Annual Meeting of the RHNMC Governing & Advisory Boards

Monday, January 8, 2007, 10AM, 2855 Overseas Highway, Marathon, FL                                                                  

Agenda 

 

I.              CALL TO ORDER, WELCOME & INTRODUCTIONS.                                                                         Mr. Luse

II.            VERIFICATION OF A QUORUM.                                                                                                                Dr. Szurek

III.           CONSENT AGENDA  (Recommended action: Approval)                                              Members

A.                  Approval of the Agenda

B.                   Approval of Minutes, 10/16/06.

C.                  Ratification of the Minutes, Membership & Nominating Committee, 12/4/06.

D.                  P & P Revision:  Per 2.10, p. 29, re: fulltime vs. part-time employees and benefits.

E.                   P & P Revision:  That all staff be required to take vacation leave during the week between the Christmas and New Year’s holidays.

F.                   Resignation of Ms. Kim Bassett (Fishermen’s Hospital) due to a conflict of interest.

IV.           Election of Directors & Officers, 2007                                                                                                         Mr. Luse               A.            New & Renewing Election of Directors

1.                   Nomination:  Mr. Dirk Smits (representing the business community)

for a 3 year term.  Other nominations.  Vote.

2.             Nomination:  Dr. Susana May (representing the Monroe Co. Health Dept.; with Steve Mason as alternate) for a 3 year term.  Other nominations.  Vote.     

B.                   Election of Officers

                1.             Nominations:  Dr. Nicki Will, Chairperson; Mr. Robert H. Luse, Vice Chair;  Ms. Dorothy Clever, Secretary; Ms. Lori DeNues, Treasurer.  Other nominations.  Vote.

C.            Installation & Commitment of the Directors & Officers                                                        Dr. Szurek

(Newly elected Chair now presides.)

D.            In Appreciation                                                                                                                                 Dr. Szurek

V.            REPORTS

                A.            Executive Directors Report                                                                                                             Dr. Szurek

                                1.             Termination of Lease by FHA & Implications

                                                a.             Summary:    What appears to be the case.  Comm. Neugent’s “meeting”.

                                                b.             Our “position” with regard to our adversaries – a discussion.  Where do we go/what do we do/how do we respond?  Relocate to the Lower Keys (Big Pine), consolidate in the Upper Keys, or “stand and fight” in Marathon/Middle Keys? (Requires Board Approval)

                                2.             Strategic Plan (Requires Board Approval)

                                                a.             Key West

                                                b.             Middle Keys

                                                c.             Upper Keys

                                                d.            Dental 

B.               First & Second Quarter, FY 06-07                                                                                 Mr. Smith

1.       Income and Expenses                                                             

2.       Revised Budget (Requires Board Approval)   

3.       Independent Audit, FY 05-06 (Requires Board acceptance)

C.               Health Services - Primary and Dental Care                                                                             Mr. Pascucci

                (Recommended action:  Acceptance of the Reports)  

                D.            Development                                                                                                                                      Dr. Szurek 

1.             Strategy/Plan

VI.           OLD BUSINESS

                A.            Dr.  Doenecke                                                                                                                                     Mr. Smits

                B.            (Other) Funding Plans                                                                                                                     Dr. Szurek

                                1.             Baptist Health So. FL (van request?)                                                                           Mr. Lazo                               2.                State Funding Request                                                                                                     Dr. Szurek

                                                a.             New Rep. District 120 - LIP Funds

                                                b.             SB 2176

                                3.             HSAB/County (informal advice from county staff)

                D.            MOU with MCHD (Disaster Recovery)                                                                                      Dr. Szurek

                E.            HRSA Performance Review (11/1/06)                                                                                      Dr. Szurek

                F.             State RHN Meeting, 12/7-8/06 (Medicaid Reform & RHN’s)                                            Dr. Szurek

VII.         NEW BUSINESS                                                                                                                                               

                A.            Submission of Section 330e Funding Request  - CHC                                                           Dr. Szurek

                                1.             Timelines

                                2.             Implications for Board meeting schedules

                                3.             Implications for Board roster

                B.            RHNMC unanimously voted to be a line item in the City of Marathon budget        Dr. Szurek           

C.            Grant Application:  (ACHA) Provider Service Network

                D.            Other New Business.                                                                                                                       Members

VIII.        COMMUNITY INPUT AND ANNOUNCEMENTS.                                                                     Members/Guests      

IX.           RHNMC ANNOUNCEMENTS  -  The next meeting of the Governing & Advisory Boards is tentatively scheduled for Monday, April 16, 2007, at 9AM, location: to be determined.  (Please recall that RHNMC must move its location no later than 3/31/07.  If awarded funding under Section 330e, monthly meetings of the Board must resume no later than in May 2007.)

X.            ADJOURNMENT OF THE ANNUAL MEETING.                                                                  Dr. Will

 

The Annual Meeting will be followed by a catered buffet lunch in the same meeting room. (Time approximate 11:30AM – 12:30PM.)

During the lunch, Dr. Szurek will highlight special recognitions and service to RHNMC and to the community to include “Employee of the Year”, “Staff Appreciation Recognitions”, and the recipient of the Lignum Vitae Award.

 

RHNMC Annual Meeting of Governing Board and Membership

Monday, January 8, 2007, 10AM, 2855 Overseas Highway, Marathon, FL 33050

Meeting Minutes

 

Board Officers in Attendance:  Dr. Nicki Will, Chairperson Elect (CEO, LFKHC); Mr. Robert H. Luse, Vice Chairperson Elect (Community-at-Large).

 

Directors in Attendance:  Comm. Sylvia Murphy (Alternate for Comm. George Neugent);  Dr. Susana May (Elect; Monroe Co. Health Dept.); Mr. Nelson Lazo (CEO, Mariners Hospital); Capt. Steven Zavalney (by appointment of the Chair; County Fire & Rescue); Mr. David Cohn (by appointment of the Chair; Islamorada Chamber of Commerce).

 

Advisory Members Present:  Ms. Suzanne Imperato, CMS; Ms. Chris Clark, MCHD; Mr. John Oliver, Mariners Hospital; Ms. Elizabeth MacGard, Health Services, Monroe Co. Correctional Facility

Board Officers Excused:  Ms. Lori DeNues, Secretary (Consumer); Ms. Ana Pena, Consumers (Treasurer).

 

Governing Board Members Excused:  Rev. Marney Brown, Consumers; Ms. Dorothy Clever, Consumers; Ms. Juanita Knudsen, Consumers, Mr. Dirk Smits, Esq., Business/Community; Ms. Julia Terrell, Consumers 

 

Advisory Board Members Excused:  Ms. Jerri Valverde, Community;  Ms. Liz Kern, Hospice/VNA’ Ms. Meylan Lowe-Watler ( LFKHC);  Ms., Debbie Premaza, Lifelines Home Health Care.

 

Staff Members Present:  Dr. mark Szurek, CEO; Mr. John Pascucci, COO; Mr. Dan Smith, CFO.

 

Guests:  None  (DRAFT)

 

I.              CALL TO ORDER.  The meeting was called to order by Mr. Luse.  Each of the attendees was asked to introduce themselves to the group.  Special welcomes were extended to Comm. Sylvia Murphy, acting as alternate for Comm. George Neugent, Dr. Susana May, governing Board member elect, and to new advisory Board member, Ms. Elizabeth MacGard, representing county correctional facility health services.    

II.            VERIFICATION OF QUORUM.  Dr. Szurek indicated that by appointment of 2 advisory members

(Capt. Zavalney and Mr. Cohn; Bylaws Article VI, 6, p. 9) to the Governing Board by the Chair for the duration of this meeting for the purpose of establishing a quorum, a quorum of 7 members (of 12) members were present to conduct business, constituting a quorum.

III.           CONSENT AGENDA.     In a motion made by Dr. Will and seconded by Capt. Zavalney, the consent agenda was considered for adoption.  Discussion:  Dr. Szurek indicated that the policy and procedure change (P&P 2.10, p. 29) allows for fulltime employees to serve a minimum of 75% time to be eligible for benefits.  Dr. Will asked what was the “conflict of interest” cited by Ms. Bassett as the reason for her resignation from the Board.  Dr. Szurek stated that Ms. Bassett had indicated to him that her resignation was reflective of a conflict between her representing HMA and RHNMC before the Fishermen’s Trustees, while Dr. Rice in another conversation with Ms. Bassett stated that she had resigned due to the fact that “over 50% of expenditures being spent by RHNMC is for administration and could not in good conscience serve on such a Board”.  Dr. Szurek said that Ms. Bassett’s statement is incorrect and that she has reviewed previous budgets in the past well enough to understand the budget breakdown does not include 50% or more for administration.  Mr. Luse asked that a precise statistic of how much is spent on administration be determined before the meeting concludes.   Ms. Clark reported that she too had heard rumors that RHNMC administrative costs are excessive.   The motion to approve the consent agenda was then unanimously approved.

IV.           ELECTION OF DIRECTOR & OFFICERS, 2007.

A.                  New and Renewing Directors.

1.       In a motion made by Dr. Will and seconded by Mr. Cohn, the Board unanimously elected Mr. Dirk Smits to a 3 year terms as a director, representing the business community.  There were no other nominations.

2.       In a motion made by Dr. Will and seconded by Mr. Cohn, Dr. Susana May (with her alternate named as Steve Mason) was unanimously elected to a 3 year term as a director, representing the Health Department.  There were no other nominations.

B.                   Election of Officers.  In a motion made by Capt. Zavalney and seconded by Mr. Cohn, the Board unanimously elected Dr. Nicki Will as Chairperson of the Governing Board;  Mr. Robert H. Luse, as Vice Chair; Ms. Lori DeNues as Treasurer; and, Ms. Dorothy Clever as Secretary.

C.                  Installation.  The Advisory and Governing Board Members in unison issued their solemn pledge to comply with and advocate for the bylaws, policies and procedures of RHNMC, and that they would seek better health for all Monroe County residents for the duration of their respective terms of office.

D.                  In Appreciation.  Dr. Szurek distributed thank-you gift baskets to Mr. Luse for his service as chair for the past 5 years, to Dr. Will for her service as vice chair, 2006; to Ms. DeNues for her service as Secretary, 2004-2006; and to Ms. Pena for her service as Treasurer, 2006.  The Board applauded Mr. Luse and thanked him for his years of service to and leadership of the organization.

V.            REPORTS.

                A.            Executive Director’s Report.

                                1.             Termination of Lease by FHA.  Dr. Szurek reported that the 10 yr no-cost lease issued by FHA to RHNMC at 2855 O/H in Marathon will terminate effective 3/31/07.  The reason for the termination was 3-fold: (1) RHNMC had not organized a holding company to govern the operations of this facility; (2) Catholic Charities had been offered space without landlord permission, and (3) RHNMC had failed to secure section 330e funding.  Dr. Szurek explained to the Board that no direction had been forthcoming from FHA to organize a holding company despite repeated requests; Catholic Charities had vacated the premises as soon as it was apparent that the landlord did not want that organization to co-locate (no charge was ever placed on Catholic Charities for this occupancy), and RHNMC had explained that there are never guarantees with regard to section 330e or any federal grants.  Nevertheless, it was clear that FHA did not want RHNMC to remain at that site, and has been given until 3/31/07 to vacate.   Dr. Szurek reported that a meeting has been called by Comm. Neugent for 1/29/07 at the Guidance Clinic (9AM-12) to try to sort out facts, i.e., who will be providing what services and in what capacity.  Comm. Murphy indicated her interest in attending.  Dr. Szurek stated that he has been seeking all options for relocation min the interim, but it remains that the FHA action is extremely disruptive, appeared to be aimed de-stabilizing RHNMC, and through the local AHEC, have actually begun negotiations with a rival, out-of-county chc, CHI, to occupy RHNMC’s existing space.

                Dr. Szurek asked for a Board response on various levels:  (a) authorization to submit a letter of protest to HRSA, (b) Agency-Member support for the RHNMC position to object to the CHI application, (c) where to relocate, given that the lease will be terminated as of 3/31/07, and (d) how to respond to the involvement of AHEC in this otherwise clandestine negotiation to disrupt RHNMC efforts and plans.

                                a.             In a motion made by Mr. Luse and seconded by Mr. Cohn, the Board unanimously authorized the executive director to issue a letter of protest to HRSA under the most recent (06-067) section 330e funding opportunity objecting to a CHI application as a duplication of services in this county.

                                b.             Dr. Will, Mr. Luse, Mr. Lazo, Capt. Zavalney, Comm. Murphy and Mr. Cohn stated that within their respective organizations, separate letters of support of the RHNMC objection would be offered to HRSA, as allowed for by their superiors and as applicable.

                                c.             In a motion made by Capt. Zavalney and seconded by Mr. Lazo, the Board unanimously approved a staff recommendation that RHNMC retain services in Marathon, Key West and in the Upper Keys.  Comm. Murphy reminded the group that continued county funding would most probably be contingent on a county-wide service provision.

                                d.            In a motion made by Mr. Lazo and seconded by Mr. Cohn, the Board authorized Dr. Szurek to issue a letter to the Director of the FL Dept. of Health objecting to AHEC’s involvement in secret negotiations that would result in a disruption of services already established by RHNMC over a number of years.  Dr. May as the sole vote against this action stated that such a protest could be interpreted as vindictive.  Capt. Zavalney stated that if AHEC has violated state codes and statutes, the department should be notified, while Dr. Will stated that AHEC’s actions could be interpreted as unethical.

                                2.             Strategic Plan.  In a motion made by Capt. Zavalney and seconded by Mr. Cohn, the Board unanimously approved the following interim strategic plan.

                                a.             Key West.  Primary care services in partnership with HMA will continue on Saturdays.

                                b.             Middle Keys.  RHNMC will seek an alternate site in Marathon, for administration, primary care and dental services.

                                c.             Upper Keys.  The mobile medical van will continue services 3 times per week reflective of funding cutbacks (see budget review below).

                                d.            Dental services will be maintained and offered at a Marathon facility.

                B.            Financial Report.

                1.             Profit & Loss.  Mr. Smith distributed the profit and loss statement for the first half of the fiscal year, noting a deficit of $15K.

                2.             Revised Budget/Revised Lab. Fee Schedule.  Mr. Smith distributed a proposed revised budget and revised lab. Fee schedule, for Board consideration. He noted throughout the draft budget where funding cuts had been executed, reflecting a decrease in $93K through layoffs and resignations.  In a motion made by Mr.  Luse and seconded by Capt. Zavalney, the Board unanimously approved the revised budget and the revised fee schedule.  Mr. Smith, accompanied by Capt. Zavalney, noted for the record that RHNMC expenditures for administrative costs were at 21% of the overall budget.  (Post script:  Subsequent to the meeting, a further staff review suggests the actual administrative costs are 14%, given that the COO is the direct supervisor of health services and is thus operational, not administrative.)  

                3.             Independent Audit.  Dr. Szurek distributed the independent audit draft as compiled by the firm of Smith, Ortiz, Gomez & Buzzi, PA.  Dr. Szurek noted that there were no reportable conditions, and that RHNMC was found to be compliant with OMB standards A-110, A-120, and A-133, for local, state and federal compliance purposes.  In a motion made by Mr. Luse and seconded by Mr. Cohn, the Board unanimously approved the audit for FY 05-06.

                C.            Health Services.  Mr. Pascucci reported on the patient demographics for the calendar year, noting that all sites had either met or exceeded their goals for service quotas.  In a motion made by Mr. Luse and seconded by Mr. Cohn, the Board unanimously accepted the health services report.

                D.            Development.  Dr. Szurek reported that efforts to accomplish traditional fundraising through events had proven to be unsuccessful.  He asked that the Board consider a different route for the balance of the fiscal year, in the hopes of raising a needed $100K. He asked Mr. Luse, Dr. Will Mr. Lazo and (in absentia) Mr. Smits if they would be individually willing to select certain local banks for contributions of $25K.  Each indicated a willingness to seek this funding through this route on behalf of the organization.

VI.           OLD BUSINESS.

                A.            Dr. Doenecke.  Dr. Szurek reported that Mr. Smits has submitted the final papers documenting a resolution with Dr. Doenecke.  In absentia, Dr. Szurek thanked Mr. Smits for his pro bono work.

                B.            Other Fundng Plans.

                1.             Baptist Health S. FL.  Mr. Lazo reported that the request for funding had been submitted to BHSF but no response has been issued by his parent organization.  Dr. Szurek thanked Mr. Lazo for his support of the RHNMC application.

                2.             State Funding Request.

                                a.             LIP (Low Income Pool) Funds.  Dr. Szurek reported that he had met with Dr. May of the health department and Ms. Pipher of the GCMK to form a coalition to secure LIP funds in this next fiscal year.  $1M was requested from the FL Legislature, to be divided in equal amounts between the partners for prevention efforts (health dept.), primary and dental care (RHNMC) and mental health and substance abuse (GCMK).  Rep. Saunders office has agreed to support efforts to secure these funds for Monroe County.

                                b.             SB 414.  Dr. Szurek reported that there is a good chance that SB 424 will pass in this next session, increasing revenues to rural health networks throughout the state.  He will continue to monitor this progress.

                                c.             HSAB/County funding.  Dr. Szurek stated that informally, county reps. have suggested that RHNMC’s application for funding be combined into the line item only and to forgo the HSAB process.  Comm. Murphy stated that she thought that idea had merit and supported such a consolidation.

                C.            MOU with MCHD.  Dr. Szurek stated that, at her convenience, Dr. May and he should meet to discuss plans for RHNMC’s involvement in county health dept. efforts to provide disaster recovery.

                D.            HRSA Performance Review.  Dr. Szurek reported that HRSA had completed a performance review of the network development grant and that the organization’s performance had met the federal expectations in all areas.  Dr. Szurek stated that performance reviews will occur for all HRSA granted projects, and that the next review was anticipated in 2008.

                E.            State RHN Meeting.   Dr. Szurek reported that the state RHN quarterly meeting had occurred in early December 2006, and highlighted Medicaid Reform and the potential increase in funding expected by SB 424.

VII.         NEW BUSINESS.

                A.            Submission of Section 330e Funding Request.  Dr. Szurek reported that this grant application had been successfully submitted electronically on 12/5/06, the day before it was due.  RHNMC now awaits a review and possible approval of the application to create a (new access point, or) CHC in Monroe County.  Implications:

                1.             Timelines.  A grant award or denial will probably occur in March 2007.

                2.             Board Meeting Schedule.  In accord with CHC requirements, the Board may need to resume monthly meetings in May 2007, but access will be accommodated through conference call-ins.

                3.             Board Roster.  In accord with CHC requirements, a simple majority of the Governing Board Membership must be current consumers of care.

                B.            City of Marathon.  Dr. Szurek reported that the City of Marathon has awarded RHNMC the distinction of being a line item on their annual budget in this next fiscal year.

                C.            Grant Application:  ACHA PSN.  Dr. Szurek reported that ACHA has offered a grant to create a pilot provider service network in one rural county.  He has respectfully declined to submit this grant since Monroe County has few Medicaid providers and recipients, and thus would not serve the purposes of the pilot if awarded.  The Board agreed with this decision.  Capt. Zavalney stated that he serves on several grant review committees and would be happy to review any draft applications prepared by RHNMC.  Dr. Szurek thanked him for this information and offer.

                D.            Other new business.  There was no other new business.

VIII.        COMMUNITY INPUT AND ANOUNCEMENTS.  There was no community input and/or announcements.

IX.           RHNMC ANNOUNCEMENTS.   The next meeting of the RHNMC Governing Board is scheduled for Monday, April 16, 2007 at 9AM at a new site yet to be determined.

X.            ACKNOLEDGEMENTS. Dr. Szurek declared that the “employee of the year” selected by the Membership & Nominating Committee was Dr. Carl Juliao, for his work in enhancing the dental program.  Mr. Smits and Ms. DeNues were also recognized for their contributions to the Network over the past year in fundraising and pro bono legal work respectively.  Ms. Debbie Premaza has been selected as the recipient of the Lignum Vitae Award 2006, for her outstanding support of RHNMC projects and her contributions to the improved health of the community.

X.            ADJOURNMENT.  There being no additional business before the Board, the meeting was adjourned by unanimous acclamation.

(The meeting was followed by a buffet luncheon on site.)

Respectfully recorded,

Mark L. Szurek, Ph.D., CEO