Chairman’s Meeting- August 16, 2023

Chairman’s Meeting- August 16, 2023

Indian River County Hospital District Conference Room/ Zoom
August 16, 2023

TRUSTEES: Marybeth Cunningham (zoom) Kerry Bartlett
Michael Kint Paul Westcott
William Cooney (zoom) Karen Deigl

ABSENT: Barb Bodnar

STAFF: Jennifer Peshke, Esq. Jennifer Frederick
Kate Voss

ZOOM: Lundy Fields William Wims
Chriss Papayannis Ann Marie Suriano
Meredith Egan Marie Andress
Pat Knipper

ATTENDEES: Ann Marie McCrystal Vicki Soule
Kosta Velis Brion Regan
Bill Stengel Charles Mackett
Warren Fuller Cecelia Stalnaker
Mary Volsky David Peter
Juliane Price Rayme Nuckles
Ginny Blossom Jessica Staudt
Autumn Schneider Taylor Farnsworth
Heather Moxley Sandy Cook
Brenda Schmerling Frank Isele

Convene Meeting – Kerry Bartlett, Vice Chair

Ms. Bartlett convened the meeting of the IRCHD Board of Trustees at 10:00 AM by welcoming those participating via Zoom and in person. She introduced and welcomed Frank Isele, as the new Executive Director for the District, and stated that he will begin his tenure on September 5th.

FY 23-24 Budget Discussion- Michael Kint, Treasurer

Mr. Kint stated that today the Trustees need to make some decisions to finalize the total budget and millage rate, before the first public hearing on September 6th. At the last budget discussion meeting in July, the Trustees had additional questions regarding some of the funding requests. Representatives from those agencies are present today and are available to respond to Trustee questions. Mr. Kint further explained that Ms. Frederick prepared a memo outlining those items which need further clarification. Discussion began with a review of the Partners in Women’s Health request, which has increased by $800,000 from the previous fiscal year. Mr. Westcott stated his concern with the increase and questioned if the District is being asked to underwrite this program or if there is cost shifting. Mr. Fuller from CCIRH addressed the board and spoke to the increase and explained that this growth is pervasive across the whole hospital system and they have not increased staff despite the 10-12% volume increase they have experienced. Additionally, they are experiencing costs due to labor shortages and salary increases which have gone up by 21%. He further stated that there is no cost shifting taking place and the funding structure remains the same as it has in previous years. Next there was discussion about the investments and improvements CCIRH is making to the Partners programs, along with the laborist program. Ms. Volsky, nurse manager of Labor and Delivery at CCIRH addressed the group and stated that approximately a year and a half ago, the hospital instituted the practice of laborist, or OB hospitalist. The laborist is a position that is present at the hospital 24/7 and is instrumental in providing safe care to mothers and babies. There was also discussion concerning the transition to midwives facilitating the delivery process and they have found that some mothers prefer this delivery method and they have seen an increase in their patient satisfaction scores. They have also seen an increase in volumes concerning deliveries as well. Next there was discussion concerning the funding request to support behavioral health integration in the emergency department. Mr. Westcott stated that he has the same concerns that he raised with the Partners program and believes that this program should be fully supported by CCIRH. There was Trustee discussion and Ms. Cunningham stated that she believes that the hospital is still a community asset and that the District should continue to provide support to CCIRH for the betterment of the community. Mr. Fuller spoke to the details of the request and stated that the program has been in effect less than a year and they are working to obtain additional reimbursement from insurance companies, and with these additional insurance reimbursements, the request may decrease over time. There was also discussion surrounding the negative impact it would have on mental health patients presenting to the emergency department should the program funding be reduced. Ms. Stalnaker explained that 400 patients were treated year to date and if funding was decreased, it would have a negative impact on the continuity of care provided to the patient. There was no further discussion and Mr. Kint made a motion to approve the Partners funding request as submitted, which was seconded by Ms. Deigl. The motion carried unanimously. Next Mr. Kint made a motion to approve the funding request to support behavioral health integration in the emergency department, which was seconded by Ms. Deigl. The motion carried 5-1, with Mr. Westcott in opposition.

Mr. Westcott stated that as the Trustees begin discussing their future plans for the HSB, he asked the representatives from CCIRH if in their strategic planning for the hospital has future use for the building or if they thought about the future impact should the District sell the building to another entity. Dr. Peter stated that they are currently developing their strategic plan and one of the main objectives is to update the aging hospital facility, along with addressing the growth and needs of the community. This would include the purchase of a new power plant, updates and reconfiguration to emergency department, and a new patient tower. Mr. Westcott stated as the Trustees come closer to deciding about the future of the HSB, he would like to hear from the hospital on how this decision would impact the future development of CCIRH.

Next there was discussion concerning the funding request from Healthy Start, specifically concerning the PEACE program. There was Trustee discussion and they recognized that the outcome measures had increased slightly but were still concerned about how this would be measured over time. Ms. Schneider addressed the board and stated that they have added additional outcome measures and their plan is to have those individuals who participate in the training have follow-up requirements at 6 months and 1 year. They anticipate this follow-up to be ongoing as well. There was further Trustee discussion, and it was asked how the training would be impacted should Healthy Start not receive the full funding. Ms. Schneider indicated that they would have to reduce the number of training courses being offered, and potentially seek funding from alternative sources. Many of the Trustees stated that they still have concerns with the overall reporting outcomes, and it was recommended that they provide $50,000 in funding, which is half of the initial request. Ms. Bartlett made a motion to approve $50,000 in funding, which was seconded by Ms. Deigl. The motion carried unanimously.

The group then discussed the funding request relative to RiteLife services and it was noted that they still had not received the organizations audit. There was Trustee discussion and many felt that the organization lacked maturity and structure. There were also concerns about the perceived lack of oversight from the board of directors. Ms. Cook from the organization addressed the board and stated that they are currently undergoing an overhaul of their board of directors and are in the process of onboarding new members. Additionally, they were told that their organization’s audit would be completed by the end of August and will provide a copy to Ms. Frederick as soon as it is received. There was Trustee discussion surrounding request and it was stated that currently there is $100,000 allocated in the budget, which does not cover the full request to cover salaries for the program. Ms. Deigl recommended that $108,000 be allocated to the budget which would cover the salaries to implement the program. She stated that this funding should be contingent upon the receipt of a clean audit report, and then the Trustees can have further discussion once the audit is received. Ms. Deigl made a motion to approve $108,000 in funding based on the conditions just discussed, which was seconded by Mr. Westcott. The motion carried 5-1 with Ms. Bartlett in opposition.

Next there was discussion surrounding the request from Sunshine Physical Therapy and the Trustees asked for clarification concerning the new portion introduced that would cover support for adult clients with special needs. It was discussed that $225,000 has currently been budgeted which was allocated to support pediatric services only. Ms. Blossom addressed the board and stated that they have secured additional funding to support pediatric services. Therefore, she is requesting that $75,000 of the $225,000 be utilized to support Medicaid shortfall for a portion of their adult patients, as well as 30 adult special needs patients. There was Trustee discussion concerning the organizations financial health and Ms. Blosom stated that they are in a much better position due to the support from the District and income from an IRS refund. There was additional Trustee discussion, and a motion was made by Mr. Kint to approve the amended request which would allocate $75,000 of the total request to support adult services as discussed previously. The motion was seconded by Ms. Deigl and carried unanimously.

The group then had discussions relative to the request from Treasure Coast Homeless Services Council and stated that they would like to have clarification concerning the number of clients they project to serve and the length of their stay. Mr. Nuckles explained that the client’s length of stay is dependent on their health condition and an individual may only utilize the respite services for 30 days, and this is why the projected number of clients is higher than average. They also have other resources available to place these clients in housing once their health status begins to improve, which will help facilitate assisting more clients. Mr. Nuckles further explained that their overall request has decreased down to $334,113 due to the receipt of some additional grant funding. He also discussed their method of data collection and management and stated that they use a system which is regulated by the US Housing Department of Housing and Urban Development. There was no further discussion and Ms. Deigl made a motion to approve the reduced request of $334,113 which was seconded by Ms. Bartlett. The motion carried unanimously.

Ms. Frederick informed the Trustees that she received a funding request from GlobeChek for the upcoming fiscal year. She explained that they will be presenting their semiannual report to the board in October and will discuss the funding request as well, at that time. She further explained that there are funds in a contingency reserve within the budget that would cover this request, should they wish to approve the same.

Discussion Concerning Future Use of HSB & Hospice House Sale Update- Jennifer Peshke, Esq.

Ms. Peshke stated that Ms. Voss put together a memo, at the request of Ms. Cunningham, that is a summary comparison of information relative to the District appraisal reports received concerning the Hospice House parcel and the Human Services building, versus the offers to purchase and/or lease the properties. She began by discussing the status of the Hospice House parcel sale and stated the next steps would include the District entering into a purchase and sale agreement with the VNA. However, there is a difference in the fair market value assessment in the two appraisal reports obtained by the District and the VNA. Therefore, the Trustees would need to agree to make a counter proposal and submit the same to the VNA for consideration. Mr. Stengle was present at the meeting on behalf of the VNA and stated that the Districts appraisal report did not take a few factors inhibiting the property into consideration, which he believes resulted in the higher appraisal number. Those factors include the deed restrictions to the property and the right of first refusal with Cleveland Clinic. There was Trustee discussion concerning the deed restrictions which are in place to protect the property from future development outside of its intended use of medical-related functions. It was recommended by Mr. Westcott that a letter be drafted by Ms. Peshke providing a counteroffer to the VNA with the Districts appraisal figure of $4.125 million. Mr. Westcott made a motion on his recommendation which was seconded by Ms. Cunningham, and the motion carried unanimously.

Next there was discussion concerning the HSB and Ms. Voss provided an update concerning the expenses the District incurred for the month of July on maintenance. Additionally, she informed the board that a water heater on the second floor burst and caused a flood on the first floor. Additionally, in a separate area on the first floor, the property manager discovered that an AC unit was leaking, and there was additional water intrusion. Both issues were addressed by a water mitigation company and the total expense for the incident was approximately $10,000. The board instructed Ms. Voss to contact the Districts insurance company to see what the Districts deductible on the two claims would be. Ms. Peshke then led a discussion concerning the two offers submitted to the District. The first offer received on July 14th from VCOM, was to purchase the property for $2.65 million. The second offer received on August 3 from Vero Beach Recovery Cetner offering to lease the property, with the lease terms to be determined. She stated that the board will need to make some decisions concerning the future use of the property. Dr. Cooney addressed the board and stated that a few months ago he submitted a proposal to the board concerning his desire to house a primary care clinic in the HSB. He stated that this would be achieved through a partnership with CCIRH, as well as VCOM. Additionally, he has had conversations with Ms. Soule from TCCH concerning their desire to staff the clinic and support the VCOM medical students. Ms. Bartlett stated that this is a larger discussion than the time allotted for the remainder of today’s meeting, and she recommended that a special call meeting be held in the next few months. The Trustees agreed. Mr. Westcott then made a recommendation to the board that they seek a consultant to assist the District in the development of long-term planning, concerning the future use of the District owned properties. The Trustees agreed that this would be beneficial, and Mr. Westcott stated that he would work with his contacts and bring forth some recommendations for the Trustees to consider.

Recommendation for Members to Finance and Audit Committee- Michael Kint, Treasurer

Mr. Kint stated that he has finalized his recommendation for membership to the District Finance and Audit Committee. Those individuals are Jeff Smith, Susan Chenault, Allen Jones, and Keith Morgan, and there still is room for one additional person should the Trustees wish to have one other member. There was Trustee discussion and Dr. Cooney recommended Michael Hammes, who is the Chairman of the CCIRH board. Mr. Kint stated that he had some initial concerns about appointing Mr. Hammes to the committee and Ms. Deigl felt that if an organization is receiving funding from the District, a representative from the organization should not be involved in the committee. Other Trustees agree with this sentiment and after a brief discussion Ms. Bartlett made a motion to approve Mr. Kints recommendations as submitted, which was second by Ms. Deigl. The motion carried.

New Horizons Task Force and Prospective Members- Kerry Bartlett, Vice Chair

Ms. Bartlett stated that during discussion concerning future funding of New Horizons, she made a recommendation to create a task force that would investigate ways to further support New Horizons and their path to sustainability. Therefore Ms. Bartlett developed a charter for the same that outlines the core areas to explore, and she reviewed those with the group. She then reviewed the proposed members list which she has yet to approach and requested their involvement with the project. Those members include Kip Jacoby, Jeff Pickering, Wes Samons, Dr. Creelman, and Lenora Ritchie. It was confirmed that New Horizons is on board with their participation in this task force and their CEO William Wims, pledged his involvement moving forward. The Trustees were in favor of the proposal and Mr. Westcott made a motion to approve the recommendation submitted by Ms. Bartlett. The motion was seconded by Ms. Deigl and carried unanimously. Ms. Frederick provided the Trustees with an update she received from New Horizons and stated that as of Monday, the Childrens Crisis unit had reopened, and they are currently serving 3 children.

Other Business

Mr. Kint stated that the Districts bank signature cards are being updated to reflect the change in executive director. He explained that Ms. Suriano will be removed from the accounts and Mr. Isele will replace her as executive director. Ms. Bodnar, Ms. Cunningham, and he will remain on the accounts in their respective positions as secretary, chairwoman, and treasurer. He asked for a motion to approve the same which was made by Mr. Westcott and seconded by Ms. Deigl. The motion carried unanimously.

Mr. Kint referred to the early budget discussion and stated that he plans to update the proposed FY 23-24 budget to reflect the changes agreed upon during today’s meeting. He confirmed that the Trustees would like to maintain the millage at its current level of .5110, and the additional monies reduced from program expenses would be moved into reserves. The Trustees agreed.

Ms. Bartlett stated that she was alerted to a change happening with the UF psychiatry and addiction medicine clinic and asked Ms. Frederick to provide the Trustees with an update. Ms. Frederick stated that a meeting was held yesterday with local mental health providers to discuss the future operations of the UF clinic, and she is preparing summary minutes that she will provide to the Trustees.

Next Ms. Bartlett stated that she would like the District to once again move forward with the creation of an executive director succession plan. She would also like to talk about the 90 day onboarding process for the new executive director. It was discussed that those items could be addressed at the September Chairmans’ meeting.

There was no further business and Ms. Bartlett asked for public comment. Ms. McCrystal addressed the board and stated that the District Trustees should consider the proposal from VCOM and that CCIRH could utilize some of the HSB for additional services. She believes that the building currently being utilized for the CCIRH sleep center could be turned into a detox center.

There was no further public commend and the meeting was adjourned at 12:35 PM.