Regular Monthly Meeting: October 19, 2023

Regular Monthly Meeting: October 19, 2023

County Commissioner Chambers/ Zoom
October 19, 2023 @ 4:00 PM

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

ABSENT: Kerry Bartlett

STAFF: Kate Voss Jennifer Frederick
Frank Isele Jennifer Peshke, Esq.

ZOOM: Ann Marie Suriano Vicki Soule
Marie Andress Ivy Duffy
William Wims Megan McFall
Nancee Long Anne Posey
Lisa Zahner Val Zudans
Kim Jeansonne

ATTENDEES: David Peter Cecelia Stalnaker
Warren Fuller Alex Greenwood Holly Mantle Steve Gagne Laura Gagne Donna Gibson Matt Reiser Michale Hammes Jad Shalhoub Deborah Shellenberger Caliegh Hanson William Mallon Jeffery Katz

Consent Agenda– Marybeth Cunningham, Chair

Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM. Rabi Michael Birnholz, Temple Beth Shalom provided the invocation and Ms. Cunningham led the group in the Pledge of Allegiance. She then asked for a motion to approve the consent agenda and monthly disbursement which was made by Ms. Bodnar and seconded by Ms. Deigl. The motion carried unanimously.

Chairmans Report- Marybeth Cunningham, Chair

Ms. Cunningham stated that it has been brought her attention that there is a post on Facebook from the District Board of Trustees stating a public service announcement and requesting the public to attend tonight’s meeting to express their concerns regarding Cleveland Clinic. She stated that this board did not author or authorize this post and it was not sanctioned by the Board of Trustees or staff. However, the Trustees always welcome the public to participate and attend the District meetings.

District Counsel Report- Jennifer Peshke, Esq.

Ms. Peshke provided her report and stated that she remains available to Trustees for questions and comments. Over the last month she has been working on the items related to the Hospice House parcel sale and is finalizing, with VNA counsel, a purchase sale agreement. Additionally, Ms. Peshke spoke in response to a memo she circulated on September 27th regarding the District performance review requirements. A Trustee questioned a provision within the legislation which states that beginning October 1, 2023, and every 5 years thereafter, each hospital licensed under chapter 395, which is governed by the governing body of a special district as defined in s. 189.012 or by the board of trustees of a public health trust created under s. 154.07, must have a performance review conducted. She explained that the Trustee questioned whether CCIRH was subject to this requirement and if an Attorneys General option should be sought clarifying this language. She further explained that she has notified CCIRH legal counsel of this language and will allow their counsel to make its determination regarding the requirement. Additionally, Ms. Peshke indicated that seeking an Attorney General option is typically the last step an attorney would take and is an extensive process. Mr. Westcott addressed the board and stated that he posed the question to Ms. Peshke and wants to make sure the District is living up to their obligations required through the statues. He further stated that irrespective of the position of CCIRH, he would like to know what the Districts obligation and responsibility is concerning this and he would like further investigation into this matter. Ms. Peshke stated that she will review these concerns with legal representatives from CCIRH and bring those comments back to the board for discussion.

Financial Statement Review- Michael Kint, Treasurer

Mr. Kint stated that after 12 months of the District’s fiscal year, the District has received 100% of its tax revenue, net of commissions and uncollectable taxes. Additionally, program and administrative expenses were both under budget. He reviewed the investment statement and stated that the District holds $2,283,829 in the preferred deposit pool and $1,203, 936 in treasury bills. Mr. Kint further explained that since the fiscal year has come to a close, the District will now begin to prepare for its end of year audit, and preparation for the same has already begun. Ms. Cunnigham asked if there was a total amount earned in investment interested reported. Mr. Kint stated that they do not have a total figure available currently, but they are able to gather that information and provide it to the Trustees at a later time.

Annual Report- Cleveland Clinic Indian River Hospital- David Peter, M.D., Vice President & Chief Medical Officer

Dr. Peter addressed the board and provided a brief introduction as to his medical background and credentials. He stated that he is here today to provide the CCIRH 2022 annual report. Dr. Peter discussed the following areas, as set forth and required within the lease agreement with the District. This includes the scope of healthcare services offered or contemplated to be offered, description of the capital spending for 2022; annual goals and benchmark achievements for quality; report on the types and value of indigent care provided to Indian River County residents; annual AHCA report; and the 2022 COVID response. There was also discussion concerning the many issues with the EPIC transition and new phone system, which Dr. Peter stated are being addressed and improved upon with a $2.4 million dollar investment being spent. Dr. Cooney addressed the board and thanked Dr. Peter for his report and stated that one area of concern he hears from the community is regarding the emergency department and asked what is being done to improve this situation. Dr. Peter stated that the hospital is very aware of the challenges with the emergency department and increased volumes due to population growth. They are currently developing a plan to renovate the area while addressing the efficiency and esthetics of the space. This project is set to begin early 2024 and will take 1-2 years. Mr. Westcott addressed the board and stated that he would still like to meet with Dr. Peter individually, and his hope is that they can work collaboratively together. Mr. Westcott stated that he is encouraged with some areas of his report and areas where they seem to be making progress, however he still has concerns with CCIRH overall sustainably and mission. He would like to see CCIRH have more autonomy and work with local entities on fulfilling their mission. Many members of the community contact him with concerns about CCIRH operations and availability of physicians. He believes there is also a perception that CCIRH is an aggressive competitor and they have taken over the market in terms of independent providers. He would like to see how CCIRH could use their pilar model to better support independent physicians. Ms. Cunningham stated that the purpose of today’s presentation was for CCIRH to provide their annual update to the board and if other items that Trustees have concerns over need to be discussed, the board will need to hold a special called meeting to address those items. Ms. Deigl addressed the board and stated that as the District appointed member on the integrity committee, she is proud of the work that is being done at CCIRH and the changes that are being made concerning their shortcomings. Lastly, Ms. Cunningham asked that Dr. Peter provide information to the public regarding where their questions and concerns should be sent regarding any issues they are experiencing with the hospital. Dr. Peter provided the information and a brochure which has additional information for the public as well.

Executive Director Report- Frank Isele, Executive Director

Mr. Isele provided his report and stated that he had just finished his fifth week at the District. He provided an update concerning the repairs to the Gifford Health Center and stated that after receiving three proposal bids, they have chosen a local contractor who was also recommended by the engineering firm who developed the structural report. The total cost of repairs should be less than $40,000 and they will begin soon after the permits are secure. Next, he provided an update concerning the closure of the UF psychiatry and addiction medicine clinic. He stated that the District has convened local behavioral health providers to address the clinics closure and find suitable transitions for the 2600 patients currently being treated at the clinic. Next, he discussed this involvement and introduction to many local community members and agencies. He also discussed that he and Ms. Frederick met with representatives from United Way and are moving forward with the utilization of EC Impact. This platform will help better assist the District with tracking metrics, the submission of funding applications, and annual reporting. Lastly, he provided an update regarding the discussions with VCOM and their desire to utilize the HSB to house a medical school. He stated that he and Ms. Cunningham had a zoom meeting with their team, and it was conveyed to them that the District would prefer to have a lease agreement in place, rather than VCOM purchasing the building. The representatives from VCOM understand the District position and will have further internal discussions, but seemed receptive to the idea.

Funded Agency Semi Annual Report- GlobeChek- William Mallon, M.D.

Dr. Mallon provided an update concerning GlobeChek and gave a brief history of the program and the Districts support of the same. He stated that they initially came to the District and a 6 month pilot program was approved. After the 6 months concluded, the District agreed to fund GlobeChek for the last fiscal year. Dr. Mallon has now submitted a funding request for the fiscal year 2023-2024, which is the same amount as the previous year. He provided a summary of the annual report and stated that there were two Globes positioned in the community, with one at Whole Family Health Center and the other at Treasure Coast Community Health. He explained that WHFC has seen a benefit to having the Globe and are now utilizing their own staff to operate the machine. He further explained the second Globe was designated as mobile and the idea was that it would be placed at various TCCH locations throughout the county. However, he stated that that relationship with TCCH has had more challenges than expected and it was decided earlier in the year to discontinue the partnership. Dr. Mallon expressed his frustration with the underutilization of the Globe and stated that their volumes were much lower than anticipated, and reviewed the data associated with those figures. He provided further background information, from his perspective, as to why the relationship between GlobeChek and TCCH did not work, thus causing reduced volumes. Next, he discussed other areas and partnerships within the community that they are exploring, to better utilize the Globe. There was some Trustee discussion and clarification was asked relative to the type of eye exam conducted through the Globe and the non-utilization of dilation of the eye. Ms. Cunningham thanked Dr. Mallon for this presentation and information and stated that the Trustees would like some additional time to review and discuss the request, before approving any funding.

Public Comment/Adjourn

There was no other business and Ms. Cunningham asked for public comment. Public comment was made by Steve Gayne of Vero Beach, Lamar Jackamo, of Vero Beach, Jad Shalhoub of Sebastian, and Doug DeMuth of Vero Beach.

Respectfully Submitted,

Barbara Bodnar, Secretary