BOARD MEETING: Regular Meeting   DATE:  June 26, 2018    MEMBERS PRESENT:  Robert T. Green, Jr. , Mary Irvin, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Patricia White.      MEMBERS ABSENT:Kenneth Clay (arrived at 6:08 p.m.)   TIME CALLED TO ORDER:  5:30 p.m.   OTHERS PRESENT:  David Jones, CEO, Pam Hughes, COO, Dakota Robinson, Controller, Walter D. (Doug) White, Hospital Attorney, Allison Jones, Attorney, Dr. John Woods, Chief of Staff,  Mary Coil, Foundation Executive Director/Marketing Director, Lanell Audirsch, Admin. Asst., Mike Vaitkus, Security.     LOCATION:  NCMC Events Center     BOARD CHAIR: Robert T. Green, Jr.     SECRETARY:  David Jones     I. CALLED TO ORDER –Robert T. Green, Jr., Chairman, 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 Green noted that there are several amendments to the agenda. Under number IX. New Business add item #4) Purchase of New Ultrasound Equipment, #5) Purchase of 2018-2019 License for 3M Coder, #6) Ratifying Phone Poll Lester, Miller & Wells for Engaging for Audit and Cost Reports, #7) Engagement of Lester, Miller & Wells for Additional Agreed Upon Procedures for Audit.  Mary Irvin made a motion amend the agenda to add the named items to the agenda under New Business. Ronnie Festavan seconded the motion. Robert Green asked if there was any discussion. There was none.     The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: Kenneth Clay    Abstained: None. The motion passed by unanimous vote.      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 May 22, 2018 –The minutes of the May 22, 2018 Regular Board meeting were mailed prior to today’s meeting for review.  Pat White made a motion to approve the minutes of the Regular Meeting held on May 22, 2018 as mailed.      Brenda Smith seconded the motion. Robert Green asked if there was any discussion or any corrections that need to be made before we approve the minutes. Robert Green inquired if there were any corrections to be noted.  Helen Godfrey-Smith noted that the minutes are showing Kenneth Clay absent at the beginning of the meeting and he came in late. Then on page 1 about midway of the page it shows Kenneth Clay he is absent during the vote. But later on it shows he was present for other votes. It would be good for us to note his time of arrival during the vote to make it clear to the public since the minutes are distributed to the public. It was noted that sometime members come in late and are noted as absent for a vote, but are recorded as present in the members present then showing them as voting later in the minutes. Ronnie Festavan asked to be recognized. Robert Green did so. Ronnie Festavan stated that it just needs to reflect what time Mr. Clay arrives, insert that in the minutes that he arrived. Ronnie Festavan stated that breaks down all business before that entry that he was not present and all business after that entry he was present.  Helen Godfrey-Smith stated that is in line with what should be noted at the beginning and then note for the first action after he arrives to make it clear. Helen Godfrey-Smith stated that was all she had.   Robert Green asked for a vote to approve the minutes with the correction noted. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: Kenneth Clay   Abstained:  None. The motion passed by unanimous vote.     VI. Presentation of HCAPS  – David Jones noted that he is asking to table this. The presenter of the HCAPS presentation came down with an illness earlier today. They had the presentation ready. He felt her expertise was needed in case the Board had a question to be answered. If we could table this until the next meeting, hopefully she will be well and ready to make the presentation then.  The item will be tabled until the July meeting.   VII.  Old Business – 1) Radiology and ER Expansion Update: David Jones noted the construction documents have been completed and turned in to the State and the USDA. The USDA has commented back on numerous items that the architect has to clear up before they will approve the documents. Also, the Fire Marshall is slated to approve the plans as well. He believes that the Fire Marshall already has those plans.  David Jones stated we are in line with the initial time plan. This is the phase that no one can guestimate how long the USDA will take, or the State or the Fire Marshall.  Robert Green asked if there were any questions.  There were none.   VIII. 1) Review May 2018 Statistics  –  Dakota Robinson:   Dakota Robinson noted that the admissions last month, you will see a key statistic here that the majority of things are rising. We had 76 admissions, which was a 43% increase from the prior month. Newborns are the one area that is very cyclical. There were three – it is down a little. In-patient days there were 242 which is a 63% increase from April which is a good trend to see. The Average Daily Census was up 59% at 7.8. Endoscopies are at 7 not the lowest for the quarter but it did trend down some. Surgeries are holding at 10. It is good to see it at or above 10. Emergency Room Visits were 451. A lot of our conversation this year is looked at the Emergency Room, Emergency Room Expansion. He pulled 2017 data for the same period. This year we have seen at an average of 22 patients more per month. Mammography had a 91% increase from the previous year at 44 mammographys.    Medical and Surgical Clinic saw 1,819 patients. They had a profit of $44,457.00. The Plain Dealing Clinic saw 647 patients and had a profit of $59,537.00.  Benton Clinic saw one more than their highest previous record at 409 and they had a slight loss of $6,780.00.  Days Cash on Hand is a very bright spot – 69.15. Mr. Jones commented a little bit on that in his management report on that. For the month we had a profit of $559,736.00.  There is another management comment on this as well – AR days for the hospital is at 37.06. That is very good for this facility. The Fitness Center memberships are at 423.  Dakota asked if there were any questions in regard to the statistics.  There were none.    2) Review May 2018 Financials – DakotaRobinson –  Dakota asked the Board members to turn to the Financial Statements.  On page 1 – The Balance Sheet – Cash on Hand – $4.1 million – Unrestricted cash if we go down to Assets you can see all the accounts that have some type of reserve whether it is internal by the Board or USDA, they are all at the levels that they need to be funded at. We put together a sheet for the Board. As of yesterday, there is about $1.4 million in restricted Bond cash alone. The reserve accounts make up a significant portion of this Balance Sheet.  You will go to page 3 to the Income Statement. There were $3.6 million dollars in revenue. That is over $600,000 difference from the previous year. Contractuals are in line with what we expect in the current fiscal year –  a little over 52%. Salaries and wages came in at almost $1.1 million, but for the current year we are still at that threshold of $500,000 in savings from the previous year which is the goal of the Finance Committee and a lot of the work that was done in reigning in some expenses. One thing he will point out on this list that looks a little odd. Looking at insurance expense – it has a negative balance of $62,000. All this is, we re-classed worker’s comp benefits. That re-class was done for cost report purposes. It is one of those things we tried to fend off an adjustment in the audit so we did it in this set of financials. We moved it up to Employee Benefits and Payroll Taxes. That $340,000, which is higher than it typically is has about $90,000 re-class of expense. It doesn’t change the Financial Statements. We are just moving it from one bucket to another. That is the main thing he wanted to point out. The same thing on Foundation Revenue, you will see a negative $25,000. That has been moved up to Other Operating Revenues for a classification for year-end purposes. Helen Godfrey-Smith asked Dakota if it would be appropriate as well to make an adjustment on the budget so that those two items look more in line. Dakota responded that he has a list of adjustments that have been made in May and June. He will do that whenever he loads the Budget in July.   On the Sales Tax Revenue, you are used to seeing $96,000 a month. We accrue that account and all we did was we brought in more money than was expected for a certain period of time so we had to accrue a little bit more money to bring that account to where it needed to be. It is at $126,477 opposed to what you are used to seeing. The 340B Revenue is $95,000 and for the current year $960,000 for a bottom line of $559,736. He knows that is a big statement. Does anyone have any questions regarding the income statement?  We will go to page #4 – Departmental Revenue and Expense. Glancing at the far right, the net difference from last year at this time you will see that pretty much down the line each department has surpassed the previous period. Bottom line, the one that shows negative $25,000 that is Obstetrics, and as we saw from the slides there were only 3 in the month. That is one of the departments that is very cyclical and we see that from time to time. Ronnie Festavan asked Dakota to back to in-patient routine care at the start – that is a negative $51,228. Dakota noted that in-patient routine care is always a negative one that is netted against expenses because that is where the nursing expense flows to. If you look at the previous period of $95,000 loss; the lower we can get that loss in that department that is where other departments pick up the slack. There is always a loss in that department just the way that revenue and expenses are calculated. Ronnie Festavan stated so we just didn’t lose as much. Dakota replied yes Sir. Even if it is an in-patient, a lot of what is done to that in-patient is Radiology, or Therapy or Lab or Pharmacy. Even though the patient is an in-patient, we get revenue off that patient being in a bed, the revenue that comes from those different departments actually goes into the departmental revenue. If you don’t have the in-patient department, the revenue from your pharmacy or your lab doesn’t exist. You see a loss in the in-patient line, but if you would net it together with all of your other clinical areas, then that is where you make your money.  Dr. John Woods stated that there is a set amount that is funded for each person being in the room. That set amount is based off of the fact that there really is nothing going to go awry with this patient; they are just sitting there. If something were to go awry, where they need a lot of ancillary care or tests all that just goes into that.  When it comes down to the patient, we always default on taking care of the patient first versus what the hospital is making off of it. We have to be blinded with all that – we take care of the patient and worry about the rest later. Ronnie Festavan said that helps a whole lot, but what he hears you saying is that we make that up somewhere else. The answer was absolutely. David Jones said 75% of that pharmacy revenue probably goes back into there and at least half of the laboratory revenue goes back into that typical, what you would think is an in-patient stay that generates revenue. And then Radiology is really hard to estimate if you ask him, it is certainly a percentage of it goes back into there too. Ronnie Festavan said thank you.  Dakota asked the Board to go to page 5. You will see the same trend. We have seen it month after month in this fiscal year as you go down the departments. Once again, Mr. Festavan, you can see too on the eleven month on the in-patient line it is a negative number and you rely on the ancillary departments to pick up that loss. If you will turn to page 6, once again this compares previous years at this time. We had 242 hospital patient days compared to 192. That is a significant increase. The highlight on this page – the number of days in AR is at 37 for the hospital as a whole and for the hospital itself is 37.7.   Brenda Smith said Dakota may be going to answer her question – you said Mr. Jones letter would refer to what. Dakota noted that Mr. Jones letter stated it is the first time since he has been here that it has been at 37.  David Jones stated that is probably in the 90th percentile in the state for AR days. They have obviously been turning out some bills. Brenda Smith said she was going to comment was there something that attributed to that decline. Dakota noted that he thinks it’s just efficiency – everybody is getting their roles. We had some shuffling either with people and where people were located. People are not at the HealthPlex and everybody is getting into their roles and it is working. Brenda Smith noted that it has been three months in a row that it has come down.  Pam Hughes noted that some of it is the MCO’s. The Medicaid – we had been having a lot of trouble with them – major. It took several months for us to get them to do what they were supposed to do and pay. We are sitting on a huge amount of that coming in. Dakota asked Pam we had some of the MCO that were how far behind in paying – she answered a year. It was a fight. Dakota noted back six months ago when you saw the AR days in the 60’s that was part of what was making up the problem. Brenda Smith said thank you. Pam noted we did get that money.  Dakota asked the Board to turn to page 8 – the Vivian Clinic. The bottom line is $44,000 profit and for 11 months – $376,000.   On page 9 – Plain Dealing Clinic – $59,000 profit with $118,000 for the year. The Benton Clinic had a loss of $6,780. We keep saying each time that we are at the cusp of getting the rate changes and we are very close to getting that rate change to decrease the contractual adjustments. You will see this clinic compared to the other ones – the contractual adjustment of $60,000 on revenue $89,000 – that is very high. It is just based on the rate that is being paid for those visits in that clinic. David Jones noted if just based our contractuals off what Plain Dealing’s are, which is no guarantee it is going to be that, but it certainly going to be a lot better than what it is, if we were being reimbursed like we are in Plain Dealing it would net you out in cash around $250,000 difference on that bottom line. Instead of a negative $18,000 it would be a positive $232,000. Ronnie Festavan, said maybe Mrs. Hughes could help with this, where are we in the evaluation with it. We talked about it last month. Did that letter come in? Pam Hughes replied no. She has to get the Medicaid number before they will do that. That is done. It should be in the next few weeks that she gets the Medicaid number. She is waiting on CMS – Medicare. She is sending them information and then they set our rates. We are probably looking at 3 to 4 weeks. Ronnie Festavan said he thinks what he hear her saying, once we get that, the Benton Clinic situation is going to begin to turn around. Pam Hughes and David Jones replied yes.  Pam said when you are getting $30 for a visit and you are going to get probably $100 for a visit it will change.  Dakota noted that you will see that reflected in the contractual adjustment line item on that clinic when that starts to take place. Dakota asked if anyone had any questions or comments. There were no further questions or discussions regarding the Statistical and Financial reports.      The Board thanked Dakota for the report.      Pat White made a motion to accept the Statistical and Financial Reports as presented subject to audit. David Norman seconded the motion.    The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None.  Absent: Kenneth Clay.  Abstained: None. The motion passed by unanimous vote.   IX.  New Business  –  1) Approval of Budget 2018 – 2019: David Jones requested a motion to approve the Budget for 2018 – 2019.  Helen Godfrey-Smith made a motion to approve the Budget that was submitted at the last Board meeting. Mary Irvin seconded the motion. Robert Green asked for any discussion.  Ronnie Festavan asked if the Finance Committee had reviewed the Budget again with a fine toothed comb. He knows we received the last Board meeting and we talked some about it – it is a lengthy document. Helen Godfrey-Smith replied yes. The Finance Committee has gone over the Budget with as fine a toothed comb as possible. He wants to feel comfortable about that. Budgets are sometimes very tricky items and have a lot of folks that want to second guess the budget after you approve it. He feels confident if our Financial Committee has given it its blessing. Helen Godfrey-Smith said we have given it as much attention and we completed our agreed upon procedures and got our policies in place and we feel very comfortable with it. Our auditors are going to affirm that we have given it adequate attention. Ronnie Festavan thanked Mr. Chairman.  Robert Green asked if there was any further discussion. There was none. The vote to approve the Budget for 2018 – 2019 : Yeas: Robert T. Green, Jr., Mary Irvin, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: Kenneth Clay.  Abstained: None. The motion passed by unanimous vote.      Helen Godfrey Smith asked to make a comment. She noted that they just finished their Strategic Planning session and there was not adequate time for them to impact our Budget with any plans that might skew these costs. That might be a point during the course of the next fiscal year, once the Board has determined that these are concrete plans that we might come back to the Board with some adjustments or amendments but you will have all of that documentation well ahead this.   2) Renewal of Inter Qual Software for 2018:  (Kenneth Clay arrived at 6:08) Robert Green asked David Jones if he was planning to discuss this further. David Jones replied, yes, after we get a motion.  Bruce Walker made a motion to approve the renewal of the Inter Qual Software for 2018.  The motion was seconded by Brenda Smith. David Jones stated that this software along with what will be #5 on the Agenda, these are recurring cost that have happened every year since he has been here. They are budgeted and put into the expenses of the departments. This particular item has inched its way up above his approval amount for purchasing.  This software is used by our Case Management Department to run criteria on every patient that is admitted. He knows that Dr. Woods has heard the term Inter Qual criteria numerous times on patients that he is admitting or tried to admit. Basically, what happens is once a patient is or suspected of being admitted, our Case Management Department comes and uploads information into this software that basically says whether it should be an inpatient status, an observation status or it should not have been neither, it should have been treated as an outpatient. A lot of times it is a documentation thing in the chart. There are several things in the chart that got left out for one reason or another that need to be added. This keeps us from getting denied from the insurance department of every insurance company, Medicare, Medicaid or every governmental payer. This is much needed. Doing this work without this software he would probably have to double the Case Management Department to do this.    Bruce Walker inquired if there is a rise in the renewal fee.  David Jones stated there was a slight rise.   It was barely under $10,000; now it is $10,992.84. Bruce Walker stated it went up basically $1,000. David Jones replied – yes Sir. Dr. Woods said that it is like everything necessary they know it is needed.  Brenda Smith said it is like Mr. Alexander said the government said they are no longer going to be passive payers. Dr. Woods said literally they go down – well, did he document such and such. Did he give so and so a certain number of treatments – did he do this – and if they find one little thing in that document it is denied. Then it starts the appeal process and that appeal process has to take the physician – take them off line taking care of other patients and get on line and talk to somebody. There are  a couple of other companies that make this kind of information available. They data mine the information. The Inter Qual is the better one.   The vote to approve the renewal of the Inter Qual Software for 2018 vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained: None.    The motion passed by unanimous vote.   3) Changing of Board Meeting for July: David Jones stated that he wanted to talk to the Board about the meeting date for the month of July. He noted that Mary Irvin, Helen Godfrey-Smith and he will be out of town for that scheduled date of July 24th. Dr. Woods will also be out of town on that date. If the Board will choose to move the date, it would be the week before or the week after as possibilities.  Brenda Smith asked about the Financials. Helen Godfrey-Smith said she was just about to ask if that would put too much pressure on Dakota considering that he is working shorthanded in the accounting department. Dakota said it would not. He was planning on meeting with Bill Stansberry, the CPA, on the 12th and 13th. As long as we don’t have a deadline of Thursday like we have been doing the week before. He could have them out Friday. Mary Irvin noted if we waited until the Tuesday after we could give a report on what we experienced at the Conference it would be fresh on their minds. David Jones said in the past we have changed it from Tuesday to Thursday – you have options of Tuesday the 17th, Thursday the 19th or Tuesday the 31st. Dakota said he would like to make one observation – this is the year end financials, he would rather not put a lot of pressure on it to get them done early.  Helen Godfrey-Smith said that was her consideration that it is the end of the fiscal year.  Dakota said it would be nice to not have to rush them.  David Jones said he will say it instead of Dakota, it would be easier for us if we could have it the 31st, but that is the Boards ultimate decision. Ronnie Festavan said he is good with the 31st.  Helen Godfrey-Smith said we are aware the auditors are in now and have started the audit. That is putting more pressure on him. We appreciate him and want to give him every chance.  Brenda Smith noted she will be out of town that day.  Ronnie Festavan made a motion to move the July monthly meeting to Tuesday, July 31st. Pat White seconded the motion. Robert Green asked if there was any further discussion.  The vote to move the July meeting date from July 24th to July 31st:  Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained: None. The motion passed by unanimous vote.    4) Purchase of New Ultrasound Equipment: David Jones noted that our main ultrasound piece of equipment in the hospital is experiencing life end issues. It is still up and running currently but they are no longer making parts for the seven year old equipment. If he can get a motion to purchase a new ultrasound equipment in the amount of $156,001.50 he can provide more information. Helen Godfrey-Smith said there is a sheet that we recommended from the Finance Committee that Dakota would submit showing the calculations so it would be clear to the Board along with an attachment from the Auditor on it as well. Helen Godfrey-Smith stated that the Finance Committee that they would start on these large purchases to show that we are in line with the Bid Laws. Here we have an email from Mary Carroll, our CPA, saying that this purchase is in line with the Bid Law to be part of the record.  Brenda Smith made a motion to purchase the Ultrasound Equipment in the amount of $156,001.50.  The motion was seconded by Pat White.   David Jones said this is one of those pieces of equipment that is not a luxury; it is a must have. It is used in the diagnosis of many things. He is glad Dr. Woods is here. He can speak on this ad nauseam.  Dr. Woods said he uses this on a daily basis.  Robert Green said you said main. Do we have another one?  David Jones said no. We had two. We had a second unit that was in the clinic. It died about two months ago. This is one of those items that would put undue pressure on the medical team to be able to diagnose a patient safely at the hospital by not having this piece of equipment.   Mary Irvin asked if this is the one in the ER or the one that the technician uses or is that the same machine. David Jones said it is the same. We move it around. They have a small one that they can use in the Emergency Room but it is a quick scan that the doctors use mainly for bladders ant that kind of thing. This does the carotids, your vessels and numerous things throughout the body. It will have the 4D capabilities for the babies. Dr. Woods stated that it is non-invasive and causes no harm to the mother and fetus. An ultrasound can see things in the tissue that a CT cannot. You can ultrasound everything from the eyeball to the sinuses to the arteries, the veins; you can do procedures with it. At some point in time he believes it will replace the stethoscope. You can glean so much information off an ultrasound. The first week after the ultrasound was bought for the Emergency Room, a patient came in with a dissecting aortic aneurysm. He would have missed totally because it looked like a kidney stone. He put the ultrasound on and he could see the vessels ripping in half there in real time and he transferred the patient immediately. The patient survived.  It is an absolute must.  Mary Irvin said we will have cutting edge technology.  David Jones said the current one is seven years old. Technology wise it has moved considerably in seven years. Dr. Woods said he hates to say it but the one in the ER is getting old. The one in the ER is a quick scan. David Jones said he believes that the Foundation purchased the one in the ER.  Brenda Smith said just an observation, that this going to be utilized in so many different areas and departments and if we start marketing the 4D baby pictures, is it going to get to the point that one is enough. Dr. Woods said we do not have it on the weekends right now. If he had it on the weekends he would use it. It is a primary reason we would transfer people because we cannot get ultrasound done in the ER or on the weekends. You have to have a specifically trained individual to do this. They are really rare. We have one fulltime and one that works one day a week. It took three years to find the one we have. Brenda Smith we were trying to get people trained. It is very lucrative for sonographers – it’s an associate’s degree and it is a technical thing – you have to know anatomy real well and you have to know how to use the probe. It is a program specifically for that. Dr. Woods said that the ultrasound is one of the best tools we have. It causes no harm and you get real time information on what is going on with the patient.   Robert Green thanked Dr. Woods for his input. He is needed here tonight.   The vote to purchase the new ultrasound equipment: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: Kenneth Clay.  Abstained: None. The motion passed by unanimous vote.     5) Purchase of 2018 – 2019 License for 3M Coder:David Jones noted that this is the other piece of equipment. It is more of a software renewal. It is something that we have used as an encoder for the last 13 years. We need to renew the 2018-2019 for the 3M Coder for our Coding Department.   Mary Irvin made a motion to purchase the licensure for the 3M Coder for 2018-2019.  The motion was seconded by David Norman.  David Jones stated that Coding Department, with this software, they take everything that the clinical areas do, the Doctors, all the procedures that we do. They change them into a number.  It is a renewal of $18,438.95. This has been done annual ever since he has been here. We shave off a little bit of it. There were a couple of pieces that were more convenience. There is a DRG grouper that we don’t necessarily use because we don’t get paid off DRG – more of an information thing. We shaved a few of the things off. It still needs Board approval to go forward. This is another piece of software that he doesn’t know what we would use if we didn’t have it. It is used on every single bill that we bill out for the hospital. Dr. Woods said an example of that would be that we use to put broken finger. Now it is transverse fracture of the first metacarpal distal – it has to be the exact with and without non-displacement. It is rigorous just to try to get the proper diagnosis on there for something very simple.  Brenda Smith stated if it is not put in right you don’t get paid right. Dr. Woods said that is correct.  David Jones said yes the will give another denial area. Dr. Woods said it is like going through a gauntlet. The vote to approve the purchase of 2018-2019 license for 3M Coder: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained: None. The motion passed by unanimous vote. 6) Ratifying Phone Poll for Engaging Lester, Miller & Wells for Audit and Cost Reports: David Jones noted that there was a phone poll that we failed to ratify last month to engage Lester, Miller & Wells for the Audit and Cost Reports for 2018 fiscal year end.  Helen Godfrey-Smith made a motion to ratify the phone poll to engage Lester, Miller & Wells for the Audit and Cost Reports for 2018 fiscal year end.  The motion was seconded by Kenneth Clay. Robert Green asked if there was any discussion. Ronnie Festavan asked to be recognized. Robert Green recognized Ronnie Festavan to speak.  There was a phone poll and what happens with that. David Jones noted that Robert Green attempted to contact Ronnie Festavan but was unable to get in touch with him at first attempt. He called Ronnie Festavan first and left him a message then he called all the other Board members. Robert Green said he and Ronnie Festavan spoke about this when he returned his call. Ronnie Festavan said now that he reminded him he understands.  Ronnie Festavan thanked Robert Green.  The vote to ratify the phone poll for engaging Lester, Miller & Wells for the audit and cost reports for fiscal year ending 2018:  Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained: None.   The motion passed by unanimous vote.    7) Engagement of Lester, Miller & Wells for Additional Agreed Upon Procedures for Fiscal Year End Audit 2018:David Jones stated there is one additional engagement letter for Lester, Miller & Wells for the additional AUP’s that were approved for this year’s audit. If he gets a motion Dakota has it with him and he will speak on it further.  Brenda Smith made a motion to approve the engagement of Lester, Miller & Wells for Additional Agreed Upon Procedures for Fiscal Year End Audit 2018.  Helen Godfrey-Smith seconded the motion.  Dakota Robinson stated this is the AUP (Agreed Upon Procedures) that was added last year from the Legislative Auditor that was handed down. It is mandatory that we do that. It was the document that Mrs. Helen Godfrey-Smith referenced earlier during the financials that there were some outstanding issues on last year. Lester, Miller & Wells, a lot of it goes hand in hand with the audit, so a lot of the materiality or documents that they use to fulfill the AUP come from the audit so it makes sense to have them together instead of a separate firm. Being that we have to do it, it is just a matter of who you chose to do it with. Robert Green asked if there was any further discussion.  The vote to approve the engagement of Lester, Miller & Wells for Additional Agreed Upon Procedures for Fiscal Year End Audit 2018:    Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained: None.   The motion passed by unanimous vote.    X. Administrative Reports:  – 1) NCMC – Current Activity:  David Jones said he would like to thank all the Board members that went to the Board Retreat. He would like to thank Mrs. Mary Coil, Mrs. Helen Godfrey-Smith and Mrs. Britney Stringum. They did a lot of the leg work to get that in place and rolling. It is an evolving process and something that he discussed with the Finance Committee; he is hoping that next year before we have it he would like to have it local. We could bring in more Department Heads throughout the day. They won’t necessarily have to sit in on the entire event but a few of the session that you could use the experience of a Department Head in Radiology, or Respiratory Therapy or maybe even get additional Medical Staff that can come.  If we have an agenda planning session that the Board could come to, multiple Board members that you wanted to add or an education piece that you felt that really needed to be on there. We could have the meeting a month or so in advance of the session itself. It was not missed by him that this was time away from your families. This is time away from your family. We want to get you the most bang for your buck. A planning session would benefit everybody on that. He again thanked the Board members that came. It was a beautiful environment and he feels there was some good that come out of it.  David Jones asked if there were any comments.   Helen Godfrey-Smith noted that she has some survey information about the session and it’s very brief.  40% of the respondents said that the overall event rated it excellent, 40% rated it very good and 20% rated it good. 50% said it was extremely organized, 50% said very organized. Some of the comments that were made – the speaker was very knowledgeable, the landscaping was great, interaction with the Board members in an environment that is separated from distractions; I love the dedicated time with each other to be able to reflect on our past two years since the last retreat and to take a candid look at where we plan to go as an organization. How would you rate the venue of the location: 40% said excellent, 60% said good. Overall, how would you rate the event: 40% said excellent, 40% said very good and 20% said good.  David Jones said he appreciated Helen Godfrey-Smith doing that survey. That is actually something that he thought about but couldn’t get a hold of to put together. She had her hands on an electronic format that was outstanding. Helen Godfrey-Smith said this is something that she would like to introduce to Mary. Once you become a member of it you can expand it and it is very inexpensive – $50 a month and you can get up to 2 to 3 thousand responses.  Brenda Smith said kudos to everyone that was involved – it was great.     2) Foundation: Mary Coil stated that she has tickets for the Gala if anyone would like to purchase those today. She also bought payroll deduction forms if you would like for them to be payroll deducted. She has those with her today. We are still are accepting sponsors and silent auction items. If you know anyone who would be willing or if the Board would like to entertain that she is here to answer any questions you have.     Robert Green asked if there were any questions for Mary regarding the Foundation.  There were none.     XI. Medical Staff Report  –  1) Recommendations – Dakota Robinson:  MEDICAL STAFF APPOINTMENTS:  1.) Adam Green, M.D.  –  Request Provisional Privileges in the field of Radiology for the period of June 26, 2018 through June 30, 2019.;    2.) Catherine Sharpe, M.D.  –   Request Active Privileges in the field of Family Medicine/ OB/GYN for the period of July 01, 2018 through June 30, 2019. (Pending LA State Medical License).  3.) Maaya Wilton, M.D.   – Request Provisional Privileges in the field of Pathology for the period of June 26, 2018 through June 30, 2019.      MEDICAL STAFF REAPPOINTMENT:  1.) Michael Banda, M.D.  –Request Courtesy Privileges in the field of General Surgeon for the period of June 26, 2018 through January 30, 2019.      2.) Justin Skweres, M.D. –Request Courtesy Privileges in the field of Radiology for the period of June, 26, 2018 through June 30, 2019.  3.) Husein Poonawala, M.D. –  Request Courtesy Privileges in the field of Radiology for the period of June 26, 2018 through October, 30, 2020.  4.) Michael Gates, M.D. –  Request Courtesy Privileges in the field of Radiology for the period of June 26, 2018 through December 30, 2020.  5.) Kevin McDonnell, M.D. –Request Courtesy Privileges in the field of Radiology for the period of June 26, 2018 through February 28, 2020.   6.) Mary Phillips, M.D. –Request Courtesy Privileges in the field of Radiology for the period of June 26, 2018 through September 30, 2020.  7.) Taro Aikawa, M.D.  –Request Courtesy Privileges in the field of Radiology for the period of June 26, 2018 through November 30, 2019. 8.) Kurtis Tedesco, M.D. –Request Courtesy Privileges in the field of Radiology for the period of June 26, 2018 through August 31, 2019.  ADVANCED PRACTICE PROFESSIONALS APPOINTMENTS / REAPPOINTMENTS:   1.) Jere Thompson, M.D.  –Request Privileges in the field of Family Medicine for the period of June 26, 2018 through July 30, 2020.   2.) Pamela Hall, CST. –  Request Privileges in the field of Surgical Technologist for the period of June 26, 2018 through January 30, 2019.  EXTENSION REQUEST:  NONE.   VOLUNTARY RESIGNATIONS:  1.) Tal Delman, M.D. –Request voluntary resignation in Radiology effective 06/11/2018.   Helen Godfrey-Smith noted that there were two typographical errors on the Medical Staff Appointment report – it should be corrected from June 31st to June 30. These corrections will be made.  David Jones noted that the appointment of Dr. Catherine Sharpe will be our new attending. She will be sliding into Dr. Taylor’s slot in the clinic setting and Dr. Taylor will be moving mainly in the ER setting. He will still have one day a week in the clinic. We are very eager to have her. Her first day will be July 9th and they already have her 19 patients scheduled already.  Ronnie Festavan asked to be recognized. Robert Green recognized Ronnie Festavan to speak.  Ronnie Festavan asked if the movement of Dr. Taylor from the clinic to the Emergency Room; does that affect this status his status by nature of him now being an Emergency Room doctor. Is he still fulltime with us. Please help him explain to that question.  David Jones stated that he will still be employed by the hospital.  Ronnie Festavan said you understand where that question is coming from – from the public. If he is moving there is he now classified as our Emergency Room folks which must be some difference?  David Jones stated that we use, as a small percentage, an ER staffing company. Dr. Woods is a North Caddo employee, Dr. Chandler is a North Caddo employee and they predominately fill our emergency room shifts. Now that Dr. Taylor is moving in there, there will be very few shifts not filled by North Caddo employees.

Ronnie Festavan said Dr. Taylor will basically be the same as Dr. Woods; still an employee. David Jones replied yes Sir.  Ronnie Festavan said the question was raised is he now a part time employee or something like that.  Dr. Woods said no – he is still a fulltime employee. He is just classified in the Emergency Room Department now. He will still work some in the clinic but his primary department is the Emergency Room. Ronnie Festavan he works enough that we can dismiss that question with that. It is something that we have tried to work with him to get him what he wanted in this. Dr. Taylor is Board Certified Emergency Medicine as well as Family Medicine. It was an easy transition. This was instituted at the request of Dr. Taylor. Mary Irvin said he has been considering this for years.  Ronnie Festavan said in a related question – did we send out, this may be for Mrs. Hughes, did we send out some letter to the public with regards to this. Pam replied yes.  Mary Irvin said she received a letter because he is one their family doctors.  Ronnie Festavan asked how we generated that letter.  Pam Hughes said we used the computer system for the last year of his active patients and sent the letter to them. David Jones stated that we didn’t want his patients not to know what happened to him if they went to schedule a visit with him and they couldn’t. Ronnie Festavan said he thinks that it was a great idea to do that. Thank you.  Mary Coil noted there was also an article this week in the Caddo Citizen about including Dr. Taylor’s letter that he sent out and also information about Dr. Sharpe as well.  Robert Green said so by that we will see more of our doctors in the Emergency Room and less of others. David Jones replied yes. Robert Green stated that is wonderful.  Robert Green stated that we need a motion to approve the Medical Staff Recommendations.  Brenda Smith made a motion to accept the Medical Staff Appointments, Advance Practice Professionals Appointments/Reappointments and Voluntary Resignation. Pat White. The vote:  Yeas:  Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained: None.   The motion passed by unanimous vote.  2) Chief of Staff Comments: Dr. John Woods, Chief Staff, said the biggest thing is that we have new Residents coming on next month they are all going to get seated in. We have a good Chief Resident, she is going to be able to orient and that is Dr. Brown. Everything is in place with that. Dr. Banda has instituted a rapid training program with the nurses to get them on par with the way they do business at Willis Knighton and bring everybody up to par and getting them ready up here. He is doing a great job. He has stepped in and made some suggestions and we are implementing them and everything is going great so far.  Pat White told Dr. Woods that he has a young Resident, she believes his name was Dr. Jeff Goorland, that tended to her when she came in on Memorial Day weekend – he was great. There was not anyone else in the Emergency Room at the time and she got full attention and he stayed right there with her and the rest of the staff too. He seemed to know what he was doing and she was very pleased with him. Dr. Woods said yes, he is a good guy.  Dr. Woods said that is all. Robert Green thanked Dr. Woods.    XII. Executive Session: Robert Green stated at this time he will entertain a motion to enter into Executive Session for Strategic Planning.    Ronnie Festavan made a motion to enter into Executive Session for Strategic Planning with a short break before entering into the session. Bruce Walker seconded the motion.      The vote:     Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained:   None.  The motion passed by unanimous vote.        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.    Mary Irvin seconded the motion.   The vote:   Yeas:  Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained:  None.   The motion carried.      XII. Adjourn:         There being no further business Ronnie Festavan made a motion to adjourn.   Bruce Walker seconded the motion.   The vote:    Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White.  Nays: None. Absent: None.  Abstained:  None.  The motion carried.          Meeting adjourned at 8:11 p.m.

 

 

 

NORTH CADDO HOSPITAL SERVICE DISTRICT

North Caddo Medical Center

Vivian, Louisiana

 

 

 

                                                               

David C. Jones, Secretary