HomeMy WebLinkAbout3/21/1996Telephone: (407)567.8000
MINUTES ATTACHED
- - BOARD OF COUNTY COMMISSIONERS
1840 25th Street, Vera Beach, Florida 32960
JOINT MEETING OF
BOARD OF COUNTY COMMISSIONERS
AND
BOARD OF TRUSTEES OF
INDIAN RIVER MEMORIAL HOSPITAL DISTRICT
AGENDA
MARCH 21, 1996
1. Opening Statements
2. Revisit contract with Indian River Memorial Hospital, Inc.
3. Make IRMH Board of Directors an advisory board with no voting power.
4. Retain all budgetary power within the District Trust Board. This includes all capital,
remuneration and operational funds. Expenditure authority of the Executive Director exists
only within the budget approved by the District Trust Board.
5. Adjournment.
ANYONE WHO MAY WISH TO APPEAL ANY DECISION WHICH MAY BE MADE AT THIS
MEETING WILL NEED TO ENSURE THAT A VERBATIM RECORD OF THE PROCEEDINGS
IS MADE WHICH INCLUDES THE TESTIMONY AND EVIDENCE UPON WHICH THE APPEAL
WILL BE BASED.
ANYONE WHO NEEDS A SPECIAL ACCOMMODATION FOR THIS MEETING MAY
CONTACT THE COUNTY'S AMERICANS WITH DISABILITIES ACT (ADA) COORDINATOR
AT 567-8000 X223 AT LEAST 48 HOURS IN ADVANCE OF THE MEETING
9
SPECIAL MEETING
Thursday, March 21, 1996
The Board of County Commissioners of Indian River County,
Florida, met in Joint Session with the Board of Trustees of Indian
River Memorial Hospital District at the County Commission Chambers,
1840 25th Street, Vero Beach, Florida, on Thursday, March 21, 1996,
at 2:00 p.m. Present were Fran B. Adams, Chairman; Carolyn K.
Eggert, Vice Chairman; Kenneth R. Macht; and John W. Tippin.
Commissioner Richard N. Bird was on vacation. Also present were
James E. Chandler, County Administrator; Charles P. Vitunac, County
Attorney; and Barbara Bonnah, Deputy Clerk.
Present for the IRMH District Board of Trustees were:
Vincent Montuoro, Chairman
Very Reverend David C. Lord
Beverly O'Neill, R.N.
Joyce Smith
Margaret Ingram
Broadus Sowell, M.D.
Heidi Gorsuch, M.D. (absent)
Alan Polackwich, Attorney
Before calling the meeting to order, Chairman Adams noted that
she serves as a moderator of the Sebastian Medical Center Board of
Trustees, which is an advisory board to the Sebastian hospital.
The advisory board has no management ability of the hospital; the
advisory board is simply a community interface board. Chairman
Adams advised that she asked the County Attorney for an opinion,
and he has assured her that there is no conflict of interest in her
chairing this meeting today or chairing her position on - the
Sebastian Medical Center advisory board.
Chairman Adams advised that this Joint Meeting has been called
to address some of the problems perceived by the public.
Vincent Montuoro, Chairman of the Hospital District Board of
Trustees, advised that they are here at the invitation of the Board
of County Commissioners who feel that the public perception of
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MARCH 21, 1996 �oo� 97 PAGE 66c"
_I
problems at the hospital require a meeting and an airing out. They
have no particular agenda for today but are here to talk about the
issues, answer any questions that come forth, and give as much
information as they can about what they are doing and what they
plan to do in the near future.
commissioner Macht noted that Agenda Item 2 involves
discussion of the Hospital District Board of Trustees revisiting
the contract with Indian River Memorial Hospital, Inc. He
believed this item has been stimulated by all that has gone on in
the press relevant to some proposals that were made to conduct a
significant part of business out of public scrutiny and in
violation of their contract which calls for the Sunshine Law to be
observed. There are some other aspects that indicate that perhaps
the present and previous Trustee boards have delegated, through
contract, more power than is appropriate to the IRMH, Inc. Board of
Directors.
Commissioner Eggert asked the Trustees' attorney to comment on
the effect on our county as a result of the Palm Beach County vs.
Everglades Memorial Hospital case.
Attorney Alan Polackwich understood there have been some
comments that as a result of that case our documents to our
hospital are invalid or unconstitutional. He frankly didn't think
that anybody can say that. It took them 5 years in that case in
two different courts to determine that those documents were
invalid. The Circuit Court held that the documents were valid; the
4th District Court of Appeal held that they were invalid because
the Hospital District had given up too much control. Our
documents are not nearly as extreme as their documents. Their
documents are pretty unusual. Our documents are more typical of 40
hospitals in Florida that follow the same general format that we do
in leasing a public hospital to a nonprofit corporation.
Attorney Polackwich felt, however, that the Everglades
Hospital case -certainly raises the question about our documents.
If we are going to deal with that question, the Legislature has to
clarify F.S. Section 155.40 and they are working on -it at this
time. Regardless of what happens to that bill, we still have a
question. Since the Supreme Court decided not to hear the appeal
from the 4th District Court of Appeal, he has advised Chairman
Montuoro that he feels our Board of Trustees needs to make some
changes in our documents to eliminate any questions that may linger
as a result of the Everglades Memorial case.
Commissioner Macht asked what specific questions it would
eliminate, and Attorney Polackwich believed it would answer the
control issue.
2
MARCH 21, 1996
Commissioner Macht understood then that Attorney Polackwich
believes the Board of Trustees has delegated too many items of
control, and Attorney Polackwich responded, "probably." The
Everglades Memorial Hospital case raises exactly that question:
Was too much control delegated.to the Inc. Board, and if so, how
much needs to be taken back to satisfy the law?
At Commissioner Eggert's request, Attorney Polackwich gave a
brief rundown of what happened in the Everglades Memorial Hospital
case. Back in 1987 Palm Beach County had three small hospital
districts that served certain parts of the county. One of those
small districts leased Everglades Memorial Hospital to EMH, Inc.
and set up essentially the same conceptual thing we have here.
Their lease was unusual in that it. was for 40 -years and it was
automatically extended for a year for every year they experienced
unless a notice not to do that occurred. That had the effect of
having a 40 -year lease at all times with a 40 -year notice of
termination required. Nothing like that is present in our case.
We have a flat 25 -year lease that simply begins and ends with 25
years.
Commissioner Macht referred to page 3 of the contract where it
seems that the IRMH, Inc. Board of Directors could extend the
contract by whatever terms they deem appropriate. He quoted the
following paragraph: "It is the intention of the parties that the
lease term shall be subject to renegotiation between them if Lessee
determines to finance additions or alterations to or improvements
in the Hospital Facilities over a period of time exceeding the
remaining lease term. Upon termination of the lease term, the
property leased or otherwise transferred hereunder, including but
not limited to, all accounts receivable, whether or not reduced to
judgment, and all unencumbered funds of the Lessee then held by the
Lessee and any Special Funds as that term is defined under the
"Master Trust Indenture" then held by the Lessee shall revert to
the possession and control of the Lessor or its successor in
interest."
Commissioner Macht felt the upshot of that is. that all the
IRMH, Inc. Board would have to do_ is -undertake some phase of
hospital expansion, such as a new facility or a new service, and it
would force the Hospital District Board of Trustees to agree to a
lease extension.
It was Attorney Polackwich's opinion that it does not. When
an agreement is for a term and then it says that it is subject to
renegotiation after that, that is literally all that it means. All
it says is that the parties will renegotiate at that time.
3 BOOK 97 FAGS
MARCH 21, 1996
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BOOK 97 PAU 61"J '67'
Margaret Ingram commented that at that point the elected Board
of Trustees would enter into renegotiation. If the public doesn't
like what is going on, and the Trustees understand that, then the
7 Trustees are the ones who will make the decision whether the
lease would be renewed.
Attorney Polackwich agreed that if we ever reached that point,
the Trustees would have a duty to renegotiate in good faith.
Assistant County Attorney Terry O'Brien felt it raises an
issue that it certainly could be litigated if, for instance, there
was 5 years left on the 25 -year contract and an improvement was
constructed with a 30 -year life on a 30-40 year mortgage. He .felt
you would be duty bound to extend that for a period of time to
cover that major alteration or addition.
Attorney Polackwich explained that they have faced that
question each time they have done bonds because they have bonds
that extend out beyond the year 2010 when the lease expires. The
way they have resolved that internally with the bond interest is to
use the year 2010.
Mr. Montuoro emphasized that no addition or improvement would
be put up without the approval of the Hospital District Board of
Trustees because they back all the bonds that are issued to pay
these off. No addition is financed through a mortgage. An
improvement is paid through an industrial revenue bond issued by
the hospital.
Attorney O'Brien suggested the language be changed to read "if
the lessee determines to finance the addition with the approval of
the Board of Trustees ..."
Commissioner Macht felt that goes to the heart of why he felt
we should revisit the contract. It appears that the Board of
Trustees is moving forward in the renegotiations of the contract.
He asked if that is an accurate statement, and Mr. Montuoro
answered that it is. He believed they are making progress, but
pointed out that these negotiations will be going on for some
period of time because it is a complex issue. A liaison committee,
composed of 3 Trustees and 3 Board of Directors, meets Monday
nights to discuss situations, problems and issues that are
pertinent to both boards.
Commissioner Eggert asked for a review of the differences
between the Indian River Hospital District Board of Trustees and
the Indian River Memorial Hospital, Inc. Board of Directors.
Mr. Montuoro explained that the Hospital Taxing District Board
of Trustees consists of 7 elected (unpaid) officials who serve 4 -
year terms. The terms are staggered with 4 trustees going out one
year and 3 the next year. The Trustees take care of the indigent
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MARCH 21, 1996
� � s
care and support several preventative and primary health care
programs such as the VNA mobile clinic and the Fellsmere Clinic. -
The Board of Directors of Indian River Memorial Hospital, Inc.
who manage the hospital and set up the operating policies consists
of 13 members:
3 are appointed by the Hospital District Board of Trustees
3 are appointed by the IRMH, Inc. Board of Directors
3 are elected by the members of the Hospital Foundation
(members who have contributed over $5 a year)
4 ex -officio members:
Chief of Staff
Vice Chief of Staff
1 member of the medical staff who is elected by the members
of the medical staff
President of IRMH, Inc., (Michael O'Grady)
In response to a question by Commissioner Macht, Attorney
Polackwich noted that the contract between the Hospital District
and IRMH, Inc. requires that the Hospital District comply with the
Sunshine Law and Public Records Act separate and apart from the
contractual agreement. There is the question of whether they are
required anyway, as a matter of law, to meet the Sunshine Law and
the Public Records Act. There is an Attorney General's opinion on
that says that depends on how much public function the Inc. Board
does. Attorney Polackwich explained -that over the years, he and
Bill Stewart, attorney for the IRMH, Inc. Board of Directors, have
disagreed on this issue. He believed they are subject to the
Sunshine Law and Public Records Act separate and apart from the
contract. However, he did not believe they are required to comply
with the financial disclosure laws.
Commissioner Macht wondered if that should be part of the
contract since so many of the physicians hold stock in competing
companies such as the Surgery Center. There is a question of
ethics if they are voting on behalf of the hospital at the same
time they have common stock in competing companies like
laboratories to which they refer patients. Commissioner Macht
believed financial disclosure should be required and that the
matter should be part of the renegotiation of the contract.
Mrs. Ingram expressed the Trustees' appreciation of the
support from the public. She has been on the Board of Trustees for
12 years, and there are so many good programs, preventive programs,
that keep people out of the hospital and save the taxpayers' money.
She urged people to attend the Hospital District Board of Trustees
regular meetings because she felt it is very important that they
understand and hear what is being done and not get caught up in one
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MARCH 21, 1996
BOOK 97 PAGE 66 7
A
FOOK �.4�7 P.,kU 658
negative situation. When you get one negative situation, you
forget about all the positive things that are going on in this
Hospital District. Mrs. Ingram emphasized that there have been
many changes made because of public input.
Joyce Smith noted that with regard to financial disclosure
they have started using the financial form the County uses in
qualifying requests for funds from various nonprofit organizations.
The packet that is given out has a lot of financial disclosure and
will help them make decisions on requests for programs by
determining where the money is going and how they want to use it.
Doctor Broadus Sowell related that he served on the Hospital
District Board of Trustees back when they operated the hospital and
it was not satisfactory. He wished to read the following statement
into the Record:
S.
F. Sowell
Statement.
congratulate the Board of County Commissioners for arranging
t;.is meeting.. I have been frustrated with the manner in which
�o;tplaints concerning the relationship between the Indian River
County Hospital District and Indian River Memorial Hospital, Inc.
:.ave been handled and are being handled. The two boards seem
disinclined to make substantive change in the contract that would
restore taxpayers, through their elected District Board
representatives, a greater voice in Hospital policy and expenditure
of money. Amendments to the original contract added to .the
Hospital's advantage and some cost the taxpayers hundreds;': of
thousands of dollars. An example is amendment four that relieved
the hospital from its obligation to complete repayment of the 1973
and 1975 bonds and interest before it made a single payment.,
The contract.--, between the District and Hospital gave.the
hospital almost:`complete control of operations and _left the
District little;,power except to act as the ultimate guarantor IQf
Hospital revenue bonds and the payor of costs over which.had.no
control. The District was left essentially unable to changejItha.ngs.
with which it :disagreed. If it disagreed. The;; agreement to ;pay':
the Hospital 95% -of :charges for indigent patients was -.-fair iri' 1`985
but became outmoded with changes that brought av6rage;collec ris'.
from most' other":payers down to approximately 50% of charges; th
medicare and medicaid paying even .Less.
It has only' -been within the past two years that- either the.
District or Hospital showed an inclination to*. change t�iatA
arrangement. Instead, both floundered around looking for a=way to
change the public's perception of the contract while -`leaving the
95% payment of charges intact: The current discussions:: -between .he'
two boards appear aimed at the minimum changes necessary t0,cbmply.
with state law rather than restoring meaningful control -to the
Cistrict.
C
MARCH 21, 1996
-I
Especially pernicious and costly to the taxpayers is the
restrictive covenant between District and Hospital that prohibits
District from obtaining equal but less expensive care for qualified
indigent patients other than at Indian River Memorial Hospital. If
t'he restrictive covenant did not exist, economic pressures might
force the hospital to lower its rates.
I hope this meeting produces meaningful and satisfactory.'
results.__ it doesn't I foresee a groundswell of anger among
`rurtratad cltizens that will force changes which may not be in-the
nest interest of those who live in Indian River County and .use
Indian River Memorial Hospital.
The audience applauded after Dr. Sowell finished reading his
statement.
Mrs. Ingram recalled that at the time the District determined
to pay 95% of the costs for indigent care, it seemed the
appropriate thing to do. Today, however, it is not the right thing
to do, which is why we are revisiting the contract.
Rev. Lord . pointed out that both Boards need to understand that
the reimbursement rate needs to be changed. They are addressing
that and they expect to.have some sort of agreement within a couple
of months.
Commissioner Macht felt the reason for the public's concern
about the bonuses was rolled up into the concern about the cost of
indigent care -when the hospital is making a profit.
Mr. Montuoro advised that matter will be addressed at
tonight's meeting of the Hospital District Board of Trustees. They
have been paying too much and he didn't believe that indigent care
should be contributing to the profit. Somebody has to pay for it,
however. We are blessed to have an excellent hospital with an
excellent staff in our community.
Commissioner Macht asked why the contract says nonprofit, and
Attorney Polackwich_understood that back in 1984 it.primarily-was
to allow some for profit subsidiaries in the hospital, such as the
bill collection operation.
Commissioner Macht felt that Item #4 on the Agenda has been
all rolled up into Items 2 and 3.
In response to Chairman Adams' inquiry, Mr. Montuoro agreed
to the Chairman opening the meeting to public input if people keep
7
MARCH 21 1996 BOOK 97 PAGF.669
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BOOK 97 PAGF. 6 d 0
to the subject at hand, which is the Hospital District Board of
Trustees and their relationship to the IRMH, Inc. Board of
Directors.
Ital Veron, 280 Peppertree Drive, Indian River Shores, felt
this joint meeting is a wonderful thing. However, he felt we
should keep in mind that these problems started years ago. In the
last 10 years the rate at the hospital has quadrupled resulting in
an increase to the taxpayers of 12.7%, which is a lot of money. No
one wants to see anything but quality care for everyone in this
county, including indigents, but they do not believe it is being
provided at the very lowest cost. They do believe that a great
deal of erosion has happened on the District Board over the years.
It seemed to him that the Inc. Board of Directors is calling the
shots. He felt that all of the changes suggested by Commissioner
Macht should be considered, such as making the IRMH, Inc. Board of
Directors an advisory board only.
Alan Seed, 200 N. Camelia Ct., a financial consultant,
announced that he is filing tomorrow to run for a seat on the
Hospital District Board of Trustees. With regard to judgment on
the Everglades Memorial Hospital case, he felt sufficient control
involves decision making, authority and power. His recommendation '
would be to renegotiate the lease or replace it with either a new
lease or a purchase/sale agreement which does have control
mechanisms embodied in it. The renegotiated document should
include budgetary approval of general rate increases and indigent
care reimbursement rate. Mr. Seed pointed out that in the past,
the IRMH, Inc. Board of Directors has told the Board of Trustees
what the deal is going to be. It should be that the Trustees tell
the Inc. Board what the deal is going to be because it is the
Hospital District Board of Trustees that represents the public's
interest. To that end, Mr. Seed wanted to see the hospital
returned back to the public sector and not see it operated with the
primary goal of making money so that they amass $6 million. He
wanted to get the hospital back so that they are providing medical
excellence at the lowest feasible cost to the patient and the
taxpayer.
Ailf Wood, 5151 AIA, felt that this meeting materialized due
to concerns voiced by the public for the last couple of years
regarding excessive bonuses, salaries, hospital costs and rates for
indigent care costs. These things have had an effect on the
taxpayers.
8
MARCH 21, 1996
IRMH is an expensive hospital, but it is not rated very highly in
comparison to other hospitals in the state.
Tom Buchanan, a resident of the Moorings, questioned why 3
members of the Board of Directors of IRMH, Inc. are elected by 3000 _
members of the Hospital Foundation who only have to contribute over
$5 a year to vote. Mr. Buchanan stated that he resented Margaret
Ingram's statement that she resented getting flack from the public.
This is the first time he could remember the Hospital District
Board of Trustees meeting with the public like this.
Mrs. Ingram felt that Mr. Buchanan must have misunderstood her
statement about the public being confused about which board is the
trustee board. She appreciated this opportunity to clear the air.
Mr. Buchanan emphasized that he supports a two -term limit for
trustees.
Sam Alia, resident of Vista Royale and a county resident for
18 years, believed that the public is concerned about the profit
that is being made by the hospital. They know that the hospital is
paid 60% from Medicare, but they are told by our legislators that
Medicare is going broke.
Mr. Montuoro explained that Medicare and Medicaid monies and
policies are a national problem, not a local problem.
Mr. Alia felt we could change that by starting in our own
backyard by being fair at our local hospital. If it is classified
as a nonprofit hospital, then it should be a nonprofit hospital.
If the hospital is making a profit, they should pay more for
indigent care. If the taxpayers are paying for indigent care,
there should not be excessive bonuses and salaries. He wondered if
there should be a another meeting with the IRMH, Inc. Board of
Directors to address these concerns.
Mr. Montuoro responded with "no." He advised that the
Hospital District Board of Trustees meets every month and the
public is welcome to attend and tell them what they think. In
fact, there is a meeting this evening at 5:15 p.m. at the hospital.
The next meeting of the Board of Directors of IRMH,. Inc. is next
Wednesday, March 27, 1996, at 4:30 p.m. in the 1st Floor Board Room
at the hospital.
Mr. Alia also raised the issue of the hospital's low ratings
in a report that came out recently, but Attorney Polackwich
explained that report was based only on billing. It didn't get
into the quality of care, and people shouldn't interpret it that
way.
FOOK 9 7 PAf,'F D
9
MARCH 21, 1996
David Gregg, 2116 South Porpoise Point Lane, county resident
for 26 years, admired both Boards for getting together today and
listening to public input. He understood that the elected Board of
Trustees represents approximately 130,000 people in Indian River
County, but from what he has heard today, he feels the Board of
Trustees is not doing that effectively. The people are upset with
the bonuses that were paid because when they go into Emergency at
IRMH, the average person comes out with a bill of $1200. He urged
the Board of Trustees to use their influence and authority to get
some things done and done very quickly, say 6 to 8 months from now.
Mr. Gregg did not understand why the Hospital District paid for the
1974-75 bonds, and pointed to Mrs. Ingram, saying that she may have
been a trustee for 12 years, but these problems have been brewing
for a long time.
Mr. Montuoro explained that the bonds issued in 1974-75 were
switched back from IRMH, Inc. to the Hospital Taxing District with
the philosophy that those bonds were issued to build the new
hospital and the taxpayers had voted for it. Mr. Montuoro
emphasized that those bonds are the only bonds the hospital has and
they will be paid off in the next two years. All the rest are
industrial revenue bonds.
Mr. Gregg asked why the Hospital Taxing District should pay `
for the bonds when the hospital is leased to IRMH, Inc.
Dr. Sowell noted that is one of the things that concerned him
and one of the reasons he is sitting on this board. In the
contract between the District and the hospital, the hospital was to
assume servicing of those bonds from 1990 on, but before a single
payment was made, Amendment #4 brought that back to the Hospital
Taxing District trustees (taxpayers) to continue paying for that.
When that debt is paid off, it will be $2 million to the taxpayers.
Part of the rationale is listed in the amendment, and it had to do
with the improvements that the hospital would make on its
facilities being diverted to the District at the end of the lease
in 2010. Dr. Sowell happened to believe that it is unfair and will
be unfair until it is over. That is type of thing that has been
going on in these negotiations over the past 10 years and sometimes
with little notice to the public.
Lou Buck, chairman of the steering committee called COAC, an
alliance of the local chapter of AARP, the Civic Association and
the Taxpayers Association, stated that as such he represents
several hundred people who feel that the taxpayers should have more
representation through the Board of Trustees. They feel that the
Board of Trustees sometimes loses sight of what they should be
10
MARCH 21, 1996
doing. They question whether control is in the right place and
question the amount of indigent care costs coming out of taxpayers'
pockets. Mr. Buck believed that something good will come out of
this meeting and advised that their group is certainly going to
monitor the negotiations between the Board of Trustees and the
Board of Directors of IRMH, Inc. in an effort to get more control
and authority back to the taxpayers.
Richard Minetti, 1126 54th Avenue, asked what is going to
happen as a result of this meeting and whether another meeting will
be held to report back to the people.
Mr. Montuoro responded negatively.
Rev. Lord advised that the Board of Trustees is in
negotiations with regard to reimbursement for the hospital indigent
care. That is underway; that is going to happen. Our attorney has
studied in depth about the changes we need to make in order to
exercise more control. we just received information this past
week, and we are going to be talking about that tonight and at
future meetings. So, negotiations are in process on two of the
items listed on today's agenda. Control of budgetary matters will
be on the table. Major capital improvements have to be approved by
the Board of Trustees.
Chairman Adams pointed out that this is just a workshop
meeting and the 4 items on the Agenda have been discussed.
Dr. Sowell announced that the liaison committee meetings will
be held at the hospital on the second Monday of each month at 5:15
p.m. Ordinarily, the liaison committee meets every other month,
but will meet monthly during these renegotiation meetings.
Commissioner Macht pointed out that a provision in the
contract gives the IRMH, Inc. Board of Directors the right to
assign the contract and all rights contained therein, to a
nonprofit hospital operator. That seemed very undesirable to him.
Attorney Polackwich believed that first would have to come to
the Board of Trustees for approval, but Commissioner Macht pointed
out that it doesn't say so.
Attorney Polackwich knew that the one time they wanted to put
a project over on a small piece of land ..... but Commissioner
Macht interjected that he understood that they are negotiating to
do that very thing, or at least part of it, with an organization
called Health First.
11 BOOK 7 PArjF 6 -'-
MARCH
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MARCH 21, 1996
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BOOK 97 PAGE 674
4
Chairman Adams suggested that we continue with public input
while Attorney Polackwich looks that up in his papers.
With the aid of the overhead projector, Richard Aldrich, 1516
E. Camino Del Rio, displayed a chart showing the difference in the
range of rates charged to various groups:
_ ALAN SEED H RICHARD ALDRICH
INDIAN RIVER MEMORIAL HOSPITAL
VERO BEACH, FL
INDIGENT CARE ANNUAL COST PROJECTIONS
WHAT MANAGEMENT IS NOT TELLING US
• ASSUME 2500 PATIENT DAYS IN THE 96-97 FISCAL YEAR.
r
• ASSUME THE 1994 DAILY PAYMENTS BY 3RD PARTIES (CURRENT AVAILABLE DATA).
• FIGURE THE ANNUAL INDIGENT CARE COSTS AT SIMILAR DAILY RATES.
MMkM*�#�#�#7R*�$cx�aM��*�KIk�kk�k+k�k�k�k�k�k�k7lc�c�k�k�kk�k�kk�k�kkk�k�k�k�kk�k�k�kik�kkyt�lc�t�ckk�k#k�kk�k�k�kkkk�k:`kkkkk+k�kXc�kk
DAELY MATE
ANNUAL $ EXCESS > MEDICAID
$2200
CURRENT 95% OF CHARGES RATE
$5.50 MM
$1270
PROPOSED ANNUAL PLAN 03/96
$3.175 MM
e :200
DISTRICT BOARD OF TRUSTEES
$3.00 MM
$1020
APPROXIMATE COLLECTED CHARGES
$2.55 MM
$930
AVERAGE IR COUNTY NEGOTIATED RATE
$2.33 MM
$872
MEDICARE
$2.18 MM
$8.50
MANAGED CARE (HMO)
$2.13 MM
$571
SEBASTIAN HOSPITAL (WILL ACCEPT)
$1.43 MM
$4.07 MM EXTRA
$1.75 MM EXTRA
$1.57 MM EXTRA
$1.12 MM EXTRA
$0.90 MM EXTRA
$0.75 MM EXTRA
- $0.70 MM EXTRA
$0000 EXTRA
$571 MEDICAID $1.43 MM $(0X)0 EXTRA
12
MARCH 21, 1996
M M
Mr. Aldrich pointed out that the Board of Trustees has missed
the fact that for the last 3-5 years the hospital has been taking
extra profits. He calculated that the hospital's break even point
is a little under $800 a day and under the concept of cost
shifting,_ there would not be a cost shift as long as the number is
at least $800. He suggested that there are other ways that the
hospital could reduce costs.
Rev. Lord asked for copies of the chart because it was hard to
see up on the screen, and Mr. Aldrich made copies available.
Bill Koolage, resident of Vista Gardens and former member of
the Board of Trustees of the Hospital District, felt that from an
organization concept the formation of these two boards
defeats anything you might do under good management principles. He
was disappointed that the Board of Trustees have not shown much
sympathy with what has been presented today. He recalled that when
the liaison committee began, he gave up on it because the chairman
of that committee was the president of the hospital. Mr. Koolage
also recalled that the hospital took over the state levy because
the hospital people said that was all part of indigent care. Mr.
Koolage stressed that all management principles tell you that the
way it is set up at present is wrong and that the years have proven
that to be true.
Al Valardi, resident of Sebastian, stated that he represents
members of Citizens Aware who feel that the price being paid for
indigent care is outrageous. Mr. Valardi wanted to know the
definition of a nonprofit organization, and asked if it is a
private organization that can spend money any way it wants to. He
felt people have a misconception of a nonprofit organization and
are concerned about the way the hospital has been spending its
profits.
Trustee Joyce Smith advised that she made a proposal at last
month's meeting that the Board of Trustees take all the tax away
from the citizens of the Hospital Taxing. District and bring those
two boards together into one board. If that was done, we would not
have to change very much. We wouldn't even have to change the
special act and the citizens of this county would own a purely not
for profit hospital. She felt the hospital could do that. Mrs.
Smith's comments were followed by applause.
Trustee Beverly O'Neil understood that people are saying that
the cost of indigent care could be spread across the citizens of
�+
MARCH 21, 1996 13 BOOK 7 PAGE 5'
I
I
BooK 97 urF 616
the community, and she commended the community's continued support
for that. She admitted that while she has been a member of the
Board of Trustees, her concentration has been more on preventive
and primary health programs to reduce the need for hospital
admittance, thereby reducing taxes. Mrs. Smith thanked the
public for their input and hoped this last year of her term will be
a productive one. They plan on opening a clinic in Gifford and are
..looking at opening one in the south county. She emphasized that
if the law says that we need to take control of the hospital, we
will do so.
Chairman Adams believed there has been very good bonding this
afternoon. The County Commissioners have received many phone calls
from people in the community who are concerned and every problem in
the community has to be the concern of the Board of County
Commissioners. She hoped that this is not the last of the
workshops and that there always will be an open door. Chairman
Adams noted that Duncan Chalmers, a former member of the Hospital
District Board of Trustees, is here today and that it is good to
see his continued interest in the community.
Mr. Montuoro thanked everyone for coming today and gave
assurance that the Trustees will take the public's recommendations,
suggestions and concerns to heart and try to do a better job.
Commissioner Tippin recalled that he was the third baby to be
born in the hospital started by Garnett Reed. Many people have a
close feeling to that hospital because of births, deaths, etc., and
it is very important for the Board of Trustees to realize that.
Whether or not it is in your by-laws to comply with the Sunshine
Law, you must do that. It is important that the IRMH, Inc. Board
of Directors realize that, too. If you are in a public position,
and you are, you have to let it all hang out whether you like it or
not. With better communication and working together, we will have
much more peace of mind.
Commissioner Eggert and Mrs. O'Neil had hoped that there would
be another workshop on the various health programs before the
budgets are finalized so that people could understand the
interaction between the Hospital District, the County, and the
Health Department.
Mrs. O'Neil believed that all changes taking place in health
care today should be based on the following statements: That
principles ultimately govern, not values, and we should value
principles. The future belongs to those who learn to live
14
MARCH 21, 1996
interdependently and not independently. The key to change must
come from inside out and not outside in."
There being no further business, Chairman Adams adjourned the
-
meeting at 3:45 p.m.
ATTEST:
<::)—� Q�' 'p, '-" 'q
J. arton, Clerk Fran B. Adams, Chairman
Minutes approved
15 nog 97 PAGE. 677
MARCH 21, 1996