Indian River County Hospital District

Regular Monthly Meeting: March 17, 2022

County Commissioner Chambers/ Zoom
March 17, 2022 @ 4:00 PM

TRUSTEES: Karen Deigl Allen Jones
Ann Marie McCrystal Kerry Bartlett
Marybeth Cunningham Barb Bodnar

STAFF: Kate Voss Jennifer Frederick
Jennifer Peshke, Esq. Ann Marie Suriano
Dawn Carboni

ATTENDEES: Cecelia Stalnaker Karissa Bolden
Liz Bruner Samantha Messina
Carrie Lester Irene Caldwell
Nate Bruckner Meredith Egan
Kip Jacoby Chief David Currey
Jeff Pickering

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. Reverend Bingham provided the invocation and Ms. Bartlett led the group in the Pledge of Allegiance.

Consent Agenda- Marybeth Cunningham, Chair

Mrs. Cunningham asked for a motion to approve the chairman’s meeting minutes dated February 16, the regular monthly meeting minutes dated February 17, and a March disbursement of $659,629.02. Mrs. Bodnar made the motion which was seconded by Ms. Deigl. The motion carried unanimously.

Mrs. Cunningham stated that the District is completing its Strategic Planning activities and is entering into the budget cycle for the fiscal year 2022-2023. As always, the focus of the board is to help support the healthcare needs of the community. She also voiced her thoughts and prayers for the people of Ukraine.

District Counsel Report – Jennifer Peshke, Esq.

Ms. Peshke provided her report and stated that progress has been made on the amended easement agreements with CCIRH and the VNA. All parties have come to a conceptual agreement and she is hopeful that this matter will be finalized in the next few months. Further, based on conversations at yesterday’s Chairman’s meeting, Mrs. Peshke has been instructed to prepare a memo outlining the process and requirements needing to be met in order for the District to sell any of its land. She will present the same to the Trustees next month for further discussion.

Financial Statement Review- Allen Jones, Treasurer

Mr. Jones stated that the District remains in sound financial position. As of February 28, the District had $15.2 million in cash and investments, less the spending just approved. This leaves about $14.5 million left in the accounts. For the balance of the fiscal year, the District has projected remaining budgeted expenses of $8.4 million. This suggests there will be about $6.1 million remaining in funds at the end of the fiscal year, with additional tax revenues of $1 million yet to be received. Next Mr. Jones stated that the District’s investments with WaterWalker have yielded very low returns this fiscal year and year to date the interest income is less than $3,500. This is a reflection of the zero interest rate policies of the Federal Reserve. However, the policy is now ending, though it is likely to take several months before short-term rates reach 1% and will not likely happen this fiscal year. In addition, WaterWalker is no longer able to provide FDIC guaranteed investments. However, the District’s investments are still very high in quality and meet Florida statute requirements, but they are not government guaranteed. With all these factors in mind, he is recommending the Trustees consider an alternative investment method for some of the funds. He explained that there is a program offered by the U.S. Government called Treasury Direct. The District can open an account and invest directly without fees in U.S. Treasury securities. As of today, rates for Treasuries that mature in one year are over 1%, and maturities of two years over 2%. Mr. Jones recommends the District allocate, initially, $2 million to this program, dividing the funds equally between the one-year and two-year maturities. In the next 24 months, he predicts the District will receive over $20,000 annually from the two-year note and another $10,000 from the one-year maturity. He further stated that it appears the returns on the $2 million will significantly exceed what the District will earn with the approximate average balance of $6 million in the current investment plan. Further, the Trustees are able to evaluate the results and potentially use them for even shorter maturities in the future, as a way to more effectively get a return on the high cash positions. The Trustees agreed with Mr. Jones’s recommendation and he and Mrs. Suriano plan to discuss the same with WaterWalker as soon as possible.

Executive Director Report- Ann Marie Suriano, Executive Director

Mrs. Suriano stated she prepared a written report which was included with the meeting packet materials for the Trustees’ review. In addition to her report, she provided an update concerning the Gifford Health Center. She indicated that Ms. Voss attends the Gifford Health Council meetings monthly and reports back on the same. The GHC has seen an increase in pediatric visits and are converting the old We Care office space, into further pediatric clinic rooms. Additionally, TCCH has hired a bilingual behavioral health practitioner to work at the center four days a week, which will be a welcomed addition for the patients. She informed the Trustees that she and Mrs. Peshke will meet next week to have further follow-up discussions concerning the Verizon wireless cellphone tower. They will come back to the Trustees next month with follow-up options for consideration.

Funded Agencies Semi-Annual Reports-

CCIRH Mental Health IOP- Karissa Bolden, Clinical Manager Outpatient Services & Cecelia Stalnaker, Inpatient Clinical Services Manager

Ms. Bolden addressed the board and stated that the IOP is currently at capacity and they have just enrolled 2 additional students for treatment. There have been 15 discharges from the program and 10 of those successfully completed their treatment, and the average length of stay for those completions was 11.9 weeks. She then discussed some challenges that they have experienced in implementing the program, which included transportation issues and language barriers. Also, many of the students are frequently absent from school, which has also posed challenges in their success of completing the program. However, they continue to address those issues and have partnered with SRA for assistance with transportation. Additionally, they continue to work with parents of the students to provide extra support when needed. Another roadblock has been the national and local shortage of mental health providers. She then provided a review of the services and programs provided in the IOP which included psychiatric evaluations; family workshops; individualized treatment planning; and substance abuse recovery. Next, Ms. Stalnaker discussed the types of issues patients are struggling with which include self-harm, severe anxiety, OCD, and substance abuse. They are also seeing an increase in younger adolescent patients needing further or inpatient, intervention. She stated that they believe that over the next five years, there will be an increased need for mental health services for young adults and a growing need for services for adolescents on an outpatient level.

Mrs. Cunningham asked if there were any questions from the other funders of this program who were also present at today’s meeting. Mr. Pickering stated that, after a review of their financials, he is concerned that they will not have enough funds to finish the fiscal year. Mr. Fuller, CFO of CCIRH, stated that there are funds from the District which have yet to be expended which will allow them to continue the operations for the remainder of the fiscal year without incident. Ms. Egan from the United Way asked about the typical age range of patients that are seen and what is their main referral source to receive these patients. Ms. Bolden indicated that, currently, females ages 13-14 make up most of their patient population, but there are a few clients age 16 and 17. Additionally, their main referral sources typically come from the CCIRH Behavioral Health Center and the IRC School District. However, they also receive referrals from the Mental Health Association and New Horizons.

Senior Resource Association- Liz Bruner, VP Philanthropy

Ms. Bruner began her presentation with a review of the Emergency Meals on Wheels (“EMoW”) program. The program provides a daily lunch and wellness visit by a trained SRA volunteer or staff member to homebound seniors who have been discharged from a healthcare facility within the last 30 days. She explained that it is a short-term program provided at no cost to the senior to assist with recovery and help prevent re-admittance to a healthcare center or hospital. Over the last six months, 63 seniors were served a total of 1,463 emergency meals. Of the 56 participants, 13 requested the continuation of meal deliveries for the second 14-day period for a total of 28 days. Additionally, 90% of those were not re-admitted to a hospital or healthcare facility. Most of the clients served in EMoW are through referrals from CCIRH. Next, she provided a review of the Public Guardian Program. She stated that since acquiring the Public Guardian Program four years ago, SRA continues to raise awareness within the community, encouraging referrals from families and friends of vulnerable seniors as well as professional referral sources. The program served 31 wards, exceeding its projected goal of 25 wards by July 2021. Of the 31 active wards, five are deceased, one was discharged, five are petitioned by the court, and one was referred by the court. SRA continues to manage the affairs of the deceased individuals and serve those waiting for assignment by the court. She further explained that with a large population of seniors living in Indian River County, there is high demand for Public Guardian services. Taking that into consideration, their current goal is 35 wards by July 2022. SRA continues to actively promote awareness of our Public Guardian Program, to help those most vulnerable residents in the community.

Substance Awareness Center IRC- Carrie Maynard-Lester, Executive Director

Ms. Lester addressed the board and stated that she would be providing them with an update concerning the five programs the District funds at SAC. She began her presentation by discussing the Peer Recovery Assistance and Outreach Programs. She stated there is such an importance in utilizing peer support and that it helps engage and retain clients into a life of recovery. Those peers help provide support in the program but also conduct assertive outreach within the community. She reviewed data associated with this and stated that they are also working collaboratively with the CCIRH, BHC, and IRC jail for further outreach support. She then discussed the medication-assisted treatment and Narcan training that has been offered and the positive impact it has made on the clients. Next, she discussed the intake assessment which is a comprehensive assessment of adults and youth who are referred to SAC for services. She explained that having the funds to support the qualified assessor has helped streamline this very cumbersome process. A total of 93 adults and 27 adolescents were assessed using the ASAM Continuum and Prevention Assessment Tool. She then discussed the Teen Intervene program which is a prevention program for youth who have been identified as engaging in health risk behaviors, including substance use. She explained that this is for clients who may not have yet developed a substance abuse brain disorder but still need a high level of intervention treatment. Lastly, she discussed the CRAFT program which is a new program to a population in our community that is often overlooked. The program is specifically for families with loved ones who have substance use and or co-occurring disorders. It is a skills-based program that impacts families in multiple areas of their lives, including self-care, pleasurable activities, problem-solving, and goal setting. It also addresses their loved one’s resistance to change and helps teach families behavioral and motivational strategies for interacting with their loved ones. Ms. Lester explained that she was unable to start the program at its original start date due to some organizational issues, but she is excited to now be able to offer the program to the community. Next, she provided an update on the Acupuncture Day Treatment program. She explained that they offer auricular acupuncture, which is done to the ear and is found to be effective in treating acute and post-acute withdrawal. The acupuncture provider also provides other stress-relieving techniques for use outside the treatment setting. Lastly, she spoke about some organizational transitions that happened within the center specifically with the staff. She stated that the SAC has had to rebuild its staff and there have been efforts within its current strategic planning process in working to obtain and retain its employees.

Presentation of Agreed-Upon Procedures FY 19-20- Kip Jacoby, CPA

Mr. Jacoby provided a review of the District’s agreed-upon procedures for fiscal year 19-20. He explained that seven of the District funded agencies were reviewed and he provided a summary of the findings. In many cases, minor issues were discovered such as only one proof of residency document provided, or undocumented exceptions made in the notes section on the portal. Overall, they were pleased with the review outcomes and feel that the database has helped in maintaining the requirements outlined in the policy and procedure manual. There was Trustee discussion surrounding the matter of the District requesting funds back from the agencies who were found to have exceptions from this report. Ms. Suriano stated that the District has not requested reimbursement for many years. There was also a question as to whether there was a policy in place that outlines a threshold amount, that would require an agency to pay back the District, should they meet that amount. Mr. Jacboy stated that he personally believes that the patients served were truly indigent and that many of the exceptions were due to lack of documentation or notations. It was further discussed that District staff has found some issues with the current policy and procedures and would like a chance to bring those forth to the Trustees for further discussion.

Public Comment/Adjourn

Mr. Pickering addressed the board and stated that he was disappointed that a Trustee was not appointed by the Governor to fill vacant seat 7 and that there is a potential to have a completely different board next year after the November election. With that in mind, he encouraged the board to utilize their large capital balance to fund further programs to make a meaningful impact on the community over the next nine months. The meeting was adjourned at 6:00 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