Indian River County Hospital District

Regular Monthly Meeting Minutes: July 25, 2018

Regular Monthly Meeting Minutes
July 25, 2018
5:00 PM

TRUSTEES: Marybeth Cunningham Allen Jones
Ann Marie McCrystal Tracey Zudans
Karen Deigl

VIA TELEPHONE: Barbara Bodnar

STAFF: Jennifer Frederick Kate Voss
Ann Marie Suriano

OTHER ATTENDEES: Angela Dickens Kathy Orton
Gerri Smith Andrea Berry
Miranda Hawker Joelle Tinney
Vicki Soule Val Zudans
Michelle Genz Father Chris Rodriguez
Kristen Crocker Karen Davis

Convene Meeting – Marybeth Cunningham, Chairwoman IRCHD

Mrs. Cunningham convened the regular monthly meeting of the IRCHD at 5:00 PM by welcoming those in attendance.

Invocation- Father Chris Rodriguez provided the invocation.

Consent Agenda- Marybeth Cunningham, Chairwoman IRCHD

Mrs. Cunningham asked for a motion to approve the Chairman’s meeting minutes dated June 20, regular monthly meeting minutes dated June 21 and a July disbursement of $1,352,921.41. Ms. Deigl made the motion to approve which was seconded by Mrs. McCrystal. The motion carried unanimously.

Mrs. Cunningham sated that at this morning’s Chairman’s meeting the board had discussion relative to IRMC’s request to implement a co-pay for non-emergency visits to the hospital emergency department, concerning indigent patients. Mrs. Zudans requested that the board seek an additional opinion from outside counsel separate from the memorandum that Mrs. Peshke prepared on the same matter. Mrs. Suriano reached out to GrayRobinson, the District’s outside counsel with Mrs. Zudans’ request, but they indicated they would like to conduct further research on the matter before preparing an opinion. Mrs. Cunningham explained that since this request is outside the scope of work that GrayRobinson was originally hired to conduct, there will be an additional expense incurred. She asked the board to either approve moving forward with the second opinion or move to accept the opinion of in house counsel Mrs. Peshke. Ms. Deigl indicated that she felt comfortable with the opinion prepared by Mrs. Peshke. Mrs. Zudans stated that the interpretation prepared by Mrs. Peshke did not fully address the issue and she was not in agreement. She further indicated that she would not vote for implementation of a co-pay based on Mrs. Peshke’s summary. She clarified that she does agree with the process of implementing a co-pay but wants surety that the District is legally allowed. Mrs. Cunningham mentioned that it is technically the hospital that is implementing the co-pay, not the District and many other District funded agencies collect co-pays from patients as well. She believes this is a policy change at the hospital and that they are seeking District approval of the same. Mrs. McCrystal recommended that the hospital present the exact policy language to the District for review and approval and Mrs. Zudans indicated she would be comfortable with that method. Mr. Jones stated that, ultimately, the hospital belongs to the residents of Indian River County and that if a Trustee has a serious concern, he supports obtaining a second opinion. Mrs. Cunningham requested that outside counsel provide a second opinion as to whether IRMC implementing a co-pay is a District issue and if they are legally able to approve the implementation of a co-pay. Mrs. Suriano indicated that the District would need to update their policy and procedure manual with language reflecting the policy change, should it be deemed legal by counsel. Pending the results from outside legal counsel, the board will discuss and vote on this matter at next month’s meeting. Mr. Jones made a motion to request a second opinion from District outside counsel which was seconded by Mrs. McCrystal. The motion carried.

Mrs. Cunningham provided an update concerning the Cleveland Clinic partnership and stated that the process is moving forward and Cleveland Clinic is about to complete their due diligence work at IRMC. She hopes by the month of August that they will have agreements to review.

Financial Statement Review- Allen Jones, Treasurer

Mr. Jones provided the financial statement review and stated that the District finances remain sound, however as noted previously, there will be little excess funds at the end of the year beyond the reserves. However, the reserves will be sufficient to manage through the beginning of the next fiscal year until the District begins to receive it tax revenues in November.

As of June 30, the District bank balances totaled a $7.6 million and with the approval of this month’s disbursements of $1.4 million, the balance remains at approximately $6.2 million. According to the budget, he projects about $4.5 million in funds left to distribute leaving approximately $1.7 million in the bank. Since the maintained reserves total a little over $2.2 million, the District must invade the reserves by approximately $500,000 by fiscal year end.

Mr. Jones noted that the figures outlined include reimbursing IMRC approximately $1.2 million for indigent volumes that have swelled beyond the amount budgeted. However, the District will have enough money to support that expense if they chose, which they have always done in the past. Mr. Jones explained that with no tax revenues coming in during the first few months of the new fiscal year, the District will likely draw down reserves further for October expenses. He further stated that in the three years he has been Treasurer, this is the first time the reserves will be utilized.

Lastly, Mr. Jones stated that this year’s results reflect two things, the first being that the current fiscal year budget minimized the millage rate on behalf of the taxpayer because the District carried over as little excess cash possible coming into the 2017-2018 fiscal year. Second was the increase in indigent volumes at IRMC. In his opinion the principle cause of the volume increase is that fewer low income residents are being covered by the Affordable Care Act. On balance, the District has sufficient funds to fully meet all funding obligations through November, when the new tax revenues will replenish the District accounts.

Executive Director- Ann Marie Suriano

Mrs. Suriano stated she has been working with IRMC in discussions concerning the emergency department co-pay. Additionally, she has worked with Mr. Jones on the District tentative budget and has been available to the Trustees for their input concerning the same.

Funded Agency Quarterly Report- VNA- Kathy Orton, VP Clinical Services

Ms. Orton provided a quarterly update concerning the VNA. She reviewed data concerning the areas of service which included home health and hospice. Additionally, she discussed patient volumes concerning the mobile unit. Ms. Orton indicated that it is still very difficult for the mobile unit staff to collect qualification data from its patients and to date, the unit has suffered a loss of $200,000. Further, the Medicaid billing number they received has not been as beneficial as they had hoped, due to the fact that many patients are covered under a Medicaid HMO and not traditional Medicaid. Therefore, they are unable to collect reimbursement for the services rendered. Ms. Orton further discussed the VNA’s plan to increase the scope of the mobile unit in a county wide health education and patient care initiative localized by zip code areas in Indian River County. She explained that VNA will work collaboratively with other local health partners to connect residents to the care they need. Mr. Lundy Fields, VNA’s CEO will address the Trustees next month to discuss this initiative in greater detail.

Funded Agency Quarterly Report- Healthy Start

Ms. Berry provided a quarterly update concerning Healthy Start. She stated that Healthy Start has implemented a statewide Coordinated Intake and Referral process. This policy solidified Healthy Start as the launching point for all mothers and infants to receive any services they need to ensure a healthy start. Further, Healthy Start works in close connection with local partner agencies to build a system that allows for each mother in the county to find services they need. In addition, Ms. Berry explained that they have added the Nurse Family Partnership program to their system of care. This program is an evidence-based program proven to decrease poor birth outcomes by addressing the social determinants of health and directly addressing these issues through a home-based clinical process. The program will launch in August, 2018. Ms. Berry further reviewed infant mortality data for the county. Ms. Crocker provided a few patient testimonies relative to the services they received through Healthy Start.

New Business- Approval of Fiscal Year 2018-2019 Tentative Budget

Mr. Jones explained that the District is required to approve a tentative budget for fiscal year 2018-2019. The millage rate approved at tonight’s meeting is the maximum millage to be assessed and unable to be increased. However, the District has the authority to decrease the millage and approve a final lower millage rate in September. The budget, as presented, would represent a millage rate of .9405. He explained that the main reason for the increase is due to the hospital’s funding request which increased by $1.2 million from last year. If the board agrees to fund the hospital at a lesser amount, it would reduce the millage significantly. The board will have the next two months to further review and trim down the budget before voting on the final millage on September 20. Mr. Jones made the motion to approve the tentative budget with the millage rate of .9405, which was seconded by Mrs. McCrystal. Mrs. Zudans stated that since there has been an increase to property values in Indian River County, she does not support the increase in millage rate. She suggested keeping the millage at its current level of .8894 which would provide the District with an excess of $1 million in tax revenues. Mrs. Cunningham indicated that she believed there will be enough information concerning Cleveland Clinic and their support of indigent care, to know exactly how much will need to be budgeted. Further, she indicated that the hospital’s funding request is the same amount as the projected year end figure for the current fiscal year. Mrs. Bodnar stated that she felt the millage rate was high but believes the board will work to decrease the rate over the next coming months. Mrs. Cunningham asked for public comment.

Val Zudans, public member, stated there was about a 3.8% decrease to ACA enrollment and does not feel that was a significant driver to the increased indigent volumes at IRMC. He believes the increase was caused by the large backlog of patients who received expensive surgical care at IRMC. Additionally, the District is set to receive approximately $980,000 in additional tax revenue from the increase in property values. Also, the District budgeted $1 million for the Partnership process and stated that amount of funding is not projected to be included for the upcoming year which should decrease the millage as well, and an increase in the rate is not necessary. He indicated that no other local government agencies have indicated that they are raising their millage and encouraged the District consider the taxpayer.

Mrs. Cunningham called the question and the motion carried 5 to 2, with Dr. Weiss and Mrs. Zudans in opposition.

Hospital Parcel Property Split Approval- Ann Marie Suriano, Executive Director

Mrs. Suriano explained that the District owned parcel that the hospital campus is located on is currently one parcel, however, the VNA Hospice House and Human Services Building are also located on this parcel but are separate entities. During this partnership process, it was suggested by legal counsel to split up the parcel and each property obtain their own parcel number with the county. She asked for a motion to approve to have the hospital parcel split. Dr. Weiss made a motion which was seconded by Mr. Jones. The motion carried unanimously.

Public Comment- There was no additional public comment.

Adjourn- The meeting was adjourned at 6:45 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