegiance. Ms. Cunningham asked for a motion to approve the April meeting minutes and a May disbursement of $833,209.39. Ms. Bartlett requested that few changes to the meeting minutes be made, the first being she would like it noted that she left the April 6th meeting early. Additionally, in the April 20th minutes, Ms. Huebner’s name was spelled incorrectly. Ms. Voss indicated that she would make the recommended changes to the minutes and with those corrections noted Ms. Bodnar made the motion to approve which was seconded by Ms. Bartlett. The motion carried unanimously.
Chairmans Report- Marybeth Cunningham, Chair
Ms. Cunningham stated that the job posting for the Executive Director position has been finalized and posted on the District website, along with various other publications for review and response.
District Counsel Report- Jennifer Peshke, Esq.
Ms. Peshke stated that she continues to be available to the Trustees by responding to questions that have arisen pertaining to various matters the District is handling at the present time. She informed the board that the current legislative session has ended and House Bill 199 which related to Special Districts, has passed. This will require the board to complete four hours of ethics training and the District office will keep the Trustees updated on future requirement deadlines. Additionally, the District received the VNA’s Notice to Exercise its Option to Purchase concerning the Hospice House parcel. The Trustees had discussion concerning the same at yesterdays Chairman’s meeting and the VNA will make a formal presentation to the board next month. Additionally, the District’s budget funding cycle for FY 23-24 is underway and she has participated in the funding request presentation meetings. Lastly, she continues to assist with the process of hiring a new Executive Director and has been working with the HR recruiter Ms. Huebner over the last several weeks.
Financial Statement Review- Michael Kint, Treasurer
Mr. Kint provided his treasurer’s report and stated that District is in a strong financial position. In the last month the District received an additional $403,000 in tax revenue, which makes up 3% of the total revenue. Currently the District has received 96% of its budgeted tax revenues. Additionally, after 7 months of the fiscal year both program and administrative expenses are under budget. He stated that due to this fact, the Trustees may want to evaluate the spending of some of these agencies who are significantly under budget and see if their funding requests for this upcoming fiscal year are in line with their projections. Next, he discussed matters concerning the District Finance Committee and Investment policy. Drafts of both of the documents have been provided to the Trustees for their review and comment. He asked that any changes be submitted to Ann Marie so she could implement the same. There was Trustee discussion and it was decided that the documents would come back before the board next month for final approval.
Executive Director Report- Ann Marie Suriano, Executive Director
Ms. Suriano provided her report and stated that the District has entered into a new three year term lease agreement for their current office space, with Lambert Commercial reality. Their current lease is in effect until July 31st, and at the end of that term the new lease will take effect. She explained that there was a slight increase to the monthly rent amount and she has allotted for this in the Districts FY 23-24 preliminary budget. Next, she discussed her involvement with the Children Services Advisory Committee (“CSAC”) which she and Ms. Bartlett are members. Mr. Kint also serves as a member of the grants review subcommittee and the needs assessment subcommittee for CSAC as well. She explained that CSAC has closed the application process for the IRC Human Services Managing Director and have received 12 applications, and have chosen 4 to move forward with in person interviews planned for the following week. Additionally, the application deadline for CSAC funding was Monday and it was reported that they have received 62 requests from 38 agencies for a total of $3.9 million in requested funding. She explained that total funds awarded from the County Commission to CSAC is $2,567,776, so there will not be enough funding to cover all the requests received. She further stated that there have been discussions with members from CSAC and the county to look at ways to align some of the funding provided by the District and the county, which may be considered duplicative. Ms. Suriano stated that she is working to put together a spreadsheet that outlines the various programs that both taxing authorities support. She has preliminarily identified 12 organizations, and four of those are for funding for the same programs. She further stated that with the reorganization of CSAC, which now includes District representation, she is hopeful that they will be able to move forward working with the county to review the funding structure.
Funded Agency Semi Annual Report –
Dynamic Life Recovery- Mike Cianci, Program Grants Manager
Mr. Cianci provided a review of the semi-annual report for Dynamic Life and stated that the organization has seen growth over the last six months. He stated that the program and operations continue to run smoothly, but one challenge they are facing is limited space and they are looking to expand in the near future. This expansion would include space for classrooms that would provide areas for training and therapy. They continue to maintain their partnership with Camp Haven and often provide referrals or receive referrals. Additionally, their partnership with the UP center continues to be positive and a great resource for the clients at Dynamic. Next Mr. Cianci stated that over the last six months, five clients have completed the Step Program at UP and have been placed at high paying jobs within the community. Next, he discussed data concerning the Rodger Ball Memorial Scholarship which included information concerning relapse and discharge rates, along with employment status and incarceration. Lastly, he stated that Dynamic continues to provide an atmosphere of community accountability in a safe and structed environment for its clients. They are appreciative of the District funding and are thankful for the opportunity to provide these scholarships.
Healthy Start Coalition- Andrea Berry, CEO
Ms. Berry addressed the board and stated that Healthy Start will soon have a leadership transition and on June 1st, they will be welcoming Megan McFall as the new CEO of Healthy Start. She will stay on through the month of June to assist in the transition and thanked the Trustees for their support during her time at the organization. She introduced her team and explained that each of them would be providing an update concerning the various programs that the District supports. Taylor Farnsworth, Director of External Engagement addressed the Trustees and provided a brief overview of Healthy Start and its mission, which is to decrease infant mortality. Next, Cheryl Martinez, Nurse Program Specialist provided the Trustees with information concerning the wrap around program and services offered through Healthy Start which directly supports mothers in Indian River County. Stacey Washburn, Direct Services Manger then discussed some recent changes that have taken place in regards to the fatherhood initiatives. She is pleased to report that the participation in the fatherhood program has been successful and they are adding a second coordinator to assist with the groups and classes. Currently 16 Dad are actively participating in the groups sessions and they have provided a 1-1 home visit for 23 Dads within the community. Next, Bridgette Jerger Doula Coordinator provided an update concerning the G.R.O.W. Doula program and stated that the Indian River County model is being used statewide and they have trained over 200 doulas in the county. Currently there are 12 active doulas working with Healthy Start and they are slated to serve 130 mothers this year. Genevieve Mallen, coordinator for the Babies and Beyond program, provided an update on same and stated they continue to work collaboratively with CCIRH and offered various support groups, which are available to their patients. Additionally, the Healthy Start lactation team will be working with CCIRH nursing staff to provide a shadow shift with a lactation specialist which will be part of their rotation during their shift. This will also be offered annually to provide the nurses with enhanced breastfeeding support and education. Lastly, Maria Roman, Maternity Navigator Coordinator, gave an update on some successes and stated that Healthy Start has been able to interact with almost all the mothers at Partners and CCIRH, pre- and post-partum. They are also working on a collaboration with Physicians to Women to be able to interact with those women as well.
Sunshine Physical Therapy- Heather Moxley, Assistant Executive Director
Ms. Moxley addressed the board and stated that Sunshine Physical Therapy has been experiencing some challenges due to the sudden departure of their Executive director back in March. Therefore, through reorganization, Ginny Blossom was named Interim Executive Director and Ms. Moxley the Assistant interim Executive Director. Ms. Moxley also serves as the clinical director and records custodian for the clinic. She discussed the report and stated that the main challenge is the low reimbursement rates received from Medicaid and that the District supports Sunshine by providing funding to offset the cost of treating those patients. She reviewed the report and stated that over the last six months the clinic saw a total of 147 patients which was made up of 39 adults and 108 pediatrics, for a total of 1449 visits. Next, she reviewed some of the outcome measures and stated that she had initially prepared the report but it was edited by another colleague who does not have a clinical background. She explained that some of the wording in the report does not address objectives, which is a key component of occupational therapy, along with visual motor skills and upper extremity coordination skills. There was Trustee discussion concerning the outcomes measures and they felt that there needed to be more clarity concerning the goals and outcomes, and what those goals are measured against for comparison, that would show improvement. Mr. Westcott stated that the area of speech development in children needs be further addressed due to the negative impact masking had on children which data shows is affecting their speech and comprehension levels. He offered to provide further support to Sunshine and help them work collaboratively with some other entities he has connection with, to address this important need. There was also Trustee discussion concerning the quarterly audit check-in that Ms. Carboni conducted on Sunshine. It was stated that there were some findings in her audit report and if a corrective action plan was in place to address those issues. Ms. Frederick indicated that the corrective action plan Sunshine submitted in response to the audit was provided with the original audit report sent to the Trustees on May 8th. The Trustees also requested that Ms. Blossom attend a future board meeting to address the Trustees and further discussed and explain how they are tracking their metrics and outcome measures.
New Business- Senior Resource Association Request for Funding EARS Program- Liz Bruner, VP Philanthropy
Ms. Bruner addressed the board and stated that she has brought forth a request for additional funding for the current fiscal year to assist with a shortfall for their Emergency Alert Response Services (“EARS”) program. She explained that the new SRA CFO Gabriel Pedrero began an in-depth assessment of all SRA program expenses upon joining the organization this spring. In this process, he discovered economies of scale, which enabled future cost per participant to be reduced from $526 to $405, thereby expanding the impact of the District’s funding to more seniors who live daily with great risk for falls or other health crises. Mr. Pedreos deep dive also surfaced a small group of seniors who are currently enrolled but whose continued Emergency Alert services were not factored into the renewal process for the remainder of the District’s fiscal year. In addition, another small group of seniors in need of an Emergency Alert lifeline, have been enrolled based on their personal risk factors, resulting in program oversubscription. She further explained that this gap funding will ensure lifesaving Emergency Alert services for 21 seniors currently enrolled with renewal dates March 18-September 30, 2023; 22 seniors recently enrolled due to high-risk demand; 24 at-risk seniors expecting enrollment. The total request for funding is $27,135 which will provide annual Emergency Alert Response Services for 67 participants. There was Trustee discussion and Ms. Bartlett made a motion to approve the request, which was seconded by Ms. Bodnar. The motion carried unanimously.
Mr. Westcott addressed the board and raised some concerns he had regarding CCIRH. He shared that CCIRH had posted a sign in the lobby of the Health and Wellness Center stating that no specimens collected by Quest Diagnostics or Lab Corp would be accepted by the hospital. He also reported that a local physician was told his specimens would no longer be accepted by CCIRH and this physician had been previously allowed to collect a specimen at his office in an outpatient setting and transfer it to the hospital lab. Under the current direction of CCIRH, the doctor will now have to arrange for the patient to go to the hospital in order to have the specimen collected there. Mr. Westcott also noted that in the Semi-Annual Report from March, CCIRH reported the development of a concierge practice. He explained that according to Section 12 of the District’s Special Act, the Hospital District is not to interfere with independent medical providers. Mr. Westcott expressed that he was concerned that CCIRH is taking advantage of its position and unfairly interfering with independent providers. Mr. Westcott also read from the Informed Consent Form used by Cleveland Clinic at all of its facilities and stated that it has been reported to him by members of the community that they are being required to sign a form that states “I voluntarily consent to all medical treatment and health care-related services that the caregivers at CCIRH consider to be necessary for me”. Mr. Westcott has also been told by members of the community that they have requested the ability to receive treatment without being required to sign the form but were told treatment would not be permitted if they did not complete the form. Mr. Westcott further stated that if this is in fact true, the consent to submitting to the Patient Acknowledgement and Consent Form is not truly voluntary and for indigent patients, a decision to not sign the form could result in an inability to get treatment and seek treatment at another hospital which does not provide indigent care. Also, Mr. Westcott pointed out that he is concerned that the form may also interfere with patients’ ability to rely on powers of attorney and medical surrogate forms. Lastly, Mr. Westcott stated that Section 11 of the Special Act allows the District to develop rules for all properties owned by the District. He believes that if CCIRH is unwilling to work collaboratively with the District, they will need to explore their ability to improve Cleveland Clinic’s level of service to the community. He also feels that CCIRH should address these concerns and others sooner than their required verbal report, which is scheduled to take place in October.
Ms. Cunningham stated that she and Ms. Suriano are scheduled to meet with Dr. Conor Delany, who is the head of Cleveland Clinic Florida, and will bring forth these concerns, along with the other concerns raised by the Trustees. She will then provide an update to the Trustee when she has more information and how CCIRH plans to address these concerns.
There was no public comment, and the meeting was adjourned at 5:30 PM