BOARD MEETING:  Regular Meeting   DATE:  August 28, 2018    MEMBERS PRESENT:  Robert T. Green, Jr., Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith.      MEMBERS ABSENT: Kenneth Clay (arrived at 5:52 p.m.), Patricia White (arrived at 5:39 p.m.).   TIME CALLED TO ORDER:  5:30 p.m.   OTHERS PRESENT:  David Jones, CEO, Pam Hughes, COO, Dakota Robinson, Interim CFO, Walter D. (Doug) White, Hospital Attorney, Mary Coil, Foundation Executive Director/Marketing Director, Dr. John Woods, Melissa L. Hay, Cardio-Pulmonary Department Director, Adam Oliver, Ambulance Service Director,  Lanell Audirsch, Admin. Asst.,     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 – Brenda Smith offered the Invocation.  Helen Godfrey-Smith asked for a moment of silence to acknowledge the loss of Senator John McCain then led the group in the Pledge of Allegiance.    III. Approval / Amend Agenda – Brenda Smith made a motion to approve the agenda. Mary Irvin seconded the motion. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith.   Nays: None.   Absent: Kenneth Clay, Pat White.   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 July 31, 2018 –    The minutes of the July 31, 2018 Regular Board meeting were mailed prior to today’s meeting for review.  David Norman made a motion to approve the minutes of the Regular Meeting held on July 31, 2018 as mailed.      Helen Godfrey-Smith seconded the motion.   The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith.   Nays: None.   Absent: Kenneth Clay, Pat White.   Abstained: None.   The motion passed by unanimous vote.   VI. Old Business – 1) Ultrasound Equipment Purchase Update:  David Jones, Administrator / CEO, reported that the Ultrasound Equipment was delivered on the Tuesday, August 21st. It has not been put into service yet.  There is some training to be done and some QC to be done before it can be put into service. Hopefully that will be a possibility for our next pre-Board meeting visit. He will try to arrange for a demonstration to see exactly what it looks like the differences of the images and the quality of the images. Be looking for the invite for the next Board meeting.  Brenda Smith asked if we were totally down for the ultrasound. David Jones replied no. The old one was still up and running as of right now and the portable one is in the ER.  Robert Green asked if there were any questions on that matter. There were none.   VII. 1) Review July 2018 Statistics  –  Dakota Robinson: Dakota Robinson noted that everyone should have the Statistical Report and a separate handout of the slides.  He noted in July we had 64 admissions; a 16% increase over June’s numbers. There were 9 Swing-Bed admissions. Newborns – 6. These were all Dr. Sharpe’s deliveries. She was quiet busy for her first month here at North Caddo. David Jones noted that she has delivered 8 already in August. He said he heard there is a huge number coming up in November and December. There were 189 in-patient days – a 24% increase from the month of June. The Average Daily Census – remember we changed the way this was reported last month to include.  (Pat White arrived at 5:39 p.m.).    Dakota continued stating that there were 8 Endoscopies. There were 6 Surgeries. There were three months trending downwards. He had Medical Records to run the numbers again for this month. As of today we have done 20 surgeries this month and four scheduled for tomorrow. It is just a pure coincidence on the scheduling of the surgeries in that number. The Emergency Room visits – there were 430; Mammograms – 35.  Ronnie Festavan asked on the Emergency Room visits, he sees that it is obviously up this time from last time but he does see it trending down a little. As far as numbers. If you look at 566 in the top left hand corner; we put a target of around 500 is what we are really comfortable with. He knows there is no set number but he is interested in what you all think about that. Dakota replied that if you look at the trend in the ER, it follows a cycle. Flu season right now is little to none. There is some going out there, but you will see those numbers creep up in January and February and even March this year with flu season being extended. That is a lot of the reason why you see increased numbers during the winter time; people are just sicker. Ronnie Festavan said that makes sense. David Jones said we have some things lined up with Mary Coil, marketing wise to help both. Our average ER wait time is significantly lower than anything in town. We actually benefited from that during flu season time because they were so inundated in town. We put a couple of ads up in the paper, along with De Soto; actually Willis Knighton put them up to get patients out of their Emergency Room. It worked; almost the next day, opposed to waiting 6 hours in town.   Dr. John Woods, Chief of Staff, said it is a traditional thing in every hospital or ER that summer time is usually the same trend.  Dakota continued noted that the Vivian Clinic had a $14,000 profit. Once again, we will go to the Plain Dealing Clinic. It is almost scary how similar the graphs are with the dips. They did see more that the last month at 591 visits. They had a slight loss of $6,000. Benton Medical you see the same thing. They had more patients than last month at 354 and they had a very slight loss of $760. Ronnie Festavan addressed Pam Hughes asking her to share what she had sent to him. Pam said Dakota will be covering that.  Dakota Robinson said we do have our rates for the Benton Clinic. We have received a Medicaid rate of $94 per visit. A significant difference from what we currently are receiving. We are trying to run the numbers to see what that would look like with that type of rate in that clinic. Hopefully we will have some better data next month to present to you. We can go back and bill what we can rebill for a certain time period. That was good news on that front as well. Dakota continued reporting the Days Cash on Hand at 63. Days Cash on Hand is still strong and you will see that in the Financial Statements presented in a little while. There was a profit this month of $388,000 and at the same time the AR went down to 44.29 days. Helen Godfrey-Smith asked Dakota to briefly explain the AR Days. Dakota stated that it is how many days in AR to operate if we were to not bring anything else in, how many of those days are in accounts receivable that we could collect. Dakota noted that Mr. Kenneth Cochran has his Financial Meeting on Thursday and these are a lot of things that he will go through and explain each and every one of these if you have any questions. Kenneth Cochran said you are going to equip me with the ability to ask a question. Dakota replied absolutely. Dakota noted that the Fitness Center membership is at 425.  Pam Hughes said she would like to explain something. She is not totally working on the billing for Benton. She has Kristin, the manager, working on reviewing those records back to March.  Dakota asked if anyone has any questions surrounding the statistics portion of this.  2) Review July 2018 Financials – Dakota Robinson – Ronnie Festavan asked Dakota to give us a short version of figuring the days cash on hand. In the minutes you referred back to certain numbers. Unrestricted cash is your statement last month. You said in unrestricted cash that gets us our Days Cash on Hand. Give him the correlation between unrestricted cash and days cash on hand. Dakota said lets open up the Financial Statements. (Kenneth Clay arrived at 5:52 p.m.)   On page 1 of the Financial report, this is where you will see your unrestricted and restricted cash. Dakota then explained the calculation in detail. Dakota would like to point out if we go down half way – Assets Whose Use is Limited – you see the Sales Tax Fund of $707,000. Sales Tax is coming in strong this year. He thinks there is a direct correlation to the internet sales tax. You see when the State started collecting those amounts and the time period when our collections started increasing a little bit. The NCMC reserve of $500,947, in the next period will be moved to the CD that the Board has directed. We got the last signature today and that should be taken care of. Ronnie Festavan asked if we put $500,000; is the $947 interest already earned on it.  Dakota replied yes Sir.  Dakota stated before we go page 2 of the Balance Sheet, he pointed out that the entire Accounts Payable – if you look at that compared to last year at this point in time, over 50% difference – it is a significant difference – a little over $600,000 compared to almost $1.4 million. He reports to the Finance Committee the total outstanding and there is nothing past due. Things are looking good and nothing has changed on that month. Ronnie Festavan said let’s stop on page 2.  Under notes payable, he noticed that that figure is higher for 2018 than 2017. Do you have a simple explanation for that? Dakota replied yes. When the building was completed more notes were put on as the bond drew down. Those bonds went into notes payable and at this time last year we had to add to get that to the audited number. As we build the hospital that number grows as we draw down on the bonds. Dakota directed them to page #3 of the Income Statement. We had $3.4 million in revenue compared to right at $3 million last year at this time. Total Operating Revenue – there was a difference of $327, 000. Down to Salaries and Wages – there were $980,000, which this time last year was $978,000. He would like to point out that is a big difference. Typically in previous years you would see a big difference in that Salaries and Wages bucket. We did a lot last year to stem costs. That is a good thing.  Under Employee Benefits and Payroll Taxes, this is the one thing on the Income Statement that sticks out as odd. You see $130,000 in expense where in the previous year it was $287,000.  He spoke last month about an IBNR – incurred but not reported – a function of our self-funded insurance plan. We had to book a credit of $150,000 for the month of June. Those are estimated claims that the employees have had either at a hospital or whatever kind of medical claim, we are making an estimated guess what that is booking it the month of June because it occurred before June 30th. We will sum that number up at the time the audit is done. We will know exactly what that number is because we will have that data in. What it does is it shows up as a credit in the month of July because it is washing that account. You will see that every year because claims data doesn’t come in for two months sometimes, depending on what type of claim it is – hospital, doctor’s office, whatever it is. There is a delay in that reporting, not only to Blue Cross but from the time that Blue Cross is able to can those reports and then get them to us. That is why an estimate has to be booked. We do have to allocate those expenses in the period that they are done in – it is accrual accounting. Under Professional Services he wanted to point something out that is a significant difference in the Operations and the Income statement this year. You see Professional Services was up to $43,000. It is going to show up on page 4. This is a new schedule, after the request of the Finance Committee. On the Income Statement there has always been Other Expense Category. They felt it appropriate to add this schedule in there to give you a little bit more insight in what those other expenses are. Now, once again, there are some subcategories one this that we tried to lump those things into because you are talking about 100 or more accounts. We tried our best to break them out. He will say booked into the supply expense for now, a function of the GL reporting that is new, Easy Sleep, we had an expense of $43,000. We did 29 sleep studies in the month of July. That is a significant number. On the Income Statement on page #3, Sales Tax Revenue, you will see there is a difference in the accrual. This is another one of those functions that we don’t get the information until after it is done, so we accrue to the best of our ability what we think we will collect in that month. We ran the calculations based on the average of the last twelve months and came up with $105,000 a month. That is what you will see in the accrual until we redo that number again. We typically redo it every quarter.  Ronnie Festavan said lets back up just a little bit. Leases and rentals are up $17,000. Dakota asked if he could get him an explanation on that one. Ronnie Festavan said when you look at something like that; you would think that would be fairly static through time. David Jones said it depends on when the payment comes through. Dakota said a lot of this is a function of timing. Ronnie Festavan said that is a good enough explanation.  Helen Godfrey-Smith asked if we didn’t get some new equipment that we leased last year. Maybe some equipment that had amortized out of the lease and it might have been low and we may have brought some new things on board with the finishing of the hospital. That is probably what happened. Dakota said he will get an explanation for him.  Down the list the 340B revenue – the highest yet of $120,000. Moving forward, Benton Clinic is going to be added to the cost report that is, hopefully, done October, November. We are going to go ahead to contract with a pharmacy in Benton and get that up and running so by the time we are eligible in Benton to add them to the 340B we will be ready to do so.  Dakota asked if there were any questions on the Income Statement. Kenneth Cochran asked if he could ask a question. Going back up to the Net Patient Revenue – is there any differentiation between non-insured patients. Dakota replied no Sir. This is total revenue – anything that happened in the facility and the contractuals that is the adjustments that we make based on that revenue that we expect not to be paid. All of that is in that number. When we get down to the Net Patient Revenue that is what we would expect to receive off of that amount of money. David Jones said we will spend a lot of time on that because that is the part that is very confusing to somebody that is not used to looking at medical finances. Dakota said we are now on page #5. Ronnie Festavan said on page #4 – he asked if that is something new. Helen Godfrey-Smith answered yes. That is the category under Other Expenses. We thought that it was prudent for us to provide for the Board a breakdown of actually what is in that. It is such a huge percentage when you look at the year to date of the overall expenses. For us to know what these expenses actually are, when you are controlling expenses, if you have a huge hunk of expenses you have no idea how to impact that. We needed to know what these expenses were so that we could figure out whether we could cut those.  Ronnie Festavan said looking at that and looking at the difference, under other expenses, it is $110,000 more. If he looked down those columns now that I am able to see all of these other things, which I think is important for us, because now we can say what does other mean. That is the question that was raised last month, and when I look at the differences of 18 and 17, I see that 18 other expenses under the difference of the expenses in one year, this could be a simple explanation; it is $110,000 more in expenses this year than last year. Is he reading that correctly? Dakota said you are in terms of financial statements – yes Sir. David Jones asked Dakota if he said it was $43,000 in supplies and expenses and that is due to a new service that we provide; 29 in one month – he doesn’t think we did 29 in a quarter when we did sleep studies before. That is $43,000 of that and then if you look down at the very last thing it looks like an accounting adjustment. Dakota said the way that we posted to the system last year at accounting time we were on an old system – we were on 2010 – we are on 2016 now. You could not open up a closed period. If there was a credit on an expense that you moved from the month of July to the month of June, it showed up literally as a credit in the month of July. If you look at laundry for instance, we all know that there was not a credit balance of $2,620 for laundry. Those expenses got moved to a different month. That is why on some of these it takes some digging into these GL accounts to see what exactly the reason was not only for this month but also for the previous period we are comparing it to. Same thing with taxes, licenses and permits – we know that was not $20,000 but anytime you get into the months of June and July there is auditing entries that take place in these accounts.  David Jones noted utility wise we weren’t in the full building until August 2018, he said we would be begging for $7,731 utility bill right now, because just the electric bill for the building alone is around $20,000 a month. Helen Godfrey-Smith said the other part of that would be the timing, this is the July statement, and we are audited as of June, so there will be adjustments for this July that the auditors might identify and say it was posted and it should have been here. It could be adjusting entries, not actual net expenses, probably offset by another category in one of these other areas. Brenda Smith said that she thinks the fact that something like this applies expense, something that we are going to get money back on. It didn’t cost us to have those sleep studies. We are going to get a profit off of it although we had to show it as an expense we will make money off of that. Dakota said we will see that played out on page #5.  The main things that we have talked about tonight are pharmacy and sleep studies, along with that added expense in pharmacy for the cost of the drugs, if you look at the pharmacy there is a difference of $178,000 in revenue and that is directly related to the snake bite. That is the correlation between that. If you go a little bit further down you see operating recovery is at $95,000 is a direct relation to the number of surgeries being done; delivery of babies. Inhalation therapy, the same thing – $90,000 in added revenue over this time period last year and it is from the sleep studies. There was a difference in that patient revenue of $350,000. The Benton Clinic also had $44,000 more in revenue that the previous July based on the number of patients that they have seen. Being the first month of the year that is the only a one month comparison. Next month, Mr. Cochran, you will see another schedule that is two months, then three months – that is where we add them.   Dakota moved to page #6 – the Number of Days Net Patient Revenues in Net Patient Receivables is 44 – the days in AR. On page #7 is the Budget Comparison. You can see when we set the budget we budgeted to have an increase in assets would profit $89,000. This last month we profited $388,000. If you look at is – Net Patient Revenues – $105,000 more than we budgeted for. Go down to Operating Expenses – $283,000 less than we budgeted for.  You can go down the list and compared to the budget it was a great month. The difference Grant Revenue – you see grant revenue $104,000 less than budgeted. He told Mr. Cochran that one you will see another column added to it as to where it is two months, three months, etc.  If we go to the clinics, you will see the Vivian Clinic we have already reported that they had a net income of $14,000. There was a slight loss in Plain Dealing of $6,000. There was a minor loss of $760 in the Benton Clinic. As he stated before, a new rate for Medicaid patients is $94. He will get you some numbers of what that does to the bottom line going forward in the Benton Clinic. Hopefully, he will have this for the Finance Committee at the next meeting.  Robert Green asked if there were any other questions about the Statistics or Financials. He thanked Dakota. He noted he would entertain a motion to accept the Statistics and Financial reports.  Helen Godfrey-Smith made a motion to accept the Statistical and Financial Reports as presented subject to audit.  Ronnie Festavan seconded the motion.   The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith,  Helen Godfrey-Smith, Pat White.  Nays: None.  Absent: None. Abstained: None. The motion passed by unanimous vote.       VIII. New Business – 1) Board Selection of Construction Company for Radiology / ER Expansion:   David Jones asked to table the motion. He would like to speak on the Board selection of the construction company for the Radiology/ER Expansion if that would be o.k.  He asked Doug White, hospital attorney to speak on this when he feels it necessary.  David Jones stated there was a bid tabulation done on August 16, 2018 at 2:00 o’clock in the Administrative Conference Room. There were (4) four General Contractors. He distributed copies of the bids submitted. The lowest bid was the ELA Group, Inc. with a bid of $1,329,000 for the construction. The second lowest bid was the Lincoln Builders of Ruston at $1,330,000. We actually had two bidders within $1,000 of each other on a $1.3 million dollar project.  There are criteria that we placed inside the bid so not just anybody could bid on the project. They had to have three projects of healthcare related of $5 million dollars or more completed and they have to have certain references from other construction projects and some background investigation is done on each one. Doug White, attorney and the architect reviewed them. Doug White said he will reserve his comments for during the executive session. David Jones said they are not ready to select which one at this time. We will more than likely be ready by the next Board meeting. The background checks and other things are still undergoing for the lowest bidder and second lowest bidder.  Robert Green stated this item needs to be tabled until the future. David Jones replied yes Sir.  Robert Green said he would entertain a motion to table this item.  Pat White made a motion to table the selection of the construction company for the Radiology / ER Expansion until a later date.  Ronnie Festavan seconded the motion.  Robert Green is there were any further questions. There were none.  The vote:  Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith,  Helen Godfrey-Smith, Pat White.  Nays: None.  Absent: None. Abstained: None. The motion to table the selection of the construction company for the Radiology / ER Expansion  until a later date passed by unanimous vote.    2) Board Approval for Purchase of Coag Machine:  David Jones stated we have two pieces of equipment to purchase that, one of which we already knew that it was going to happen in this fiscal year and has been budgeted for – the coag machine. If he could have a motion on that, then he and Dr. Woods will speak more on the subject. The motion will be for the purchase of the Coag Machine – CA-660 in the amount of $19,500.  Mary Irvin made a motion to approve the purchase of the Coag Machine – CA-660 in the amount of $19,500.  Pat White seconded the motion.  Robert Green opened the floor for discussion.  David Jones stated our current coag machine is (13) thirteen years old. It was depreciated over five years – it has been fully depreciated for 8 years now. It is at what we call end of life. In December of this year, they will no longer service it or produce parts for it. It has been a workhorse. It is still going, but the problem is that we will not be able to buy anything for it past December. The new piece of equipment runs a D-dimer assay. That is something that Dr. Woods in the Emergency Room has been asking for, for quite some time. We have been trying to figure out how to upgrade our current piece of equipment or do a serology test that can also do that. This actually quantifies that. David Jones asked Dr. Woods if he would like to comment on what that is and the severity of what it means. Dr. Woods stated that the D-dimer is the end product of the clotting cascade. A lot of times we have to stratify patients in order of probability whether they are low, intermediate or high probability on whether we suspect specific things such as pulmonary emboli and DVT’s. You see a lot about it in current news and advertisements. There are lot of reasons why people can come in short of breath and one of the things that is very difficult, even with this D-dimer, to diagnose is a pulmonary emboli. When we think that they are low to moderate risk you can do a D-dimer and it is a relative fast, inexpensive lab work that you can use to stratify if the D-dimer is negative, you can say this is a very low probability that his person has a DVT and you can save them from getting a CT. What we are having to do in the end point is when we suspected somebody of a DVT we had a choice of either sending out via a courier, a tremendous cost and turnaround time is usually 3-1/2  to 4 hours that the patient has to sit wait. Then only can you look at the D-dimer and make the choice to whether to CT them or let them go home. It is pretty onerous on the patient and the staff blocking a room for a period five hours.  It is a needed adjunct to that machine that will be very beneficial to the Emergency Room and the hospital. Robert Green thanked Dr. Woods and asked if there were any other questions.  Ronnie Festavan noted that David Jones wrote that this price was obtained through a group purchasing organization. He knows that he has explained that, he is not asking for an explanation for him, but he thinks for the record he might want to speak to the bid law relationship to how we are buying this just so the public understands.  David Jones stated that when you purchase something through a group purchasing organization you don’t have to put it out for advertised bids to get the lowest bid. That is basically a way to generate and provide public bodies so that they get the lowest price on something and that is what a group purchasing organization does for a medical facility, it allows us to get the piece of equipment at the best price available. That is how that price of $19,500 was obtained. This is considerably under what the list price was.  Ronne Festavan asked if we have satisfied any questions that anyone might have as far as the relationship of the bid to these purchases. Would that be a correct statement? David Jones replied yes Sir. Ronnie Festavan said thank you.  Robert Green asked if there was any other discussion. There was none.  The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith,  Helen Godfrey-Smith, Pat White.  Nays: None.  Absent: None. Abstained: None.  The motion to purchase the Coag – CA-660 in the amount of $19,500 passed by unanimous vote.    3) Board Approval for Purchase of Portable Ventilator:  David Jones stated if he could get a motion for the second piece of equipment, the purchase of a portable ventilator – Hamilton T-1 in the amount of $18,669.23, we will discuss it more and he would like to introduce a few people to the Board as well.  Helen Godfrey-Smith made a motion to approve the purchase of the Hamilton T-1 portable ventilator in the amount of $18,669.23.  Brenda Smith seconded the motion.  Robert Green noted the floor is open for discussion.  David Jones said he would like to introduce our Respiratory Therapy Director, Lynn Hay. She is doing a fantastic job since she took over that department. He also introduced Adam Oliver who is the EMS Director. The two of them met with Dr. Woods and they evaluated the need. He asked one of them to speak on what a ventilator is and what we’ve been doing and what we would like to be able to do with it. Lynn Hay said she will start off then Adam can finish up. She said with the ventilator, that is the life support machine, so when a patient comes into the hospital, whether they have fully coded, where they are not breathing on their own, their heart in not going, we put them on the ventilator to keep them alive and then we will transport them. We keep them in the ER as short of a period as we can until there is an accepting facility. In the past we have had to wait for Highland, Willis Knighton or another facility to come and pick up these patients. We are perfectly capable of taking care of them but of course they need to be in an acute setting to where there is an ICU unit and further testing available. We came up with suggestion that we get a transport vent and allowing our team to transport that patient to the accepting facility getting them to where they need to be quicker and hopefully helping their outcome. She said at this point she would yield to Adam since that would fall into his department. Adam Oliver said he appreciated Mr. Jones for the time to give them time to speak. As far as the ventilator, he will break down what it does and how it functions. What we have done in the past, and this has been a trend in the EMS and Critical Care transport in the last 10 to 15 years. We use to put a bag on the patient and bag them the whole way there. Never thought we were doing any harm. It was the only thing we had. A lot of changes and a lot of studies came out and starting looking at this. The effects of that makes people stay on the ventilator longer once they are in the ICU setting wherever they end up. There was a big push over the last 10 to 15 years to go to a transport ventilator. It controls pressures and it keeps you from damaging lungs because you are relying on someone pressing a certain amount of volume into the lungs and that changes with a bump in the road or anything like this where this is a precise pressure and it treats it like a ventilator that you would have in the ICU. As far as patient outcomes, it tremendously helps the patient in their long term affect.  The great thing about North Caddo in the transport environment, we have the ability to take care of our patients not only bring them into our hospital but whenever it reaches a time when our hospital reaches it capacity as far as taking care of them and we have to take them to an ICU setting, with this purchase, we are able to take care of them the proper way to get them to the other facility. That is a benefit instead of waiting for somebody, or waiting for the helicopter or when it is raining and the helicopter can’t come, we are able to function at a higher level and provide the best care. With the Hamilton, we went through three or four different ones. He had some previous knowledge of the Hamilton and also previous knowledge of two other ventilators that he has used in the critical care setting. The Hamilton ventilator is by far the most user friendly; it is a ICU ventilator in its functionality, but at the same time they have taken and put it in a transport mode so instead of having to buy a transport mode ventilator for the ambulance and getting to the hospital and hooking from the ventilator we have now, we would just show up and grab the ventilator and put it on there and not have to switch over and then we would be able to use it for that function because it has the capacity to do both and that saves up a lot of money as far as not having to have two separate ventilators to provide for the patient. As far as the bid, we did look at and we did trim it down. There were some things on the first bid that came in we trimmed down some of the functionalities of it to get it to the price that it is. That is through the group purchasing organization. It provides our patients the best care that we can provide and really increase their outcome when we get them down there. Brenda Smith said she is curious once they hook them up and when you take them down there what happens to our piece of equipment, how does it get back here.  Adam replied that it comes back with us. He said as soon as they get down there, since they have no training on our equipment, they will have a ventilator waiting for us there and then we unhook from our ventilator and hook to their ventilator. Adam stated that a ventilator connects everything to the tube going down the throat and every ventilator has the adapters to connect to theirs and they will swap the piece of equipment. Dr. Woods said that is called the circuit, which is a disposable piece of the equipment.  Brenda Smith said we are talking about doing one piece of equipment and we should not need another by the time that piece gets back. How often do we need something like this? Lynn Hay said our current ventilator we have had about 13 years. Being the type of facility that we are, it has not been used a fraction of what Willis Knighton or Highland’s ventilators are. The current ventilator we have is like an ICU ventilator. It is very big compared to the transport ventilator. We are going to still have that one. In the event we have two patients, we can take care to two patients at once and let Adam and his crew roll with one and we can take care of the other one until someone gets here.  Pat White said she notices that it says adult. Can children be hooked up this also? Adam answered yes. It goes to neonates, pediatrics and adults; it is functional for all of them. We will not, most likely, be transporting a neonate, that is whenever the neonate team comes down. That is a specialized type of critical care transport. It does have the functions to go as slow as it needs to. Robert Green asked if there were any other questions. Ronnie Festavan stated that he appreciates the forward thinking of this collaboration of putting this together as something better for our hospital and for our patients. That is the kind of thing, as a Board member, he looks for – what makes us better. This is obviously something that will make us better. That is a job well done. David Jones stated that we have always had good department heads in this hospital. A department head in a rural hospital is, in his opinion, worth ten times what one is in a large hospital. They look at the entire picture, because they have to look at it every day. The budget in Radiology at WK is probably twice what our entire hospital’s is. They don’t have to look at those kinds of things.  Adam and Lynn are forward thinking but they also know they don’t have an unlimited budget to go and do whatever they want to with. They do pick and choose. They do their due diligence a little harder than probably most and try to get every bang for their buck that we can actually get and still give top rate care to the people that we serve. He throws the credit back at them for sure because the level of our department heads right now, in his opinion, is second to none.  Pam Hughes stated that they demonstrate progressive thinking, also, to find programs or things to make their department more cost effective and actually can make some money. Lynn and several others have done that. It is very important and we appreciate their due diligence on that.  Helen Godfrey-Smith said it seems to her that this is a good opportunity to improve our brand in the community. A good PR, press release, would be wonderful and lauding both Lynn and Adam for their creative thinking and an opportunity to highlight their expertise and visionary of our leaders that we have at our hospital and the fact that our Board is on point. She is not just saying that to brag, the community needs to know to help them to make a decision to come and use our facility.  Robert Green asked if there were any further questions. There were none. The vote:  Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith,  Helen Godfrey-Smith, Pat White.  Nays: None.  Absent: None. Abstained: None. The motion  to approve the purchase of the Hamilton Portable Ventilator for $18,669.23 passed by unanimous vote.   IX. Administrative Reports  – 1) NCMC – Current Activity:  David Jones said he wanted to give a brief update on the Employee Enhance Committee. They have broken it into eight subcommittees. He noted that Lynn and Adam are two members of that committee. We have some department heads on it and they are some of those. We have several staff members on it as well. He wanted to give the Board a brief update. The subcommittees are: A Caught In the Act committee developing a program which is self-defining. We have a Bi-Annual Star Employee that he and the HR Director are taking the lead on trying to identify. Healthcare wise, specifically, but he knows a lot of fields are going to this, just about every department of the hospital that you can imagine, has a week throughout the year that their organization or degree program try to laud. We have Lynn taking over that trying to identify. We will have calendars and such to try to do something on the intranet and maybe externally as well to try to shine some light on some employees. In using the intranet as a communication device within our system, we are trying to figure out some ways – another whole subcommittee working on that. We have a new employee newsletter being run – it is put together and going out very soon. We have Adam and Mary – Adam’s expertise on social media, he and Mary are working a social media subcommittee. He and Adam are working on a volunteer program as well. We spoke on that a little earlier. The subcommittee is trying to figure out a way to get our employees more involved in the community. We are trying to actually reward them for doing that. We have a small subcommittee of employees that always attend everything. Mr. Festavan has spoken on this before of how intertwined the hospital is to the community itself. In trying to get our name and our brand out there as much as possible as Mrs. Helen spoke about, that is one way we feel like we can do that. We have an awesome Ministerial Alliance Program here. We are trying to develop ways to intertwine the employees in the Ministerial Alliance a little bit more. There is a group of men that meet here once a month, and their heart and soul is for the people of our community. It has been their vision and what they stand for. We are trying to figure out ways to intertwine the employees in with them too. He will be giving a detailed report as we go further on that, exactly how that is going to look. There will be several things he will come to the Board to request.  Helen Godfrey-Smith said she would encourage him to consider the place during the year when we have the sick time buy back; one of the things that she did that they gave the employees a bonus every year to the employees if they met a certain bottom line. What was required was a certain number of hours of volunteering in order to qualify, regardless of everything else you did that was great, you had to volunteer so many hours to receive this bonus. That was all part of the criteria. You might consider this. They are going to get something as a reward. That will encourage them. That is something to think about. Robert Green noted speaking about the Ministerial Alliance we have a good working relationship with the hospital. Also, members of the Ministerial Alliance, based on the emergency chaplain list that get calls when they are needed, he thinks that they do something to encourage other ministers in the area to become part of that because it is part of our community. We are working on trying to get more involved with our Ministerial Alliance that we can work hand in hand with the hospital and the community because those are the people that we do pastor and we need to show support there. David Jones said he would like to personally brag on Robert Green, because operationally, through the hospital, he guaranteed Dr. Woods could speak on it, every time there is a horrific accident or tragedy in the community it is a very emotional time. We do get a large number of people that come to the hospital. He does not think there has been a time that Robert Green does not come, no matter what time of night, and he helps to diffuse any type of situation. The chaplaincy program, if we could push it forward to that degree. The staff can only do what they are supposed to be doing for the patient. To have a minister there it automatically brings anxiety down at least a notch or two. Robert Green has on numerous occasions been the one here to help us in any way he can. He wants to personally brag on him and thank him for doing that.  Pam Hughes spoke up and said she has been up here several times and Robert Green is the man you want to see walk in the door. Everything gets calmer. It gives her, and she knows Mr. Jones, too, a relief knowing that he is there because he takes care of it. Robert Green thanked them. The reason he mention he knows there are great ministers that could help the community if they would get involved. We are working on trying to get more involved and we do meet here once a month and that is great. If you know any that are not a part of the alliance will you please ask them to come and be a part. We do a lot of things other than just here. It is to help the community. We go to the schools and we have pastors on patrol. True religion is not what you talk about it is what you do.  Brenda Smith said she has a comment. She wanted to thank whoever is in charge of the social media. The things you are putting out on face book is a wonderful thing. She has seen a lot of comments on that like Mrs. Billie coming back; those kind of things – that is a positive thing that goes on at this hospital that no one knows about other than people in the hospital. Not even Board members know about. She didn’t have any idea that was going on. To put that out there in a setting like that where you have an opportunity to reach thousands of people just like that. She wanted to tell you guys you are doing a great job. David Jones noted she was talking about Mrs. Billie Hindsman.   2) Foundation: Mary Coil stated that she wanted to give the Board a Financial Reports from the Gala. They had a wonderful auction. We probably had 40 more items in 2017 when we last did the Gala, but we raised less than $1,000 difference in the amounts from 2017 to 2018. It was the quality of items that we had on the auction. We had great quality before, don’t get her wrong, but we had some really big ticket items that people enjoyed and supported us on. It was fun! Mary Coil reported that the auction raised a little over $13,000. Sponsorships are our major income. We met with our Gala Committee last week and gave them the numbers as well. They worked so hard on this and we wanted them to know what their hard work came to do. They were very excited and had lots of great things to say.  Helen Godfrey-Smith asked how did this number compared to what you generated with the shoot last year.  Mary said there is a significant difference, just because the shoot doesn’t have the same opportunity for income as the Gala. There can only be so many shooters. That is a significant difference. With the sponsors for a shoot, it is just different, but we are still very much in favor of the shoot because we were able to able to reach a totally different demographic than come to the Gala, #1 and #2 the men really liked it. She heard there was a lot of talk going from station to station about the attire that they got to wear to the event. They really enjoyed it. As she said we were  able to reach a different demographic for our donor base as well. We are still very happy with that. She feels like our Gala went great and the volunteers and the Board were very excited about the outcome. We appreciate the Board’s support.  It was definitely in line with what the expenses have been in the past. We are very happy with the outcome. The capital campaign typically last for around five years. We are in the middle of that. We do have a significant way to go. Part of how we want to accomplish that is not by Galas but by seeking donations from private donors. That comes in line with us getting face to face visits with those donors and asking them to begin a pledge to our Foundation. We have great participation within the hospital. We have a 100% participation in Administration, which has always been a great bragging point because the first thing our donors want to know is who else is giving. That is something that we are very proud of is our Administrative team. That is how we are going to want that number to climb. If you know someone who you believe; she is not only talking about large donors, but anyone can be a donor. She is a donor and she obviously cannot give the same amount that other people can give, but she gives every month. If you know somebody who you feel like this would be a great project or a great cause for them and they would like to give to a worthy cause in their own community or a community that they are tied to. They may not live here anymore.  Please give her their name. Let her contact them and let’s take a tour of the hospital. Let’s find out what level they would like to be involved with North Caddo. She turns to the Board of the Foundation, to the Volunteers of the Foundation and she turns to you as representatives of the hospital as well as leaders of the hospital. If you have a thought on someone that would enjoy that opportunity, please let her know. Philanthropic souls, as she likes to call them, like to find out about new things that they can become a part of. We want to be sure that they know about this opportunity. Brenda Smith said this is a good time also to remind Board members that you can do a payroll deduction if you would like to give every month. That is an opportunity. We appreciate all the gifts and all the things that go along with the gifts which is the meaning behind it. Thank you. Robert Green stated we are truly grateful for the Foundation. He thinks we need to put a letter together and tell them how we appreciate their efforts and at their next meeting they will hear from the Hospital Board and we appreciate what they are doing. He gives a little each month. He might up it this year. He thanked Mary.    X. Medical Staff  –  1) Recommendations – Dakota Robinson:  MEDICAL STAFF APPOINTMENTS: None.   MEDICAL STAFF REAPPOINTMENT: 1) Jonathon Lee, M.D.- Request Courtesy Privileges in the field of Radiology for the period of August 28, 2018 through September 31, 2019.   2) Adam Hecht, M.D. – Request Courtesy Privileges in the field of Radiology for the period of August 28, 2018 through October 31, 2020.    ADVANCE PRACTICE PROFESSIONALS APPOINTMENTS/REAPPOINTMENT: None.   EXTENSION REQUEST:  None.   VOLUNTARY RESIGNATIONS:  1) Leah Chiles, M.D. – Request voluntary resignation in Urology effective 07/31/2018. Relocating to Texas.   2) Robert Henry, M.D. – Request voluntary resignation in Radiology effective 08/13/2018.     Mary Irvin made a motion to accept the Medical Staff Reappointments, Advance Practice Professionals Reappointment and Voluntary Resignations.    David Norman seconded the motion. The vote:  Yeas:  Robert Green, Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White.  Nays: None. Absent: None.    Abstained: None.   The motion passed by unanimous vote.  2) Chief of Staff Comments:  Dr. John Woods said no news is good news. Everybody is doing their job and all is going good.     XII. Executive Session:  Robert Green noted that we needed 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.   Pat White seconded the motion.  The vote: Yeas:  Robert Green, Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, 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.      Ronnie Festavan made a motion to enter back into regular session.    Helen Godfrey-Smith seconded the motion.   The vote:   Yeas:  Robert Green, Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White.  Nays: None. Absent: None.  Abstained: None.   The motion carried.      XII. Adjourn:    There being no further business Pat White made a motion to adjourn.  Kenneth Clay seconded the motion.   The vote:    Yeas: Robert Green, Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White.  Nays: None. Absent: None .   Abstained: None.  The motion carried.      Meeting adjourned at 8:22 p.m.




North Caddo Medical Center

Vivian, Louisiana



David C. Jones, Secretary

Approved by the Board of Directors at the regular Board meeting held September 25, 2018