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1991-05-22 Regular Meetingr KODIAK ISLAND HOSPITAL ADVISORY BOARD MEETING MAY 22, 1991 PRESENT: Ben Ardinger, Gil Bane, William Brewer, Gretchen Saupe, Betty Springhill, Jeannie Volker, Lorne White, Ed Myers, Administrator, Keith Vorachek, Finance Manager, Kate Fitzgerald, Patient Care Administrator, Corlene Hogg, Director of Ancillary & Patient Information Services, Stacie Heiden, LHS Management Company. , ABSENT: Gordon Gould, Wayne Stevens With a quorum present, the meeting was called to order at 7:05 P.M. ACCEPTANCE OF AGENDA: Moved, seconded and carried to accept the agenda. APPEARANCES AND COMMUNICATIONS Ms. Springhill stated that in a telephone conversation with Representa- tive Davidson regarding the lack of funding for a new facility, that he had indicated that legislation for hospital funding had been caught up in unrelated issues, especially those bills related to Humana and Provi- dence Hospitals. There was discussion regarding the Alaska State Hospi- tal and Nursing Home Association's apparent fragmentation on legislative issues, which was felt to be a factor in the failure to get the neces- sary legislation to fund the new facility. As this is a two-year legis- lative session, the bill will again be presented. Ms. Springhill stated that Rep. Davidson had indicated that he felt that if the facility was not funded from legislation, that there was some possibility that fund- ing could be obtained through bonds. Staff was requested to invite Representative Davidson to the Board meeting scheduled for June 5, 1991. Stacie Heiden of LHS Management Company stated that computer system proposals had been submitted by six vendors to LHS and that the field would be narrowed to two candidates who had the strongest core system with long term upgrade capabilities. She stated that the system prices contained in the bids were locked in until January of 1992. Mr. Myers stated that in view of the facility's financial situation, that there was a possibility that no system would be purchased. There was discus- sion relative to using the Borough's hardware and purchasing applicable software. Mr. Myers stated that the cost of integrating software with the Borough's system might be as expensive as a total new system. Mr. Myers was asked if personnel costs incurred because of the ineffi- ciency of the present system was a factor. Advisory Board Meeting May 22, 1991 Page Two He responded that although such costs were a factor, that the main problem was that the facility's present system is at storage capacity. Several options regarding purchase vs. lease of a system were discussed. Mr. White stated that when a final recommendation can be made, that the proposed system should be presented to the Borough Assembly before the end of the fiscal year. MEETING MINUTES Moved, seconded and carried to approve the meeting minutes of May 8, 1991 as distributed. C01 EMTrTEE REPORTS Gretchen Saupe reported that the Quality Assurance Committee had met. Corlene Hogg explained the quality review activities for the first quarter 1991 and indicated that there was a new format for the Patient Care Quality Report. This report will be issued quarterly to the Board. Mr. Bane asked if the statistics of the previous year could be provided for comparison. Ms. Hogg indicated that they could. The possibility of a peer review program was discussed. Dr. Brewer indicated that there were some peer overview functions through subcommittees such as O.B., E.R., M & M, etc., and that in some instances individual cases have been referred to specialists outside the hospital for review. There was some discussion of specific areas of the Patient Care Quality Report. Ben Ardinger reported that the Finance Committee had met. He noted several payable items pertained to maintenance of the facility and stated that he felt strongly that all costs associated with maintenance of the building should be paid by the Borough. Mr. Myers stated that he has been working with the Borough to establish a policy which will establish levels of payment for maintenance of the facility and estab- lish a joint responsibility for prioritization of maintenance issues. Keith Vorachek reported that the April financial analysis of the facili- ty disclosed a $40,000 overall loss. Contributing factors included Hill -Burton writeoffs, non-payment by ICF residents, and a large ac- counts receivable. OLD BUSINESS A. KIH/CC Improvement Plan Mr. Myers explained that action had already been taken various areas of concern identified within the Plan, including a hiring freeze. He distributed suggested Advisory Board assignments to the Improvement Plan Teams and asked for the Board's support and in- volvement through participation in these committees. Advisory Board Meeting May 22, 1991 Page Three He stated that it is anticipated that the committees will meet once per month and have a very set agenda. The committees will begin meeting in June and work towards having a final report in Septem- ber. This is one part of the three-part budget procedure. It was the consensus of the Board members that they were supportive and would participate in the committees. NEW BUSINESS A. Medical Staff By -Laws Mr. Myers presented a matrix of Medical Staff Bylaws Amendments dated April 19, 1989 through February 20, 1991 which had been approved by the Medical Staff. Mr. Myers stated that although these amendments had not been approved by the Advisory Board nor LHS Management Company, the Medical Staff had been operating under these amendments on the assumption that the changes had been ap- proved. Gil Bane moved and Lorne white seconded to approve all Medical Staff Bylaws Amendments as contained within the matrix. Following discussion, Lorne White moved and Gil Bane seconded to amend by striking Medical Staff Bylaw Amendment Article III, Sec- tion 3, E, Page 6, from consideration. Roll Call vote on main motion as amended: Ayes: Ardinger, Bane, Brewer, Saupe, Springhill, Volker, White Noes: None Motion carried. Gretchen Saupe moved and Gil Bane seconded to approve Medical Staff Bylaw Amendment to Article III, Section 3, F, Page 6, dated May 15, 1991. Roll Call vote: Ayes: None Noes: Ardinger, Bane, Brewer, Saupe, Springhill, Volker, White Motion failed. Medical Staff recommendation of May 15, 1991 to grant temporary privileges to Dr. Alvarez for a three month period was presented. Mr. Myers stated that privileges could not be granted to Dr. Alvarez under the Medical Bylaws because of his lack of malpractice insurance. Lorne White stated that the document should include the phrase, "...regardless of malpractice coverage" so that the recom- mendation would read in whole, "To grant temporary privileges to Dr. Alvarez for a three month period, regardless of malpractice coverage." Advisory Board Meeting May 22, 1991 Page Four Lorne White moved and William Brewer seconded to recommend accep- tance of the Medical Staff Recommendation that Dr. Alvarez be granted temporary privileges for a three month period, regardless of malpractice coverage. Roll Call vote: Ayes: None Noes: Ardinger, Bane, Brewer, Saupe, Springhill, Volker, White Motion failed. B. Ambulance Situation Mr. Myers reviewed the current situation and policy of the city that it will not pick up crews and equipment at the airport and transport them to the hospital as part of an emergency medivac. He reported that he had met with city officials, but no commitment for resolution had been received. He stated that the hospital is willing to pick up the crews, but does not have an appropriate vehicle to do so. Mr. White stated that the Borough had bought an ambulance and asked about the status of that vehicle. Mr. Myers reported that the ambulance in question was now defunct and ';a that Requests for Proposals to sell the vehicle had been issued. Mr. Myers reported that if no resolution was forthcoming, that the situation would probably have to be elevated to the Borough. C. Security Room situation Mr. Myers distributed a situation analysis which outlined problems and suggested corrective actions. It was the consensus of the Board that it would support a facility policy which would require that an incarcerated person not be released to their own recogni- zance upon admission to the hospital and would further include the right of the facility to require that the police provide vigilance of the prisoner. ADMINISTRATOR'S REPORT Written report as attached. Mr. Myers requested input from the Board as to whether they wished to pursue funding a new facility, stating that he wondered if the facility had reached the point of looking at alternatives. After discussion, it was the unanimous consensus of the Board that they still supported the building of a new facility. AUDIENCE COMMENTS None. Advisory Board Meeting May 22, 1991 Page Five C • s : 1 9 ul►ll ►Y Betty Springhill asked about the status of the midwife situation. Kate Fitzgerald reported that she is still awaiting information from Sue Gross at LHS. Ms. Fitzgerald reported that she had received a letter from the State Board of Nursing and they were of the opinion that there was nothing that could be done. Ms. Springhill asked about the status of the nursing survey. Ms. Fitz- gerald stated that the survey has not arrived from LHS. Ms. Springhill asked Dr. Brewer if Dr. Rapatz of the Coast Guard would be amenable to attending a Board Meeting. Dr. Brewer stated that he would invite Dr. Rapatz to a Board Meeting. Ms. Springhill also asked Dr. Brewer what was the purpose of the KANA contract meeting. Dr. Brewer stated that KANA is working to establish contracts with local providers and decrease the frequency of sending patients off island. Lorne White asked if Administration was recommending that malpractice levels be reestablished in the Medical Staff Bylaws. Mr. Myers request- ed that this matter be deferred until after future discussions with the Medical Staff. Mr. Myers noted that the Medical Staff Bylaws, as cur- rently written, would allow any "duly licensed physician" to practice at Kodiak Island Hospital & Care Center in an emergency situation, regard- less of their malpractice coverage status. Mr. White asked about the status of the Solarium. Mr. Myers stated that it is currently on the Borough's capital improvement list, but that the top priorities for the facility are repairs to the floor in the Laundry and repair or replacement of the hot water system. The Borough had delayed funding the solarium, pending the legislative decision regarding new facility funding. Noting that the Smoke Shack had been closed up and locked, Mr. White asked if there had been any problems. Mr. Myers indicated that there had not been. Gretchen Saupe asked about the status of the liability insurance propos- al. Mr. Myers indicated that only one physician had responded to date. Ms. Saupe stated that she felt the parking situation at the facility was very inadequate. Mr. Myers stated that he had presented a proposal containing two possible scenarios to provide additional parking to the Borough and was awaiting their response. Gil Bane asked what the meeting schedule of the Board would be through the summer. It was determined that the Board would meet on the follow- ing dates through the summer: June 5, 1991, July 24, 1991, August 28, 1991. Advisory Board Meeting May 22, 1991 Page Six Ben Ardinger suggested to Dr. Brewer that when Dr. Mickleson is away from the facility, that it would be appropriate if more medical staff would be willing to provide E.R. coverage. NzSek+ ;t 1cea1 p1,uJ9;nansdo the p C",eriii�.R.�FUch.rsp;raA beoxLksecfCQs1aswCAa+cd Wi+h lcc. rr, k Betty Springhill stated that she was concerned that it appeared that KIH staff would be required to be in Anchorage for thirty days during the Cathev hearing. Mr. Myers stated that he has referred the situation to LHHS for their recommendation and indicated that the attorneys are hoping to get a settlement prior to trial. Ms. Saupe stated that she was pleased to see that the new bus would be in the Crab Fest Parade, and that the seniors had decided to call them- selves "Fuller's Flyers". Mr. Myers reported that Ms. Fuller has left a charitable remainder trust to Kodiak Island Hospital & Care Center, the funds of which will be used for maintenance of the bus and for items for the Care Center. EXECUTIVE SESSION Not called. 1 • 1: ♦lul ►Y Moved, seconded and carried to adjourn at 9:45 p.m. Recorded by Debra Raper. Jeannie Volker, Secretary/Treasurer *k en2n5 Con+raC--Fs and heusi.�oJ a-nd Vehicle "penSeS.