BOARD MEETING: Regular Meeting   DATE: April 25, 2017     MEMBERS PRESENT: Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Patricia White   MEMBERS ABSENT: Helen Adger    TIME CALLED TO ORDER: 5:30 p.m. OTHERS PRESENT: David Jones, CEO, Pam Hughes, COO, Dakota Robinson, Controller, Lanell Audirsch, Admin. Asst., Mary Coil, Foundation Director/Marketing Director, John Woods, Chief of Staff, Todd Hopkins, Caddo Parish Commission Clerk, Erica Bryant, Caddo Parish Commission Director of Finance and Human Resources, Krystle Grindley, Chris Davis, Security           LOCATION: NCMC Events Center BOARD CHAIRMAN: Robert Green   SECRETARY:

David Jones   I. Called to Order   Robert T. Green, Jr – Chairperson, called the meeting to order. II. Invocation and Pledge of Allegiance –Helen Godfrey-Smith offered the Invocation and Brenda Smith led the group in the Pledge of Allegiance.   III. Approval / Amend Agenda –Robert Green stated that the first item on the agenda is to approve or amend the agenda.   Pat White made a motion to approve the agenda as presented. Brenda Smith seconded the motion. The vote: yeas: Robert T. Green, Jr., Pat White, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker; Nays: None; Absent: Helen Adger, Kenneth Clay, Abstained: None. The motion passed.   IV. Community Comments –Robert Green, Chairperson, noted there were no signed Visitor Recognition Cards requesting to address the Board.   V. Minutes – Regular Meeting March 28, 2017 –The minutes of the March 28, 2017 Regular Board meeting were mailed prior to today’s meeting for review. Brenda Smith made a motion to approve the minutes of the regular meeting as mailed. Helen Godfrey-Smith seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker; Nays: None; Absent: Helen Adger, Kenneth Clay, Abstained: None. The motion passed.   VI. Presentation By The Caddo Parish Commission Regarding Caddo Parish Renewals And Rededication Election To Be Held On April 29, 2017 – Todd Hopkins, Caddo Parish Commission Clerk, introduced Krystle Grindley, the Caddo Parish Commission Public Information Officer, Erica Bryant, the Caddo Parish Commission Director of Finance and Human Resources, to the Board. He noted that they had a short presentation for the Board regarding the Caddo Parish Commission Renewals and Rededication Election set to be held on April 29, 2017. He stated they will show a short film and afterwards if there are any questions they will be happy to answer them. Krystle Grindley noted that Doug Dominick was planning to attend the meeting tonight, however, he had to travel out of town and he is deeply sorry he was unable to make it today. Krystle Grindley said the short video is to explain what is on the ballot for the election with more information about the millages and what they mean for Caddo Parish. If you have any questions, she and Erica Bryant are to answer those questions. Due to a technical malfunction, they were unable to show the film. Krystle noted you could go to the Caddo Parish Commission website and there is a link that is millage renewal information and you can find all the information about voting, the millages with a link to the video and a link to the push card she provided to the Board. Erica Bryant stated there are five items on the ballot. She noted these are all renewals – they are not new taxes. Item #1 – .83 millage for Public Facilities and Recreation – used for maintaining and operating parks and recreational facilities like Earl Williamson Park; public road systems, garbage disposal and industrial waste programs, surface water drains and drainage facilities. #2 – .87 millage for Public Health – Maintaining and operating public health units, mosquito and rodent control units, and animal control facilities. #3 – 1.967 millage for Juvenile Court and Juvenile Detention. Maintaining, equipping and operating the Juvenile Court and Detention facilities. #4 – 2.72 millage for Courthouse and Parish Buildings – Maintaining, equipping and operating Parish Courthouse and ancillary offices. #5 – 1.5% Sales Tax (excludes voters within the city limits of Shreveport and Vivian) Purpose of Rededication: Authorizes the Caddo Parish Commission to rededicate the proceeds from a 1% road sales tax and a .5% solid waste sales tax to be used for roads, bridges, drainage, solid waste, water and sewer infrastructure. They want to combine these so they can be used for both purposes. These renewals are for 10 years from the date of expiration. The millage rate for 2015 totaled 28.83. We decreased this to 28.60 and with these renewals we will maintain these at 28.60. She noted that #1 – Parks and recreation expires in 2018. The election had to be called this year for that millage. In an effort to save money we added the other items that were close in proximity of expiration since an election had to be called anyway. That is the reason the other items are on the ballot so we would not have to come back in two years to have another election. This would have meant an election in 2019, 2020 and 2021. To avoid the costly elections, these were all put on this ballot. #2 – Public Health expires 2020, #3 – Juvenile Court and Juvenile Detention expires in 2021 and #4 – Courthouse and Parish Buildings expires 2021. Helen Godfrey-Smith inquired when these are approved, will this extend these millages. Erica Bryant noted that they are asking to renew for 10 years and would be extended through 2030. Bruce Walker inquired why Vivian and Shreveport aren’t included in the sales tax. Ms. Bryant stated when we originally authorized the sales tax, Vivian and Shreveport did not participate; it was held outside of the cities. In order to encompass Vivian, they would have to have an election in Vivian and that has not been pursued. At that time there was still Federal funding coming to small towns. They had their own public works department and wanted to be separate at that time. The smaller towns did not have that. Pat White inquire about the expiration dates. There are various expiration dates and they cycle is every five years. If renewed, it will be from the date of expiration. The Board extended their appreciation to Todd Hopkins, Erica Bryant and Krystle Grindley for their presentation and information.     VII. Old Business: 1) Construction Update – Pam Hughes reported that they have started on the other side of the parking lot. They are about on grade now. They will start curbing and guttering tomorrow if there is not bad weather. The front looks great. They are going to do the floor next week. They are painting and the ceiling is up. The water wall is supposed to be received in a couple of weeks. The gift shop is almost completed. The chapel is looking very good – wallpapering and flooring. The upstairs – they have come in to the nurses’ station to put in the windows where the stairs were – the fire escape. They need to clean up and do some last minute work on it. The curbing and guttering may take three weeks, without rain, then they will come in and pave it. The fountain is going. It is hooked up and the dirt. There are fill areas that need to be filled with dirt. They will come back and put in the hydro mulch. Bruce Walker asked about the side panels that were removed at the fire escape. David Jones noted that those were temporary fire escapes and will be gone. Pam Hughes noted they are putting the panels on the porte-cochere. David Jones noted there are very few areas that do not have the panels. Pam Hughes stated that they will take off the other fire escape and put that door in.        David Jones stated that Billie Goodson has donated some things for the gift shop and for the chapel. There was the huge retirement last year with Dr. Haynes and this year there are more retirement parties. There are two more department heads – Billie Goodson is to retire in May. Mrs. Goodson is a unique individual. James Martin retires in August – this is a massive loss. What he knows, who he knows and how he knows is incredible. He deserves to have some rest and relaxation. Then another long- time employee, Kathy Moore, who works in the Lab, will also retire. We have lost quite a bit and are losing more. We will try to fill those positions and hope to fill them well. That is the cycle of everything.        The construction is coming to an end for the most part. We will plan a huge grand opening once we actually have ability to guestimate within a couple of weeks of completion. It has been almost four years coming.     2) Dialysis Clinic Partnership Update– David Jones reported that all the changes to the contract that Doug White has made has been sent to the project head. He in turn has forwarded it to the heads of Fresenius to review. This is a big company and won’t happen overnight. This will possibly be completed in the next couple of weeks. He and Pam went to tour a facility that this man has built. It was done very nicely. We are hoping to have the same type building here. The corner lot is clean and ready for construction. 3) Tribridge Financial Upgrade Update – Dakota Robinson reported that it was supposed to go live this Friday, however, IT notified them that there was some malware that somebody had placed on a server. Unfortunately, that took down the work that they had done on the upgraded server, so they are having to start over. David Jones stated, interestingly enough, someone created a bitcoin maker on our server. Dr. Woods stated that there have been a few hospitals that the hackers have seized their records and the hackers ransomed their records. David Jones said, of course, that had delayed our go live date for our financial upgrade. Dakota Robinson said they were thinking maybe three to four weeks. That is if depending on if everything is set up correctly. David Jones noted that this is our financial software. This bills everything that we do in the hospital. We can’t have hiccups in that type software. We will not go live until it is correct. This is our delay – not Tribridge. Dakota Robinson stated that we do carry insurance on those type things. In our insurance policy there is a portion that is software related. VIII. 1)            Review March 2017 Statistics – Allyson Allums –   David Jones noted that Allyson Allums is not present tonight due to a personal tragedy. Dakota Robinson, Financial Controller, has stepped in to present the March Statistical Report. There were 65 Admissions and 66 Discharges with Total Days Stayed –238. The Average Length of Stay – 3.6 Days. Total In-patient Days – 220. The average Daily Census – 7.1. Our Total Occupancy Rate was 47.30%. Total Surgeries for March (In-patient – 1 / Outpatient – 2). Endoscopies performed in March –   12. The total Emergency Room patients seen – 551. Swing Bed Admission – 10. There were 150 Total E.M.S. runs in March. Observation Patients for March- 41. There were 4 Newborns in March. The total Patient Visits for the Medical & Surgical Clinic is 2086. The Plain Dealing Clinic saw 807. Benton Medical saw 163; their highest to date. There were 18 Mammograms for March. 2)            Review March 2016 Financials – Allyson Allums – Dakota Robinson presented the Financials. Hospital Revenue over Expense. Revenue –$3,550,000, Expense – $1,988,000 with a loss of $297,000. The AR Days for all three facilities – 45; for the hospital only is at 44.8 days. Plain Dealing Clinic – Revenue over Expense. Revenue –$180,231, Expense – $91,473 with a profit of $24,960. Medical and Surgical Clinic – Revenue over Expense. Revenue – $536,770 Expense – $263,480 with a profit of $52,899. Benton Clinic – Revenue over Expense. Revenue –$45,135 Expense – $20,388 with a loss of $5,577. The Bad Debt Expense is at 2.2%. Days cash on hand fell slightly – 24.00 days. Self-Funded Insurance – still doing well in comparison to the previous year. For this month we at $687,000 for the year. Last year at this time we were at $720,000. The aggregate cost of those The total expense was $120,000 for this month and the specific reimbursement, for any claim over $50,000, we only had $899. That will change next month. We had several large claims – probably close to $200,000. We will get a portion of that back in the following month. He will add a 340B slide so you will be able to track the 340B program that went live April 11th. No hiccups so far. Walmart holds their claims for 14 days. We don’t see anything for that period of time. They are the main pharmacy here in town. In less than 2 weeks, the program has brought in $12,000. That is after expenses have been cleared and fees have been paid to the respective pharmacies. We netted $12,000 in less than two weeks.     Pat White made a motion to accept the Statistical and Financial Reports as presented pending the audit. Brenda Smith seconded the motion.      Brenda Smith inquired if the numbers for Plain Dealing were the highest they have had. David Jones replied no. It is pretty close. The new Nurse Practitioner is doing an excellent job. She is outstanding. She has been in this area for the most of her life. She has the right work ethic and attitude that brings success. Her knowledge base is top notch.       Brenda Smith also inquired about the Benton Clinic having a different reimbursement to the other clinics. Where are we on finding out? David Jones noted that we have been told that we are eligible to make that a rural health clinic. We are in the process of making it a rural health clinic. That can take upwards of six to nine months. That being said, our PA there has tendered her resignation. We have interviewed a Nurse Practitioner that lives in Benton and currently working in Coushatta. We have high hopes for her as well. He needs the contract committee to review the contract to make an offer. He feels this individual has the personality to build a clinic relationship with the patients to grow the patient base.        The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker; Nays: None; Absent: Helen Adger, Abstained: None. The motion passed.       IX. New Business: 1) Approval of Surplus Equipment List –David Jones stated the Surplus Equipment List should have been in the Board mail-out packets for review. This will need to be published in the official journal for the appropriate time frame for sealed bids. The last few surplus equipment lists that were put out, most everything was bought. The twelve years he has been here, the last four or five, is the first time that has happened. We need the Board’s approval to put it out for public bid.      Pat White made a motion to approve the Surplus Equipment List as submitted. Mary Irvin seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker; Nays: None; Absent: Helen Adger, Abstained: None. The motion passed.       The Surplus Equipment List will be published in the Official Journal, the Caddo Citizen, for the appropriate time frame for public bid.       2) Approval of Meaningful Use Upgrade – David Jones requested this item be tabled until the next meeting. Allyson Allums is the head of the Financial Department and has all the pertinent information to be presented. If this is an issue the Board will be contacted. We were being proactive to get that piece of software to get Meaningful Use Stage #3. That is that last stage of Meaningful Use. Once we get that, the Meaningful Use requirements go away. That is for the $1.4 million dollars to pay for our computer system. These are hoops we must jump through.     Pat White made a motion to table the approval of the Meaningful use Upgrade. Kenneth Clay seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker; Nays: None; Absent: Helen Adger, Abstained: None. The motion passed.       3) Discussion of Radiology and ER Expansion– David Jones stated as of right now, we are somewhere in the $1.3 – $2 million dollars under budget for the construction of the replacement hospital, which is North Caddo Medical Center. We are currently underway in a project to purchase an MRI unit with help from our Foundation. That being the case, there is no place to put that unit. We had talked about expanding the hospital out to house the unit itself. What he is asking permission for is to go forward with seeking out bids for that expansion. We’ve got TEG, who was the architect for the building, gave us some preliminary drawings that they could not only expand out one of the back doors of the hospital. Once you open it up and go into that you are in the middle of the Radiology. Basically they will add to the building right there at that door. This is one of the things, when we all sat down and designed the building, the ER is set to expand where the drive through is. Radiology is set to expand. Everything but the Laboratory is built to expand in one shape, form or fashion because the Laboratory is in the middle of the building. The preliminary drawings from what TEG has thrown out there would put us still within budget of the total cost of our bonds we have for our hospital. That is not to say that once we put out to bid it may come in way over that. We may not be able to do this. He is asking for permission to put this project out for bid to see how much this is actually going to cost then come back and decide if we want to do this or not. To get the MRI, we will have to build something to put it in anyway. When they did the preliminary plans they also figured out a way to give the Emergency Room two more rooms without expanding brick and mortar out any. To keep cost down to the point to where it is still doable. We think we think we can get in within that $1.3 million dollars. We won’t know that until it goes out to bid and they bid on it and they tell us how much it is going to be. It will be a one story, one large room that will hold the MRI unit. They will build out just a little bit, move Ultrasound from where it is; flip Ultrasound and make it into an ER Room. There is an office that is in the Emergency Room right now that will be converted into a patient room as well. It will go from 4 to 6 rooms in the Emergency Room. Long term wise, we are going to have to expand the Emergency Room. It may be 12, 36 or 60 months; but sooner or later Dr. Woods is going to put his hands up and say we can’t do anymore without more rooms. Hopefully that will be a very short time frame that we will have to come back to do that. It is what we have – we built what we could. Most of that money has come from equipment shortfalls that we didn’t need that was budgeted for. Those kind of things have been watched closely by Pam Hughes. The additional times spent by the contractor has not cost us. We have talked to the USDA about this and they are completely okay with this. USDA made note of the money available and if you need to expand. We said we have an MRI project that is going on and they said that would be a good use. We don’t know what it is going to cost yet. We need to push forward to see exactly how much it is going to cost to see if we have the money or not.        Robert Green inquired if David Jones wanted a motion carried to give him the leave way to go put out to bid to see what the cost would be. David Jones replied yes.    David Norman made a motion to grant David Jones permission to put the Radiology and ER Expansion out to bid to see how much it will cost to determine whether to move forward. Bruce Walker seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker. Nays: None; Absent: Helen Adger, Abstained: None The motion passed.           Brenda Smith asked Dr. Woods how it is working now in the Emergency Room where you actually have separate rooms and not just a curtain between beds. Dr. Woods replied it is so much better. He stated you have to give patients their privacy. It was very difficult to do with just a curtain. Patients like it. These are large rooms, but the government mandates the large trash cans and other equipment, then a large room is back to feeling like a smaller room again. Dr. Woods stated it is definitely well designed and very useful. Dr. Woods said the employees like the lights to be dim in the rooms. Brenda Smith stated, according to statistics, they have been pretty busy in the Emergency Room. Dr. Woods said they are already in the process to streamlining common procedures to cut down on costs and make it a lot quicker to patients in and out. They now have Lisa Stewart, RN, Assistant DON, manning things now and that has been a tremendous help. Since they have segregated themselves as an independent department, it has really helped a lot. Brenda Smith thanked Dr. Woods for the information.       IX. Administrative Report: 1) NCMC – Current Activities – David Jones said he wanted to inform the Board that he, Dr. Woods, Dr. McCommon and Allyson Allums went to a Physician Leadership Conference this past weekend. This if the first Physician Conference he has strongly encouraged the doctors into going. It did disrupt their workweek and away from their personal lives. We wanted it to be a good workshop. He has lost his faith in workshops after bad experiences. He will have Dr. Woods speak on it. David Jones stated that the session he attended was outstanding. Dr. McCommon was wowed on the session she attended. Allyson Allums attended a credentialing session that she obtained good information. David Jones stated that all the heartache they have had in the last six years could have been totally been fixed and solved had our bylaws said what they needed to say and what they say now. There are still some things that need to be tweaked and adjusted and we need peer reviews. If we had these in place, it is black and white – rules in place. We are not the only hospital that have these needs. Dr. Woods inquired about an age policy in one of the session. There was from 100 to 150 physicians at this conference. He expected to see more administrative opposed to physicians. This is where the future of healthcare is going – active medical staffs.        David Jones wanted to inform the Board that he had a formal meeting with Mr. Jim Elrod at Willis Knighton about a month and one half ago. He meant to report this at the last Board meeting but forgot to. It was a two hour meeting. It was very good and very solid. Mr. Elrod personally asked him to portray this message to the Medical Staff and the Board. He understood all the decisions that have been made and he fully supports all the decisions that have been made over the last six months here. He understands they were tough decisions and sometimes when tough decisions are made people’s feelings get hurt. He is 110% behind the Board and the Medical Staff. He ask David Jones to verbalize this to the Board. It was a very good meeting.        We do have Hospital Week coming up here in the next week or so. If any of the Board can make any of the festivities, please do. The employees always love to see the Board members when they come. It is good to have the Board members to participate. Board members requested they be given notification of the times in order to plan to be here. Mary Coil noted that it will be the week of May 8th through May 12th. At this time she was unable to tell them exactly what activities would be each day but she will let them know. It is a National Hospital Week.   2) Infection Control Committee Report – David Jones noted that the Infection Control Committee will not be presented tonight. That will be changed to another report for the next meeting. He has not made that decision as of yet. There will be more of these forth coming. He said they were planning to have Dakota Robinson to do a 340B report, however, he didn’t want him to at this time because he wanted we feel that there’s going to be some “wow’s” in the next four or five months when it comes to this program. He wants to bask in the glory of it whenever it does happen. Honestly, this is Dakota’s project that he has spearheaded with our Pharmacist, and the two of them have been working diligently on this and have been doing an outstanding job. He wanted Dakota to “wow” you when he does give this report. This is going to be a good thing for us.       3) Foundation – Mary Coil stated that many of you know the Chairperson of the Foundation, here tonight, as the Caddo Parish Commission Clerk. She is glad he is attending the meeting tonight. She put the Foundation minutes out at each Board member’s chair. She also put out some fliers. There will be a sporting clay shoot on July 15th. We will also be having Bingo. We are having it at Los Paloma. If you have not been there, it is in Benton and it is a wonderful event center. The shoot will start at 8:00 a.m. and the Bingo will start at 9:30 a.m. There’s something for everybody. There will be more brochures that will be going out. That is just a flier to let everyone know when it is, who contact to register. We will have a brochure to go with the registration. Christy Hall, shoots sporting clay competitively. She will chair the shoot. Missy Moore, New Beginnings, will chair the Bingo. Todd Hopkins said earlier today, he has been surprised at the people being excited over the Bingo. Missy said she plans to group the prizes and hope that every prize is worth $100. There will be lunch as well. She will keep them updated. She does have a title sponsor, Cerner, who is over all of our software, our electronic medical records for the hospital. They title sponsored this event. We are very appreciative.        Brenda Smith inquired if the sporting clay shoot and the Bingo be taking place at the same location. Mary Coil responded yes. Mary said they have a beautiful indoor facility, patio and pond. The facility is air conditioned. It is extremely nice. Mary encouraged the Board to get them a team for the shoot. This event will replace the Gala this year. This will be a fun event. Todd Hopkins noted this is an opportunity to reach a different base of people coming and contacts that we can utilize later and things that should help us up here.        Pat White stated she would like thank Lanell Audirsch for providing the Personal Financial Disclosure Statement form that the Board has to fill out annually. It is helpful. Don’t forget to send it in certified mail.        XI. Medical Staff Report: 1) Recommendations – Allyson Allums – Dr. Woods noted that Radiology has a huge turnaround of individuals because it is a large group. It is usually 15 to 20 each month. They have a very good credentialing ability to make it very clear that these individuals are credential to do what they can do.        Dakota Robinson presented the Medical Staff recommendations for the Governing Board approval: MEDICAL STAFF APPOINTMENTS: 1. Cathleen Ann Ivy, M. D. – Requests Provisional Privileges in the field of Radiology for the period of April 1, 2017 through April 30, 2018.     2. Waikeong P. Wong, M.D. – Requests Provisional Privileges in the field of Radiology for the period of April 1, 2017 through April 30, 2018.       MEDICAL STAFF REAPPOINTMENTS: 1. Edward W. Wong, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of June 1, 2017 through June 30, 2019.   2. Michael Joseph Cooney, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of May 1, 2017 through May 31, 2019.   3. Jon Engbretson, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of May 1, 2017 through May 31, 2019.   4. Andrew Marsala, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of April 1, 2017 through April 30, 2019.   5. Steven Edson, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of July 1, 2017 through July 31, 2019. ADVANCE PRACTICE PROFESSIONALS APPOINTMENTS/REAPPOINTMENTS: NONE.    EXTENSION REQUEST: NONE.   VOLUNTARY RESIGNATIONS: NONE.   Pat White made a motion to accept the Medical Staff Recommendations for Medical Staff Appointments, Reappointments. Mary Irvin seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker. Nays: None; Absent: Helen Adger, Abstained: None. The motion passed.        2) Chief of Staff Comments – Dr. John Woods, Chief of Staff, stated that the Physicians Conference that he attended this past weekend in New Orleans was a nice eye-opener for him. When he was reading the by-laws, a lot of it was very unfamiliar territory for him; especially the performance peer reviews. He noted that there is something very similar to that in the military. He was kind of familiar with it but not on the civilian side. On the military side they make you review yourself. You have to have all these parameters – how you improve this, how you did this, how you made this unit better. After you review yourself, then your rater reviews you. It’s a pretty good system. He had no clue on how to implement this at a hospital. When he attended this meeting, they gave a very good historical perspective of the reason why you’re having this implemented in the first place. Some of it is scary. They used to have a physician that was a serial killer. They had no idea. There is a reason for credentialing. He had no idea that any of these kind of things happened. It all boils down to the fact that people are human and everyone makes mistakes – no one is perfect and everyone can better themselves. If you don’t believe in those aspects you really don’t need to be in this line business. That is one of the problems that we are having because a lot of these personnel were good physicians but they had professionalism issues and etc. that could have easily been taken care of once we identified the problem and had a policy and procedure to deal with that. It gave him a foundation as to where we need to go with this. It was not cookie cutter. They gave you the matrix of what you have to do. A lot of this is basically going to be handed over to the departments what they call metrics or something they are going to measure in the area of professionalism, in the area of skills, etc. That part is going to be one aspect of it. The first aspect is going to be selling the whole point of why we are doing this in the first place. When he first presented this he got some serious flack – we already know that. No one wants to be reviewed. Everyone thinks they are top quality and they are doing their job and don’t want to be supervised. He thinks it is going to be a pretty easy sell. Long story short, it is in the by-laws and we are proceeding forward. He feels its going to be pretty easy. It was a great meeting and he learned a lot. He was like David Jones; he was surprised because he was not sure he was going to get much out of it.        Brenda Smith inquired if this was from the standpoint of the physician by-laws and you found some information on Board by-laws? The answer was no – Dr. Woods stated that in the Physicians by-laws there is an area where they are supposed to be doing ongoing performance peer reviews and functional peer reviews. When he came across that he said he had no idea how to start or implement this. This has not been going on for the past 30 – 35 years. Pat White said medicine changes so and people being in a rural area, she does not feel that people look at it as serious even though it is serious within the hospital but as far as following guidelines a lot of the time you use something because it is an emergency right then and you don’t stop to think – who do I have to report this to or what do I have to designate and that is all changing now. It is for your own good as well as the patient. Dr. Woods stated that as in the military you think you are doing all the right things and then someone comes along and says hey – you need to tighten this up. He considers it positive – a lot of times you don’t realize what you are doing; you are just trying to do your job. Feedback or constructive feedback is good. He thinks we are headed in the right direction. He noted that we have Chairs in the departments now about three to four months ago. In the next meeting it will be proposed that each department come up with their metrics on their own that they are going to be evaluating themselves. There are two levels – an ongoing peer review for certain metrics they will be looking for. If there are bumps then it becomes focused peer review. That specific problem gets looked into specifically. An example – professionalism comes – someone being brash with the staff or whatever, it will fall back on the bylaws and what do we do in this situation if some repeatedly continues to be unprofessional, even though they are a great physician. The by-laws will address that. If there isn’t anything in the bylaws, it prompts you to address that. He plans on utilizing, he doesn’t plan to create the wheel again. He said it puts everyone on the same sheet of music and everybody is headed in the same direction. Then there are always those that will be negative regardless. He said it was very interesting how they laid out the program. You can tell they have a system and it is very rock solid. Robert Green stated that it is good to attend these conferences to get this information. There is a lot of information that we need. David Jones noted that for years he has tried to get Board members to attend the LHA Summer Conference. Robert Green noted that attending these conferences make us better.    Dr. Woods noted that next month we are supposed to have a mass causality scenario where Life Air, our EMS system and many others will participate on May 15th. This will be on a grand scale. Dr. Woods stated these drills prepared us in the event. Mary Coil stated there will a public service announcement regarding this so everyone will be aware this is a drill.        XIII. Adjourn: There being no further business Kenneth Clay made a motion to adjourn. Bruce Walker seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Bruce Walker Nays: None; Absent: Helen Adger, Helen Godfrey-Smith. Abstained: None. The motion passed.   Meeting adjourned at 6:49 p.m.