Chairman’s/Budget Request Presentation Meeting- June 14, 2023

Chairman’s/Budget Request Presentation Meeting- June 14, 2023

Indian River County Hospital District Conference Room/ Zoom
June 14, 2023

TRUSTEES: Marybeth Cunningham Barb Bodnar
Michael Kint Paul Westcott
William Cooney, M.D. Karen Deigl (zoom)

ABSENT: Kerry Bartlett

STAFF: Ann Marie Suriano Jennifer Peshke, Esq. (zoom)
Kate Voss Jennifer Frederick
ZOOM: Marie Andress

ATTENDEES: Ann Marie McCrystal Pat Knipper
Bill Stengel William Stewart, Esq.
William Wims Robin Curby
Dixie Tooke-Rawlins Matthew Cannon
Nicole Menz Vicki Soule
Bruce Cady Rayme Nuckles
Chriss Papayaniss Kathryn Hensley
Amanda Busbin

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.

VNA’s Notice of Exercise of Option to Purchase Presentation- Bill Stengel, Chairman of the VNA Board

Mr. Stengel addressed the board and provided a PowerPoint presentation outlining this matter. He explained that on May 9th the VNA submitted a Notice of Exercise of Option to Purchase the land which the Hospice House sits on, commonly referred to as the Hospice House Parcel. The parcel is a total of 14.5 acres which includes the existing VNA Hospice House. Per the terms of the lease, the property must be sold at fair market value and the VNA must obtain and pay for an appraisal of the property, which was conducted by Armfield-Wagner on April 20, 2023 and appraised at $3.4 million. The property shall be sold “as-is” and he discussed some items relative to the property and its condition. Lastly, he explained that the closing shall occur within 180 days of the date that the VNA exercises its option to purchase and shall pay all closing costs. Therefore, an estimated closing date would be on or around December 31, 2023. Next, Mr. Stengel provided a historical review of how the VNA reached this point in their efforts to exercise their option to purchase, He explained that after three years of delays due to COVID, inflation and economy uncertainty, the VNA now has major donor support to move forward with the purchase and have invested $850,000 to date on this project. He then reviewed the positive outcomes this sale would have for the VNA, the District, and the community as a whole. He then discussed the next steps to close the sale which included the District being favorable to the sale and passing the appropriate board resolution per the terms of the Special Act; an additional property appraisal conducted by the District; agreeing to the Fair Market Value terms; and other various real estate check list items. Lastly, he reviewed a proposed timeline for the process and completion of the new VNA Center. There was Trustee discussion and Mr. Westcott questioned how the VNA would move forward, should the Trustees not agree to the sale. Mr. Stengel explained that the VNA would remain in the existing lease it currently has with the District and continue to move forward with efforts to construct the new VNA Center. He further explained that during fundraising efforts, many donors expressed their desire for the VNA to purchase the property, which their board also felt was the best option for long term stability. There was further Trustee discussion and there were no objections to the proposal. Ms. Peshke stated that a resolution has been prepared outlining the requirement of deeming the property surplus property. and will be presented at tomorrow night’s meeting for approval. Additionally, it was agreed that the District would also obtain their own appraisal of the property to be used during negotiations in determining the fair market value.

Via College of Osteopathic Medicine (VCOM) Presentation- Dixie Tooke-Rawlins D.O., President & Matthew Cannon, D.O., Dean for Carolinas Campus

Dr. Tooke-Rawlins introduced herself and Dr. Cannon, who are addressing the board on behalf of the Via College of Osteopathic Medicine (VCOM). She began her presentation by providing an overview of the credentials of an osteopathic physician, which is a person licensed to practice the full scope of medicine, just like a medical doctor. Once graduated from Osteopathic medical schools, they enter the same residency programs as MD’s and learn an approach to caring for the patient that considers the spiritual, physical, mental, socioeconomic and environmental factors that affect health. Next, she provided an overview of the VCOM and its mission, which is to prepare globally-minded, community focused physicians to meet the needs of rural and medical underserved populations and promote research to improve human health. VCOM has four campuses and reviewed their logistics in detail. They have 15,000 applicants annually and have over 5000 graduates, and will graduate over 600 new physicians annually from their four campuses, and have become one of the largest medical schools in the country. Dr. Tooke-Rawlins stated that it was important to note that over 60 percent of VCOM graduates enter into the primary care fields of family medicine, internal medicine, pediatrics, and OB/GYN annually. She further discussed the student body population and recruiting statistics, and reviewed data concerning their student’s performance on state board exams and residency placement. She then discussed the partnership between VCOM and Cleveland Clinic and stated that VCOM has placed students in clinical training opportunities within Florida for many years and recently have had students placed at CCIRH. The future plan is for VCOM to increase the number of medical students in clinical training within Florida Cleveland Clinic hospital systems over the next several years. Therefore, VCOM is seeking to utilize the Human Service Building on the CCIRH campus to support both medical student education and residency programs that will be offered in the future. This will include classroom space, a medical library, simulated training facility and possibly a research laboratory. Ms. Cunningham stated that it wasn’t initially clear why VCOM was addressing the Trustees today and felt that more background information should be provided. Mr. Papayannis who currently serves as the Cleveland Clinic’s Director of Real Estate for the Florida Market, addressed the board and provided some historical context relative to this discussion. He explained that based on correspondence the District sent to the hospital back in December, notifying them of the VNA’s notice to vacate the HSB, their team reviewed possible solutions to utilize the building. Legal Counsel for CCIRH provided a response back to the District stating they were interested in entering into negotiations with the District concerning the property and would be favorable in amending the current lease agreement to include the HSB. There was subsequent Trustee discussion at a chairman’s meeting and the Trustee felt that they would prefer to have some form of revenue being generated from utilization of the building and Ms. Peshke informed CCIRH of that desire. CCIRH then responded and stated it was unable to put forth any capital expenditures for the building at this time. Therefore, CCIRH decided to look at other options for utilization of the building and based on their partnership with VCOM, recommended they provide a presentation to the District as an introduction. He further explained that CCIRH would be willing to waive their Right of First refusal on the property should the District agree to lease or sell the building to VCOM. There was Trustee discussion and many felt that this matter would need further discussion and consideration. Ms. Peshke suggested that VCOM be given a tour of the building and fully consider their options before submitting a property proposal for the District to consider. Once a formal proposal is received, the Trustees can then fully review their options and discuss how they would like to move forward. It was also discussed that the District may want to market the property and see what other offers might be received for consideration, before approving any deal with VCOM. Ms. Peshke also reminded the Trustees that if they were considering a sale of the building, that they would need to follow the process they just went through concerning the Hospice House land parcel.

FY 23-24 Budget Request for Funding Presentation

Mental Health Court of Indian River County- Vicki Soule, Board Member & Nicole Menz, 19th Circuit County Judge

Ms. Soule provided the Trustees with a brief history of how the mental health court was established in IRC. She stated that 7 years ago Judge Cox, with the help of a federal grant, began the program and three years ago Judge Menz took on oversite of the program. Due to changes in grant funding from the state, the upcoming fiscal year will not be funded and they are requesting support from the District to continue this much needed program. She explained that The Project Director will continue to collaborate with the contracted provider Southeast Florida Behavioral Network (“SEFHN”) to ensure that all Memorandums of Understanding (MOU) agreements between providers are signed and designated, that properly trained staff are in place to provide the identified evidenced based interventions, and that performance outcome data is collected and monitored on an on-going basis. Judge Menz addressed the board, and discussed the program and its capacity for providing services, along with the request for funding. She stated that the budget submitted with the request for funding is a true reflection of the total costs to run the program and they are not requesting any additional funds over the true cost. She stated that some items on this budget will be reduced from the total request to the District which includes $185,000 for case managers which is being covered by the sheriff’s office. Also, through SEFHN they have applied for two additional grants that would be effective October 1st. One grant is in the amount of $250,000 and the other is for $183,000. However, they will not be notified that the grant was awarded, until late September, and these grants are highly competitive with many counties applying for the same funding. She further explained that there is also $150,00 that has been awarded from the Opioid Settlement funds, but that it will be distributed amongst all three diversion courts and must be utilized for an opioid related offense to provide treatment support. Next there was discussion surrounding the issue with lack of housing and the effect this has on the clients participating in the program. There was also discussion surrounding the partnership TCCH has in providing health services at the jail, which includes mental health treatment. There was Trustee discussion surrounding the request and the amounts for each service line or position. They voiced their appreciation to the fact that this breakdown was included so that they could see exactly what was being requested and supported. It was understood that the total request for funding is $843,086, but will be reduced by $185,000 and potentially more if the grants they have applied for are awarded.

Treasure Coast Homeless Services Council, Inc.- Rayme Nuckles

Mr. Nuckles introduced himself and stated that he is the new visionary leader for the Treasure Coast Homeless Service Council (“TCHSC”), an organization that has been in existence for the last 22 years. He spoke to his previous background which included work with the US Department of Government Affairs and the Homeless Program office in Washington DC. He explained that the funding request before the board is to support a rapid resolution respite, and the total amount of funding is $484,796. He provided a review of TCHSC and their mission which is to prevent and end homelessness on the Treasure Coast and to assure that if homelessness happens, it is brief and non-recurring. TCHSC is the lead agency for the continuum of care of the Treasure Coast for homelessness, a designation assigned by the Federal Government, and they receive 2 million dollars annually to provide services to Indian River, St. Lucie and Martin Counties. They also have 64 collaborative community partnerships that help them assist their clients as well. Next, he discussed the Point-In-Time Count which takes place annually in January. This survey showed that over 340 individuals in Indian River County are homeless which is an 18% increase over last year. He then provided a review of the funding request and discussed the components of Rapid Resolution Respite (RRR). He explained that RRR focuses on three health priorities as identified through Indian River County’s CHIP plan, and utilizes social determinates of health. The program will support individuals exiting the hospital system into homelessness and place them into immediate respite housing where they can continue to heal and access resources. He further explained that TCHSC has identified a duplex facility that would be appropriate for use as a medical respite, and the location is within one mile of CCIRH. The facilities would provide short-term medical care and a place to connect to the communities’ supportive services when the clients no longer need hospital-level care. Next, he reviewed projected outcomes for the program and stated that removing the financial burden from the healthcare system and placing the Client in permanent supportive housing is the program’s measure of success. He then discussed the medical respite center and stated that it will employ a case management methodology that will work collaboratively with multiple partner agencies to create an individualized, holistic, interdisciplinary team to support the client. Their case managers will routinely use soft handoffs when referring clients to another team member or partner organization. The medical respite staff will also coordinate with mental health providers, other supportive service organizations, and individuals to increase access, decrease duplication, and facilitate community-wide support of mental health, education, and employment issues. He then discussed staffing needs for the program which consisted of a county operations director shelter manager, case manager and four shelter monitors. All staff are trained in trauma informed care and first aid/cpr. He then reviewed the timeline concerning the number of days a client is at the respite and the services they will receive during that time. Lastly, he discussed their various community collaborators, and explained that they have 36 partnerships within Indian River County. Those agencies provide support with various support including food, housing, and medical care. Mr. Nuckles thanked the Trustees for the opportunity to bring forth this request. He stated that he is continuing to work towards changing the communities negative perception of TCHSC and building those important community collaborative partnerships.

New Horizons- William Wims, Executive Director

Mr. Wims addressed the board and introduced New Horizons Board Chair Kathryn Hensley, who joined him for today’s discussion. He apologized to the Trustees for his absence at their semiannual report back in April and would like to address some of the concerns that were brought up during that meeting, today. He began by addressing the findings from their Audit report prepared by Keefe McCullough CPA’s, which sited significant deficiencies in internal controls and substantial doubt about an entity’s ability to continue as an organization. He explained that New Horizons has hired a consulting firm to look at operations and financials and are working on a corrective action plan to address those deficiencies. Many of the financial shortcomings have been addressed and he provided some examples of where they have been able to cut costs or eliminate duplicative staff positions, which has provided a cost savings to the organization. Also, he informed the board that the new CFO who was hired earlier in the year is no longer with the organization, and did not perform up to the standard that they initially hoped he would. They are also working to strengthen their internal controls mechanism and debt collection, which he believes will result additional revenue. Lastly, they are continuing to work on strengthening their leadership and are currently developing a succession plan. Next, he addressed the audit report that Ms. Carboni submitted and stated that he was displeased with her report and felt some of her reporting was inaccurate. He further stated that he believes he has always been transparent and available when contacted to provide feedback or follow up. There was group discussion and Ms. Cunningham asked if the children’s crisis unit had been reopened since its closure earlier in the year. Mr. Wims indicated that the unit was still closed due to staffing shortage. Next there was discussion surrounding their FY 23-24 funding request. Ms. Suriano questioned their low utilization of District funds for the current year and asked how they are justifying this new request. Ms. Curby addressed the group and agreed that the billings are low concerning District patients and attributed that to their difficulty in qualifying patients under District guidelines. She stated that they are working to improve that system and have a better structure in their qualifying process. Ms. Frederick indicated that she had met with representatives at New Horizons months ago to address this same issue, and was told they were working on finding a better process to qualify patients and utilize the funding. The Trustees agreed that this matter should be addressed and discussed further outside of this meeting. There was further Trustee discussion and the group agreed that New Horizons provides much needed services to the community and they were hopeful that they will be able to make the necessary changes to the organization to provide further stability for future sustainability.

Other Business-

Ms. Cunningham stated that Dr. Delaney and Dr. Peter will be attending the Districts July Chairman’s meeting, to address the board. Additionally, she provided an update concerning the Executive Director search and stated that 12 candidates have applied. Seven of those are from the American College of Healthcare Executives, four from InDeed, and one local candidate. Ms. Huebner has conducted her first round of preliminary interview and is scheduling a second round of interviews for three of those candidates. The job posting to South Florida Hospital News will be posted in July and she has received no responses from the posting on FASD.

Dr. Cooney addressed the board and stated he received a report published by the County titled ‘Livable Indian River’ and he felt the report was not well written and seemed to be duplicative in nature. It was discussed that this was a work product of the County and the Health Department and data from the Community Health Improvement Plan. Ms. Suriano indicated that she would look further into this matter, to address Dr. Cooney concerns.

Public Comment & Adjourn-

Mrs. Cunningham asked for public comment and there was none. The meeting was adjourned at 12:35 PM.