Sep 21 Regular Monthly Meeting- July 20, 2023
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
July 20, 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: Ann Marie McCrystal Pat Knipper
ATTENDEES: Vicki Soule Caryn Toole
Wes Samons Lisa Kahle
Convene Meeting, Invocation, Pledge & Consent Agenda– Marybeth Cunningham, Chair
Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM. Reverend Derrick West the Senior Pastor at Genesis Church provided the invocation and Ms. Bartlett led the group in the Pledge of Allegiance. Ms. Cunningham asked for a motion to approve the June meeting minutes and a July disbursement of $1,066,210.87. Ms. Bartlett made the motion to approve which was seconded by Ms. Bodnar. The motion carried unanimously.
Chairmans Report- Marybeth Cunningham, Chair
Ms. Cunningham stated that a very important piece of business this evening is to read a proclamation recognizing Ann Marie Suriano for her time at the Hospital District. She stated that this is her last official meeting as the full time Executive Director. She read the proclamation into the record and thanked her for her dedication and service to the District.
District Counsel Report- Sebastian DeMaio, Esq.
Ms. Peshke began by congratulating Ms. Suriano on her retirement. She provided her report and stated that she continues to respond to various questions that may arise from Trustees concerning current matters the District is working on and continues to participate in the District FY 23-24 budget cycle. Additionally, the matter concerning the sale of the Hospice House parcel is moving forward and the District is waiting to receive the appraisal report outlining the value of the property. Also, she is involved with matters concerning the future utilization of the Human Services building, and the District is also awaiting the appraisal report for that property as well. Lastly, she has been involved in the process of hiring a new Executive Director and has been working with the recruiter to help facilitate the process.
Financial Statement Review- Michael Kint, Treasurer
Mr. Kint provided his report and stated that after 9 months of the fiscal year, the District is in excellent financial condition. The District has received 99.4% of its budgeted tax revenue and program and administrative expenses continue to remain under budget. Total investments with DeepBlue are $7.4 million and the investment T-bills total $4.5 million. He explained that recently one of the T-bills matured and Ms. Suriano requested that DeepBlue transfer the $1.5 million in interest earned into a money market account, which is earning 4.7% interest. Ms. Suriano confirmed the interest rate amount has increased slightly to 5.1% and stated that there was further discussion concerning reinvesting the funds and she instructed DeepBlue to reinvest the funds into a new T-bill which will mature in January.
Executive Director Report- Ann Marie Suriano, Executive Director
Ms. Suriano provided her report and stated that the kickoff meeting with BJM group to discuss the process of conducting the performance review has been scheduled. She explained that this is an initial meeting of the District staff and the team from BJM to discuss the process, timeline, and provide an overview of what will be requested from District. She stated that there will be future opportunity for any Trustee who is interested, to meet with representatives from BJM to better understand the process or have any questions answered. Additionally, she provided the Trustees with an update concerning the issues surrounding the generator at the Gifford Health Center. She explained that the current generator utilizes diesel fuel to operate and that the diesel tank has rusted and is unsafe to refill. Therefore, she has been working with the TCCH maintenance supervisor to look for a suitable replacement. Through their research it was suggested that the unit be replaced and switched to propane fuel, which is safer and more efficient. Ms. Suriano has also worked with Ms. Peshke to make sure any future purchases of a new generator were in compliance with the procurement requirements outlined in the Special Act and Florida Statutes. Therefore, she informed the Trustees that the total cost to purchase is $73,000 and she is requesting approval to move forward with the purchase of a new unit, which would take approximately 8-9 months to receive. Mr. Kint made a motion to approve, which was seconded by Ms. Cunningham. The motion carried unanimously. Next, Ms. Suriano stated that it was also discovered that there are some structural issues within the building at the Gifford Health Center and she met with an engineer to assess those issues. They provided a verbal assessment of the issues but Ms. Suriano stated that she would like to move forward with obtaining a written report of their findings which would also include repair recommendations. She further stated that any repairs to the building would also need to be done in compliance with the requirements in the Special Act and Florida Statutes, and they will look to that legal process once it is discovered what repairs need to be made and the cost associated with the same.
Funded Agency Semi Annual Report
Mental Health Collaborative & McCabe Connections Center- Wes Samons, Executive Director
Mr. Samons addressed the board and thanked them for their support of the Collaborative and Connections Center. He stated that he was hired as the Executive Director in February and has been working to become more familiar with the role, and thanked Lisa Kahle for her support during the transition. He provided updates concerning the Connections Center and Mental Health Collaborative and stated that a new benefits specialist was hired at the center and he has done well in the position. Additionally, they transitioned to a new financial oversight and are using the services of Melissa Medlock, CPA. Next, he discussed new initiatives concerning the Collaborative and stated that the board recently held a retreat which was facilitated by Michael Felix. They also updated their database of available providers in the community which helps better assist connecting clients to services. Ms. Bartlett asked if there were any overarching themes that were revealed when updating the data. Mr. Samons explained that there is a capacity issue concerning licensed therapists and psychiatric services. Additionally, long wait times continue to be an issue, with clients waiting 2-3 months to receive an appointment. He stated that he has met with representatives from CCIRH and MHA, and has held discussions on how they can work collaboratively to problem solve and address the needs. Another area of need is retention and recruitment of providers. Mr. Samons further explained that he meets monthly with independent providers in the community to gather additional information and continues to expand relationships with those providers. Next, he discussed future plans for the organization which include more community outreach. Also, they have started a pilot program at the UP Cetner, that provides outreach and support services twice a week. Additionally, they are looking to expand their Mental Health First Aid training to a peer based model. The Trustees thanked Mr. Samons for his continued efforts in providing mental health support to the community and asked that he provide them with a copy of the new strategic goals and objectives when they become available.
Approval of Tentative FY 23-24 Budget- Michael Kint
Mr. Kint stated that presented tonight is a tentative budget for fiscal year 23-24 and is reflective of discussion that the Trustees had at the July 11th special meeting. He explained that the Trustees obligation is to approve a budget which includes a cap on the millage rate. The Trustees agreed during discussion at the July 11th meeting to hold the millage rate at the current rate of .5110, with the understanding that over the next few months there will be further discussion and possible reduction to the overall budget. He further stated that the millage rate adopted today can only be reduced and not increased. Therefore, the budget for approval at tonight’s meeting has a proposed millage rate of .5110, which will produce an anticipated tax revenue of $13,573,305. He further explained that the first public budget hearing is scheduled to take place on September 6th at 5:01 pm, at the county commission chambers, and the final budget hearing is scheduled for September 21st at 5:01 pm, also at the county commission chambers. The regular September board meeting will take place immediately following the final hearing. Mr. Kint made a motion to approve the tentative budget adopting a mileage rate of .5110 and ad valorum tax revenue of $13,573,305. The motion was seconded by Ms. Cunningham and the motion was opened for Trustee discussion. Ms. Bartlett asked for clarification concerning the total ad valorum tax revenue of $13,573,305 verses the total program expenditures of $16.2 million, which results in a $3 million deficit. Mr. Kint confirmed this and stated that the District holds substantial reserves to cover this deficit. Mr. Westcott stated that another variable which would attribute to making up the deficit is the potential sale of the Hospice House parcel. He further stated that he will vote to approve the proposed budget as presented but pointing out that on July 11th the board was limited to their discussion concerning all budget line items, he would likely raise a couple of concerns he has on some of the other funding requests. The first being the Partners program, which he would like to see additional information provided which justifies the $800,000 increase from last fiscal year. He also has concerns over the request for the CCIRH emergency department behavioral health component. Together, both requests total 24% of the District program expense requests. He feels that CCIRH, as part of their obligation to the lease agreement, should solely support these services and not be an additional burden to the tax payers. Ms. Cunningham stated that in the next few months she would like to have a Trustee meeting where there can be discussion surrounding Cleveland Clinic and its obligations to the District under the lease, and the Districts relationship with CCIRH, as it seems there is differing opinion regarding the same among the Trustees. Mr. Kint stated that he agreed with the initial process of following the scoring matrix concerning initial budget discussion but welcomes the idea of further discussion on line items that weren’t discussed previously, and those should take place at either an upcoming special meeting or the August Chairman’s meeting. There was no further Trustee discussion and the motion carried unanimously.
Mr. Westcott stated that after yesterday’s Chairman’s meeting, he received an email from Ms. Peshke concerning some comments he made during the meeting. He read the email which stated that three Trustees had contact her about a comment Mr. Westcott made stating that the District has the duty to help assist the hospital in its day to day operations. Those Trustees who contacted her were not comfortable with the phrase of assisting in the day-to-day operations, and believe that the lease with the hospital does not include oversight of operations. Mr. Westcott stated that he does not believe that the District being involved in the day to day operations of CCIRH is warranted or necessary. He believes the Special Act gives the District oversight responsibility for the performance of the hospital, and those rights were not contracted away in the lease agreement, and still rest with the District. He was encouraged by the meeting yesterday and would like to see the District and the hospital continue to work together and move forward, but he still feels there is work to be done. He referenced section 11 and 12 of the Special Act which he believes addresses the oversight language. He further stated that if any Trustees had further concerns or questions, he would address them at this time. Ms. Bartlett asked Ms. Peshke if Mr. Westcott’s understanding of the Special Act aligned with her understanding of the Special Act. Ms. Peshke stated that the language he is referencing, is within the Special Act, but when the act was written as the enabling legislation creating the District, the Trustees did have oversight to the daily operations of the hospital. Subsequent to this, the District entered into a lease, to lease the facilities and give authority for operation of the business, as 7 elected officials may not be the best suited individuals to run the day to day operations of a hospital. Ms. Cunningham stated that she received feedback from some participants in the room yesterday that felt Mr. Westcott was grilling the representatives from CCIRH, instead of participating in the discussion and felt that all future discussions should remain respectful. Ms. Westcott responded and referenced the process of getting CCIRH to address the board, which he felt had been put off several times and stated that he felt his decorum during the meeting was professional and to the point. He questioned whether the past board members have not asked the tough questions he has or held them accountable for their shortcomings. He believes that in order to resolve conflict it needs to be addressed head on and that to ignore the negative perception that the community holds against Cleveland Clinic and pretend that there aren’t issues that need to be delt with, would be a mistake. However, just because he is asking tough questions does not mean he does not want them to succeed. Ms. Cunningham stated that she does not believe any Trustees are ignoring the fact that there are issues, and there have been conversations about the issues community members bring to their attention regarding CCIRH. Further, she stated that Dr. Delaney called her this morning and stated that he felt that their discussion with the Trustees was productive and he would like there to be more frequent discussions between the two entities.
Mrs. Cunningham stated that members of the board will be conducting one-on-one interviews with the finalists for the Executive Director positions this week. Subsequent to those discussions the board will need to meet for a special meeting to discuss the candidates and ultimately vote to approve who will be hired for the position. Ms. Voss will be coordinating the scheduling of that and asked that she start that process.
There was no public comment, and the meeting was adjourned at 5:15 PM