BOARD MEETING:Regular Meeting   DATE:December 27, 2016     MEMBERS PRESENT:Helen Adger, Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda D. Smith, Helen Godfrey-Smith, Bruce Walker, Patricia White MEMBERS ABSENT:None TIME CALLED TO ORDER:5:30 p.m.   OTHERS PRESENT:David Jones, CEO, Pam Hughes, COO, Allyson Allums, CFO, Lanell Audirsch, Human Resources, Allison A. Jones, Attorney, Doug White, Hospital Attorney, Mary Coil, Foundation Director/Marketing Director, John Woods, Chief of Staff, Mike Gray, Susan Cross, Lydia StewartLOCATION:NCMC Events Center   BOARD CHAIRMAN: Robert Green   SECRETARY:David JonesI. 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 Pat White 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. There were no changes to the agenda noted. David Norman made a motion to approve the agenda as presented. Pat White seconded the motion. The vote: yeas: Robert T. Green, Jr., Pat White, Helen Adger, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker Nays: None; Absent: Kenneth Clay, Abstained: None The motion passed.     IV. Community Comments:  Robert Green, Chairperson, noted that there was one visitor that is present tonight who signed the required Visitor Recognition Card to speak to the Board. The individual requesting to speak to the Board is Susan Cross. Robert Green noted the time limit per subject – First person is allowed (3) minutes and additional individuals wishing to comment will be limited to (1) minute per the same subject. Robert Green submitted the floor to Susan Cross who noted on the Visitor Recognition Card that the subject to be discussed is “Dr. Haynes – response to inquiry made in November Board meeting”.   Susan Cross stated – she is the designated spokesperson for 200 people who support Dr. Haynes. She has not received a response regarding the questions to explain, from a hospital point of view, the reason Dr. John Haynes was released from his PRN, or part-time status, with North Caddo Hospital. Ms. Cross was assured she would receive a response from the hospital attorney. Doug White stated he would get the letter mailed the next day if provided with Ms. Cross’s mailing address. Robert Green thanked Susan Cross.     V. Minutes – Regular Meeting November 29, 2016:The minutes of the November 29, 2016 regular Board meeting were mailed prior to today’s meeting for review. Brenda Smith made a motion to approve the minutes as mailed. Helen Adger seconded the motion. The vote: yeas: Robert T. Green, Jr., Pat White, Helen Adger, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker Nays: None; Absent: Kenneth Clay, Abstained: None The motion passed.     VI. Old Business 1) Construction Update:David Jones stated that at the latest update meeting they were told the hospital completion date would be 1/27/2017. The weather will be a big factor. The steel workers can continue. This is a good steel crew. The progress of the parking lot and dirt work depends on the rain. We want this project to be completed. There are many extenuating factors that have caused delays. 2) Renewal of Ambulance Tax:  David Jones stated he had a good report – the Ambulance Tax renewal passed. There was a closer percentage than the previous vote. There were a lot of votes throughout the entire area. It has been a rough time of the year with the Presidential election. There were so many for the renewal and the recognition of the importance of the tax to continue the Ambulance service. We are happy and pleased with the results and can move forward.   3) Sick Time Buy Back:David Jones reported that the employee luncheon was on Tuesday, December 20th. Mr. Jones stated, with the Board approval of the Sick Time Buy Back, he was able to pass out the checks to the eligible employees. It was a huge morale booster. We have been able to do this for the past few years and luckily were able to do it again this year. He has received many personal letters and emails expressing their appreciation. This was a huge plus for the organization. There were many happy employees! We express to the employees each year that it is not a guarantee. Mr. Jones expressed his appreciation to the Board for their perseverance in this.     VIII. 1) Review October 2016 Statistics – Allyson Allums:Allyson Allums presented the November Statistical Report. There were 55 Admissions and 58 Discharges with Total Days Stayed –232. The Average Length of Stay – 3.8 Days. Total In-patient Days – 215. The average Daily Census – 7.2 Our Total Occupancy Rate was 47.80%. Total Surgeries for November (In-patient – 3 / Outpatient – 2). Endoscopies performed in November 19. The total Emergency Room patients seen – 434. Swing Bed Admission – 11. There were 134 Total E.M.S. runs in November. Observation Patients for November – 28. There were 5 Newborns in November. The total Patient Visits for the Medical & Surgical Clinic is 1928. The Plain Dealing Clinic saw 638. Benton Medical saw 110. There were 41 Mammograms for November.     2) Review October 2016 Financials – Allyson Allums:Allyson Allums presented the Financials. She reported Bad debt was 1.6% Days cash on hand 24.9. Hospital Revenue over Expense. Revenue –$3. Million Expense – $1.7 million with a loss of $168,000. AR Days 69 days due to a clinic contractual problem – a paperwork stall. The AR Days for all three facilities – 64.3. Plain Dealing Clinic – Revenue over Expense. Revenue –$128,595 Expense – $88,916 with a loss of $48,328. Medical and Surgical Clinic – Revenue over Expense. Revenue – $501,999 Expense – $270,882 with a profit of $87,939. Benton Clinic – Revenue over Expense. Revenue –$29,939.50 Expense – $21,196.12 with a loss of $5,927.28. Self-Funded Insurance – Not all of the numbers were available; this will be deferred until next month to report.       David Jones noted that the year-to-date stats vs last year are looking stronger.                    Pat White made a motion to accept the Statistical and Financial Reports as presented pending the audit. Helen Adger seconded the motion.   The vote: yeas: Robert T. Green, Jr., Pat White, Helen Adger, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker Nays: None; Absent: None Abstained: None The motion passed.      IX. New Business 1) Medical Staff By-Law Revision Approval:David Jones noted that Chief of Staff, Dr. John Woods would present the Medical Staff By-Law Revision to the Board.     Dr. John Woods stated that the process of the revision took a little more time than expected. The revision was in reference of the by- laws section stating – upon reaching the age of 75, a Medical Staff member or Allied Health Practitioner credentialed through the medical staff process shall no longer be granted privileges, which was approved by the Board. Dr. Woods gave a brief history of the by-laws. They were recently updated and had not been reviewed in excess of 30 years. Dr. Haynes, former Chief of Staff, announced his retirement sometime in August 2015 and formally retired August 1, 2016. Dr. Taylor was elected Chief of Staff in April 2015. A request was made of Dr. Taylor, from the Board of Directors, to update the bylaws and report back to the medical staff upon completion. It was agreed upon that Dr. Chance would use Willis Knighton’s bylaws as a template. The Board had specifically requested the topic of age be addressed as a safeguard to patient safety. The medical staff agreed to place the section 4.A.4 Clinical privileges after the age of 75 years of age into the bylaws. The Board unanimously passed the new bylaws. Following the meeting, the board asked for the medical staff to review the Age topic again to see if it could be modified in anyway without jeopardizing the patient safety. A meeting was held to look into the revision request. The following definitions are to be added to the bylaws: Both of the referenced exams are based on UC San Diego PACE program: (1) PAPA Exam: (Physician Aging Physician Assessment) generally started at age over 70 years of age. Purpose: to detect the presence of any physical or mental health problems affecting his/her ability to practice safely. If concerns are found, further evaluation is recommended. This is NOT diagnostic, NOT for cause. Possible results: Fit for duty, Further evaluation recommended. Pricing: $2-2.2K.   Components of PAPA: 1.Review of self-report health questionnaire. 2. History and physical examination. 3. MicroCog. TM Cognitive screening examination Mental health screen. 4. Dexterity test. *The dexterity test component applies only to proceduralists. 2) PACE -Physician Competency Assessment – Evaluates competency for Physicians seeking privileges at NCMC over the age of 70 year old. It is fair and unbiased. There is a remediation plan (if applicable). There is willingness to testify if required. This cost is physician’s responsibility for payment. The recommended changes are as follows: 4.A.4 Clinical privileges after age 70: 1. Removal of the mandatory relinquishment of medical privileges at age 75. Replaced with the following: Individuals who desire to exercise clinical privileges after age of 70 must apply for reappointment on a yearly basis.     Biennial PAPA exams will be a part of the reappointment process, these members shall be required to have a physical and mental health assessment performed consistent with the PAPA exam guidelines or its equivalent as approved by the medical staff. If the medical staff member fails this examination they will be required to be evaluated for fitness for Duty or its equivalent as approved by the medical staff. If the medical staff member fails this exam or refuses to take either exam their medical privileges will be revoked. Any future privileges would only be granted consistent with the same guidelines as for a new applicant.     If the committee determines that there are issues in any of these areas and/or other concern areas, the committee shall determine what next steps are to be taken to address the concerns raised. The committee may meet with the individual to discuss these concerns and to try to determine what collegial and voluntary steps, such as a voluntary restructuring of privileges, further monitoring, or focused review (as examples only), can be taken.     Dr Woods proposed the following changes to the current bylaws section 2.A.1 subsection (f,) to read as follows: 2.A.1 subsection (f): All applicants for medical staff privileges must be Board Certified in their specialty at the time of initial appointment for any privileges that are not currently granted unless they are Board eligible for at a maximum of 36 months post completion of residency if Board Certification must be delayed due to their specialty board requirements. Any applicant who is greater than 70 years of age at the time of application must pass an exam such as the PACE exam or its equivalent as approved by the medical staff at their own expense, prior to their application being considered.       Dr Woods proposed the following changes to the current bylaws section 2.B.1 to read as follows:   2.b.1 subsection (e):All applicants for courtesy medical staff privileges must be Board Certified in their specialty at the time of initial appointment for any privileges that are not currently granted unless they are Board eligible for at a maximum of 36 months post completion of residency if Board Certification must be delayed due to their specialty board requirements. Any applicant who is greater than 70 years of age at the time of application must pass an exam such as the PACE exam or its equivalent as approved by the medical staff at their own expense prior to their application being considered.         Bruce Walker made a motion to approve the Medical Staff by-Laws Revision. Brenda Smith seconded the motion. The vote: yeas: Robert T. Green, Jr., Pat White, Helen Adger, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker Nays: None; Absent: None Abstained: None The motion passed.     2) Board Officer Election for 2017:It is time for the election of the Board Officers for the year 2017 – The Board Chairperson and the Vice Chairperson. Mr. Jones said typically what we have been doing is raising the Vice-Chair to Chairperson and a new Vice-Chair is elected. One year as Chair is a short period of service. The current Chair and Vice Chair were agreeable to serve another year.     Brenda Smith made a motion to approve Robert T. Green, Jr. as Chair and Pat White as Vice Chair for 2017. Mary Irvin seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Helen Adger, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker Nays: None; Absent: None Abstained: None The motion passed.       Many thanks were extended to both Robert Green and Pat White for their service and the great job they both are doing as officers of the Board.   3) Dialysis Clinic Partnership:  David Jones stated that this project had been on hold due to the audit. The audit has been cleared and there were no findings and we can now move forward. After several conversations, he would like to have the Board approval. Instead of North Caddo owning the building the plan is to lease the dirt for the building to Fresenius. Fresenius wants to move forward on this project. The Dialysis Clinic will be here on campus and is a much needed service to this area. It is preapproved to put out to bid. This is a good concept. It will need approval to get bid out. This is a 30 day bid process. Pat White made a motion to proceed with the necessary bid process to enter into a Dialysis facility with Fresenius to provide dialysis services. Helen Adger seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Helen Adger, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker Nays: None; Absent: None Abstained: None The motion passed.   X. Administrative Report – 1) NCMC – Current Activities:David Jones stated it is Christmas time and everything is outstanding. The hospital will soon be done and it is the center point of Highway 1 area. The employees’ spirits are high from the Sick Time Buy Back approval. The Christmas luncheon was well attended. We will soon have the Grand Opening and invitations will be sent out to many dignitaries and the public.   2) Foundation:Mary Coil, Foundation Executive Director, reported that the response for Christmas gifting has been great. There were many donations in honor of the staff members. A lot of great things were accomplished in 2016 and the Board is now looking to begin an MRI fund raising. Nuclear medicine was a consideration, however; the Board decided there will be a greater need for the MRI at this time. We look forward to that venture. There is proof in the past of how people will turn out to help.     XI. Medical Staff Report – 1) Recommendations – Allyson Allums:Allyson Allums presented the Medical Staff recommendations for the Governing Board approval:   MEDICAL STAFF   APPOINTMENTS:     1. Elaine G. Khatod, M. D. – Requests Provisional Privileges in the field of Radiology for the period of December 1, 2016 through December 30, 2017.     2. Mark Alan Banks, M. D. – Requests Provisional Privileges in the field of Anesthesiology for the period of December 1, 2016 through December 30, 2017.     MEDICAL STAFF REAPPOINTMENTS:   1.Stephen G. Taylor, M.D. – Requests Staff Privileges in the field of Family Medicine and OBGYN for the period of December 1, 2016 through December 30, 2018.2. Eric Postal, M. D. – Requests Consulting Privileges in the field of Radiology for the period of February 1, 2017 through February 30, 2019.   3. Cristina M. Cavazos, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2017 through January 30, 2019.    4. Omar A. Mahmood, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2017 through August 31, 2019.   5.   William Dennis, M. D. – Requests Courtesy Privileges in the field of Emergency Medicine for the period of November 1, 2016 through June 30, 2018.   ADVANCE PRACTICE PROFESSIONALS APPOINTMENTS/RE-APPOINTMENTS:   1. James Thomson, CRNA –Requests Privileges in the field of Certified Registered Nurse Anesthetist for the period of December 1, 2016 through July 30, 2018.     EXTENSION REQUESTS:  None. VOLUNTARY RESIGNATIONS:   1. Mark Davis, M. D. – Voluntary resigns Courtesy Privileges in the field of Radiology effective December 21, 2016.   2. Tamara Richards, M. D. – Voluntary resigns Courtesy Privileges in the field of Obstetrics and Gynecology due to relocation effective December 21, 2016.   Kenneth Clay made a motion to accept the Medical Staff Recommendations for Medical Staff Appointments, Reappointments, Advance Practice Professionals Appointments/Reappointments and Voluntary Resignations. David Norman seconded the motion. The vote: yeas: Helen Adger, Kenneth Clay, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey Smith, Bruce Walker, and Pat White. Nays: None; Absent: Mary Irvin, Abstained: None.   The motion passed.   2) Chief of Staff Comments:Dr. John Woods stated he made all of his comments earlier and looked forward to next month.         David Jones noted that the USDA is taking over our loans and the paperwork be being finalized.       XII. Executive Session:   None       XIII. Adjourn:There being no further business Kenneth Clay made a motion to adjourn. Pat White seconded the motion. The vote: yeas: Helen Adger, Kenneth Clay, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey Smith, Bruce Walker, Pat White, Nays: None; Absent: Mary Irvin, Abstained: None The motion passed.     Meeting adjourned at 6:45 p.m.