Chairman’s Meeting- July 19, 2023

Chairman’s Meeting- July 19, 2023

Indian River County Hospital District Conference Room/ Zoom
July 19, 2023

TRUSTEES: Marybeth Cunningham Barb Bodnar
Michael Kint Paul Westcott
William Cooney Karen Deigl
Kerry Bartlett

STAFF: Ann Marie Suriano Jennifer Peshke, Esq.
Kate Voss Jennifer Frederick

ZOOM: Marie Andress Anne Posey
Stanford Erickson Matt Blaze
Rose Eisenberg Jack Eisenberg
Liz Adams Amy Erickson
Kosta Velis Caitlyn Moorehouse

ATTENDEES: Ann Marie McCrystal Lundy Fields
Matt Cannon Dixie Tooke-Rawlin
Bill Stengel Conor Delaney
David Peter Barbara De Castillo
Chriss Papayannis Vicki Soule
Caryn Toole

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. She stated that there was a change in the agenda and the discussion concerning an update on the Executive Director search would take place first.

Update on Executive Director Search

Ms. Cunningham stated that Ms. Huebner has been conducting due diligence in finding suitable candidates for the Trustees to consider for the Executive Director position. Most of the candidates were located through InDeed or LinkedIn, and several preliminary interviews have taken place with Ms. Cunningham and Ms. Huebner. They are now working to narrow down the finalists that will meet with the other Trustees for one-on-one interviews. Once the interviews are complete, the Trustees will meet for a special meeting to discuss the candidates and make their selection. She is hopeful that by the first part of September, the position will be filled. Ms. Bartlett questioned if there was a scoring rubric used during Ms. Cunninghams interview process. Ms. Cunningham stated that she bases her questions on the candidates’ work history and asks questions with regard to various situations they may encounter as executive director, and how they would manage the same. She also questioned their previous employment history and knowledge surrounding the District and its operations. There was further discussion surrounding the qualifications and experience the Trustees were looking for within the candidates. Lastly, it was discussed that Ms. Huebner would prepare a packet of documents with the candidate’s information and other materials for the Trustees to review, prior to the interviews which were scheduled for July 27th. Ms. Cunningham further stated that Ms. Huebner would also be available to answer any additional questions from the Trustees.

Cleveland Clinic Indian River Hospital Update- David Peter, M.D. Interim President CCIRH & Conor Delaney, MD, CEO & President, CCF Florida Region

Ms. Cunningham introduced Dr. Peter and Dr. Delaney, as well as their legal counsel Barbara De Castillo and stated that they are here to respond to the some of the Trustee questions that were presented to them a few months ago and provide an update concerning CCIRH. Mr. Westcott thanked the representatives from CCIRH for coming to address the board and stated that it was communicated to the board by Ms. Suriano that the representatives from CCIRH would be providing a narrative response to the questions that were submitted by the Trustees and that not all of the questions would be provided with a response, nor would they address each question individually. He requested to know which questions were not being answered and the reason they were not being addressed. Dr. Peter addressed the group and stated that two sets of questions were provided to him, and most will be addressed with the exception of items that are considered not to be part of the board discussion and related to internal documents that they are unable to share. Ms. Cunningham requested that Dr. Peter and Dr. Delany be able to first provide their presentation and discussion and then there would be time for the Trustees to provide feedback or comments.

Dr. Delaney addressed the group and stated that Cleveland Clinic is committed to working with the District and committed to providing health care to the community. He provided a brief introduction of his medical background and association with Cleveland Clinic which began in 1999, and in 2020 he was assigned as the CEO and President of Cleveland Clinic Florida. He discussed the mission of Cleveland Clinic and how the organization operates with an emphasis on patient care and education. He further stated that they continue to focus their efforts on making the hospital operations sustainable, as there are many challenges they face as a not-for-profit hospital. CCIRH alone suffered a $100 million-dollar operating loss over the last two years, and they continue to look for meaningful solutions to lower overhead costs, while supporting their staff and caregivers.

Dr. Peter addressed the board and discussed his clinical background and history with Cleveland Clinic and stated that he joined the team at CCIRH in March of 2019. He discussed the commitment Cleveland Clinic has in providing healthcare to the community and stated that CCIRH was one of the first sites for COVID testing and vaccinations, and they further collaborated with 40 other not-for-profits to continue their response to COVID. He then discussed the decrease in utilization of traveling nurses which was at 45% during the peak of COVID and the various factors that attributed to the use of traveling nurses during that time. They were also able to improve their rating with US News & World from 31 to 18 due to increased quality and safety efforts put into place. Next, he discussed the contributions CCIRH is making in the community and stated that they host learners and medical students from Florida State, as well as 19 physician assistant students, and have 10 students from VCOM. Additionally, they help support 537 nursing students and 114 allied health students. Next, he discussed their community partnerships and collaborative efforts which included the Learning Alliance, Healthy Start, Indian River County School District, VNA, and the FL Department of Health. Dr. Peter then provided an update concerning the Emergency Department, which many Trustees submitted questions and concerns over. Dr. Peter recognizes that the ED has its challenges and that they are currently developing plans for a renovation and addition which would address the issues with patient flow, efficiency and aesthetics. They have already raised $5 million towards the project and see this as an 8 to 10 year commitment towards improvement. Next there was discussion surrounding updates to the Behavioral Health Center and improvements in providing those services. He stated that there are plans to build a four bed psychiatry safe area within the ED for behavioral health patients. Next, he discussed protocols with boarding behavioral health patient and explained that periodically behavioral health patients are admitted to the ED due to various issues with capacity and available beds, or unavailable staff at the Behavioral Health Center. Currently there are 332 beds, with 46 of those designated for behavioral health. He further explained that the organization is looking at long-term solutions to address the growth happening within the community and their long term facilities plan is being developed which may include a new patient tower. Next there was discussion concerning Vero Radiology and the transition issues since the organization dissolved at the end of 2022. He stated that they recognize the issues during the transition with respect to IT conversion and appointment scheduling, and worked quickly to resolve the same. Vero Radiology is currently undergoing equipment updates and improvement, and adding additional equipment to meet the demand for services. Additionally, the reading of scans are able to be read remotely by additional Cleveland Clinic staff within the enterprise, to reduce further wait times. Dr. Peter then discussed matters concerning operating rooms which he reported have improved dramatically and the Labor and Delivery project. He stated that $7.3 million has been raised towards the Labor and Delivery project and it is set to begin the first quarter of 2024. Additionally, the update to the labor and delivery area will free up additional operating rooms for utilization. It was asked by a Trustee whether this update would better help facilitate high risk pregnancy cases, and alleviate the need for mothers to travel out of county to seek care. Dr. Peter stated that as a health system, each hospital has designated specialties and CC Martin Health is designated as the location for high-risk pregnancy cases and that each hospital is unable to have all service areas at the highest level. He then discussed the additional staff and service lines that have been added to the organization which included advancements for cardiac and breast cancer treatments. They are also looking to recruit more primary care physicians and continue to foster their relationship with the independent physicians in the community. Next there was discussion surrounding the capital improvements made to the hospital and Dr. Peter stated they are halfway to their $250 million commitment. He discussed some of the improvements which included replacing all hospital beds, roof replacement, upgrades to the elevators, along with electrical and unity upgrades. Next, he discussed the issues surrounding the phone systems and stated they have begun to upgrade the system, which will take 12 months to complete and cost approximately $2.3 million. Lastly, he discussed Cleveland Clinics partnership with VCOM and stated that they are committed to the partnership and working to bring more medical students to CCIRH with the hopes of them staying in the area to provide primary care services to the community.

There was Trustee discussion and they felt that this dialogue was productive and are hopeful that communication between the District and CCIRH will be more frequent. They also encouraged the representatives to work on providing better communication to the public, and improving upon their phone and appointment systems, which currently are not user friendly. Also, there was discussion surrounding the financial assistance policy which is only effective for 90 days. It was explained that some patients are waiting longer for appointments and procedures and their coverage expires before they can be seen or treated. Dr. Delany stated that they appreciate the comments and are working to find meaningful resolution to the same.

Discussion on Future Utilization of Human Services Building- Ann Marie Suriano, Executive Director

Ms. Suriano stated that the VNA has officially vacated the Human Services building and Ms. Voss has been working diligently to transfer and update accounts relative to the maintenance of the building. Additionally, Lambert Commercial Reality has been hired to provide property management services with regard to checking the property weekly for any issues and being on call in case of emergencies. Ms. Voss will maintain all other matters concerning scheduling vendor services and bill processing. The monthly cost associated with maintaining the building is approximately $2,000. Further Ms. Suriano stated that she has ordered an appraisal of the building and parcel, and is awaiting the report. However, the District has received an offer to purchase the property which was submitted by VCOM, along with a proposal from Dr. Cooney with his recommendation for future use of the building. With those items in mind, Ms. Suriano stated that the Trustees should have discussions determining whether they would like to lease or sell the property. Ms. Cunningham stated that she would be unable to make a determination to either lease or sell, until an appraisal was received, and the Trustees agreed with her comments. Ms. Peshke addressed the board and spoke to the process of either selling or leasing the property. She stated that should the Trustees choose to sell the property; the process would be the same as the one they are currently going through with the VNA relative to the Hospice House parcel. One item to note is that CCIRH has the right of first refusal on the property, so the District would need to receive notice from CCIRH that they are not interested in purchasing or leasing the property, before entering into and sale or lease agreement with another entity. Ms. Peshke also recommends that CCIRH provide the District with correspondence stating that they do not wish to move forward with a lease or sale agreement at this time. However, should the District receive any future proposals which the Trustees are considering, they must still provide the right of first refusal to CCIRH, who would need to follow up with their own offer or give up their right to lease or purchase.

Next there was discussion surrounding the proposal received from VCOM and Dr. Cooney. Ms. Tooke-Rawlin addressed the board and thanked the Trustees for the opportunity to submit the proposal. She stated that VCOM is committed to becoming a long-term partner within the community and already has a strong partnership with Cleveland Clinic. Dr. Cooney addressed the board and stated that he would like to see the property used to house a primary care clinic, which would provide additional support to indigent care patients. He felt that through a partnership with VCOM and CCIRH, the building could be used as a clinic and teaching facility. There was further Trustee discussion, and it was agreed that until an appraisal report was received and reviewed, they would not make any decisions on whether to lease or sell the property. Ms. Suriano stated that as soon as the report was received, she would provide the same to the Trustees. They could then have further discussions at the next Chairman’s meeting.

Public Comment & Adjourn-

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