SUMMARY MINUTES
CHAIRMAN’S MEETING
Indian River County Hospital District Conference Room/ Zoom
December 18, 2024
10:00 AM
TRUSTEES: Marybeth Cunningham Barb Bodnar Michael Kint Paul Westcott
William Cooney Karen Deigl
Kerry Bartlett
STAFF: Dawn Carboni Jennifer Frederick
Kate Voss Frank Isele
Jennifer Peshke, Esq. Kaytlin Dickens
ZOOM: Anne Posey Larry Reisman Marie Andress Kim Jeansome
Mike Bolack Lisa Zahner
Ivy Marchesini Judi Miller Chuck Brookes Fran Prossick Allen Jones Deborah Shellenberger Nick Slater Cecelia Stalnaker Heather O’Shea Raquel Rivas Pat Knipper Kristina Roberts Thomas Kenny Jeff Susi Jennifer Pippin Lisa Witkowski
Andrew Decicco
ATTENDEES: Vicki Soule Jan Mooney Carol Kanarek Ann Marie McCrystal Lauretta Farrell Shaun Leydon Bob Auwaerter Sandy Stepanek Kelly Corrigan Brook Chipman Lance Lunford Jennifer Holloway Richard Corrigan Stuart Kennedy Rosemaire Wilson Rod McLachlan Bonnie Sciarretto Shane Meeks Wayne Creelman
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. She stated that for clarification purposes the District Trustees will not take any formal action or vote today. Today will consist of discussion only. Next, she stated that during this season of thankfulness she would like to recognize the District staff for their work this year.
TCCH & Mental Health Court Semi Annual Update
Ms. Soule stated that the six-month update regarding TCCH and their clinics was submitted to the Trustees prior to today’s meeting. Additionally, Shaun Leydon Director of the Mental Health Court program was also present for today’s meeting; to answer questions the Trustees may have regarding his report. The Trustees were pleased with the outcomes for the mental health court and felt that the programs operations were moving in a positive direction. There was also discussion encouraging them to continue to look for additional funding sources for the program. Additionally, Mr. Leydon is scheduled to meet with Ms. Frederick and Ms. Carboni for discussions on how they can develop stronger data collection and metric outcomes for the program.
Next, Ms. Soule discussed accomplishments, challenges and unforeseen events TCCH has experienced over the last 6 months. She stated that they have finished their conversion to Epic, which initially had its challenge and led to a decrease in patient encounters but has shown to improve efficiency in the long run. There was also discussion surrounding the Districts financial assistance application process required for TCCH patients and the challenges their patients experience with providing the requested documentation. Ms. Dickens stated that she is working with some of the health navigators at TCCH to work through these challenges, as well as making potential updates to the District’s financial assistance database to offer a electronic option for completing the paperwork. It was assured that the District is committed to working with TCCH to solve these issues moving forward. Lastly, Ms. Soule stated that they expect to see a dramatic increase in Indian River County residents who rely on community health centers for their primary and preventative care. Due to the uncertain changes in federal and state funding for healthcare, it could potentially drive more to the emergency department, increasing the burden on CCIRH further. This is another reason why TCCH’s expansion is so critical to the residents of Indian River County to continue to address the county’s healthcare gaps.
Continuing the discussion, Ms. Farrell addressed the board and discussed the investment request which TCCH has brough before the board. She explained that they are requesting $1 million to support the expansion of primary and prevention healthcare services. She explained that TCCH has embarked on an initiative to develop a 20,000 square foot healthcare center dedicated to children from birth to 18. The total cost of the expansion plan is $21 million, which also includes a new health center in the western part of the county. Through the New Markets Tax Credit Program and a partnership with the Florida Community Loan Fund that will provide $15 million towards this project. She further explained that to qualify for the $15 million, TCCH needs to raise an additional $4 million, to bring this project to fruition. It was further clarified that the $4 million in funds would need to be pledged by February 2025. Currently, they have raised over $800,000, with an additional $100,000 commitment grant secured. There was Trustee discussion surrounding the request and it was decided that Trustees would submit their comments to Mr. Isele for follow up, with the intention of further discussion and deliberation in January.
CCIRH Uncompensated Care Follow Up Discussion
Ms. Cunningham addressed the board and spoke to the historical timeline of this matter. She stated that back in July, Dr. Rothman and Dr. Pease provided a presentation to the District regarding quality and patient care at CCIRH. During that time there was discussion surrounding the hospital’s indigent care volumes and outcomes. The Trustees asked for additional information and Dr. Rothman stated that he would come back before the board in the next few months to provide an update. In September, Dr. Rothman provided a presentation which discussed uncompensated care data and the reasonings behind the increase volumes and cost associated with it. The majority of the Trustees at that time asked how the District could help and approved Ms. Cunningham and Mr. Isele as the point of contact to work with CCIRH on a proposal. She clarified that CCIRH did not request funds from the District but that she and Mr. Isele created those figures based on the conversation they had with CCIRH CFO Mr. Iannucci. She further apologized to her fellow Trustees for any indication that she was trying to rush a decision on this matter, which was not her intention. It was further explained that, Mr. Isele is still working through obtaining the responses to the follow-up questions the Trustees have submitted. She further stated that this support is in no way a bailout and that these funds make up .7% of CCIRH total budget. She also reiterated that the Trustees would have additional time to consider this in the coming months and she will no longer be part of the process. Mr. Westcott referenced the correspondence written to CCIRH in July which addressed specific items with regard to indigent care and believe those questions had not been answered. It was discussed that CCIRH may not be open to sharing all information due to some items being of strategic in nature. Mr. Westcott further questioned the transparency of this matter and items not being shared publicly. There was also discussion surrounding the process of reviewing off-cycle funding requests and whether this was being circumvented for CCIRH. Mr. Isele stated that the District has an off cycle funding request policy and it is followed in this instance as with all other requests the District receives. There was also discussion surrounding how the District reviews financial and operating information for the funded agencies and Ms. Carboni spoke to the process that in in place. She confirmed that during her review she does not treat any agency differently from the other. She further stated that when she conducted the audit review of the Partners program, CCIRH was forthcoming with all the information she requested which took her several months to review. There was also discussion surrounding CCIRH responsibility to provide the District with audited financial statements and if there was language in the partnership agreements precluding them from this. Ms. Peshke stated that she believes CCIRH is in compliance with their reporting requirements, however she would review the documents to see if there was further language referencing an obligation to provide more detailed financial information. After further Trustee discussion it was confirmed that Mr. Isele would continue to work with CCIRH on obtaining responses to the Trustee questions with a goal of having those responses in 60 days.
Public Comment & Adjourn
There was no further business and Ms. Cunningham asked for public comment. Mr. Bob Auwaerter from Indian River Shores provided this public comment and encouraged the Trustees to obtain detailed financial statements for CCIRH operations, to assure the District is not supporting operational losses. He further stated his displeasure with any additional millage increase which would result in higher taxes. Mr. Stuart Kennedy of Vero Beach provided his public comment and stated that he recognizes the complexity of these issues but based on the reporting in 32963, it does not paint this situation in a good light. He encouraged the board to provide better transparency and insight to the public, to justify any additional spending. Ms. Kelly Corrigan of Vero Beach provided her public comment and stated that she appreciated the discussion today, however she believes that the public is not appropriately informed about these issues. She also questioned the terms CCIRH lease agreement and rental forgiveness clause. She further questioned areas of CCIRH operations including doctors leaving, patient satisfaction and emergency department wait times. She encouraged the board to take additional time and effort before making any decisions with regard to funding CCIRH. Next, Ms. Voss read two public comments which were submitted via the Zoom chat. The first was from Lisa Witkowski who stated that Ms. Cunningham should recuse herself from any board vote with regard to Cleveland Clinic. Second, she referenced the terms of commitment by the District to support indigent care during 2019, 2020, 2021 and if the District is still contractually obligated to provide financial support for indigent care. Lastly, Mr. Andrew Decicco recommended that the Trustee obtain a CCIRH audit report, not only the Cleveland Clinic Florida audit report. Additionally, he would like to see the CCIRH/IRCHD partnership documents posted to the Districts website. There was no further comments or discussion. The meeting was adjourned at 11:40 AM.