MINUTES
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
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
