By Jerry Morgan, Reporter

VAN DYKE -- Two new directors were sworn in and new officers were elected on Tuesday, May 22, at the first meeting of the Board of Directors of the Comanche County Consolidated Hospital District after the recent local elections. The Board is the governing body for the Comanche County Medical Center and Doctors Medical Clinic.

Following a cursory canvass and certification of the May 12 election results and the signing of required directors' statements, the new Board took their oath of office. Janna Morris and Billy Ray Evans took their seats at the table as the retiring directors, John Mack Weaver and Mary Jane Atkins, were thanked for their service and left the meeting.

Drawing for Terms of Service

DRAWING FOR TERMS. Gale Easley, on the right, who was elected as the new president of the Hospital District Board, draws a slip of paper from the cap which determined her term of office. Directors Joe Locke and Janna Morris await their turn at the drawing. Easley drew a one year term, and Locke and Morris drew two year terms.

A drawing for terms of service was then conducted by passing around a cap with six folded slips of paper representing one, two or three year terms.

Charles Mazurek and Gale Easley each drew one year terms, Joe Locke and Janna Morris both drew two year terms and Karen Carr and Billy Ray Evans each received three year terms.

Hereafter, annual Hospital District Board elections will be conducted with two members elected each year to serve three year terms.

Election of Board Officers

The next order of business involved the election of new Board officers. Charles Mazurek, president of the previous Board, nominated Gale Easley as president by acclamation, noting that she had the longest tenure of total hospital Board service of any active director, had previously served in that capacity and had agreed to serve again. Karen Carr seconded and, there being no further nominations, Easley was elected as president by the other five directors' unanimous vote.

Mazurek then passed the conduct of the meeting to Easley, who said, "Thank you, thank you... I think." She then called for nominations for the other two Board officers, vice president and secretary.

Karen Carr nominated Joe Locke for another term as vice president, adding that he had served well and worked hard in that capacity for the preceding three years. Charles Mazurek seconded and then Billy Ray Evans offered an amendment to the motion that nominations cease and Locke be elected by acclamation, which Mazurek again seconded. The vote of approval was unanimous.

Charles Mazurek nominated Karen Carr to serve as Board secretary by acclamation, Joe Locke seconded and, again, the vote of approval was unanimous.

Medical Staff Report

The next item of business was presented by Dr. Howard Dickey, Chief of Medical Staff. Dr. Dickey noted that the medical staff had met on the preceding Tuesday with "no fireworks" and had voted to approve two candidates for addition to the courtesy medical staff at CCMC.

Dr. Dickey reported that Dr. Alphonso Pino has announced that he was retiring after 50 years of medical practice, effective May 24. He added that Dr. Michael Chiang has tendered his resignation to take effect in 90 days to practice medicine elsewhere. Dr. Dickey added that this would leave the hospital with only four full time physicians.

Interim CEO Kurt Meyer quickly noted that Dr. Chiang had indicated that he might reconsider his decision if things change. Dr. Dickey added that Dr. Chiang's decision was not "written in stone", but that the resignation had occurred and he was obligated to inform the Board of the development.

Dr. Dickey said that the hiring of an outside group of physicians to provide Emergency Room coverage had been delayed, at least through June. He reported that Dr. Eisenrich had offered to provide some coverage and that the mid-level physician's assistant and nurse practitioner, along with Dr. Peter Fagan, would provide daytime ER coverage, thus freeing up the staff physicians for maximum effort at the clinic.

Dr. Dickey added that the medical staff was reluctant to bring in outside medical help if ER coverage could be achieved locally. He added that outside medical coverage might still be required in July.

Ambulance Purchase Proposal

CCMC's Director of Emergency Medical Services, Danny Owen, was given the floor to discuss ambulance needs. In turn, he introduced Brant Stovall from Professional Ambulance in Alvarado, who had made two separate ambulance proposals to the hospital.

Owen spoke regarding the hardships currently being faced by the EMS department, displaying statistics showing the rapidly growing number of calls the department was answering.

Owen noted the hospital has four ambulances, three of which are primary emergency responder units, and one of which is more devoted to patient transfer service. Three of the four units have total mileage of around 150,000 miles or more, all 1998 or 1997 models, and the oldest unit, a 1997 Ford, was described as needing a replacement engine. The newest unit is a 2004 Ford with less than 50,000 miles.

Owen said that the average useful life of an ambulance truck is four to seven years, or 200,000 miles. He described the variety of drivers, rough roads, extended idles and frequent hard driving as ambulance truck wear factors.

Owen said that his department had experienced a growing number of breakdowns, including a transmission that failed in Abilene in April requiring a tow. Another unit suffered mechanical failure about the same time was still out of service.

While those two units were out of service in the preceding week and another was out of town on a heart attack patient transfer and the one remaining ambulance in service started dying and cutting out while on an emergency call.

"We found ourselves in a predicament that for about 45 minutes. We were without any ambulance whatsoever to cover Comanche County," Owen commented, adding that he was preparing to use his personal vehicle if another call came in. He added that the preceding month had been "very stressful."

Owen then explained the two ambulance proposals being presented for Board consideration, noting that they were several months old.

One was for the outright purchase of a fifth ambulance, a 2007 GM G3500 diesel Type III ambulance at the cost of $98,683. The second proposal called for the purchase of a new 2007 Chevrolet G-3500 chassis and the remounting of the ambulance box currently on the oldest existing ambulance unit. Owen reminded the Board that the hospital had a $35,000 grant available to help fund the proposed expenditure.

Brant Stovall was then asked to discuss the two proposals. He described the disruption in diesel-powered ambulance trucks due to problems with Ford's 6 liter engines being pulled from the market. He said the GM trucks have been used for the preceding two years with very good results.

A lengthy discussion followed regarding ambulance boxes, levels of ambulance service, ambulance box remount time requirements, truck chassis availability and the relative merits of differing brands and types of diesel truck engines.

Stovall noted that well built ambulance boxes should be good for a 20 year life and two or more remounts. Stovall added that the remount proposal cost would be somewhat higher now since all of the available 2007 model truck chassis were already sold and a 2008 model, with an accompanying higher cost, would be needed.

Danny Owen recounted the good experience that the hospital has had in working with Professional Ambulance. He restated that the hospital needs to start an annual ambulance replacement program and his worries regarding ambulance availability given the aging nature of the hospital's fleet.

Chief Nursing Officer Shannon Steigleder commented about how important ambulance capabilities are to the hospital's total level of service rating, adding that the hospital could lose significant revenues if its rating was lowered. She added that the ambulance difficulties had been stressful on the nursing department as well.

The availability of grant and tobacco lawsuit settlement funds and the proceeds from the sale of the old Comanche clinic building was asked about and reviewed. Various leasing options were also discussed.

Danny Owen commented that repairs to existing ambulances had cost around $8,000 in the last few weeks and noted that newer equipment tended to cost much less to keep running.

Joe Locke stated that given the availability of funds and the time element involved in an ambulance box remount, that he was leaning toward the purchase of a new, additional ambulance.

Gale Easley asked if that was a motion and Locke replied that it could be.

Charles Mazurek inquired whether the hospital was required to put the ambulance purchase out for bids.

Danny Owen responded that additional quotes had been obtained back in the late fall when the ambulance matter had last been considered. He was requested to produce the other bids.

Hospital Bylaws Amended

While the search was underway for documentation of the earlier ambulance bids, Easley directed the Board's attention to a proposed amendment of the hospital's bylaws. The amendment stipulated both the Chief Financial Officer and Chief Nursing Officers as subject to hiring and termination by the Board, rather than solely at the discretion of the Chief Executive Officer.

Karen Carr offered a motion to approve the amendment, Janna Morris seconded and, after brief discussion, the motion was approved by unanimous vote.

Water District Note Agreement Approved

The Board next heard a presentation by Gyale Pirkle, Board president for the Upper Leon River Municipal Water District, in which he requested formal Hospital District approval of a note to the Water District for expenses incurred to pump the hospital's sewage to the Water Districts wastewater treatment facility. The total principal amount involved was $130,344.17 and bears an interest rate of 4.375% payable in monthly payments of $1,165.08 over a 12 year period.

Charles Mazurek pointed out that the cost incurred for wastewater treatment facilities was included in the original construction plan and that the final cost was considerably less than originally budgeted.

Mazurek then made a motion to approve the note and to authorize Gale Easley to sign the appropriate documents. Karen Carr seconded Mazurek's motion and the vote of approval was unanimous.

Gyale Pirkle then discussed the highway widening project in front of the hospital, stating the Water District's concerns that work on the east side of the roadway was endangering the water lines in front of the hospital (which also serve the City of DeLeon and beyond).

Gary Lacey, the Water District's General Manager, reported that he had been advised by the engineers only two hours before the meeting that the work underway would not affect the buried water lines, and then expressed his intention to obtain similar assurances from the general contractor.

Executive Session

The Board next went into a closed, executive session for the purpose of reviewing an unspecified executive position and to consider the appointment of two physicians to the courtesy medical staff.

After a 35 minute closed session, the Board resumed open session and Karen Carr offered a motion, seconded by Charles Mazurek, to approve the appointment of Drs. Ren Zhang and Richard Reinmund to the CCMC Courtesy Medical Staff.

Ambulance Discussion Continued

The Board then resumed discussion of the ambulance purchase proposal. Danny Owen reported that after considerable time spent searching during the intervening executive session, had had been unable to produce the competing ambulance quotes. He noted that the competing bids had been turned over to former CEO Evan Moore and did not know what had happened to them since that time.

Brant Stovall discussed how other public body ambulance purchasers used buying groups that regularly conducted competitive bidding and that a purchase made through one of them would meet all state legal requirements. He noted that it would cost an additional $800, a fee due to the buying group, to make the ambulance purchase proposed.

Charles Mazurek asked Gale Easley if a special called meeting to further consider the ambulance purchase might be in order and Easley expressed agreement with the suggestion.

Easley asked the Board members if they were pretty much in agreement with the purchase of a new ambulance.

Charles Mazurek stated that he felt the more important consideration was the time out of service for an ambulance box remount onto a new chassis, and that if a new ambulance were to be purchased, the hospital would then be in better shape to pursue ambulance box remounts in the future.

Joe Locke agreed with Mazurek's assessment.

Billy Ray Evans questioned whether the matter should wait until the new CEO is in office. He was told that the matter was urgent and would not go away.

Evans then noted that if only $8,500 was being offered in trade on the 1997 Ford chassis, that it could be refitted with a new motor for a lot less than that sum. Others agreed with that assessment.

Easley called for a motion to pursue the purchase of a new ambulance through the buying group.

Joe Locke made a motion to that effect. Charles Mazurek seconded.

Billy Ray Evans continued to question whether this was the only company's bid being considered and suggested that local area vehicle dealers be given an opportunity.

Stovall responded that during the earlier competitive bidding, his company had been able to provide a chassis at a substantially lower cost than available locally due to their larger volume purchases and governmental discounts available.

Evans commented that even though they were discussing spending taxpayers' money, that he didn't like to spend it if he didn't have to.

Gale Easley responded that she believed this was a "have to" situation. She then called for a vote on the motion and there were five votes in favor with Evans abstaining.

PHNS Continuing Management Services Proposal

Interim CEO Kurt Meyer noted that the hospital's interim management services agreement with PHNS, his employer, was coming to a close and that May 30 would be his last day of service at CCMC. That is also the day the hospital's new CEO, Kevin Storey, is scheduled to begin his duties.

Meyer then began presentation of a PHNS proposal to continue to provide management oversight, benchmarking and the development of a three year strategic plan and an annual tactical business plan corresponding to the budget year.

Under the proposal, PHNS would also assist in management development of the hospital's new administrative and financial leadership.

Meyer said that under the proposal he would spend at least one day a month at the hospital working with the new Chief Executive and Chief Financial Officers as well as the Chief Nursing Officer, Shannon Steigleder. Weekly telephone consultation would also be conducted. PHNS personnel would also hold one day on site strategic planning sessions with the physicians and the Board to develop the strategic and tactical plans.

Meyer said the cost of the PHNS continuing management services proposal would be $4,931 per month for one year beginning June 1, and thereafter subject to re-evaluation and renewal.

Gale Easley clarified that no hands-on management services, such as business office management, was included in the proposal. She inquired and was told that the proposal had been requested by the executive committee of the previous Board (Charles Mazurek, Joe Locke and John Mack Weaver).

Easley then asked Locke and Mazurek if the proposal was what they had been looking for.

Joe Locke responded that while the new CEO, Kevin Storey, has had extensive CFO experience, he has had relatively little interim CEO experience.

Locke stated, "We...felt like...he may need some resources to go to if he gets in a situation he is not familiar with. And, PHNS has those resources available to him as we have seen in the last four months."

Locke added that the benchmarking tools have not been used in the past and should prove to be valuable in evaluating hospital operations and management. He reiterated that mentoring services could prove valuable in hospital management development.

Locke did express some doubt about the immediate need for the strategic planning services portion of the proposal. He noted that the new management should be put into place before taking on the additional strategic and tactical planning expense.

In response to a Board question, Meyer noted that there was also a 90 day option included in the proposal.

Karen Carr inquired if PHNS would be checking to insure that things were continuing to operate in the manner they had instituted during their interim management period now drawing to a close.

Meyer responded that he would be the person making the monthly visits and that would be an important part of his visits.

Carr then stated that she thought the continuing PHNS management services proposal was a good idea.

She said, "At least if there is a problem, it will be detected within 30-60 days and it won't be six months before we know we have a problem... and address it."

Joe Locke inquired how much of the cost was for strategic planning.

Kurt Meyer responded that he did not have the exact numbers in front of him, but that the strategic planning portion was a large part of the total cost. In response to further Board questioning, Meyer said that a lower cost proposal could be developed that would not include the strategic planning activities.

Billy Ray Evans then commented to the Board, "You hired somebody to come in here and do it (provide executive leadership), and now you are saying he's not capable of doing it? And now you are hiring somebody else to overlook him?... Y'all hired somebody. Is he able to do it, or isn't he?"

Evans' question was met with responses of both "We think so," and "We don't know."

He then asked whether for $60,000 the Board wanted to be sure. Evans answered his own question with a firm "No!"

Charles Mazurek said that the proposal included other things besides oversight of the new CEO. He suggested that the Board needed to have another special called meeting shortly after the new CEO begins work and look at ways to restructure the proposal and its cost.

Evans continued, "Either you all have confidence in the guy that he's the right one, or you don't. And this is a way of your saying that, 'I don't have confidence in him.'"

Karen Carr asked if new CEO Kevin Storey was aware that PHNS had been requested to make a management services proposal and was told that he was aware.

Evans then asked, "I wonder if he has confidence in himself!"

There was some discussion of the differing levels of confidence and arrogance exhibited by the various CEO candidates that had been interviewed.

Joe Locke suggested that the PHNS proposal might be tabled pending receipt of information on the cost exclusive of the strategic and tactical planning components.

Meyer said he could get the requested itemized cost information prior to his departure on May 30.

Gale Easley reiterated that the whole matter was new to her and expressed the desire that it be studied further after itemized cost information was obtained.

Executive Report

Interim Chief Executive Officer Kurt Meyer reported that the hospital was holding steady in the number of FTE's (full time equivalent employees) in the 195-197 area, and that would be the area where the budget for the coming year would be prepared.

The FTE's per adjusted patient day was at 4.48 in March, and had declined to 4.39 for April. Meyer commented that it was a measure indicative of good management of hospital labor resources.

Meyer indicated that progress was continuing in making proper utilization of the capabilities of the environmental management computer system, and noted that the information systems network has continued to stabilize. He described an information systems problem that had occurred in the Home Health operation and the work that had taken place to rebuild and create hardware backup for that system.

The total amount of unbilled services continues to fluctuate at between $125-$200,000, an amount representing around three business days' billings. This same amount had been as low as $75,000, however, the higher complexity cases being experienced in recent weeks has caused the figure to grow.

Cash collections for April exceeded the monthly target by $45,000, reaching a total of $1,313,000. The total amounts of accounts receivable has been reduced to $650,000. The average length of patient stay increased slightly to 4.0 days as the result of the increased severity of illness index.

Meyer added that the hospital is processing information into TORCH (the Texas Organization of Rural and Community Hospitals) in participation with its benchmarking program.

Significant developments in the next month should include interviewing and possibly hiring a Chief Financial Officer, continuing work on inventorying, the start of work for the new Chief Executive Officer on May 30 and CPA Bill Parrish meeting with the physicians and administration regarding Clinic operations.

Nursing Report

Chief Nursing Officer Shannon Steigleder discussed laboratory operations, now under the supervision of Sarah Anderson, noting that it had been surveyed in the past month by the Texas Department of Health and passed, although with some minor deficiencies.

Steigleder added that once the written report has been received that an action plan will be developed to address the minor deficiencies, which mainly involved documentation. The laboratory performed 8,971 billable procedures during April.

Steigleder reported that the hospital was in the early stages of an 18 month process for being recertified as providing Level IV trauma care. She noted that it involved much paperwork and required rewrites of trauma care protocols.

Steigleder stressed the importance of the Level IV designation to federal funding, adding that it amounted to around $150,000 annually. She reiterated that ambulance transport capabilities play a big role in the designation.

Steigleder said that the hospital's Health Fair had an overwhelming turnout with many patients having to be rescheduled for their screening tests at a later time. She also reported on the recent mock crash conducted at DeLeon High School, noting that it had been very successful despite threatening weather.

Financial Report

Interim Chief Financial Officer Jim Gardner noted that revenues for the month of April were up to almost the highest level of the year. Operating expenses were down slightly with salaries remaining flat.

Full time equivalent employee numbers have been relatively flat in the last couple months at around 195. Days of accounts receivable were up due to primarily to increased revenues. Accounts payable were up slightly, but only slightly, at just over $800,000.

Gardner said cash balances were in pretty good shape with $1.1 million in total available cash and near-cash liquid assets.

The hospital reported a profit of $262,000 for April, bringing the 10-month year-to-date net results to a $70,000 profit. Cash flow has been good, since over $950,000 of non-cash depreciation expense is taken out in calculating net income.

Gardner discussed budget preparations for the coming next fiscal year which begins on July 1. He referred the Board to a draft schedule of budgeted salaries for FY 2008 totalling slightly over $6.5 million, down almost $1 million from the projection for FY 2007.

Gardner noted that the schedule included a 2% salary increase to be granted each employee in the month of their employment anniversary. The number of FTE's budgeted was around 196. The FTE's at the start of FY 2007 were 236.

Gardner said he expected to have a proposed budget for the Board to review and approve at their next regular monthly meeting, which would possibly be his last meeting.

Next Board Meeting

The Board then discussed having a special meeting prior to its next regular meeting on the fourth Tuesday of June.

They discussed and agreed to meet at 9:00 a.m. on June 7, immediately prior to a reception that the Healthcare Foundation will host for hospital donors.