Chairman’s Meeting: September 20, 2023

Chairman’s Meeting: September 20, 2023

Indian River County Hospital District Conference Room/ Zoom
September 20, 2023

TRUSTEES: Marybeth Cunningham Kerry Bartlett Michael Kint Barb Bodnar
William Cooney (zoom) Karen Deigl (zoom)

ABSENT: Paul Westcott

STAFF: Jennifer Peshke, Esq. Jennifer Frederick
Kate Voss

ZOOM: William Wims Cecelia Stalnaker
Ann Marie Suriano Vicki Soule
Marie Andress Kim Jeansonne
Anne Posey Angela Guzenski

ATTENDEES: Ann Marie McCrystal Carol Kanarek Bill Stengel Chriss Papayannis

Convene Meeting

Mrs. Cunningham convened the meeting of the IRCHD Board of Trustees at 10:00 AM by welcoming those participating via Zoom and in person.

Update regarding UF Clinic- Jennifer Frederick, Program Liaison

Ms. Frederick stated that since the announcement was made by UF Addiction and Psychiatry Medicine notifying the community that they were closing their Vero Beach clinic at the end of December, the behavioral health leaders of the community convened to discuss next steps in supporting the 2,600 patients who are currently receiving services through UF. Initially UF had received a letter of intent from Galen Mental Health, who was interested in taking over the clinic. However, that offer has since been rescinded. Additionally, there were discussions with PUR Health and Wellness clinic in Vero Beach who has offered to help treat some of the patients. However, it was discussed that they are a for-profit entity and there were concerns with their capacity to treat under insured or not insured patients, and they also do not currently accept Medicaid. Mental Health Association, TCCH, and Whole Family Health Cetner have also offered to help absorb some of the patients, and it was reported that the UF patients have already began contacting those other agencies to schedule appointments. Ms. Frederick stated that there is still more planning and discussion to be had, and that the group plans to meet again in the next few weeks. Wes Samons of the Mental Health Collaborative is taking the lead on this initiative and the Trustees asked Ms. Frederick and Mr. Isele to take a leadership role as well. There was additional Trustee discussion and some asked if there was anything the District could do in order to keep UF in the community. Ms. Frederick stated that their decision to leave is final and that UF no longer wishes to operate the clinic. Additionally, Ms. Bartlett reminded the Trustees that the initial agreement made with UF was for a five-year commitment to operate in Vero Beach, and that the clinic has extended those terms several times, and it was never their intention to stay in Vero Beach indefinitely. The Trustees questioned if the patients have been notified that the clinic is closing, and Ms. Frederick stated UF is currently working on drafting a letter to notify them. She further stated that during future discussion, it is identified how the District can offer additional support, she will let the board know as well. The Trustees agreed that this is an important matter that must be addressed immediately, and they also expressed concern about the current staff at UF being displaced.

Update regarding New Horizons Task Force- Kerry Bartlett, Vice Chair

Ms. Bartlett provided an update concerning the New Horizons Task Force and stated that she has provided the minutes from the September 7th meeting for the Trustees review. She explained that the members who attended were identified in the minutes, with the exception of Jeff Pickering who declined to participate in the group. During the meeting Ms. Bartlett provided a situational review which outlined why the District was taking this initiative on as an opportunity to support New Horizons, and to assure that they will be able to provide sustainable behavioral health support to Indian River and the surrounding counties. The group also outlined the guiding principles and reaffirmed that this would be a collaborative effort, and that New Horizons leadership would be an active participant in the process. In further discussions with the group, it was discovered that Ann Berner, from the managing entity of New Horizons, has been conducting similar work with the organization and they asked for her participation moving forward. Ms. Berner provided an update concerning the work that has been done this far and outlined a dozen action steps New Horizons has been working on to strengthen the organization. Those include the onboarding of a new COO and an overhaul in the finance department. They are continuing to collect data and will provide the same to the District. Ms. Bartlett then reviewed the next steps for the group which included a meeting with CEO William Wims, the Medical Director and Board Chair, to review the next action steps in the process, which were also outlined in the minutes provided. It was further discussed that the New Horizons Childrens Crisis Unit has remained open, and they have 10 beds available for utilization. Ms. Frederick informed the board that through the organization’s review of the finances it was discovered that there may be potential for them to submit some additional billings which have not yet been submitted for the current fiscal year. Ms. Frederick stated that the District has the funds to support those billings but indicated that New Horizons must submit the same by the October invoice deadline, to be included in this fiscal year.

Update regarding Hospice House Parcel Sale- Jennifer Peshke, Esq.

Ms. Peshke provided an update concerning the sale of the Hospice House parcel and stated that back in June, the board passed a resolution which authorized the sale of the Hospice House Parcel. Since that time, both the VNA and District boards obtained appraisals of the property. The VNA’s appraisal report figure came in at $3.4 million, while the District’s report was slightly higher and appraised at $4.125, resulting in a $725,000 difference between the two. She explained that representatives from the District and the VNA met to discuss next steps and the differences between the two appraisal reports. It was discussed that the VNA appraiser came to their figure by taking into consideration the deed restrictions which are placed on the property and there was group discussion concerning the same. The parties also discussed the $725,000 difference between the two appraisal prices, and it was recommended that the parties agree to split the difference and settled on a purchase price around $3.75 million. There was also discussion surrounding the scenarios of the parties not in agreement with a fair market value purchase price. Ms. Peshke explained that if this scenario were to occur the parties shall obtain two additional appraisals, and the fair market value will be determined jointly or by a majority of the three independent appraisers. There was Trustee discussion and many of the Trustees felt expending additional funds and resources would not be the best use of tax dollars, considering the overall difference in fair market value price was not substantial. Additionally, it was discussed that further appraisals would most likely be comparable to the ones already received, given that one considered the deed restrictions and the other did not. Also, the Trustees felt that VNA has been a long term community partner and they want to continue to honor the partnership by working collaboratively for the betterment of the community. Therefore, it was agreed that they would not move forward with obtaining additional appraisal and submit a counteroffer of $3.8 million to the VNA for their consideration. Dr. Cooney made a motion to approve the same, which seconded by Ms. Bartlett. The motion carried unanimously. Ms. Peshke stated that she would notify the VNA of the action taken at today’s meeting and provide the Trustees with an update as soon as additional information became available.

Discussion on HSB Future Use- Frank Isele, Executive Director & Marybeth Cunningham, Chair

Mr. Isele addressed the board and stated that he prepared an overview of the three options that have been presented to the Trustees concerning the future utilization of the Human Services Building. The first being the offer to purchase submitted by VCOM. Mr. Isele stated that he has had discussions with the representative from VCOM and they are very interested in pursuing this offer to bring an osteopathic college of medicine to Vero Beach. There was also discussion surrounding the future retention of primary care doctors and how having the college and their academic programs could help assist in promoting that growth. There was also discussion surrounding their strong partnerships with Cleveland Clinic and TCCH, and the utilization of VCOM medical students at both entities. Next, he discussed the second option which is a lease agreement with Vero Beach Recovery Center. The center submitted a proposal to lease the building with the intention of operating a detox and inpatient rehab facility. Their proposal outlines their plans to provide services and in lieu of paying rent, and they would cover the build out costs and offered to see a portion of uninsured patients. There was Trustee discussion and while they agreed that the need for these services was great, they had concerns about partnering for a for-profit entity that mainly treated insured patients. Additionally, they were not comfortable leasing the building without any type of rent reimbursement. Lastly, he discussed the third option which was a combination of VCOM operating the medical school and the creation of a primary care clinic, to which Dr. Cooney submitted a proposal addressing the same. Mr. Isele stated that during his conversation with VCOM they expressed their interest in supporting a primary care clinic within the building and it was discussed that the residency program would need a few years to become viable before they could support the venture. Dr. Cooney addressed the board and discussed his proposal, which was submitted to the group. He discussed his goals to support this initiative which included increasing access to primary care for adults and children in Indian River County. He referenced the Partners’ program as an example of how a strong collaborative partnership can bring quality care and improved health outcomes to the community. He stated that it is his understanding that the CCIRH emergency department is overcrowded, and that low income and indigent patients often use the ED as their source of primary care. He believes that the District should partner with the local FQHC’s and CCIRH, to operate a primary care clinic at the Human Services Building to address this issue. Additionally, medical students from VCOM could assist in providing the care under the supervision of CCIRH doctors. He further believes that this should be done through a lease agreement and not a sale of the property/building. There was Trustee discussion, and many had questions concerning Dr. Cooney proposal and who would oversee and be responsible for operating the clinic. The Trustees were agreeable to the idea of a primary care clinic being offered but felt there needed to be further exploration as to how this idea would be executed and if the entities to which the partnerships are being proposed are on board with the process. Additionally, Ms. Cunningham asked that District staff to investigate the claim that the CCIRH ED is still being highly utilized for non-emergency visits. She stated that contrary to many claims that are being verbalized, she understood those rates to be decreasing due to increased access to primary care being provided by the local FQHC’s and she would like to see the data on these outcomes. After further Trustee discussion, Ms. Bodnar made a motion to move forward with the third option of engaging VCOM for further discussion regarding the medical school and exploring the idea of housing a primary care clinic partnership. Dr. Cooney seconded the motion and it carried unanimously. Mr. Isele stated that he would work to coordinate a meeting with representatives from the respective agencies to have further detailed discussions.

Executive Director Succession Plan – Kerry Bartlett, Vice Chair

Ms. Bartlett stated that she amended the executive director succession plan policy and has brought back the document for review and approval by the Trustees. Mr. Kint recommended a few additional edits to the document which Ms. Bartlett indicated she would make. With those changes in mind, she asked for a motion to approve the executive director succession plan policy which was made by Mr. Kint. The motion was seconded by Ms. Cunningham and carried unanimously.

Other Business

Ms. Bodnar addressed the board and spoke to the untimely passing of local pediatrician Dr. McCain. She stated that this is a huge loss to the community and there will need to be additional support for pediatric care. Ms. Soule stated that TCCH has already begun to see an increase in request for pediatric appointments and they have just recently hired an additional physician and ARNP specifically for pediatrics. Ms. Stalnaker addressed the board and stated that CCIRH is also offering behavioral health support to the patients and staff of Dr. McCain to help them through this difficult time.

Mr. Kint stated that Marie O’Brien from the Learning Alliance had reached out to him about some upcoming events with the Moonshot Moment scheduled for October 3rd and 4th. He asked Ms. Voss to forward the information to the Trustees for their review. Next, he stated that he is representing the District as a member of a steering committee that is looking to address affordable housing within Indian River County. The group held their second meeting recently and are developing an action plan based on information provided from the Community Health Improvement Plan from the Department of Health. He explained that the group is working through some organizational challenges with regard to leadership for this initiative. There was discussion surrounding the development of a land trust and if the District had any available land for future utilization. Further it was discussed that Dori Stone from the Chamber of Commerce, was convening local business to discuss the impact the housing crisis has on employee retention and how the community can collaborate to find meaningful solutions to this problem.

Mr. Isele stated that over the last two weeks he has had the opportunity to meet with most of the District funded agencies and is grateful for the hospitality he has received from them, and to Ms. Frederick for helping him understand the relationships the District has with those entities. Additionally, he provided the Trustees with an update concerning the Gifford Health Center and stated that they received the engineering report which outlines the repairs needed to correct the structural issues with the building. Next steps will be to work on gathering the bids for the project. He then provided the Trustees with an update concerning the performance review and stated that he will be scheduling a meeting with BJM so that he can be introduced to the team. Ms. Voss has provided 90% of the requested documents for the project and they will be working on the next steps with the team at BJM moving forward. Lastly, he stated that he has met with Dawn Carboni, who has agreed to return to the District in her previous role as Internal Audit and Data Analyst. She will start at the end of October.

Public Comment & Adjourn

Ms. Carol Kanarek, on behalf of the VNA, thanked the Trustees for their continued support of the VNA and moving forward with the sale of the Hospice House parcel. There was no further public commend and the meeting was adjourned at 11:35 PM.