Chairman’s Meeting: November 15, 2023

Chairman’s Meeting: November 15, 2023

Indian River County Hospital District Conference Room/ Zoom
November 15, 2023

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

ABSENT: Barb Bodnar

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

ZOOM: Anne Posey Nancee Long
Mich D Ceclia Stalnaker Lisa Zahner

ATTENDEES: Ann Marie McCrystal Matt Riser Bill Stengel Vicki Soule Rob Siedlecki Shaun Leydon

Convene Meeting

Ms. 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 New Horizons Task Force- Kerry Bartlett, Vice Chair

Ms. Bartlett provided the Trustees with an update concerning the New Horizons Task Force and stated that the group recently met for their final meeting. She reviewed the meeting minutes with the Trustees and provided an overview of the committee’s recommendations for moving forward. She explained that the group is recommending approving the funds including in the Districts fiscal year 23-24 and processing payment for the reimbursement invoice received for October services. Secondly Mr. Isele has been tasked with convening the local stakeholders to understand the current situation, needs and gaps, as well as potential solutions for better utilization of the New Horizons IRC Mobile Response Team, which is a critical program for the community. Next Ms. Carboni will initiate and complete an audit on New Horizons in the next six months and report to the Trustees not only the outcome of the audit but also the availability of leadership during the process. Lastly, Mr. Isele will reach out to the Treasure Coast County leaders who support New Horizons, for a roundtable discussion about New Horizons and mental health services. There was further discussion and the Trustees agreed that this organization has undergone many changes and their need for an internal reshaping. They are hopeful that with the recommendations from the task force, they will continue to be proactive and move in a positive direction. It was also discussed that New Horizons must remain proactive and engaged in this process, in order for there to be sustainable change. The Trustees questioned how committed New Horizons was in their efforts to strengthening services provided in Indian River County. After further Trustee discussion, Mr. Westcott made a motion to approve the recommendations brought forth by the task force, which was seconded by Ms. Cunningham. The motion carried unanimously. It was also agreed that Mr. Isele would look to other counties who were providing the same types of services as New Horizons, to see if there would be an opportunity to work collaboratively together to provide substance abuse, detox, and behavioral health services to Indian River County residents.

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

Ms. Peshke provided the Trustees with an update regarding the sale of the Hospice House parcel. She provided a copy of the purchase and sales agreement and proposed board resolution approving the same, to the Trustees for their review. She is also in the process of reviewing the title commitment and has sent the VNA’s counsel all the deed restrictions that were derived from the 2018 lease as documented in the memorandum of lease, as well as the deed restrictions in the 2021 lease amendment as documented in the 2021 memorandum of lease. She further explained that the VNA is paying all closing costs which was part of the deal provided in the option to purchase in the lease for this parcel. Lastly, she explained that if all is approved at tomorrow’s meeting, there should be a contract in place by the end of next week. It was also discussed by the group that a formal announcement from the District and the VNA should be presented to the public concerning this transaction.

Update on UF Transition- Frank Isele, Executive Director

Mr. Isele provided an update concerning the closing of the UF Psychiatry and Addiction Medicine Clinic. He explained that two meetings were held in November and with the strong collaborative effort from the group, almost all of the 2,600 patients have been connected to other providers. However, there is still one outstanding issue affecting approximately 200 patients who are insured through Medicare Advantage plans. He explained that there are very few providers in Indian River County who accept Medicare Advantage, and while TCCH does accept these plans, they currently do not have the capacity to accommodate the entire patient load. Therefore, Mr. Isele stated that the District is working with the group to find a temporary solution to assist these patients with their treatment and medication assistance. He explained that one option discussed was for the District to provide temporary financial assistance to providers willing to see these patients, until a long term solution can be established. There was Trustee discussion and it suggested that the District research which Medicare Advantage plans are accepted by local providers and to encourage the patient to make changes to their plans during open enrollment, in order to expand their covered services. Others felt that the District should intervene and provide financial assistance in order to avoid these patients potentially experiencing medical emergencies from lack of proper medication. It was also noted that the District should be careful in setting a precedent for funding services for Medicare Advantage plans. Mr. Isele stated that there are further group discussions that will take place, and he will bring forth an update to the Trustees next month.

Review of GlobeChek Funding Request- Frank Isele, Executive Director

As a follow-up to the funding request submitted by GlobeChek last month, Mr. Isele provided the Trustees with a summary of funding from fiscal year 2022-2023. He discussed the areas of this program that were working well, which included the partnerships with Whole Family Health Center and United Against Poverty. Next, he discussed the other portion of this program which included a mobile Globe which was initially to be utilized at the various TCCH locations throughout the county. Unfortunately, due to various issues, this partnership did not work, and the Globe was not utilized in its mobile capacity. Another factor contributing to this was that GlobeChek was unable to hire a driver for the unit and to date have still not secured someone to fill this position. There was discussion concerning GlobeChek, and their apparent lack of engagement and action to grow this program. Mr. Isele stated that District staff has met with representatives from GlobeChek concerning the future of this program and their willingness to continue providing the services. He stated that they are currently working on hiring a driver and Ms. Deigl indicated that she may be able to help assist in that area. There was also discussion concerning the qualifications a person needed for the position. Mr. Isele then presented his recommendation for funding the program to the Trustees. He proposed approving funding for the portion relative to Whole Family Health Center and United Against Poverty, as those seem to be effective in the utilization of the Globe. However, he recommended holding the portion of funding requested for the mobile Globe until the organization has a strategic plan in place and has also hired a full-time driver. The Trustees agreed with the recommendation and a formal vote will take place at tomorrow evening’s regular monthly meeting.

Review of RiteLife Audit Report- Dawn Carboni, Internal Audit/Data Specialist

Ms. Carboni addressed the Trustees and provided an update concerning RiteLife services. She gave a historical review and stated that the organization completed the pre-audit questionnaire, and a site visit was conducted in April 2023. At the time of the visit, limited required documentation was received and there were some initial concerns about the maturity of the organization. However, they did submit a funding application for the FY 23-24 and $108,000 was approved in the annual budget, with the understanding that the organization would need to provide an audit report before any funds were disbursed. She further explained that the organization has recently provided an annual audit, strategic plan, and Board meeting minutes for consideration. The audit report reflected that Ritelife has presented their financial statements fairly, in all material respects and the organization is funded primarily by grants and contract support from the FL Department of Children & Families. In FY 2022 the agency had $1.2 million in grant funds released from donor restrictions, however the Executive Director was unable to answer questions regarding the assets released from restriction. She further explained that Rite Life does have formal financial policies and a comprehensive Policies and Procedures Manual. However, there is no formal Finance or Human Resources department and with the amount of funding the agency receives, there should be an experienced accounting or finance person on staff. Lastly, Ms. Carboni and Ms. Frederick both recommended that they perform another site visit to discuss these observations, clarify the different funding streams the organization is receiving and how salaries/expenses are allocated among the four counties. There was Trustee discussion and agreed with the recommendation and felt that the organization still lacked maturity and oversight. They will await a further update before any reimbursement funds are distributed. Also, during Trustee discussion, it was noted that RiteLife helps assist individuals in Mental Health Court and Ms. Soule introduced Mr. Shaun Leydon, as the new project director for the Mental Health court.

Other Business

Dr. Cooney stated that at the last board meeting there were several comments made concerning CCIRH and some of the hospitals’ operating practices that he would like to address and clear up. He stated that first is the notion that CCIRH is forcing physicians out of the organization. In his view this is not true, and he provided some explanation behind various instances where doctors had left the organization, on their own accord. Next, he discussed a perceived issue that all patients need to sign a do not resuscitate form (“DNR”), which he explained was not true and that patients are required to have an advanced directive, which can include a DNR. He then addressed an article in the local press which questioned the changes to titles within CCIRH leadership. He explained that leadership titles are the same throughout the enterprise with one CEO of the organization and one president. All other subsidiary hospitals within the Cleveland Clinic system have leadership roles of vice president and chief operating officer, which is also the case here locally. He further stated that for the public to assume that Dr. Peters title change to vice president was a reflection on the hospital being downgraded was incorrect and that his title is consistent with all other Cleveland Clinic hospital systems.

Mr. Kint addressed the board and stated that he recently attended the Power by Purpose event hosted by the United Way. The event focused on veterans and provided a powerful message concerning the challenges this population faces. He recommended that the executive director Cynthia Ryan, from the Indian River Veterans Council, come to an upcoming District meeting to provide more information to the Trustees about their organization and how they support Indian River County veterans. The Trustees agreed that Veteran services were extremely important to the community, and they welcomed the opportunity to hear from Ms. Ryan.

Ms. Deigl informed the board that recently there was a ribbon cutting for the new medical clinic in the 787 building. She explained that this clinic is in partnership with Cleveland Clinic and the county and is specifically for Indian River County employees.

Mr. Westcott addressed the board and spoke to some of Dr. Cooney’s comments which he believed were in reference to comments he had made at a previous board meeting. He clarified that the form he was referring to was the Informed Consent form, not the DNR, and whether or not this form was creating a barrier to care because of the way it is drafted. He also addressed the comments related to Cleveland Clinic restructuring the titles of their leadership team and felt that CCIRH should have informed the District directly of the change and allowed for the District to offer its comments and feedback. Lastly, he addressed his comments about CCIRH being unduly competitive and stated that he feels the bigger issue is that doctors are leaving the community and how can they mitigate that issue. He also believes the District should look into this matter further. There was also Trustee discussion concerning the national shortage of physician and how this is affecting this community.

Public Comment & Adjourn

There was no further business and Ms. Cunningham asked for public comment. Mrs. McCrystal and Mr. Riser provided their public comment. The meeting was adjourned at 11:30 am.