Indian River County Hospital District

Chairman’s Meeting Minutes: July 25, 2018

Indian River County Hospital District
July 25, 2018

TRUSTEES: Marybeth Cunningham Tracey Zudans
Ann Marie McCrystal Dr. Michael Weiss
Allen Jones

EXCUSED: Barbara Bodnar

STAFF: Ann Marie Suriano Jennifer Frederick
Kate Voss

OTHER ATTENDEES: Miranda Hawker Joelle Tinney
Kathy Orton Karen Davis
George Eighmy Robert Brugnoli
Jeanne Shepard Janet Begley
Michelle Genz Vicki Soule

Convene Meeting – Marybeth Cunningham, Chairwoman

Mrs. Cunningham convened the Chairman’s meeting of the IRCHD at 2:00 PM by welcoming those in attendance.

IRMC Emergency Department Co-Pay Process- Ann Marie Suriano, Executive Director & George Eighmy, IRMC CFO

Mrs. Suriano stated that through multiple community health improvement plan meetings, the collaborative group recognized the issue of high volumes in the emergency department. It was determined that many indigent patients were utilizing the hospital’s emergency department for non-emergent issues. This form of care is more costly and does not provide a continuum of care for the patient. Additionally, it affects the time it takes to treat those with medical emergency issues. The group had multiple discussion on this matter and agreed that a process should be implemented to assist patients in finding a long-term primary care resource to treat their medical issues, instead of utilizing the emergency department. However, this process must abide by federal EMTALA laws, which govern emergency treatment in hospitals.

Mrs. Suriano explained there has been much discussion in the collaborative group meetings concerning the implementation of a co-pay to those indigent patients presenting to the emergency room with non-emergent issues. Mrs. Suriano further explained that this matter was also discussed among the District Trustees and, last month, Mrs. Zudans questioned whether the District was legally permitted to request some form of payment from an indigent patient and requested legal clarification on the matter. Through her review of the District Special Act, Mrs. Peshke prepared a memorandum on the matter as requested and has indicated that the District has the authority to approve a co-pay, being collected by the current operator of the hospital. This is an administrative function of the operating entity of the hospital, which the District has been requested to approve. Mrs. Suriano further stated that the District would need to update their policy and procedure manual to reflect the change. She stated that many hospitals, along with local District funded agencies, also implement some form of co-pay to its patients. Additionally, private insurance companies have the same policy or may even deny non-emergent claims completely. Mrs. Zudans stated that while she agrees with the idea of implementing a co-pay, she disagrees with Mrs. Peshke’s interpretation in her memorandum. Mrs. Cunningham acknowledged Mrs. Zudans statements and indicated that perhaps outside counsel could review review this matter as well. The board agreed with her recommendation. She asked Mr. Eighmy to review with the board, the hospitals proposal concerning the implementation of a co-pay for non-emergent visits at the emergency department.

Mr. Eighmy stated that, from the discussions with the collaborative group, the hospital has developed a process to manage the high patient volumes in the emergency department. He explained that when a patient presents at the emergency department, they will immediately go through a medical screening performed by a physician to determine if their issue is emergent or non-emergent. If the issue is an emergency, the patient will be given treatment immediately. If the issue is determined to be non-emergent, the patient will speak with a financial counselor to discuss their medical coverage options. If the patient has no medical insurance, they will complete a questionnaire to determine if they are indigent or eligible for Medicaid. The patient is then given the option to seek care at another local provider who could address their needs or continue care through the emergency department. If the patient chooses to remain at the emergency department, they will be required to pay a $50 co-pay and be responsible for any additional ancillary or physician fees incurred through their treatment. Mr. Eighmy also stated that they plan to expand and hire additional emergency department navigators to provide more direct patient support and ultimately get the patient the most appropriate care.

There was further Trustee discussion on this matter and Mrs. Cunningham stated that the District would contact outside counsel to further review and they would revisit the item at tonight’s regular monthly meeting.

MHA School Violence Prevention/Intervention Discussion- Robert Brugnoil, Ph.D.

Dr. Brugnoil explained that at a past regular monthly meeting, the District Trustees invited the Mental Health Association (“MHA”) to submit a grant for new services addressing violence prevention in Indian River County schools. Subsequently, there were discussions between the MHA and Dr. Lillian Torres-Martinez, director of student services for the School District of Indian River County, and they identified the need for this program at two local high schools. This program would include prevention intervention with all ninth-grade students and a more intensive intervention for at-risk students at all high school grade levels. This program would also be one program among many others in response to Senate Bill 7026, which is to enhance school safety in light of the mass shooting which took place in February, 2018, at Stoneman Douglas Highschool in Parkland, Florida.

Dr. Brugnoli provided a review of the High School Violence Prevention and Intervention Program. He stated that using research about evidence-based interventions and best care practices for violence prevention, the cost to provide the program case is estimated at $75,905, which would include adding one masters degree level mental health professional on a full-time basis. They believe this program will impact students by the development of improved skills for emotional health and well being. Mrs. Shepard, Clinical Director at MHA, reviewed statistics and data relative to the success of the program. She explained that MHA will also work with other local organizations, such as the Health Department, on this initiative. There was further discussion among the Trustees and they requested to see the blue print of the program with the school boards input.

FY 2018-2019 Budget Review- Ann Marie Suriano, Executive Director

Mrs. Suriano stated that she and Mrs. Frederick prepared a document clarifying some items relative to the 2018-2019 funding requests for Tykes & Teens; UF Suboxone program; and the Healthy Start Nurse Family Partnership program. There was further Trustee discussion concerning the same. Additionally, Mrs. Suriano stated that with the updates from the last budget discussion meeting, the proposed tentative millage rate would be .9330.

Mr. Jones discussed his efforts to enhance the utilization of the District owned Gifford Health Center. He informed the Trustees that he attended the Gifford Health Council meeting on July 24 and received a list of the current needs for the community. Those include primary care, extended clinic hours and mental health services. There has been discussion about moving the VNA’s mobile unit to the Gifford Health Center on Saturday mornings, as an alternate place for residents of the area to seek care. The Council further discussed the initiative to have staff from Healthy Start and Partners in Women’s Health to provide additional support and services. Mr. Jones stated that the Gifford Health Council expressed their desire to keep the Health Department as the main health agency in the area, due to their strong relationship with the community. They felt placing an alternative agency in the area would be disruptive to the community. Mr. Jones and the Council agreed that a stronger relationship between the District and those working in their Gifford community needs to be established. Currently Ms. Hawker is putting together a proposal for the future utilization of the Gifford Health Center. As an estimate, they believe the project will cost approximately $1 million and project to receive $400,000 in revenues. Mr. Jones stated that he will be following up with the Trustees for discussion and feedback once more information becomes available.

Other Business-

Mrs. Cunningham requested the availability of the Trustees for the month of August. She stated that there is potential that the District and IRMC Board of Directors will hold a joint meeting to discuss the terms of the Cleveland Clinic partnership. Additionally, the Trustees may hold a special meeting to also review and discuss the terms of the lease agreement with Cleveland Clinic.

Public Comment- There was no public comment.

Adjourn- The meeting was adjourned at 3:45 PM



William P Cooney MD is an orthopedic surgeon (retired) who has been a resident of Vero Beach since 2004. He practiced orthopedic surgery at Indian River Medical Center from 2006-2015 within the orthopedic practice of Prosports. He served on the IRMC Foundation for four years. Prior to this, he was a Professor of Orthopedics at Mayo Clinic in Rochester Minnesota, Chair of the Division of Hand Surgery and Vice president of the Department of Orthopedic Surgery. He served as the Vice Chairman of the Mayo Clinic Development Department. He has been President of the American Society for Surgery of the Hand, Orthopedic Research and Education Foundation, Consultant at Shrine Hospital systems. He was editor in chief of the Journal of Orthopedic Surgery and co-editor of the Journal of Hand Surgery. He held grants in hand and wrist surgery sponsored by National Institute of Health (NIH) and Stryker Orthopedics and has over 250 publications in the field of orthopedic surgery, hand, wrist and elbow surgery and microsurgery- free tissue transfers. Within Indian River County, he has served as Chairman of the Board and President of the Hope for Families Homeless Center, Board of the Indian River Hospital Foundation, We Care and Whole Family Health Center medical practices.

Term:  1/23-12/24

Origination: Elected (2 OC)

Occupation: Retired Surgeon



Kerry Bartlett,  of Vero Beach, has more than 30 years experience in philanthropy, including as vice president of the VNA & Hospice Foundation; VNA chief advancement officer from 2001-2007; and executive director of the Indian River Community Foundation from 2008-2014. Kerry is the founder of The Bartlett Company, which focuses on nonprofit and philanthropic consulting. She also is a managing director for Carter, a Vero Beach company that specializes in advancing philanthropy worldwide. Kerry has spent more than 25 years in the nonprofit sector as a fund development professional and has particular expertise in annual funds, major gifts, endowment campaigns and legacy giving. Kerry is also known for creating and implementing effective donor-centered stewardship programs that build, maintain and strengthen nonprofits’ relationships.

Term:  3/21-12/22   |   1/23-12/26

Origination: Appointed by Governor Ron DeSantis
Elected NOC

Occupation: Philanthropic Consultant/Managing Director



Karen has been President and CEO of Senior Resource Association, where she successfully advocates for older adults and their families, since 2006. In that role, she helps provide activities, education and services benefiting older and disabled adults in Indian River County. In addition, Karen provides oversight of the community mass transit system for residents and visitors of the county. As CEO, Karen is responsible for a $7 million operational annual budget and managing more than 100 employees. She ensures that fiscally sound and responsible solutions are created to provide healthcare and a better quality of life for all Indian River County residents. Karen earned a BS in Health Administration from Florida Atlantic University and an MHA from the University of Florida. She was elected to the Indian River County Hospital District Board of Trustees in 2016, and joined the Board in January 2017.

Term:  1/17-12/20   |   1/21-12/24

Origination: Elected 1 OC | Elected NOC

Occupation: President/CEO



Paul Westcott has been a Board Certified Workers' Compensation Attorney since 1999. In addition, Paul has earned his certification from the Florida Supreme Court as a Circuit Civil and Family Law Mediator. Receiving his Bachelor of Arts degree in both Economics and Political Science at Florida Southern College, he continued his education at Stetson University College of Law. He graduated from Stetson in 1988, having been a published member of the Stetson Law Review. Paul has been a member of the Florida Bar since 1988.  He began his practice in a combined civil litigation and transactional practice before serving as an Assistant State Attorney.  He began his career in Workers' Compensation with Rissman, Weisberg, Barrett, Hurt, Donahue & McClain P.A., where he handled Workers' Compensation cases at the trial and appellate levels.  In 1997, Paul opened the Ft. Pierce office of Hurley, Rogner, Miller, Cox, Waranch & Westcott P.A. handling workers' compensation cases at all levels throughout central and south Florida, while managing the operations of that office.  During his nearly 25 year career in Workers' Compensation, he lectured on a wide range of industry topics.

1/23-12/26   |   1/21-12/24

Origination: Elected 1 OC 

Occupation: Attorney & Mediator



Barbara has practiced physical therapy, specializing in orthopedics and sports medicine, in her hometown of Vero Beach since 1981. She was an integral part of the sports medicine team at Vero Beach High School for 35 years. Barbara completed the reserve police academy training, and served with the Vero Beach Police Department from 1982-1989. Her volunteer involvement in the community includes serving on the City of Vero Beach Recreation Committee, Arthritis Association of Indian River County, and the Senior Good Life Games. She and her husband, Michael, enjoy spending their free time traveling in their RV and training their Labradors, Gunner and Chase, in K-9 performance events, including agility and dock jumping. Barbara is a lifelong resident of Indian River County, and received her degree in physical therapy from Chattanooga State College. Barbara was elected to the Indian River County Hospital District Board of Trustees in 2016, and joined the Board in January 2017.

Term:  1/17-12/20   |   1/21-12/24

Origination: Elected 1 OC | Elected 1 OC

Occupation: Physical Therapist



Born and raised in Illinois, Michael was a Theatre and Speech Instructor at Lincoln College when he moved to Indian River County in 1984. He was the Director of Education for the Riverside Theatre for a decade, helping to build the Riverside Children’s Theatre and directing many productions. Michael is well known in the community for his 25 years of service at the United Way of Indian River County, 16 of those years as the CEO. He is very proud of his work with dozens of nonprofit agencies and his commitment to creating and strengthening community collaboratives. Michael was also an Adjunct Faculty member at Barry University for 20 years. He has served on many boards and committees over the years, including: Children’s Services Advisory Committee Needs Assessment, Chair of the Emergency Food and Shelter Program for many years, and he was a founding member of the Mental Health Collaborative, the Senior Collaborative of IRC and the IRC Executive Roundtable. As a Hospital District Trustee he is committed to serving all the citizens of our county. In particular, he hopes to see enhanced availability and affordability for behavioral/mental health for all in need.


Term: 1/23- 12/26

Origination: Elected 1 OC

Occupation: Retired CEO United Way



Marybeth’s professional career encompasses 34 years of working for GM/Delphi in a variety of positions. Starting out as a traffic claims clerk, she worked her way through the organization, with roles in Purchasing, Engineering, and Quality and Reliability. She retired in 2009 as the executive director of Global Operations for the Packard Electric Division of Delphi. In this position, she was responsible for 94 plants in 33 countries. Marybeth has served on the board of directors for numerous non-profits, including Northeast Ohio Adoption Agency; United Way of Warren Ohio, where she served as chairman of the annual campaign for two years; Up with People; Head, Heart and Hands of Indian River Club; Indian River Community Foundation, and the Indian River Mental Health Collaborative. She earned her B.A. in Political Science from Albion College. Marybeth was elected to the Indian River County Hospital District Board of Trustees in 2014, and joined the Board in January 2015. She currently serves as Chair.


Term:  1/15-12/18   |   1/19-12/22   |   1/23- 12/24

Origination: Elected 1 OC | Elected  NOC | Elected NOC

Occupation: Retired Executive GM