BOARD MEETING: Regular Meeting     DATE: May 23, 2017   MEMBERS PRESENT: Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Patricia White     MEMBERS ABSENT: Helen Adger, Bruce Walker     TIME CALLED TO ORDER: 5:30 p.m.   OTHERS PRESENT: David Jones, CEO, Pam Hughes, COO, Allyson Allums, CFO, Lanell Audirsch, Admin. Asst., Mary Coil, Foundation Director/Marketing Director, John Woods, Chief of Staff, Allison Jones, Attorney, Walter D. (Doug) White, Hospital Attorney, Casey Jones, 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:  Robert T. Green, Jr. offered the Invocation and David Jones led the group in the Pledge of Allegiance.     III.   Approval / Amend 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, Nays: None; Absent: Helen Adger, Kenneth Clay, Helen Godfrey-Smith, Bruce Walker; 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 April 25, 2017:The minutes of the April 25, 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. David Norman seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Mary Irvin, David Norman, Brenda Smith, Nays: None; Absent: Helen Adger, Kenneth Clay, Helen Godfrey-Smith, Bruce Walker; Abstained: None. The motion passed.   VI. Old Business:   1) Construction Update – David Jones reported that they started on the installation of the water wall. They had the bottom base done at about 3:30 p.m. this afternoon. It seems to be, to the eye, two pieces a day on the face. That is the main thing left in the building. There are a few things to be done, but for the most part the building is done. They will take the back stairwell off by the end of the week. We actually got them to create an exit door onto the roof of the first floor for the maintenance employees. They have some very large filters and things like that to go to the big air handlers. They needed a portal to step out on to. Now the parking lot – it might be a while before it gets completed due to the weather. They still have to level and bring it up to grade as far as rock on the north side of the parking lot. When they are done with that they will have to shut the parking lot off for a few hours on the weekend because they have to bring the south side back up to grade because everybody has been parking on that and wore it down to some degree. Then they say they can pave it all in one weekend. He would say we are in the last four or five weeks, depending on the rain. It may stretch it or we may get lucky and it come to a little under that. We shall see. Brenda Smith inquired if the only actual part that is being concreted is direct entrance and under the porte cochere. David Jones noted that all that is done. He said other than a few small spots there would not be any more concrete; everything else is to be paved.       David Jones encourage the Board members to come by to see the water wall if they had an opportunity. We are very excited about this. The front entrance is very pretty even without the water wall. The Gift Shop did open last week. With Missy Moore operating the gift shop, there are some really nice things in the gift shop. Missy Moore of New Beginnings was the only one that put a bid in on it. All the items in the shop are hers. There is good quality items and fresh flowers. The chapel is open. It is not totally complete. Mrs. Billie Goodson purchased some stained glass for the door of the chapel. Please feel free to come to the front of the hospital now. It is something to see. A lot of sunlight. The actual waiting room of the clinic is now open and is much better than it was. It is all coming together. Brenda Smith inquired about the temporary doors coming into the front. David Jones said they are not totally gone yet. They are working on the automation of the front door. They are still working on the front and do not want anyone driving through the circle driveway because they are working on the fountain. They will figure out a way to wall part of it off and then open up the front.   2) Dialysis Clinic Partnership Update –  David Jones reported that Frescenius still has not returned the agreement back to us. The builder of the clinic has been working with Citizens Bank to do the financing with them. David Jones has been told there are some snags in that. He does not know if that will happen or not. He tried to refer the business to Citizens to keep it local if possible. There were no actual details but as of right now they are at an impasse. This does not affect us. Hopefully we will get our part back in the next week or so then we will be collecting monthly rent and waiting on them to build the building.     3) Tribridge Financial Upgrade Update – David Jones asked Allyson Allums to give the update regarding the Tribridge Financial Upgrade. Allyson Allums stated that the system upgrade is up and running as of today. It is completely installed and we are using it. We had one small glitch yesterday trying to get some checks out and that was fixed today.     4) Surplus Equipment Update– David Jones noted that the ads need to run in the paper for a period of three weeks. Once this is completed, we will see if bids are received and report the outcome to the Board. There has been one gentleman that has been putting in bids for the last couple of surplus lists and will probably bid on some of this list.         Mary Irvin did have a citizen ask her about the surplus equipment if they were interested. She suggested they call Mr. Jones. She inquired if it was all in one central place. David Jones replied yes; most of the time it is. He will keep the Board updated.     5)   Radiology and ER Expansion Update – David Jones stated that we are at the beginning phase of this. The design phase that TEG has done, we are trying to get a waiver. It is another one of those regulations. You have to build certain rooms in the hospital that we consider wasted space, but are required by DHH. Another thing for an MRI stand-alone unit is an ante room that is right outside of the MRI unit. We have a waiting room that will be right next to the MRI unit anyway. We have submitted a waiver to DHH to squash the need for that. TEG feels that will not be a problem. You have to go through the process to get approved. Once we get the plans finally done we will put it out to bid and then we will see what it comes back. As of right now, it looks like we are going to have right under $1.3 million as far as under budget for the building of the hospital. TEG still feels confident that we can build that expansion within that amount. We will have to see. Depends on cost. We should have something by the next Board meeting on maybe a bid date to go out for this.   VIII. 1)   Review April 2017 Statistics – Allyson Allums:  Allyson Allums presented the April Statistical Report. There were 55 Admissions and 58 Discharges with Total Days Stayed –209. The Average Length of Stay – 3.6 Days. Total In-patient Days – 232. The average Daily Census – 7.7. Our Total Occupancy Rate was 51.60%. Total Surgeries for April (In-patient – 1 / Outpatient – 2). Endoscopies performed in April –   16. The total Emergency Room patients seen – 479. Swing Bed Admission – 16. There were 145 Total E.M.S. runs in April. Observation Patients for April- 30. There were 3 Newborns in April. The total Patient Visits for the Medical & Surgical Clinic is 1720. The Plain Dealing Clinic saw 617. Benton Medical saw 161. There were 24 Mammograms for April.   2) Review April 2016 Financials – Allyson Allums – Allyson Allums presented the Financials. Hospital Revenue over Expense. Revenue –$3.5 million Expense – $1.9 million with a loss of $297,000. The AR Days for all three facilities – 45; for the hospital only is at 44.0 days. Plain Dealing Clinic – Revenue over Expense. Revenue –$139,000, Expense – $77,000 with a loss of $77,000. Medical and Surgical Clinic – Revenue over Expense. Revenue – $483,000 Expense – $304,000 with a loss of $22,000. Benton Clinic – Revenue over Expense. Revenue –$31,000 Expense – $19,000 with a loss of $9,800. The Bad Debt Expense is at 2.0%. Days cash on hand– 24.00 days. Self-Funded Insurance –The total expense was $123,000 for this month and the specific reimbursement, for any claim over $50,000, we received $899. Comparing the two years from when we were not self-funded to comparing self-funded to self-funded now. We are just a little more – $687,000 compared to $720,000. We had a few large claims in this month that made this month higher.         David Jones noted that Pam Hughes is in Baton Rouge attending a Rural Hospital Coalition Conference. She sent him word today that we are submitting the paperwork to transfer Benton Clinic into a rural health clinic. There are three different kinds of rural health clinics. One is provider based, one is a stand-alone and one is a free standing rural health clinic away from the hospital. Pam Hughes informed him that there is a backlog of 1,300 applications for rural health clinics. We are probably going to need some Board help in contacting some of our local legislators. Helen Godfrey-Smith asked if this comes from the State level. David Jones replied yes. We have had to do that throughout the past decade for one thing or another that we have done. It’s just part of the process. You can tell from a reimbursement standpoint, if you look at the ten months of the Benton Clinic, we write off more than we collect, which is extremely off for a clinic. This is a reason why a lot of Shreveport and Bossier Clinics do not accept any new Medicaid or any Medicaid period because they pay them very poorly. There is a huge difference in reimbursement from our Plain Dealing Clinic and Vivian Clinic to our Benton Clinic. It is just part of that process. Once we go over to a Rural Health Clinic, that rate will climb. Pat White noted that once it gets established it will get a little more. Brenda Smith commented that is why its rate of profit/loss is so high. David Jones agreed. Brenda Smith inquired if any of that loss can be written off on the cost report. David Jones said there will be a filing at the end of the year. He is not certain how that will affect it, but every expense we have, other than certain Administrative expenses, goes on the cost report. Brenda Smith said she didn’t know if that one, being different from our other clinics, if the criteria would be different. David Jones stated that we don’t file separate cost report for those.             Brenda Smith stated it was a slow month? David Jones said not really. From a statistical and billing standpoint – especially if you compare to same time last year at this time it was far better. Of course, coming off two of the busiest months we’ve had in probably the last 12 months, that is what made it look a little slower. For an April, it was pretty busy. Dr. Woods stated that, typically, when it is really pretty outside people tend to put off going to the doctor until they can’t ignore it any longer. David Jones said May has been up and down. With the weather being nice, it has to be serious for people to come in. Robert Green commented on the cash. Allyson Allums stated we do interim cost reports. We completed one. They increased our rates $400 a day for each Medicare patient, regardless whether they are in Swing or Acute Care – we get a little over $2,000 a day. Once they did the interim report, they owed us $734,000 back. It will be in next month’s financials. We have been paid that. We also have some more payments coming for some other unsettled cost reports. We have $160,000 coming from Medicaid and we are waiting on that. David Jones said that tells you of our expenses for the last four or five months. The interim reports were from the end of last year through April. That is why our cash has dried up because our expenses have gone up so high because of the new building. That is part of the catch up phase. Now they go back look at what you spent and note you spent much more than we paid you so here is a large payment to equal that out. With it going up $400 – about 30% of our inpatient per diem, they increased to actually keep us from having that large deficit for the next three to four months. Then they will settle up at the end of the year. Pat White inquired if we are still getting a good return on the prescription program. David Jones replied yes. By the end of the year, that will be a large cash influx for us – by the end of the year.         Brenda Smith inquired about the stats for the WIC program. David Jones said they are reviewing these numbers. He is questioning if they are correct. He will report to the Board his findings. There is no issue with the program. Allyson Allums stated there may have been a typo.    Pat White made a motion to accept the Statistical and Financial Reports as presented pending the audit. Brenda Smith seconded the motion.     The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith Nays: None; Absent: Helen Adger, Bruce Walker; Abstained: None. The motion passed.     IX. New Business:   1) Approval of Meaningful Use Upgrade– Allyson Allums, CFO, stated that Board Approval is needed for a Meaningful Use Upgrade. She reported that we are in the last stage of Meaningful Use. In order for us to meet those requirements, they have to do some additional work to the EHR. We have to have some new things installed in it for us to be able to meet those requirements. The cost for this is $22,000. Because of the dollar amount of the purchase, we need the Board approval to do this be able to meet Meaningful Use for the last stage – Stage Three.    Helen Godfrey-Smith made a motion to approve the expenditure of $22,000 for the Meaningful Use Upgrade as presented. Pat White seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith Nays: None; Absent: Helen Adger, Bruce Walker; Abstained: None. The motion passed.     Brenda Smith expressed her congratulations to everyone involved putting in so much time and effort in implementing this program. David Jones noted that Allyson Allums was one of the heads of the project from the beginning – installing Cerner. This is just a long list of things we have done in the last decade that doesn’t get the press it should. The largest health facility in Northwest Louisiana still does not have a fully electronic medical record and we do. Our doctors, even though they have fought through the process, and there has been pain in the process, but they are up and running and fully integrated. They put in orders for the patients and things get done from there. It could be better; there is no perfect system – they all have flaws. Hopefully as things go on throughout time, those things will smooth out and actually used for what is supposed to be used for – as an aid for the doctors and not a negative for the doctors.         Brenda Smith asked when we finally get to the end of this, what will that mean for us? The incentive. David Jones said we have already received that. Allyson Allums stated that we got that money as we incurred the expense. We turned that in and we have been reimbursed. If we don’t accomplish all stages by certain dates, they want the money back.         Brenda Smith asked how far ahead we are. Allyson Allums stated that middle of next year is when we can attest again and must meet all requirements. Brenda Smith asked what the final date is to have it all completed. An exact date was not available, but an approximate year of 2020. If you don’t have it completed, they will start cutting payments to the hospital and the physicians as well.   2) Robert T. Green, Jr. Reappointment –David Jones noted that we have one reappointment coming soon. Robert T. Green, Jr. is up for reappointment. Robert Green T. Green, Jr. has agreed to serve another service term if approved by the Board. Pat White, Board Vice-Chair asked for a motion to approve Robert T. Green, Jr. for reappointment to the Board of Directors for a service term of six years.     Kenneth Clay made a motion to approve reappointment of Robert T. Green, Jr. to the Board of Directors for a service term of six years. Mary Irvin seconded the motion. The vote: Yeas: Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith Nays: None; Absent: Helen Adger, Bruce Walker; Abstained: Robert T. Green, Jr. Pat White, Vice-Chair noted the vote was unanimous in favor and the motion passed.       Pat White, Board Vice-Chair will send a letter to the Douglas Dominick with the Caddo Parish Commission, to request reappointment of Robert T. Green, Jr.           The Board members expressed their appreciation to Robert Green for his willingness to be reappointment and that his service is greatly appreciated by all.     IX. Administrative Report: 1)     NCMC – Current Activities –David Jones stated that there was a lot going on in the month of May. We celebrated Hospital Week a week ago. He gave kudos to the Marketing Director, Mary Coil, for putting together a very festive hospital week. Several of the employees said this was the best hospital week they have had. We had snow cones one day; the doctors provided Canes chicken for the entire hospital – day and night shift; we had a fish dinner provided by a home health company for the whole hospital one of the days; administration served a pancake breakfast, had donuts one day and games throughout the week. It was a good time had by all plus we took care of patients!       We still have the recruitment effort going on for OB/GYN. He has spoken to one of the residents at LSU that is interested. She is still interested. They are very busy at LSU right now. She hopes to come back in a few weeks to sit down and visit about this soon. They are going to push for a final decision or we are going to have to open up recruitment efforts up beyond LSU. We thought that LSU is our best recourse. If we can develop that relationship and make it solid between the OB program and our OB program, then that helps call and so many things we can keep going. He and Dr. Woods spoke with Dr. Taylor. Dr. Taylor is leaning towards staying in the clinic. No final decision yet. In the near future we will need him to make that decision.          Allyson Allums distributed a copy of the 2017-2018 Budget Draft for the Board members to take home and review for the next few weeks. If you have any questions, call Dakota Robinson or her and they will research them. They did a pretty conservative budget with a profit of $400 – $600,000 for the year. You will see on the front page they added the addition for the 340B program estimated $750,000 increase from that. They worked with each department and went through their expenses. It was budgeted for a 4% raise in salaries and that is if the Board chooses to do that.         Helen Godfrey-Smith stated that the Finance Committee, one of their first official duties, met with the accounting team and leadership of the hospital and they received a copy ahead of time and they have been reviewing and had some discussions. They will be following through with the process and move forward. They are receiving a second copy today. They have a couple of things they have requested – assumptions is one of the things you will find with your next copy. Meaning, explanations of anomalies. If there seems to be an extra high expenses for next year, or lower revenues for some reason, we are asking that they use the white space at the bottom of each departmental sheet for comments so there is no doubt in their minds why the anomalies are there. She noted that the excel spread sheet added across the line and should not have (an incorrect formula). The numbers down the side are correct. The Finance Committee consists of David Norman, Robert Green, Bruce Walker and Helen Godfrey-Smith.         The budget will be up for approval at the June Board meeting. A final will be distributed at the Board meeting.         Pat White inquired about the Nurse Practitioner contract. David Jones stated the contract has been signed by her. She will start in late June. David Jones stated they are very excited about her. She already has patients scheduled at the Benton Clinic. She is from Benton and very tied into Benton. The town is very excited to have her. She has requested to meet with our marketing team several times. He and Rachel Bouchard met with her about a week ago to discuss some other things about the clinic. She is wanting it to be up and running. She is talking about going out to the different businesses herself; going to the schools. She is going to be a good addition. Helen Godfrey-Smith stated that great thing about this kind of aggressive energy, it will usually spread to the other clinics. This will be good.       2)            Safety/Risk Committee Report –   David Jones – Our Safety Committee Report. David Jones stated that our Safety/Risk Director, Daniel Marze, is in a meeting in Baton Rouge. Allyson Allums is on the Safety Committee and is going to give a brief report of some things the safety committee has been going over. We had a pretty large event a few weeks back that she was very integral in. Allyson Allums stated that Daniel is the Safety/Risk Officer. Within the committee we have been focusing on getting our staff trained in all areas of emergency preparedness – Active Shooter, weather related such as tornado drills; fire drills, mass casualties; hazmat. They do a quarterly report looking at any kind of occurrence – injury to patients such as slip/falls; injuries to employees; looking at lost work hours due to the injuries; needle sticks, medication errors and variances. We also look at a number of other things. Daniel has started training for active shooter. He has completed all the training for active shooter. He did about 20 classes – about 300 hours of training. We had a disaster drill on May 9th. It started with an active shooter at the high school – bringing in 9 patients. Also an active shooter at the hospital of an angry family member. Involved in this drill were Fire District #8, Caddo Sheriff’s Department, Vivian Police Department and Homeland Security. There were two evaluators for the Disaster Drill to evaluate how we performed – Knox Andress, the Director of Emergency Preparedness Coordinator at LSU, Tony LeBlanc, Homeland Security. Daniel received an email from Mr. LeBlanc that said he was really proud of the job that Daniel and his staff had done and that the communication area was good control and command was also good. David Jones noted that Allyson Allums was over command control. David Jones said he and Pam Hughes took a backseat. Pam Hughes was the shooter at the high school and was flown over as a patient. He was a victim downstairs as well. He wanted this scenario in the event they were out of town. He said Allyson did very good job. She said she learned a lot. Knox Andress worked through hurricane Katrina, through many different things that have happened. He is extremely up to date. We had the Homeland Security guy for Caddo Parish here. They were walking around watching what we were doing and how we were doing it. On top of the fictitious shooting at the high school, we had a fictitious shooter show up at the hospital. We had a double drill. We had a disaster drill and an active shooter drill going on while all this mass of hysteria was going on as well. You never know what could happen. We are very visible, a beacon in Vivian. All that activity was going on here. We had about 15-18 Caddo Parish Sheriff cars. We tried to inform the public well. Then the ER got busy. Dr. Woods said it looked very realistic – had a bad nose bleed. Everyone did extremely well. We are planning to try to do something at night and the weekend. You never know when something can happen. That is when we have our lightest staff – night and weekends. David Jones told Allyson he didn’t mean to interrupt her, however, he wanted to give her credit and praise because she did very well during the drill.          Allyson Allums stated that after the active shooter training, Daniel is now working on Fire Drills. There was a company that came in to do the fire drills, however, Daniel has extensive training in this area; he will conduct these. He will do the first one on Friday. They will alternate shifts; one during the morning; one in the evening. He is working on the new evacuation routes for the new facilities. They have developed an environment of care rounds. Daniel goes around once a month to check for different safety hazards in the hospital; doing a walk through using a check off list and submit this to get any issues fixed. He is working on the next disaster for July 1st. He wants to do a hazardous material – such as a derailed train car. We will have to test other aspects that we didn’t use in the last disaster. We will have to ask people to come in. We are developing new policies and procedures and we have completed the active shooter. We have completed Code Pink – Child Abduction. We are still working on others. We are doing an Evacuation Chair training. She thinks Daniel will come at a later date to do a presentation. Daniel is a high energy person. He has been working as a PRN Paramedic for many years. He is doing a great job.       3)   Foundation – Mary Coil stated that she has brochures for the Sporting Clays and Bingo. The Bingo presale tickets are on sale now at New Beginnings and the Gift Box and of course from her. These are $20. We are gladly accepting sponsors. There are several different levels. One team would be a great help to the foundation. This will be in place of the Gala. We are not doing a gala this year. We didn’t want you to have to choose. Allison Jones noted that the Federal Bar Association has done their fund raiser there and it has always been very successful and everybody has raved about it. It is a very nice place. Mary Coil stated how nice the facility and accommodations are. It will be early in the morning since it is July. A shotgun has been donated. It is to be raffle – a Beretta A400 Xplor Action 28 gauge shotgun. She said they are accepting prizes for the Bingo. David Jones noted that Kids Shooting teams are growing. This has become a growing program is now a scholarship activity. This is a different venue.       X. Medical Staff Report: 1) Recommendations – Allyson Allums – Allyson Allums noted that this is a first. There are no appointments, reappointments, advance practice professionals appointments/reappointments or extension requests. There is one resignation.   Allyson Allums presented the Medical Staff recommendations for the Governing Board approval:     VOLUNTARY RESIGNATIONS: 1) Timothy Donovan, M.D. – Voluntarily Resigns Courtesy Privileges in the field of Emergency Medicine as of February 21, 2017.     Helen Godfrey-Smith made a motion to accept the Medical Staff Recommendations for Medical Staff Voluntary Resignation. David Norman seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith, Nays: None; Absent: Helen Adger, Bruce Walker Abstained: None The motion passed.     2)   Chief of Staff Comments – Dr. John Woods, Chief of Staff, reported they held their Medical Staff meeting yesterday. They introduced the Peer Review process. The majority of the medical staff was there. Everything that he learned was that you have to have a buy off into this or you will have a poor outcome. It was an introduction why it is important and why we are going to be doing this, not just because it is in the bylaws. He thinks they got the point across why it is important and he thinks he got a buy off on it and interaction into it. They gave the Medical Staff a copy of the WK policy and used it as a template. It will be tweaked for our hospital and the intervals will need to be broader and the criteria is still there. Also discussed was we have Dr. Banda’s group coming on in July. They emphasized the importance to welcome these guys and get them patients through referral sources. Everybody is on board with this. This group is highly regarded in Shreveport and a lot of people already know who they are and they have a lot to bring to this hospital. It will be new for both parties – the clinicians and the group. He just wanted everybody to be on board with this and push to give them a reason to be here. Once everybody realized their services that they can provide, it will open up a whole new service. There are three general surgeons from Bossier. They are trying to expand their bulk of business. They can also provide trauma services if they are in the house. You don’t know what you have until they actually start coming. Most people don’t like to leave this area. We will need to do some strong advertising. The surgeons really like the operating room. David Jones noted to the Medical Staff, that Dr. Woods has been working, since he has been Chief of Staff, trying to get the bylaws done and completed and rounded out as we need them. The Peer Review process is a huge part of that as well. One thing that really stood out at the meeting they attended in New Orleans– if had we had those things in place like they should have been, we would not have gone through what we have gone through the last two to three years. It would have corrected itself way before it ever got to that point. For the future, we have to continue that process to make sure that we never go through that kind of thing again. Pat White commented that the doctors should understand, after seeing what happened and how necessary it is. David Jones agreed. It affected them all as well. Dr. Woods stated the only other thing that was brought up is that we are delivering babies here. He was on call and a child was born here that needed a bilirubin light. We did not have one. He didn’t understand why. It is a simple light and it is very safe. He feels we should have one. There is no reason to ship a child for a bilirubin light. Helen Godfrey-Smith asked Mary Coil if that was something the Foundation had talked about. Mary replied that it was a warmer.       Everything is going well. The next phase is going to be designing the Peer Review Process. The majority is in place. We are trying to figure out how to evaluate each other. All his peers do not like to be evaluated. This is something he has been doing for years in the military. You have to evaluate yourself and then your boss evaluates you. It is very difficult to evaluate yourself. It is a good process – it makes you grow. Everybody can always improve. You have to consider clinical skills, performance and professionalism. He said in the past it use to be that the doctor comes in and it didn’t matter about attitude. He made it very clear that this is no longer acceptable. You have to treat everybody equally fair and the way you would want to be treated. Can’t bite someone’s head off because you had a bad day. He has witnessed bad attitudes and would get away with it because of their position. It will be very self-correcting.         Helen Godfrey-Smith wanted to suggest adding the Introduction of the Budget to the Agenda. Pat White noted it will be on the agenda for June. This would show our diligence and that we are being thorough with the budget. She suggested it be added as #3 under New Business since it was discussed at that time.     Helen Godfrey-Smith made a motion to amend the Agenda to add #3 under New Business of Introduction of the Budget and Discussion of the Same. The motion was seconded by Mary Irvin. The following vote by roll call: Robert Green: Yea; Kenneth Clay: Yea; Mary Irvin: Yea; David Norman: Yea; Brenda Smith: Yea; Helen Godfrey-Smith: Yea; Pat White: Yea; Absent: Helen Adger, Bruce Walker. Abstain: None. The motion passed.     Allison Jones stated that she has some written information she will provide to Robert Green to use as a guideline.   XI. Adjourn:    There being no further business Kenneth Clay made a motion to adjourn. Pat White seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Helen Godfrey-Smith. Nays: None; Absent: Helen Adger, Bruce Walker. Abstained: None. The motion passed.       Meeting adjourned at 6:59 p.m.