BOARD MEETING: Regular Meeting DATE: July 30, 2019 MEMBERS PRESENT: Robert T. Green, Jr., Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Patricia White. MEMBERS ABSENT: Kenneth Clay (arrived at 6:13 p.m.), Helen Godfrey-Smith (arrived at 5:35 p.m.) TIME CALLED TO ORDER: 5:30 p.m. OTHERS PRESENT: David Jones, CEO, Pam Hughes, COO, Dakota Robinson, CFO, Dr. John Woods, M.D., Chief of Staff, Walter D. (Doug) White, Hospital Attorney, Ross Hansen, IT 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 – Robert Green offered the Invocation. Mary Irvin led the group in the Pledge of Allegiance. III. Approval / Amend Agenda – Brenda Smith made a motion to approve the agenda as presented. Mary Irvin seconded the motion. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White. Nays: None. Absent: Kenneth Clay, Helen Godfrey-Smith. Abstained: None. The motion passed by unanimous vote in favor. 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 June 25, 2019 – The minutes of the Regular Meeting held June 25, 2019 were mailed prior to today’s meeting for review. Robert Green stated he would entertain a motion to approve the minutes. Pat White made a motion to approve the minutes of the Regular Meeting held on June 25, 2019 as mailed. David Norman seconded the motion. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White. Nays: None. Absent: Kenneth Clay, Helen-Godfrey Smith. Abstained: None. The motion passed by unanimous vote in favor. VI. Old Business – 1) All Scripts Interface Update – David Jones noted that we have the forever item – the All Scripts Interface Update. They are working on it. There has been some advancement. We have our IT Director here tonight. I think he had a couple of calls this week about it. We are progressing. 2) X-Ray Room and Mobile X-Ray Update – David Jones stated we are actually slated for Friday, the ninth to receive our Mobile Unit. We will have it in and of course we will have to do some training on it to get it fully up and running. The X-ray Room, we are struggling to get a hard date on when they are going to install that. Robert Green asked if there were any further questions. There were none. VII. 1) Review June 2019 Statistics – Dakota Robinson, CFO – Dakota Robinson, CFO, noted as we go through the stats and the financials I will do a lot of talking about the twelve months, we won’t necessarily just be looking a June individually but we will do a lot of year end discussion. We have seen a decrease in June in the number of admissions. There were 34 Admissions on the Acute side and 12 in Swing Bed. That is a positive thing. We were down to 4 in December Swing Bed admissions and we have gotten that number up to 11 and 12 the past two months. (Helen Godfrey-Smith arrived at 5:35 p.m.) The difference between last year and this year we have seen about a 7% decrease in the number of inpatient admissions but I will show you where we have made some of that up further in. If we look at the Inpatient days you sort of see that trend once again; lower admissions. We’ve got a lower amount of inpatient days. There were 85 for the month of June. I will say that’s where we’ve seen that this year. This year we are down about 10% on inpatient days, but we are up 50%, I said that correctly, 50% on the number of acute days stayed. Basically, it is just a severity level of that patient. We had 1,114 Observation Days for 2019; for 2018 we had 743. So we do look at this graph and we see a reduction but there is an increase in the Observation Days by 50% so we have seen just a little bit of a transfer from one to the other. We look at the Average Daily Census, we will see across the board that Swing Bed and the Acute stay at 8.3; it is down slightly from the previous months of 8.9. Looking at Surgeries, there were 3 surgeries for the month. For the year 2019 there was 119 surgeries. Endoscopies were down at 4. For 2019 there were 140 Endoscopies; 2018 – 114 so there is a 23% increase this year. ER Visits were down slightly to 459. We have seen, I think there is a direct correlations when we have construction projects going that there is a reduction in the usage of the service. We saw it in the main hospital and I think we see it in the Emergency Room right now. In 2018 there were 6,670 visits; in 2019 6,123. Hopefully when all that construction that you saw comes to a close we will see some of those numbers bounce back up similar when we opened up the new facility. If we look at Mammographies, there were 29 Mammographies for the month of June. They were up about 7% on the year. They did a total of 388 Mammographies. Newborns – Newborns were quite busy compared to 2018. Even though we only had one in June, for 2019 as a whole there were 81; that is a 37% increase from the previous year. Vivian Clinic visits – for the month of June they had 1,746. They actually saw a 12% increase this year. They went from right at 22,000 visits to 24,597. They saw quite a few more patients at that location. Plain Dealing – Plain Dealing was down on the month at 480 and on the year they saw 7,033 patients. Benton Clinic – Benton Clinic saw 343 for the month of June and for the year they saw 4,602. That is right at 700 more than the previous year. We have seen a drastic increase at the Benton Clinic which is what we are looking for. At the Fitness Center, their membership was down slightly at 438. Dakota asked if there were any other questions on the Statistics. There were none. 2) Review April 2019 Financials – Dakota Robinson, CFO – Dakota Robinson, CFO, said just a brief overview of the month. All of you know that obviously June is the year end. That means that this set of financial actually goes to the auditor for audit and we typically see adjusting journal entries in November or December to correct the things that have happened that either haven’t been recorded or things that were waiting for estimates and such. (Kenneth Clay arrived at 5:50 p.m.) We were able to push the Board meeting back a week so I was able to accrue more things with better understanding with that extra week of time so there are quite a few journal entries in this set of financials and we will look at a lot of twelve months similar to what we did the statistics piece. Looking at page 1 of the Balance Sheet you will see that Days Cash on Hand rose slightly from the previous months 47 to 48.73. With the reserve fund, that number you are looking right at 60 days Cash On Hand. As of this set of financials, that is $3.8 million, so cash remains high and remains in a very healthy position compared to previous years. Helen Godfrey-Smith spoke up and said, for clarity, Dakota, can you go back over that reserve again. Are you saying that we are not required to have the funds in that reserve? Dakota said if you look at the Balance Sheet, it is not technically a reserve. It is not falling below the line to where that Assets Whose Use is Limited. These are the CD’s that the Board authorized us to move some of the operating funds into it. It would require a Board motion to move that out, but in terms of the outside public, it is not reserved. Helen Godfrey-Smith I understand. Dakota said I am going to change that slide to clarify that a little bit in the next meeting. Helen Godfrey-Smith said we can access the dollars if we want to. Dakota replied exactly. Dakota said I did want to point out one thing, if you go down to Other Receivable you will see that there is a $962,000 balance in there. That consists of several different accounts. The biggest one is 340B. We accrue 340B accounts now. We changed the accounting system to where we can actually keep track of what they are owing us on a monthly basis. There is $300,000 accrued in there. We do have the accounts receivable from the UCC which is a little under $300,000 so a large portion of that is made up of those two account. That is something that hasn’t been there is the past. We do have one contract pharmacy that continues to not pay us timely. The Finance Committee is working with us to work through that. But those are higher than what they have been in previous years. I did want to point that out. If we do want to go down into the Assets Whose Use is Limited, we bring this up over and over again but that $390,247, as of 7/02 becomes unrestricted, it is unrestricted currently because that is the money that is being released by the USDA with the new bonds that were issued on 7/02. So right now the bonds are being held by CB&T of Vivian and no longer at Citizens National Bank. But for this set of financials the bonds are still at Citizens National so that is why it is still under a limited use category for the Balance Sheet. That will change as well. We will see that change take place in July. On the Income Statement on page 3, I will be doing a lot of the 12 month numbers. You can see that we did $3.2 million in revenue this June compared to $3.7. If you look at the year as a whole we did a little over $43 million dollars in revenue compared to a little over $42 million in 2018. Revenue is up. Dropping one line underneath it you will see that there was almost $24 million dollars in contractual adjustments. That basically equates to 55% of our revenues are contractually adjusted off currently as of June 2019. If we look at 2018, final audited numbers, the percentage of contractual adjustments is a little over 52%. We have a 3% spread in contractual adjustments right now. We have to remember that this is a lot of true data in this number but there’s a lot of estimates. We are estimating what are we going to collect on the total outstanding AR. So this number can fluctuate depending on is it Medicare, is it Medicaid, is it self-pay – what does the Cost Report say. We won’t know that number until the Cost Report is finalized and that will be obviously later in the year and that is always one of the larger adjusting journal entries that we see when the audit comes because there is no way to tell that number right now. It will take us months to prepare that and then book it in this entry. My professional opinion is that the contractual adjustments are not 55%. We have not seen that at North Caddo. Typically, like I said, 52 to 53% range. I do believe that it will be higher than previous years but quite that high. Hopefully there is a receivable that will be there by the time the audit rolls around. If we get into Salaries and Wages, there was an 8.9% increase to $12.7 million dollars. We discussed this in the Finance Committee about restructuring some of the way that Management was on a different line item is now in the Salaries and Wages. We added a physician in Dr. Sharpe. We added a Chief of Surgery. There were a lot of things that we did in this year that we didn’t have in the previous period. There is an increase there along with the 4% that was budgeted. The good news is we go one item lower in the Employee Benefits and Payroll Taxes, there is a reduction at 4.5% in that category to $2.8 million dollars. What we’ve seen happen in that category is the self-funded insurance plan about 30 days ago was running about $200,000 to $250,000 less than we expected it to. Once again, we don’t know what that final number is until months from now, because we are waiting on those incurred claims to come in and right now we’ve just booked an estimated. It is called an IBNR – incurred but not reported. If you look at total expenses for the year of $23.5 million dollars, that is a three quarter of a million dollar increase from the previous year. When you look at it percentage wise it is an increase of 3.41% in total expenses. Expense wise to stay in the 3% range is a good thing that we were able to accomplish considering all that was done in this year. Getting down into the Non-operating Revenues we will see that in the Grant category there was $1.2 million dollars, obviously the majority of that I believe that $1.1 million is directly related to UCC dollars. We all knew that it wasn’t going to come in like it did the previous year, but it did come in more that it was expected to. We keep going down further – Sales Tax Revenue increased from the previous year and 340B Revenue went from right at $1 million dollars to almost $1.5 million dollars and I think we will continue to see that increase in fiscal year 2020. Looking at the increase of Net Assets for 2019, as of right now we are at $918,477; previous year we were at $2.6 million. We do also have to remember that we are tied into the pension plan now so as of last year’s set of financials, remember there was a large adjusting entry when they ran the pension plan of whether it was over funded or under-funded. We try to get this as close as possible and then we work with the auditors to tie out the loose ends that require a lot of work after year end. Any questions on that page. There were none. AR for the month is at an eight month low – we are at 50.29 days. That has come down almost 5 days from 54 in the previous month. The high in the last eight months is 76. Going to the Departmental Expense on page 6 – this is the 12 month Departmental Expense. If you look at the top line item – Inpatient Routine Care. If you will look at that there is a net difference in 12 months of $51,000. Even though, quote – unquote, inpatients, we had less acute inpatients. We made that difference up in the Observation stays. Those are lumped into this category. You can see that there is a net difference of only $50,000. Even through on the Statistics side, that looks like a big difference from one to the other, but by the time you add back together as a whole revenue wise it is very minimal – $50,000. Any questions on the Departmental Schedule? There were none. On the Budget Comparison on page 8 – We will go through a few of the things that we have already discussed. Operating Revenue – you can see that it is below of what we budgeted by a little under 5%. But, on the flip side the Total Expense we are at 3.8% below budget at $23.5 million instead of what we budgeted at $24.5. If we go down directly to profit – we are looking at 10% off budget. We did have a pretty strong budget this year – pretty lofty goals that we set upon ourselves because we knew that there were going to be changes across the board that we were doing. So to be just 10% off on a million dollars I feel like that is pretty good. The one difference that I’ll show you what it plays a part – we budgeted for 53.52% on the contractual adjustments and right now we’ve got 55.16%. So that difference right there, we are not talking tens of thousands of dollars we are talking about hundreds of thousands dollars in possible Cost Report receivables which is, like I said, my professional opinion, what we are looking at, is hopefully we are looking at a receivable on that end. Are there any questions on this budget page? I know it is a lot of information to digest with year-end numbers. If there is nothing on that page we will go to page 9 getting into the clinics. Looking at the Vivian Clinic, they were up over 2,000 visits for the year. They do have a profit of $65,000 in the month of June and 2019 profit of $702,000. We’ve seen a dramatic increase in that department and partially from the way that it is structured and some of the changes that were made in adding a physician this year, just a few of the changes that were done. Looking at page 10 for the Plain Dealing Clinic you will see that they did have a slight loss for the month of June but their 2019 profit was $80,000. So in a clinic like that if they do turn a small profit that is a benefit. It is adding to the whole. We are still battling in Benton; we are still battling that rate number. That rate should be very similar to what it is in Plain Dealing, as of right now it is not, so some of those patients that we are seeing flux from Plain Dealing to Benton were getting that lower rate. When you look at contractual adjustments, it is just one of the things we discussed in the Finance Committee. If you look at the contractual adjustments in Benton for a 12 month period, you are at $532,000 on a million dollars of revenue so it is over 50%, but if you look at Plain Dealing on page 10 over 12 months they had $584,000 worth of contractual adjustments on $1.6 million dollars. So on an extra $600,000 revenue on the books they’ve got almost the same amount of contractual adjustments. Dakota asked if there were any questions, comments or concerns. There were none. Robert Green stated he would entertain a motion. Pat White made a motion that the Statistics and Financials be approved as presented subject to audit. Helen Godfrey-Smith seconded the motion. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, Kenneth Cochran, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: None. Abstained: None. The motion passed by unanimous vote in favor. Robert Green, Chairperson, stated that I apologize, I am going to have to leave the meeting early. When we moved this meeting we moved it to a time of another already scheduled program that I have to be part of, which started at 6:00 p.m., so I will be late there. They already know. I explained it to them. If I may be excused, I am turning the meeting over to the Vice Chair, Mary Irvin. There were no objections. Robert Green bid them a good evening and departed the meeting at 6:08 p.m. VIII. New Business – 1) Approval of Purchase of Exchange Server – David Jones stated if he could have a motion for the Purchase of the New Exchange Server, I have our IT Director here who would like to talk a little further on that. Brenda Smith made a motion to approve the Purchase of a New Exchange Server. Ronnie Festavan seconded the motion. David Jones told Ross Hansen, IT Director, the floor was his. Ross stated that the Exchange is the email platform that we utilize made by Microsoft. We have had our existing right about since I’ve started and it is time to be replaced. The PC connection quote that should be one of the ones in the packet is the one I’m proposing that we go with. David Jones asked the total cost. Ross stated it is $22,650 per year. David Jones said in layman’s terms, basically our email server is our computer that runs our email is seven years old. It is at end of life and we need to replace it and this is the solution that our IT Director has found for us to fix that. Brenda Smith asked is there an email limit as far as volume of emails that you keep or would it archive or is this simply per user. Ross replied the subscription is per user and there are different levels of exchange plans. The limits that would affect us would be mailbox size. On site we limit them to a certain amount just because we have to physically host that equipment here and if everybody could have unlimited storage it would be like a filing cabinet that fills up and becomes much harder to maintain. There’s unlimited in place archiving in the cloud. You can keep twenty years’ worth of HR email. Brenda Smith said I’m sure that there would be some users that would have more of that that needed to be kept and archived for whatever purposes than others. Ross replied certainly. Brenda Smith said o.k. Thank you. Mary Irvin said I am going to say there are tier levels based on the job title. Ross replied yes and the cloud lets us do that too. We are going with the Exchange Plan two which is one that appropriate for the size that we have now but you can raise people to a higher levels if they need additional functionality such as some of the services they offer with teams and share point which we don’t currently use so there is no requirement to do so. Ronnie Festavan asked Ross to go over the cost again. Did you say yearly? Ross replied yes. Tell me again about the cost. Ross stated subscription based with the Exchange online hosted the yearly cost, they will either per month per user or per year per user, there is really no difference you just choose if you want to pay in one lump sum or if you want to pay monthly. The way the program works we can adjust per month so it makes more sense to pay on the monthly scale because we might have 250 this month, 245 next month, if you pay a year ahead of time you pay for them whether you use them or not. So we would pay per month per user the yearly cost on that would be $22,650. Ronnie Festavan asked if that was a set price. Dakota Robinson replied no. It is set per user. I think the number on that is $7.55 per user per month. What Ross is saying with the fluctuations in fulltime and PRN employees that number could go up or that number could go down. We are reporting based on our estimates of current employees as of today, we are estimating that cost in the next twelve months will be $22,650. Ronnie Festavan said it is his follow up question, it somewhat like a budget projection based on usage, so you don’t really have that number, it is a floating moving target. My next question is, is there a line item in the budget that supports that; did we plan for that to happen. Dakota Robinson replied yes. 7011 is our expense code. Ronnie Festavan said so what you do in your budgeting process then is that you put an amount of money in there that you feel like that your staff feels like would cover things like this or unexpected things. Dakota replied correct. We get with the Department Heads and we are looking at is there anything could be an expense this year as opposed to just give me your schedule of things that you need in the budget. Let’s look at the things that could happen, and we try to, especially in IT, to build that in because something is going to happen that is not expected and it is not going to be cheap. Ronnie Festavan asked Dakota if you do any type of analysis of equipment so that you might determine you might predict somewhat. Dakota replied that we do have an asset module that basically, anything that he purchases goes into it so we can track the age of it, whether it is a server or blades, everything that he does is tracked like that and then that is where we rely on his expertise to tell us my useful life when I’m looking as an accountant behind the desk my book tells me it is five years. Well, at North Caddo Medical Center, let me tell you we don’t go by the book. We push it out. That is where we rely on his expertise to say I know what it is saying here but realistically what are we looking at. Ronnie Festavan said o.k. Helen Godfrey-Smith asked if she could address from the Finance Committee, since the inception of the Finance Committee there are some things that we are hoping to improve processes and the is one of the things that we have been talking about in the Finance Committee is that we want to have a capital budget where we will get to the point that at the time we submit our regular budget we will also submit some projections for things that we know possibly would need to be replaced over the next twelve months. It doesn’t mean that they will be but we have to move until we get to that point, but we are building some enhancements in to get there. Ronnie Festavan said I’m comfortable with the process that he described whereby there is some tracking of age of equipment. It’s pretty simple, you can do it with automobiles, you can do it with lawn mowers, you can do it with lots of things and so you can somewhat predict that the lifespan of a piece of equipment is getting close then you can budget for that. Helen Godfrey-Smith said in this year’s budget there were a couple of things that are being replaced and is outlined in the budget that the amortization will be complete on these items. These items are being replaced so that he is doing that to a certain degree, we are just explaining to you that there is probably still a little bit more room for fine tuning and projecting so that especially some of the larger things that we get here at the Board table, that we want to make sure that those large items that we’ve looked forward and we are prepared financially to be able to do those things. Ronnie Festavan said thank you. Mary Irvin asked if there are any other questions or discussion that we need on to have on this motion. She thanked Ross for his explanation. Mary Irvin asked for a vote. The vote: Yeas: Mary Irvin, Kenneth Clay, Ronnie Festavan, Kenneth Cochran, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr. Abstained: None. The motion passed by unanimous vote in favor. 2) Approval of the Blanchard Clinic Project: David Jones said this is the initial approval only. We will have final approval when we get the actual detailed cost, but I am asking for a motion and second for discussion. Helen Godfrey-Smith said I am pleased that we went through a lot of analysis and discussion and we had several months of presentation of information and at our last meeting last Friday, the Finance Committee unanimously would like to make a motion that we move ahead with the Blanchard Clinic Project subject to the Board understanding and receiving the information that we received and we are hoping you will accept our motion. Ronnie Festavan seconded the motion. David Jones stated from that Dakota has one of the presentations with a budget. At the last couple of Board meetings we’ve given some handouts with all this information on it but we are still looking at the same cite. From that cite there will be build out. Going forward we never got actual approval from the Board to take the next steps. Once we get that first initial step there is a secondary step that I am going to ask for tonight also and that is the selection of an architect, because until we actually bid this construction out, we are not going to know how much it is going to actually cost. Until we bid it out and get that all approved, it is in a holding phase. We have projections for the revenue. Helen Godfrey-Smith asked if she could interject. Dakota said absolutely. Helen Godfrey-Smith said one of the things that we are charged with as a Finance Committee is to come up with two to three scenarios that will dictate how we will finance. You are looking at the cost that it will take for build out. But we know we have to get the money from somewhere. So once this is approved then we will be getting to work on what those scenarios might be. We will bring some ideas back for you. The Board might approve a combination or parts of two of those scenarios saying you know let’s do $300 here, let’s do $200 here, but we are going to bring you some ideas back where the funds could come from. I know that has got to be one of your questions. We are talking about spending money, where are we going to get it from. I just wanted to put that in the mix. Dakota said you can see obviously I did not throw you a number of $250,000. It is going to be a significant investment but that leads us into the way that we structure the rental on the building. The terms of that lease agreement, we don’t have anything set in stone as far is it a ten year, is it a twenty year, does it have options, what does that look like. All those are things that will come together but we have to get a grasp on what this number is going to be to be able to move forward. If you look at the budget that we prepared. We tried to take a clinic very similar to Benton and the way that Benton started out. Helen Godfrey-Smith said we at Finance Committee committed to September, October timeframe. September where we hope working with Dakota and David that we will have those scenarios ready to present to the Board so that you all will be able to determine, if we vote tonight to go ahead, of how the financing will be structured which is important piece because we have to decide that before we really sign the contract, because if we let them do some build out then the actual rental itself and the amounts we pay would be altered to take that into consideration. We will be making these decisions sooner rather than later. Dakota said Pam knows what she is doing with clinics so I have no doubt, and you can stop me if I’m wrong Pam, you can work pretty quickly with the design team at Vintage. Vintage is actually the company that we selected after getting with TEG, which is TEG is actually had all the work in the new hospital. The one firm that stuck out with everybody was the Vintage Design Group. They have done a few clinics in Shreveport / Bossier and knew exactly what we were talking about and felt very comfortable in planning and designing a building that would be up to specs and what we are used to dealing with. It was at a much cheaper rate. That is what we have put before you. That is their proposed contract that goes with it. David Jones said if we get a vote that we approve the initial I am going to ask for another motion that we go with that architect group. Like I said we are at a standstill until we select them and they start actually the design phase with the construction documents. Mary Irvin asked if that would be separate motions. David Jones replied yes. Mary Irvin asked if there was any further discussion about moving forward with the Blanchard clinic project. If not we are ready to vote. Ronnie Festavan asked if what we are voting on is to move forward. Mary Irvin replied yes. Then we will follow up with a second motion about choosing the architect. Brenda Smith stated not that we approve to do it but just to go out and get some numbers for us to look at. Mary Irvin replied yes. Kenneth Cochran stated we’re looking for approval to know where we are and spend a little money. Dakota Robinson noted to explore. Helen Godfrey-Smith said she would like to clarify the motion though, just for the sake of everybody here. The motion is to move forward to expand our service footprint to have a clinic in Blanchard. It is to move forward, we have already looked at it and talked about it in planning session, now the Board is making a decision to move forward. We are not saying how much we are going to spend. Those are the decisions that we are not making, but we are, with this motion, making a decision to do a clinic in Blanchard. Mary Irvin said this is the first official motion we had on the Blanchard clinic. Helen Godfrey-Smith replied absolutely. I just want to make sure we are clear with that. Mary Irvin asked if there were any other questions. Ronnie Festavan said I seconded the motion because I am very much in favor of moving forward and when you put a timeline like we have on here that is putting pressure on you all. David Jones said yes Sir. Not that I don’t believe that you can’t do it but it is aggressive, based on my experience with it. So I guess I am just being encouraging and I would very much like to see this happen. Blanchard, if you look at statistics, one of the fastest growing areas in the state of Louisiana by I-49. If you look at what is going on there, I would like to have that footprint, as you call it, in the area. There are a lot of I’s to dot and lot of T’s to cross between now and opening the doors. David Jones said yes Sir. Ronnie Festavan said I guess I’m just being encouraging, I’m not complaining. Kenneth Cochran said I appreciate this enthusiasm that I feel from all of you. Mary Irvin stated reiterating from the whole Board, thank you Dakota, for all those that have worked in the Finance Committee, also, on their efforts with it. Mary Irvin called for a vote. The vote: Yeas: Mary Irvin, Kenneth Clay, Ronnie Festavan, Kenneth Cochran, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr. Abstained: None. The motion passed by unanimous vote in favor of moving forward with the Blanchard Clinic Project. David Jones said the side motion, if we could have a motion to go ahead and engage the Vintage Design Group. We did engage TEG initially to see, that is the Estopinal Group, the one that designed our hospital. Theirs was more than double coming back. They kind of knew that to begin with because this is an extremely small project for them. We went to Vintage because we went to another architect that designs smaller buildings. They sent us to them. There was another engineer that Dakota knew that sent us to them. Helen Godfrey-Smith said she wanted to ask a question and give him a chance to make it clear to us when we see Physical Therapy simultaneously with the Blanchard Clinic, and I see here that Physical Therapy is $1,500, when we are approving this architectural contract, are we also approving them building out, laying out, doing for the Physical Therapy as well as the clinic. David Jones replied for the most part yes. You have to understand that the Physical Therapy area is basically going to be a lot of open square footage. From a construction standpoint, very, very little bit of the cost will come from the PT area. 95% of the cost will be coming from the clinic area. Helen Godfrey-Smith, but again, just for clarity of the Board’s understanding that at the time the 4,500 square feet encompasses enough space to accommodate a Physical Therapy facility there in Blanchard and more than likely as we open the clinic the PT area will also be opened. David Jones replied that is correct. Brenda Smith made a motion to approve engaging Vintage Design Group as requested by David Jones. Pat White seconded the motion. Mary Irvin asked if there was any further discussion. There was none. Mary Irvin called for a vote. The vote: Yeas: Mary Irvin, Kenneth Clay, Ronnie Festavan, Kenneth Cochran, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr. Abstained: None. The motion passed by unanimous vote in favor of the approval of engaging the architect Vintage Design Group. Helen Godfrey-Smith said she would also like to mention, because these professional services it is not essential to send this out to bid even though it exceeds $10,000. With that we can make this decision to choose this firm and be clear about it. IX. Administrative Reports – 1) NCMC – Current Activity: David Jones stated for current activity this is fiscal year end. We did have our inventory audit going on at the end of June. Luckily we scooted through that like we normally do. Dakota said no, he wanted to clarify. The auditor actually said we have the best inventory in the software system that actually spits out risk analysis that tells them what to check, when to check it. It actually shot out an error code that they didn’t really need to check anything. They did but they said it is that good. So, I commend all the Department Heads that count everything in the building. David Jones said I don’t know how a couple of Pam’s Department Heads even made it through it alive because they were so tensed up the whole week long on that whole process. Dakota said but that is how they treat it. David Jones ask if the ones that attended the LHA Conference wanted to give a report. Mary Irvin said we will include our trip to the Louisiana Hospital Association Convention in current activities. Mr. Cochran, myself and Mr. David Norman were all in attendance for those three days of conference. Mr. Cochran has prepared a presentation. Kenneth Cochran stated we visited South Baldwin Regional Medical Center. What we found out in this conference is #1 – I was impressed by the LHA Organization. It was good. I have been to a lot of conferences – national, state, regional, local and I’ve seen a lot of good ones and I’ve seen some really poorly organized. This one was first class. They didn’t waste our time. The speakers were good, they had their visuals and they gave us clear information. It was good to find out that we are there in so many places to be reassured that we are in the time that we need to be in most everything. I was very impressed with that. Not only is our CEO really well thought of amongst that group, other staff members were mentioned in this networking thing. A few interesting things, they had a very centralized online ordering supplies that was everything brought to one place. Other than the drugs it all went there. The vibration there was very much like North Caddo. Really good vibrations from the employees. You could feel it in the committee meeting we had. You could feel it in seeing the people around. They also promoted from within whenever they could. They planned and trained for that. That is one of the one of the reasons their morale factor and why our morale factor is good here. We thought the survey they did was good. Kenneth Cochran said we had a lot of questions but most of it was stuff we are doing here. In fact, we have some advantages in our location for some things. They are very locked in where they are. We are sitting pretty good. Mary Irvin said there are links to everything that we did but we will forward out through email if you interested in seeing more. Thank you all for your support and allowing us to go and hope that you will consider it in the future. Everybody was asking where is David. Ronnie Festavan said just to comment on Mr. Cochran. It might give you some comfort. There is actually Walmart Corporation is very involved in the healthy foods initiative. They are spending millions of dollars. I attended a meeting early on, on a grant that we received. Their philosophy is to approach what you just talked about at a very young age to get those programs in at the school levels beginning at the kindergarten level where you educate. 2) Foundation: David Jones said Mary Coil actually is off tonight. Of course the Foundation has a pretty big date coming up in two and one half weeks, shockingly it is only two and one half weeks away, but that is our Havana Nights. I hope to see everybody there. I guarantee you it’s going to be a fun night. It is their major fund raiser and those funds will come back to us here. I can’t say enough good about the Foundation and what they do, why they do it and how they do it. I want to thank one of our current Board members for being on that initial Foundation Board because they got the ball rolling and it has done very well since then. Mary Irvin said all those other hospitals we visit are always very impressed that we have a Foundation and we were told early on that we would never be able to support one. 3) Construction Report: David Jones asked Pam Hughes to give a report on the Construction. Pam Hughes said some of the Board have been through it. We are about to the phase that we are going to move some of the equipment over in the next couple of weeks and then we will start tearing out the wall to put the MRI in. David Jones stated the Fire Marshall office was actually slated to come on Monday, yesterday, to do some inspections, but I believe the inspector himself had some type of personal emergency and didn’t make it. They have stayed very close to their time constraints and it has been raining a lot in the last 7 to 8 months. They have done a very good job in this project. X. Medical Staff Report – 1) Recommendations – Dakota Robinson: Dakota Robinson presented the Medical Staff recommendations for the Governing Board approval: MEDICAL STAFF APPOINTMENTS: 1. Andrew Sholl, M.D – Requests Provisional Privileges in the field of Pathology for the period of July 23, 2019 through July 31, 2020. MEDICAL STAFF REAPPOINTMENT: 1. Catherine Sharpe, M.D. – Requests Active Privileges in the field of Family Medicine for the period of July 23, 2019 through June 30, 2021. 2. Alecia Rideau, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of July 23, 2019 through July 31, 2021. 3. Donald Nicell, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of July 23, 2019 through July 31, 2021. 4. Steven Davis, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of July 23, 2019 through July 31, 2021. 5. Joseph Heard, M.D. – Requests Courtesy Privileges in the field of Pathology for the period of July 23, 2019 through July 31, 2020. 6. Steven Edson, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of July 23, 2019 April 30, 2021. 7. Jeffrey Goorland, M.D. – Requests Active Privileges in the field of Emergency Medicine for the period of July 23, 2019 through July 31, 2021. ADVANCE PRACTICE PROFESSIONALS APPOINTMENTS / REAPPOINTMENT: 1. Sean Landrendeau FNP, – Requests Active Privileges in the field of Family Nurse Practitioner for the period of July 23, 2019 through July 31, 2021. 2. Sanjeevi Tivakaran M.D. – Requests Courtesy Privileges in the field of Sleep Medicine for the period of July 23, 2019 through November 31, 2020. 3. Ruth McRae, CRNA – Requests Courtesy Privileges in the field of Anesthesia for the period of July 23, 2019 through July 30, 2020. EXTENSION REQUEST: NONE. VOLUNTARY RESIGNATIONS: 1. Paul Schuler M.D. – Voluntary Resigns his Privileges in the field of Sleep Medicine effective 04/30/2019. 2. James Thomson CRNA – Voluntary Resigns his Privileges in the field of Anesthesia effective 06/30/2019. Brenda Smith made motion to accept the Medical Staff Reappointments, Reappointments, Advance Practice Professional Appointment / Reappointments and Voluntary Resignations as presented. Kenneth Clay seconded the motion. The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr. Abstained: None. The motion passed by unanimous vote in favor. Helen Godfrey-Smith stated last month I left the meeting early. In this area of the minutes from last month it says that I seconded the motion but it also says immediately after that that I was absent. Right here on page 5 of the minutes and so I would like to make sure that that gets corrected. Kenneth made the motion but I did not second it. I’m not sure who did because I was gone. Mary Irvin said those are the minutes from the previous month. Helen Godfrey-Smith said yes that we approved tonight, that adjustment needs to make sure that is corrected. David Jones asked which one it is. Helen Godfrey-Smith said it is page 5 and it is the motion for Medical Staff Reappointments and it is about mid page. It says Advance Practice Professionals Resignations as presented. Helen Godfrey-Smith seconded the motion. It needs to be corrected before it is published. Ronnie Festavan said it is no big deal to me but you have a set of approved minutes, now do you need to go back and approve the minutes as amended. We need someone to make a motion to go back and amend the minutes from last month based on Mrs. Godfrey’s correction. Pat White made the motion and David Norman seconded. Pat White moved that the minutes be approved subject to correction. Ronnie Festavan said hold that thought. Ronnie Festavan asked Doug White for procedure. Doug White said it is being done the right way. Ronnie Festavan asked if nothing had to be done about the prior approval then. Doug White said a motion seconded I believe cures the problem. I’m not sure what you are going to fix it with. David Jones stated that his notes reflect that Pat White seconded the motion. Mary Irvin asked are we in proper order to continue with that. Pat White made the motion and David Norman seconded the motion for revision. The vote to approve last month minutes based on the revision. The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr. Abstained: None. The motion passed by unanimous vote in favor. 2) Chief of Staff Comments: Dr. John Woods, Chief of Staff, stated that the hospital is running smooth. We have new Residents that have started. I rounded with one of the new ones this weekend. Everything was very good. It went smooth. Mary Irvin stated before we move to the next item, I know that many of you all responded through text when we received the announcement that our CEO, David Jones, had been nominated to be part of the LHA Board, I know that all the Board members agree with this, we are so proud of that. David, those are big accolades, the confidence that they have in you to serve on the Board. Thank you for being willing to do that. David Jones stated that I appreciate the Board for letting me do that. I’m hoping to bring a lot of information back to our hospital in our way based off of that. Mary Irvin said your picture came right on time. Helen Godfrey-Smith stated that I think our vote to hire him as our free standing CEO is impetuous for because it would have been difficult and confusing for him to have been a Willis Knighton employee and our CEO so I think our decision kind of opened up the way for them to recognize all of that and that should make up feel good. Mary Irvin stated we are very proud of you David. David Jones stated thank you. Mary Irvin stated you will get to meet with them quarterly. David Jones said yes, four times a year. David Jones said it has definitely been the biggest factor of my career by far, is being the CEO of North Caddo Medical Center and working with the Doctors and employees and working for this Board has definitely been the centerpiece of my career and I am looking forward to the future. Mary Irvin said we are very proud of that. Brenda Smith said and also congratulations on your new grandbaby. David Jones said thank you, I am extremely proud of that. XI. Executive Session: Mary Irvin stated she would entertain a motion to enter into Executive Session for the purpose of Strategic Planning. Helen Godfrey-Smith made a motion to enter into Executive Session for Strategic Planning. Ronnie Festavan seconded the motion. The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr. Abstained: None. The motion passed by unanimous vote in favor. Mary Irvin noted there will be a brief break prior to entering into Executive Session. The Executive Session was entered into. No action was taken during the Executive Session. David Norman made a motion to enter back into regular session. Ronnie Festavan seconded the motion. The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr. Abstained: None. The motion passed by unanimous vote in favor. XII. Adjourn: There being no further business Kenneth Clay made a motion to adjourn. Brenda Smith seconded the motion. The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr. Abstained: None. The motion carried by unanimous vote. Meeting adjourned at 8:20 pm.
NORTH CADDO HOSPITAL SERVICE DISTRICT
North Caddo Medical Center
David C. Jones, Secretary
Approved by the Board of Directors at the regular meeting held August 27, 2019