SUMMARY MINUTES
CHAIRMAN’S MEETING
Indian River County Hospital District Conference Room/ Zoom
February 14, 2024
TRUSTEES: Marybeth Cunningham Barb Bodnar Michael Kint Paul Westcott
William Cooney Karen Deigl
Kerry Bartlett
STAFF: Jennifer Peshke, Esq. Dawn Carboni
Kate Voss Frank Isele
ZOOM: Anne Posey Wayne Creelman
Lauretta Farrell Ceclia Stalnaker
Lisa Zahner Pat Knipper
Chriss Papayannis Marie Andress
ATTENDEES: Vicki Soule Ann Marie McCrystal
Wendy McDaniel Rayme Nuckles
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.
District Matters Update- Frank Isele, Executive Director
Mr. Isele stated there are a few items from last month which he is providing additional follow-up. The first being the inquiry related to the GlobeChek referral process for patients requiring follow-up procedures to include surgery. It was discussed that GlobeChek maintains a spreadsheet of all scanned patients and assigns a category of severity for follow up. Additionally, Ms. Frederick spoke to Marie Andress and Jamie Merritt of Whole Family Health Center (“WFHC”) provided additional information regarding their referral process for patients. It was also noted that 11 ophthalmology referrals were made to the We Care Foundation in 2023.
Next there was follow up regarding the usage of the Treasure Coast Homeless Services Counsel (TCHSC) Rapid Resolution Respite program. Program Director Rayme Nuckles was present at the meeting and spoke about the utilization of the program. He explained that one delay in utilization of the program was the lack of a memo of understanding in place with CCIRH, and they are now working to resolve that issue. Currently at both locations, they have served 14 clients, and it was discussed that they are housing men and women at separate locations, for safety reasons. Mr. Nuckles further stated several of the clients currently housed in the respite required some level of assisted care following discharge. This has been a challenge with the clients who have no health insurance. TCHSC is trying to get these clients qualified for Medicaid so that they can be transferred to an assisted living facility. There was Trustee discussion, and it was inquired whether TCHSC has reached out to Sebastian River Medical Center in order to assist patients who may benefit from this service. He stated that he recently spoke with a representative there and they expressed interest in working with the organization, however they would also like to have a MUA in place. They requested that once TCHSC and CCIRH have the MUA in place, they would like to have further discussions and review the document, in order to establish a partnership.
Lastly, Mr. Isele stated that the District was recently notified that CCIRH has made changes to their Financial Assistance program and application process. Applicants are no longer able to complete their application on line and are required to have an appointment with a Patient Financial Advocate in order to complete their application. If the applicant has a medical appointment scheduled for any type of Cleveland Clinic service, the applicant will be provided with an appointment with the Patient Financial Advocate to complete an application in person or via telephone. This new process will deter residents from completing applications every 90 days without ever presenting for services.
Beyond SNAP Proposal- Frank Isele, Executive Director
Mr. Isele stated that he has provided the Trustees with the outline of the program and Wendy McDaniels from United Against Poverty was here today to discuss the program further. She also provided a cost analysis and anticipated the 6-month pilot program would cost $7,000. Ms. McDaniels further discussed the process and procedures for qualifying and screening individuals in their crisis department. There was Trustee discussion and it was expressed that they want to make sure clients follow the protocols in place to receive the support and that there is accountability with their participation in the program. Ms. McDaniels assured the Trustees that there are safeguards in place to prevent misuse of the items being provided. They will also be tracking the clients’ progress through their crisis team database. After further Trustee discussion, they agreed to fund the 6-month pilot program at a total cost of $7,000.
Update on Agency Audits- Dawn Carboni, Internal Auditor & Data Analyst
Ms. Carboni provided the Trustees with an update concerning the District funded agency audit process. She stated that she recently has been working with CCIRH, to audit the Partners program. She conducted two separate site visits and CCIRH has been forthcoming and responsive when she has requested information. She noted that most of her work has been with CFO Warren Fuller and she was appreciative of his assistance during the process. She further explained that this audit has been challenging due to the volume of documentation she has had to review. She hopes to have the completed report done by the end of the month and provide the summary to Trustees soon thereafter. She further discussed the next round of audits being conducted will include the Mental Health Collaborative, Childcare Resources and Whole Family Health Center.
Next, Ms. Carboni provided the Trustees with an update regarding the Performance Review process. She explained that District staff received the draft report and are internally reviewing the document, which is 128 pages. She plans to prepare an executive summary for the Trustees review and representatives from BJM will be available via Zoom at the March Chairman’s meeting, to answer questions.
Update on Lease Agreement with VCOM- Jennifer Peshke, Esq.
Ms. Peshke provided an update concerning the discussion with VCOM about their potential interest in leasing the HSB for a new medical school campus. She explained that she, Mr. Isele, and Ms. Cunningham have a call scheduled with representatives from VCOM later this afternoon to discuss this matter further. Currently the parties are working on drafting a memorandum of understanding with CCIRH, that would outline their interest and participation in support of a residency program, which they feel is critical to the overall success of this partnership. Additionally, Ms. Peshke stated that a lease amendment would need to be drafted between CCIRH and the District, because of the way the parcels are referenced in the current lease agreement. There was Trustee discussion regarding this process. Mr. Westcott indicated that he would like the Trustee to potentially engage in the process of looking at future use for the property and how best it would support the needs of the community. Additionally, he would like to obtain for review any future operating or strategic planning materials that CCIRH has, in order to determine that they have not anticipated any future use for the HSB property. Mr. Isele stated that all hospital systems have these types of facility plans in place and he would work with Dr. Peter on obtaining the same.
Update on Women’s Sober Living Property- Jennifer Peshke, Esq.
Ms. Peshke indicated they are still working through matters relative to the title search and property appraisal report. She recommended that a single Trustee be appointed to work as a representative on behalf of the board, which would help facilitate more appropriate negotiation discussions. They are also still working on matters relative to the land restrictions in place for the property. Mr. Nuckles addressed the board and stated that he had some historical insight into this matter that he shared with the Trustees. He explained that in order for TCHSC to provide funding for the original purchase of this property, a land restriction was put into place restricting the property for use to house homeless youth. Recently when their organization was looking into potentially purchasing this property, he made a call to the state about the removal of the land restriction. He stated that the person he had worked with originally has left the position and since then there have been several individuals who have served in the role. He expressed his frustration in not being able to connect with someone who is familiar with the events but stated that he would again be willing to contact the state on behalf of the District, to try and gather some information on the steps needed to remove the land restrictions. There was Trustee discussion and they agreed with Ms. Peshke’s recommendation to appoint a Trustee to work directly with her and Mr. Isele on this matter. Ms. Deigl made a motion to nominate herself as the appointed Trustee, which was seconded by Dr. Cooney. The motion carried unanimously.
Other Business
Mr. Westcott stated that considering the recent reporting from the Mental Health Association concerning the increased need for mental health care and services, and how Indian River outcomes were elevated compared to the state average. He would like to further investigate the causes and drivers of this occurrence and suggested that an advisory committee be formed to collect and review data points to better understand the drivers of these outcomes. This committee could also be an advisory source for other units of local government. There was Trustee discussion and some felt that this role was already being fulfilled by the Mental Health Collaborative. It was also discussed that there may be some educational institutes who are also collecting and assessing this data. Ms. Cunningham stated as a member of collaborative they have not discussed this matter and she would be happy to bring forth this recommendation of further exploration into causes and drivers of mental health needs with the group. Ms. Soule stated that she would also be willing to assist, and she and Ms. Cunningham stated that they would hold a meeting with Wes Sammons to discuss it further. There was also Trustee discussion surrounding what the District could be doing strategically to address the shortage in healthcare providers, specifically in the areas of primary care and behavioral health. Ms. Cunningham stated that Johns Island Service League is working on a program to provide stipends to medical students, to help further support recruitment and retention to our area.
Ms. Bartlett asked for an update concerning next steps of the District strategic planning since their meeting on the 7th. Mr. Isele stated that Ms. Peshke has prepared summary minutes which he will provide to the Trustee for their review. There was discussion surrounding the date of the next meeting and it was agreed that the group would meet on March 28th from 1-5 PM at Jennifer Peshke’s office. There was also discussion surrounding scheduling for upcoming budget presentation meetings and the Trustee requested that a schedule be prepared for them in advance.
Ms. Voss informed the Trustees that the required ethics training curriculum has been established and available to be accessed. It is a 4-hour online course that covers Florida’s ethics law, public records law, and public meetings law. She and Mr. Isele plan to take the course initially and will update the Trustees with further information. Next Ms. Voss discussed the need to move the regular monthly meeting date in May. There were Trustee conflicts with the new proposed date and Ms. Voss stated that she would follow up via email with other available options, once she confirmed the County Commissioner Chambers were available.
Ms. Soule addressed the board and stated that she is requesting the relocation of $500,000 in funding, to support the new TCCH mobile unit. She has been working collaboratively with the VNA and they are excited to share this new program with the community. It was explained that the reallocated funds would come from the medical and dental funding already included in the TCCH approved budget. There was further Trustee discussion and Mr. Westcott made a motion to approve the reallocation request, which was seconded by Ms. Deigl. The motion carried unanimously.
Public Comment & Adjourn
There was no further business and Ms. Cunningham asked for public comment. There was no further public comment, and the meeting was adjourned at 11:35 am.
