Indian River County Hospital District

Regular Monthly Meeting Minutes: April 19, 2018

Regular Monthly Meeting Minutes
April 19, 2018
5:00 PM

TRUSTEES: Marybeth Cunningham; Allen Jones;  Ann Marie McCrystal; Dr. Michael Weiss; Karen Deigl; Tracey Lockwood Zudans; Barbara Bodnar

STAFF : Jennifer Frederick; Kate Voss; Jennifer Peshke, Esq.

OTHER ATTENDEES: Jason Carey;  Angela Dickens; Brett Hall; Stan Boling;  Phil Matson;  Rick Van Lith;  Miranda Hawker;  Kathy Orton; Vicki Soule; Val Zudans

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.

Senior Pastor Jim Gallagher, of The Calvary Chapel of Vero Beach, provided the Invocation and Dr. Weiss led the group in the Pledge of Allegiance.

Consent Agenda- Marybeth Cunningham, Chairwoman IRCHD

Mrs. Cunningham asked for a motion to approve the Chairman’s meeting minutes dated March 14, regular monthly meeting minutes dated March 15, and an April disbursement of $1,431,902.54. Ms. Deigl made the motion, which was seconded by Mrs. Bodnar. The motion carried unanimously.

Mrs. Cunningham provided an update concerning the Partnership process with Cleveland Clinic. She explained that currently the attorneys for all parties are conducting their due diligence and have collected data from the last 30 years concerning the hospital and the District. The parties continue to move forward in this process and they are committed to the deal.

District Counsel Report- Jennifer Peshke, Esq.

Mrs. Peshke provided her District Counsel Report and stated that she has been working with the attorneys in the due diligence process concerning the partnership with Cleveland Clinic. Additionally, she is working with District staff on the upcoming budget cycle concerning the funded agency requests for fiscal year 2018-2019.

Financial Statement Review- Allen Jones, Treasurer

Mr. Jones provided the Treasurers report and stated that the District currently remains in sound financial condition. He explained that should the District’s spending rate continue at its current volume, it could require utilization of the reserve funds that have been set aside for other purposes. In doing this, it could negatively affect the next fiscal year’s millage rate, to make up for any drawdown of those reserves.

Further, Mr. Jones stated that through March 31, the District’s bank deposits totaled approximately $10.6 million and $2.5 million of those funds represent reserves. After allocating the payment of $1.4 million for this month’s distributions, the operating account will drop to approximately $6.6 million. The District is projected to receive an additional $900,000 in tax revenues for the remainder of the fiscal year, which would bring the operating account up to $7.5 million. Mr. Jones explained that program expenses, District administrative expenses, and the additional expenses associated with the partnership process and repairs to the HSB are expected to require around $7.9 million. Therefore, the District may need to utilize some of its reserve funding.

Thus far, the District has paid approximately $400,000 in expenses for the partnership process and the total budget set aside for this purpose is $1,000,000. Mr. Jones stated that extensive legal work is being undertaken and it is possible that total cost will exceed the budgeted amount. He explained that he is providing this information to the Trustees so they are aware that this year’s budget may turn out to be tighter than previous years. Additionally, IRMC has experienced an increase in volumes of indigent patients. For the first six months of this fiscal year, indigent outpatient volumes are up 7.5% and the more expensive inpatient volumes are up 18.8%. However, there are indications these increases may moderate and there may be some reversals of charges in the District’s favor, over the next coming months. Mr. Jones recommends until these reversals actually materialize, the District should avoid approving new spending, if it is not currently in the budget.

Funded Agency Quarterly Report- Brett Hall, Executive Director McCabe Connections Center & Mental Health Collaborative

Mr. Hall provided a quarterly update concerning the McCabe Connections Center. He discussed their collaboration with the Indian River County Mental Health Court which is under the supervision of Judge Cox and Sherriff Loar. The program is now serving 110 participants and is designed to get those with mental health issues out of jail and into treatment. The program just completed a review of 100 patients that participated in the program. They ran their participants arrest records from the year prior to their participation in the program and the group had a combined total of 387 arrests. Subsequently, they took the same group of people and reviewed their arrest records a year after their participation in mental health court program and found that there were only 8 re-arrests.

Mr. Hall explained that the McCabe Connection Center just celebrated their one year anniversary since opening and provided services to 1300 community members. Additionally, the center has helped expand the guardian advocates program by recruiting additional volunteer guardians. The program provides guardianship over individuals who have been deemed by a judge as incapable to manager their own personal affairs. Further they are working with County Commissioner Mr. O’Bryan and a local land developer, to help with a housing initiative. He explained finding affordable housing is a challenge for many who struggle in the community. Lastly, Mr. Hall explained that there is a large substance abuse issue in Indian River County and there are few resources for advanced therapy. The Connections Center, along with other health agencies in the community, are looking to provide those services and offer free depression screenings. Mrs. McCrystal suggested that the center utilize the VNA mobile unit to provide depression screenings, in different areas of the county. Mr. Hall said that he is currently working with VNA on that matter.

IRMC, Inc. Monthly Report- Journey to Excellence Project Update- Jason Carey, VP

Mr. Carey provided an update concerning the Journey to Excellence project at IRMC. The focus of the project is on process of improvement through elimination of waste and creating a standard of work to facilitate patient centered care. Mr. Carey’s team works under the guidance of the Executive Guiding Team with a goal of bridging gap between administration and frontline caregivers with process improvement. He explained that through this initiative they have provided guidance, coaching and the tools necessary for caregivers to participate and problem solve in a centergistic approach to patient care. The initial value stream selected for improvement was the optimization of nursing work flow, to allow for a greater percentage of nursing time to be centered on direct patient care. IRMC Chief Nursing Officer Linda Walton sponsored the first value stream and provided her support with its success. Mr. Carey explained that two weeks ago they gathered 10 caregivers at IRMC and two patient representatives for the first rapid process improvement workshop. The workshop topic was nurse to nurse communication and the event was a great success. He introduced Ms. Crystal Golightly, nurse manager at IRMC, who served a process owner for the workshop. She discussed the initiatives from the workshop which have been implemented into the patient rooms. Additionally, Ms. Paula Anderson Finley, an active volunteer in the IRMC patient and family engagement committee spoke in support of this initiative and the positive outcomes that have evolved from their efforts.

New Business- Proposed Aviation Blvd. Extension- Phil Matson & Stan Boling

Mr. Stan Boling, planning director at the Indian River County Commission provided a review of the proposed Aviation Blvd. extension. The extension is intended is to provide an alternative route to 37th street due to increased traffic on the road. He explained that 37th street is the main area in Vero Beach for medical care and that during peak hours of 8:00 AM- 6:00 PM, the capacity is 880 cars. Currently, 700 cars utilize the road during those hours. Mr. Boling explained that this road is anticipated to greatly exceed capacity by 2040. He reviewed alternative routes and models that the county has developed with the Trustees. The county believes that this extension would also add an advantage of reducing traffic on US 1. Currently they are in the development stages of this proposal and have reached out to the main surrounding property owners, which include the District. There was further Trustee discussion and Mr. Boling indicated that he and Mr. Matson would remain in contact with the District regarding any future developments.

Public Comment-

Val Zudans, M.D. community member stated that as a local physician he sees patients and colleagues throughout the week and many have provided positive feedback concerning the partnership with Cleveland Clinic. However, some local physicians have shared their anxiety with him concerning the process. He feels that since the deal is not complete there is still a sense of the unknown which can cause concern. Some physicians have concerns regarding their own practices and how the partnership will affect their livelihood and if they will be able to continue to practice, as they are today. Some physicians feel that they have not been given an opportunity to participate, provide feedback or better understand the process. Dr. Zudans encouraged the Trustees to contact community members like the president of the local medical society and the former chief of staff at IRMC for their opinion and recommendations. Additionally, he feels that the District has an obligation to inform the public about the terms of the lease and he does not feel that has been adequately portrayed. Many are concerned that specialty services such as OBGYN, behavioral health and pediatrics may be discontinued. He believes it is the District’s responsibility, not the hospital, to make sure those services are included in the final lease agreement. The District must also look at the potential financial impact this deal will have on the community and whether Cleveland Clinic be paying rent to lease the facilities and at what rate. He further believes they have a responsibly to support indigent care, as they had stated they would do during their initial pitch.

Adjourn- The meeting was adjourned at 6:30 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