BOARD MEETING: Regular Meeting     DATE: August 22, 2017      MEMBERS PRESENT: Robert T. Green, Jr., Patricia White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker     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., John Woods, Chief of Staff, Walter D. (Doug) White, Hospital Attorney, Allison A. Jones, Attorney, Mary Coil, Foundation Executive Director / Marketing Director, Mike Gray, Security      LOCATION: NCMC Events Center     BOARD CHAIR: Robert T. Green, Jr.   SECRETARY:   David Jones  I. Called to Order  –  Robert T. Green, Jr., Chairperson, called the meeting to order.   II.               Invocation and Pledge of Allegiance–   Robert T. Green, Jr. offered the Invocation and David Jones led the group in the Pledge of Allegiance.   III. Approval /  Amend Agenda  –Robert T Green, Jr. stated it is time for approval or amendment of the agenda. No amendments noted.    Brenda Smith made a motion to approve the agenda as presented. Mary Irvin seconded the motion. 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 T. Green, Jr., Chairperson, noted there were no signed Visitor Recognition Cards requesting to address the Board.   V.  Minutes – Regular Meeting  July 25, 2017  –  The minutes of the July 25, 2017 Regular Board meeting were mailed prior to today’s meeting for review.  Robert Green inquired if there are any corrections to be noted. If not, he would entertain a motion to approve the minutes.     Patricia White made a motion to approve the minutes of the regular meeting as mailed.  David Norman 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.   Old Business:   1)  Construction Update–  David Jones stated this will conclude the construction update being on the agenda until any future phases come along. He asked Pam Hughes to give the finishing report. Pam Hughes stated everything looks like it is about finished. She said they finished the landscaping. They had a few little things they had to come back to do on the roof; not the roof itself but the metal around it. There was one problem with the fountain. That is being resolved and we will have the fountain going at the Grand Opening. The staff will be waxing the floors tonight and cleaning the parking lots and we are getting ready for the big moment! Brenda Smith noted that as Mr. Jones stated sometimes it seems like yesterday, then again it feels like it was a hundred years ago. It is amazing to think, not just the time of building but the time that has gone into planning before the building – it’s been eight or nine years.  Helen Godfrey-Smith stated it is just beautiful. There are so many touches the more you are around. It is just quality. Brenda Smith said it is comfortable and safe when you go there – not so sterile feeling – has a homey feeling to it. Pam Hughes stated that the architect sent a photographer. They came and did the inside. They were not able to do the outside because it rained. They are going to send us all the pictures at no cost. This will be in an architectural magazine. Helen Godfrey-Smith said she would imagine that the USDA would feature the building. Pat White said the before and after pictures show what they worked around to do it all. David Jones stated that, at the time, we were the largest project that they had ever done in the state of Louisiana – $25 million was the largest. This may have changed by now, but at the time this was the largest. They normally do fire stations and those type of buildings but nothing this big.  David Jones said Tony Matlock, who was our contact for USDA has moved up two ranks since this project started. He is now over the whole region.    2) Dialysis Clinic Partnership Update  –  David Jones noted they are working just about every day doing something. He was not sure what they were doing the day before. They have poured the footings for the building and going forth from that. He foresees that building going up pretty quickly. The clinic itself is about 5,000 square feet. It will go up much faster than the hospital did. When the shell is completed maybe the Board could come early and tour the progress to see what it is going to look like when completed. Mary Irvin inquired if there is an anticipated opening date. David Jones replied sometime early next year. Of course, weather can adjust that big time. They are looking to open as soon as they can. Brenda Smith said if they can get the outside up before winter they can work inside when the weather is inclement.      3)   Radiology and ER Expansion Update –   David Jones stated that it is taking a while to get this stuff cranked up. There has been so much going on, it has kind of taken a back burner to some things. He needs to talk to the architect about in their contract, going forward if we were to use them and there are some things that we need get approved. We have to find out from the USDA standpoint if we can get it paid for; there is an issue with were they are going to build it. Whenever they built the phasing process, there were massive power and water lines going in right where we want to build this expansion. They want to make sure that they get that mapped to the inch from that standpoint. There are a couple of companies that they suggest to do this for approximately $12,000 to $15,000. But then again, if someone cuts into one of those they would not walk away. It is that kind of power going in there. As you can guess from our Radiology Department, to run an MRI or CT machine, they are pulling some pretty serious power.  After we get the Grand Opening done, he is hoping to get this ball rolling a little faster just to see where we are at as far as final money. We are still under budget quite a bit, but trying to find out exactly what that dollar figure is and then going forward with what we can do with the expansion standpoint. Brenda Smith inquired if he had heard anything on the waiver. David Jones replied not yet.    4)    Security Assessment of IT System Update –    David Jones reported that we had the Security Assessment of the IT System under New Business last month but requested it be tabled until this month. He put it under Old Business because we did find out that we can do it internally. We are going to save that dollar amount that it was going to cost to have another person come in to do that. He did want to give the Board an update on where we were with that. Brenda Smith asked if our IT staff would oversee it. David Jones replied that is correct. She asked if he has to report it to someone. David Jones stated that the IT Director has to write it up and keep a log of everything that he reviewed and how he reviewed it. He thinks it took about one and a half weeks to two weeks. It is very in depth. It takes him out of pocket for just about the entire time. It is something that will save us several thousands of dollars. Brenda Smith inquired if the data he collects stays in house; it doesn’t have to be reported to anyone. David Jones replied that is correct. They will come and audit and will see exactly what he has done. Brenda Smith asked if there were guidelines for the data review and David Jones replied yes.         Robert Green inquired if there were any additional questions. There were none.      VII.   1)  Review June 2017 Statistics – Allyson Allums –   Allyson Allums was unable to attend the meeting. Dakota Robinson, Controller, presented the July 2017 Statistical Report in her absence. There were 66 Admissions and 66 Discharges with Total Days Stayed –258. The Average Length of Stay – 3.9 Days. Total In-patient Days – 238; the most in the Quarter. The average Daily Census – 7.7. Our Total Occupancy Rate was 51.20%. Total Surgeries for July (In-patient – 3 / Outpatient – 1).  Endoscopies performed in July – 7.  The total Emergency Room patients seen – 496.  Swing Bed Admission –12. There were 149 Total E.M.S. runs in July.  Observation Patients for July- 32.  There were 5 Newborns in July.  The total Patient Visits for the clinics are slightly down; it is July and should rebound in August.  Medical & Surgical Clinic is 1678.  The Plain Dealing Clinic saw 566. Benton Medical saw 157. There were 33 Mammograms for July.     2)  Review July 2017 Financials – Allyson Allums   –  Dakota Robinson presented the Financials. Hospital Revenue over Expense. Revenue –$3.3 million Expense – $1.6 million with a profit of $86,000 – Three months in the black. The AR Days for all three facilities – 58.0; for the hospital only is at 49.69 days. Plain Dealing Clinic – Revenue over Expense. Revenue –$129,000, Expense – $95,000 with a small loss of $11,857.00. Medical and Surgical Clinic – Revenue over Expense. Revenue – $462,000 Expense – $250,000 with a loss of $36,787. Benton Clinic – Revenue over Expense. Revenue –$35,000; Expense – $19,000 with a small loss of $3,000. They ran some numbers as August 17th, with Jere Thompson, Nurse Practitioner and Dr. McCommon, they have already seen as many visits as they did in this month as of the 17th – with two more weeks of data not included. Next month he expects good things out of this. The Bad Debt Expense is at 3.2%. Days cash on hand– 7.00 days. He noted that this is leveling out. Self-Funded Insurance– He noted it is running a little hot this year. The total expense was $174,000 for this month and the specific reimbursement, for any claim over $50,000, we received $594. In comparison to the previous year, we were at $1.2 Million at this point last year; we are $1.35 million. We sort of expected that when we went into it this year. The costs are continuing to rise. We are trying to make some changes in the structure of this in the next year to get these costs back down.  He noted in the financials, they were not mailed out to you, we got it completed. This is the first month of the new fiscal year. On page 5 you will see what the budget versus actual was. The new budget numbers that were approved last month. The financials compared to July of last year it is a lot better month.   David Jones noted the cash standpoint we are way lower than we need to be. The Finance Committee is looking at this. It seems to have leveled off and we have some hope for the future building it. We don’t build it $4 million a month from our standpoint – we build it a thousand dollars at a time.  It will take a while to get to where we want to be. This is something we will have to continuously stay on top of.  He is anxious to see what our cost report looks like when they file the final year end one. He is thinking there will be some break there as well. We will have to wait to see what those numbers look like when they are done. He asked Dakota if there was any word on this as far as timing. Dakota replied no. Helen Godfrey-Smith stated that the Finance Committee has been meeting on a regular basis and they have been baptized by fire learning. Thanks to the members, they are being faithful the staff makes sure they are getting the information that they need in order to really be a help and to be able to report. They will probably work on going over more in detail what the reports say and really mean. You will be hearing more from them from time to time. They are planning to meet the Friday prior to the Board meeting, so if you have any concerns or questions to be addressed and bring back to the Board, make sure to get those to the Accounting Division or Administration so they can discuss and get the information and have it ready for the Board meeting.  Brenda Smith voiced her thanks to them for doing this. Brenda Smith had a Dakota question. She thinks the 340B is interesting. Is there any way to add something to the slide show? Dakota said absolutely. He will enter numbers similar to the self-funded slide – number of prescriptions and revenue progression. He said you can see it now on the financials. We said it would take a few months for the Board to see it come through. $63,000 in revenue last month. That’s pretty good.        Robert Green asked if there was any more discussion or comments. If not he would entertain a motion to accept the Statistical and Financial Reports.         Patricia White made a motion to accept the Statistical and Financial Reports as presented subject to audit. Helen Godfrey-Smith 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.        III.          New Business:  1) Annual Review – a.)  Medical Staff Bylaws, b.)  CQI Policy & Procedure Manual, c.)  Administrative Policy & Procedure Manual, d.) Safety Risk Management Policy & Procedure Manual, e.)  Anesthesia Policy & Procedure Manual, f.)  Infection Control Manual – David Jones stated that we normally bring this to the Board in July. With everything going it got bypassed. The Board has certain manuals that it has to approve every year. You approved the updates on the Medical Staff by-laws. We typically do this every year in the summertime so he added the Medical Staff By-laws as well. There have been no changes since the last update. The only real change noted is to the Infection Control Manual – there was one change. There is an Antibiotic Stewardship Program added. This is a hot topic going on throughout the State now. That is pretty much it as far as changes go. These are the same manuals that we have been using. The CQI Policy & Procedure Manual will probably be completely redone by this time next year. That one will be a new one. For the most part the rest of them have been reviewed. Helen Godfrey-Smith inquired what the acronym stands for. David Jones replied Continuous Quality Improvement. It is another thing we have to do as mandated from the State. There were slight modifications to each one of them. Any policy and procedure that referred to the old build or design of the building – a department location, etc. There is an ongoing effort and has been ongoing for a couple of years now, but it will be intensified – all these manuals, by this time next year, will be online and viewable that way. We have several that are now, but we have several that are not. That is our goal to get every single one of these in electronic format. He does need the Board to approve them once again this year.        Robert Green inquired if there was any further discussion or comments. If not, he would entertain a motion to accept the annual review of the policy and procedure manuals.       Brenda Smith made a motion to accept the annual review of the Policy and Procedure Manuals as presented. Patricia White 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.         IX. Administrative Report:    1) NCMC – Current Activities –  David Jones stated he did want to report that we got the final settlement for the Sleep Study RAC audit that we got hit with. Doug White, our hospital attorney, actually worked with the Assistant U.S. Attorney to devise a payment plan to pay it out monthly opposed to writing one large check. That was a big help. This whole process – we are going to get hit again by something over the next 5 to 10 years. They are in a financial bind so they are looking to scrape any penny that they can get out of anybody. Any loop hole they can find they will pursue. We are trying to do our best to close these up. With the process we are doing stuff slips through. They hit Willis Knighton to the tune of about $5 million dollars with this. If you owe $5 million dollars you can spend $150,000 on an attorney to fight it and come out in the positive more than likely; that is what they did. They may have ended up paying maybe $300,000 to $400,000 of the $5 million they owed. Brenda Smith said it should have been class action for all of them. Doug White said he believes we got ours to $42,000. He said they wanted a mortgage and a promissory note. He explained what the USDA had and they came off of all that. We have 2% interest and we will pay it in 10 monthly installments. He said he had an updated agreement that he needs to present so he can send it back tomorrow. They give these companies a percentage of whatever they find. The companies are digging constantly trying to find from any angle. They found this loop hole that a ton of hospitals didn’t check up on – the certain credentials in our state alone; they knew that most probably didn’t have it. They looked and found that a lot of them did not have it. They hit just about every hospital with it. We are hoping to limit that as much as possible. They are taking $42,000 from a small rural hospital – if they are that bad off, we will all be in trouble in another decade or sooner.      We have this small event going on Thursday. He doesn’t know if anybody has heard about it. He keeps calling it the grand breaking and he has called it the ground opening, but it is the Grand Opening. We will be cutting a ribbon. We do have Paul Salles, President of LHA, coming to speak and we have the State Director of the USDA coming to speak as well. We have several of our political representatives in the whole region coming or they are sending someone to come. They will be doing a little speaking as well. Then, we will move outside at the end to do the actual ribbon cutting. Of course, we want the Board that is going to be the ribbon cutters to be there and the Board, the Foundation Board will line up there; and all the employees that can be there after that, and whoever guests want to file in for the picture after that. We are going to do our best to get Mrs. Helen Adger here. Jeannie is working to get this accomplished. We hope she will be there. There will be a small memorium to Bob Guth, Earl Williamson and Mrs. Billie Van Hoose. Two Hospital Board members and one Foundation Board member that we have lost along the way. They loved this hospital and they bought in and sold into everything we do – they will always be a part of us. It is going to be a good day. He is already getting antsy about it. It has been a while coming. He hopes to see everybody there for that of course.       Robert Green inquired if everybody is planning to attend. Everyone said they plan to do their best.        Pat White noted that there is a party for James Martin on Saturday. David Jones stated James Martin retired last Friday. They will throw him a very large party. The Department Heads and his department have gotten together and bought him a couple of gifts to present to him. There were a few tears shed. James was not only an important cog in our wheel, he is an extremely good man. It is a pleasure to have known him for as long as he has and hopefully he will know him for quite a long time to come. He deserves everything he has got and we hope he has nothing but fun times ahead of him and hope to see him more often in his retirement. Helen Godfrey-Smith inquired what time. Mary Coil said it is at 6:00 p.m. at the Oil City Rotary and if you could let her know that you are coming that would be great. They are trying to get a head count for the food.        Robert Green stated he had to leave. He apologized for having to leave but he is in revival this week. He is turning the Chair over to Patricia White for the remainder of the meeting.         2)   Foundation –   Mary Coil noted that it’s been a month. She was not at the last meeting – she was on vacation. She wanted to give an update on the Bingo / Shoot Out. They did wonderful. She noted that they had 30 teams. They told her that was more teams than some of their shoots that they have had. She has heard great things. Everybody had a great time. We had some people that shoot all the time and those that never shoot. We had 30 teams of 4 shooting and we had about 100 people playing bingo inside. Missy Moore chaired the Bingo. She got all the prizes donated. It was her first time to do it. She stays so busy. She took it on and lots of businesses donated prizes for the Bingo. People had a big time. You could tell those that play Bingo all the time – that came in with their bags and dobbers. We learned a lot from the event. We had a lot to say they hoped we would do this again next year so they would not have to wear a suit. She is not making any promises. Christy Hall was the Chairperson for the Shoot. She did a wonderful job to recruit 30 / 4 man teams. She said she thinks there were four 4-H teams -from Webster, Lincoln, Bossier and Caddo parish. That was a great turnout for the kids. She did a wonderful job. Our profit was around $24,000, which is wonderful for a shoot. We learned a lot – learned where some more opportunities are for the fund raising, for the event. She thinks it did exactly what the Foundation board wanted it to do – something new for the year and reach out to a different group and see some growth in our event on a different level. She thinks it went wonderful. She expressed her appreciation to the Board; the Foundation Board very much appreciated the Boards contribution to the event. She left a thank you note last meeting. The Foundation asked her to relay that to them again. We did well.      David Jones stated that it was amazing how many people were actually there.  There were people running around everywhere. To walk in from outside, thinking that most people were still outside. You walk in and there was standing room only. Some of them came to shoot, they paid their money and they were supporting this hospital. It was neat to see. Just from a skills standpoint, just watching the guys that could shoot, it was pretty impressive. Some of the kids could really shoot. Brenda Smith said it was a great idea to get the 4-H’ers to shoot. David Jones said shooting and archery is a big thing now. Bruce Walker stated that Casey Hall was a good shot and Christy Hall’s sister is a very good shot. Mary Coil said she won the women’s division. She won with a 95 out of 100; the man that won had a 98 out of 100. David Jones said the kid that won had 98 out of 100 – he was about 14 years old. Mary stated that Los Paloma’s was a wonderful facility and great to work with. She watched some of the target – they were challenging. David Jones said Dakota was a good shot. He let on that he was not but he did well. He carried their team.    X.   Medical Staff Report:    1)                Recommendations – Allyson Allums –   Dakota Robinson presented the Medical Staff recommendations for the Governing Board approval:  MEDICAL STAFF APPOINTMENTS:  1.   Jonathon A. Lee, M.D.– Requests Provisional Privileges in the field of Radiology for the period of August 22, 2017 through August 31, 2018.    2.   Adam R. Hecht, M.D.– Requests Provisional Privileges in the field of Radiology for the period of August 22, 2017 through August 31, 2018.      MEDICAL STAFF REAPPOINTMENT:  1.   Gregory Wellman, M. D. – Requests Courtesy Privileges in the field of Pathology for the period of August 22, 2017 through August 31, 2019.     2.   William Liles, M.D.– Requests Courtesy Privileges in the field of Pathology for the period of September 1, 2017 through July 31, 2018.     3.   Leah Chiles, M.D. –  Requests Courtesy Privileges in the field of Urology for the period of August 22, 2017 through August 31, 2019.     4.   Matthew Mastrodomenico, M.D.- Requests Courtesy Privileges in the field of Pathology for the period of August 22, 2017 through October 31, 2019.     5.   Daniel Hennigan, M.D.- Requests Courtesy Privileges in the field of Radiology for the period of June 30, 2017 through June 30, 2019.       ADVANCE PRACTICE PROFESSIONALS  APPOINTMENTS/REAPPOINTMENT:  1.    Ruthie McRae, CRNA– Requests Courtesy Privileges in the field of Certified Registered Nurse Anesthetist for the period of July 1, 2017 through July 30, 2019.      EXTENSION REQUEST:    NONE.       VOLUNTARY RESIGNATIONS:   NONE.      Helen Godfrey-Smith made a motion to accept the Medical Staff Recommendations for Medical Staff Appointments, Medical Staff Reappointments, Advance Practice Professionals Appointments/Reappointment. Mary Irvin seconded the motion.  The vote: Yeas: Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen-Godfrey-Smith, Bruce Walker. Nays: None. Absent: Helen Adger, Robert T. Green, Jr., Abstained: None. The motion carried.        2)    Chief of Staff Comments –  Dr. John Woods mentioned that the new residents have oriented themselves pretty quickly. It is a fairly easier process over the last few years. Everybody is oriented and knows their job and are doing it quite well. These are usually kind of scary months in July for residents and attendings. That is over with. He also saw a very interesting article in JAMA Surgery that came out – It was – Should Older Doctors Be Examined, Tested Or Forced To Retire. Allison Jones, attorney, noted that she read that article as well. Dr. Woods said it is refreshing to know that we are doing the right things by thinking about this and we are not alone in what we are doing. Some of the things it mentioned is that some observations since 1975, the number of practicing physicians older than 65 years in the United States has increased by more than 374%. In 2015, 22% of the practicing physicians were 65 years or older and research shows that between the ages of 40 and 75 the meaning cognitive ability declines by more than 20%, but there is a significant variability from one person to another as we have already alluded. They also talk about that this is actually a regular thing in a lot of the fields such as pilots, judges, air traffic controllers, Federal Bureau of Investigation employees and fire fighters all have maximum ages. The conclusion is that physicians age are required cognitive evaluation compliant with a confidential anonymous feedback evaluation by peers and co-workers regarding wellness and confidence would be beneficial for the physician and their patient. While it is unlikely it will become a national standard soon, individual healthcare organizations could develop policies similar to those present at a few U.S. institutions in addition, large professional organizations should identify a range of acceptable policies to address the aging physician while leaving institution flexibility to customize the approach. Absence of robust professional initiative in the area regulators and legislators may impose more draconian measures. And that is basically the way it ends. He thought it was refreshing that we were not spearheading this or fabricating a problem. He knew we weren’t. It has been brought out. We are kind of leading the way.  Brenda Smith noted that there are not standards set as yet. Dr. Woods stated this is not un-ventured waters. Mary Irvin said her mother is a Willis Knighton Hospice Nurse. Mary was telling her mother a little about thoughts on this subject. Her mother said Dr. so and so had to go to Boston to go through some testing. Something to do with his age and being able to continue to practice. Mary said that was interesting.         Dr. Woods noted that everybody seems to be doing a great job. No events, no worries. Bruce Walker asked how many residents there are now. Dr. Woods said there are six.         Helen Godfrey-Smith said she recently had heart surgery. She would like to thank Dr. Woods and North Caddo Medical Center because she had no idea that she had a heart problem. She came to the hospital to have her blood pressure checked because she had been having some elevated blood pressures. She was in the ER getting ready to be sent home to come back the next day to be checked. The Chief of Staff decided to do one more check on the blood pressure. It caused him to request to have an echo done on her heart a couple of days later. From that point it was an emergency. She ended up with double open heart surgery. She had replacement of a valve and blockages in her arteries. It was quite frightening. Her cardiologist said it was just a miracle that she retired and did not die on her desk. She is most thankful and grateful. She feels so much better. She is a true advocate.   XI. Executive Session –  Pat White stated we are at the point to enter into Executive Session. She will need a motion to enter in to Executive Session for the purpose of strategic planning.     Helen Godfrey-Smith made a motion to enter into Executive Session for the purpose of strategic planning. Bruce Walker seconded the motion. The vote: Yeas: Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen-Godfrey-Smith, Bruce Walker. Nays: None. Absent: Helen Adger, Robert T. Green, Jr Abstained: None. The motion carried.          The Executive Session was entered into. No action was taken during the Executive Session.      Helen Godfrey-Smith made a motion to enter back into regular session. David Norman seconded the motion. The vote: Yeas: Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith,  Helen-Godfrey-Smith, Bruce Walker. Nays: None. Absent: Helen Adger, Robert T. Green, Jr., Abstained: None. The motion carried.     XII. Adjourn  –     There being no further business Kenneth Clay made a motion to adjourn. Brenda Smith seconded the motion. The vote: Yeas: Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen-Godfrey-Smith, Bruce Walker. Nays: None. Absent: Helen Adger, Robert T. Green, Jr., Abstained: None. The motion carried.            Meeting adjourned at 6:42 p.m.