BOARD MEETING: Regular Meeting DATE: June 23, 2020 MEMBERS PRESENT: Mary Irvin, Kenneth Cochran, David Norman, Brenda Smith, Patricia White. MEMBERS PRESENT VIA TELECONFERENCE: Helen Godfrey-Smith MEMBERS ABSENT: Kenneth Clay (arrived at 3:49 p.m.), Ronnie Festavan (arrived at 4:23 p.m.), Robert T. Green, Jr. (arrived per teleconference at 3:40 p.m.) TIME CALLED TO ORDER: 3:30 p.m. OTHERS PRESENT: David Jones, CEO, Pam Hughes, COO, Dakota Robinson, CFO, Dr. John Woods, Chief of Staff, Mary Coil, Foundation Executive Director / Marketing Director, Walter D. (Doug) White, Hospital Attorney (Via Teleconference), Melissa Martin, Radiology Director, Britney Stringham, Administrative Assistant, Ross Hansen, IT Director, Lanell Audirsch, Admin. Asst. LOCATION: NCMC Café and Via Teleconference – Conference ID 626 735 880 BOARD CHAIR: Mary Irvin SECRETARY: David Jones I. CALLED TO ORDER – Mary Irvin, Board Chair called the meeting to order. II. Invocation and Pledge of Allegiance – David Norman offered the Invocation. Brenda Smith led the group in the Pledge of Allegiance. III. Approval / Amend Agenda – Pat White made a motion to approve the agenda as presented. Brenda Smith seconded the motion. The verbal vote: Yeas: Pat White, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Helen Godfrey-Smith. Nays: None. Absent: Kenneth Clay, Robert T. Green, Jr., Ronnie Festavan. Abstain: None. The motion passed by unanimous vote in favor. IV. Community Comments – Mary Irvin, Chair, inquired if there was anyone from the community logged on. Dakota Robinson stated there were no visitors logged on. V. Minutes – Regular Meeting May 26, 2020 – The minutes of the Regular meeting held May 26, 2020 were mailed prior to today’s meeting for review. Brenda Smith made a motion to approve the minutes of May 26, 2020 as mailed. Kenneth Cochran seconded the motion. Mary Irvin asked if there was any discussion or corrections to be made regarding the May 26, 2020 minutes at this time. There were none. The verbal vote: Yeas: Pat White, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Helen Godfrey-Smith. Nays: None. Absent: Kenneth Clay, Ronnie Festavan, Robert T. Green, Jr. Abstain: None. The motion passed by unanimous vote. VI. Foundation Report – Mary Coil, Foundation Executive Director / Marketing Director, gave her report. Mary Coil said I will give a quick update. We have quite a bit going on. We were able to donate the funds to purchase two halo bedside cribs which are pictured above. These are a great addition to our OB department. These came in today. We also had two of our Foundation Board members fulfill their terms of service – Mr. Greg Hall and Mrs. Christy Hall. We were able to provide them with a small thanks for their service that they have given to the Foundation Board. They will continue to be great advocates of this hospital and the work that our employees and unit as a whole accomplish for health care. We are going to miss them but thank them for their service. We did recruit a new Board member. Mrs. Valarie Hoogland. We’re excited to have her and she is excited to join the Board. She has a real heart for our area and healthcare in general. I think she’s going to bring great things to our Foundation. Also, keep in mind at the end of August we are planning a smaller event. It is in the very beginning stages. Mary Irvin thanked Mary Coil. (Robert T. Green, Jr. arrived via teleconference at 3:40 p.m.) VII. Chief of Staff Report – Dr. John Woods, Chief of Staff, said we do have some new residents that are going to be starting. Next, probably more urgent, is we’ve been having issues with our CT scanner for quite a while. We’ve been trying to remedy that. I started basically with querying the Radiologists that we utilize and asking them since they will be ultimately reading the films what their suggestions were. We’ve had several conversations over the last few weeks. Long story short it has to do with our current equipment that we do have as far as MRI, which is Philips brand. Because of contractual agreements from a cost and maintaining this, it would behoove us to stick with the same model of Philips with the CT scanner as well. Mary Irvin said that is something that we will be discussing during our New Business with the CT scanner and they did email out information about that. Dr. Woods said other than that everything is going great. Mary Irvin asked Dr. Woods if there was anything that he would say about you all being on deck with the COVID situation. Dr. Woods said this hospital has done an incredible job of staying on top of the state delegated standards and actually been in front of anticipating on what they are going to do. Really we’ve got such a good handle on this I don’t even really consider it an issue. It’s just another one of those disease processes that we have a handle on. We have a scanner at the door that patients and the general public is getting a read as they enter the door. That is not even something the state required or asked for it is just something that we figured we ought to do and it’s done. I’m pretty sure we will see people following suit with that. You are going to see a lot more influx of people that are going to test positive for this but of course they are also testing more. The one thing that they do know is that it is contagious but you will also see that the mortality and fatality of the disease is also going down at least over 40%. People are going to acquire this disease but I don’t think it is going to be as fatal. (Kenneth Clay arrived at 3:49 p.m.) Kenneth Cochran said I just had one accolade. From the lay position it looks like the hot bed of all this came from the nursing home. We, obviously, with Dr. Taylor and other intervened and that was a really good thing. David Jones said outcome wise it definitely was. Dr. Taylor, Dr. Woods, Dr. Chance and myself and a couple of others, we actually created a team. We had a couple of our third year Residents that basically were on call 24/7 just for the nursing home with a nurse and any type of issue that they would have over there we would send them over there and if they suspected anything odd going on with any patient we immediately sent them over there to start addressing issues and then we got with LSU and they were the first testing site that agreed to test everybody in the building. That gave us a baseline where to work at as far as who was positive, who was negative at that particular moment which then allowed them to start isolating patients moving them over. Kenneth Cochran said I don’t think it was a coincidence. I think our staff is to be commended. David Jones said I agree with that completely. I think the deaths would have at least been doubled from what they were. Dr. Woods said if we had waited on recommendations it would have been a lot worse. This was before they were even selective isolating. We just used common sense and basic science and knowledge and then basically employed what we needed to get done. First identify who actually had COVID and then isolate them from everybody else. Also supply them with PPE material that they didn’t even have. David Jones said it was the quick action of the team that help dissolve some of the brunt of that. We did it because it was what was right to do for the people in that facility. Mary Irvin said there was proactive positive results from the direct result of our hospital being involved. Kenneth Cochran said there was good decision making. David Jones said thank you. Mary Irvin said I know we did last time but really appreciate Dr. Woods and his leadership through this whole process because there was a lot of extra time put in. David Jones said I can’t say enough about what he and Dr. Chance really stepped up to the plate and did above and beyond with that. Dr. Chance was centered in what was going on with the clinic side and Dr. Woods took the whole rest of the hospital and took care of it from there. Both of those doctors in particular. The entire medical staff stepped up. Dr. Woods said everybody – all the nurses, nobody backed away, nobody shied away, everybody stepped up to the plate and did their job. It is very commendable. David Jones said it is easy to belittle it now a little bit, because we are so used to these things and everything, but don’t forget there were several weeks in there where there was some severe worry about all of our lives. Like he said there never was one that said they were not coming to work, there never was one that got angry because they were here. We did everything, in my opinion that we could have done to make it a safe environment for them to work in. That’s part of our job. Dr. Woods said nobody sat around and waited for us to go – what do we do. Mary Irvin stated we greatly appreciate it from all of you. Mary Irvin thanked Dr. Woods. VIII. Old Business – 1) Purchase of ADP HR System Update: David Jones said I will give a quick update on the ADP HR System. There were a couple more implementation meetings that’s happened over the last month. There’s a couple more bits of the system that were put in. We are still not at 100%. Those will still continue to flow as time goes on. The whole COVID pandemic, of course, put the screeching halt on a lot of this or at least slowed it down immensely. That will probably be over the next coming months that we will finally get the entire system in place. IX. 1) Review of May 2020 Statistics – Dakota Robinson: Dakota Robinson, Chief Financial Officer, said I think last month we saw not numbers that we wanted to see but definitely improved from what it could have been. I believe when we look at the statistics this month we will continue to see that trend going in a good direction. Looking at Admissions there were 41 Admissions so that is a reduction from the previous month but what we saw is that there was a definite increase in the length of stay. You’ll see the Inpatient Days went from a low in March of a 133, in April to 219 and then in May to 226. You’ll see the Average Daily Census with Acute and Swing together. We’re at 19.5. Now this doesn’t count any patients that are in the hospital for observation, so I’ll tell you we had plenty of days where this hospital was at maximum capacity. If you look at surgeries you’ll see that those increased to 11. If we look at Endoscopies, obviously the month before there were zero. We could not perform those based on the guidelines of the Governor but you’ll see in the month of May we hopped right back up to 12. If we look at Newborns we had 5 compared to 11 the month before and this is just sort of your typical swing. Some of the areas that we did see dramatic increases in were the clinics. We went from a little over 1,600 visits to almost 2,100 visits in the Vivian Clinic. If you talk to any of those physicians or any of those nurses, they’ve been very busy. We saw the same thing in Plain Dealing. They went from 527 to 746 and we saw the same thing in Benton. We went from 429 to 551. Are there any questions on the Statistical Analysis for the month of May? If not we will open up the Financial Statements. There were none. 2) Review April 2020 Financials – Dakota Robinson: Dakota Robinson stated that on page one of the Balance Sheet by looking at the Statistical Analysis you’ll see that most of the areas had increases. If you look at the very top under Current Assets you’ll see that we still have the Certificate of Deposit equal in about $724,000 but the main thing that we see is the Payroll Protection Program is still there. I said the significant increase in cash position from the previous year. The calculation on that is about 182 days Cash On Hand with CDs and the Payroll Protection Program and if you take out the CDs you’re 150 days Cash on Hand. Another area that we like to look at and we like to look at Assets Not in Service and Assets Whose Use is Limited. The Sales Tax Funds you can see has a balance of $952,000 as compared to $611,000 the previous year. Any questions on Cash or Liabilities on the Balance Sheet? There were none. Dakota said we can turn to Page 3 on the Income Statement. At the top we look at Revenue. Revenue increased dramatically from the previous months Revenue. If we look at Net Patient Revenue this period compared to last year which last year obviously does not have COVID in it, you’ll see that there’s only a difference of about $77,000. I believe that’s pretty commendable to be at a position so close to what it was in the previous year. If we get down into Operating Salaries and Wages, it was slightly higher than the previous year, but we are also under the Payroll Protection Program and we have a very large census so there are some increased costs that we’ve seen on the payroll side. If you look at the Total Operating Expenses, about $2.4 million and then we get into Non-Operating Revenues and Expenses, this is one of the areas that we’ve looked at so much in the past year because we’ve had some large numbers that could never be expected. One of the areas, obviously with an increase in cash position we’ll see a definite increase in Interest Expense so Interest Expense went from $7,000 the previous year to almost $16,000. When we get down into Grants you can see that there were $3.7 million dollars in grants and a majority of that coming from the Health and Hospitals CARES Act money that we showed you on the previous slide. All in all you look at 340B Revenue we’ll see that there’s $191,000 in revenue. I will put a little plug in there. We did have a 340B audit from the federal government in the month of February and we came out of that audit with no findings. If you look at the increase in Net Assets you’ll see that there’s an increase on the month of almost $3.1 million and on an 11 month basis it’s $4.3 million compared to $549,000 the previous year. Any questions on the Income Statement? Brenda Smith said I would just like to back just a little bit to the 340B audit. The Finance Committee really commends Dakota and everyone who has worked on this because, as Mr. Jones stated, this is not just a cut and dry, everything clear what you are supposed to be doing and everything and they’ve done their due diligence and to pass an audit like that with no findings, I think, is a great testimony to the people who are watching this and handling this. The Finance Committee gave kudos to them but I just wanted all of you to know that was a wonderful thing to come out of an audit like that and have no findings. So, thank you Dakota and whoever else helps you with that. Dakota said thank you. I appreciate it. Dakota continued stating if you look at page 5, it’s the One Month Revenue and Expense. I’m not going to spend too much time on it but basically what you’ll see here is it’s sort of a mixed bag of increases or decreases. Some of the areas where we saw increases from the previous year – Inpatient Routine Care. If we look at the comparison to Budget on page 7 we’ll start at the top in Gross Revenue. You’ll see that the revenue continues to fall behind what was budgeted for. Obviously when the budget was prepared COVID was nowhere in sight and not even on the radar for that matter. Contractual adjustments has come in as well under budget so that helps out significantly, but we expect to see there is less contractual adjustments with less revenue. When we get in Operating Expenses you’ll see the Salaries and Wages are definitely under budget for the month and when you look at the 11 month time period, we budgeted for $12.9 million and we’re currently at $12.5 million. So the Employee Benefits and Payroll Taxes the majority of this is related to the health, dental and life insurance that we have on the employees. We’ve seen an increase there but when you net those two together you’ll see that they pretty much offset each other which is a good thing. When we get down in the Total Operating Expenses for the 11 months you’ll see that we budgeted for $23.7 million dollars. We are currently sitting at $23.4 million dollars so we’re below what we budged to spend on the year which helps eat into the reduction in revenue that we’ve seen. Non-Operating Revenues, we’ve seen a dramatic increase in grant revenue. Look at Sales Tax Revenue, Sales Tax Revenue as of May is above where we were at the previous year so we’re at a very good position. What we’ve seen over the past three years is that continually increase. So if we do happen to see a decrease it’s not going to be something that can’t be handled easily because there were a few years, probably four or five years ago, where we did see it. You’ll see that we budgeted for an increase or a profit of $13,000 and this month it was almost $3.1 million and on the 11 month $4.3 million as opposed to the budgeted of $148,000. Mary Irvin asked if there were any questions or comments. Dakota said I will get to the clinics and go through those real quick. Like I said we discussed the increase in the clinic visits to 2,049 in the Vivian Clinic. You’ll see that the profit that they had went from $14,000 last month up to $66,000 for the month of May. You’ll see that as well in the other two. In Plain Dealing there’s 746 visits and turned a profit of a little over $17,000. And then our good old faithful Benton Clinic had 551 visits and turned a profit of $36,000. All in all the Financial Statements, compared to where they could be, are in a very good position. Pat White made a motion that the Statistics and Financials be approved as presented subject to audit. David Norman seconded the motion. The verbal vote: Yeas: Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green, Helen Godfrey-Smith. Nays: None. Absent: Ronnie Festavan. Abstain: None. The motion passed by unanimous vote in favor. (Ronnie Festavan arrived at 4:23 p.m.) X. New Business – 1) Approval of Budget Year 2020 – 2021: David Jones stated we have a lengthy new business list but we are at the approval of the Budget for the Fiscal Year 2020 – 2021. We passed it out at the last Board meeting. We’ve gone over it at length with the Finance Committee. If I can get a motion and a second then if you have any questions we can go from there. Brenda Smith made a motion to approve the Fiscal Year Budget 2020 – 2021. Kenneth Cochran seconded the motion. Mary Irvin stated the floor is now open for discussion regarding our budget for our upcoming year. Mary Irvin asked Mrs. Helen is there anything that you’d like to address the Board regarding the Finance Committee’s discussion. Helen Godfrey-Smith replied no. I don’t think so. It seems that we made some calls to be sure that all of our Board members had adequate time. They felt they had adequate time to review the budget and all. I mentioned the ones that I spoke to that this is probably one of those budgets that is as speculative as you probably would ever see because this is certainly an uncertain time. We thank Dakota and his team for what they’ve done and how much time they put in and they’ve done their absolute best estimate of potential revenues and expenses for the next year and we’re going to just see how this goes, but we expect there will be some variances as we move forward and we will handle those as we get to them. Thank you all so much. Helen Godfrey-Smith asked if she could acknowledge the Finance Committee members. On a monthly basis you allow me to say some things every now and then but there are some other team members that are very faithful, rarely do any of us miss our Finance Committee meeting. Mrs. Brenda Smith and David Norman and now it was Reverend Green but beginning in December Mrs. Mary Irvin came on board and we’ve just got a really faithful and committed team of people who are trying our best to follow Dakota’s and our CEO’s lead as we ponder the finances so a special thanks to all of our committee members and executive team that worked so closely with us. Mary Irvin said thank you so much Mrs. Helen. Thank you for your leadership on that committee. If there is no more discussion or questions we are now at the place to approve the Budget for Fiscal Year 2020 – 2021. There was none. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green, Helen Godfrey-Smith. Nay: None. Absent: None. Abstain: None. The motion passed to approve the Budget for Fiscal Year 2020 – 2021 by unanimous vote in favor. 2) Purchase of New CT Unit: David Jones stated it is time for us to purchase a new CT Unit. It is our recommendations that we purchase the 64 slice Philips Brilliance CT with the iPatient dosage for $267,521.40. If I could have a motion and second we will open it up for discussion. David Norman made a motion to approve the purchase of the 64 slice Philips Brilliance CT with the iPatient dosage for $267,521.40. Kenneth Clay seconded the motion. David Jones said as Dr. Woods spoke on earlier, this is probably the workhorse of the hospital and our current unit is 10 years old. Pat White said I was just curious with a purchase of this type does a service contract come with it or do we purchase it separately on a yearly basis. David Jones replied unfortunately after the first year we are going to have to purchase it separately Mrs. White. Pat White said I’m sure it’s not cheap. David Jones replied no ma’am it’s definitely not cheap. Dr. Woods said that is one of the reasons why we stuck with Philips products because our MRI is also Philips and instead of parsing it out with two different subcontracts for two different machines and driving up the cost and don’t see how that would be beneficial and in keeping the same vendor across the playing field would also make it a lot easier for learning curves and everything else, because all of them do the same thing, but they do it different. Mary Irvin asked if there was any further discussion. There was none. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion passed to purchase a new CT Unit by unanimous vote in favor. Mary Irvin asked how soon will be have that in place – just a prediction. David Jones replied possibly December. 3) Approval of Bio Medical Services with GE: David Jones stated one thing we were working with getting a partner hospital that is one of our main needs. We knew we were going to have to contract with someone. Ochsner is using GE’s services throughout the state so we were able to obtain GE rates. It is my opinion that we should go with the Bio Medical Services provided by GE. The price tag is $165.17 per piece of equipment which we’ve estimated it would cost us somewhere around $68,000 a year. If I could get a motion and a second then I will speak more on that. Brenda Smith made a motion to approve the Bio Medical Services with GE. David Norman seconded the motion. David Jones said what the Bio Medical Services are for, every piece of equipment that we have here in the hospital has to be reviewed and updated if need be by someone with a biomedical engineering certification. It is required by our state. It is one of the first things they look at when they come in and inspect us. That’s all of our IV pumps, all of our defibrillators, the Bair Hugger warmers in surgery and on down the line – every single piece of equipment that we have in here that we use for patient care and they will come up and start servicing them. Mary Irvin asked is it correct that once they do it they tag it. David Jones said that is correct – it shows the date, who they are and so on. That is basically what the state comes in and reviews and make sure everything is signed off on. Mary Irvin said it is a bachelor’s degree at a university in Bio Medical Technology. David Jones replied that is correct. Mary Irvin asked if there were any questions or discussion. There was none. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion passed by unanimous vote in favor. 4) Approval of Allscripts Maintenance Agreement: David Jones said really the next three but we will gone one at a time, are things that we approve yearly. The first is the approval of the Allscripts Maintenance Agreement for $27,893. Just a reminder Allscripts is our electronic medical record that we use in the clinic. We use Cerner for the hospital side, but we use Allscripts for the clinic side. The maintenance goes over upgrades to the software, any type of down time they come and fix. It is something we would be dead in the water without. It is certainly my recommendation that we approve that maintenance agreement for that amount. Brenda Smith made a motion to approve the Allscripts Maintenance Agreement. Pat White seconded the motion. Mary Irvin asked if there were any questions or discussion. Mary Irvin said I do have one question. If you could tell us why the clinic is on one software and hospital is on another. David Jones said we went live with the clinic software in 2008 and we got a grant to pay for that at that time. We did our due diligence and we looked around. Allscripts was the number one or number two vendor of clinic software in the nation at that time and still is one of the top two or three. We have looked at potentially going with Cerner’s to get them all under one umbrella. We’ve had Dr. May and Dr. Chance to site visits on two different hospitals to see if that is something. Mary Irvin asked if there was any other discussion. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion passed for the approval of the Allscripts Maintenance Agreement by unanimous vote in favor. 5) Approval of Inter Qual Software License – 2020: David Jones said it is our recommendation that we purchase our Inter Qual Software License. We got somewhat of a discount by going with a multi-year license. It a five year license for $63,283.85. If we have a motion and a second we will talk more about that. Kenneth Clay made a motion to approve the Inter Qual Software License as recommended. Ronnie Festavan seconded the motion. David Jones said the Inter Qual criteria if you remember is every patient that is requested to be admitted to the hospital we check the criteria for the appropriate level of service. They take all of your symptoms, all of what the doctors says is wrong with you and they input it in the software and it puts out whether Medicare will approve or the insurance companies will approve for an inpatient stay or an observation stay or they don’t really meet criteria for what is given. It is a front end way to make sure that we have enough documentation to get paid for the patients that we are putting in the hospital. Mary Irvin said this is a contract that we’ve had. David Jones said that is correct. We’ve used Inter Qual since before I came here. Mary Irvin ask if there were any other questions. There were none. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion pass to approve the Inter Qual Software License by unanimous vote in favor. 6) Renewal of 3M Encoder Software License – 2020: David Jones said the renewal of 3M Encoder Software License for 2020 is at cost of $19,561.89. That is the encoder that we have used since I’ve been here. An encoder creates a number for every diagnosis that we have on every patient and also CPT codes are attached to that. That’s how they pay bills based off those numbers and not an actual word diagnosis. The coders need that to identify which diagnosis code to use for each patient. Mary Irvin said again this is just a renewal. David Jones replied correct. Mary Irvin said we need a motion and a second. David Norman made a motion to approve the Renewal of the 3M Encoder Software License for 2020. Brenda Smith seconded the motion. Mary Irvin asked if there was any discussion. There was none. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion to renew the 3M Encoder Software License for 2020 passed by unanimous vote in favor. 7) Engage Lester, Miller and Wells CPA Firm for Fiscal Year End Audit and Cost Report: David Jones said it is once again time to engage a CPA firm to do our fiscal year-end audit and our cost report. Lester, Miller and Wells is the firm that we have used for quite some time to do our fiscal year-end audit. Their amount for that this year is $43,000. There is potential for us to have a single use audit as well and that amount is on the screen. Dakota Robinson said it could range between $5,000 and $8,000. David Jones said it is not a guarantee but it is probably a strong likelihood that we will have to do that as well for this year and then the Cost Report for this year is $24,000. It is my recommendation, simply to do with the knowledge base and this is the elite CPA healthcare firm in the state of Louisiana and like I said we have used them for the majority of the time that I have been here. It is my recommendation that we engage them again for both. Mary Irvin said we need a motion and a second. Pat White made a motion to engage Lester, Miller and Wells CPA Firm for Fiscal Year End Audit and Cost Report. Ronnie Festavan seconded the motion. Mary Irvin stated we are now open for discussion. Brenda Smith asked is it what we call the mid. Dakota said no, you will never know the difference. There won’t be a single audit report that comes out, it will just be the audit report, but there will be more work that went into that audit and that’s why they break it out separate is if we hit those limits to where one is required they basically have to do a second engagement to say, hey, we’re going to do this extra work as required, but it’s really one report. Ronnie Festavan said let me catch up with you Dakota. So if I were to just ask a simple question, what is the audit going to cost us next year. Would it be the sum of those figures? Dakota said the audit is literally going to be $43,000 if there’s not a single audit required. If that happens I would say you would add the first two together so it would be somewhere around $48 to $50,000. Then the Cost Report is separate all in itself. That’s basically where we sum up our expense, our cost and our revenue that we’ve brought in and we true up with Medicare and Medicaid. Mary Irvin said I was going to remind the Board that the Board, you know, based on the CEO’s recommendation, but ultimately the Board engages the audit firm in recognizing that we have a relationship with the audit firm, Mary Carroll is the person that works with the hospital. They’re familiar with us and as he said they are the leading hospital auditing accounting firm in our state. I just wanted to remind you all this is something that is at the will of the Board who we engage as the auditors. Keep that in mind. I think that in having conversation and I think that we all know a lot of us have an idea of Mary Carroll, how deep she goes and how thorough she is and how efficient she is. Kenneth Cochran said just to confirm my understanding. We might not have to pay that single audit if we don’t meet that federal threshold, but you are thinking we will meet that threshold. Dakota Robinson replied yes. Mary Irvin asked if there were any other questions or thoughts about that. There were none. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion to engage Lester, Miller and Wells CPA Firm for Fiscal Year End Audit and Cost Report passed by unanimous vote in favor. 8) Policy and Procedure Review for 2020: David Jones said the Policy and Procedure Review is something once again the state requires the Board to approve, all of our policy and procedures of the hospital. We kind of discussed this a little bit last year and not saying anything just for the Board and even myself, because it was policy before that the CEO sign every policy in every manual, which didn’t make a lot of sense to me. What exactly is that saying? I had no idea how to do a colonoscopy in this hospital. I don’t mean to be insulting but nor does anybody sitting around this table. Why would I put my name on it saying that is the correct procedure? We formed a committee headed by the DON of the hospital. It’s a multidisciplinary committee. It’s got somebody from Finance on it, somebody from Administration, somebody from the Medical Staff and that is Dr. John Chandler and they review every policy that comes in the hospital for appropriateness and correctness with the appropriate Department Head. Therefore, somebody with significant expertise is going over every policy that we’re going through. From a Board standpoint, we have to do this for clerical reasons and the state audit, and it is one of the things required that the Board votes and approves all these. It is like the Medical Staff bylaws and recommendations. The Board doesn’t necessarily review the criteria for every doctor that we give privileges but there is somebody with expertise that does in this hospital. The committee has sent this to the Board that is basically a statement that says – “The Department Policy and Procedure Manuals for North Caddo Medical Center have been reviewed and/or advised for the year 2020” to which the Chairman of that committee signed off on it and there is a place for Mary Irvin, the Board Chair, to sign once the Board approves it. There were a few new policies that I tried to send in the Board packet. I hope everyone got them. They were related to COVID-19. Those really were the only new procedures that we had for the upcoming year. Anything that is new, before it is put in place it is brought to this committee and they must sign off on it before it is put in place. Kenneth Cochran said I commend that procedure wholeheartedly. David Jones said it is something that I have always had an issue with. Kenneth Cochran that protects all of them? David Jones said yes absolutely. It is my recommendation that the Board approves the Policy and Procedures Committee’s recommendation for 2020. Kenneth Cochran made a motion to approve the Policy and Procedures Committee’s recommendation for 2020. David Norman seconded the motion. Mary Irvin said is there any further discussion or questions regarding the Policy and Procedure review. I do just want to state to all the Board members if at any time in the future you want to see all those Policy and Procedures they are available in Administration. They are available at any time if you want to look at those. There was no further discussion or questions. We appreciate those members that serve on that committee. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion passed by unanimous vote in favor. XI. Administrative Reports: 1) NCMC – Pandemic Update: David Jones said I want to give a quick over of what we’ve been seeing and what’s been going on at the hospital. We have recommendations from the State and National guidelines which were reflected in the policies that we sent out. We’ve done our due diligence and we’ve gone above some of those, in my opinion, because of our number one priority is our employee’s safety. There will be a flair up of this in the coming months more than likely after the heat starts dropping and it starts getting cooler and the days become shorter there will be a flair up just like the flu. We will be prepared. We are far better prepared than we were six months ago for something like this, that’s for sure. We are exposed to a lot of them and now, in my opinion, we are a little bit more ready to handle those. This is an ongoing thing. This is something that we are reviewing policy wise on a monthly basis with the Medical Staff and they are taking a lead in approving and putting forth these safety measures. That’s what is going on with the pandemic. Mary Irvin said I just wanted to make a plug, thank you to the office staff when you receive your Board packet email or in your packet, just a reminder behind all our normal paperwork after the reappointments, you will have a sheet that tells what is behind there and we really appreciate David for preparing an Administrative report. If you will take a few minutes to read over that prior to the Board meeting it gives you a good idea of what is about to come. I appreciate you doing that. XII. Medical Staff Report – 1) Recommendations – Dakota Robinson: Dakota Robinson presented the Medical Staff recommendations for the Governing Board approval. MEDICAL STAFF APPOINTMENTS: None. MEDICAL STAFF REAPPOINTMENT: 1.) James Faliszek, M.D. – Requests Courtesy Privileges in the field of Radiology for the period or June 23, 2020 through June 30, 2021. 2.) Louis Sardenga, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of June 23, 2020 through June 30, 2021. 3.) Joseph John, M.D. – Request Courtesy Privileges in the field of Radiology for the period of June 23, 2020 through April 30, 2022. ADVANCE PRACTICE PROFESSIONALS APPOINTMENT/ REAPPOINTMENT: None. EXTENSION REQUEST: None. VOLUNTARY RESIGNATIONS: 1.) James Chen, M.D. – Voluntary resigns his privileges in the field of Radiology effective 05/28/2020. 2.) Cristina Cavazos, M.D. – Voluntary resigns his privileges in the field of Radiology effective 05/28/2020. 3.) William Wong, M.D – Voluntary resigns his privileges in the field of Radiology effective 06/09/2020. 4.) Waikeong Wong, M.D – Voluntary resigns his privileges in the field of Radiology effective 06/09/2020. 5.) Dawood Malik, M.D. – Voluntary resigns his privileges in the field of Radiology effective 06/09/2020. 6.) Steven Lengle, M.D. – Voluntary resigns his privileges in the field of Radiology effective 06/09/2020. 7.) Christine Lamoureux, M.D – Voluntary resigns her privileges in the field of Radiology effective 06/09/2020. 8.) Charles Henry, M.D. – Voluntary resigns his privileges in the field of Radiology effective 06/09/2020. 9.) Christina Geatrakas, M.D. – Voluntary resigns her privileges in the field of Radiology effective 06/09/2020. 10.) Jean-Paul Dym, M.D. – Voluntary resigns his privileges in the field of Radiology effective 06/09/2020. 11.) Michael Cooney, M.D. – Voluntary resigns his privileges in the field of Radiology effective 06/09/2020. 12.) Karen Caldemeyer M.D. – Voluntary resigns her privileges in the field of Radiology effective 06/09/2020. David Norman made a motion to approve the Medical Staff Reappointments and Voluntary Resignations as presented. Brenda Smith seconded the motion. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion passed by unanimous vote in favor. XIII. Executive Session: Mary Irvin stated she would entertain a motion to enter into Executive Session for the purpose of Strategic Planning. Ronnie Festavan made a motion to enter into Executive Session. Kenneth Cochran seconded the motion. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion passed by unanimous vote in favor. There will be a brief break. 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. Kenneth Cochran seconded the motion. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion passed by unanimous vote in favor. XIV. Adjourn – There being no further business Mary Irvin called for a motion to adjourn. Kenneth Clay made a motion to adjourn. Pat White seconded the motion. The verbal vote: Yeas: Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Kenneth Cochran, Robert Green. Nays: None. Absent: Helen Godfrey-Smith. Abstain: None. The motion passed by unanimous vote in favor to adjourn. The meeting adjourned at 5:37 p.m.
North Caddo Hospital Service District
North Caddo Medical Center
David C. Jones, Secretary
Approved by the Board of Directors at the regular meeting held July 28, 2020