SUMMARY MINUTES
CHAIRMAN’S MEETING
Indian River County Hospital District Conference Room/ Zoom
August 26, 2024
1:00 PM
TRUSTEES: Marybeth Cunningham Barb Bodnar Michael Kint Paul Westcott
William Cooney (zoom) Karen Deigl (zoom)
Kerry Bartlett
STAFF: Dawn Carboni Jennifer Frederick
Kate Voss Frank Isele
Jennifer Peshke, Esq. Kaytlin Dickens
ZOOM: Jeff Pickering Chriss Papayannis
Lisa Zahner Allen Jones
Tricia Boyle Rafael Colon
ATTENDEES: Ann Marie McCrystal Ceclia Stalnaker
Megan McFall Matt Tanner
Vicki Soule Shaun Leydon Randee Bok Anne Posey Liz Bahl Carrie Lester
Shannon Bowman Wes Samons Chuck Mackett Pat Knipper Carol Kanerak Mike Cianci Liz Bahl Lauretta Farrell
Kim Jeansonne
Convene Meeting & Approval of July Mintes and August Disbursements
Ms. Cunningham convened the meeting of the IRCHD Board of Trustees at 1:00 PM by welcoming those participating via Zoom and in person. Ms. Cunningham asked for a motion to approve the July meetings minutes and an August disbursement of $1,309,178.66. Ms. Bondar made the motion to approve, which was seconded by Ms. Bartlett. The motion carried unanimously.
SNAP Up Pilot Program Request- Wendy McDaniel, Crisis Stabilization Manager, United Against Poverty
Ms. McDaniel addressed the board and thanked them for their support for this valuable pilot program which helps supply essential items to homeless individuals and families in crisis. She reviewed data related to the utilization of the program over the last 6 months and stated that they have distributed 786 hygiene packs to 338 individuals. She expressed the gratitude the recipients have had and stated that many of them are single parents with multiple children. She also shared some success stories from the families impacted. Next, she reviewed the funding request, which totaled $15,000, and would provide support for the continuation of the SNAP UP program through July 31, 2025. There was Trustee discussion and overall, they were in support of approving the funding for the continuation of the program.
FY 24-25 Funding Request Follow Up & Budget Discussion – Frank Isele, Executive Director & Jennifer Frederick, Program Liaison
Ms. Frederick addressed the board and stated that she provided the Trustees with several updates to the follow-up items requested during the last budget discussion meeting. She began by providing an update on Camp Haven’s revised budget reflecting the transition to fee for service for the counseling sessions. This reduced their overall budget request by $17,091.
Mr. Isele then led a discussion surrounding the Learning Alliance and stated that there have been several meetings with representatives from the organizations to discuss the request attempting to centralize clinical skill sets with other local organizations that already have those services in place. Specifically, whether the role of the behavior technician, which the Learning Alliance is requesting funding for, could be supported by another agency. Ms. Bahl provided the Trustees with information relative to their request and discussed in detail the role of the behavior technician. Ms. Posey from Tykes & Teens also addressed the board and responded to questions regarding whether her organization could collaborate with the Learning Alliance and fulfill the role, instead of the District supporting it. It was discussed that while Tykes & Teens offers similar programs to the Learning Alliance, the role of a behavioral technician is not something they provide. There was lengthy Trustee discussion regarding whether the services requested are healthcare or education. There was also discussion as to what the school district’s responsibility to support these services is and why there is not more support being provided. After further discussion, Ms. Cunningham asked the Trustees to vote on their approval of the request. All Trustees, except for Ms. Bartlett, who voted to fund the request at $100,000, voted to approve the full request of $155,000. However, it was expressed by the Trustees to the representative from the Learning Alliance, that they should look at other avenues for long term funding solutions for these programs.
Next there was discussion surrounding the funding request for the TCCH Medical Mobile Unit, as well as Mental Health Court. The Trustees requested follow-up regarding the Mental Health Court program and representatives from the organization were present to respond to those questions. Ms. Soule and Mr. Leydon addressed the Trustees and spoke about the transition the Mental Health Court program has undergone since TCCH assumed operational responsibly. There was discussion surrounding the large funding request and what percentage of the total program was being supported by the District. Some of the Trustees felt that the total financial picture was not clear and would like to better understand the financial structure of the program. Mr. Leydon stated that over the last 8 months, he has been working diligently to bring structure and clarity to the operations of the program and will be able to provide the Trustees with additional information in the next three months. It was also suggested that the District convene a meeting to bring all the Mental Health Court providers together for a round table discussion. Ms. Deigl volunteered to be the Trustee point of contact and support for this initiative. Additionally, the Trustees agreed to fund the request for Mental Health Court at the full amount requested. There was also discussion surrounding the TCCH mobile medical unit and Ms. Frederick stated the Trustees had requested that the Mobile Medical Unit budget be broken down between medical and dental services, and she provided an updated budget for the Trustees review.
Next Mr. Isele led a discussion surrounding the request from GlobeChek. He stated that he and Ms. Cunningham spoke with Dr. Mallon about the District’s transition to fund most agencies with a fee for service model. A review was conducted relative to their FY 24-25 funding request against their volumes for the current year and they developed a fee for service amount that would be reimbursed for each scan done through the Globe. Dr. Mallon agreed to this formula and also agreed to hire a marketing director at their cost, in order to promote the Globe and their business. Most of the Trustees felt that further group discussion was needed and asked Ms. Carboni to speak on the audit report she prepared for the organization. Ms. Carboni stated that GlobeChek is unable to adhere to the District’s funding eligibility and requirements put into place, specifically having a yearly financial audit and strong KPI’s. As the District’s internal auditor, she is tasked with making sure all District funded agencies are following the District’s criteria put in place and the District should be consistent with holding all funded agencies accountable and in compliance. Mr. Isele also disclosed to the board that Whole Family Health Center is no longer working with GlobeChek and offering those services at their clinic. It was also confirmed that the services GlobeChek is providing are not billable services through insurance. Ms. Deigl addressed the board and stated it is clear to her that GlobeChek is unable to comply with the District’s financial policies and procedures put into place, which is ultimately putting the District at risk. Therefore, funding should not be approved. After further Trustee discussion, the majority of the Trustees agreed not to approve the FY 24-25 funding request.
Ms. Frederick then led discussion surrounding the remaining FY 24-25 funding requests which the board had yet to discuss. She pointed out that based on the results from the funding evaluation tool, the majority of the Trustees were supportive of funding these requests. Therefore, it was agreed that they did not need to review each request. It was decided that they would review only the portions of each request where a Trustee had questions or requested a lower funding amount.
The first item for discussion was the Integration of Health in the Emergency Department at CCIRH. Only one Trustee voted not to approve funding for this program. However, during Trustee discussion it appeared that no Trustees had any issues with the request, therefore, it carried unanimously. Let the record reflect that Mr. Westcott was not present in the room during this discussion.
The next item was the music therapy request from VNA. Dr. Cooney indicated that he had questions regarding the program but conducted his own research and was satisfied with his finding. Therefore, the request was approved unanimously by all Trustees, however Mr. Westcott was not present in the room during this discussion.
Next there was discussion surrounding the TCCH medical mobile unit and Ms. Frederick referred to the updated budget she provided to the Trustees. There was also discussion surrounding the chart she prepared which outlined the three mobile clinics being offered in Indian River County. The chart also references data regarding schedule, location, and medical services available which are available on each of the medical units. The Trustees agreed that all three mobile units should be billed to the District on a fee for services basis and Ms. Knipper and Ms. Soule indicated that they have been working with District staff to transition their billings to that method. Based on those discussions and explanation the Trustees were comfortable moving forward with funding the mobile unit funding request. Mr. Westcott was not present in the room during this discussion.
There was then discussion surrounding the amended Whole Family Health Center funding request. Ms. Frederick explained that WFHC has decreased their original total request by $53,114 and an updated budget schedule was provided which outlined the changes to the service lines. Ms. Andress also addressed the board and spoke to the large increase in their pharmacy budget and the reasoning behind the increase. After further Trustee discussion, they agreed to approve the amended request. Also, Mr. Westcott had rejoined the meeting and was present for most of this discussion.
Ms. Frederick provided some additional updates that were not included in the meeting materials, including an update relative to Dynamic Life. She stated that they were notified by Mr. Cianic that the organization plans to submit their audit report and 990 form to the District, in the next few days, once they receive approval from their board. Additionally, Suncoast Mental Health has been able to develop an hourly rate and will transition their request to fee for service. Mr. Isele stated that he would update today’s budget based on the changes made during today’s discussion and circulate the same to the board.
Funding Cut from DCF/SEFBHN Discussion- Frank Isele, Executive Director
Mr. Isele stated that he was recently notified by leaders from the Substance Awareness Center, Tykes & Teens, and Healthy Start Coalition that recently approved funding agreements with Southeast Florida Behavioral Health Network (“SEFBHN”) supporting preventative care programs were being terminated effective July 1, 2024. It was explained that the funds had initially been allocated to SEFBHN from the Department of Children and Families (“DCF”) and there was little explanation given to SEFBHN as to why the funds were no longer available. It was anticipated that a total of $320,000 was being lost between the three agencies and that emergency funding was needed to support the current programs from July through September. Ms. McFall, Ms. Lester and Ms. Posey spoke to the challenges that each of their organizations were facing regarding the loss of funding for these preventative health care programs. Mr. Isele stated that he is working with the United Way and Indian River Community Foundation to split the cost of the $320,000 needed to sustain the program after September, however there is a current unmet need of approximately $80,000 being requested to support the loss of funding between July through September. There was Trustee discussion, and many were frustrated with the funding stream issues that have been occurring with SEFBHN and felt that there needs to be strong board representation from Indian River County within that organization. Mr. Westcott also recommended that those agencies affected by the loss of funding have their attorneys review the funding agreements, as well as Ms. Peshke to see if there is any legal recourse to enforce their signed agreements. After further Trustee discussion Mr. Westcott made a motion to approve $80,312.50 in emergency funding to support the loss of SEFBHN funding, as well as have Ms. Peshke look at the funding agreements in place with SEFBHN and DCF, to see if the District could recoup the funds being allocated to support the loss in funding. The motion was seconded by Mr. Kint and carried unanimously. Mr. Samons addressed the board and stated that this loss of funding will also affect other Indian River County agencies who have not contacted the District and the total impact is still yet to be determined. Additionally, it was suggested that letters regarding this loss of funding be sent to Senator Grall and Representative Brackett, for their response and hopefully support.
HSB/VCOM Lease Discussion & Approval of Resolution 2024-02- Frank Isele, Executive Director
Ms. Peshke stated that the Trustees had previously seen the lease agreement between the District and VCOM, and an addendum has also been added to address some additional language needed. This lease was prepared by Ms. Peshke and no other changes have been made since the inclusion of the addendum. She discussed the terms and deliverables due per the lease and Mr. Isele reviewed those in detail with the board. There was also discussion surrounding the fair market value rental amount, which will go into effect after the initial 10-year term. There is also language stating that VCOM may have the option to purchase the property after the 10-year term, if they meet all the benchmark requirements within the lease. Should they choose not to purchase the property, the fair market value lease payments will go into effect. After further Trustee discussion Ms. Peshke stated that she prepared Resolution 2024-02 which authorizes Ms. Cunningham to sign the lease agreement on behalf of the District. She asked for a motion to approve the same, which was made by Ms. Deigl and seconded by Mr. Kint. The motion carried unanimously.
Other Business
Ms. Bartlett stated that she would like the board to finalize a date for the next strategic visioning meeting and there was discussion surrounding availability. It was determined that Ms. Voss would send communications to the board in order to find the most suitable date.
Mr. Westcott stated that in looking at the District’s reserves in the budget, he would like to determined what the appropriate amount of reserves are needed to support expenditures for the next fiscal year, and should more reserves be utilized so that the millage can be lowered. It was discussed that this budget includes utilization of some of the District’s reserve funds, and that the board has cut $2 million from program expenses that were being requested. There was further discussion on what makes up the budgeted $9 million in reserves which includes $4 million for the purchase of a sober living property; $3 million for two months of District operating expenses; and $2.5 million for investments. It was further discussed that since the District received $4 million from the sale of the Hospice House land, it has further offset the increase in millage, which would have been higher if the District had not received the sale proceeds. Mr. Isele also spoke to the talking points he prepared which explained in detail the reasoning behind the increase.
Next there was discussion surrounding the sale of Sebastian River Medical Center and Mr. Isele explained that there is currently a lawsuit which was filed by the landowner Medical Properties Trust against Steward Health Care. Currently, Orlando Health submitted a bid to purchase the three hospitals including Sebastian and the other two in Brevard County, however there are many legal obstacles that need to be addressed, which will cause this sale to be postponed. Therefore, it is unknown when the sale will actually take place, or the bankruptcy case be concluded.
Public Comment & Adjourn
There was no further business and Ms. Cunningham asked for public comment. Mr. Allen Jones addressed the board and thanked the Trustees for their service and dedicated work on the FY 24-25 budget. He also highlighted the comment made by Ms. Andress regarding the unintended consequences of the Inflation Reduction Act which are damaging to Indian River County. He believes these issues further highlights the importance of the District and the vital – support it provides to the residents of Indian River County. He also believes there is an opportunity for additional cost benefit analysis and outcome measurement, which he is qualified to assist with. There was no further public comment, and the meeting was adjourned at 3:45 p.m.
