BOARD MEETING:  Regular Meeting   DATE:  November 27, 2018    MEMBERS PRESENT:  Robert T. Green, Jr., Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Patricia White.      MEMBERS ABSENT: Mary Irvin, Helen Godfrey-Smith, Kenneth Clay (arrived at 6:07 p.m.) TIME CALLED TO ORDER:  5:36 p.m.   OTHERS PRESENT:  David Jones, CEO, Pam Hughes, COO, Dakota Robinson, CFO, Mary Coil, Foundation Executive Director/Marketing Director, Dr. John Woods, Chief of Staff, Walter D. (Doug) White, Attorney, 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.  Brenda Smith led the group in the Pledge of Allegiance.    III. Approval / Amend Agenda – Brenda Smith made a motion to approve the agenda. Ronnie Festavan seconded the motion. The vote: Yeas: Robert T. Green, Jr., Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White.   Nays: None.   Absent: Kenneth Clay, Mary Irvin, Helen Godfrey-Smith.   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. Robert Green noted that he would like to make a comment. Mrs. Helen Godfrey-Smith would not be attending the meeting tonight due to a family illness / emergency. They brought them here to North Caddo then, after being stabilized, they were transferred to Willis Knighton.  Robert Green stated that when he got to Willis Knighton they praised what was done here at North Caddo. They said what was done at North Caddo made their job that much easier once they got there. Mrs. Helen wanted him to let you know and to let us know of how proud of the work that was done in the ER at North Caddo Medical Center. The Emergency Doctors at Willis Knighton said because of what was done, made their job that much easier. Mrs. Helen was very proud. Robert Green spoke directly to Dr. Woods stating that we appreciate the work that you do in the Emergency Room. For Willis Knighton to say that you did exactly what needed to be done made us very proud. Mrs. Helen wanted him to let you know that everything went well.  He thanked Dr. Woods again.     V. Minutes  – Regular Meeting October 23, 2018 – The minutes of the Regular Meeting held October 23, 2018 were mailed prior to today’s meeting for review.    Robert Green stated he would entertain a motion to receive the minutes with the necessary correction.  Pat White made a motion to approve the minutes of the Regular Meeting held on October 23, 2018 with the correction noted.  Kenneth Cochran seconded the motion.   The vote: Yeas: Robert T. Green, Jr., Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Kenneth Clay, Mary Irvin, Helen Godfrey-Smith.   Abstained: None.   The motion passed by unanimous vote.     VI. Old Business – 1) None.    VII. 1) Review October 2018  Statistics  –  Dakota Robinson: Dakota Robinson, CFO, asked the Board members to turn to the statistical booklet in the packet. The Statistics were reviewed. There were 55 admissions in October and in September there were 78 – a 30% reduction in the number of admissions.  If you see the September numbers, 280 in-patient days and fell to 162 in October. With those lower patient numbers, obviously, the Average Daily Census and acute and swing fell 6.9 from 14.2. Endoscopies remained high at 15. Surgeries – Dr. Banda is still doing quite a few surgeries at 18. He is doing a lot of surgeries at North Caddo. Emergency Room visits were down slightly at 431. Mammographys are about average at 31 for October. Medical and Surgical visits – they did see an increase at 2,355 visits at the clinic for the month of October with a profit of $95, 229.  Plain Dealing Clinic saw an increase as well at 699 patients and they had a profit of $11, 661. The Benton Clinic saw an increase number of patients at 434 – a trend on the clinic side with increased numbers. Their loss for the month went from $11,978 in September to $1,168 for the month of October. Ronnie Festavan asked if he would entertain a question about that. When you look at this, and this may have been all along and he didn’t pick up on, but if you look at the numbers you are going over, for the example the Vivian Clinic, you see total revenue at $617, 124 and then you see total expenses at $286,896, that doesn’t come out to be $95,229. He went to schedule 5,6 and 7 and figured it out on his own, and he is not asking him to change anything, but obviously if I were at home and not on the Board and he subtracted those two numbers, that profit is way off. The outside public would not know to go to page 5, 6 and 7 to see that the bad debt is taken out of there. It that not the reason for that. Dakota replied yes, the contractual adjustment and bad debt is taken out of that number.  Ronnie Festavan said do you see how that could be confusing. He is not asking to do anything different. He is just raising that question. At home, the way you do your books – this is how much I made, this is how much I spent and this is how much is left over – that number is not what reflects that. Dakota stated if it is the will of the Board for him to add a line that is what he will do. Ronnie Festavan said it may not be that big of a deal. He just wanted to bring that up to make sure he had done his math right and figured it out correctly. Dakota said it is an easy reference point. If you all like that statistic page and it is a quick reference instead of having to go through the financial statements each month and look that is an easy thing that he can put in there. David Jones said it is not a lot of labor and we can do that.  Ronnie Festavan said he doesn’t want to create work. That was not his point. He tries to put himself in the place of our public and when he immediately saw that number – he knew this minus this minus this is not this and there is not an explanation on that page. If you dig on through and you go to your schedules then one of the schedules it will explain that if you set there and figure it out. Dakota said that is not a disruption, he can put it in there without a problem. The numbers are calculated any way. Ronnie Festavan asked Mr. Chairman what his wisdom on that. Robert Green stated just has he said, anybody else on the outside looking would not know. If it is not a problem and no effort whatsoever to fix that would be better. David Jones said it would be none at all. Ronnie Festavan asked Dakota if he would just put a contractual debt line item in there. Dakota replied yes Sir. Robert Green said if there is little effort and no problem we can fix that.  Dakota said he would do it next month like that and if you see any changes or suggestions. Ronnie Festavan said why not try that because that page alone would make a lot more sense. Without going through the whole thing, you don’t know that is how it is. It almost looks like an error in the adding or program. Ronnie Festavan said thank you to Dakota. Dakota noted on the Days Cash on Hand did creep up slightly to 66. He told the Finance Committee, the way that we had a payroll, we had a bi-weekly payroll and a physician payroll cut on the first of November. That is inflated just a little bit. At the Finance Committee it was somewhere at 59 days, just be aware of that at the next meeting that should come down slightly. If you look at the profit/loss, we did a loss of $142,054 for the month of October which is pretty clear when we look at the patient volumes and the statistics out of the hospital. When we have a reduction in revenue in a month, especially that first month, the AR days tend to climb. It did climb to 57.52 from 44. Fitness Center memberships – they had 415 members as the month of October – only 12 membership increments on the graph. Dakota asked if there were any questions. Ronnie Festavan said it would appear to him that as you go through all of it and you look at individual numbers that fit your chart, it would seem a simple explanation that we had a loss of customers. By one being down, obviously there is a positive effect on everything else being down. Is that what he is looking at? Dakota said that is why we tend to put the in-patient statistics up first because that is a good indicator of how busy the hospital was. Your in-patients are obviously the sickest. They are having things from Respiratory, to Physical Therapy and every ancillary department is pretty much going the way that the in-patients do. Even the ER, typically the more ER patients you have the more admits you are going to get out of it. When you see those numbers start to come down, you are for sure going to see it in the financial statements that month. When you see the previous month that we had, with 280 patient days you saw the month we posted last month. They are directly correlated. David Jones, said in conversation with Willis Knighton they have been on a down turn for the last thirty to forty days as well. Dr. Woods said he tried to transfer patient to the VA. They cursory try to do it because there is never a bed open at the VA. They called and were surprised that they accepted a patient because they never do. Dr. Woods said you see the trend too, that a lot of people are going to the clinic than going to the Emergency Room. You have a lot more minor events going on than major. It’s a good thing. Primary prevention is being done here. That is what is happening.  Dakota said he did look at the numbers, the month of November and the Finance Committee meeting was last Wednesday and we were on track to surpass October’s numbers and it is not going to be as bad a month as November. Not great but better than October. Ronnie Festavan said he just wanted to get a little understanding of what your thoughts were on that.  Brenda Smith asked Pam Hughes to bring us up to date on where we are at Benton Clinic. They are almost to break even. Pam Hughes stated there are five Medicaid, Bayou Health Plans, and we have Blue Cross paying, Aetna is paying, United Healthcare is not and LHC is not. She has everything in with them and it should not be long. AmeriHealth is paying now but no one has paid back. They have each asked her to send them a spreadsheet and they will go off of that. Brenda Smith stated that things are just progressing. Pam Hughes replied yes. Dakota stated slowly but surely.   2) Review October 2018 Financials – Dakota Robinson – Dakota Robinson began with page one – the Balance Sheet. We looked at the Cash – Certificates of Deposit. The $700,000 the Board approved to move in to Reserve. The Cash On Hand – $3.9 million. We had a provider payroll and a bi-weekly which is a significant amount of money to come off of that number as of November first,  which will bring 66 days Cash on Hand to somewhere in the upper 50’s. On a month where we have a loss like October, we do eat into a little bit of that cash, but nothing significant at this point. If you go Other Receivables, it is a negative number, because we expected, at year’s end, to owe back a significant amount of money on the cost report. They tried to get the cost report prepared and audit done at this meeting; obviously it will be in December. The number that we are expected to pay back is significantly lower than what the Auditor initially thought. That is good news. We will see a lot of adjustments in these categories when the audit actually gets produced and all those AJE’s get pushed out in the December set of financials. He will point these out when we see some big fluctuations in that. Going down to the reserve accounts, the Sales Tax fund, Reserve fund, everything is funded at the levels that they need to be for the Bond Covenants. Sales Tax is actually coming in at a little bit over 5% better than it was the previous year looking at a yearly average. Good news is Sales Tax going up and that is one of those things that we really don’t have any control over so it is nice to see it when it does increase.  On page two, looking at Accounts Payable; currently there is nothing outstanding as far as past due in Accounts Receivable. The Accounts Payable line item – $693,000; this time last year was at $1.1 million. Still healthy there. The Finance Committee does look at this every single month. We give them an accounts payable report so they are paying attention to that. The difference in the accrued salaries; that line item is $785,000 as opposed to $138,000 – the main difference there is we made an accounting change this year. We accrue the salaries instead of posting them to the month, so your cash is what is in the bank accounts on the balance sheet then the liability shows up on the liability section. That is corrected in this and that is why we see a big difference in accrued salaries and withholdings.  Dakota asked if there were any questions on the Balance Sheet. There were none. On page three, this basically follows the statics – the revenue from this time last year down about $500,000 to about $3.4 million. If we do look at the four month – he will point out the highlights. Total operating revenue is up $60,000 from this time last year. That is a bright aspect even with a loss this month. In the Salaries and Wages – are up $162,000 which is 4%. We did institute the 4% raise at the facility. Nothing is out of line there. We did sustain some extra expense in the month of November. That should not wipe out $273,000 but it will take a chunk of that. Down the line items, professional services, the reason that is at $377,000 as opposed to $293,000 – $111,000 increase – that is where our Sleep Study line item is. We do increase revenue by those sleep studies but they obviously have an incurred cost. That is why that is different. If you look at the cost report in accounting, that is another one of the big accounts that is different. That is because we have completed aspects of the Cost Report and the Audit quicker this year, so they were billed out quicker. We spend right at $69,000 last year after he got down looking at it and it is going to be about that this year. Nothing alarming. Depreciation is more and we expected that with all of the things that have been added. If we get down into the non-operating revenues and expenses, the one thing he keeps preaching is we look at the grant line item – we are not getting $1.9 million dollars in UCC funds. We were supposed to be a little over $700,000 but they disallowed some of that down to about $500,000. We appealed that and won some of that back. We are hoping to get all of that back and get the $700,000. That is the main difference – we go from $1.9 to $700,000 – down $571,000 and that is based on the accrual of the UCC dollars. Sales Tax revenue is up and 340B revenue is up. We are at a decrease in the assets of $142,054 and for the four month time period an increase in asset up $545,000. Dakota asked if there were any questions on the income statement. There were none. On page four – this is the break out of Other Expense which was requested. One of the main things he pointed out was the Laundry line item is $5,000 more than last year. Dakota asked them to proceed to page number five. It is the one month Revenue and Departmental Expense Report. Going down the line it goes hand in hand with the statistics again. He does want to point out the bright spot in all of this – if you look at Operating/Recovery Room at $165,000 in revenue; the previous year they had $48,000 – it is a significant increase in that. If we take it one step further, on page six, talking about the same line item, there is $571,000 in revenue; the previous year it was $89,000 – a $472,000 difference just in that one department, which obviously Anesthesiology is affected in that as well with the more surgeries the more Anesthesiology revenue. You will see a four month increase of $56,000 in that department and obviously Inhalation Therapy with the Sleep Studies an increase of $144,000. Going down in the clinics and you look at Vivian, Plain Dealing and Benton all have an increase in revenue as well over the previous period. Dakota asked if there were any questions on those two schedules. Brenda Smith stated she had a comment of that was what we were looking for when we started trying to find a person to come in and do some surgeries because we had that beautiful surgical suite and we knew that that would be a stream of income for us. (Kenneth Clay arrived at 6:07 p.m.) We were aggressively looking for someone to come in and utilize that and make it a better, much more productive revenue stream for us.  Dakota stated he will say, and he is just the financial side, but he sees it a lot that the patient is seen in the clinic and Dr. Banda just happens to be here or here the next day and the patient stays here for the pre-op, stays here for the surgery and they can turn that around very quickly. Dr. Woods stated surgery patients come through the ER as well. Dakota said it is a great added benefit. Brenda Smith commented that is better for the patient to be able to get it done quicker. Dr. Woods said it is very convenient for everybody.  Brenda Smith said kudos to everyone involved in that.   Dakota stated before we go to the Budget, on page eight – on page seven, looking at Gross Revenue – Gross Revenue is down but at the same time contractual adjustments and bad debt is down as well compared to what we budgeted for. When we get down to Total Operating Revenues, there is only a 1½% decrease from the Budget; that is very minor. Almost $7 million as opposed to $7.1 million; there is no alarm in those categories. If we look at Salaries and Wages; down the line to Employee Benefits, Medical Supplies and Drugs – all of those categories are down. Professional Services is up and it is up just because of the sleep studies. That has increased that category by about $111,000. Under Other Expenses, the report we went through earlier, is down about $100,000. Net Expense is $596,000 less that what we budgeted for – that is a 7.2% decrease from the budget. Down under Non-operating Revenues, even with the reduction of UCC dollars that are being accrued, we only see $288,000 difference from what was budgeted.  If we get into the increase in Net Assets, we are at $545,000, we budgeted for $348,000, a difference of $196,000 in the right direction. Going to page nine – the Vivian Clinic  – you see they had a $95,000 profit for the month of October; page ten – the Plain Dealing Clinic $11,661. Then we get to the final one – Benton Clinic, which hopefully is leveling out, went from about $11,000 loss last month to $1,100. With the reimbursement rates that are slowly but surely coming in, hopefully in the near future we’ll see that number flip. Pat White commented that we pretty well knew that Benton was going to take a while to get leveled off and start showing profit, but she thinks overall it’s going to come up pretty quickly. Once you start getting the other people paying in their share on it. Dakota asked if there were any questions on the financial statements. There were none.  Brenda Smith asked if she would be remiss in asking Dakota to speak to the Board about Mary Carroll calling in for a conference with the Finance Committee and an update of where they are in the audit. Dakota said we did have Mary Carroll, who is the auditor for Lester, Miller and Wells, dial into the Finance Committee just to give a brief overview of what is going on. They are expecting to report to the next Board meeting. The audit from all that he has heard is going well. They are basically in the findings and cleaning it all up to be reported to the Board and the Legislative Auditor. We went from forty something journal entries down to sixteen – a significant reduction in that, which is great. We will always have journal entries due to the way that information flows in after the fact, but that was pretty much the report that we received from them.  Robert Green, Chairman, asked if there were any other comments. There were none.  Pat White made a motion to accept the Statistical and Financial Reports as presented subject to audit. David Norman seconded the motion. The vote:   Yeas: Robert T. Green, Jr., Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Mary Irvin, Helen Godfrey-Smith.   Abstained: None.   The motion passed by unanimous vote.     VIII. New Business – 1) Sick Time Buy Back: David Jones stated he would like to have a motion to approve the Sick Time Buy Back for the year of 2018 in the amount of $65,988.88. If he could get a motion and second he would like to speak further on the matter. Brenda Smith made a motion to approve the Sick Time Buy Back for the year of 2018 in the amount of $65,988.88. Pat White seconded the motion.  David Jones Mrs. Helen had decided to do this report but of course she couldn’t make it today based off of her family needs. He did want to speak on it. He noted that they have a Sick Time Buy Back Analysis that gives a review of the last three years of the hours bought back. We talked about it last year; this is an extremely popular program that a lot of the employees look forward to. These hours are used, Dakota looked at the clinical departments alone would have cost about $41,000 if they actually took that sick time, David Jones said that is just in the clinical departments of the hospital if they had actually taken their sick time. That is areas you can’t go without an employee. Dakota broke down the eligibility piece; it is actually an increase of hours based off of actual eligible hours. Dakota said in 2017 there was a total of 599,000 hours that could have been paid – not just total hours. In 2018, the way we restricted department and reduction in salaries, there were 555,000 total hours, so there was a reduction but when you divide that into the total hours eligible to be bought back – in 2017 it was .51% of that total number and this year it is actually .53% of that total number. Even though there is a reduction in the total number of hours bought back, when you look at the percentage as a whole, there is actually an increase in the eligibility or participation in the sick time buy back. David Jones said when you look at the decrease in the dollar amount, the higher paid employees, if they are out they take sick time or they have a surgery, then that greatly reduces the amount of money we have to pay back. We had a couple of higher paid employees that took sick time this year. This is always a thing Mr. Guth would bring up. There is no guarantee that this caused that employee not to come. The way to prove it would be to not do it next year to see what that does. That is not practical. Pam can attest to this. Those of the Board members that were there at the Christmas party last year when we were able to give the check, you could tell on their faces they were waiting on that check. Kenneth Cochran said it becomes a morale point rather than a financial point. David Jones agreed. He noted that those that don’t get it – there is a level of jealously too. Kenneth Cochran asked if there was any other strategy being used other than that to build that pride? David Jones said they are doing things with the Employee Enhance Committee that we have programs that we are throwing out there. Kenneth Cochran said the morale is a bigger priority sometimes than the money. Dakota said when we do the evaluations each year, there is a section that they have to meet certain criteria to be eligible for the full 4% and 1% of that is derived from how much sick time have you have taken. There is a portion that affects what they are eligible for on a raise as well.  Kenneth Cochran said there should be a reward for that. Brenda Smith commented she would say that you talked about last year coming right up to the cutting off point then we found out there were some employees that didn’t get put in that should have been put in. We have been assured this year that this is not the case. We are assured that everyone has been included and no one excluded. David Jones said we have involved the department heads in detail this time and we have put it on their heads to make sure that they go with every single employee that we’ve got on this list that says are you eligible and does this look right and if something didn’t look right that was their time to step up and questions it.  Ronnie Festavan asked what is the difference this year money wise in what we gave last year and what we are giving this year. Dakota said if you look at the sick time buy back analysis we were at $72,125 last year and this year it is at $65,988. David Jones stated it is a little bit above $6,000.  Brenda Smith said she would like to say she remembers a time when we had to bring in agency nurses. To her when you have to do that it is an added cost and you never know what you are going to get. You would lose some productivity when you were not familiar with whom you were working with. Dr. Woods said there is a lot of re-train and re-teach with how everything flows on the floor and where medication is kept and how things are done. Brenda Smith that is something else you can’t gauge is the loss of productivity and thinking about the incentive it gives them. David Jones said we have never used agency nurses since he has been here and since Stacy Alexander has been the Director of Nurses. Ronnie Festavan said he appreciates her pointing that out. In 2016 when we paid $80,000 then we paid $72,000 last year so that number is decreasing. Is that all of what this discussion was about, the reason it is decreasing. David Jones said he went over the reason it decreases 2017 to 2018. Ronnie Festavan asked how did we pay so much in 2016. David Jones said in 2016, we actually had a reduction in workforce to 2017. Ronnie Festavan so you had a different number to work off of so that makes your percentages different. That is what he was trying to make sense. If you evaluated based on this flow of numbers you would say it is not working. David Jones said less effective. Dakota said that is why we tried to do that analytical analysis of breaking it down in to the total numbers of hours worked, which is something we haven’t done previously. Ronnie Festavan remembers when we did this last year. It was his first or second Board meeting. He recalls saying when it gets to this point this year I need you to show me how this is improving things. If you think it works. Dakota said we went to a .51% to a .53%. He thinks like Mr. Cochran thinks, from us working with people and morale being what we know it had to be in a school system, you couldn’t buy morale. If you have good morale and people showing up with a good attitude the whole thing is better. If you believe this is good he is going to support this 100% himself. Pat White said when you got people who take pride in their job and where they are working and they don’t want to disappoint either. Kenneth Cochran that is team building within your organization because a small group gets to talking to each other in those team meetings and it becomes real important. Ronnie Festavan said he would encourage you to keep reinforcing that concept of this comes from how well you respond to it. Robert Green asked we are going to pass those out at the Christmas party. He asked when the Christmas party is. David Jones replied it is December 6th. Robert Green asked for a vote on the motion and second of the approval of the Sick Time Buy Back for 2018. The vote: Yeas: Robert T. Green, Jr., Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Mary Irvin, Helen Godfrey-Smith.   Abstained: None.   The motion passed by unanimous vote.  2) Allscripts Interface:   David Jones requested a motion to approve the Allscripts Cerner Interface for the Laboratory in the amount of $40,700 he will speak more on that as well. David Norman made a motion to approve the Allscripts Cerner Interface for the Laboratory in the amount of $40,700. Kenneth Cochran seconded the motion. David Jones stated when you talk about computer systems, and we are completely integrated, and he will ask Pam Hughes and Dakota Robinson to speak on this as well. Dakota Robinson had provided each Board member with an informational “Lab Interface” recap.  David Jones noted that we took over doing some of our chemistry profiles from an outpatient laboratory center. We started bringing them in-house. We saw the amount of revenue that it could possibly potentially bring in for us. In doing so, we knew that we would probably have to go and spend some money sooner or later to do this once it got up to speed. He asked Dakota Robinson if we had the total number of tests. Dakota replied yes it was somewhere in a two and one half month time period about seven hundred. David Jones said you are talking about 700 chemistry profiles – (there are 12 individual tests in a BNP and CNP) and somewhere around 8,400 individual tests such as a sodium result, a chloride, glucose and a potassium result and those kinds of results. We are running all those from the clinic. We get the specimen from the clinic, take it into our Laboratory, register into Cerner; someone in our Laboratory runs it in Cerner, takes that result that comes off the machine, goes into Allscripts, which is the clinic medical record, pulls up that patient and one by one enters the results in. Dr. Woods can attest what one 140 result turns into a 410 result because someone transposed the one and the four – what that could mean on a particular patient. We knew going into this that there we were probably going to have to spend this money. We have been talking to Allscripts and Cerner and we have negotiated down. It is just like anything else you buy from any other company, it’s just really a piece of software that you will never see; this interface is.  Kenneth Cochran said he had a question about that. It says the interface is immediate according to the information here. Doesn’t somebody have to put that into the program? David Jones replied once the interface is done all you have to do is order it in Cerner and as soon as it is resulted off it goes straight into Allscripts. Pam Hughes stated it talks to your computer. We already do that now with the (LabCorp) outpatient laboratory center. Kenneth Cochran asked who introduces that – if that is all in the program to start with. David Jones and Pam Hughes replied yes. David Jones said which reduces the amount of errors – the human error element. Plus, because you are manually entering that into Allscripts the doctors have to actually go to a different field to review the laboratories because they have to review the labs on every single patient that they order at the end of each day. They are actually going to a different area reviewing that and putting it in so it is creating a little more work from the physician end making it a little bit more cumbersome for them to review as well. We knew we were going to do this if it took off. In revenue you are talking about $170,000 and we have already collected off that revenue $28 – $29,000 and that is in the first two and half months of this. The expected cash result by pulling in these lab results is $250,000. You are talking about a one-time cost of $40,700 and each year we are going to be bringing in a quarter million dollars in cash. You want to do your due diligence to reduce the amount of human error that could happen. We are thankful most of those are caught once they are put in. A physician sees a 410 result when they normally see 140 they are going to question what they are seeing there typically. It could be the opposite – it could be an abnormal result that they transposed into a normal, so the physician looks at it and it is a normal result thinking there is nothing I need to do here. That is a bad problem to have. That is what this interface does. We did negotiate with Cerner and they did come off $4,000 off the price – the initial was $33,000 in change so this did come down somewhat to what their initial offer was. You have to go through them. It’s their software and they are the only ones that would allow you to adjust it. It’s not like you go to a third party vendor and ask for an interface to be written because they won’t give you the rights to use it. It is what it is. He asked Dakota and Pam if they had anything to add to that. Dakota said he will say that it is one of those increases in revenue where we did not have to hire staff in the Lab. That is the time that the Lab employees are in there, if it takes up five minutes for each CNP it will eventually get to a point to where we would have to add a staff member in there to keep up with that. He put in there that it allows for the growth of the program. For the first month and one half, almost two months, we were just doing Vivian to try to get the process down and see how many it would be and make sure the Lab could handle the volume. Then we got to a point where an interface was looking more likely than not. We added Plain Dealing recently with the hopes to eventually add the Benton Clinic. All those labs will eventually come back to North Caddo and not having to add that extra employee to process all this manually. Kenneth Cochran asked if there will be a need for upgrades to the interface along the way. David Jones said typically when you buy an interface it is pretty much what it is; unless you change software to some degree or if we got rid of Allscripts and went to another. Dr. Woods said it is strictly a data base and that is what you are paying for is a creation of a database and when the software updates that is global. Kenneth Cochran said so we won’t see new quotes on operating. Dr. Woods said you should not unless they additional information. Dakota said we have quite a few interfaces at the hospital. David Jones said every instrument in the Laboratory is interfaced with Cerner. Everyone that goes in the results automatically feed into Cerner so the Doctors can pull them up right then and there.  Ronnie Festavan asked Dr. Woods, as Chief of Staff, for the records, for the minutes. Would you speak to this as to the effect on your medical staff, having this? If we purchase this, what is the effect on your medical staff? Dr. Woods said as David alluded to it, because it is not interfaced, we have to take additional time with every person that we see, going to a separate part of Cerner and revalidate every one of those labs that we had because we don’t have this interface. It is very annoying on the physicians, because we have already seen them and now we have to go back and look at again in a separate area that we have to log into. We have to do this on a daily basis. It creates redundant, unnecessary work on that end. The other thing that is most essential is if he starts telling a person to type in a number and after it goes around by the time it gets over here it is going to be a different number – it creates less area for mistakes to be made. Kenneth Cochran asked if there are any confidentiality concerns. Dr. Woods replied none. It is going into a data base that only the people that are allowed to look at that information gets to look at it. Ronnie Festavan said would you summarize by saying that it would increase the overall efficiency of your medical staff? Dr. Woods added and decrease errors. Ronnie Festavan thanked Mr. Chairman. Brenda Smith said she has a question. She understands how the labs are received from our clinic here but how will it be sent from Plain Dealing or Benton Clinic. Dakota stated we have a courier.  Pam Hughes said they pick up at 1:30 p.m. every day except on Friday; we pick up at 3:00 p.m. on Friday so it won’t stay all weekend. They bring it back here and they run it here. Brenda Smith said thank you. That answered her question.  Pam Hughes also stated on the days they don’t have anything the clinic will call and tell them not to come. Robert Green asked if there were and further questions or discussion. If not he would entertain a vote.  The vote: Yeas: Robert T. Green, Jr., Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Mary Irvin, Helen Godfrey-Smith.   Abstained: None.   The motion to approve the Allscripts Cerner Interface for the Laboratory in the amount of $40,700 passed by unanimous vote in favor.  3) Move December Board Meeting Date:     Robert Green stated we need to look at the schedule of the Board Meeting for December. David Jones noted that the regular meeting date for December is Christmas day. Robert Green suggested December 18th, the previous Tuesday. David Jones noted that December 18th is fine for the Auditors to do their presentation. Robert Green asked if anyone had a problem with December 18th as the date for the December Board meeting. There were no objections. Robert Green asked for a motion. Pat White made a motion to change the regular meeting date for the December meeting from Tuesday, December 25th to Tuesday, December 18th. Brenda Smith seconded the motion. Robert Green asked if there were any further questions or discussion about the move of the regular meeting to the 18th of December. Brenda Smith asked for someone to call and send out an email to remind the Board members since we have some members that are not present and just as a reminder.   There was no further discussion.   The vote:  Yeas: Robert T. Green, Jr., Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Mary Irvin, Helen Godfrey-Smith.   Abstained: None.  The motion passed by unanimous vote in favor.    IX. Administrative Reports – 1) NCMC – Current Activity:  David Jones noted that under current activity that we point out several dates in December. The first of which is December 6th. We have budgeted for and was approved by the Finance Committee for the Christmas Party on December 6th. It will be at 6:30 p.m. in the main lobby. It will be the North Caddo Medical Center family only. We are not going to invite outside people. It worked well last year. The Foundation Board is considered our family and they of course will be invited. You and your spouses, we love for you to come. Dakota volunteered to dress up like an Elf to pass out the checks but his caveat was that I dress up like Santa Clause. If we need to we can get it done. There are several that love to see that go down. He asked Mary Coil to talk about the entertainment.  Mary Coil stated that we will have a saxophonist named Eddie Spencer. He played at a David Raines Banquet in the past and she heard nothing but great reviews about him and we are looking forward to him spending the evening with us. It was a great time last year. We just feel like this is an addition of easy listening as we mingle with our co-workers and Boards. David Jones said he didn’t know if anyone has had a chance to go through the front lobby or the hospital. Our Christmas Elf, Mrs. Hughes and her crew, have decorated and made a very much winter wonderland. They have done a great job as they always do. She made it a team effort and got more employees involved and multiple people were having a grand time making ribbons and running around doing all kinds of things. Brenda Smith made a comment that the patient doors look nice. Pam Hughes commented that Lynn White helped a lot and Melissa Martin hobbled up here in her wheelchair and helped a lot. All the cleaning staff, a lot of the Lab and Dietary all helped and made it all good because the employees enjoyed it and felt comfortable to come out and help. David Jones said it was more of a family thing. It was pretty awesome to see them all working on it. It looks beautiful. We have a lot of space there and after six o’clock the clinics shut down and very few people enter that area at that time of night. Last year we removed the chairs and it was a big open space there. We had a table with refreshments on one end and we will have the saxophonist playing in the corner as well. We will be able to enjoy each other of a night. We don’t always get to do that. Plus, we have a great venue to do it in our front lobby. Brenda Smith said it looks festive when you drive by and see all the people in there. David Jones said he certainly wants you to remember December 19th, and you will be getting updates and phone calls on this. Don’t think this is the only time he is going to give you these dates. David Jones said he wants the Board to judge the food categories. They will have sheets to sign. It is going to be an individual contest this year – not a team contest. There are competitive juices there. This will be the day after the Board meeting. David Jones said you won’t walk away hungry. We will have a snack judge, a main entrée judge and a dessert judging. Pam Hughes reminded him there is a door contest.  He noted they have a door decorating contest for Christmas going on. He is has an open mind after what they did with the Halloween Pumpkin Decorating contest.  He doesn’t know if they got to see the lanterns that we did – the odd thing is that the winner for the Town didn’t even make our top three. For some reason all of the pumpkins didn’t make it down there for the contest. The one that didn’t even top our top three was one of the best in the Town and the Town put out some good ones. Our pumpkins blew him away. He, Pam and Dakota will be the judges on the door decorating contest. They will be the bad guys. Robert Green said Mary Irvin wanted to do a door for the Board. Robert Green encouraged her to participate. We will get a departmental gift going for them somehow. Pam said she had a preview of a couple of them today. It is going to be tough.  David Jones said it is going to be something else and once those competitive juices get flowing over there and there are some people with some artistic talent and it is impressive. Brenda Smith asked if they are sure they want to judge. David Jones said somebody has to be the bad guy. The Board will judge the food and they might as well take the bullet on the other one. December 18th the Board meeting that will be the night the audit will be gone over. That is always an important one as well. That is all for the current activity.    2) Foundation: Mary Coil said today was giving Tuesday which was a movement for social media for charity organization, the Tuesday following Cyber Monday. The Foundation joined in on that. A couple of the Foundation Board members created fundraisers and she did as well. Facebook and Pay Pal are supposed to match the donations. They do it up to $7 million dollars. Of course that is across all the charities involved. Hers alone raised $1,000 and they are supposed to match that. We have some other ones that raised around $500 and different ones. She hasn’t seen all of them. Missy Moore, with the Gift Box and New Beginnings, gave an incentive for our employees that if they donated they would be put in a drawing for a gift card for the Gift Box. We really appreciated her support in doing that. This is our first year and we were trying to see what it was all about and we had a great response. We appreciate those who were involved. Also, we have a new Board member. Crystal Wooldridge has joined our Board and she attended her first meeting last month and we are very excited to have her on board. She volunteered with the Gala and had many great ideas so we are really looking forward to now being a part of us and her fresh ideas coming on board. We have the ornaments for the Christmas tree. They are $10 each if you would like to give one in memory or in honor of someone. I hope you received that in the mail but just in case you didn’t she has some forms here tonight. We will hang ornaments on the tree like we do every year in those names that donors choose. We have that rolling as well.  David Jones asked if they still contact the person that you do it in honor of? Mary said if you would like we will send a notice to the individual. Sometimes we have people give to honor a friend and we will send it saying this donation has been given in honor of you. Sometimes it is a memorial and we will a letter to the family and say a gift has been given in this person’s name in memory of this person and tell them the appreciation we have as a charity to receive such an honor gift.  Ronnie Festavan asked if that tree will be up and on display the night of the Christmas party. Mary replied yes Sir.  That was all she had to report.    3) Construction Report:  David Jones stated that he thinks we have a date. On December 12th at 10:00 a.m. we are going to have our pre-construction meeting. He thinks we finalized that about an hour and a half ago. That should give us for the December Board meeting some timelines as to where and when and how that is going to go down as far as ground breaking and moving around. Of course, as you all know from the last construction project we did, you may as well throw those timelines out the window – the odds of us hitting any them are uncertain. It is the lowest bid project and they will have certain time constrains and honestly, like he has said before, every time we stick a shovel in the ground here it is a guarantee rain for about every four days. Go ahead and get ready – if you have gardens or anything we can help out. That is good news from the constructions report standpoint that we finally know when we are going to move forward. That is pretty much it from the construction report.    X. Medical Staff Report – 1) Recommendations – Dakota Robinson: MEDICAL STAFF APPOINTMENTS: 1) Almas Syed, M.D.  –  Requests Provisional Privileges in the field of Radiology for the period of November 27, 2018 through November 30, 2019.  MEDICAL STAFF REAPPOINTMENT: 1) Charles Henry, M.D. –  Request Courtesy Privileges in the field of Radiology for the period of November 27, 2018 through November 30, 2020.  2) John Chang, M.D. –  Request Courtesy Privileges in the field of Radiology for the period of November 27, 2018 through November 30, 2020.  3) Donald Nicell, M.D. –  Request Courtesy Privileges in the field of Radiology for the period of November 27, 2018 through July 30, 2019.  4) Christine Lamoureux, M.D. –  Request Courtesy Privileges in the field of Radiology for the period of November 27, 2018 through June 30, 2019.  5) Marc Paul, M.D. –  Request Courtesy Privileges in the field of Radiology for the period of November 27, 2018 through November 30, 2019.  6) John Chandler, M.D. –  Request Active Privileges in the field of Emergency Medicine for the period of November 27, 2018 through November 30, 2020.     ADVANCE PRACTICE PROFESSIONALS  – APPOINTMENTS / REAPPOINTMENT:       1) Joseph Martin, APRN-CNP –  Requests Provisional Privileges in the field of NP/PA for the period of November 27, 2018 through November 30, 2019.     EXTENSION REQUEST: None.     VOLUNTARY RESIGNATIONS: 1) Michael Futrell, M.D. –  Requests Resignation in the field of Cardiology effective 12/01/2017.   2) David Remedios, M.D. –  Requests Resignation in the field of Wound Care effective 05/01/2018.   3) Michael Lewis, CRNA – Voluntary Resignation due to failure to comply with the Medical Staff Bylaws of the reappointment process.  4) Jason Horn, CRNA – Voluntary Resignation due to failure to comply with the Medical Staff Bylaws of the reappointment process.     Pat White made a motion to accept the Medical Staff Appointments, Reappointments, Advance Practice Professional Appointment, and Voluntary Resignations.    Ronnie Festavan seconded the motion. The vote:  Yeas: Robert T. Green, Jr., Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Mary Irvin, Helen Godfrey-Smith.   Abstained: None.  The motion passed by unanimous vote in favor.     2) Chief of Staff Comments: Dr. John Woods said there is nothing to report that all is going well.  XI. Executive Session: Robert Green noted that we need 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.   Brenda Smith seconded the motion.  The vote:  Yeas: Robert T. Green, Jr., Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Mary Irvin, Helen Godfrey-Smith.   Abstained: None.  The motion passed by unanimous vote in favor.  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 vote:   Yeas: Robert T. Green, Jr., Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Mary Irvin, Helen Godfrey-Smith.   Abstained: None.  The motion passed by unanimous vote in favor.    XII. Adjourn:    There being no further business Kenneth Clay made a motion to adjourn.  Pat White seconded the motion.   The vote:  Yeas: Robert T. Green, Jr., Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Pat White   Nays: None.   Absent: Mary Irvin, Helen Godfrey-Smith.   Abstained: None.     The motion carried.      Meeting adjourned at 8:00 p.m.




North Caddo Medical Center

Vivian, Louisiana



David C. Jones, Secretary


Approved by the Board of Directors at the regular meeting held December 18, 2018