SUMMARY MINUTES
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
May 19, 2022 @ 4:00 PM
TRUSTEES: Kerry Bartlett Barb Bodnar
Marybeth Cunningham
ABSENT: Ann Marie McCrystal
STAFF: Kate Voss Jennifer Frederick
Jennifer Peshke, Esq. Ann Marie Suriano
Dawn Carboni
ZOOM: Karen Deigl Allen Jones
Jeanne Shepard Sam Mesena
ATTENDEES: Mike Cianci Andrea Berry
Jad Shalhoub Gina Palladino
Convene Meeting – Marybeth Cunningham, Chair
Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM by welcoming those in attendance and via Zoom. Mrs. Cunningham stated there was a change to this evening’s agenda. She explained that due to the lack of a physical quorum, the board will be unable to approve its consent agenda, and it will be placed on the agenda for next month’s meeting to be approved. However, the District’s monthly payables and reimbursements to the funded agencies will still be processed.
District Counsel Report – Jennifer Peshke, Esq.
Ms. Peshke stated that she has responded to questions from Trustees as they have arisen pertaining to various matters the District is handling at the present time. She continues to review the annual deadlines and deliverables due to the District under the Lease with CCIRH. She is also actively following the current legislative session for bills related to Hospital Districts and will bring forth information when necessary. Ms. Peshke further stated that she has reviewed the FY 22-23 budget funding request and participated in the meetings with the funded agencies who have given presentations.
She continues to work with counsel for CCIRH and the VNA to complete amendments to the existing Agreements the District and the hospital entered into in 2018 to reflect these changes. There are numerous attorneys involved and so they are working to expedite a resolution to bring before the board as soon as there is agreement on the language in the documents. To date, draft documents are with the hospital’s counsel and she has asked for an update on the status of this matter this week. Mr. Jones asked if there would be language included in the amendments that would state CCIRH has no viable use for the property. Ms. Peshke indicated that giving CCIRH the right of first refusal in the lease to purchase the property from the VNA, would essentially solidify that language, but she will take that request back to the other parties to see if additional language needs to be included. It was further discussed that the VNA has not made a formal offer to purchase the land from the District, nor has the District deemed the property unusable surplus property. Lastly, she provided an update concerning how a potential county ordinance change regarding stormwater retention may impact the IRC floodplain and stormwater code changes, as it relates to the property the Hospital District owns. She followed up on this matter and spoke to the county’s attorney who indicated that this matter has been placed on hold for the time being.
Financial Statement Review- Allen Jones, Treasurer
Mr. Jones provided the financial report and stated the District is in strong financial condition. Through April 30, the District possessed about $13,650 million in cash and investments, less the $760,000 just spent for the monthly disbursements in May. He explained that the District also expected to receive about $400,000 in additional tax revenue during the remainder of the fiscal year, and including all those amounts, the District has approximately $13.3 million in funds, versus the $6.2 million in budgeted expenses remaining for the fiscal year. Further, he stated that since Trustee approval last month, the District has taken $1 million and invested it in a one-year U.S. Treasury bill projected to yield 2.164%. He explained that because this is a “bill” rather than a “note”, they will receive no separate interest payment. Instead, the District purchased a one-year U.S. Treasury bill for $978,766.67, which will mature on May 18, 2023, at $1,000,000. This leaves the District a profit equating to interest of $21,233, according to Treasury Direct. The second million is designated to be invested in a two-year U.S. Treasury note, however, he and Ms. Suriano decided to delay investing those funds until July. The reason being is that it enables the District to complete the maximum budget projected expenses for the next fiscal year, to more accurately estimate when the funds may be needed for program expenses. Secondly, it appears interest rates will only be higher by waiting and thirdly, the difference between one-year rates and two-year rates has narrowed substantially, and they may add to the one-year bill rather than add a year of maturity for relatively little additional interest. Lastly, he explained that Water Walker has paid the District through April 30 $8,439.56 in interest, on average. Water Walker’s interest rates have soared since the beginning of the fiscal year to .7% in the most recent month, versus around .1% for most of the fiscal year.
Executive Director Report- Ann Marie Suriano, Executive Director
Mrs. Suriano provided her report and stated that there was a pipe burst at the VNA Human Services Building (“HSB”), which caused significant damage to the first floor of the building. The District has filed a claim with the insurance company and is working to reimburse the VNA for expenses incurred during the repairs. She informed the Trustees that while talking to the insurance adjuster it was noted that there are many old and possibly corroded pipes at the HSB, and these may need to be replaced before future damage should occur. The Trustees agreed that Ms. Suriano should look into the matter of replacing the pipes, to avoid further damage. Additionally, she stated that she met with members of Senior Resource Association (“SRA”) who spoke to her about an opportunity with the American Rescue Plan to provide additional funding for the Emergency Meals on Wheels program. In order to participate, they need to acquire a local match and are requesting those funds from the District. The total amount requested is $54,433 and it will be billed to the District over time. There was Trustee discussion and they verbally agreed to support the request, however since there was not a physical quorum of Trustees, they were unable to have a formal vote. Therefore, Mrs. Suriano stated that she will prepare an outline of the request and it will be placed on next month’s agenda for a formal vote by the Trustees.
Internal Audit & Data Specialist Update- Dawn M. Carboni
Ms. Carboni provided an update concerning the internal Audit process and stated that she provided copies of the Audit documents given to each funded agency, to the Trustees. This included a pre-audit questionnaire which each agency must complete and return to Ms. Carboni before their on-site Audit visit. To date, she has completed 15 out of 16 Audits and has completed four Audit reports. She indicated that once she has completed more reports, she will begin to provide 3-4 reports at a time to the Trustees for their review. During Trustee discussion, it was discussed that findings in these audits are public records and they were concerned with any negative impact this may have on the funded agencies. Therefore, Ms. Carboni will work with the Chair on how to best provide her findings to the Trustees without negatively impacting the funded agencies.
Funded Agencies Semi Annual Reports-
UF Center for Psychiatry & Addiction Medicine- Gina Palladino, Clinic Manager
Ms. Paladino provided an update concerning the UF clinic. She stated that Dr. Yergen has increased her schedule from 2 days/week to 5 days/week. This will help offer an increase to patient care and access to patients. Additionally, they will also acquire a new Post-Doctoral Associate to replace their current associate Dr. Lauren Stroker, when her rotation ends in September. Dr. Stroker has now been hired by UF as a Community Psychologist to increase access to patients for therapy and testing services. Next Ms. Palladino discussed emerging issues the center is seeing locally and how it is affecting the patient population that they serve. He explained that there is increased demand for services across all specialties in the community. As the increase in population continues to rise, there is a high demand for services in adult psychiatry and addiction. Currently, there is an 8-10 week wait to see a mental health provider, which can be longer depending on the agency. They have also seen an increased need for children’s psychiatry services. Lastly, she stated that the clinic will continue to grow to help meet the demand for service, by increasing access to providers and increasing the services that are offered. There is also a need for further addiction and recovery treatment services. Unfortunately, Ms. Paladino suffered a medical emergency at the end of her presentation and was unable to answer any Trustee questions. Ms. Frederick indicated that she would follow up with Ms. Paladino at a later date, to have any Trustee questions that were unable to be responded to at the meeting.
Dynamic Life Recovery- Mike Cianci, Executive Director
Mr. Cianic addressed the board and thanked the Trustees for their support and the support of the District staff. He also thanked Ms. Carboni for her work on the Audit. He began his presentation by stating the biggest challenge they have faced was the untimely death of their leader Pastor Roger Ball. During the grieving process, their team kept everything operating as normal, through adversity and uncertainty. By focusing on their core values, they were able to keep the Pastor Roger Ball Memorial Scholarship program moving forward, to support those most vulnerable members of the community. Also, through community collaboration, they have been able to keep things a status quo. He discussed program statistics concerning employment, length of stay, and participation in 12 step programs. Through the scholarship program supported by the District, their length of stay has increased for an average of 15 weeks. 13 individuals have completed the program and found gainful employment, and are also working with United Against Poverty’s Step program. He then discussed the center’s continuum of care and the work they are doing to make this program sustainable. He explained that due to the nature of the current economic crisis, there is no way to properly prepare for the tidal wave of need that will be upon them. They will continue to provide resources and support to those individuals who are ready and willing to accept care. There is still a strong need for addiction and recovery services in the community, and he does not see that need decreasing any time soon. Their plans for the future include using the Dynamic Recovery model to include a program for women as well. There was Trustee discussion and Mr. Jones asked about the relapse rate for the Rodger Ball program, which was at zero. Mr. Cianci indicated that all those who have completed the program are included in that rate, and not those that leave the program early, or are discharged due to non-compliance. Ms. Bartlett confirmed that if a client should relapse, they are given an opportunity to reenter the program. Mr. Cianci explained that are given a two-week probation period to test negative for drugs and alcohol. Exceptions are made however if a patient has chosen to enter a treatment facility first before coming back to the program.
Healthy Start Coalition- Andrea Berry, Executive Director
Ms. Berry addressed the Trustees and thanked Ms. Carboni for a seamless Audit process. She briefly discussed Health Starts’ mission, which is to prevent infant mortality by offering many programs and services in Indian River County. She began the presentation by reviewing data concerning the county birth rates over the last 6 months, which had increased from last year when there was a slight decline. She further stated that their outcomes for the District supported programs were all positive, and there were no further Trustee questions on that data. Next, she discussed the unexpected changes they have experienced over the last 6 months. She explained that Healthy Start, as an organization, is constantly changing as it responds to the community and its needs. They have now adopted their Prevention Education and Community Enhancement (“PEACE”) program which is built out of findings through the FIMR process. Initiatives are then put in place to support areas of need and she discussed a few which included a fatherhood initiative, and preconception health. Southeast Behavioral Health Network has provided funding to support this program to move that work forward. Next, she discussed that the Community Doula Program has expanded statewide and will be offered in every county throughout Florida. Lastly, they have added the services of a coordinated intake and referral support staff at Partners which is important in the intake process for pregnant women. Lastly, she discussed that the Health Start board has voted to take back the Ounce of Prevention contract from Tykes & Teens to run the Healthy Families Program, beginning July 1. She then informed the board that only one practice is delivering babies at CCIRH, as Florida Women’s Care is delivering at Lawnwood Regional Medical Center. This has not been well received by the community and the Trustees were also concerned by this news. Ms. Berry stated that she did not have any further details and that concerns should be addressed directly to CCRIH. Ms. Cunningham stated that she would be following up with CCIRH to obtain further information on this matter. Ms. Berry then discussed that there has been a significant decline in the Partner’s prenatal screenings and are working to find out what the cause is of this. Lastly, she discussed the Fetal and Infant Mortality Review (“FIMR”) which brings together key members of the community to examine the information from individual cases of fetal and infant death, to identify the factors that contributed to those deaths, determine if those factors represent system problems that require change, develop recommendations for change, assist in the implementation of change, and determine community effects. She invited the Trustees to participate in the next review if they are interested. She explained that unfortunately, Indian River County saw an increase in infant deaths in 2021 and they are working to understand the cause and factors that attributed to this rise. She further explained that due to a change in Florida legislation, the definition of fetal death has changed with could also attribute to the rise in rate.
Other Business
Mr. Jones addressed the board and stated that he would like to propose a cost-of-living increase for the District staff beginning July 1. As the Trustees are aware, inflation is at an all-time high and in an effort to show appreciation and maintain the District’s small but effective District staff, he is proposing the increase, which would be separate from the staff’s merit increases which are awarded in December. Mrs. Cunningham requested that Mr. Jones prepare a formal recommendation for the Trustees to consider and vote on at the June regular monthly meeting. Mr. Jones agreed to Mrs. Cunningham’s request.
Public Comment/Adjourn
There was no public comment and the meeting was adjourned at 5:30 PM
