SUMMARY MINUTES
CHAIRMAN’S MEETING
Indian River County Hospital District Conference Room/ Zoom
May 14, 2025
10:00 AM
TRUSTEES: Chuck Mackett William Cooney Michael Kint Paul Westcott (zoom)
Allen Jones Kerry Bartlett Karen Deigl
STAFF: Dawn Carboni Jennifer Frederick
Kate Voss Frank Isele
Jennifer Peshke, Esq. Kaytlin Dickens
ZOOM: Chuck Brooks Barb Bodnar Ann Marie McCrystal Jeff Pickering Lisa Zahner Kelly Williams Carrie Lester Nancee Long Raquel Rivas Kim Jeansonne
ATTENDEES: Vicki Soule Wayne Creelman
Lauretta Farrell Vicki Soule Anne Posey Colette Heid Marie Andress Marybeth Cunningham
Convene Meeting
Dr. Cooney convened the meeting of the IRCHD Board of Trustees at 10:00 AM by welcoming those participating via Zoom and in person. He provided some Chairman’s remarks and thanked the staff for their continued support through the FY 25-26 funding cycle. Specifically, the e-C Impact review process. He also reminded the Trustees that communications or record requests to the media should be made through the District offices and Ms. Voss, in her role as records custodian. Further, he requested that all Trustee communication to CCIRH and their representatives be conducted through Mr. Isele, so that CCIRH is not inundated with several Trustee requests. Lastly, he informed the board that next month staff will be prepared to provide an update to the Trustees on the Women’s Recovery Residence.
Access and Sustainability for Key Services Discussion
Mr. Isele provided the Trustee with a memo discussing the challenges the healthcare system is facing specifically regarding maternity care and inpatient psychiatric services. In a review of trends hospitals offering these services are under increasing financial strain due to rising costs, declining reimbursement rates, recruitment difficulties and growing demand for care. He provided some data regarding labor and delivery services which showed that more than two-thirds of rural hospitals lack maternity care. Additionally, he discussed the maternity trends locally and stated that Cleveland Clinic is on track to deliver approximately 800 babies this year, with around 75% of those being Medicaid recipients. The hospital’s maternity program incurs expenses of $18 million against revenues of $11 million, resulting in a $7 million shortfall. Further, the financial viability of the labor and delivery department is under scrutiny due to a significant number of mothers choosing to deliver elsewhere with 400 babies being delivered out of the county. There was also lengthy discussion about the CCIRH Partners program, its relationship with the District and its importance to the community, which former board chair Marybeth Cunningham spoke to. There was also discussion surrounding the District financial support of the Partners program, along with the discrepancies in the reimbursement rates CCIRH experiences verses a hospital such as HCA. There was further discussion surrounding the potential consequences of not having maternity services available in the community and that this should be a community conversation with key stakeholders, in order to find a sustainable solution. Discussions also included the need for data on the movement of mothers and babies in and out of the county for deliveries.
Next, Mr. Jones provided an update on the Partners program and reviewed outcome metrics on neonatal mortality and first trimester care. Additionally, with the support of District there have been additional strides to understand fetal infant deaths, and the expansion of the FIMR review has allowed key stakeholders to dig deeper into understanding why these deaths occur. In all areas of metrics Indian River County performed better than the state average and as of 2023, the neonatal mortality rate had reduced to zero. He also discussed the CCIRH hospitalist model which has supported these improved outcomes and assures that a caregiver is always available to support the patients and address any emergency situations which arise. Mr. Jones also informed the board that on October 10th, Megan McFall will be presenting this data to the community and encouraged the Trustees to attend the event. There was group discussion on the next steps, and it was suggested that a group be convened to start these conversations and Mr. Isele would report back with updates to the Trustees.
Next Mr. Isele led a discussion on inpatient psychiatric care. He explained that demand for these services has risen sharply in recent years due to increased mental health disorders and substance use crises. However, access to these services has declined, as hospitals struggle with negative margins and staffing shortages. He provided some statistics on reimbursement rates for these services which are reimbursed at an average of 34.3% below actual costs across all payers. Additionally, over the past decade nearly 100 U.S. hospitals have shuttered their inpatient mental health services, often due to financial losses associated with these units. Further, Florida has some of the lowest per-capita psychiatric bed availability rates in the country. He also discussed some growing needs within Indian River County which are also driving increased demand for mental health services and without adequate inpatient psychiatric services, many individuals may be discharged without a treatment plan, leading to repeat hospital visits, incarceration, or homelessness. There was discussion surrounding the current model at CCIRH for behavioral health and how they continue to lose money on these services. Mr. Isele reiterated that it is important to begin discussions on the sustainability of these services for the community. Dr. Creelman provided a public comment and discussed his recent attendance at a health and substance abuse forum. He informed the Trustees that PUR Health is opening a 27-bed detox facility in St. Lucie County on the boarder of Indian River, which could support Indian River residents. PUR also offers outpatient substance abuse treatment services at their local office in Vero Beach. He suggested the District speak to their CEO Ken Cooper to discuss their service model, so that when the District moves forward with a recovery residence, services are not being duplicated. Ms. Anne Posey addressed the board with her public comment and stated that as a former Administrator at the CCIRH behavioral health center she has seen these trends firsthand and understands the risk associated with inadequate behavioral health services within a community. She further stated that the CCIRH BHC is the only Baker Act receiving facility in the area servicing Brevard and St. Lucie County as well. There was Trustee discussion, and they agreed that there should be a larger conversation with the community and additional data collection.
Trustee Liaison Update
Dr. Mackett provided an update to the Trustees regarding the partnership with Edward Via College of Osteopathic Medicine (VCOM). He stated that on May 5th he and Mr. Isele had a call with leadership to receive an update on their progress in obtaining approval from the state. He explained that the recent legislative session wrapped up without VCOM successfully joining a bill, but they plan to pursue a new opportunity in the next session. They are also considering engaging a new lobbyist to help advance their legislative efforts in the upcoming session. They also had discussions regarding the terms of the lease-to-own agreement for the facility and their requirement to spend $1 million on improvements each fiscal year. Additionally, VCOM applied for a National Council for State Authorization Reciprocity Agreements (NC-SARA) agreement. This will allow VCOM to offer online coursework across state lines. In addition, it was also confirmed that CCIRH has given a verbal commitment to continue hosting third- and fourth-year student rotations into the foreseeable future. There was a group discussion and Ms. Peshke asked for permission to further review the current lease terms with VCOM to see if there are any areas that need to be amended, specifically with regard to financial improvement requirements. The Trustees agreed that Ms. Peshke should further review the lease and provide an update to the board in the next month. There was group discussion surrounding the difference between residency programs and 3rd/4th year medical students. There was also discussion understanding the distinction between a Doctor of Osteopathic (D.O.) medicine and a Medical Doctor (M.D.) which are both legitimate physicians who go through similar schooling and training.
Public Comment & Adjourn
There was no additional public comment, and the meeting was adjourned at 11:50 AM.
