L E E M E M O R I A L HEALTH SYSTEM BOARD OF .... BOX 2218 FORT MYERS, FLORIDA 33902 239-332-1111 CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER TO: Lee Memorial & HealthPark HEALTHPARK

ELECTRONIC BOARD PACKET

___________________ L E E M E M O R I A L HEALTH SYSTEM

BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS MEETING

Thursday, December 3, 2009 Lee Memorial Hospital

12:00pm – Lunch Meeting With Medical Staff

(Medical Staff Conference Room)

1:00pm – Board of Directors Meeting (Boardroom)

ELECTRONIC BOARD PACKET

P.O. BOX 2218 FORT MYERS, FLORIDA

33902

239-332-1111

CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER

HEALTHPARK MEDICAL CENTER

LEE MEMORIAL HOSPITAL

THE CHILDREN’S HOSPITAL THE REHABILITATION HOSPITAL

LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE

Stephen R. Brown, M.D.

Marilyn Stout

DISTRICT TWO

Richard B. Akin

Nancy M. McGovern, RN, MSM

DISTRICT THREE

Lois C. Barrett, MBA

Linda L. Brown, MSN, ARNP

DISTRICT FOUR

Frank T. La Rosa

Dawson C. McDaniel

DISTRICT FIVE

James Green

Jason Moon

L E E M E M O R I A L HEALTH SYSTEM BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

TO: Lee Memorial & HealthPark Medical Staff Physicians FROM: Richard Akin, Board Chairman DATE: Thursday, August 27, 2009 TIME: 12:00 p.m. to 12:45 p.m. PLACE: Lee Memorial Medical Staff Conference Room (MSCR)

A personal invitation from Board Chairman Richard Akin

Hello, Lee Memorial & HealthPark Physicians:

Please accept this special invitation to attend

‘lunch with the Board of Directors’.

The Board of Directors will be hosting a special informal ‘meet and greet’

lunch rotating each month to a different campus.

Stop by, grab a bite to eat, and let’s meet!

Looking forward to seeing you!

Richard

Please RSVP by August 21, 2009. Fax response to Board of Directors OfficeFax 336-6194 or call 334-5943

_____ Yes, I plan on attending. _________________________________ Name (please print) _____ No, I will not be attending.

Any Public input is limited to three minutes and a “Request to Address ‘


33902

239-332-1111

CAPE CORAL HOSPITAL

GULF COAST MEDICAL CENTER HEALTHPARK MEDICAL CENTER



LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Frank T. La Rosa

Dawson C. McDaniel

DISTRICT FIVE

James Green

Jason Moon

The Board of Directors” card must be completed and submitted to the Board Assistant prior to meeting.

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS

Thursday, December 3, 2009

LEE MEMORIAL HOSPITAL BOARDROOM

AGENDA

1. 12:00 – 12:45 Lunch meeting with LMH/HP Medical Staff – in the LEE MEMORIAL MEDICAL STAFF CONFERENCE ROOM

2. 1:00pm - CALL TO ORDER (Richard Akin, Board Chairman) LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS, sitting as the Lee Memorial Health System (LMHS) Board of Directors for Gulf Coast Medical Center & Lee Memorial Hospital/HealthPark Medical Center and the Board of Directors of its subsidiary corporations: Cape Memorial Hospital, Inc. doing business as Cape Coral Hospital; Lee Memorial Medical Management, Inc.; Lee Memorial Home Health, Inc.; and HealthPark Care Center, Inc.

3. Public Input - Agenda Items: Any Public input is limited to three minutes and a Request to Address the Board of Dire tors” card must be completed and submitted to “ c

the Board Assistant prior to meeting.

4. Invocation and Pledge of Allegiance (Reverend Ben Keller)

5. RECESS LEE MEMORIAL HEALTH SYSTEM BOARD MEETING to CALL TO ORDER Lee County Trauma Services District Board Meeting

6. RECONVENE LEE MEMORIAL HEALTH SYSTEM BOARD MEETING

7. Minutes of October 29, 2009 (Linda Brown, MSN, ARNP, Board Secretary) (Approval) A. Medical Staff Lunch Meeting & Board of Directors Meeting

8. Lee Memorial Hospital Operations Report (Accept) (Gaile Anthony, Chief Administrative Officer, LMH)

9. HealthPark Medical Center Operations Report (Accept) (Donna Giannuzzi, RN, Chief Patient Care Officer, HPMC)

10. Medical Staff Business (All Directors) A. Recommendations of November 30, 2009 (Approvals) i. Lee Memorial Hospital/HealthPark Medical Center ii. Cape Coral Hospital iii. Gulf Coast Medical Center B. Issues/Discussion

11. Consent Agenda (All Directors) (Approval)

12. Old Business – EMR/EPIC Expansion Lease (Approval)

(Mike Smith, Chief Information Officer, IS)

13. New Business - Proposed 2010 Legislative Program (Approval) (Sally Jackson, System Director Community Projects)

14. President’s Report (Jim Nathan, CEO/President)

15. Board of Directors’ Liaison Report – Dawson McDaniel (Verbal)

16. Board of Directors’ Reports & Board Liaison Report

17. Date of the next LEE MEMORIAL HEALTH SYSTEM BOARD MEETING TUESDAY, January 5, 2010, 12:00pm

ANNUAL ORGANIZATIONAL BUSINESS MEETING (Lee Memorial Hospital Boardroom)

18. ADJOURNMENT V:\PRESENTATIONS\2009\FULL BOARD\120309\120309 Full Board FINAL Agenda.doc


BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

PUBLIC INPUT – AGENDA ITEMS:

Any public input

pertaining to items on the Agenda is limited to three

minutes and a “Request to Address the Board of Directors”

card must be completed and submitted to the Board Assistant

prior to meeting.

Refer to Board Policy: 10:15E: Public Addressing the Board Non-Agenda Item: Individuals wishing to address the Board on an item NOT on the Agenda, the Board office must be notified of subject matter at least seven (7) days prior to the meeting to allow staff time to prepare and to insure the matter is within the jurisdiction of the Board.

RECESS LEE MEMORIAL HEALTH SYSTEM BOARD MEETING TO CALL TO ORDER: LEE COUNTY TRAUMA SERVICES DISTRICT

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS MEDICAL STAFF LUNCH MEETING MINUTES MEDICAL STAFF LUNCH MEETING MINUTES

Thursday, October 29, 2009 Thursday, October 29, 2009 LOCATION:LOCATION: Cape Coral Hospital Auxiliary Meeting Room MEMBERS PRESENT: Richard Akin, Board Chairman; Nancy McGovern, RN, MSM, Board Vice Chairman; Marilyn Stout, Board Treasurer; Linda Brown, MSN, ARNP, Board Secretary; Steve Brown, M.D., Director; Dawson McDaniel, Director; Frank La Rosa, Director; James Green, Director; Jason Moon MEMBERS ABSENT: Lois Barrett, MBA, Director OTHERS PRESENT: Cathy Stephens, Board of Directors’ Liaison; Chuck Krivenko, M.D., Chief Medical Officer/Clinical and Quality Services; Larry Antonucci, M.D., Chief Operating Officer; Doug Luckett, Chief Administrative Officer/GCMC/CCH; Tom Presbrey, M.D., Chairman/Physician Leadership Council; Yvonne Obrien, Director/Physician Services/GCMC; Joseph Daley, M.D., Guest; Tim Keys, M.D., Guest; Antony Mathew, M.D., Guest; Sumeet Shetty, M.D., Guest; Dan de la Torre, M.D, Guest; Alan Tannenbaum, M.D., Guest; Isabel Firth, Administrative Secretary/Board of Directors; Beth Kilgore, Executive Secretary/Board of Directors

NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and on the Board of Directors website at www.leememorial.org/boardofdirectors, for public inspection.

SUBJECT DISCUSSION ACTION MEETING

CALLED TO ORDER

The LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS MEDICAL STAFF

LUNCH Meeting was CALLED TO ORDER at 12:25p.m.

by Board Chairman Richard Akin.

The Board sits as the Lee Memorial Health System Board of Directors of Gulf Coast Medical Center, Lee Memorial Hospital,

HealthPark Medical Center and the Board of Directors of its subsidiary corporations:

Cape Memorial Hospital, Inc. doing business as Cape Coral Hospital; Lee Memorial

Medical Management, Inc.; Lee Memorial Home Health, Inc.; and HealthPark Care

Center, Inc.

WELCOME AND INTRODUCTIONS

Richard Akin welcomed the physicians and others in attendance. He said the purpose of this lunch is to create an opportunity for discussion between the Board and physicians. He said there is no set agenda and he opened the floor for discussion.

DISCUSSION

The following topics were discussed: • The process of how the Physician Leadership Council (PLC) was created • The flow of communication between the medical staff, Medical Executive Committee (MEC), and the PLC • Emergency Room call coverage • Medical staff bylaws • Future planning to ensure an adequate number of trained general surgery and primary care physicians • Creating a better System for recruiting physicians to the community • Determining the role of the Hospitalist, handling unassigned patients, physician referrals, and creating an effective and quality

based culture in the System. Richard Akin thanked everyone for attending.

NEXT REGULAR

MEETING The date of the next LMHS Board of Directors Medical Staff Lunch meeting will be 12:00pm, December 3, 2009, Lee Memorial Hospital Medical Staff Conference Room, 2776 Cleveland Avenue, Fort Myers, FL.

ADJOURNMENT The Lee Memorial Health System Board of

Directors Medical Staff Lunch Meeting was ADJOURNED at 12:54p.m.

by Board Chairman Richard Akin. Minutes were recorded by Beth Kilgore, Executive Secretary/Board of Directors

______________________________________ Linda Brown, MSN, ARNP

Board Secretary

http://www.leememorial.org/boardofdirectors

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS

MEETING MINUTES MEETING MINUTES Thursday, October 29, 2009 Thursday, October 29, 2009

LOCATION:LOCATION: Cape Coral Hospital Auxiliary Meeting Room MEMBERS PRESENT: Richard Akin, Board Chairman; Nancy McGovern, RN, MSM, Board Vice Chairman; Marilyn Stout, Board Treasurer; Linda Brown, MSN, ARNP, Board Secretary; Lois Steve Brown, M.D., Director; Frank La Rosa, Director; Dawson McDaniel, Director; James Green, Director; Jason Moon, Director MEMBERS ABSENT: Lois Barrett, MBA, Director OTHERS PRESENT: James Nathan, President/CEO; Cathy Stephens, Board of Directors’ Liaison; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; Larry Antonucci, M.D., Chief Operating Officer; CB Rebsamen, M.D., Chief Medical Officer/Ambulatory and Strategic Services; Chuck Krivenko, M.D., Chief Medical Officer/Clinical & Quality Services; Donna Giannuzzi, RN, Chief Patient Care Officer; John Wiest, Chief Financial Officer; Doug Luckett, Chief Administrative Officer/GCMC/CCH; Gaile Anthony, Chief Administrative Officer/LMH; Tom Presbrey, M.D., Chairman/Physician Leadership Council; Mark Atkins, M.D., Vice President/Lee Physician Group; John Iacuone, M.D., Executive Director/The Children’s Hospital; Chris Nesheim, System Director/Care Management; Dave Cato, System Director/Outpatient Services; Brad Pollins, System Director/Organizational Effectiveness; Karen Krieger, System Director/Public Affairs; Donna Bradish, Director/Volunteer Resources/LMH/CCH; Sandi Falk, RN, Surgical Services Specialist/HPMC; Jennifer Craft, RN, Clinical Educator/CCH; Nora Harmon, Auxiliary President/LMH/HPMC; Jack Hess, Outgoing Auxiliary President/CCH; Nancy Stanfield, Auxiliary President/GCMC; Kerry Babb, Guest; Donald Brown, Guest; Isaac Brundage, Guest; Linda Morrow, Guest; Peter Young, Guest; Isabel Firth, Administrative Secretary/Board of Directors; Beth Kilgore, Executive Secretary/Board of Directors

NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and on the Board of Directors website at www.leememorial.org/boardofdirectors, for public inspection.

SUBJECT DISCUSSION ACTION FOLLOW-UP MEETING

CALLED TO ORDER

The LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS meeting was

CALLED TO ORDER at 1:11pm by Board Chairman Richard Akin.

The Board sits as the Lee Memorial Health System Board of Directors of Gulf Coast Medical Center, Lee Memorial Hospital, HealthPark Medical Center and the Board of Directors of its subsidiary corporations: Cape Memorial Hospital, Inc. doing business as Cape Coral

Hospital; Lee Memorial Medical Management, Inc.; Lee Memorial Home Health, Inc.; and HealthPark Care

Center, Inc.

INVOCATION AND

PLEDGE OF ALLEGIANCE

The Invocation and Pledge of Allegiance was given by Reverend Tom Brenner.

PUBLIC INPUT

Linda Morrow

Richard Akin announced Linda Morrow has submitted a public ‘Request to Address the Board’ card. (Exhibit #1). Linda Morrow said the purpose of her addressing the Board is to make the Board aware of a situation she experienced on May 10, 2004 when she was admitted to the Cape Coral Hospital emergency room having a massive stroke. Linda said she was experiencing the symptoms of a stroke while waiting in the emergency room and was not seen by a physician or given care until four hours had passed. She said she made several attempts, requesting care from the triage nurse but received nothing. She said even now that five years have passed she still is experiencing pain as a result of the stroke and possibly as a result of not receiving immediate care from the emergency room at the onset of her stroke. Linda said she has made several attempts to communicate her experience to LMHS however, has received no response. Linda said she is not taking legal action against the hospital however; she is concerned about the possibility of this type of situation happening to other patients. She thanked the Board for allowing her to share her story and said she has additional copies of information (Exhibit 2) for distribution to the Board Richard Akin thanked Linda for sharing her story with the Board and said the Board’s primary concern is ensuring the patients in our community receive the best care and the Board will do everything possible to make this situation right. Administration will follow up with Ms. Morrow to discuss the details further.


LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS MEETING MINUTES Thursday, October 29, 2009 Page 2 of 5

SUBJECT DISCUSSION ACTION FOLLOW-UP RECOGNITIONS

Kerry Babb Term of Service

Chris Nesheim American Case Management Recognition

2nd Annual

Rose of Care Award Sandi Falk

Certificate of Appreciation

Kappa Alpha Psi Fraternity, Inc.

VHA Bright Ideas Award

Richard Akin provided a historical overview of past Board member Kerry Babb’s service on the LMHS Board of Directors from November 7, 2006 to July 24, 2009. He said Kerry played a key role in several initiatives for the System. Richard presented Kerry with a plaque in honor and gratitude for his service and tenure on the Board. Richard also congratulated Kerry on recently becoming a Registered Respiratory Therapist and accepting a position at Cape Coral Hospital. Kerry Babb said he is honored and thankful for the opportunity to serve the LMHS Board and the citizens of Lee County. Jim Nathan said he recently received a letter from the American Case Management Association (ACMA) (Exhibit 3) recognizing Chris Nesheim for the contributions she has made to the ACMA Florida Chapter. Jim read the letter and said Chris does an excellent job at bringing people together to do great things. Chris thanked Jim and the Board for recognizing her and said she has a great team and is thankful for the continued support from leadership and the Board. Donna Giannuzzi provided information on the 2nd Annual Rose of Care Award (Exhibit 4), recently awarded to LMHS nurse Sandi Falk. She congratulated Sandi and thanked her for serving Lee County and LMHS as an exceptional nurse. Sandi Falk thanked Donna and the Board for recognizing her but said there are so many others who have helped her to make this possible. She said she has received tremendous support from senior leaders, her management team, and her family and she couldn’t have been successful without them. James Green introduced Isaac Brundage, Director of Community Affairs at Florida Gulf Coast University and a member of the Kappa Alpha Psi Fraternity, Inc. Isaac presented Richard Akin with a certificate of appreciation (Exhibit 5) for the support LMHS provides to their various programs and scholarship funds. Isaac said these different programs help to support and nurture the education and future of the community’s youth, raising and developing them into successful young adults. Marilyn Stout said she recently attended the 2009 Voluntary Hospital Association (VHA) Southeast Conference. She said on behalf of LMHS the VHA presented her with the 2008/2009 Bright Ideas Award. She said this award was awarded to LMHS for the System’s continued focus on costs savings, enhancing revenue, and promoting a positive organizational culture. She reviewed highlights included in the VHA article (Exhibit 6) regarding LMHS’ success in the 2008-2009 year. She asked John Wiest to come to the podium to accept the award. John Wiest thanked Marilyn and said he only accepts the award on behalf of the entire System. He said the success made by the System in the past year is a team effort. He said it takes a tremendous amount of people and support, working together to achieve this type of success. Cathy Stephens then called Frank La Rosa to the Podium to accept a framed picture of his VHA “Big Fish” Award at the Fishless tournament presented at the conference.

TOBACCO FREE LEE PROJECT

UPDATE

Brad Pollins provided a brief verbal update on the Tobacco Free Lee Project currently underway. He said November 19, 2009 will be the first day that all the System’s facilities become tobacco free. He said they have been heavily planning and campaigning for this initiative which has included training and educational sessions for System leadership and management. He said this campaign has already had made major successes and there have been over four hundred employees who have quit smoking as a result so far.

MEETING MINUTES

Linda Brown asked if anyone wished to make any additions or corrections to the Lee Memorial Health System Medical Staff Lunch and Board of Directors meeting minutes from September 24, 2009.

A motion was made by Marilyn Stout to approve the Lee Memorial Health System Board of Directors Medical Staff Lunch and Board of Directors meeting minutes from September 24, 2009. The motion was seconded by James


SUBJECT DISCUSSION ACTION FOLLOW-UP Green and it carried with no opposition.

CAPE CORAL

HOSPITAL OPERATIONS

REPORT

Doug Luckett reviewed highlights included in the Cape Coral Hospital Operations Report (Exhibit 7).

A motion was made by Nancy McGovern to accept the Cape Coral Hospital Operations Report (Exhibit 7). The motion was seconded by Frank La Rosa and it carried with no opposition.

MEDICAL STAFF

BUSINESS Physician

Leadership Council (PLC) Report

Medical Staff Recommendations

Lee Memorial Hospital/HealthPark

Medical Center

Cape Coral Hospital

Gulf Coast Medical Center

Tom Presbrey reviewed the Physician Leadership Counsel report (Exhibit 8). Richard Akin said there was a memorandum from Chuck Krivenko, distributed to the Board (Exhibit 9), which provided a summary of issues addressed at the Medical Staff’s Hospitalists Task Force meeting on October 26, 2009. He said this memo outlines the proposed standards and accountability for the System. Steve Brown said in reviewing this memo he would like to make a formal motion to accept the recommendations in moving forward. Richard Akin said the Medical Executive committee’s have made progress however are still in the midst of coming to an agreement.

Richard Akin reviewed the Medical Staff Recommendations of October 15, 2009 for Lee Memorial Hospital/ HealthPark Medical Center (Exhibit 10).

Richard Akin reviewed the REVISED Medical Staff Recommendations of October 15, 2009 for Cape Coral Hospital (Exhibit 11).

Richard Akin reviewed the Medical Staff Recommendations of October 15, 2009 Gulf Coast Medical Center (Exhibit 12).

Steve Brown said he is concerned with the current credentialing process and with providing privileges to physicians practicing as telemedicine providers who live outside of the community. He said he would like further information on this for various reasons and concerns that he has. Richard Akin requested Chuck Krivenko to provide information to the Board regarding the credentialing and privileging process at a future committee meeting. Chuck Krivenko said he will ask Mark Greenberg to present.

A motion was made by Steve Brown to endorse the direction of the proposed Hospitalist standards and accountability summary provided by Dr. Krivenko’s memorandum of October 23, 2009 (Exhibit 9) with any final recommendations to return to this Board for final approval. The motion was seconded by Dawson McDaniel and it carried with no opposition. A motion was made by Nancy McGovern to accept the Physician Leadership Council (PLC) Report for October 29, 2009 (Exhibit 8). The motion was seconded by Marilyn Stout and it carried with no opposition. A motion was made by Marilyn Stout to approve the Lee Memorial Hospital/HealthPark Medical Center Medical Staff Recommendations of October 15, 2009 (Exhibit 10). The motion was seconded by Nancy McGovern and it carried with no opposition. A motion was made by Marilyn Stout to approve the REVISED Cape Coral Hospital Medical Staff Recommendations of October 15, 2009 (Exhibit 11). The motion was seconded by Nancy McGovern and it carried with no opposition. A motion was made by Marilyn Stout to approve the Gulf Coast Medical Center Medical Staff Recommendations of October 15, 2009 (Exhibit 12). The motion was seconded by Nancy McGovern and it carried with no opposition.

Final Recommen-dation to come back to the Board for final approval via Quality Committee

Mark Greenberg to discuss the credentialing and privileging process – at an upcoming Quality committee meeting


SUBJECT DISCUSSION ACTION FOLLOW-UP CONSENT AGENDA Richard Akin asked if anyone wished to pull any items listed on the Consent Agenda (Exhibit

13) for discussion.

A motion was made by Linda Brown to approve the Consent Agenda consisting of the following items. 1. Approval for the Cape Coral Hospital and Gulf Coast

Medical Center Auxiliaries to become sub-agencies within the Lee Memorial Health System.

2. Approval of $694,960 for the refurbishment of 2-West at Lee Memorial Hospital which includes, furnishings, hospital beds, medical equipment, and information technology.

3. Approval of the Continuing Medical Education (CME) Mission Statement.

4. Approval of the recommendation to obtain Det Norske Veritas Healthcare (DNVHC) accreditation concurrently with The Joint Commission (TJC) accreditation. After accredited by DNVHC, re-evaluate continued TJC accreditation prior to next survey (2011).

The motion was seconded by Dawson McDaniel and it carried with no opposition.

SUPPORTING

AGENCY BUSINESS

Cape Coral Hospital Auxiliary Annual

Report

Lee Memorial

Hospital/HealthPark Medical Center

Annual Auxiliary Report

Recognizing Outgoing Auxiliary

Presidents

Welcome Nancy Stanfield

Jack Hess reviewed the Cape Coral Hospital Annual Auxiliary Report with revisions (Exhibit 14). Nora Harmon presented the Lee Memorial Hospital/HealthPark Medical Center Auxiliary Report (Exhibit 15). Jim Nathan spoke on behalf of himself and Jon Cecil (who could not attend), thanking Jack and Nora for their service as president on the LMHS Auxiliaries. He said they have both done a tremendous job and LMHS is truly appreciative for their leadership and devotion to their auxiliary. Richard Akin and Dawson McDaniel presented Jack and Nora flowers and a gift card in appreciation for their service. Dawson said it has been a privilege to have worked with Jack and Nora. He said they have made a positive impact to the System by providing monetary support through various funding raising projects. Richard Akin introduced and welcomed incoming LMHS Auxiliary President Nancy Stanfield.

(Frank La Rosa left the meeting at 2:27pm)

A motion was made by Dawson McDaniel to accept the REVISED Cape Coral Hospital Annual Auxiliary Report (Exhibit 14). The motion was seconded by Steve Brown and it carried with no opposition.

A motion was made by Nancy McGovern to accept the Lee Memorial Hospital/HealthPark Medical Center Auxiliary Report (Exhibit 15). The motion was seconded by Nancy McGovern and it carried with no opposition.

OLD BUSINESS

Sale of Real Property

1228 SE 8th Terrace

Mark Atkins reviewed the information included in the recommendation for Board Action on the Sale of Real Property 1228 SE 8th Terrace, Cape Coral, FL. (former Domingo/Radhakrishna building) (Exhibit 16). He said the Board previously approved the sale of this property June 25, 2009, however the financing for that buyer was not approved. Mark said they have received an offer from another buyer for the same price of $450,000, as previously approved by the Board. Jason Moon asked if this building has been considered for use in the future. Mark said Dr. Radhakrishna moved to the Pine Island Building in April 2008 and the 1228 SE 8th Terrace property has been empty since then. He said this building requires an extensive amount of renovations and therefore no other LMHS departments have expressed interest in the building due to lack of capital money for repairs.

A motion was made by Linda Brown to approve the Sale of Real Property, 1228 SE 8th Terrace, Cape Coral


SUBJECT DISCUSSION ACTION FOLLOW-UP building (Exhibit 16) for current offered price of $450,000. The motion was seconded by Jason Moon and it carried with no opposition.

NEW BUSINESS There was no “New Business’ to report. (Linda Brown left the meeting at 2:43pm)

PRESIDENT’S

REPORT

Jim Nathan provided a verbal President’s Report which included an update on the upcoming Community Healthcare Symposium on November 2, 2009 at the Harborside Event Center, downtown Fort Myers. He said Paul Keckley will be a guest speaker providing information and creating awareness of key trends impacting healthcare both nationally and locally. Jim provided an overview of Paul Keckley’s professional background (Exhibit 17) and said Paul serves as a key player in the development of leadership. Jim encouraged the Board to attend and said this is a positive step into the future.

BOARD OF

DIRECTORS’ LIAISON REPORT

Steve Brown, MD The Children’s

Hospital

Steve Brown reviewed information included in his Board of Directors’ Liaison Report on the The Children’s Hospital of Southwest Florida (Exhibit 18) which included updates on the election of new officers, outgoing officers, Executive Directors’ report, Sunshine Ambassador Committee kiosk project, and the child advocacy program.

BOARD OF

DIRECTORS’ REPORTS

Nancy McGovern announced she participated in a public service announcement regarding the upcoming LMHS tobacco free initiative to begin on November 19, 2009. She said it will run on various radio stations throughout Lee County.

BOARD LIAISON

REPORT

November Board Calendar

Happy Birthday Wishes

Cathy Stephens reviewed the November 2009 Board of Directors Calendar (Exhibit 19), highlighting meetings and special events being held throughout the month. November Happy Birthday wishes went to Drew Mikulaschek Nov. 6th, John Wiest Nov.10th, herself Nov. 16th, Frank La Rosa Nov. 17th and Jim Nathan Nov. 23rd. Cathy said all documents pertaining to the meeting can be reviewed on the LMHS Board of Directors website at www.leememorial.org/boardofdirectors.

NEXT REGULAR

MEETING The date of the next REGULAR meeting of the Lee Memorial Health System Board of Directors is Thursday, December 3, 2009, 12:00 p.m. Medical Staff Lunch meeting in the Medical Staff Conference Room, Lee Memorial Hospital followed by the 1:00 p.m. Full Board of Directors meeting in the Lee Memorial Hospital Boardroom.

ADJOURNMENT The Lee Memorial Health System

Board of Directors Meeting was ADJOURNED at 3:22p.m.

by Board Chairman Richard Akin.

Minutes were recorded by Beth Kilgore, Executive Secretary/Board of Directors Office _________________________________________________________________

Linda Brown, MSN, ARNP Board Secretary


Lee Memorial Hospital Operations Report to the Board of Directors

Gaile Anthony, Chief Administrative Officer LMH

September 30, 2009

Key Facility Statistics Include:

• Admissions YTD budget 10,873, YTD actual of 12,102 (over budget by 11.3%)

• Average LOS YTD budget 5.02 days, YTD actual 5.36 days (6.8% variance)

• ER Visits YTD budget 47,112, YTD actual 47,350 (over budget by 0.5%)

• ER Admits YTD budget 7,975, YTD actual 10,272 (over budget by 28.8%)

• Surgery Cases LMHS System Budget 2009 YTD 42,764, actual YTD 39,602, 3,162 cases under budget (7.4%). LMH budget YTD 9,402, actual cases 9,231 YTD (<171 cases or 1.8% under budget YTD).

• Gain From Operations budget YTD $25.4 million – YTD actual $37.4 million (up 47.2%)

• Strong September - Admissions 22.9% over prior year, 23% over prior year patient days

• Strong October and November for patient admissions

Patient Satisfaction – 2009

• Patient satisfaction “likelihood to recommend” score is 85.2. HCAHPS “Recommends this Hospital” 60.3. The Patient Care Services team has several positive initiatives in process to improve the patient experience.

• The Emergency Department patient satisfaction overall rating score is 74.9. The Emergency Department Nursing Team has several initiatives in process to improve the ED patient experience and to expedite admission to the nursing unit when a patient is admitted.

Highlights For 2009

• The 3 West 15-bed Senior Behavioral Health unit continues to identify and evaluate appropriate patients to be treated on this unit. The unit has had 200 admissions YTD (10 months). The average daily census is at 13 – 15 patients. The next phase of service for this unit is Intensive Outpatient Psychiatric care. Additional Behavioral Health services are being developed to meet the increasing demand of psychiatric patients needing care in the Emergency Rooms. We will be hiring or contracting with additional psychiatric care providers.

• The Infusion Center located in the MOC at LMH has been open for 6 months. The Center reopened to accommodate patients from the System who need antibiotic therapy on a outpatient basis and can be discharged from the Acute Care Hospital. The Center is treating 25 patients per day. The next service to open will be anticoagulant therapy.

• Capacity Management – Construction on 2 West in process to increase capacity to 20 beds (private rooms), to be completed January 1, 2010. Additional programs are being explored to move appropriate care to an Outpatient setting for the ability to increase Acute Inpatient bed capacity.

• Comprehensive Spine Program located at the Sanctuary continues to grow in the volume of patients treated by the Interventional Physiatrist (8 new patients/day with a total of 20 – 25 patients/day). The next level of comprehensive spine care using the Nurse Navigator and Specialist Physicians at the clinic is in the planning process.

• LMH continues to develop the patient and family center care concept. The pilot nursing unit on 5 North continues to implement the concepts that represent patient/family centered care. All nursing units at LMH are working to improve the patient experience.

• The All Star Total Joint Program continues to grow in volume and continues to have high patient satisfaction scores. The physicians participating in the program increased their orthopedic volumes by 50%.

HealthPark Medical Center Operations Report to the Board of Directors

Donna Giannuzzi, Chief Administrative Officer December 3, 2009

For Fiscal Year To Date through September 30, 2009 Key Facility Statistics:

• Admissions: Budget = 21,159 Actual = 21,554 (+1.9% Variance) • Average Length of Stay: Budget = 4.62 days Actual = 4.81 days (+4.1% Variance) • ER Visits: Budget = 48,902 Actual = 54,326 (+11.1% Variance)

• Surgery Cases: Budget = 10,742 Actual = 10,929 (+1.7% Variance)

• Gain from Operations: Budget = $79.7 million Actual = $81.11 million (1.41 more than budget)

Patient Satisfaction: The inpatient patient satisfaction “likelihood to recommend” score for Fiscal Year 2009 is 90.2. Emergency Services is 75.2. Highlights Women’s and Children

• Based on information from CDC and recommendations from the Children’s Hospital sub-specialists, LMHS developed and implemented a plan to limit child visitation at LMHS. The recommendation limited children below the age of 12 visitations in the Critical Care environment.

• CNN filmed a story in November about one of our H1N1 patients called “Hali’s Story”. It focuses on helping parents understand that they need to watch their children closely for signs and symptoms of H1N1. It also focuses on the importance of the vaccine.

• A influenza clinic was held at HP and CCH in partnership with the Health Department on 11/7 to provide H1N1 vaccines to pregnant women in our community.

• Awaiting the arrival of Brain Cooling Equipment for the NICU to reverse the effects of anoxic brain events in neonates. This was funded 100% by Philanthropy.

• The first Pediatric Nephrologist for TCH, Dr. Irina Gershin-Stevens started in November.

Cape Coral • Opened CCH pediatrics on Oct 19th. CCH Peds has an ADC of 4-6. Doing so has helped decompress

the ED’s at both CCH and HP and has eliminated diversions due to bed capacity.

HPMC

• The Patient Care Division during the year organized and chartered several flow initiatives with OI to improve SPCU and MPCU transfer from critical care, supported a housekeeping/transport initiative with the purpose of improving flow and cross training of staff for downtime. Additionally, organized a PPT initiative that improved care; decreased surgery cancellations and reduced cost per stat changing the staffing mix while reducing the number of patients in the pipeline.

• Chartered a team with staff nurses and nurse leaders to research, assess, diagnosis, plan, implement and evaluate nurse to nurse hand-off communication across the system.

• Organized and supported flow changes in the ED. Pediatrics patients are now triaged separately from adults and streamlined though the ED.

• Spread nursing redesign to all medical surgical units at HPMC including intentional rounding. • Expanded customer service responsibility for the 3rd floor waiting area that supports surgery and

cardiology. • Initiated the pull of patients out of the ED into medical surgical overflow areas. • Initiated the adult/pediatric admit area on the second floor to handle increased capacity and pull

pediatric patients out of the ED awaiting a bed. • Exceeded the goal of HPMC FTE per AOB by 2% Actual 3.99 vs. 4.07. • HPMC YTD gain from operations 81.11 million which is 1.41 million more than budget. • Hosted 1182 employees and 53 volunteers for a total of 1235 for “Jim’s video, the year ahead. • Met the goal for HPMC Press Ganey’s “Likelihood to Recommend” score of 90.2. • Met the goal for HPMC HCAHPS “Recommend this Hospital” score 76.9. • Exceeded the RN turnover goal for TCH and HPMC score 8.1%. • The critical care environments continue with positive safety results. • A single incision procedure, a colon removal was a first for HealthPark Medical Center. • Opened a six bed Neurosurgical ICU on Monday, November 23rd. • Added 16 monitored beds to 6W. • Converted 6W Medical/Surgical to a Progressive Care Unit after six months of orientation and unit

based experience training. • Received funding from Gulf Coast Harbor for equipment in the ED so that staff can implement

protocols and reassess patients waiting to be seen.



MEDICAL STAFF

BUSINESS

LEE MEMORIAL HEALTH SYSTEM Lee County, Florida

#1 M E M O R A N D U M

To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Date: November 30, 2009 Subject: Lee Memorial Health System (Lee Memorial Hospital and

Health Park Medical Center) Medical Staff Recommendations The Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Frederick Beckett, III, M.D. – Internal Medicine b. Amy Fox, M.D. – Radiation Oncology c. Reza Hussain, M.D. – Pulmonary Medicine d. Francisco Quiles-Cruz, M.D. – Internal Medicine

2. Privilege Requests:

a. Juan Hernandez, M.D. – Family Practice, Class I Conscious Sedation b. Timothy Snodgrass, M.D. – Internal Medicine, Class I Conscious Sedation

3. Advancements from Provisional to Active Staff:

b. Kathleen E. Shimp, M.D. – OB/Gyn 4. Advancements from Provisional to Associate Staff:

a. James S. Manzanares, M.D. – Orthopedic Surgery 5. Resignations:

a. Steven R. West, M.D. – Cardiology, effective 12-01-09 b. George Kovacevic, M.D. – OB/Gyn., effective 12-01-09 c. Jeffrey Martin, D.O. – Dermatology, effective 11-10-09

6. Reappointments – Medical Staff and Allied Health Practitioners – 01-01-10 – 12-30-11 (see attached listing)

Memorandum to Board of Directors November 30, 2009 Page 2 of 2

7. Privilege Requests – Allied Health Practitioners: a. Caryle Clyatt, ARNP – Dr. Pescitelli – Hemostasis and exposure through the

appropriate use of instruments, suture, staples, cautery, retractors, suctioning and sponging techniques.

b. Kyle Brown, PA - Florida Heart Associates – cardiac arrest patient management c. Debra Dean, PA – Dr. Kokal – cardiac arrest patient management d. Lynne Campbell, ARNP – Dr. Kole – internal jugular central line placement

8. Allied Health Practitioners: a. Mary Gelormine, PA – Florida Cancer Specialists b. Veronica Vasquez, PA – Lee Physician Group – Dr. Bustillo c. Tamara Dominick, ARNP – add Dr. Mahadevan d. Denise McPherson, ARNP – add Dr. Theerathorn, IPC e. Shelly Taylor, ARNP – add Dr. Chavakula

9. Practitioners-in-Training:

a. Bess Raulerson – PA student with Dr. George Kovacevic, 10-05-09 to 11-11-09 b. Kiersten Ball - PA student with Dr. Roberto Monge, 10-19-09 to 11-11-09 c. Carly Anne Grandidge – Medical Student from UCI, 01-04-10 to 02-12-10 d. Anthony Gielow – Medical Student from KCOM, 01-04-10 to 04-23-10 e. Colby Suttles – PA student with Dr. Pescitelli, 10-05-09 to 11-11-09 f. Susan Nolan – PA student with Dr. Kowalsky, 10-05-09 to 11-11-09

Approved by the Board of Directors – December 3, 2009

__________________________________________ Richard B. Akin, Chairman - Board of Directors

LEE MEMORIAL HEALTH SYSTEM

Lee County, Florida #2

M E M O R A N D U M

To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Subject: Cape Coral Hospital Medical Staff Recommendations Date: November 30, 2009 The Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Frederick Beckett, III, M.D. – Internal Medicine b. Amy Fox, M.D. – Radiation Oncology c. Reza Hussain, M.D. – Internal Medicine d. Francisco Quiles-Cruz, M.D. – Internal Medicine

2. Intrasystem Appointment to Associate Staff:

a. Natalya Suchodolski, M.D. – Internal Medicine

3. Privilege Request: a. Juan Hernandez, M.D. – Family Practice, Class I Conscious Sedation

4. Advancements from Associate to Active Staff:

a. Ihsan A. Alsalman, D.O. – Emergency Medicine b. Viswanathan Nagarajan, M.D. – Internal Medicine

5. Leave of Absence:

a. Chris Rosioru Ross, M.D. – Pediatric Gastroenterology - Medical LOA 10-31-09 to 11-28-09.

6. Resignation:

a. Jeffrey Martin, D.O. – Dermatology, effective 11-10-09

7. Reappointments – Medical Staff and Allied Health Practitioners, 01-01-10 – 12-30-11 (see attached listing)

Memorandum to Board of Directors November 30, 2009 Page 2 of 2

8. Allied Health Practitioners: a. Mary Gelormine, PA – Florida Cancer Specialists b. Joe Gray, PA – Cape Coral Emergency Physicians c. Tamara Dominick, ARNP – add Dr. Mahavedan d. Denise McPherson, ARNP – add IPC, Dr. Theerathorn

9. Privilege Request – Allied Health Practitioner:

a. Caryle Clyatt, ARNP – Dr. Pescitelli, Hemostasis and exposure through the appropriate use of instruments, suture, staples, cautery, retractors, suctioning and sponging techniques


a. Bess Raulerson – PA student with Dr. George Kovacevic, 10-05-09 to 11-11-09. b. Kiersten Ball - PA student with Dr. Roberto Monge,10-19-09 to 11-11-09. c. Anthony Gielow – Medical Student from KCOM, 01-04-10 to 04-23-10 d. Susan Nolan – PA student with Dr. Kowalsky, 10-05-09 to 11-11-09

Approved by the Board of Directors, December 3, 2009

__________________________________________ Richard B. Akin, Chairman – Board of Directors

LEE MEMORIAL HEALTH SYSTEMCCH REAPPOINTMENTS

01-01-10 - 12-30-11Name Suffix Specialty TypeMEDICAL STAFFAdkins, H. Lee D.O. Family Practice AssociateBaker, Keith A. D.O. Family Practice AssociateBruno, John S. M.D. Plastic Surgery AssociateClimaco, Rafael V. M.D. Family Practice AssociateConstance, Christopher G. M.D. Plastic Surgery AssociateConstante, Galo M.D. Family Practice AssociateCurtis, Charles H. M.D. Family Practice ActiveDavid, Hilario G. M.D. Family Practice ActiveDrass, Edward F. M.D. Family Practice ActiveEngel, Paul B. M.D. Family Practice ActiveFarahmand, Audrey E. M.D. Plastic Surgery AssociateFlesner, Walter B. III D.O. Family Practice AssociateGarramone, Ralph R. M.D. Plastic Surgery AssociateGross, Michael P. M.D. Plastic Surgery AssociateHayes, William A. D.O. Family Practice AssociateHernandez, Juan J. M.D. Family Practice ActiveKamkar, Naser M.D. Family Practice AssociateKirley, Frank R. M.D. Family Practice ActiveLang, Jeffrey M.D. Plastic Surgery AssociateMackie, Christine M. M.D. Family Practice ActiveMartinez, Alejandro N. M.D. Family Practice ActiveMuller Carioba, Joanna C. M.D. Family Practice ActiveNielson, Christine P. M.D. Family Practice AssociatePiccola, A. Joseph D.O. Family Practice AssociateReddy, Nallu S. M.D. Family Practice ActiveRitrosky, John D. M.D. Plastic Surgery AssociateRodgers, Mark M.D. Family Practice AssociateRodi, Alexander E. Jr. D.O. Family Practice ActiveSchneider, Marc S. M.D. Plastic Surgery AssociateScott, Clarence A. D.O. Family Practice AssociateSell, Barry J. M.D. Family Practice ActiveThomas, Jerry V. M.D. Family Practice ActiveTraiger, Dean S. M.D. Family Practice ActiveVerwest, Michael S. M.D. Family Practice HonoraryWiley, Scott E. M.D. Family Practice ActiveWittenborn, William S. M.D. Plastic Surgery Associate

ALLIED HEALTHAlbright, Nannette M. ARNP ARNP AHPBanderas, Pablo R. P.A. PA AHPBenitez, Nereida CRNA CRNA AHPBenson, Jessica D. CRNA CRNA AHPBerry, Debra L ARNP ARNP AHPCanfield, Mary CRNA CRNA AHPDickey, Beth A. ARNP ARNP AHPFlint-Lowe, Christina G. ARNP ARNP AHPJones, Stuart A. CRNA CRNA AHPJurek, Jana L. CRNA CRNA AHPLugo, Edrei CRNA CRNA AHPMcCarty, Tammy L ARNP ARNP AHPMorris, Billy E. P.A. PA AHP

LEE MEMORIAL HEALTH SYSTEMCCH REAPPOINTMENTS

01-01-10 - 12-30-11Name Suffix Specialty TypeNeill, Gertrude F. CRNA CRNA AHPPosegay, Lorrie A. ARNP ARNP AHPRizzo, Lorraine A. ARNP ARNP AHPSensecqua, Andrea R. P.A. PA AHPStokey, Emma P. CRNA CRNA AHP

LEE MEMORIAL HEALTH SYSTEM Lee County, Florida

#3

M E M O R A N D U M To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Subject: Gulf Coast Medical Center Medical Staff Recommendations Date: November 30, 2009 The Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Ovidiu Ranta, M.D. - Internal Medicine b. Frederick Beckett, III, M.D. – Internal Medicine c. Reza Hussain, M.D. – Pulmonary Medicine d. Margaret Taha, M.D. – Diagnostic Radiology

2. Intrasystem Appointment to Active Staff:

a. Natalya Suchodolski, M.D. – Internal Medicine 3. Advancement from Associate to Active Staff:

a. Viswanathan Nagarajan, M.D. – Internal Medicine 4. Change of Status – Honorary to Associate Staff:

a. K. Ranjit Fernando, M.D. – Rheumatology 5. Reappointments – Medical Staff and Allied Health Practitioners, 01-01-10 – 12-30-11

(see attached listing) 6. Leave of Absence:

a. Chris Rosioru Ross, M.D. – Pediatric Gastroenterology, 10-31-09 – 11-28-09 7. Resignations:

a. Steven R. West, M.D. – Cardiology, effective 12-01-09 b. George Kovacevic, M.D. – OB/Gyn., effective 12-01-09 c. Jeffrey Martin, D.O. – Dermatology, effective 11-10-09

Memorandum to Board of Directors November 30, 2009 Page 2 of 2 8. Privilege Request - Allied Health Practitioner:

a. Caryle Clyatt, ARNP – Dr. Pescitelli – Hemostasis and Exposure through the appropriate use of instruments, suture, staples, cautery, retractors, suctioning and sponging techniques.

9. Allied Health Practitioners:

a. Mary Gelormine, PA – Florida Cancer Specialists b. Tamara Dominick, ARNP – adding Dr. Mahadevan c. Denise McPherson, ARNP – adding IPC – Dr. Theerathorn d. Shelly Taylor, ARNP – adding Dr. Chavakula


a. Bess Raulerson – PA student with Dr. Judith Krammer, 10-05-09 to 11-11-09 b. Anthony Gielow – Medical Student from KCOM, 01-04-10 to 04-23-10 c. Colby Suttles – PA student with Dr. Pescitelli, 10-05-09 to 11-11-09 d. Susan Nolan – PA student with Dr. Kowalsky, 10-05-09 to 11-11-09

Approved by the Board of Directors – December 3, 2009

_________________________________________ Richard B. Akin, Chairman, Board of Directors

LEE MEMORIAL HEALTH SYSTEMGCMC REAPPOINTMENTS

01-01-10 - 12/-30-11Name Suffix Specialty TypeMEDICAL STAFFAdkins, H. Lee D.O. Family Practice ActiveBaker, Keith A. D.O. Family Practice AssociateBlack, Debra T. D.O. Family Practice AssociateBridewell, Bruce M. M.D. Family Practice AssociateBrueck, Robert J. M.D. Plastic Surgery ActiveBruno, John S. M.D. Plastic Surgery ActiveBurford II, Fred J. D.O. Family Practice ActiveCaignet, Robert A. D.O. Family Practice AssociateClimaco, Rafael V. M.D. Family Practice AssociateConstante, Galo M.D. Family Practice ActiveCox, Laura M. M.D. Family Practice AssociateDegraff, Claude M.D. Family Practice AssociateEshbaugh, Willis G. Jr. M.D. Plastic Surgery AssociateFarahmand, Audrey E. M.D. Plastic Surgery AssociateFitzgerald, George P. III M.D. Family Practice ActiveFulk, Bill R. M.D. Family Practice AssociateGardner, Paul M. M.D. Plastic Surgery AssociateGarramone, Ralph R. M.D. Plastic Surgery AssociateGolosow, Lorraine M. M.D. Plastic Surgery ActiveGreer, Shannon Scott D.O. Family Practice AssociateGross, Michael P. M.D. Plastic Surgery AssociateGuadiz, Patrick H. M.D. Family Practice AssociateHernandez, Juan J. M.D. Family Practice ActiveHughes, Douglas S. D.O. Family Practice ActiveKamkar, Naser M.D. Family Practice ActiveKillam, Dana G. M.D. Family Practice AssociateKim, Michael K. M.D. Plastic Surgery ActiveKlokochar, Nicholas P. M.D. Family Practice AssociateLang, Jeffrey M.D. Plastic Surgery ActiveLautenbach, Peter D.O. Family Practice AssociateLopez-Gutierrez, Jose L. M.D. Family Practice AssociateLukasiewicz, Cynthia A. D.O. Family Practice AssociateMackie, Christine M. M.D. Family Practice ActiveMaggiano, Robert B. D.O. Family Practice AssociateMandraccia, Robert V. M.D. Plastic Surgery AssociateNielson, Christine P. M.D. Family Practice AssociateNovoa, Ricardo E. D.O. Family Practice AssociateOakes-Lottridge, Andrew J. M.D. Family Practice AssociatePritt, Robert B. D.O. Family Practice AssociatePynckel, Gary L. D.O. Family Practice AssociateReddy, Nallu S. M.D. Family Practice ActiveReynolds, Brian E. D.O. Family Practice AssociateRitrosky, John D. M.D. Plastic Surgery AssociateRodgers, Mark M.D. Family Practice AssociateRodi, Alexander E. Jr. D.O. Family Practice AssociateRodriguez, Julio L. M.D. Family Practice ActiveSabha, Khalid M. M.D. Family Practice AssociateSansone, Peter F. M.D. Family Practice HonorarySchneider, Marc S. M.D. Plastic Surgery AssociateSewell, Erica A. D.O. Family Practice AssociateSnodgrass, Timothy J. D.O. Family Practice ActiveSosa, Javier E. M.D. Family Practice Associate

LEE MEMORIAL HEALTH SYSTEMGCMC REAPPOINTMENTS

01-01-10 - 12/-30-11Name Suffix Specialty TypeStrausbaugh, John D. D.O. Family Practice AssociateUsberghi, Eugene Jr. D.O. Family Practice AssociateWallace, Tasha B. D.O. Family Practice AssociateWilliamitis, Anthony J. M.D. Family Practice AssociateWilson, Richard R. D.O. Family Practice AssociateWittenborn, William S. M.D. Plastic Surgery AssociateZivkovic, Krista M. D.O. Family Practice Associate

ALLIED HEALTHAlexander, Stacie W. CRNA CRNA AHPBanderas, Pablo R. P.A. PA AHPBerry, Debra L ARNP ARNP AHPCriswell, Christopher W. CRNA CRNA AHPDickey, Beth A. ARNP ARNP AHPFlint-Lowe, Christina G. ARNP ARNP AHPGillis, Makenzi R. P.A. PA AHPHayes, Vicki L. ARNP ARNP AHPJohns, Angela R. CRNA CRNA AHPKnight, Gregory A. P.A. PA AHPMarkowski, Walter A. CRNA CRNA AHPMorris, Billy E. P.A. PA AHPPosegay, Lorrie A. ARNP ARNP AHPRizzo, Lorraine A. ARNP ARNP AHPSantini, Joseph P P.A. PA AHPSensecqua, Andrea R. P.A. PA AHPTracy, Mavis F. CRNA CRNA AHPYoung, Michael J. P.A. PA AHP



MEDICAL STAFF BUSINESS

Issues – Discussion

120309 Consent Agenda Page 1 of 2

______________ L E E M E M O R I A L HEALTH SYSTEM


CONSENT AGENDA December 3, 2009

A Director or member of the public for discussion may pull any item on the Consent Agenda. Copies of all listed items are available for review in the Meeting Agenda/Exhibits Folder in rear of the room. The remainder of the Consent Agenda can be

approved by a single vote. Items pulled will be considered separately immediately following the Consent vote.

November 5, 2009 Governance Committee of the Whole:

1. Acceptance of the FY 2009 Board of Directors’ Budget.

2. Acceptance of 4th Quarter, FY 2009 Corporate Compliance Report.

3. Acceptance of the Board Counsel Annual Evaluation Results.

4. Approval of the proposed job title change for Cathy Stephens to Board Administrator.

5. A Board Directive to create a Proclamation recognizing the life of Horace Smith and to

commensurate his time and service to LMHS and all of Lee County.

6. Approval to revise the Board of Directors’ 2010 meeting schedule, which includes

alternating the Planning and Quality & Education Committee of the Whole meetings every

other month to allow more time for each committee meeting. The revision also includes

changing the start time for only the Planning and Quality & Education Committee of the

Whole meetings to 3:00pm for six month trial period.

November 12, 2009 Quality & Education Committee of the Whole:

7. Acceptance of the FY 2009, 4th Quarter Risk Management Report.

8. Board Endorsement of the following Healthcare Performance Improvement (HPI)

Recommendations:

1. LMHS Board of Directors to have key oversight of this program.

2. Make patient safety a top priority for the System.

3. Adopt the work plan consisting of the following Proposed Milestones:

a) Complete culture design by 18 Jan 2010

b) Begin Red Rule implementation by 10 Dec 2009

c) Begin leader education by 16 Feb 2010

d) Begin physician & staff education by 24 Mar 2010 (to complete by 24 Sep 2010)

4. Charge Administration, HPI, Physician Safety Group and Legal with presenting a

solution at the *January meeting for making harm visible.

5. Charge the Physician Safety Group with presenting a plan at the *February meeting

for safer processes and physician Red Rules.

*(dates dependent on new proposed Board meeting schedule- see Governance item #6)

9. Acceptance of the FY 2009, 3rd Quarter Organizational Performance Measure Scorecard.

120309 Consent Agenda Page 2 of 2

November 12, 2009 Planning Committee of the Whole:

10. Approval to authorize Administration to begin The Children’s Hospital of Southwest

Florida Pediatric Acute Care Tower facility planning up to $500,000 to conduct a formal

planning assessment, including: detailed space program with representative schematic

drawings of all clinical, ancillary and support relationships. This should include patient

volume impacts on existing patient and ancillary support departments, critical clinical

flow and access between buildings. Include within this assessment a site impact

study, looking at internal/ external road access, zoning, flood plain, signage, parking,

water management, permitting, impact fees and site infrastructure

requirements. Develop systems infrastructure plan, including, mechanical/electrical,

plumbing, fire protection, structural and communications study of systems and

placement." Authorize the LMHS Foundation to initiate a Capital Campaign to assist

with the funding of this project.

11. Approval of the FY 2010 Strategic Scorecard indicators and targets as revised adding

regional reference as applicable.

November 19, 2009 Finance Committee of the Whole:

12. Approval to enter into a Master Lease agreement with Bonita Community Health Center

to include a LMHS Outpatient Lab Draw Station. The Master Lease also will include the

existing Bonita Primary Care, Bonita GYN, and Dr. Goldsmith practices as outlined in the

Schedule A of the attached Master Lease. The terms of this lease are contingent upon

final LMHS counsel and Board counsel review.

13. Acceptance of the FY 2009 4th Quarter Investment Portfolio Performance Report.

14. Approval of an operating lease with Stryker Finance and Stryker Surgical to acquire

surgical equipment as presented, total proposal cost $3,515,615.

15. Acceptance of the Fiscal Year Ending 9/30/09 Financial & Statistical Reports.

16. Acceptance of the Quarterly Capital Report Ending 9/30/09.

17. Acceptance of the FY 2010 October 31, 2009 Financial & Statistical Reports.

18. Approval for Finance Administration to pursue refinancing current SunTrust variable rate

bonds.

V:\PRESENTATIONS\2009\FULL BOARD\120309\DRAFT TIME CHANGE 2010 Posted Notice 120309.doc


33902

239-332-1111

CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER

HEALTHPARK MEDICAL CENTER



LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Frank T. La Rosa

Dawson C. McDaniel

DISTRICT FIVE

James Green

Jason Moon

CConsent Agenda Item #6: onsent Agenda Item #6:CCoonnsseenntt AAggeennddaa IItteemm ##66:: DRAFTDRAFT -- LLEEEE MMEEMMOORRIIAALL HHEEAALLTTHH SSYYSSTTEEMM -- DRAFTDRAFT

&& LLEEEE CCOOUUNNTTYY TTRRAAUUMMAA SSEERRVVIICCEESS DDIISSTTRRIICCTT BBOOAARRDD OOFF DDIIRREECCTTOORRSS

DRAFT 2010 MEETING SCHEDULE Proposed Changes in RED!Proposed Changes in RED!

Full Board Meetings – 1:00PM:

NOTE: 12:00 – 12:45pm Monthly Medical Staff Luncheon at designated campus.

• Tuesday, January 5 – (12:00pm???) Annual Organizational Meeting & concurrent with Lee County Trauma Services District Annual Organizational Meeting – LMH ??Propose time change off 12:00pm??

• Thursday, January 28 – CCH • Thursday, February 25 – HPMC • Thursday, March 25 – GCMC • Thurs, April 29 & concurrent with Lee County Trauma Services District LMH • Thursday, May 27 CCH • Thursday, June 24 HPMC • July – NO MEETINGS • Thursday, Aug 26 & concurrent with Lee County Trauma Services District LMH • Thursday, September 30 GCMC • Thursday, October 28 CCH • Thursday, Dec 2** & concurrent w/ Lee County Trauma Services District LMH

**Propose change to Thursday, Nov 18th (and moving Finance to Nov 11)

GOVERANCE Committee of the Whole (Quarterly) Meetings,1:00pm • Thursday, Feb 4 • Thursday, Aug 5 • Thursday, May 6 • Thursday, Nov 4

PLANNING & QUALITY/EDUCATION Committee of the Whole Meetings • Jan 14 3:00pm Planning • Feb 11 3:00pm Quality/Education • March 4 3:00pm Planning • April 8 3:00pm Quality/Education • May 13 3:00pm Planning • June 10 3:00pm Quality/Education • July NO MEETINGS • August 12 3:00pm Planning • Sept 16 3:00pm Quality/Education • Oct 14 7th 3:00pm Planning *Change due to FHA Conference dates • Nov 11 4th 3:00pm Quality/Education

FINANCE Committee of the Whole Meetings, 1:00pm • January 21 • June 17 • February 18 • July – NO MEETINGS • March 18 • August 19 • April 22 • September 23 (October–NO MEETING) • May 20 • November 18 11 **

LOCATIONS LMH - Lee Memorial Hospital Boardroom (All Committee of the Whole meetings are held at LMH)

GCMC – Gulf Coast Medical Center Community Room (Off Atrium) CCH – Cape Coral Hospital Auxiliary Room (Off Main Lobby)

HPMC – HealthPark Medical Center, Meeting Rooms 1A and 1B (Off Cafeteria)

Any person requiring special accommodations at any of the meetings because of a disability or physical impairment should contact the Board of Directors office at (239) 334-5943

at least five calendar days prior to the meeting.

ALL MEETINGS ARE OPEN TO THE PUBLIC AND THE PUBLIC IS INVITED TO ATTEND Any Public Input pertaining to an agenda item is limited to three minutes and a “Request to Address the Board

of Directors” card must be completed and submitted to the Board Assistant prior to the meeting.



OLD BUSINESS

• EMR/EPIC Expansion Lease

(Mike Smith, Chief Information Officer)

(Approval)

______________

L E E M E M O R I A L HEALTH SYSTEM BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc)

Keep form to one page, SUBMIT (thru SLC Member) ELECTRONICALLY to L Drive – Miscellaneous - BOD Presentations by Noon the Friday before you’re scheduled on agenda.

DATE: December 3, 2009

SUBJECT: Ratification of 9299 College (Information Systems Building) Lease Expansion

REQUESTOR & TITLE: Mike Smith, Chief Information Officer PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.)

June 25, 2009 LMHS Full Board Approved authorized Dawson McDaniel (Board of Directors’ Facilities Liaison) and John Wiest and/or Jim Nathan to approve lease amendment to expand the Information Systems facility space at 9299 College in order to accommodate space needs of staff for the Epic EMR project.

SPECIFIC PROPOSED MOTION:

Motion to Ratify the final lease for the expansion of the Information Systems facility space at 9299 College Parkway.

PROS TO RECOMMENDATION Not Applicable

CONS TO RECOMMENDATION Not Applicable

LIST AND EXPLAIN ALTERNATIVES CONSIDERED Not Applicable FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement)

The lease specifics are: Lease expansion for an additional 10,284 square feet, for a total of 33,449 sq. feet. Price is $13.50/sq ft/year, plus cam, with a 3% annual escalator. The lease extension (including existing and added space) is for 15 years, with an LMHS opt-out option at 10 years (essentially a 10 year lease with a 5 year automatic extension).

The landlord will build out the space to LMHS specifications. The landlord will contribute a $105,000 build-out allowance and will also cover additional build-out costs above and beyond that $105,000 amount, up to a total maximum of $620,000, with the additional amount (above $105,000) plus finance costs to be amortized over 60 months and added to the first 60 monthly lease payments. At this time, it is anticipated that the actual build-out costs will be less than $500,000.

OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) No operational implications, other than the monthly lease payments mentioned above.

SUMMARY In June 2009 the Board gave approval to negotiate and complete that lease. Board counsel has recommended that the Board ratify the lease, now that it has been finalized and signed. The lease has been negotiated, reviewed by legal, reviewed by Dave Kistel, reviewed and approved by Dawson McDaniel, and signed by John Wiest. Final lease document attached.

BOD/Forms/Board (Action) Reporting Form – updated 9/2/09 cs



NEW BUSINESS

• Proposed 2010 Legislative Program

(Sally Jackson, System Director Community Projects)

(Approval)

1

PPRROOPPOOSSEEDD 22001100 SSTTAATTEE LLEEGGIISSLLAATTIIVVEE PPRROOGGRRAAMM

LMHS Board of Directors Meeting December 3, 2009

The Lee Memorial Health System legislative priorities for the 2010 Legislative Session are very much a continuation of last year. New items include a proposed Baker Act amendment, authorization for DNV hospital accreditation under Florida Statutes and support for Brain and Spinal Cord Injury Program funding. SUPPORT CONTINUED FEDERAL MEDICAL ASSISTANCE PERCENTAGE INCREASE (FMAP) Thank you for your support last year of the temporary increase in the Federal share of Medicaid funding (FMAP), thus providing increased federal match for the Medicaid program through December 2010. The availability of FMAP not only helped maintain the Medicaid program as we know it, but also helped to underwrite other shortfalls in General Funds. While the additional FMAP certainly helped protect this vulnerable population, unfortunately Medicaid reimbursement rates to hospitals were further cut. In fact over the past three years, Medicaid rates have been reduced by approximately 13%. With the continuing economic crisis, it may be necessary to maintain FMAP support until state revenues can recover. We ask that you consider working with our Florida Congressional Delegation to develop an appropriate plan for the future that may continue this increased federal match. States are making significant spending reductions to address the fiscal crisis, but realistically can only cut so much before they begin to jeopardize fundamental responsibilities to state constituents, particularly in Medicaid, for which demand has increased during times of economic downturn.

Recommendation: Encourage our state elected officials to voice support to our Florida Congressional Delegation for maintaining the FMAP increase beyond the current statutory deadline tied to economic recovery.

TOBACCO SURCHARGE SPENDING Thank you for your support and successful passage last spring of the Tobacco Surcharge we recommended. Not only will this change provide nearly one billion dollars annually to the state of Florida, it is already serving as a deterrent to both current and future smokers. This change is truly saving lives, as nearly 1 of every 5 deaths in the United States can be tied back to the adverse effects of cigarette smoking. We are pleased to announce that as of November 19, 2009 all LMHS properties are tobacco free. In fact, all of the hospitals in Lee and Collier Counties joined us in the implementation of tobacco free properties as of this date. We continue to encourage other businesses and organizations in our community to do so as well. We are pleased that the Tobacco Surcharge funds are deposited in the Health Care Trust Fund within the Agency for Health Care Administration, yet disappointed that those funds have been used to cover other shortfalls in General Revenue. We recognize and share your concerns regarding the challenges of balancing the need for state services during times of revenue shortfalls, but urge you to continue to give priority in this year’s funding decisions to the needs of the Medicaid population. We recommend that existing Medicaid programs should continue to be funded at adequate levels that reflect the increased

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demand for services. This Health Care Trust Fund can help to fund the Medically Needy and Aged/Disabled Medicaid population.

Recommendation: Use the surcharge on tobacco sales to cover the continuing costs of critical Medicaid programs, particularly the Medically Needy, Aged and Disabled populations.

PRESERVE MEDICAID REIMBURSEMENT In our most recent FY 2009 LMHS unaudited financial statements, we incurred $16.8 million in actual costs on behalf of Medicaid patients served and an additional $31.8 million in actual costs for patients who did not qualify for Medicaid and were deemed charity patients through Florida rules. The actions of the 2009 Legislature further reduced Medicaid reimbursements to hospitals. Costs of medical care continue to increase. The Florida Medically Needy and Aged and Disabled (Medicaid population) program is scheduled to sunset December 31, 2010. The current federal terms and conditions for the increased FMAP funding also require that all Medicaid services in effect be continued. Do we really want to leave this most vulnerable population of nearly 50,000 people without medical care? And obviously those who become sick enough to require emergency medical care will still come to the hospital emergency room for treatment with no reimbursement for their care. At LMHS the uninsured, those unable to qualify for Medicaid, represented 8% of patients in Fiscal Year 2009. LMHS Medicaid patients were 21% of our payer mix in FY 2009. Also in FY 2009, LMHS experienced a 12% increase in losses due to those with insurance who could not afford to pay their co-pays or deductibles, on top of a 23% increase last year. This has become the fastest growing population for LMHS. We have unemployment rates nearing 14%, much higher than the state average during this economic decline. As a Safety-net provider, we incur these costs as part of our mission. The state of Florida can recognize the value of this patient care by helping protect further erosion in Medicaid reimbursement.

Recommendation: Protect Medicaid funding from further erosion or technical changes that negatively impact LMHS and other Safety-net providers. (Specific Medicaid recommendations follow.)

MEDICAID REFORM For the past four years, Florida’s Medicaid program has been operating under the terms of a section 1115 waiver under federal law. This Medicaid Reform waiver includes the operation and evaluation of Medicaid Reform pilots. The Agency for Health Care Administration (AHCA) Inspector General’s audit of the Medicaid Reform pilots in Duval and Broward counties cautions that the pilots may have been implemented too quickly without adequate access and staffing.

Recommendation: Support continued review and improvement of Medicaid Reform pilots. Do not pursue legislation for rapid expansion of Medicaid managed care reform until there is evidence that it is working in the test markets.

MEDICAID LOW INCOME POOL AND DISPROPORTIONATE SHARE (DSH) FUNDING The section 1115 federal waiver that created Florida’s Medicaid Reform initiative created the Low Income Pool (LIP) with fixed funding for each of five years. A September 2, 2009 letter from AHCA asserts continued eligibility for the full $1 billion in Federal funding for the final year of the waiver, FY 10-11. If CMS disagrees, it could put $300 million of this total at risk. LIP is designed to provide some funding for

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uncompensated care provided by Florida’s public and safety net hospitals. This is accomplished in part through the rebasing of Medicaid rates for those safety net hospitals that provide a disproportionate share of charity care. In recent years, the legislature reduced the state’s share of rebasing, thus shifting costs significantly to local governments.

Recommendation: Support the LIP funding formula and recommendations of the statutory LIP Council to fully fund LIP, Special Medicaid Payments to hospitals and disproportionate share (DSH). Support the AHCA letter to CMS and urge members of the Florida Congressional Delegation to fully fund the Florida Medicaid Waiver at $1 billion in FY 10-11.

Further, all federal health care reform legislation defines significant reductions to both Medicaid and Medicare DSH payments to hospitals. These funds are designed to offset some of the costs to those safety net hospitals that serve the preponderance of the uninsured/charity care. Florida ranks 44th in the nation for per capita Medicaid DSH allotments. New York, California and Texas each receive $l billion more than Florida’s annual $200 million. Any reduction at all will be seriously damaging to Florida’s safety net. For example, safety net hospitals represent only 10% of all Florida Hospitals, but 92% of Medicaid DSH. With such potential implications in federal funding, it is more important than ever to protect state reimbursement methods too while recognizing that Florida presently does not get its fair share of these federal dollars. Recommendation: Urge the Florida Congressional Delegation to hold harmless low Disproportionate Share (DSH) states like Florida and more fairly distribute DSH funds among the states. MEDICAID HMOS While AHCA has given written support for state regulated Medicaid HMOs to provide an increased reimbursement rate for hospitals with high Medicaid and charity care, some HMOs still pay no more than the lower “county billing rate” for out-of-network hospital services; thereby, not accepting the state’s attempt to assist safety net providers. A recent court decision in Duval County ruled in favor of assuring appropriate out-of-network payments to hospitals for emergency care and the “Reasonable Value” rate for non-emergent care where no contract exists with the Medicaid HMO and hospital. HMOs have encouraged the state to move Medicaid recipients quickly into managed care, including mandatory assignment into HMOs. Concerns of access and quality of care persist, and when there is an insufficient physician panel, Medicaid clients end up in the local Emergency Department for care. With the advent of an increased presence of Medicaid HMOs, AHCA should have an increased emphasis on fraud and abuse activities in the managed care arena and increased oversight of contract terms and performance. Legislation was filed during 2008 and 2009 to address this concern, but failed to ultimately pass.

Recommendation: Support legislation to clarify the definition of Medicaid rates for all safety net hospitals so that non-contracted providers will be paid their full, rebased rate for both emergent and non-emergent care. Ensure that Floridians have an active voice in choosing their own health care options. Direct AHCA to terminate Medicaid HMO contracts in counties where it is determined that there is an inadequate network.

MEDICAID NURSING HOME REIMBURSEMENT While nursing homes often provide cost effective alternatives to hospitalization, Medicaid reimbursement is 85% or less of actual costs. Adjustment of state approved rates sometimes takes up to four years, further increasing the underpayment. Additional costs are incurred because Florida is

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one of the few states requiring mandatory (underfunded) clinical staffing ratios at 1:1 for nurses and 2.9:1 for certified nurse assistants. Last year, for the first time, the "Nursing Home Quality Assessment Program" was created to assess nursing homes and draw down additional federal matching dollars. This seems to be beneficial as our non-reimbursed costs have been improved from a loss of 20% last year to a loss of 15% of actual costs now.

Recommendation: It is imperative to maintain our existing Medicaid rates without further funding cuts during the upcoming session and maintain the federal match for the Nursing Home Quality Assessment Program.

MEDICAID HOME HEALTH Medicaid Home Health reimbursement in Florida has not been increased since 1987, and is now the lowest in the nation at only 20% of cost being reimbursed. That leaves 80% unfunded. These costs are also limited to only an RN or home health aide visit. Physical, Occupational, or Speech Therapy is not covered, nor are any needed medical supplies. Since the de-regulation of certificate of need in 2000, there has been a 74% increase in new providers, many of which do not take Medicaid or charity care cases, creating an unbearable burden on those who do. The new Medicaid Authorization for Home Health in Florida requires the patient to see their physician prior to the home health start of care. This creates a delay for home health to provide services in a timely manner.

Recommendation: Support licensure, regulatory or statutory solutions such as a return to CON, to ensure Medicaid and charity care needs can be met. Provide much needed increases in Home Health reimbursement as a cost-effective alternative to hospital care. Expand authorization of physician office visit to 30 days for Medicaid patients.

MEDICAID KIDCARE Federal re-authorization of the State Children’s Health Insurance Program (SCHIP) with a generous 70% federal to 30% state match, allowed some improvements in Florida KidCare to be enacted last session. Enrollments in Florida dropped from a high of 350,000 in 2004 to 208,000 children as of October 2008. Recent data shows enrollments up slightly at 230,000 so far this year, with a target of 244,000 budgeted. While we are moving in the right direction, a recent study found Florida last among all 50 states in coverage for children’s health, based on 2007 enrollments, which were very similar to 2009. We have a long way to go.

Recommendation: Support any federal efforts to expand SCHIP. Maximize funding for outreach, and eliminate local match to optimize enrollment and retention. Streamline the cumbersome application process and unify component programs under one administrative entity.

CHILDREN’S CANCER CENTER The LMHS Children’s Hospital of Southwest Florida operates one of 10 State-designated pediatric hematology/oncology centers. The original six centers continue to receive state funding ranging from

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$40,000 to $555,000 while the remaining four, including LMHS, receive no funding. Last year we provided life-saving services using nationally recognized methods for 2,598 inpatient days and 5,767 outpatient visits, allowing children and their parents in our multi-county region to receive specialized care close to home.

Recommendation: Support increased funding in the line item for state designated pediatric hematology/oncology centers to allow the Children’s Hospital of Southwest Florida to be funded comparably to other funded children’s cancer centers. (Note: This is not a CBIR but rather a request to allow equitable state funding of all children’s cancer centers.)

STATE BRAIN AND SPINAL CORD INJURY PROGRAM The State Brain and Spinal Cord Injury Program, BSCIP, did not fund all the certified programs. Specifically, the LMHS Rehabilitation Hospital received zero dollars. Recommendations: Fund the BSCIP program for this vulnerable patient population. TRAUMA FUNDING In recent years the number of state-designated Regional Trauma Centers has dropped over 50% due to financial and operational challenges. LMHS provides the only designated Trauma Center between Tampa and Miami, and our annual shortfall exceeds $9 million, including physician services and stand-by costs required to operate a major regional trauma center.

Recommendation: Support legislation to increase traffic fines for risky driving behavior for trauma funding. Work with all 21 state-designated trauma centers and the Florida Trauma Alliance to provide funding to assure Florida’s trauma network remains viable.

BEHAVIORAL HEALTH Significant dismantling of the state’s behavioral health institutions is placing a burden on local communities and support services. Southwest Florida has by far the worst ratio of residential beds with psychiatric support, following the closures of G. Pierce Wood Hospital, Charter Glade Hospital, and the phase out of Gulf Coast Center. We are making some progress to improve this situation. Thank you for supporting the continued funding of the Lee County Behavioral Triage grant, a 3-year award to Lee County for law enforcement diversion. This remains a small part of the solution to this problem. We support the Certificate of Need for The Pavilion at HealthPark to build a new freestanding psychiatric hospital with private investment and are pleased with the Administrative Law Judge’s recent recommended decision in favor of issuing the CON. Lee County still does not receive its “fair share” of limited state funding, primarily found in DCF grants to Lee Mental Health Center, therefore patients remain underserved. This year LMHS converted 15 beds at Lee Memorial Hospital to a Senior Behavioral Center, under contract to provide specialized care to existing patients in need of geriatric psychiatric services. While we are not a Baker Act receiving facility, we do receive patients in need of emergency care. Current statutory language relating to persons for whom an involuntary examination has been initiated, who is being evaluated or treated at a hospital for an emergency medical condition, is unclear regarding what professionals are deemed qualified professionals to perform an involuntary examination and make the determination whether the person

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meets or does not meet the criteria for involuntary placement. For hospitals such as LMHS, that are not receiving facilities, statutory clarification is needed.

Recommendation: Support clarification in the law as to what types of professionals in a hospital that is not a Baker Act receiving facility are able to perform certain examinations and make determinations under the Baker Act. Continue to support Lee County for the third year of the Triage/Low Demand Shelter grant. Ensure that adequate DCF resources are allocated to Lee County clients. Support the investment in additional beds for psychiatric care.

HOSPITAL ACCREDITATION AUTHORITY In September 2008, the Centers for Medicare and Medicaid Services (CMS) granted deemed status to DNV Healthcare, Inc. to become an accrediting agency for hospital compliance with Medicare Conditions of Participation for hospitals. This is the first change in over 30 years as far as choice of accreditation entities. In order to qualify to conduct these surveys for CMS, the state in which the survey is conducted must also authorize the accrediting body. Florida has not yet passed such legislation. LMHS joins the Florida Hospital Association in requesting this amendment to Florida statutes. Our Board of Directors has voted to pursue this new approach to accreditation, which includes ISO 9001 Quality Management Standards to provide outcome-based continuous improvement processes tied to innovation, collaboration, and best practice protocols. We intend to continue accreditation with The Joint Commission during the evaluation period. Recommendation: Support amendment to Florida statutes to officially recognize CMS-approved accrediting bodies. FREESTANDING EMERGENCY DEPARTMENTS There is no longer a moratorium on additional freestanding emergency departments. Certain areas in Florida including Southwest Florida are facing delays and lengthy access to hospital-based emergency departments, particularly during the winter seasonal resident and tourist months. We believe state regulatory authorities should define a clinically safe and affordable emergency facility with rules somewhat in between a hospital-based ED and a minor emergency center.

Recommendation: Seek regulatory best practices in other states to create clinically safe and affordable emergency facilities with rules in between a hospital ED and a minor urgent care center, considering special circumstances such as drive time.

CERTIFICATE OF NEED (CON) Significant deregulation of Certificate of Need passed during the 2008 Legislature. The legislation limited the Agency for Health Care Administration's review to consideration of the need for the hospital by the availability and utilization of existing hospitals in the service district of the applicant, and the applicant's level of health care services to Medicaid patients and the medically indigent. CON protects the state’s safety net health care providers by ensuring a sufficient level of patient volume in hospitals and skilled nursing homes that care for patients without regard to ability to pay.

Recommendation: Monitor and oppose further de-regulation or repeal of Certificate of Need. Such action will de-stabilize the health care industry in Florida.

LMHS Board Meeting President’s Report December 3, 2009

Patient Safety Strategy Committee (11/24/09)

• Encourage Board to adopt patient safety as the overriding core value for Lee Memorial

• Incorporate patient safety discussions at the beginning of Board and Executive, Senior and Physician Leader meetings

• Consider requiring employees, volunteers and physicians to sign safety commitment statement to acknowledge plan to enhance patient safety through collegial behavior

• Develop methods to make harm visible as well as to recognize successes o Requires measuring patient safety such as Serious Safety Event Rate

(SSER) o Requires finding ways to communicate appropriate and timely

information on a consistent and regular basis to each different audience within the system including event descriptions and lessons learned

• Create ongoing patient safety leadership committees o Establish system‐wide Patient Safety Steering Committee with physician,

clinical and administrative leadership, legal and board chair o Establish facility specific collaborative teams with clinical and

administrative leaders, risk managers, and clinical staff members o Establish facility specific discussion forums at each hospital including

nurses, physicians and administrators Perform culture design retreat to select staff behaviors and

develop an education plan for staff Identify and record best collegial practices and share among

facilities Select at least one metric to document success in improving

teamwork (collaboration and/or communication) and report to oversight groups monthly

• Engage Medical Staff o Form a physician work group (has already met twice)

Adopt system‐wide disruptive behavior policy within medical staff rules and regulations

Train physician leaders in best approach to confront disruptive behavior (already have plans to implement learnings from a Vanderbilt Medical Center program)

Develop measurement system to track incidents of potential suboptimal quality and disruptive behavior and organize periodic reports to the MECs, Quality and Safety Committee and Board

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• Determine appropriate non‐negotiable “red rules” and consequences of not following such rules

o Physician committee to discuss at next meeting o Common examples include patient identification, time‐out before

procedures and double‐checks for high‐risk medications & blood • Hold Leadership Behavior Design Sessions

o Focused on increasing leadership and staff accountability o Establish specific measurement and communication requirements to be

incorporated in individual and leadership accountability standards for next year

o Strengthen and clarify role of CAOs in patient safety problem solving and creating forums to discuss and learn from opportunities for improvement

• Pursue resolution to key programs that would assure safer processes o Hospitalist and intensivist policies and practices o Identify opportunities to improve communication

Appropriate use of non‐English language Enhance compliance with universal protocols Set standards for use of verbal orders Dissuade and deal with disruptive behavior

• Create opportunities to learn from potential incidents and actual occurrences o Cause analysis training

i. Regular reporting, dialogue, education, training, evaluating and resolving Physician Patient Safety Meeting (11/24/09)

• Chair: Brett Shannon, MD • Facilitator: Dave Morehead, MD, HPI • Focus: Physician/nurse relationships • Dr. Kole shared story of enhanced ICU communications • Nurses shared communication challenges

o Impact of collegial vs. non‐collegial behaviors o Safe environment for dialogue

• Action steps: o Physicians agreed to participate in facility‐based physician/nurse

collaborative discussions o Physicians agreed to participate in facility‐based patient safety

committees o Physicians agreed to work with their respective medical executive

committees to have patient safety reports part of standing agenda items o Physicians agreed to share the impact of this meeting with their

colleagues as well as increase sensitivity as to their interaction with clinical staff

o Brett & Chuck will communicate with physician members as to their interest in specific roles relative to patient safety leadership

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o Will meet again in January; red rule discussion will be a part of agenda • Chuck summarized with role of Board and its motion relative to patient safety as

overriding core value of health system planned for today’s Board meeting o Suggested consideration of endorsing behavioral norms, at next meeting,

including physician‐to‐physician communication of consults, mandatory consultation, universal protocols, hand washing, no verbal orders, etc.

o Also asked for support and advocacy of hospitalist standards and standardized ICU care throughout the system, which, at a minimum, would require every patient admitted to the ICU get a mandatory consult by a qualified, dedicated intensivist

Patient Safety Upcoming Events (being scheduled for mid‐December)

• Patient Safety Leadership Training o Craig Clapper, HPI, to conduct o Half day session

• Patient Safety Staff training retreat o Afternoon plus following day o Develop safety tools (safety toolkit) that will be used for facility‐specific

patient safety programs, collaboratives, accountability, etc. Nurse‐to‐Nurse Handoff Communication

• One of a number of patient safety, quality and process improvement initiatives underway

• Purpose: To develop an efficient and effective standardized process for hand‐off communication during transitions in care across the LMHS continuum

• Being tested on certain units and developed for system‐wide roll out • May be a good presentation at a future Board Quality Committee meeting

Tobacco Free Lee

• Some incidents and challenges but for the most part a successful first two weeks • Signage has been important

o 329 permanent signs; 100 temporary and 8 banners • Our efforts have had far reaching impact on our entire community; many

businesses joined or planning to join • Students Working Against Tobacco (SWAT) … increased local energy

Robotic Surgery

• Foundation has been working hard to raise sufficient funds for robotic surgery • Foundation board member, Lex Roulston has led effort now at $1.145 million

with a target of $1.7 million • Now that we are nearing success in fund raising, we will be working on a

proforma, training, timing and other information to bring to the LMHS Board, very possibly in January

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Special Florida Legislative Session in December

• Special sessions are limited to “announced” purposes • “The Role of Rail” as a part of future Florida transportation systems • Consider a comprehensive rail transit policy for Florida

o Short term economic development o Long term transportation improvements o Funding consideration: conversion of future road funds for rail

development • Upcoming LMHS Board Planning Committee to learn of “light rail” discussions for

Lee County utilizing existing rail system through center of county Congratulations to Dr. John Iacuone

• Selected by the American Hospital Association to a three year term on the Maternal and Child Health Governing Council

• Council made up of 15 individuals representing healthcare leaders from nation’s leading women and children’s health providers

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Board Liaison Report

Director: Dawson McDaniel

(Verbal Update)



BOARD OF DIRECTORS’ REPORTS

(All Members)

&

BOARD LIAISON/ ASST TO THE BOARD

REPORT (Cathy Stephens)

LLEEEE MMEEMMOORRIIAALL HHEEAALLTTHH SSYYSSTTEEMM && LLEEEE CCOOUUNNTTYY TTRRAAUUMMAA SSEERRVVIICCEESS DDIISSTTRRIICCTT

BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS CCCAAALLLEEENNNDDDAAARRR December 2009

Sunday Monday Tuesday Wednesday Thursday Friday Saturday 1

8:30am – 10:30am Special Leadership Session with Author

Fred Lee “If Disney Ran Your

Hospital” Author First Christian Church,

2061 McGregor Blvd ++++++++++++++++++++

FOUNDATION EVENT “An Evening of Appreciation”

(Paseo Village Center) BY RSVP ONLY

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3

Gene Principi

++++++++++++++++++++++++++

12:00noon Medical Staff Luncheon – LMH MSCR

1:00pm Full Board

& Lee Country Trauma District Board of Directors Meetings –

LMH Boardroom *(held concurrently)

4 5:30 -7:30pm Annual Freedom Fund and Awards

Celebration Crown Plaza at

Bell Tower BY RSVP ONLY

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Board Holiday Social 6:00pm Social 7:00pm Dinner

Royal Palm Yacht Club

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7

8 12:00-12:30

“Ribbon Cutting & Stroll” for the START!

Walking Path HP Medical Center

Entrance A

9

10

11

Hanukkah begins

at Sundown

12

James Green

13

14

15

16

17

18 19

20

21

1st day of Winter

+++++++++++

22

23

24

25 Merry Christmas

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Kwanzaa Begins

27

28

29

30

31 New Year’s Eve! +++++++++++++

Joe Catti

Key: LMH – Lee Memorial Hospital HPMC – HealthPark Medical Center CCH – Cape Coral Hospital GCMC – Gulf Coast Medical Center DDaatteess ttoo RReemmeemmbbeerr:: TUESDAY, January 5, 2010, 12:00 pm, BOARD ANNUAL ORGANIZATIONAL MEETING, LMH Boardroom

Please call the Board of Directors office at (239) 334-5943 if you have any questions about this schedule.

FFoouunnddaattiioonn EEvveennttss:: For information on Foundation events, please call the Foundation office at 239-985-3550.



ADJOURN

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS

MEETING

DATE OF THE NEXT REGULARLY SCHEDULED

*FULL BOARD OF DIRECTORS MEETING:

Tuesday, January 5, 2010 - 12:00pm* ANNUAL ORGANIZATIONAL BUSINESS

MEETING

LEE MEMORIAL HOSPITAL BOARDROOM

2776 Cleveland Avenue, Ft. Myers, FL 33901

*Held concurrently with the Lee County Trauma Services District Board of Directors meeting