Transcript of Open Session Meeting - Illinois.gov · 2020-02-26 · Transcript of Open Session Meeting Date: December 10, 2019 Case: State of Illinois Health Facilities and Services

Transcript of Open SessionMeeting

Date: December 10, 2019Case: State of Illinois Health Facilities and Services Review Board

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ILLINOIS DEPARTMENT OF PUBLIC HEALTH HEALTH FACILITIES AND SERVICES REVIEW BOARD

OPEN SESSION - MEETING

Bolingbrook, Illinois 60490 Tuesday, December 10, 2019 9:05 a.m.

BOARD MEMBERS PRESENT: DEBRA SAVAGE, Chairman SENATOR DEANNA DEMUZIO (present via telephone) SANDRA MARTELL LINDA RAY MURRAY KENT SLATER

Job No. 223752APages: 1 - 204Reported by: Melanie L. Humphrey-Sonntag, CSR, RDR, CRR, CRC, FAPR

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EX OFFICIO MEMBERS PRESENT: DAN JENKINS, Department of Healthcare and Family Services DEBRA BRYARS, Department of Public Health DULCE QUINTERO, Department of Human Services

ALSO PRESENT: COURTNEY AVERY, Administrator RUKHAYA ALIKHAN, General Counsel MICHAEL CONSTANTINO, IDPH Staff ANN GUILD, Compliance Manager GEORGE ROATE, IDPH Staff

Transcript of Open Session MeetingConducted on December 10, 2019 2

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C O N T E N T S PAGECALL TO ORDER 5ROLL CALL 5APPROVAL OF AGENDA 6APPROVAL OF TRANSCRIPTS 7PUBLIC PARTICIPATION CGH Medical Center 8 Associated Surgical Center 25ITEMS APPROVED BY THE CHAIR 28ITEMS FOR STATE BOARD ACTIONPERMIT RENEWAL REQUESTS Memorial Hospital East Medical Clinics 30 Building Advocate Christ Medical Center 38 Alden Estates of Bartlett 48ALTERATION REQUESTS Memorial Hospital East Medical Clinics 35 BuildingEXEMPTION REQUESTS Anderson Hospital 56 Community Hospital of Staunton 63 Little Company of Mary Hospital 66 Schwab Rehabilitation Hospital 72



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C O N T E N T S C O N T I N U E D PAGEAPPLICATIONS SUBSEQUENT TO INITIAL REVIEW Coulterville Rehabilitation and Health 77 Care Center Greater Chicago Center for Advanced 83, 115 Surgery Advanced Surgical Institute 84 Fresenius Kidney Care Mount Prospect 131 HSHS St. John's Hospital 144 Palos Health Mokena Medical Office 149 Building CGH Medical Center 153 DaVita Driftwood Dialysis 176 Riverside Medical Center 181 Associated Surgical Center 187EXECUTIVE SESSION 200COMPLIANCE ISSUES/SETTLEMENT AGREEMENTS/FINAL ORDERS Referrals to Legal Counsel 200OTHER BUSINESS Financial Report 201ADJOURNMENT 203



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P R O C E E D I N G S CHAIRWOMAN SAVAGE: Good morning, everyone. AUDIENCE MEMBERS: Good morning. CHAIRWOMAN SAVAGE: We have a full agendatoday, and I appreciate everybody being here. Asnoted on the agenda, today's meeting is being heldin two different locations. So our SenatorDemuzio is joining us from Carlinville, and we askthat you exercise your patience with ourtechnology. I would like to welcome the Board'sgeneral counsel, Ms. Rukhaya Alikhan, and DebraBryars, and I want to wish each of you a veryhappy holiday and a very healthy, happy,prosperous new year. So, Mr. Roate, please call the roll. MR. ROATE: Thank you, Madam Chair. Senator Demuzio. MEMBER DEMUZIO: Present. MR. ROATE: Dr. Martell. MEMBER MARTELL: Present. MR. ROATE: Dr. Murray. MEMBER MURRAY: Present. MR. ROATE: Mr. Slater.



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MEMBER SLATER: Present. MR. ROATE: Chairwoman Savage. CHAIRWOMAN SAVAGE: Present. MR. ROATE: That's five in attendance. CHAIRWOMAN SAVAGE: Thank you. May I have a motion to amend the Tuesday,December 8th [sic], meeting agenda to considerD-01, Memorial Hospital East medical clinicsbuilding alteration request, immediately followingItem A-01, Memorial Hospital East medical clinicsbuilding 12-month renewal request. May I have a second. MEMBER MARTELL: Second. MS. AVERY: You need a motion. CHAIRWOMAN SAVAGE: All right. Is thereany discussion? (No response.) CHAIRWOMAN SAVAGE: Okay. All in favor,aye. (Ayes heard.) CHAIRWOMAN SAVAGE: Okay. The ayes haveit and our motion is approved. May I have now a motion to approve theTuesday, December 6th [sic], meeting agenda?



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MEMBER MARTELL: I so move. CHAIRWOMAN SAVAGE: A second? MEMBER MURRAY: Second. CHAIRWOMAN SAVAGE: All in favor? (Ayes heard.) CHAIRWOMAN SAVAGE: The ayes have it.Motion approved. May I have a motion now to approve theTuesday, October 22nd, meeting transcript. MEMBER MURRAY: So moved. CHAIRWOMAN SAVAGE: A second? MEMBER SLATER: I second. CHAIRWOMAN SAVAGE: Okay. Discussionabout that? (No response.) CHAIRWOMAN SAVAGE: Okay. All in favorsay aye. (Ayes heard.) CHAIRWOMAN SAVAGE: And the ayes have it.The meeting transcript is approved. - - -



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CHAIRWOMAN SAVAGE: I ask the speakersplease adhere to our two-minute rule and concludecomments when Mr. Roate signals. Ms. Guild, please proceed. Thank you. MS. GUILD: The first group for publicparticipation is Project 19-049, CGH MedicalCenter in Sterling. I'm going to call up the first five.There are eight total. You can testify in anyorder that you choose. And keep it totwo minutes, and you're reminded to both say andspell your name for the court reporter. Sheriff John Booker. Skip Dettman. BethFiorini. Mayor Skip Lee. And Chief Tim Morgan. CHAIRWOMAN SAVAGE: May I have a motion toapprove Project 19-049 -- MS. AVERY: No. CHAIRWOMAN SAVAGE: Oh, this first? Okay. MS. GUILD: You can start anytime. MR. BOOKER: Good morning. My name isJohn Booker, B-o-o-k-e-r. I am the sheriff ofWhiteside County. Ensuring the safety of our residents is my



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number one priority, and the consistent increasein mental illness in our community and our countyjail is a cause for major concern. Whether it's answering a 911 call,handling inmates in the jail system, the growth ofacute mental illness is far above the access toinpatient units to serve those in greatest needs. It is frustrating for my deputies tocontinue to handle incidents related to mentalillness over and over because these individualsare waiting 24 hours or several days for aninpatient bed to appear. We are not meeting the needs of ourresidents when they must travel one to two hoursfrom home or, worse, be discharged without theopportunity for full behavioral health treatmentand care. Having behavioral health treatment andcare is a must for my county. It is amazing to me that I can effectivelycoordinate mental health services in my countyjail but our general population must wait inline for acute mental health services. From what I understand, opening abehavioral health unit is a huge undertaking,



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highly regulated, and generally not a source ofrevenue. Some would say CGH is crazy for takingthis on, but I simply see this as CGHdemonstrating their mission to serve the needs ofour community. They are taking responsibility tobe an effective partner in our region to meet theneeds of a population that is underserved and manyignored. I respectfully request that you approvethis application. Thank you for your time. MS. DETTMAN: Good morning. My name isSkip Dettman, S-k-i-p D-e-t-t-m-a-n, and I alsoask that you please approve that Project 19-049,CGH Medical Center's request to open an inpatientbehavioral health unit. I'm a licensed clinical social worker andalso a certified advanced alcohol and drugcounselor. I work as a program director withLutheran Social Services in Sterling, Illinois.We specialize in the outpatient treatment ofmental health, mental illness, and substanceabuse. Many of our programs are specificallydesigned to support recovery after a patient isdischarged from a hospital setting, an inpatient



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hospital setting. We provide services throughout the regionserved by CGH Medical Center, including the Countyjail and school systems. We are part of aregional network of intensive outpatient andrecovery services and see firsthand the challengesof sustainable recovery from mental illness andsubstance abuse. Our network of providers workextremely well and have the ability to work as ateam for community case management of our clients. The largest gap in our region is a lack ofaccess to inpatient mental health services.I work with individuals who regularly requirehospitalizations, yet many of our clients havenever seen the inside of the Dixon or Rockfordhospitals. Because of limited admissions to theprograms in those communities, well over50 percent of our clients requiring inpatientservices are transferred to the Chicagoland areafor inpatient crisis stabilization services. We know that case managers workpersistently to get clients in crisishospitalizations, but Chicago-area facilities arefar too often the accepting hospital. Once



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transferred to these distant programs, we lose ourclients for follow-up, which is a desperately --which -- for treatment is desperately needed forongoing recovery. CGH Medical Center understands this needand is taking responsibility to address the crisisin our community. I respectfully request that you approvetheir application. Thank you. MS. FIORINI: Good morning. My name isBeth Fiorini, B-e-t-h F-i-o-r-i-n-i. I recently retired as the public healthadministrator and chief executive officer of theWhiteside County Health Department/WhitesideCounty Community Health Clinic. The WhitesideCounty Community Health Clinic is a Federallyqualified health clinic that provides medical,dental, as well as behavioral health and substanceabuse services in the HRSA 1 region. We have11 licensed therapists and a medication-assistedtreatment program for opioid and alcohol abusers. Finding the County's -- findings from theCounty's most recent needs assessment identifieddepression and anxiety as the number one health



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concern. Through local partnerships, we haveincreased access for outpatient services; however,we continue to lack acute inpatient services tosupport continuity of care. When there is anacute care need, our patients present toCGH Medical Center for screening and transfer toan AMI mental illness unit. Not only are ourpatients waiting many times over 24 hours for anAMI bed, they are rarely, if ever, accepted to thelocal hospitals in Dixon or the Rockford region. This poses a challenge for us asoutpatient providers. This results in reboundingof patients back into the cycle of ED and transferwhen we could simply keep many of theseindividuals locally at CGH. Often when our behavioral health patientsshould self-admit to the KSB mental healthinpatient unit, they refuse because it's too faraway. 15 miles might as well be 300 miles inrural Illinois where there's limited publictransportation. The addition of a behavioral health unitwill appropriately address the challenges of



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access in our community and allow us toeffectively care for this highly complex, yetunderserved population. Thank you. MAYOR LEE: Good morning. My name isSkip Lee, S-k-i-p L-e-e. I have been the mayor ofSterling, Illinois, since 2011. I am here to askthat you approve CGH Medical Center's request toopen an inpatient behavioral health servicesprogram. Our hospital is a municipal hospital, andit has been an honor to work with this exceptionalteam of health care leaders. Additionally, as youcan or will see from the other support testimony,our team of community leaders and organizationsshare my commitment to creating a community whereresidents can successfully live and work. As a mayor, I have a unique opportunity tounderstand both sides of the behavioral healthcrisis facing our community. From the Cityperspective, I see the impact of chronic and acutemental illness on crime, homelessness,unemployment, and simply how citizens struggle tobe productive members of our community. I see how



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the lack of mental health treatment optionsnegatively impacts our fire, police, and EMS'ability to provide for the citizens of Sterling. From a health care perspective, the lackof available mental health inpatient beds createsa continuous dilemma for CGH Medical Center.While our outpatient resources have flourishedover the last decade -- and, of course, that'swhat we want to see, the vast majority of theservice provided -- our community's lack of accessto inpatient behavioral health services isindefensible. Addressing the acute behavioral needs ofour community has been a topic at the annual boardretreat for CGH over the past few years. Untilrecently, however, CGH did not have the availablespace in the hospital for a dedicated unit. Itnow has the ability to address this critical needbased on a reorganization of its space plan andits board of directors approving the undertaking. As mayor, I'm committed to our citizensbeing able to receive care and treatment at alocal level. Mental illness is a disease thatdoes not require tertiary care hours away in an



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academic medical center. Our community deservesbetter. MR. ROATE: Two minutes. MAYOR LEE: I'm sorry? MR. ROATE: Two minutes. MAYOR LEE: Okay. Thank you very much. MR. MORGAN: Good morning. My name isTim Morgan, T-i-m M-o-r-g-a-n. I'm the chief ofpolice for the City of Sterling Illinois. I'm here to ask that you approve CGHMedical Center's request to open a 10-bed unit forpatients suffering from mental illness,Project 19-049. As police chief, I'm responsible forpromoting and preserving the security and safetyof residents in the Sterling community. Wecollaborate with CGH Medical Center directlythrough the Whiteside County Healthier CommunitiesPartnership, as well as the Crisis InterventionTeam. These partnerships support continuity andcommunication of services and resources, which, inturn, create a safer environment for our citizens. CGH calls upon our officers regularly when



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assistance is needed to protect staff and patientsfrom violent individuals who need acute mentalhealth services. Officers report back that thesepatients are many times waiting for placement forseveral days. When they inquire why transferhasn't occurred, the consistent response is thatwhile 35 hospitals are called each time and thenevery day once a patient leaves admissions, noneof those hospitals will accept the patient. This is their right. They're not underlegal obligation to do so, and without insurancefrom any of these patients or with Medicaid as theinsurance, these other hospitals do not readilyaccept patients needing intensive behavioralhealth services. When patients get this treatment inChicago or any other hospital, our officers runinto these individuals postdischarge after they'vegone several days without medications or anoutpatient treatment plan. These individuals endup back in the ED, and the cycle starts again.It's frustrating and upsetting to my officers totry to support these patients as they experiencethe trauma of receiving inadequate care.



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This isn't a criticism of other hospitals;it's simply obvious that there aren't enoughresources to serve these patients. The solutionthat prevents this ongoing poor use of resourcesand tax dollars is the project before you. Pleaseallow CGH to open a behavioral health unit.Everyone in my community will benefit from thiscritical resource being offered in our owncommunity. Thank you. MR. ROATE: Two minutes. MS. GUILD: Thank you. THE COURT REPORTER: Please leave yourremarks with Mike. MS. GUILD: There are three more peopleregistered to speak on Project 19-049, so pleasecome up to the table. Chief Tammy Nelson, Patrick Phelan, andDiana Verhulst. We have one person who is speaking onbehalf of Associated Surgical Center, so JulieYarosh, can you come up to the table, too, butspeak last? You can begin at any time.



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MS. AVERY: Senator Demuzio, can you muteyour phone? We're picking up your papers. MEMBER DEMUZIO: I'm sorry. MS. AVERY: Thank you. MEMBER DEMUZIO: Okay. CHAIRWOMAN SAVAGE: She didn't hear you. MS. AVERY: It looked like it's muted. (An off-the-record discussion was held.) MS. GUILD: You can begin. MS. NELSON: Good morning. My name isTammy Nelson, T-a-m-m-y N-e-l-s-o-n. I am thechief of police for Rock Falls, Illinois. Ourcommunity is directly across the river fromSterling, Illinois. MS. AVERY: Can you speak directly intothe mic so that we can make sure the Senatorhears? MS. NELSON: My officers and I arecommitted to the safety and well-being of the9,000 residents of Rock Falls. Through proactivecommunity engagement and partnerships in the areasof homelessness, mental illness, and substanceabuse, we work every day to improve the lives ofthe residents we serve.



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Like the Sterling PD, our officers aremembers of the Crisis Intervention Team, whichpartners with community agencies to identify andcase-manage citizens struggling with mentalhealth, homelessness, substance abuse by linkingthem to needed services. Because CGH does not have a dedicatedbehavioral health unit, the citizens we work withare usually transported over two hours away whenacute inpatient mental health services are needed.As a primary health care service, sending thesepatients away for behavioral health services isunacceptable. This poses an extremely difficultsituation for the families left behind, and ourofficers experience firsthand the difficulties andnightmare scenarios associated with thesetransfers, including the challenges of finding away home after discharge and then sometimes a homeafter that. Chicago hospitals like Hartgrove andChicago Behavioral Hospital do not have dischargefunctions that can effectively help with WhitesideCounty patients' transition to outpatient setting.



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In Whiteside County alone, one out of fiveadults suffer from mental illness. Suicide is theleading cause of death for ages 15 to 43. Thevast majority limit seeking out care because ofthe stigma of mental illness, transportationproblems, lack of access, and fear of beingtransferred outside of the community, away fromtheir families. Lack of care continually negativelyimpacts the ability for our City to successfullyhelp these citizens become productive members ofthe community. The demand here and the lack ofaccess to beds close to home hurts everyone in ourcommunity and most particularly this marginalizedand vulnerable group. Please approve this application. My cityis in desperate need of access to these servicescloser to home. Thank you. MS. VERHULST: Thank you. My name isDiana Verhulst. I'm the CEO of United Way ofWhiteside County. Please approve CGH MedicalCenter's request to open an acute mental illnessprogram, Project 19-49.



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For 74 years in Whiteside County, ourUnited Way has raised money to provide services toenhance the dignity of all people and strengthenour communities. I am here to advocate for thevulnerable members of our community. We have to advocate for them becauseindividuals with mental illness are some of themost marginalized people in our state. Ourcommunity needs an inpatient behavioral healthservice center at CGH. As it stands, CGH can onlyoffer basic stabilization through medicationadministration in its emergency department, andthey are usually required to transfer thesepatients over 100 miles to get the patientcomprehensive inpatient psych services. As I serve on several local task forces,I am aware of our community's behavioral healthneeds. Since 2017 more than 215 of our residentswere unable to obtain transfer after waiting forup to four days and sometimes longer to haveanother hospital accept them. Often it is theuninsured patients who cannot be transferred.This is unconscionable. These patients neverreceive the proper treatment that they deserve.



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Similarly, 30 percent are not accepted fortransfer until at least 24 hours afterpresentation, and 57 percent of these patients aretransferred more than 50 miles away. People who have what are considered to bemedical diseases are treated far better by thehealth care system. Mental illness is real andtreatable, but these patients live in the shadowof our society. Our local PADS homeless sheltersees that. Many of those who appear at theirdoor, sometimes in the middle of the night and inthe dead of winter, are mentally ill. MR. ROATE: Two minutes. MS. VERHULST: Thank you very much forallowing me to speak. Please approve thisproject. MR. PHELAN: Good morning. My name isPatrick Phelan, P-a-t-r-i-c-k P-h-e-l-a-n, and I'mthe president and CEO of Sinnissippi Centers,Incorporated, which is the primary provider ofoutpatient behavioral health care in NorthwestIllinois. At Sinnissippi we provide quality,coordinated, and responsive health care services



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to a broad segment of the communities that weserve. It's with this mission in mind that I'mhere to support CGH Medical Center's request toopen an inpatient behavioral health unit. As an organization serving the needs ofthe community, CGH has identified a noticeabledisparity in the availability of access toinpatient behavioral health services. Sinnissippishares this concern and believes the addition of abehavioral health unit at CGH will close that gap. Sinnissippi currently provides crisisintervention services and inpatient placement forCGH. Our team is challenged daily with findinginpatient beds for patients presenting to CGH withbehavioral health needs. We know firsthand thenumber of patients who are referred away from ourcommunity. In many cases these people are placed athospitals that are easily one to two hours fromhome. This impacts continuity of care and ourability to effectively follow up with outpatientcare. Unfortunately, this cannot -- this canresult in individuals returning to the emergencydepartment due to a continued cycle of acute



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episodes of mental health crisis. As an independent organization servingboth CGH Medical Center and KSB Hospital, we donot believe that the addition of behavioral healthbeds in this area will duplicate services providedat KSB Hospital. Rather, the addition of bedswill serve to augment further access. On behalf of Sinnissippi, I urge you toapprove this proposal so that we can effectivelyand successfully provide behavioral healthservices to our community at a local level. MS. GUILD: Thank you. And the last project is AssociatedSurgical Center, Project No. 19-054. MS. YAROSH: Can you hear me? My name is Julie Yarosh, J-u-l-i-eY-a-r-o-s-h, and I'm here to ask for approval forAssociated Surgical Center. I am a very active member of thenorthwestern suburban community as well as a veryactive member of Eastern European community in thenorthwest suburbs. I'm also a board member of thechildren's organization who serves EasternEuropean community and other immigrant



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communities. Also, I'm a patient of Dr. Levitin, aswell as my entire family. THE COURT REPORTER: I'm sorry. Say thatagain. MS. YAROSH: I'm a patient of the centeras well as my entire family, my husband, myfather, even my 11-year-old daughter. I can also say that most of the kids thatwe work with and those -- again, kids from otherimmigrant families, their parents and theirgrandparents and their families are also patients. Everyone in our community knows thatcenter. This is the center that provides great,great health care. It also serves -- it alsoserves a purpose of getting access -- gettingaccess to that quality health care to theunderprivileged community in northwest suburbs. Having an orthopedic arm of it isabsolutely paramount to our community. At thispoint it's a huge void, and providing thoseservices in the setting that is comfortable topeople who are, in a lot of cases, not familiarwith the medical practices in this country is



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absolutely essential. And, again, I respectfully ask forapproval. MS. GUILD: Thank you. Is there anyone else in the audience whowishes to speak who didn't give me a registrationform? (No response.) MS. GUILD: Doesn't look like it. THE COURT REPORTER: Please leave yourremarks with Mike. - - -



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MS. AVERY: Good morning. I wanted togive you-all an idea of what we're -- how the dayis going to proceed. So we will take a break for lunch about1:30, quarter to 2:00, depending on where we arein the agenda, and the break will be anywherebetween an hour to an hour and 15 minutes. So we'll do as much as possible to try togive you exact times and updates as we gothroughout the morning. Thank you. CHAIRWOMAN SAVAGE: Mr. Constantino,please read into record these items approved bythe Chair in accordance with the Illinois HealthFacilities Planning Act. Thank you. MR. CONSTANTINO: The following items havebeen approved by the Chair: An 18-month permitrenewal for DaVita Hickory Creek Dialysis, PermitNo. 17-063; a permit renewal for FKC New Lenox,Permit No. 17-065; a 12-month permit renewal forIllinois Spine Institute, Permit No. 18-044;relinquishment of a permit, FMC West Belmont,Permit No. 18-045; a one-year extension of a



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financial commitment period, Permit No. 18-034,for Edward Hospital; and a discontinuation ofintensive care services at HSHS St. Joseph'sHospital in Breese, Illinois, ExemptionNo. E-050-19. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. - - -



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CHAIRWOMAN SAVAGE: Next on the agenda isItem A-01, Project 17-069, Memorial Hospital Eastmedical clinics building in Shiloh. May I have a motion to approve a 12-monthpermit renewal for Project 17-069, MemorialHospital East medical clinics building, Shiloh. MEMBER MARTELL: I so move. CHAIRWOMAN SAVAGE: A second? MEMBER SLATER: Second. CHAIRWOMAN SAVAGE: Please be sworn in andidentify yourselves. (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: Senator Demuzio -- MEMBER DEMUZIO: Yes? CHAIRWOMAN SAVAGE: -- can you putyourself back on mute, please? THE COURT REPORTER: Would you raise yourright hands, please. (Two witnesses sworn.) THE COURT REPORTER: Thank you. CHAIRWOMAN SAVAGE: Mike, please give theState Board staff report. MR. CONSTANTINO: Thank you, Madam Chair. The permit holders are asking the



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State Board to approve a 12-month permit renewalfor Permit No. 17-069, from December of 2019 toDecember 2020. In February of 2018, the State Boardapproved the permit holders for a three-storyaddition to a medical clinic building, approved asPermit No. 16-018, that is located on the campusof Memorial Hospital East in Shiloh, Illinois. The permit holders state the reason forthe permit renewal is to accommodate theinstallation of a second linear accelerator inspace originally designated as physician officespace. Approximately 45 percent of the projecthas been expended, and the permit has beenfinancially committed. This is the first permitrenewal request for this project. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. Please proceed with your statement to theBoard. MR. BRATCHER: Hi. My name is GregBratcher with BJC HealthCare. The basic impulsebehind this project was to bring a comprehensive



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cancer center to Southern Illinois. Comprehensivecancer centers are designated by the NationalInstitute of Health with a rigorous set ofcriteria. There are 51 in the country. And thatmay first sound like there's one per state plusthe District of Columbia, but, instead, it is only36 states that have them. Illinois is lucky. It has two. They'rein Chicago, both of them, Northwestern and theUniversity of Chicago. This project would bring acomprehensive cancer center -- the second cancercenter -- to Southern Illinois. We had estimated 8,000 treatmentprocedures in the first year on the linearaccelerator and 9200 in the second. Last year wewere at 9900. We think we'll be at 10,000this year. It seems prudent, while we're stillthere, to go ahead and bump out a second vault andadd this linear accelerator. Thank you very much for your time. I'llanswer any of your questions. CHAIRWOMAN SAVAGE: Are there anyquestions by the Board members? (No response.)



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CHAIRWOMAN SAVAGE: Okay. George, willyou please call the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Dr. Martell; seconded byMr. Slater. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon the -- onthe State report. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, approve based onconformance with standards. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the reportwe've heard. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the reportand the testimony. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thereport and his testimony.



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MR. ROATE: That's 5 votes in theaffirmative. CHAIRWOMAN SAVAGE: The permit renewal isapproved. Thank you. - - -



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CHAIRWOMAN SAVAGE: All right. So next onthe agenda is Item D-01, Project 17-069, MemorialHospital East medical clinics building in Shiloh. May I have a motion to approve analteration to Project 17-069 to increase projectcost by $2,446,980 or 5.34 percent. MEMBER MARTELL: I so move. CHAIRWOMAN SAVAGE: And a second? MEMBER MURRAY: Second. (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: Mike, please presentour staff Board report. MR. CONSTANTINO: Thank you, Madam Chair. The permit holders are asking the Board toapprove an alteration to Permit No. 17-069 thatwould increase the cost of the project fromapproximately $38.3 million to $40.7 million orapproximately 5.3 percent. There is no increase in the total grosssquare footage. As mentioned previously, this isa result of the addition of a linearaccelerator -- second linear accelerator at thismedical clinics building. Thank you, Madam Chair.



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CHAIRWOMAN SAVAGE: And please proceedwith your statement to the Board. MR. AXEL: Thank you, Madam Chairman. The alteration does relate directly to theaddition of the second linear accelerator, andI would just like to note that the increasedproject cost is consistent with your alterationguidelines. We'd be happy to answer your questions. CHAIRWOMAN SAVAGE: Do we have anyquestions? (No response.) CHAIRWOMAN SAVAGE: Okay. George, pleasecall the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Dr. Martell; seconded byDr. Murray. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thereport. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on staffreport.



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MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the reports. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the report. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on reportand staff -- or testimony. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit alterationis approved. Thank you. MR. BRATCHER: Thank you. MR. AXEL: Thank you. - - -



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CHAIRWOMAN SAVAGE: So next on the agendais Item A-03, Project 14-057, Advocate ChristMedical Center in Oak Lawn. May I have a motion to approve a 32-monthpermit renewal for Project 14-057, Advocate ChristMedical Center in Oak Lawn. MEMBER MURRAY: So moved. CHAIRWOMAN SAVAGE: A second? MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: Please identifyyourselves and please be sworn in. MS. SWEIS: Good morning. Rolla Sweis,R-o-l-l-a S-w-e-i-s. MR. LYONS: Patrick Lyons, L-y-o-n-s. THE COURT REPORTER: Would you both raiseyour right hands, please. (Two witnesses sworn.) THE COURT REPORTER: Thank you. Pleaseprint your names, as well. CHAIRWOMAN SAVAGE: Mike, please give thestaff Board staff report. MR. CONSTANTINO: Thank you, Madam Chair. The permit holders are asking the Board toapprove a 32-month permit renewal for Permit



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No. 14-057, to August 31, 2023. In January of 2015, the permit holderswere approved to expand and modernize its Level Itrauma center and its adult and pediatricemergency departments, relocate three inpatientendoscopic rooms, and expand its Phase I andPhase II recovery units. The permit holders state the reason forthe permit renewal was the unanticipateddeficiencies with the existing building rampinfrastructure that was to be used as part of themodernization/expansion project approved as PermitNo. 14-057. The permit is financially committed. Thisis the first permit renewal request for thisproject. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Please proceed withyour statement to the Board. MS. SWEIS: Good morning. Our emergency department is a Level Itrauma center. We're a part of Advocate AuroraHealth system. We have over a hundred thousandpatient visits. And as stated, we're here for a



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renewal request regarding the project. I will turn it over to Pat to give alittle bit more detail as to the reasons behindthat. MR. LYONS: Good morning. I am thedirector of design and construction -- MS. AVERY: Can you speak closer to themic so she can hear? MR. LYONS: Good morning. My name isPatrick Lyons. I am the director of design andconstruction with Advocate Aurora. And with regards to this project, wecertainly understood, going into it, thecomplexity of this project, and we also knew someof the challenges. We encountered a number ofchallenges along the way that was a little bitmore than we had foreseen, and that's where we'reat at this particular point now, asking for anextension. The main item that really caused the delaywas the ambulance ramp. The ambulance ramp sitson the west side of the campus. And at thatparticular point, that's where all the ambulancesenter and drive up this ramp to deliver the



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patients into the emergency department. The reason the ramp is there is over a fewdecades of expansion the multiple expansions ofbuildings onto that emergency departmentpropagated west. And when it finished at the end,right before Kilbourn Street, there's an 8-footdifference in height between the west side of thecampus and the east side of the campus, so thedifference was made up with a ramp, and we utilizethat ramp to escort the ambulances up and deliverthe patients into the emergency department. Part of the emergency department planningtook into account that that ramp looked physicallyin good shape. It was renovated about two yearsprior to that, and we did not foresee any issueswith utilizing that in place. All of our work plans that we had put inplace when we came to this Board back then hadnumerous amounts of work that were going to bedone together. And when the ramp was discoveredthat it had deficiencies in the steel structure,we had to then move to a sequential amount of workplanned because we had to replace the entire ramp. What we found was underneath the ramp it's



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supported by major beam structures, and they wereall fireproofed with a fireproofing material.What that did was that kind of masked theintegrity of the steel structure. We had scraped off early on to do someclip points for some mechanical ductwork and somelighting, and what we noticed, that the webbing inbetween the beams had deteriorated by almost50 percent. There was holes sizeable enough toput your hand through, and all that was masked bythe fireproofing. We then understood that we were going tohave to replace this ramp in kind, and it is abouta 200-foot-long ramp section. That really slowedus to bring power into the building and finishsome of the subsequent items that would beunderneath that area and some of the expansionuntil that ramp was done. Our request is really broken into twoparts for you to understand it a little bitbetter. We really need 24 months to finish all ofthe work that's needed to renovate and maintainthe scope and the intent of the permit. The otherseven to eight months is really the closeout piece



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and final reporting to the State. So the 24 months is -- we're going to befocusing on completing the work and, with a safeand integral manner, to upgrade the emergencydepartment at Grace Medical Center on its intentof completing all that full scope. That's -- ifwe can get that extension, that is really ourfocus at this time. And if you have any questions, I'll behappy to answer those. CHAIRWOMAN SAVAGE: Questions? (No response.) CHAIRWOMAN SAVAGE: My question to themembers would be, do we think a yearly annualreport might be helpful in this situation? (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: An additionalreporting every six months. Or do we think what they're proposing nowis sufficient? MS. AVERY: Right now annual reports aredue once a year, and the next report is due inFebruary. MR. LYONS: Correct.



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MS. AVERY: So we're asking this Board ifthey think, based on the testimony, if we can havean abbreviated report that's due every six monthsand still the full report due annually. And we will work with the Applicant togather any information to make sure it's not anundue burden on them and that the staff is gettingthe information as needed, if you think that the32 months has been explained. That was the question, was the 32-monthextension too long. So do you just continue to want the annualreport? Or would you like an abbreviated reportevery six months and then a full report onthe year mark? MEMBER MURRAY: So, again, let me be clearabout our strange rules. So we -- what I hear you saying -- MS. AVERY: A little closer to the mic. MEMBER MURRAY: What I hear you saying isthat in a few months, in February, they'll have tomake a report, and then they don't have to makeanother report for another 12 months. MS. AVERY: Correct.



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MEMBER MURRAY: And this is -- this can'tbe shifted? Like if we renew it today. MS. AVERY: No. MEMBER MURRAY: All right. In that case,then, 32 months does seem a little long and maybethe 6-month report would make sense. MS. AVERY: Okay. And from theApplicant's point, do you think that will be anundue burden? We will work with you on the abbreviated;it doesn't have to be as much detail as in theannual report. MR. LYONS: If that satisfies the Board,we'd be happy to do that. MS. AVERY: Great. Mike, any feedback? MR. CONSTANTINO: That will work. MS. AVERY: Okay. Thank you. CHAIRWOMAN SAVAGE: Thank you. Do we have any other questions? (No response.) CHAIRWOMAN SAVAGE: Okay. George, pleasecall the roll. MR. ROATE: Thank you, Madam Chair.



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Motion made by Dr. Murray; seconded byDr. Martell. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thecomment and testimony and the report that I'veheard today. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on the staffreport, testimony, and then the six-month report. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on theagreement we've come to. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the reportand the testimony. MR. ROATE: Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thereport and the revised six-month report. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit renewal is



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approved. Thank you. - - -



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CHAIRWOMAN SAVAGE: Next on the agenda isItem A-06, Project 16-006, Alden Estates ofBartlett. (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: May I have a motion toapprove a 24-month permit renewal for theProject 16-006, Alden Estates of Bartlett. MEMBER SLATER: Move to approve. CHAIRWOMAN SAVAGE: A second? MEMBER MURRAY: Second. CHAIRWOMAN SAVAGE: Please be sworn in andidentify yourselves. THE COURT REPORTER: Would you raise yourright hands. (Three witnesses sworn.) THE COURT REPORTER: Thank you. Andplease print your names. MR. KNIERY: My name is John Kniery. I'mthe CON counsel -- I'm sorry -- CON consultant forthe project. And with me to my left is Alan Gaffner.He is government affairs and business developmentfor Alden. And to his left is Joe Ourth, theCON counsel.



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Thank you. CHAIRWOMAN SAVAGE: Mike, please presentthe staff Board re- -- staff report. MR. CONSTANTINO: Thank you, Madam Chair. I'd first like to ask -- remind the Boardmembers this was emailed to you after we got thepermit renewal a little later than we usually do.So, hopefully, all of you have read the comment --read the report. The permit holders are asking the Board toapprove a permit renewal of 24 months from -- toDecember 31st, 2021. In May of 2016, the State Board approvedProject 16-006. The permit authorized theestablishment of a 68-bed long-term care facilityin Bartlett, Illinois. The project is obligatedand the current project completion date isDecember 31st, 2019. The project is approximately 5 percentcomplete. Architectural drawings to IDPH have notbeen submitted, and the project cost isapproximately $19.1 million. This is the first permit renewal for thisproject.



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Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Please proceed withyour statement to the Board. MR. GAFFNER: Thank you. Good morning, Madam Chair, Planning Boardmembers, including Senator Demuzio inCarlinville -- MEMBER DEMUZIO: Hello. Hi there. MR. GAFFNER: -- and Planning Board staff. Thank you very much for the opportunity tobe included on the agenda today. We originally had an ambitious plan thatwould build our newest nursing home behind anunrelated assisted-living memory care facilitythat was being planned. This area is growing and when the projectwas approved, the assisted-living facility wasahead of our project in the development processand just completed their project this year. Thatinherently delayed our project and created adomino effect of delays on other components tocomplete before our construction could commence. Please know that this unique location,behind an existing, unrelated memory care



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facility, has proven to be much more difficultthan originally anticipated. Today we are respectfully requesting arenewal of our permit that would, in essence,restart our development time line. Final workingdrawings are in place but cannot be completeduntil final approval of a planned unit developmentby the Village of Bartlett. We can then finalizeour working drawings and submit for review to theIllinois Department of Public Health. Upon approval, we can begin construction,and with a 14-month construction time line, weproject to break ground in the fall of thiscoming year so that we are in the ground and,hopefully, enveloped and enclosed before wintersets in and gives us a little time afterconstruction is complete to obtain licensure. MR. KNIERY: I'd just like to add that,first and foremost, we have tried to keep theBoard and staff abreast of the project status, theproject's -- including the project's annualprogress report. And in addition, I'd like to assure theBoard of the Applicant's commitment to the



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project, as Alden has invested nearly $1 millionin this project. And I'd love to have any questions you mayhave. Thank you. CHAIRWOMAN SAVAGE: Any questions? (No response.) CHAIRWOMAN SAVAGE: One question I have:Would you be able to do the -- or would you do theabbreviated staff report every six months to keepus up to date and the annual report? MR. GAFFNER: Madam Chair, we wouldcertainly provide those time line reports. CHAIRWOMAN SAVAGE: And that would be anabbreviated report, as Courtney had mentionedbefore, that the staff could work with you on thedetails. MR. GAFFNER: Yes. We would be happy todo that. MS. GUILD: Question over here. CHAIRWOMAN SAVAGE: Yes. Go ahead. MEMBER MARTELL: Can you give me a littlemore updated information on how the discussionwith the Village of Bartlett and their plan reviewis going?



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MR. GAFFNER: As mentioned, the completionjust recently of the construction of thatassisted-living facility now brings us back towhere we can take some of those initialdiscussions and make them more detailed and thenget into the queue for that. Some preliminary work has been done, butthat final planned unit development approval hasreally been on hold while this was occurring as itrelates to roadways and some other aspects. I hope that provides some additionalinformation. MR. KNIERY: And if I may, all theconversations to date with The Alden Group --they've represented -- are very positive with theVillage. What's moved forward is just thetechnical issues, getting down -- we receivedinitial approval. The change that has to come isfrom changing the ingress and egress to theproperty -- to the site -- and that is requiringthis -- the new change. But so far everything has been positive.They've approved everything to date. We just needto -- it's more of a technical issue at this point



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that's holding us up. MEMBER MARTELL: And I would like to seethat addressed in the updated reports, where theVillage is on their approvals. CHAIRWOMAN SAVAGE: Any other questions? (No response.) CHAIRWOMAN SAVAGE: George, can you pleasecall the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Mr. Slater; seconded byDr. Murray. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thecomments I've heard and the report, staff report. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on staffreport and the more frequent reporting. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on morefrequent reporting and the staff report. MR. ROATE: Thank you. Mr. Slater.



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MEMBER SLATER: Yes, based on the reportand the testimony. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thereport and the six-months abbreviated detail. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit renewal isapproved. MR. KNIERY: Thank you. MR. GAFFNER: Thank you very much. THE COURT REPORTER: Leave your remarks,if you would, with Mike, please. - - -



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CHAIRWOMAN SAVAGE: Next on the agenda isItem C-03, Project E-048-19, Anderson Hospital,Maryville. May I have a motion to approveExemption E-048-19, Anderson Hospital, for achange of ownership. MEMBER DEMUZIO: I motion. CHAIRWOMAN SAVAGE: Second? MEMBER SLATER: Second. CHAIRWOMAN SAVAGE: Please identifyyourself and be sworn in. MR. PAGE: Keith Page, president ofAnderson Hospital. THE COURT REPORTER: Would you raise yourright hand, please. (One witness sworn.) THE COURT REPORTER: Thank you. Andplease print your name, as well. CHAIRWOMAN SAVAGE: Mike, please presentthe staff Board report. MR. CONSTANTINO: Thank you, Madam Chair. There are two exemptions associated withthis corporate restructuring, E-048-19, AndersonHospital in Maryville, and E-049-19, Community



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Hospital of Staunton. They're asking the Board to approve thiscorporate restructuring in order to establishAnderson Healthcare to oversee and control twolicensed hospitals. At the conclusion of thetransaction, Anderson Healthcare will become thesole corporate member of Southwestern IllinoisHealth Facilities, Inc., therefore having ultimatecontrol of both hospitals. There is no cost to the transaction, andthere is no change in the licensee or owner of thesite. No public hearing was requested, and nocomments were received by the Board. Thank you very much, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. Please proceed with your statement to theBoard. MR. PAGE: Good morning, Madam Chair andmembers of the Health Facilities Services ReviewBoard. Thank you for the opportunity to speak onbehalf of the COEs submitted by Anderson Hospitaland Community Hospital of Staunton. I am Keith Page. I'm president of



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Anderson Hospital. Historically, since Southwestern IllinoisHealth Facilities, Inc., an Illinois not-for-profit corporation, d/b/a Anderson Hospital, firstopened its doors in 1977, the corporation has hadno corporate member. Over the past few decades,Anderson Hospital has been an integral health careprovider to residents of Madison County, Illinois,and has expanded its operations to include notonly Anderson Hospital but Community Hospital ofStaunton, Anderson Medical Group, MaryvilleImaging, and other entities depicted in theorganizational chart provided with the COEapplication. As the organization has grown andexpanded, the board of trustees determined that itwould be appropriate to restructure the corporateorganization by creating a new not-for-profitentity called Anderson Healthcare to oversee allthe organizations now under the Anderson Hospitalumbrella. To implement the reorganization, AndersonHealthcare has been incorporated, and it will bedesignated as the sole member of Anderson



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Hospital, Community Hospital of Staunton, and theother entities as noted in the posttransactionorganizational chart. The purpose of this reorganization is tostructure Anderson Healthcare and its affiliatesin a manner which will allow for more streamlinedgovernance structure, more uniform oversight oforganizational operations and compliance matters,greater operational flexibility, and improvedoverall organizational efficiency. I'm happy to answer any additionalquestions at this time. CHAIRWOMAN SAVAGE: Any questions? (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: Mike, do you have anyquestions about the corporate restructuring? MR. CONSTANTINO: Could you explain whythis is being done, Mr. Page? MR. PAGE: Yes. So currently our hospital board -- which,as you recall, was formed when we just had asingle hospital as part of the organization. Wenow have two hospitals, an imaging center, amedical group, a real estate company, and a



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surgery center which will be opening in the summerand then a rehab hospital coming. All of that isreporting to the Anderson Hospital board. This is a structure that will allow theAnderson Hospital board to continue to focus onthe operations of that hospital, quality careinitiatives. And the overall governance of allthose entities will then fall under the AndersonHealthcare board, so that is the purpose of thisrestructuring. CHAIRWOMAN SAVAGE: Any other questions,Mike? MR. CONSTANTINO: Are you going to be theCEO of Anderson Healthcare? MR. PAGE: I will be the -- I will be theCEO. There's actually -- the CFO of AndersonHospital will be the CFO of Anderson Healthcare.The nine members that are being appointed to theAnderson Healthcare board are all coming from ourAnderson Hospital board and will continue to serveon the Anderson Hospital board at this point, aswell. So there's actually no changes in thepersonnel involved in this organization at this



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time. CHAIRWOMAN SAVAGE: Any other questions? (No response.) CHAIRWOMAN SAVAGE: Okay. George, pleasecall the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Senator Demuzio; secondedby Mr. Slater. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thecomments I've heard today and, also, the staffreport. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on the staffreport and the testimony heard today. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on theapplication and staff report. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the reportand the testimony.



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MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thestaff Board staff report and the testimony today. MR. ROATE: Thank you. That's 5 votes in the affirmative. MR. PAGE: Thank you very much. CHAIRWOMAN SAVAGE: The exemption isapproved. Thank you. - - -



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MS. AVERY: Members, although we combinedthe two exemptions, C-03 and C-04, I've beenadvised that we need separate votes on that butnot another testimony. So there will be a motion for this samegentleman but we'll vote -- unless you havequestions for him. One second, sir. Any questions for him on the CommunityMemorial health change of ownership? (No response.) MS. AVERY: Okay. We'll make the motionand approve it. Although it's combined on the State Boardstaff report, we need separate motions for it.Sorry. CHAIRWOMAN SAVAGE: So may I have a motionto approve Exemption E-049-19, Community Hospitalof Staunton, for a change of ownership. MEMBER SLATER: I move to approve. CHAIRWOMAN SAVAGE: A second? MEMBER MARTELL: I second. CHAIRWOMAN SAVAGE: Roll call, please,George.



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MR. ROATE: Thank you, Madam Chair. Motion made by Mr. Slater; seconded byDr. Martell. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thereport. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on the staffreport and testimony. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the previousvote. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the previousvotes. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on staffreport and testimony. MR. ROATE: That's 5 votes in theaffirmative.



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CHAIRWOMAN SAVAGE: The exemption isapproved. Thank you. MR. PAGE: Thank you again. - - -



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CHAIRWOMAN SAVAGE: So next on the agendais C-06, Project E-051-19, Little Company of MaryHospital in Evergreen Park. May I have a motion to approveExemption E-051-19, Little Company of MaryHospital. MEMBER SLATER: I move to approve. CHAIRWOMAN SAVAGE: A second? MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: Please identifyyourselves and then be sworn in. MR. HOHULIN: Mark Hohulin, senior vicepresident with OSF HealthCare system. MR. QUERCIAGROSSA: A. J. Querciagrossa,executive sponsor, OSF HealthCare system, forintegration of Little Company of Mary. DR. HANLON: John Hanlon, J-o-h-nH-a-n-l-o-n, president and CEO of Little Companyof Mary Hospital. THE COURT REPORTER: Would you raise yourright hands, please. (Three witnesses sworn.) THE COURT REPORTER: Thank you. Pleaseprint your names, as well.



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CHAIRWOMAN SAVAGE: Mike, please presentthe State Board staff report. MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the State Boardto approve a change of ownership of a 298-bedacute care hospital known as Little Company ofMary Hospital and Health Care Centers in EvergreenPark. OSF HealthCare system will become a hundredpercent owner of the hospital upon completion ofthe transaction in February of 2020. The hospital will be known asOSF HealthCare Little Company of Mary MedicalCenter. The licensee and owner of the site willbe OSF HealthCare system. There is no cost to the transaction. Nopublic hearing was requested, and letters ofsupport were received. No oppositions werereceived by the State Board. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Okay. Please proceedwith your statement to the Board. MR. HOHULIN: Good morning. We'd just like to thank the State stafffor the review and support of the change of



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ownership application for Little Company of Maryto become part of the OSF HealthCare system aswell as the CON Board for your review thismorning. We really don't have any additionalcomments but are happy to answer any questions youhave. CHAIRWOMAN SAVAGE: Does anyone have anyquestions? (No response.) CHAIRWOMAN SAVAGE: I do have onestatement. There were several attempts to merge andpurchase Little Company of Mary Hospital. Couldyou provide us with more insight into yourdecision about this purchase? DR. HANLON: Little Company of MaryHospital is a stand-alone hospital in EvergreenPark, and we've been seeking an affiliationpartner for about three years now. And we havebeen doing that because we've had some operationalchallenges, and we've realized that in thishospital and medical environment it really isimpossible to succeed as a stand-alone hospital.



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This is evidenced most recently by theclosure of MetroSouth Hospital, which is 4 milesaway from Little Company of Mary Hospital. So we think we have found inOSF HealthCare a health care system that isaligned with our philosophy and our mission and isgoing to allow us access to capital, access toinnovation, access to personnel to help us todevelop our -- our ability to deliver health careto the community. CHAIRWOMAN SAVAGE: Thank you. Mike, do you have any questions? George? MR. ROATE: No. MR. CONSTANTINO: Is there any intent todiscontinue any services at the hospital? DR. HANLON: No, there is not. In fact,we think this will help us to grow our servicesbecause of the ability to innovate and toinstitute best practices, which OSF has institutedon the system level. MR. CONSTANTINO: Is OSF HealthCarecommitted to spending capital for the hospital? DR. HANLON: Absolutely. That's part of



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the affiliation agreement. MR. CONSTANTINO: How much? Do you have afigure you could give the Board? DR. HANLON: 300 million over 10 years. MR. CONSTANTINO: Thank you. CHAIRWOMAN SAVAGE: Any other questions? (No response.) (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: George, please callthe roll. MR. ROATE: Thank you, Madam Chair. Motion made by Mr. Slater; seconded byDr. Martell. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon the staffreport. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on the staffreport. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the reportand testimony.



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MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the reportand the testimony and the commitment thatSt. Francis has made to future capital. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on theState staff Board report as well as the testimony. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The exemption isapproved. Thank you. DR. HANLON: Thank you. MR. QUERCIAGROSSA: Thank you. - - -



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CHAIRWOMAN SAVAGE: Next on the agenda isItem C-07, Project E-052-19, Schwab RehabilitationHospital in Chicago. May I have a motion to approveExemption E-052-19, Schwab RehabilitationHospital, to discontinue a 21-bed long-term carecategory of service. (No response.) CHAIRWOMAN SAVAGE: A motion to approve? MEMBER SLATER: I move to approve. CHAIRWOMAN SAVAGE: A second? MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: Please identifyyourself and then be sworn in. MS. GOLLINGER: Good morning. My name isMary Gollinger, and I'm the vice president ofSchwab Rehabilitation Hospital. THE COURT REPORTER: Would you raise yourright hand, please. (One witness sworn.) THE COURT REPORTER: Thank you. CHAIRWOMAN SAVAGE: Mike, please presentthe State staff Board report. MR. CONSTANTINO: Thank you, Madam Chair.



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The Applicants are asking the State Boardto approve the discontinuation of a 21-bedlong-term care category of service at SchwabRehabilitation Hospital in Chicago, Illinois. There were no letters -- excuse me. Nopublic hearing was requested, and no letters ofopposition were received. We did receive lettersof support for this application. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. Please proceed with your statement to theBoard. MS. GOLLINGER: I have no other things toadd other than what were in the report or toanswer any questions you may have. CHAIRWOMAN SAVAGE: Do members havequestions? (No response.) (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: Are you able toeducate the Board on the CMS reimbursement changeand the possible effect on similar institutions? MS. GOLLINGER: So the CMS reimbursementchange, there has been a model that's called PDPM,



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which is -- MS. AVERY: Hold the microphone closer. MS. GOLLINGER: I'm sorry? MS. AVERY: Hold the mic closer so we canhear. MS. GOLLINGER: Okay. -- PDPM, patient-driven payment model,which is under the guidelines for nursing homes.And so what it does is it pays for patients innursing homes or long-term care facilities --which this was licensed under -- for acute nursingcare, and Schwab provided intense therapyservices. So those patients that we took whoneeded intense therapy services were not acategory that we would be reimbursed for. My understanding is the nursing homeindustry, in general, has already changed theirmodel. And it is unlikely that, you know, theircensus will decrease, but those patients who needintense rehab services but don't qualify for aninpatient level of rehab care, an LTACH, or homehealth care outpatient are going to be withoutsomeplace to go, but I believe that will be asmall number. I believe they'll be able to figure



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that out. CHAIRWOMAN SAVAGE: Any other questions? (No response.) CHAIRWOMAN SAVAGE: Okay. George, pleasecall the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Mr. Slater; seconded byDr. Martell. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon the staffreport. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on staffreport. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the staffreport. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the report. MR. ROATE: Thank you. Chairwoman Savage.



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CHAIRWOMAN SAVAGE: Yes, based on thestaff report. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The exemption isapproved. Thank you. MS. GOLLINGER: Thank you. - - -



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CHAIRWOMAN SAVAGE: Next on the agenda isItem H-01, Project 19-030, CoultervilleRehabilitation and Health Care Center inCoulterville. May I have a motion to approveProject 19-030, Coulterville Rehabilitation andHealth Care Center, to add 25 long-term care bedsto its existing long-term care facility. MEMBER MURRAY: So moved. CHAIRWOMAN SAVAGE: A second? MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: Please identifyyourselves and then be sworn in. MR. OBERLINK: Whitney Oberlink. MR. HYLAK-REINHOLTZ: Joe Hylak-Reinholtz,counsel for the Applicant. MR. LEVITT: Michael Levitt, vicepresident, Tutera Senior Living & Healthcare. THE COURT REPORTER: Would you raise yourright hands, please. (Three witnesses sworn.) THE COURT REPORTER: Thank you. CHAIRWOMAN SAVAGE: Mike, please presentthe State Board staff report.



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MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the Board toapprove the addition of 25 long-term care beds toa 75-bed long-term care facility for a total of100 long-term care beds at a cost of approximately$2.4 million. The expected completion date isDecember 31st, 2020. A public hearing was offered regarding theproposed project but none was requested. Lettersof support were received. No opposition werereceived by the State Board. Board staff found one criterion out ofcompliance with Board rules regarding -- it wasregarding the reasonableness of project cost, sitepreparation fees. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. Please proceed with your statements to theBoard. MR. OBERLINK: Good morning, ChairpersonSavage, other distinguished members of theState Board, Administrator Courtney Avery, andex officio agency reps. My name is Whitney Oberlink. I'm the



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administrator of Coulterville Rehab and HealthCare facility, a long-term care facility inCoulterville, Illinois, located in Randolph Countyand Health Service Area 5. I am here representingthe Co-Applicants. Today I respectfully ask you to grant aCON permit for this important project, whichproposes a 25-bed expansion to our existing 75-bedlong-term care facility. At the table to my left is our CONattorney and consultant, Joe Hylak-Reinholtz. I'malso joined by Mike Levitt, vice president fromthe Tutera Group, who oversees businessdevelopment for all Tutera-affiliated facilities. If the Board desires to proceed to a votenow, that's fine. Alternatively, we are happy toprovide a very brief summary of the project andanswer all questions you might have. CHAIRWOMAN SAVAGE: Do we have anyquestions? (No response.) CHAIRWOMAN SAVAGE: Mike and George, anyquestions? MR. CONSTANTINO: How does the change in



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reimbursement affect the long-term care facilitiesthat we just heard? MR. OBERLINK: Well, the new PDPM rate sofar has been not a negative effect at all for ourfacility. We've actually seen an increase in ouraverage daily reimbursement for our skilledreferrals. CHAIRWOMAN SAVAGE: Okay. Thank you somuch. George, will you please call the roll. MR. ROATE: Thank you, Madam Chair. Motion -- CHAIRWOMAN SAVAGE: I'm sorry. We haveone more question. MEMBER MARTELL: And, again, there was --one of the areas that was found was thereasonableness of cost expenses, the survey andsite prep. Can you speak to that? MR. LEVITT: Yes. I -- Mike Levitt, vicepresident, Tutera Senior Living. Yes, it's separate areas of costallocation in the project that's over $2 million,and in our site prep we exceeded the State check



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on that at 5 percent. So in the process of actually developingthe project once we get going, we'll bring thatback down to that amount. It's -- I think,Mike -- I don't have the number in front of me -- MR. HYLAK-REINHOLTZ: It's 1.67 percent. MR. LEVITT: It's 1.67 percent over the5 percent, so we'll manage back down to that5 percent. It should not be an issue at allfor us. CHAIRWOMAN SAVAGE: Other questions? (No response.) CHAIRWOMAN SAVAGE: Okay. Now, George,please call the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Dr. Murray; seconded byMr. Martell. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon the staffreport. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on staffreport and testimony.



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MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the staffreport and testimony. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on staffreport. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on staffreport and testimony. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit isapproved. Thank you. MR. LEVITT: Thank you very much. MR. HYLAK-REINHOLTZ: Thank you. MR. CONSTANTINO: Dr. Martell, thatcommitment will be noted in the permit letter whenthey receive the permit letter. - - -



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CHAIRWOMAN SAVAGE: Okay. Next on theagenda is H-03, Project 19-032, Greater ChicagoCenter for Advanced Surgery in Des Plaines. May I have a motion to approveProject 19-032, Greater Chicago Center forAdvanced Surgery, to establish a limited-specialtyASTC. MEMBER MARTELL: I so move. CHAIRWOMAN SAVAGE: Do we have a second? MEMBER MURRAY: Second. MR. AXEL: Madam Chairman, the Applicantjust stepped out to make a phone call, if we coulddrop back a project. CHAIRWOMAN SAVAGE: Sure. (An off-the-record discussion was held.) MS. AVERY: Sorry. - - -



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CHAIRWOMAN SAVAGE: Okay. So now, next onthe agenda, instead, Item H-02, Project 19-031,Advanced Surgical Institute, Evergreen Park. Senator Demuzio, if you could try to muteyour line again, please. May I have a motion to approveProject 19-031, Advanced Surgical Institute, toestablish a single-specialty ASTC. MEMBER MARTELL: I so move. CHAIRWOMAN SAVAGE: A second? MEMBER MURRAY: Second. CHAIRWOMAN SAVAGE: Please identifyyourselves and then be sworn in. MR. NIEHAUS: Bryan Niehaus, B-r-y-a-nN-i-e-h-a-u-s. I'm a consultant representing theApplicants. DR. AL-KHALED: Dr. Nouri Al-Khaled,N-o-u-r-i. Al-Khaled, A-l, hyphen, K-h-a-l-e-d. DR. SPEAR: Dr. William Spear, S-p-e-a-r. THE COURT REPORTER: Would you raise yourright hands, please. (Three witnesses sworn.) THE COURT REPORTER: Thank you. Andplease print your names, as well.



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CHAIRWOMAN SAVAGE: Mike, please presentthe State Board staff report. MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the State Boardto approve the establishment of a single-specialtyASTC performing cardiovascular surgical servicesin Evergreen Park, Illinois. The cost of theproject is approximately $6.1 million, and thecompletion date is April 22nd, 2021. No public hearing was requested, and oneletter of support was received. No letters ofopposition were received by the State Board. Board staff found three criteria out ofcompliance with the Board rules. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. Please proceed with your statements to theBoard. MR. NIEHAUS: Thank you. I'd just like tobriefly thank the Board staff for their review ofthe project and the Board for your time today. Before I turn it over to the tworepresentatives for the Applicant, I just wantedto briefly provide some comment about the three



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deficiencies that were found in the Board staffreport. The first two are very familiar to thisBoard for ASTC filings in Chicagoland regardingservice accessibility and duplication of services.These are standards that are based on the currentutilization levels of other facilities in themarket and do not reflect always a like-to-likeabout the need for this facility. As the two doctors will cover in moredetail, there is a need for this facility. Thereis only one operating room approved forcardiovascular procedures within the market today.That project is not in opposition -- and islocated at the edge of the 10-mile radius --because they cannot handle the volume of thisproject and they are servicing their own patientbase that is different from this application. Finally, the third deficiency regardingstandards on the project cost, the main findinghere is the equipment funding is in excess of theState standards. This is because there's a nearly$1 million piece of equipment -- we have anestimate of 900,000 -- for cardiovascular imaging



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equipment, which is not a standard piece ofequipment for equipment in operating rooms, so itis not commonly considered as part of these ASTCstandards. Without that, we are in compliancewith the State standards. The hope is that the Applicant will beable to obtain the equipment below that $900,000cost estimate with the closure of many hospitalfacilities and obtaining refurbished equipment onthe open market, but we wanted to provide thehigher estimate for new equipment in the eventthat is required. We're happy to answer any morequestions on that front as requested by the Board. And I would just like to note that theproject did have no opposition and MetroSouthHospital, located 6 miles away, has one operatingroom for cardiac procedures and three cath labsthat are going to be closing, so there's onlygoing to be a heightened need for this facility toprovide outpatient surgery options for outpatientcardiovascular services. DR. AL KHALED: Thank you very much forallowing me the time. I'm here today to ask thisBoard to support my group's goal to create a new



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option for our patients to receive cardiovascularhealth care to be performed on an outpatientbasis. As Bryan had covered the technicalcomponent of our filing to the Board, I would liketo summarize the reasons which we are here today. I am currently Dr. Nouri Al-Khaled, themanaging partner of an 11-man single-specialtycardiology group that's Consultants in Cardiology& Electrophysiology. Our group operates out ofthree locations, including our main office inEvergreen Park, which is currently located next tothe proposed ambulatory surgical center. This project was borne out of the need todeliver best care for our patients at the mostcost-effective way. As the Board is well aware,for a number of years the surgical landscape inthe United States has been evolving at a veryrapid pace. This evolution of health care is theresult of significant advancement in technologyand improvement in the size and the precision ofthe equipment we use during surgical proceduresand intervention. Adding to that is the pricing



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awareness and the importance of cost-effectiveness. All that had led Medicare, Medicaid, andcommercial insurance carriers to approve moreprocedures to be performed in an ambulatorysurgical center. Over the past two decades, in the last20 years, cardiologists in general and ourpractice in particular have been -- have seen thewell-reported benefits of the ambulatory surgicalcenter setting realized by other medicalspecialties, such as orthopedic surgery,gastroenterology, pain management, podiatry,ophthalmology, and others. This Board had approved numerous suchprojects and is very much familiar with thebenefits our patients would gain in an ambulatorysurgical center setting, including reduced risksof infection, reduced length of stay, decreasedcosts, improved outcome, increased patientsatisfaction and comfort, and so on. It is nowthe right time to offer our patients these exactsame benefits. I'd like to note that the final 2019 CMSrule revised the definition of "surgery," which



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resulted in the addition of 12 cardiaccatheterization procedures to Medicare ambulatorysurgical center payable list, specifically forvascular, electrophysiology, and diagnosticcardiocatheterization procedures. Now, the final 2020 CMS statement to -- CHAIRWOMAN SAVAGE: Doctor, excuse meone second. Can we ask you to hold on one secondwhile we fix our technical difficulties? I just noticed she's not there anymore. DR. AL-KHALED: Oh, well -- CHAIRWOMAN SAVAGE: One second. Dr. Demuzio, do you hear us? (An off-the-record discussion was held.) MR. ROATE: There we go. CHAIRWOMAN SAVAGE: Can you hear us now,Dr. Demuzio -- or Senator Demuzio? (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: Can you hear us? MEMBER DEMUZIO: I can hear you, yes. CHAIRWOMAN SAVAGE: Oh, good. We can'tsee you but we can hear you. Can you hear thetestimony already or do you need it repeated? MEMBER DEMUZIO: Yes -- no, I can hear it.



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CHAIRWOMAN SAVAGE: Okay. Great.Thank you. Okay. Please. DR. AL-KHALED: Should I repeat or -- MS. AVERY: No. CHAIRWOMAN SAVAGE: No. She said shecould hear you. DR. AL-KHALED: So I'm going to say --yeah, I was at the Medicare note. The final 2019 CMS payment rule revisedthe definition of "surgery," and this revisionresulted in the addition of 12 cardiaccatheterization procedures to the Medicareambulatory surgical center payable list,specifically for vascular, electrophysiology, anddiagnostic cardiocatheterization. Now, just recently, the final 2020 CMSpayment rule, approved in November, added sixangioplasty and stenting procedures to theambulatory surgical center covered procedure liststarting with the calendar year 2020. Pleasenote, due to the timing, our filing does not evenconsider the additional volume of patients for thesix new procedures added in 2020.



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Both recent updates are the result ofimpressive advances in technology, allowing healthcare providers to deliver best care to patientssafely, effectively, and comfortably; for example,the evolution of the radial access forcardiocatheterization where, actually, a fullcardiac catheterization and angioplasty and astent of the carotid artery could be done throughthe wrist, through the radial artery. Evolution of vascular closure devices.These are like little devices, little stitches,little holes, plug holes that -- you literallycould plug the femoral artery. Those advances have led to the adoption ofsame-day discharge programs. Those advances allowpatients to ambulate early, discharge early, anddecrease the risk of bleeding almost to zero. These advances and these -- the adoptionof the same-day discharge programs was not only asafe option for our patients, not only made theaddition of the cardiac catheterization and theangioplasty to the ambulatory surgical centerprocedure list safe but also a necessary option todecrease the cost of our patients and our



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community. We set our priority right. So I would like to reiterate that patientsafety comes first and we know that not everysingle patient will be done in the ambulatorysurgical center, but the expertise of ourcardiologists could exactly identify which are thebest patients to be taken care of in thoseambulatory surgical centers. Looking at Medicare alone, we think ourpatients would be able to save somewhere between10 to -- 10 percent to over 50 percent compared tohospital outpatient settings for the same if noteven better quality of care. Having specialized, trained staffavailable for our procedures only enhances qualityand safety. Locating the surgery center next doorto our Evergreen Park office will allow for ourpatients to be treated in a familiar, comforting,and low-stress environment. I hope I was able to convey that theadvances in technology and payment recognition aredriving this project. My group is excited tooffer our patients the same options offered topatients of other specialties for decades.



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I believe this single-specialty centeropening will allow access to improved care for ourcommunity, including our Medicaid and our indigentpatients. I firmly believe this ambulatorysurgical center is a clear choice to approve. I respectfully request that the Boardapprove this project, and I ask that you pleaseprovide us a chance to address any doubts orconcerns you have before your vote. Thank you. DR. SPEAR: Thank you. My name is Dr. William Spear. I'm acardiac electrophysiologist and a partner inConsultants in Cardiology & Electrophysiology.Thank you for your time today. I'd like to briefly build upon thecomments of Bryan and Dr. Al-Khaled, and I wouldlike to reiterate why this venture is absolutelynecessary. To start, although the staff Board reportnotes that there is sufficient volume of ASCsurgical options in the market, I would like tonote that there are not any viable options for ourpractice or for our patients in reality.



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Currently, of the nine licensed ASCswithin the market area, none of these ASCs offercardiovascular services. And an additional twoASCs are located within the market area, but theyare not yet licensed or operational. Both theVascular Access Centers of Illinois and PremierCardiac Surgery Center are designed and intendedto service an existing patient base which is otherthan ours. Neither the Vascular Access Centers orPremier is intended to or capable of servicing ourvolumes. In fact, Premier is intended to operateas a hybrid OBL-ASC with only one operating room.This clearly restricts the ability of the facilityto shoulder our proposed volumes. Likewise, the Vascular Access Center isdesigned for dialysis patients and end stage renaldisease patients and not cardiac patients. It isnot designed for PCI, pacemaker, cardiaccatheterization procedures, which our project isdesigned for. Clearly, these two facilities couldnot equip, staff, and service the complex casesand volumes that we intend by our project. Given this reality, there's no current ASC



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setting option for our patients and none on thenear horizon. This deprives them of theassociated patient satisfaction, access to care,quality, and decreased costs associated with anASC setting. Given the complexity of theoperations we perform, we believe it is also veryimportant for the facility and the staff to bededicated and specialized for our procedures. Let's see. Owning and operating the ASC will allow usto control the cost and satisfaction in a way thatis not possible by trying to add PCI or cathintervention capabilities to another facility inthe market. Lastly, I want to note that we appreciateand will continue to partner and utilize ourhospital partners in the neighborhood formedically appropriate patients. We believe ourdoctors and patients deserve the option of anonhospital surgical setting approved by Medicare,Medicaid, and commercial insurers to offer moreprice effective and quality care. In addition, due to the paucity of currentcath labs and capable operating suites in our



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area, our patients often have to wait up tosix weeks for elective procedures which otherwisecould have been done in a more cost-effective andexpedient way. The current cath labs in ourhospitals are often running at about 150 percentcapacity, performing cases late in the eveningsand have high turnover of staff due to highburnout rates from the staff working in thehospitals. By approving our ASC, we will be able tooff-load the appropriate cases from the hospitalsto allow them to perform the more complex cases onthe sicker patients at the appropriate time. I hope the Board understands the need forour surgical center, and I respectfully requestthe Board approve this project and I ask that youplease provide us a chance to answer any questionsyou may have. Thank you. MR. NIEHAUS: Before I turn it over,I just wanted to quickly note my error in updatingthe doctor. Premier, it has been opened. He said thatthere were two not-yet-licensed facilities.



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Premier has been approved and is operational thatwe're aware of. CHAIRWOMAN SAVAGE: Does the Board haveany questions? (No response.) CHAIRWOMAN SAVAGE: One question I wouldhave, do you have an agreement with MetroSouth fortheir equipment yet? Or a promise to sell itto you? DR. AL-KHALED: No. We have no agreementwith MetroSouth to buy it from them. Theequipment -- the highest-cap dollar equipment,which is the cardiocatheterization lab, it'spriced at -- brand-new -- at 900,000. But thecurrent changes in health care with closure ofhospitals may allow us to be able to get a goodpiece of equipment for probably half that price,but this is something to be found and negotiated. We know that MetroSouth -- there's acontractor that practically bought everything tothe best of our knowledge. So we don't know whothat is yet, but we will look into lowering thecost if we can. MR. CONSTANTINO: Madam Chair, I just want



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to make sure that these folks understand this isnot cardiac cath. You'd have to address thecardiac cath requirements already -- do weunderstand? MR. NIEHAUS: They were only performingthe same procedures this Board has approved in theASC setting that Premier is approved to operateunder, as reflected in the report in ouroutpatient. MR. CONSTANTINO: Okay. We have to stopcomparing previously approved projects. This hasbeen going on too long. We have -- MR. NIEHAUS: I'm not trying to --understood. MR. CONSTANTINO: Okay. MR. NIEHAUS: I'm just speaking of -- whatwe're doing is just ASC-approved procedures.I understand there's a separate cardiac cathcategory. MR. CONSTANTINO: I think -- I think thepermit letter ought to make it clear that nocardiac cath lab is being established at thisfacility. MR. NIEHAUS: How do you define the



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cardiac cath lab versus the Medicare CPT codes? MR. CONSTANTINO: You have to tell me if acardiac cath is going -- lab -- is going to beestablished here at this facility. If you do -- if you are, then we have todefer this project and come back before the Boardand you address those criteria. If we made a mistake understanding whatyou -- MR. NIEHAUS: So I just want to understandclearly so that we understand. We're only performing things that are --the way we're speaking about this is how thefacility is licensed and reimbursed, and theASC payment schedule is the ASC payment schedule.And any ASC that is approved to operate aspecialty in Illinois can perform those proceduresthat are listed on an ASC payment schedule. Thoseare the only ones we would perform if we wereapproved for cardiovascular. Not all cardiac cath procedures areapproved under the Medicare payment schedule.I think it's a difficult discussion because thedefinition on Illinois standards is not entirely



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clear about what is included in a cardiac cathfrom a reimbursement standpoint. We're only sticking to those proceduresthat are in the ASC setting that sometimes includea catheterization terminology but are notinclusive of all cardiac cath lab procedures. MR. CONSTANTINO: I still think thereneeds to be a condition on the permit that nocardiac cath lab is going to be established atthis facility. MR. NIEHAUS: I think that we're open toaccepting that as long as we can also define what"cardiac cath lab" includes. MR. CONSTANTINO: Or we can extend thereview period and bring it back until we've had anopportunity to discuss with the Applicants whatexactly is going to be occurring here, if that'sthe wishes of the Board. DR. AL-KHALED: Can I comment onsomething, please? CHAIRWOMAN SAVAGE: Certainly. DR. AL-KHALED: The ambulatory surgicalcenter is currently the -- approved in Illinois.This is something very new that's going on.



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I mean, the -- since Medicare had come up with thenew criteria to be able to perform cardiovascularprocedures in ambulatory surgical centers. The definition of a cath lab versus anoperating room -- first, it's called a hybridsuite -- is practically the same for us asphysicians. For us, it means that you are going toperform cardiovascular procedures and those are --either you're going to do percutaneous work --percutaneous work would require an X-ray machineand just like when the end stage renal diseasepatients require access for dialysis -- so youpractically go in and work on their vascularsystems under X-ray and under fluoroscopy. So if you define a cardiac cath procedurejust because it is a procedure that is done withthe utilization of fluoroscopy and percutaneousapproach, it's just a -- we are talking aboutdifferent wordings, but it's practically the samething. A cardiovascular procedure is almostalways -- in the ambulatory surgical center -- ispercutaneous for the carotid arteries. And for



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the -- for the pacemaker technology, it isrequiring a fluoroscopy room. So I don't understand how you could defineit from our perspectives as physicians. Youcannot do any of these procedures without havingfluoroscopy. So you could call it a cath lab oran ambulatory surgical center operating room,which is practically a lot more sophisticated thaneven a cardiac cath lab. CHAIRWOMAN SAVAGE: Okay. MR. CONSTANTINO: The cardiac -- CHAIRWOMAN SAVAGE: One second. Dr. -- Senator Demuzio, are you stillthere? MS. AVERY: It keeps going in and out. MEMBER DEMUZIO: I'm here. CHAIRWOMAN SAVAGE: She can hear. MS. AVERY: He said as long as it doesn'tgo off, we're fine. CHAIRWOMAN SAVAGE: Okay. MR. CONSTANTINO: We have -- the Board hasa specific category of service for cardiac cath.That's my concern with this, why I think they needto address that.



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And they haven't so far. MR. NIEHAUS: Respectfully, we're onlyapplying for an ASC approval. If the State isgoing to come out with clear standards that aregoing to restrict ASCs from performing certaincardiac catheterization procedures, includingcurrently approved ASCs, we will, of course, abideby that. All we're asking for is to be treated asan ambulatory surgical center, as we are under therules today, as with other applicants have beenhistorically under State rules. I would request that we have a vote fromthe Board so we can at least have clarity on this.And we will, of course -- as the State clarifiesits rules, we will comply with whatever isrequired by the State. (An off-the-record discussion was held.) MEMBER MURRAY: Is there a reason thatthis wasn't done before this meeting? MR. NIEHAUS: Not -- it was not raised, tomy knowledge. All of the procedure codes that wehave been performing were reported in ourapplication and are clearly transparent in the



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public documents. MEMBER MURRAY: I think what staff may beasking you -- you will not perform any proceduresthat are not already covered in your application? Is that what you're asking? MR. NIEHAUS: Abso- -- we will not performanything that is not approved by both the Stateand the Federal government for conductingprocedures in an ambulatory surgical center. I don't know how else any applicant cancome before the Board and make a differentguarantee. MEMBER MURRAY: So let me ask the questionagain. I feel like I might -- MR. NIEHAUS: I'm sorry. MEMBER MURRAY: Okay. What I heard, staff concern is to makesure that, in your application, you appropriatelycovered what you're actually going to do. MR. NIEHAUS: That is correct. MEMBER MURRAY: And he is concerned, withthis equipment, that you may slip into someprocedures that are not covered in the applicationyou applied under but may be covered in a cath



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application. Is that -- is that right? MR. CONSTANTINO: Yes. MEMBER MURRAY: Okay. MR. CONSTANTINO: And we have specificrules for cardiac cath labs. MEMBER MURRAY: Okay. So now -- MR. CONSTANTINO: This Board does. MEMBER MURRAY: So, now, that seems to meto be a simple question. So let me ask it again. In your application you listed a bunch ofprocedures with the codes. MR. NIEHAUS: Uh-huh. MEMBER MURRAY: Is there any intention ondoing any procedures that are not in that specificlist of your application codes? MR. NIEHAUS: There is not unless CMSwould, in the future, add additional codes thatare appropriate to the ASC setting. Everythingthat we've reported -- MEMBER MURRAY: Okay. So -- and, again --so just because something is in CMS -- the Statewould have to change its little rules for you tobe in compliance with the State; is that correct?



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MR. NIEHAUS: If that were to occur, yes.We would not do anything that is not included inthe State rules. MEMBER MURRAY: In the State rules? MR. NIEHAUS: That's correct. Of course. MEMBER MURRAY: I'm just working here forthe State. Okay? MR. NIEHAUS: Yeah. Absolutely. MEMBER MURRAY: All right. All right. So as long as that's clear,then I can -- I can understand it. MR. NIEHAUS: We're happy to report theprocedures -- as this Board can require -- thatthis facility performs moving forward. MEMBER MARTELL: As a follow-up, given allthe testimony that we heard about cardiac cath --and that was said by both physicians there --were -- the procedures that were used for thecalculation, did that include cardiac cath? MR. NIEHAUS: Again, some of the procedurecodes included catheterization nomenclature in theCPT coding. I am not aware of any defined list ofprocedures that the State has enumerated for howthey distinguish between cardiac cath lab and



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what's on an ASC procedural approval list, whetherState or CMS. So all we can commit to without furtherinformation is that we're going to conductprocedures that are allowable by the Federal andState government. MEMBER MURRAY: Let me ask the question adifferent way. MR. NIEHAUS: Yeah. MEMBER MURRAY: Would it perhaps be moreprudent to have your application include theState's process for catheterization labs? MR. NIEHAUS: That will be a decision forthe State. I -- it's hard for me to project onthat, given my ill understanding of how this isinterplaying and was not raised for our attentionpreviously. My only concern is the amount of time wemay delay the project and the Applicants, asthey're tied up with resources financially for thebuilding they're looking to seek approval on. Butif that's what the Board feels is appropriate,we'll go with what the Board believes is the bestprocess.



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As I said earlier, if we seek approval andshould the Board graciously approve our filing asan ASC, we, of course, will comply with anydecisions and guidance and regulatory requirementsthis Board or the State comes out with subsequentto our approval. There's already ASCs approved forcardiovascular services in this state. We'regoing to not -- we are not going to operate out ofcompliance, just as they will not. MEMBER MURRAY: So I have a question forstaff. Theoretically -- hypothetically -- if wewere to approve what they applied for, the codesthat they put in, could they then -- could werequest that they come back and finish whatevergaps might exist between this present applicationand between the State's cardiocatheterization labapplication? MR. CONSTANTINO: Yes, you could do that. MEMBER MURRAY: Does that seem reasonableto you gentlemen? MR. NIEHAUS: That does seem reasonable. DR. AL-KHALED: Yeah.



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(An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: Melanie, would you beable to read back Dr. Murray's testimony? THE COURT REPORTER: Dr. Murray'stestimony? (An off-the-record discussion was held.) MEMBER MURRAY: I can restate themotion -- I didn't make a motion, but I could makeit if you want. CHAIRWOMAN SAVAGE: Yes, please, if youcould read it. MS. AVERY: Just the last -- last littlebit that she was talking about. THE COURT REPORTER: See if this is whatyou want. "So I have a question for staff. "Theoretically -- hypothetically -- if wewere to approve what they applied for, the codesthat they put in, could they then -- could werequest that they come back and finish whatevergaps might exist between this present applicationand between the State's cardiocatheterization labapplication?" Mr. Constantino said, "Yes, you could do



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that." Member Murray said, "Does that seemreasonable to you gentlemen?" Mr. Niehaus and the doctor both said,"That does seem reasonable." Is that the part you wanted? (An off-the-record discussion was held.) MEMBER MURRAY: Let me vote out of order.I vote yes. MS. AVERY: We didn't vote yet. We'lltake a break. I'm sorry. There's only five of us --five of you. MEMBER MURRAY: Sorry. CHAIRWOMAN SAVAGE: George, did you have aquestion? MR. ROATE: No, ma'am. We discussed itamong staff. MS. AVERY: Mike, any other? MR. CONSTANTINO: No, ma'am. MS. AVERY: All right. Thank you. CHAIRWOMAN SAVAGE: George, please callthe roll. MR. ROATE: Thank you, Madam Chair.



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Motion made by Dr. Martell; seconded byDr. Murray. Senator Demuzio. MEMBER DEMUZIO: I am -- I'm going to goahead and vote yes, but I'm very reluctant todoing so. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: I'm going to say theintent to deny with the concerns that wereexpressed in the testimony related to cardiaccath. MR. ROATE: Thank you. MS. AVERY: Wait, George. I think you have to clarify. You have tovote yea or nay. MEMBER MARTELL: No. MR. NIEHAUS: Can we request that theBoard defer rather than vote no if the concern'sgoing to be about interpretation of Board rulesand not the substance of our application? MS. AVERY: Yes, but we don't have aJanuary meeting scheduled. Our next meeting isscheduled for February --



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MR. NIEHAUS: I understand. MS. AVERY: Okay. THE COURT REPORTER: Excuse me. Excuse me. The next meeting is scheduled when? MS. AVERY: February. THE COURT REPORTER: And you said what? MR. NIEHAUS: "I understand." THE COURT REPORTER: Thank you. Sorry. MS. AVERY: Okay. Do you want to defer? MR. NIEHAUS: I would request a deferral. MS. AVERY: Okay. Thank you. MR. NIEHAUS: Thank you. MS. AVERY: We're taking a break,10 minutes. CHAIRWOMAN SAVAGE: We're going to take a10-minute break. (A recess was taken from 10:53 a.m. to11:16 a.m.) MS. ALIKHAN: After our brief recess --here we go. Can you hear me now? Okay. After a brief recess, I've advisedthe Board to consider withdrawing the initial --the earlier motion on Project 19-031. (An off-the-record discussion was held.)



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CHAIRWOMAN SAVAGE: George, who made themotion to approve 19-031? MR. ROATE: Motion made by Dr. Martell;seconded by Dr. Murray. MEMBER DEMUZIO: I cannot hear what's -- MR. ROATE: I'm sorry. My apologies. Motion made by Dr. Martell; seconded byDr. Murray. MEMBER DEMUZIO: And what item are we on? MR. ROATE: That was -- CHAIRWOMAN SAVAGE: 19-031, the AdvancedSurgical Institute in Evergreen Park. MEMBER DEMUZIO: Got it. Okay. CHAIRWOMAN SAVAGE: Dr. Martell, would youmake a motion to withdraw your motion to approve? MEMBER MARTELL: I withdraw my motion toapprove. CHAIRWOMAN SAVAGE: Thank you. (An off-the-record discussion was held.) MS. AVERY: Okay. - - -



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CHAIRWOMAN SAVAGE: All right. So next onour agenda is H-03, Project 19-032, GreaterChicago Center for Advanced Surgery inDes Plaines. May I have a motion to approveProject 19-032, Greater Chicago Center forAdvanced Surgery, to establish a limited-specialtyASTC. MEMBER MURRAY: So moved. CHAIRWOMAN SAVAGE: May I have a second. (No response.) MS. AVERY: Second? Somebody? MEMBER SLATER: Second. CHAIRWOMAN SAVAGE: Okay. Would youplease identify yourselves and be sworn in. DR. DOMB: Dr. Benjamin Domb. MR. AXEL: Jack Axel. THE COURT REPORTER: Would you raise yourright hands, please. (Two witnesses sworn.) THE COURT REPORTER: Thank you. Andplease print your name, as well. CHAIRWOMAN SAVAGE: Mike, would you pleasepresent the State Board staff report.



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MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the Board toapprove the establishment of a limited-specialtyASTC to perform orthopedic and pain managementservices in Des Plaines, Illinois. The cost of the project is approximately$8.1 million, and the expected completion date isMarch 31st, 2021. No public hearing was requested, andletters of support were received. No letters ofopposition were received by the Board. Board staff found five criteria out ofcompliance with Board rules. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Okay. If you wouldplease proceed with your statement to the Board. DR. DOMB: Good morning. Thank you verymuch for the opportunity to speak with you thismorning. MS. AVERY: Closer. DR. DOMB: My name is Dr. Benjamin Domb.I'm a double-board-certified orthopedic surgeon.I'm medical director of The American Hip Instituteand chair of the nonprofit The American Hip



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Institute Research Foundation. I have a very specific specialty inrobotic and arthroscopic surgery for hip injuries.As one of just a handful of surgeons in thecountry with this particular specialty, I treatpatients from all over the country and throughoutIllinois, including professional athletes andactive individuals who want to be treated likeprofessional athletes. Over a decade ago I founded the nonprofitThe American Hip Institute Research Foundation,dedicated to research and education. I spend atleast 40 days per year lecturing at national andinternational meetings for other orthopedicsurgeons, teaching orthopedic surgeons, andperforming research to advance the field. I recently left a large group practice inorder to devote more time to research andeducation and created The American Hip Institute'snew facility in Des Plaines. For many years we have done procedures attwo out-of-state surgery centers, one in Indianaand one in Wisconsin, because of the availabilityof robotic technology and specialized operating



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rooms and equipment dedicated to the uniqueprocedures we perform. Presently there are nosurgery centers in our area with the roboticsystem or the other specialized equipment requiredfor our procedures, and the needed equipment isvery costly. We're also doing outpatient procedures inhospitals, which will be moved to the proposedsurgery center, as well as the over 300 proceduresthat were performed last year between myself andmy associates at the two out-of-state surgerycenters. Virtually all of those will be moved tothe proposed surgery center in Des Plaines. By way of introduction to The American HipInstitute, it is the first and only clinic of itskind in the nation dedicated specifically tocutting-edge treatment of hip injuries. The threepillars of the mission of The American HipInstitute are unique surgical expertise,charitable work, and research and education. The core mission of patient service is toprovide comprehensive evaluation and treatment forpatients with athletic hip injuries or earlyarthritis who often have great difficulty in



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obtaining a correct diagnosis and finding theright specialist. 60 percent of our patients areinitially misdiagnosed. They have seen an averageof three to four doctors before getting the righttreatment plan. The American Hip Institute aims to getpatients the right diagnosis, the correcttreatment plan, and the best specialist for theirproblem, all in a single day. The charitable pillar includes care foruninsured patients and includes specifically carefor uninsured active duty or retired militaryservicepeople through a program that we createdcalled "Hips for Heroes." The third pillar is research and teaching.In this mission we aim to advance the field,creating innovative new procedures with provenpatient outcomes. We've published over250 articles in peer-reviewed medical journals tofulfill this mission. We also serve as a teachingresource to surgeons from around the world,spreading knowledge of how to correctly diagnosecomplex hip injuries. A very specialized surgery center is



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currently The American Hip Institute's missinglink in providing continuity of care to ourpatients and bringing that care to the patients inour specific community. The unique procedures weperform cannot be done in other surgery centersdue to the costly and highly specialized equipmentrequired, which other surgery centers are notwilling to acquire. This project has the support of the localhospitals where we practice, as represented in theletter from the CEO of Lutheran General Hospital.The implementation of robotics and other advancedprocedures at the proposed surgery center willhave tremendous benefit to Illinois patients. We've proven that the precision ofrobotics reduces errors by 94 percent, decreasingrisk of leg length discrepancies, hipdislocations, and other complications. Bycustomizing the procedure to the individualpatient's anatomy, we can restore their hip tofeeling like and functioning like a normal hip. The primary benefits to our patientsassociated with moving cases to the surgery centerproposed and to this setting are a reduced risk of



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acquiring hospital-borne infections, the patients'preference to recover at home, and a costreduction of over 35 percent relative to thehospital setting. Professional athletes come from around thecountry for our procedures, and the proposedsurgery center will enable us to provide everydaypatients from our community and throughoutIllinois with the same elite level of care. Jack will now address the findings of thestaff report. I thank you very much. MR. AXEL: Thank you, Dr. -- is this on? MS. AVERY: Yes. MR. AXEL: Thank you, Dr. Dome. As noted in the staff report, this projecthas been reviewed against 22 separate criteria andhas been found out of compliance with 5. I'llfocus my comments on those five criteria and thereasons for the negative findings. The first finding is that the projectedphysician referrals did not justify the proposedtwo operating rooms. This finding was made solelybecause the Indiana and Wisconsin procedures of



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Dr. Domb and his associate Dr. Lall were notincorporated into the staff calculation. As notedby Dr. Domb, last year he and his associatebrought over 300 cases to the Wisconsin andIndiana ASTCs having the robotic capabilities thathe referenced a few minutes ago. That was over athird of the cases they performed last year. These aren't cases going to California;they're not cases going to New York. They arebeing done literally within 3 miles of theIllinois state line, and as Dr. Domb said, theywill be done in the proposed ASTC. Includingthese cases in the calculation would easily haveresulted in a finding of noncompliance -- excuseme -- in a finding of compliance. The second criteria calls for 50 percentor more of the patients to reside in thegeographic service area, that being within10 miles of the proposed surgery center. Five ofthe seven physicians providing historical patientinformation, those being physicians other thanDr. Dome and his associate Dr. Lall, eachdocumented that in excess of 50 percent of theirpatients reside within that 10-mile area.



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Because of the nature of their practice,Drs. Domb and Lall do not anticipate that50 percent of their patients will likely be arearesidents within two years. As a result, thecomposite 50 percent level likely will not beattained within the two years noted in thecriterion. From a historic perspective, Drs. Domb andLall's 50 percent level was not reached for tworeasons: First, because of the specialty natureof the procedures they perform, one would expectpatients to come from a broader area, and that hasbeen the historical case with their patients. Forexample, during 2018 Dr. Domb performed outpatientsurgery on 622 patients. Those patients residedin 276 different zip codes, in state, out ofstate, and internationally. Second, Dr. Domb and Dr. Lall moved theirpractice from DuPage County to Des Plaineslast year. As a result, the nearby patients thatthey performed cases on in the past now residemore than 10 miles away from the proposed ASTC. While the percentage of nearby patientsbeing operated on at the surgery center will



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likely increase over time, it would not bereasonable to anticipate that the 50 percentthreshold will be reached within two years. Weare anticipating compliance, however, within3, 3 1/2 years from the opening of the surgerycenter as AHI becomes better known in thenorthwest suburbs. The remaining two criteria both deal withthe availability of orthopedic surgery in thearea. As has been noted with other projectspresented to the Board, it's doubtful that thereis a service area in the state of Illinois wherethere is not access to orthopedic surgery;however -- and particularly after Dr. Domb'scomments -- I think we can all agree thatorthopedic surgery is not orthopedic surgery isnot orthopedic surgery. And based on Dr. Domb's description of hispractice and the procedures that he performs,including his ASTC robotic procedures, thisproject does not result in an unnecessaryduplication of services but, rather, providesaccess to state-of-the-art services in Illinois. In closing, this project was in compliance



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with all of the financial criteria. This projecthas received no opposition. This is anopportunity to do something to directly benefitIllinois residents, and it will provide a costsavings to the patients. The Applicants are thankful for theletters of support that have been received, and wewould be happy to answer any questions you mayhave. Thank you. CHAIRWOMAN SAVAGE: Thank you. Any questions? (No response.) CHAIRWOMAN SAVAGE: Comments? (No response.) CHAIRWOMAN SAVAGE: Mike, George, do youhave any comments? MR. CONSTANTINO: No. MR. ROATE: No. MEMBER MURRAY: I have a question for you.I'm only an internist, so I get lost on thesesurgical issues. CHAIRWOMAN SAVAGE: Please talk louder. MS. AVERY: Closer to the mic.



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MEMBER MURRAY: And while I know you'reobviously a champion for this new robotic stuff,could you give us a sense of how the field ischanging, how many procedures are moving into thisarea of using robotics, how fast you think that'sgoing to increase? And, also, are there anyrobotic surgery centers anywhere in the state? DR. DOMB: Thanks for the question. Firstof all, don't say "only an internist" because aninternist's job is much harder than mine, a lot ofarea to cover. In terms of the growth of robotics, I'llgive you a little historical perspective. So wedid the first outpatient robotic hip replacementin the country now about six years ago, and thatwas done at the out-of-state surgery center inIndiana. Over the last six, seven years, we havedone extensive research on the outcomes and theaccuracy of the robotics and published on thatresearch, so that has essentially broughtknowledge of the science around it and theoutcomes into the mainstream orthopedicpeer-reviewed literature. So I think today there



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is an acceptance in the orthopedic community thatthe benefits we hoped for six or seven years agohave actually come to reality and been borne outin the science. In terms of the actual catch-up of thefield in moving patients to this technology, thereare a couple hurdles. One is it is not a simple procedure tolearn or to become expert in, so we have afellowship as part of The American Hip Institutewhere we train surgeons who have completed theirorthopedic surgery residency for one to two yearsin an apprenticeship-style fellowship. We startedthat about 10 years ago. That's part of thenonprofit work that we do. And the goal of that fellowship is thatthey come out of it trained as experts in roboticand other advanced hip procedures. So we've nowtrained 21 fellows who are around the country --and a few actually around the world -- and who arecurrently practicing with this technology. In terms of the actual equipment, that'sthe second hurdle. So after a surgeon becomes an expert in



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it, they have to actually get a robot, a roboticsystem, and it's a very expensive system. Sothere are not a lot of facilities that have them,and there is, to my knowledge, only one otherambulatory surgery center in the state of Illinoisthat has robotics, and that particular surgerycenter has a closed medical staff, so it's not anoption for us in The American Hip Institute. So this would be, to my knowledge, thefirst center in the state and, certainly, in theChicago area to have open access to thistechnology for myself, my associates, and theothers that we train. MEMBER SLATER: Where is that otherfacility? DR. DOMB: That's located in Westmont. CHAIRWOMAN SAVAGE: Mike and George, doyou have any comments? MR. ROATE: No. MR. CONSTANTINO: No. CHAIRWOMAN SAVAGE: Any other comments,questions? (No response.) CHAIRWOMAN SAVAGE: Okay.



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George, if you could call the roll vote. MR. ROATE: Thank you, Madam Chair. Motion made by Dr. Murray; seconded byMr. Slater. Senator Demuzio. MEMBER DEMUZIO: Yes, based upontestimony. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on testimony. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on clarifyingtestimony. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the reportand the specialized services that are offered. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thestaff report and the testimony and the specializedrobotics that they're talking about. MR. ROATE: Thank you.



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That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit isapproved. Thank you. MR. AXEL: Thank you. DR. DOMB: Thank you very much. THE COURT REPORTER: Leave your remarkswith Mike, if you would. - - -



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CHAIRWOMAN SAVAGE: Okay. Next on ouragenda is H-04, Project 19-040, Fresenius KidneyCare Mount Prospect. May I have a motion to approveProject 19-040, Fresenius Kidney CareMount Prospect, to add eight stations. MEMBER SLATER: I move to approve. CHAIRWOMAN SAVAGE: A second? MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: Please identifyyourselves and be sworn in. MS. WRIGHT: Lori Wright. MS. MORRISON: Abbie Morrison, A-b-b-i-eM-o-r-r-i-s-o-n. DR. HAN: Dr. Tina Han, H-a-n. THE COURT REPORTER: Would you raise yourright hands, please. (Three witnesses sworn.) THE COURT REPORTER: Thank you. Andplease print your names, as well. CHAIRWOMAN SAVAGE: Mike, if you couldplease present the State Board staff report. MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the State Board



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to approve the addition of eight ESRD stations toits existing eight-station facility inMount Prospect, Illinois. There was no request for a public hearing,there was -- excuse me. The approximate cost of the project isapproximately $255,000. No letters of oppositionwere received. The Applicants have met all therequirements of the State Board. We have asked the Applicants to provide anoverview of what -- their intent to do here atthis facility. This is -- I can't recall if we --if the Board has seen a project of this type, butI think more will be coming. Thank you. CHAIRWOMAN SAVAGE: Thank you. If you would please proceed with yourstatement to the Board. MS. WRIGHT: Good morning. Again, my nameis Lori Wright, CON specialist -- MS. AVERY: Closer. MS. WRIGHT: -- CON specialist forFresenius Medical Care.



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To my right is Abbie Morrison, RN,regional vice president with Fresenius; and to herright is Dr. Tina Han, who is the medical directorat our Mount Prospect facility. First of all, I want to thank the Boardstaff for their positive review of this project,and I also want to thank all of you here today foryour time. Even though this project does meet allyour criteria, we do want to give a briefpresentation to introduce you to our transitionalcare unit concept. And to start that off, I'mgoing to hand this over to Abbie Morrison. MS. MORRISON: Thank you. I'm excited to be part of Fresenius' newtransitional care unit or TCU program that we'vejust initiated in Illinois this past year at theMount Prospect facility. The TCU is designed toencourage more patients to choose a home dialysisoption. The urgency of this program's rollout hasreally been heightened by the President'sexecutive order on American kidney healthrequiring more patients to be on home dialysis, as



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well as our expanded use of the NxStage homehemodialysis machine. Traditionally, as you know, in-centerdialysis patients are receiving treatment at anin-center station utilizing a full-sizeconventional hemodialysis machine in a recliningchair in that station, and they generally treatthree times a week, approximately four hours induration, on a Monday-Wednesday-Friday or Tuesday-Thursday-Saturday schedule, and that translates tosix patient shifts per week, which is where theBoard gets their utilization calculation from. The TCU station is a certified station onthe same treatment floor as the traditionalstations, although offering a more gentle andfrequent dialysis of four to five times a week forapproximately a three-hour duration. The patienttypically utilized the TCU for 30 days, dialyzingon the NxStage home hemodialysis machine whilereceiving individualized education and supportfrom the staff. I'd like to turn this over to Dr. Han sothat she can -- since she's had the experience oftreating patients utilizing the TCU at the



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Mount Prospect facility. DR. HAN: Hello. I'm Dr. Tina Han and I'ma nephrologist, and I am excited to share with youour experiences at Mount Prospect with the TCU andexplain more about it. I am very appreciative ofthe fact that many of the Board members areinterested in what's going on here in our dialysisworld. In the past patients really had very fewchoices on dialysis. When they have kidneyfailure, they end up at the dialysis unit, asAbbie has mentioned, three times per week on aconventional dialysis machine; however, over thelast year we have been really encouraging the useof home dialysis, and this has made a big impactin the health of the dialysis community. There are two different ways patientsreach that point of end stage kidney disease. Oneis a gradual way. When it's gradual, the patientshave the luxury of sitting with the nephrologistover a period of time, discussing which is bestfor them, in-center dialysis or home dialysis. However, when somebody is suddenlyrequiring dialysis, they end up in the hospital,



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let's say because they have sepsis or pneumonia,and they unexpectedly have to be on dialysis.Patients are often very overwhelmed, and theydon't know what to do. And for us to just askthem what they want to do, they're not going toknow that. And so that's where the transitional careunit comes in, the TCU. They would go to ourunit, our Mount Prospect unit, and in the TCU theywould have 30 days to decide what they want to do.And during that 30-days period, they would beusing a home dialysis machine four to five timesper week. And at the -- while they're doing theirdialysis in that month, they're receiving all theeducation that is necessary for the different homedialysis modalities. And at the end of that period, they canmake an informed decision on whether they want togo home with that type of machine, the NxStagemachine, which is very gentle and a little morefriendly for their use, or they could pickperitoneal dialysis, which is a dialysis done withthe abdomen. And if neither is suitable, they'llstay in-center for their dialysis, but we've seen



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a lot of people go from the transitional care unitto -- and choosing home dialysis. Now, I see both types of patientsregularly, in-center dialysis patients and thehome dialysis patients, and there is a remarkabledifference in the outcomes and how they feel, eventheir attitudes. So the in-center patients often say thatthey are feeling drained after dialysis, andsomebody likened it to a flight from Chicago toLos Angeles. I thought that was a very goodcomparison. If you know how tired you feel aftersitting in a plane for four hours, that's howthey're feeling on dialysis. And they go home torecover, and they try to recover the next day.The fatigue finally starts to go away, and thenthey have to do dialysis again the next day. Sothis becomes a cycle, and a lot of them don't feelso well. Now, the home patients I see on a regularbasis are telling me a different story. They'renot talking about feeling drained. They'retalking about saving a lot of time because they're



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not waiting for transportation and all the waittimes, and, also, because it's so gentle andeasier on their system, they're not feeling thatdrained feeling. In fact, they take ownership oftheir health better, and they can manipulate thedialysis to what suits them on a daily basis. So, for example, after a big Thanksgivingmeal, they're able to take off more fluid, or ifthey haven't had an appetite in three days, theywon't take off as much fluid. So they almostbecome experts in the way they treat their ownbodies, and they are, overall, much happier, andthey're just healthier in general, and I've seenthese outcomes as a reality. The patients who are already on dialysisand they've been on dialysis for years, we'reoffering them the same kind of experience, called"Experience the Difference" program. So over atwo-week period, they get to try using the homedialysis machine. And if that makes them feel alot better and they want to switch over to homedialysis, they can also go to the transitionalcare unit to utilize this. So this is anopportunity for existing dialysis patients and new



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dialysis patients, and we find that very exciting. Currently I'm working with the community,the hospital, the nursing homes, the home healthto try to make this more available and easier totransition into for patients. And I really appreciate this opportunityto talk with y'all about this, and I'm hoping fora future of healthier, happier dialysis patients. Thank you. CHAIRWOMAN SAVAGE: Thank you. Do we have any questions? MEMBER MURRAY: In your facility would yougive us an estimate percentage of patients that goto this transitional unit end up choosing homedialysis? DR. HAN: Yes, ma'am. Most -- in the transitional care unit,about half the patients end up going on homedialysis. And in some cases, where they don't feelthat it is suitable for them and they're not ableto do it at home, they will stay in-center. CHAIRWOMAN SAVAGE: Okay. Mike or George,any comments or questions?



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MR. ROATE: No. MR. CONSTANTINO: Why are you convertingto this model? DR. HAN: The main reason to convert tothis model is that the home therapies are verygentle on the system, and it's more of a frequenttherapy; it's more physiologic. When you do three-times-per-week dialysisat the dialysis center, you're taking off anenormous amount of fluid at one time and puttingthe blood flow through very high flows. Andbecause all of that is very hard on the body, wewere trying to find a way to have patients dialyzemore frequently when there was just a little lesstime per session. And we have found that, doingthat, patients feel much better. MR. CONSTANTINO: Is there a reimbursementissue here with this transition? DR. HAN: Do you know? MS. MORRISON: There's no reimbursementissue, per se. It's dependent on a physician'sprescription. And if the patient needs indicatethat they need more frequent dialysis, then thephysician simply writes the order and we treat the



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patient and bill accordingly. But there's noparticular reimbursement issue. CHAIRWOMAN SAVAGE: So even if thepatients were to choose -- the traditionalpatients -- to try the TCU and then do that, isthere a reimbursement issue with that? MS. MORRISON: No. There's still -- we'restill billing for the treatments that we'reperforming. MEMBER MARTELL: As a follow-up, do youanticipate the number of the traditional stationsdeclining with the advancement of the TCU? MS. MORRISON: Well -- CHAIRWOMAN SAVAGE: Dr. Demuzio -- orSenator Demuzio, could you please try to mute yourphone? MEMBER DEMUZIO: Hello. Sorry. MS. MORRISON: So to your question aboutthe need for stations decreasing over time, basedon the predicted numbers of patients in need ofdialysis in the coming years with thepopulation -- the expected ESRD populationgrowing, we don't really anticipate an extremechange in the number of stations needed, although



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we do expect that we are going to see a shift ofmore patients choosing a home therapy option asthere's an overall culture change given theexecutive order and overall feedback fromphysicians on improving outcomes for patients. CHAIRWOMAN SAVAGE: Any other questions,comments? (No response.) CHAIRWOMAN SAVAGE: Okay. George, if youcould please call the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Mr. Slater; seconded byDr. Martell. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thetestimony I've heard and the State report. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on the staffreport and the clarification and discussion on TCU. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the staffreport.



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MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on the reportand the testimony. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thestaff report and testimony. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: So the permit isapproved. Thank you. MS. WRIGHT: Thank you. MS. MORRISON: Thank you. DR. HAN: Thank you. - - -



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CHAIRWOMAN SAVAGE: Okay. Next on theagenda is Item H-05, Project 19-042, HSHSSt. John's Hospital, Springfield. May I have a motion to approveProject 19-042, HSHS St. John's Hospital, for amajor modernization and expansion project. MEMBER SLATER: I move to approve. CHAIRWOMAN SAVAGE: A second? MEMBER MURRAY: Second. CHAIRWOMAN SAVAGE: If you could pleaseidentify yourselves and be sworn in. MS. PAUL: Allison Paul, P-a-u-l. MS. GOEBEL: Julie Goebel, G-o-e-b-e-l. MR. LAWLER: Dan Lawler, L-a-w-l-e-r,CON counsel. THE COURT REPORTER: Would you raise yourright hands, please. (Three witnesses sworn.) THE COURT REPORTER: Thank you. Pleaseprint your names, as well. CHAIRWOMAN SAVAGE: Okay. Mike, would youplease present the State Board staff report. MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the State Board



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to approve the modernization of its 56-bedintensive care service and increase the bedcomplement from 56 to 64 ICU beds. In addition,the Applicants propose to increase itsmedical/surgical bed complement from 200 beds to232 beds. The cost of the project is approximately$17.3 million, and the expected completion date isJuly 31st, 2023. No letters of support or opposition werereceived, and there's no request for a publichearing. The Applicants have met all therequirements of the State Board. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. If you would please proceed with yourstatements. MS. GOEBEL: Good morning. My name isJulie Goebel. I'm vice president of strategy forthe Hospital Sisters Health System, CentralIllinois division. Seated with me today isAllison Paul, our chief nursing officer. We appreciate the staff's finding that our



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modernization and bed expansion project is inconformance with all Board criteria, and there isno opposition to this project. St. John's Hospital is a regional medicalcenter that is designated as a Level I traumacenter. We have our own college of nursing, andwe are a teaching hospital for the SouthernIllinois University School of Medicine. This project provides needed upgrades toour ICU and bed increases for both the ICU andmedical/surgical services. We'd be happy to answer any questions thatyou have. Thank you. CHAIRWOMAN SAVAGE: Any questions? (No response.) CHAIRWOMAN SAVAGE: Mike or George, wouldyou have any questions, comments? MR. CONSTANTINO: No. MR. ROATE: No. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Okay. All right. George, if you could pleasecall the roll. MR. ROATE: Thank you, Madam Chair.



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Motion made by Mr. Slater; seconded byDr. Murray. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thetestimony I just heard and the staff report. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on the staffreport. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the staffreport. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Based on the staff report,yes. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thestaff report. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit is



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approved. Thank you. MS. GOEBEL: Thank you. MS. PAUL: Thank you. - - -



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CHAIRWOMAN SAVAGE: Next on the agenda isItem H-07, Project 19-048, Palos Health Mokenamedical office building in Mokena. May I have a motion to approveProject 19-048, Palos Health Mokena, to establisha medical office building. MEMBER DEMUZIO: Motion. CHAIRWOMAN SAVAGE: Do we have a second? MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: Okay. Please identify yourselves and be sworn in. MR. BROSNAN: Tim Brosnan, B-r-o-s-n-a-n. MS. FRIEDMAN: Hi. I'm Kara Friedman ofPolsinelli. THE COURT REPORTER: Would you raise yourright hands, please. (Two witnesses sworn.) THE COURT REPORTER: Thank you. CHAIRWOMAN SAVAGE: Mike, if you wouldplease present the State Board staff report. MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the Board toapprove the construction of a medical officebuilding in Mokena, Illinois, at a cost of



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approximately $29.7 million. The expectedcompletion date is January 1, 2022. No public hearing was requested, and noletters of support or opposition were received bythe State Board. The Applicants have met all therequirements of the Board. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. If you'd please proceed with yourstatement to the Board. MR. BROSNAN: Sure. Thank you. I really have no formal comments otherthan to thank the staff for their helpin completing this application -- in completingthe review of the project and, also, for all theirefforts that have taken place to make sure thatthis meeting could take place today. If you have any questions, I'd be happy toanswer them. CHAIRWOMAN SAVAGE: Do we have anyquestions? (No response.) CHAIRWOMAN SAVAGE: Okay. Mike or George,



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any questions? MR. ROATE: No. CHAIRWOMAN SAVAGE: Okay. George, if youwould please call the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Senator Demuzio; secondedby Dr. Martell. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon the staffreport. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on staffreport. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the staffreport. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Based on the staff report,yes. MR. ROATE: Thank you. Chairwoman Savage.



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CHAIRWOMAN SAVAGE: Yes, based on thestaff report. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit isapproved. Thank you. MR. BROSNAN: Thank you very much. MS. FRIEDMAN: Thank you. - - -



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CHAIRWOMAN SAVAGE: So next on the agendais Item H-08, Project 19-049, CGH Medical Centerin Sterling. May I have a motion to approveProject 19-049, CGH Medical Center, to establish a10-bed acute mental illness unit. MEMBER MARTELL: So moved. MEMBER SLATER: I second. CHAIRWOMAN SAVAGE: A second -- thank you. If you could please identify yourselvesand be sworn in. DR. STEINKE: Paul Steinke, S-t-e-i-n-k-e. MS. GEIL: Kristie Geil, K-r-i-s-t-i-eG-e-i-l. MR. KAVANAUGH: David Kavanaugh. It'sD-a-v-i-d K-a-v-a-n-a-u-g-h. THE COURT REPORTER: Would you raise yourright hands, please. (Four witnesses sworn.) THE COURT REPORTER: Thank you. Andplease print your name on the sheet, as well. CHAIRWOMAN SAVAGE: Mike, would youpresent the State Board staff report. MR. CONSTANTINO: Thank you, Madam Chair.



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The Applicants are asking the Board toapprove the establishment of a 10-bed acute mentalillness category of service on the campus ofCGH Medical Center, a 98-bed acute care hospitalin Sterling, Illinois. The cost of the project is approximately3.3 million. The expected completion date isNovember 30th, 2020. The State Board has received a number ofletters of support from employees of the hospitaland the community. No opposition letters werereceived, and there was no request for a publichearing. Thank you, Madam Chair. (An off-the-record discussion was held.) CHAIRWOMAN SAVAGE: Okay. If you wouldplease proceed with your statement to the Board. DR. STEINKE: Thank you. Today we're here requesting your approvalto open a 10-bed behavioral health unit forintensive behavioral health intervention at ourcommunity hospital. Thanks to your staff for their work on theBoard staff report, which is fully positive to the



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extent the findings are under our control. Ourlegal counsel will discuss the report in moredetail in a moment. Let me begin by saying that this is anessential endeavor for our community. It willsupport the excellent community-based care thatthese patients receive from our crucial partners,the Whiteside County Health Department, LutheranSocial Services, and Sinnissippi Centers. I amhonored to collaborate with so many communityorganizations which are here with us todaydescribing this critical need. You heard fromthem earlier. This includes our City of Sterling MayorSkip Lee; Sterling and Rock Falls police chiefs,Chief Morgan and Chief Nelson; and the WhitesideCounty Sheriff, Sheriff Booker; Beth Fiorini, therecently retired public health administrator forthe Whiteside County Health Department; SkipDettman from Lutheran Social Services; and DianaVerhulst of the United Way of Whiteside County.The CEO of Sinnissippi Centers, Patrick Phelan,was also here. Plainly stated, we are here today because



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our community hospital needs an inpatientbehavioral health unit for patients presenting toour ED in an acute mental health crisis thatrequires stabilization. I've been CEO for the last seven years,and we've struggled to manage these patients withoutside resources. The hospital in the nextcounty is only accepting one out of five of thesereferrals, and the hospitals in Rockford, whichare over 50 miles away, are no more willing orable to take these patients, either. Our board is resolved that the option ofcontinuing to send these vulnerable patients outof the community to even more distant programs isnot a reasonable approach. It creates anavoidable break in care that is devastating forthese patients and their families. While the mental health crisis is notunique to our community, it is exacerbated by ourarea's natural rural situation wheretransportation gaps and other socioeconomicdisadvantages create an enormous burden for ourvulnerable patients. Sinnissippi Centers is treating 4,500



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individuals with mental illness in its four-countyarea at any given time and 6,000 patientsannually. LSSI carries 1,100 patients, WhitesideCounty 2,500. They are actively intervening on anoutpatient basis with patients suffering frommental health disorders. Many of these patientsare cycling in and out of the inpatient programs. As a frame of reference here, we arelocated in Northwest Illinois, primarily servingthe twin cities of Sterling and Rock Falls, withthe border -- with a broader four-county servicearea with over 135,000 residents. I was raised in Sterling, came back aftermedical training to practice family medicine.I still provide patient care when there arecoverage needs in our rural health clinics andelsewhere. As a practicing physician,I understand the importance of providing essentialprimary care services to our underserved patients.As the hospital CEO, I help guide our organizationto provide all the required services a communityour size can expect. Sterling and Rock Falls sit along theRock River with a combined twin city population of



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25,000. We are in Whiteside County. As a frameof reference, our county is 115 miles west of theChicago Loop, 55 miles southwest of Rockford, and75 -- 70 miles north of Peoria. The MississippiRiver is our western boundary, about 55 milesaway. There is one small inpatient mental healthunit within the planning area. We are an independent, municipally ownedhospital. In our role in the region, we serve asthe primary referral hospital for the smaller orless-specialized community providers in theregion. Tertiary services are referred to distanthospitals in Rockford, Peoria, or metro Chicagoareas. This project is under the oversight of ourlong-serving CNO and VP of patient servicesKristie Geil. MS. GEIL: Good morning and thank you. In my role as chief nursing officer, it'smy responsibility to ensure the hospital maintainsservices in accordance to applicable law andhealth care standards, and that includes patientsafety and access to appropriate level of care. Our approach to behavioral health care has



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become a key priority for not only our communitybut our hospital and, therefore, a crucialresponsibility for me in my role. So why is this? I serve, actually, on theWhiteside County Healthier Communities PartnershipCoalition, as well. In our Whiteside Countycommunity needs assessment, which was developedpursuant to the Illinois Project for LocalAssessment of Needs -- or the IPLAN -- identifiedaccess to inpatient mental care as the number onepriority for our County's residents who arecurrently unable to receive those services locallywithin our region. This need was further supported by theIllinois State Health Improvement Plan wheremental health was one of nine priority healthconcerns with a key goal being to increaseintervention and treatment statewide. One in five of our residents currently isaffected by mental health. The CDC published astudy in June indicating suicide rates are at thehighest level since World War II and they are onlygetting worse. We are experiencing the samephenomenon in Whiteside County, which further



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highlights the importance of appropriate treatmentin our local area. As we submitted, the bed supplyrecommended by experts is 40 to 60 bedsper hundred thousand people. Our statewideaverage is about 34 beds per hundred thousand. Inour planning area, which you can see is circledthere in red, you can see the access to care is asignificant problem. As you can see, there's a fair number ofplanning areas that fall in the range of therecommended supply and a few that are heavilysupplied, and those are the ones that are locatedin the metropolitan Chicago area. CGH is here onthe graph showing that we have less than 20 bedsper 100,000 residents. Now, the other two on that graph are nottruly the outliers they appear because thisplanning area also includes Elgin Mental HealthCenter, which has 75 civil beds. So, technicallyspeaking, our patients have the poorest access toinpatient behavioral health services in the stateof Illinois. With the next closest hospital only



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being -- only accepting one in five of ourrequests for transfer and the abysmal lack of carecontinuity these patients have when they're sentto 1 of 34 different facilities up to two hoursaway, this outmigration situation has reallybecome untenable for us. As many of you know, mental illnessepisodes in the acute setting -- a personcannot -- no longer work, they can't care fortheir families, they can't function in society anddo regular activities. In these cases supervisedintensive inpatient treatment is necessary andrequired to protect patients and others in ourcommunity. We need a program that is designed toreturn patients to a supportive, safe, andproductive member of the family and our communityrather than having him or her conditionexacerbated by an inadequate patchwork of servicesand then lack of us being able to follow up withthem once they're discharged from thosemetropolitan hospitals. Our emergency department are on the frontlines of this crisis, triaging and initiating



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admissions to multiple behavioral health patientson any given day, including those in our HSA 1region. We cannot continue to merely serve as anintake point without admitting these patients to adedicated unit within our hospital. Our patientswait too long and are transferred too far away totolerate this situation any longer. Our communitydeserves for us to provide these services. This diagram provides a heat map by thedensity of AMI patients by residence in ourservice area and depicts the long distance to thevarious psychiatric programs we routinely transferto if a patient requires admission. As you cansee, they're clustered in and around theChicagoland area, making a large component ofthese transfers easily two hours by ambulance. Our inability to have these patientstimely and consistently admitted to nearbyhospitals is affecting not only these patients andthe outcomes that they have but also is disruptingthe other essential medical care we need toprovide here in our emergency department. When these patients come to CGH, theyrequire direct visualization at all times with



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sitters who are actually pulled from otherdepartments, who provide other patient carefunctions within the hospital, which actuallyimpacts negatively our staffing ratios in otherareas. Without a program we are particularlyfailing patients who cycle in and out of inpatienttreatment at distance programs, as youheard earlier. As you all likely know, in anycircumstances managing a patient with mentalillness, especially ones living in a rural areawith socioeconomic challenges and disadvantages,has its own challenges. We have strong community service partnerswith Sinnissippi Mental Health, LSSI, WhitesideCounty Health Department, and our law enforcement.Despite this, we are not giving our residents thebest chance for mental health illness recovery ifwe don't provide inpatient services. With this program and based on historicaladmissions for our community residents outside ofour region, we expect between 500 and 600 patientsa year to be admitted through our emergencydepartment, which will fully justify the size of



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the program we are currently proposing. As you've heard from the testimony, wehave partnerships with law enforcement to try andimprove the lives of our residents with mentalillness. We collaborate with police and thecommunity-based services -- sorry -- providers totry to deescalate situations when an individualwith a mental health crisis is exhibiting unlawfulconduct or pose a risk to our community. These programs are promising. Andhistorically law enforcement and behavioral healthsystems haven't always gotten along. We areuniquely -- we uniquely have an advantage in thissituation as our officers are well trained andhave gained an excellent awareness of the specialneeds of people with mental illness. We havedeveloped alternatives to arrest and know how toaccess our community-based crisis stabilizationservices and mental health hotlines. Even so, we don't have a full scope ofservices, though, without this program. Ourofficers and provider staff experience frustrationand distress as they encounter the same familiarfaces time and time again to see the health and



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well-being of these individuals deterioratebecause we cannot provide continuity of care. Our emergency department director,Dr. David Kavanaugh, is confronting this crisisfirsthand, and he will discuss our currentsituation and how we handle these patients withoutthe benefit of an inpatient program. Thank you for your time. DR. KAVANAUGH: Thank you very much forhaving us here. You've heard the data and the demographicsthat we are challenged with, but I just wanted tospeak plainly to you about what happens, whatthese patients go through, what we see in theemergency department. When these folks present, we, as thephysicians, initially need to see them, determineif they have a medical condition, and deal withthat initially. Once that has been cleared and we haveseen them and determined that they need to beadmitted to an inpatient hospital, that is when wehave our partners from Sinnissippi help us findthe appropriate placement for these folks.



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This is the point where I interact withpatients, patients' families, their loved ones,and they frequently ask -- they beg -- "Don't sendme away; don't send me to Chicago; don't send meso far away. My family doesn't have a car; myfamily can't visit me. How am I going to gethome?" I frequently have the same response:"I don't have another option." And I think we have an opportunity foranother option. I think these patients deservesomething better than what they've been given, andthis, today, is our opportunity to give themsomething better. I appreciate your time, and I know ourpatients appreciate your consideration for thisproject. Thank you. I'll give it back to Kara. MS. FRIEDMAN: Thanks. So as you saw in your Board staff report,this project meets your Part 1120 requirements.And to the extent any of the elements of theapplication are within the control of thishospital, it meets the other requirements, as



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well. What we're confronted with is twotechnical negative findings. This project, as youread, is fully supported by the community. Weappreciate them being here today. CGH needs to address its lack of access tothese services. In doing so, it will fulfill acore tenet of your Act, which is to promote accessto safety net services. Patients with mentalhealth illness are some of the most marginalizedand vulnerable patient population that any healthcare providers in the state serve. I want to address their plan to operatethis unit relative to the need methodology for AMIservices -- THE COURT REPORTER: I'm sorry. "Relativeto the" -- MS. FRIEDMAN: -- "need" -- THE COURT REPORTER: Thank you. MS. FRIEDMAN: -- methodology for theseservices and the service accessibilityrestrictions that CGH Hospital patientsconsistently experience for this service. As you heard, CGH is here today due to the



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extreme involuntary outmigration for behavioralhealth services from this region along with theonly hospital in the GSA accepting only one out ofevery five of their patients. As you can see from the last illustrationthat was circulated around -- and Anne has alarger copy of it here -- this is the outmigrationthat this planning area sees for patients thatrequire admission for mental illness. Thepercentages that you see are those percentagesthat have to leave the nine-county planning areato get services, and this is based on statewidecomp data. So our mission is -- in opening thisunit -- is primarily to serve Jo Daviess,Stephenson, Carroll, and Whiteside Counties, andyou'll see those have the highest percentages ofoutmigration, 80 percent leaving, 76 percent,63 percent, and 54 percent. So we hope, withadmitting the 5- to 600 patients a year, thatwe'll substantially address that outmigration. In Lee County you can see that DixonHospital is doing better with outmigration, andour general understanding is those patients that



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present to their ED will generally be admitted ifthe scope of care that they need is appropriatefor the level of service they provide. So if wecan get to 21 percent or even far better thanthat, then I think we'll feel that we'refulfilling the mission of this project. In the larger planning area, the needmethodology does recognize a need for one bed, butit doesn't account for the outmigration, and theminimum beds of 100,000 people is only 11 beds.We feel that's too low. It's too low compared towhat -- the access that other people in the stateget and according to the 40 to 60 per $100,000[sic] that we think is a better target. And in the staff report there was anotation that, as a whole, the State gets betteraccess with the State getting only one-third --excuse me -- this area getting only one-third ofthe beds that is seen on a statewide basis.That's 1 for every 3,000 residents statewide and1 for every 7,000 residents in this area. AMI services are primary care servicesthat could be provided locally and should beprovided locally. We really do want to



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distinguish sometimes outmigration is appropriatefor patients if they're needing to access tertiarycancer care, surgical services, neonatologyservices but not acute mental illness services.We really need to see this service provided in thepatient's community to ensure their continuity. So we're proposing a small unit. We dobelieve that we address the service accessibilitydeficit and dramatically reduce outmigration. Wewill significantly improve the overall health carecosts by reducing inefficiencies and eliminatingambulance transport costs to provide theseservices locally. Thank you so much. We're happy to answerquestions. CHAIRWOMAN SAVAGE: Anyone with questions? Go ahead. MEMBER JENKINS: You noted that the nearbyhospital, KSB, is only taking one of fivereferrals. In the staff report it shows that it'sonly at 39 percent occupancy rate. Is there any reason that you know of thatKSB is not accepting more of the referrals thatcome to them?



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MS. GEIL: Sure. Actually, we were at KSB just last week.I keep in touch with their CNO, who's in charge oftheir program on a regular basis. And there havebeen times when I've called her directly saying,"Hey, we have this patient and we can't get inanywhere. Do you have an opening?" and I'm alwaystold no. When we met last week, I -- they know thatwe were coming here to present, and we were justtalking through how we might be able to partner ifour project is approved. And I said, "You know,help me understand this again because I want tomake sure -- I'm going to get asked this, so helpme understand what I -- how I need to express thisto you." And, really, her challenge as anorganization is an acuity-versus-actual staffingsituation. So they actually purposefully willkeep their census at a five or a six because theycan only appropriately staff for the acuity atthat level. So it isn't necessarily that therearen't patients trying to get in there. It'sreally, truly, a staffing issue for them.



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They do their best to maintain admissionsfor those patients that come in directly to theiremergency room. And outside of that, it is almostimpossible for them to take anyone from a referralperspective. Similar statement from Swedes when we wentup and met with them and saw their facilitybecause they -- I know -- yeah, throughout the HSAarea, that was a concern. MEMBER JENKINS: Thank you. And yourintention would be to fully staff your facility tohandle occupancy? MS. GEIL: Yes. And we also would be hopeful that we couldprovide resources for KSB as well as Swedes oranyone in our region that would actually needservices that we could provide. That is ourcommitment. MEMBER JENKINS: Thank you. MEMBER MARTELL: So a follow-up to thisdiagram with the outmigration, you indicated thatyou were going to serve as a catchment forJo Daviess, Carroll, Whiteside, Lee. So, again, you are expecting clients and



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patients from those regions to come to CGH formental -- acute mental illness? DR. KAVANAUGH: Yes. Some may. I mean,our primary objective is to serve our owncommunities and our own population first. But weexpect -- if we are able and -- able to take thoseadmissions from the surrounding area, I thinkwe'll get some from them, too. MEMBER MARTELL: Did you look at asmaller-size unit at any point beyond the 10 beds? MS. GEIL: The minimum requirement is a10-bed unit, so we went with the minimumrequirement. Also, just so you -- for a generalawareness, when you look at rural communityprimary care services, we actually do provideprimary care services up in the Carroll Countyarea, so we do see some drift with primary carefrom some of those other areas as well as fromStephenson and Freeport. So -- we have satellite clinics in thoseareas, so it would potentially -- we -- that wouldbe how we would capture some of that migration,because we're known in that region. It's really



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kind of a scarce area for health care up there. CHAIRWOMAN SAVAGE: Other questions? (No response.) CHAIRWOMAN SAVAGE: Mike or George, anyquestion or comment? MR. CONSTANTINO: No. Thank you. CHAIRWOMAN SAVAGE: Okay. George, if youwould call the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Dr. Martell; seconded byMr. Slater. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thetestimony and the staff report. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on ruralaccess. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on theapplication and staff report. MR. ROATE: Thank you. Mr. Slater.



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MEMBER SLATER: Yes, based on thetestimony and the staff report. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thetestimony and staff report. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit isapproved. Thank you. MS. FRIEDMAN: Thank you very much. MS. GEIL: Thank you. THE COURT REPORTER: Please leave yourremarks with Mike, those of you who have writtenremarks. - - -



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CHAIRWOMAN SAVAGE: Next on the agenda isH-09, Project 19-051, DaVita Driftwood Dialysis inFreeport. May I have a motion to approveProject 19-051, DaVita Driftwood Dialysis, to addone station to its existing ESRD facility. MEMBER SLATER: I move to approve. MEMBER DEMUZIO: Motion. CHAIRWOMAN SAVAGE: Do we have a second? MEMBER SLATER: Second. CHAIRWOMAN SAVAGE: Okay. Mike, if youwould -- oh, sorry. First, identify yourselves and then pleasebe sworn in -- but you were already sworn in. Soif you could identify yourselves. MS. FRIEDMAN: Hi. Kara Friedman andAnne Cooper, counsel for the Applicant. CHAIRWOMAN SAVAGE: Okay. Mike, if younow would please present the staff -- State Boardstaff report. MR. CONSTANTINO: Thank you, Madam Chair. DaVita, Inc., is asking the Board toapprove the addition of 1 station to its existing11-station facility in Freeport, Illinois.



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The cost of the project is approximately$631,000. The expected completion date isJanuary 31st, 2021. No letters of support or opposition werereceived, and no public hearing was requested. The Applicants have met all therequirements of the State Board. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. Please proceed with your statement to theBoard. MS. FRIEDMAN: Hi. Thank you. Unless there are any questions, we'reready to proceed with the vote. Thank you. CHAIRWOMAN SAVAGE: Any questions? (No response.) CHAIRWOMAN SAVAGE: Okay. George, pleasecall the roll -- oh, sorry. I didn't see you. MEMBER MARTELL: Yeah. I do have a question because it seems likethere's a consolidation or a closure of a unit andthen the addition of the one. Can you talk more to that?



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MS. FRIEDMAN: Yeah. I think there's atiming issue. I think there's three differentapplications pending right now, and there was someexpectation -- things have just been moved arounda little bit. But in February we'll be proceeding withan application to close the other clinic that's inFreeport to consolidate the services. MEMBER MARTELL: Thank you. CHAIRWOMAN SAVAGE: Okay. George, if we can please call the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Demuzio; seconded bySlater. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon the staffreport and -- MR. ROATE: Thank you. THE COURT REPORTER: I can't hear you."Based upon" -- what, please? CHAIRWOMAN SAVAGE: Can you repeat that? Senator Demuzio, can you please repeatthat?



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MEMBER DEMUZIO: Yes. I vote yes, based upon the staff reportand the comments that were made regarding thisproject. CHAIRWOMAN SAVAGE: Okay. MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on the staffreport and the intent to submit on the closure ofthe Freeport. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the staffreport. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Based on staff report, yes. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on staffreport and testimony. MR. ROATE: Thank you. That's 5 votes in the affirmative. MS. COOPER: Thank you.



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MS. FRIEDMAN: Thank you. CHAIRWOMAN SAVAGE: The permit isapproved. Thank you. - - -



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CHAIRWOMAN SAVAGE: Okay. Up next isItem H-10, Project 19-052, Riverside MedicalCenter in Bourbonnais. May I have a motion to approveProject 19-052, Riverside Medical Center, toestablish a medical office building. MEMBER SLATER: I move to approve. CHAIRWOMAN SAVAGE: Second? MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: If you could pleaseidentify yourselves and be sworn in. THE COURT REPORTER: Would you raise yourright hands, please. (Three witnesses sworn.) THE COURT REPORTER: Thank you. Andplease print your names, as well. CHAIRWOMAN SAVAGE: Would you pleaseidentify yourselves. MS. JACOBI: Chairman Savage, members ofthe Board -- CHAIRWOMAN SAVAGE: We can't hear you. MS. JACOBI: Let me start over again. Chairman Savage, members of the Board, I'mPaula Jacobi. I'm the senior vice president and



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general counsel for Riverside Medical Center. I am pleased to have with me today to myleft Kyle Benoit, who is a senior VP and chiefoperating officer; and, also to my right, our CONcounsel, Joe Ourth. We thank Mr. Constantino and Mr. Roate fortheir work on your State Board report. CHAIRWOMAN SAVAGE: One second. Okay. Mike, if you would please presentthe State staff Board report. MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the Board toapprove the establishment of a medical officebuilding in approximately 75,000 gross square feetof space located in Bourbonnais, Illinois. The project cost is approximately$27 million. The expected completion date isOctober 31st, 2021. No letters of support or opposition werereceived, and there was no request for a publichearing. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: In the interest oftime, if you could just hit whatever major points



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you want to cover. MS. JACOBI: Okay. In the interest of time, we are proposingthe construction of a three-story medical officebuilding, which will include one floor of shellspace. We have had growth in our medicaloffice -- or excuse me, our medical group -- of aquadruple in size, from 43 providers to now174 providers. The physician office space isnecessary to accommodate the growth in ourmedical group. We are committed in our application toreturn to the Board for the construction of theshell space, at which time that would take place. We have had positive findings on allcriteria with the exception of a small variance onthe cost of construction of 2.7 percent. We haveworked with our architect to minimize constructioncost as well as to identify those areas for apremium from the State standard. There's asummary chart which I believe the State staff haveincluded in your report that explains that. Again, in the interest of time, we won'trepeat any of that information but are happy to



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answer any questions in regard to that variance orany other aspect of the application. Thank you. CHAIRWOMAN SAVAGE: Does anyone have anyquestions? MEMBER MARTELL: I have a question for ourstaff. It's to understand about the projectpremiums. Are we seeing these in other projects? MR. CONSTANTINO: Yes, we are. MEMBER MARTELL: In construction? MR. CONSTANTINO: Yes, we are. CHAIRWOMAN SAVAGE: Okay. Any other comments or questions, Mike orGeorge? MR. CONSTANTINO: No. CHAIRWOMAN SAVAGE: Okay. George, if youcould please call the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Mr. Slater; seconded byDr. Martell. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thetestimony and, also, the State report.



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MR. ROATE: Thank you. Dr. Martell. MEMBER MARTELL: Yes, based on the staffreport. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based on the staffreport. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on staffreport. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thestaff report. MR. ROATE: Thank you. That's 5 votes in the affirmative. MS. AVERY: I apologize for rushingyou-all. I was thinking we were limited to 12:45.It's actually 1:45 so I apologize for that. MS. JACOBI: It's perfectly all right.We're very happy with the outcome. Thank you. MS. AVERY: I'm in a little paranoid



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state right now. MS. JACOBI: Thank you. MR. BENOIT: Thank you. CHAIRWOMAN SAVAGE: The permit isapproved, then. Thank you. - - -



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CHAIRWOMAN SAVAGE: So next on the agendais Item H-11, Project 19-054, Associated SurgicalCenter in Arlington Heights. May I have a motion to approveProject 19-054, Associated Surgical Center, to adda surgical specialty. MEMBER DEMUZIO: I motion. CHAIRWOMAN SAVAGE: Second? MEMBER MURRAY: Second. CHAIRWOMAN SAVAGE: If you could pleaseidentify yourselves and be sworn in. MR. AXEL: Madam Chairman, I'm Jack Axelof Axel & Associates. Seated to my right isDr. Yelena Levitin -- MS. AVERY: The mic. CHAIRWOMAN SAVAGE: The mic. The Senatorcan't hear. MR. AXEL: I'm sorry, Senator. I'm Jack Axel of Axel & Associates.Seated to my right is Dr. Yelena Levitin, medicaldirector of Associated Surgical Center; and to myleft is Mr. Mark Mayo, the administrator of thesurgery center. CHAIRWOMAN SAVAGE: Thank you.



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THE COURT REPORTER: Would you raise yourright hands, please. (Two witnesses sworn.) THE COURT REPORTER: Thank you. Andplease print your names. CHAIRWOMAN SAVAGE: Mike, would you pleasepresent the State Board staff report. MR. CONSTANTINO: Thank you, Madam Chair. The Applicants are asking the Board to addorthopedic surgical specialty to a multispecialtyASTC. The cost of the project is approximately$121,000, and the expected completion date isFebruary 2020. No letters of opposition were received.Letters of support were received by the StateBoard, and there was no request for a publichearing. Thank you, Madam Chair. CHAIRWOMAN SAVAGE: Thank you. If you'll please proceed with yourstatement to the Board. MR. AXEL: Thank you. Members of the Board, as Mike noted, thisproject is limited to the addition of orthopedic



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surgery as an approved specialty to be provided atan existing ASTC. Before I focus on the stafffindings, with your indulgence, I'd like to givejust a little bit of background. This ASTC was originally approved inDecember of 2012 but not opened until 2016. ThisASTC has two unique characteristics. First, thisASTC has a very large patient base that canperhaps best be described as the working poor. Asa result, this ASTC's provision of charity careand services to Medicaid recipients far exceedsthat of any of the other three ASTCs in theBoard's defined service area. Specifically and as documented on page 60of the application, 5.8 percent of the ASTC'spatients are Medicaid recipients, compared to 4.2,.02, and .8 percent at the other ASTCs. Similarly and using the State's definitionof "charity care," that being no expectation ofany level of payment, 1.2 percent of this ASTC'spatients are treated without charge, compared to0.3 percent at one of the area's other ASTCs andno charity care being provided at the other areaASTCs.



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Last, when an ASTC categorizes patients as"private pay," it typically means that servicesare being provided for an agreed-upon amount,often including a discount plan. 10.6 percent ofthis ASTC's patients fall into this category, withthe other ASTCs ranging from 2.1 percent to0.4 percent. These patients are often thepatients that I referred to as the working poor. The second unique characteristic of thisASTC is that nearly 90 percent of the patientstreated at the ASTC are of Eastern European --primarily Russian -- or Hispanic ethnicities.And to address the needs of these patients, theASTC employs a staff that speaks 15 differentlanguages. Calls to other ASTCs in the areaconfirmed that none of them can communicate topatients using Eastern European languages. By the way, there are nearly20,000 Russian immigrants alone living within10 miles of the ASTC. In addition, the ASTC has developed arelationship with a large primary care practice inthe northwest suburbs that provides servicesprimarily to a low-income Hispanic population,



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and, as a result, last year over a third of theASTC's patients spoke Spanish as their primary oronly language, and this primary care center hasbeen asking the ASTC to begin providingorthopedics. Also, they are intending to open asecond location within 2 miles of the ASTC withinthe next year. What this all means, at least to me, isthat the Applicant Surgery Center addresses theneeds of a patient population that doesn't haveaccess to other ASTCs, whether it is due to alanguage barrier, because they're Medicaidrecipients, or because they just can't affordtheir care. As you can see in the staff report,utilization of the ASTC started out very slowly,but it took off in 2018 with a 107 percentincrease in 2018 over 2017 and a 59 percentincrease this year over the first -- or during thefirst nine months of this year over the sameperiod last year. These increases are attributed to twofactors: First, the ASTC has received Medicaidcertification in 2018 and now participates in



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five Medicaid programs, and, second, therelationship with the large and growingHispanic-focused primary care practice thatI mentioned a minute ago. Turning to the State Board staff report,the project was reviewed against 22 criteria, andthere are negative findings on 5, addressingtwo issues. The first three negative criteria alladdress utilization, and the fourth and fifthcriteria address accessibility/unnecessaryduplication. The Applicant acknowledges thatutilization during the ASTC's first years ofoperation was lower than expected, but theaddition of orthopedic surgery, which is thesole -- excuse me -- which is the sole focus ofthis project, cannot help but increase the ASTC'snow rapidly growing utilization. As I mentioned a minute ago, the ASTC'sutilization increased by 107 percent in 2018,and year-to-date 2019 utilization is up by another59 percent. Referral projections for three orthopedicsurgeons were provided in the application, and



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since the filing of the application threeadditional orthopedic surgeons have applied forprivileges. The privileges for these six orthopedicsurgeons are targeted to be approved next month,pending the approval of this application. As noted in our November 12th submission,there are currently a total of 10 physicians inthe credentialing process, and that will increaseutilization even further. In addition, this yearthe center began doing gynecological, urology, andpain management procedures, none of which had beendone in 2018. Again, utilization is absolutelytrending upward, and the addition of orthopedicscan only help that trend. Addressing the accessibility andunnecessary duplication issue, the project wasdetermined not to improve accessibility and toresult in a duplication of orthopedic servicesbecause these two criteria are based solely onwhether or not orthopedic surgery services areavailable within 10 miles. Accessibility and unnecessary duplication,however, go beyond that simple assessment. Otherissues come into play. If you're covered by



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Blue Cross and you are fluent in English, I cantell you that you don't have an accessibilityissue in Arlington Heights. But I provided you with the numbers acouple minutes ago. If you're covered by Medicaidor if you can't pay the full price or if you needa special payment plan or you have a highdeductible or you have no ability to pay or if youspeak Russian or Croatian or numerous otherlanguages or if you need a procedure performed at5:00 p.m. on a Friday so that you don't miss work,accessibility is an issue. And this ASTC steps up. It provides ahigher percentage of charity care than any otherarea ASTC. It provides a higher percentage ofcare to Medicaid recipients than any other areaASTC. It provides a higher percentage ofdiscounted care than any other area ASTC. Itprovides off-hour surgery to patients who can'tafford to miss work, and it provides staff thatspeaks 15 languages to meet the needs of this verydiverse patient population. Accessibility is an issue here, and thisis not a simple case of unnecessary duplication,



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which, in this case, is defined simply as havingother providers in the area. As you have probably picked up from theother ASTC projects that you've heard today and atpast meetings, it's extremely doubtful that anASTC project anywhere in this state can be foundin compliance with the simple definition. In closing, this project is limited to theaddition of one surgical specialty to an existingsurgery center. There is no construction orrenovation cost associated with this project. Nooperating rooms or procedure rooms will be added,so there is no increase in capacity in theplanning area. The project does not impact any ofthe other area ASTCs. The project's cost is only3.4 percent of the reviewability threshold, andthere has been no opposition filed by the providercommunity or anyone else. I thank you for your attention, and we'dbe happy to answer any questions you have. CHAIRWOMAN SAVAGE: Any questions? MEMBER MARTELL: Yes. Can you provide a clarification on thethree additional physicians who will make



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referrals and how many referrals that is? MR. AXEL: Mark. MR. MAYO: The three surgeons are allorthopedic surgeons. One of them specializes inmore complex orthopedic cases and has an excellentclinical relationship. We have not determined hiscase mix based on his referral pattern fromexisting facilities. The other two had expressed interest. Oneof them is from the greater Chicago area, has anexcellent clinical relationship in our community,but his primary office was located elsewhere. Buthe asked to come into the project if we gotapproved for this project. And the third orthopod is in conjunctionwith pain management services that we're nowcurrently providing. MR. AXEL: I think the other piece of theanswer to your question, Ms. Martell, is that thatlarge Hispanic clinic treating low-incomeindividuals has been asking us to provideorthopedic surgery services. Their patients havehad great difficulty accessing that in the past. MEMBER MARTELL: So the anticipated number



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of referrals? MR. AXEL: We would anticipate somethingin the neighborhood of 250 to 300 a year. MEMBER MARTELL: That's additionalreferrals? MR. AXEL: Incrementally, yes. MR. MAYO: Yes. CHAIRWOMAN SAVAGE: Any other questions? (No response.) CHAIRWOMAN SAVAGE: Mike or George, anyquestion or comment? MR. CONSTANTINO: What's the name of theSpanish medical practice? DR. LEVITIN: Marcon -- MR. MAYO: Marcon -- go ahead, Doctor. DR. LEVITIN: Marcon Medical Center. MR. CONSTANTINO: I'm sorry; I couldn'tunderstand. MR. MAYO: Marcon Medical in Elgin. When we got affiliated with the clinic,they were not providing general surgery or GI, noteven -- not even surgical care but primary carefor general surgery or GI procedures or cases. So in addition to just the surgical cases



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that the surgery center is receiving from thatclinic, we're also providing nonsurgical servicesto those patients who can be medically managed,and we do that at their clinic or in our offices,our doctors' offices. MEMBER MARTELL: And that location's inElgin? MR. MAYO: Yes, ma'am. MR. AXEL: Yes. MR. MAYO: And the second center thatwe're looking at is in the Prospect Heights/Wheeling area, which is -- also has a largeHispanic population. CHAIRWOMAN SAVAGE: Any other questions? (No response.) CHAIRWOMAN SAVAGE: Okay. George, if youcould please call the roll. MR. ROATE: Thank you, Madam Chair. Motion made by Demuzio; seconded byMurray. Senator Demuzio. MEMBER DEMUZIO: Yes, based upon thetestimony I heard and, also, the State report. MR. ROATE: Thank you.



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Dr. Martell. MEMBER MARTELL: Yes, with some cautionregarding their volumes on referrals. MR. ROATE: Thank you. Dr. Murray. MEMBER MURRAY: Yes, based upon thetestimony. MR. ROATE: Thank you. Mr. Slater. MEMBER SLATER: Yes, based on Mr. Axel'stestimony. MR. ROATE: Thank you. Chairwoman Savage. CHAIRWOMAN SAVAGE: Yes, based on thestaff Board report and the testimony. MR. ROATE: Thank you. That's 5 votes in the affirmative. CHAIRWOMAN SAVAGE: The permit isapproved. Thank you. MR. MAYO: Thank you. MR. AXEL: Thank you. (An off-the-record discussion was held.) - - -



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CHAIRWOMAN SAVAGE: May I now have amotion to proceed into closed session pursuant toSection 2(c)(1), 2(c)(5), 2(c)(11), and 2(c)(21)of the Open Meetings Act. MEMBER MURRAY: So moved. MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: Okay. So we are nowgoing to clear the room. (At 12:41 p.m. the Board adjourned intoexecutive session. Open session proceedingsresumed at 12:54 p.m. as follows:) CHAIRWOMAN SAVAGE: Okay. May I have amotion to refer cases to legal counsel. The cases are Javon Bea Hospital, RocktonAvenue campus, Rockford; HSHS St. Joseph Hospital,Breese; SwedishAmerican Hospital, Rockford; andGenesis Medical Center, Silvis. MEMBER SLATER: Madam Chair, don't youhave to go back into open session -- MS. AVERY: We did. MEMBER SLATER: -- to accomplish that? Are we back in? MS. AVERY: Yes. We did. That's why he'sin here.



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Yeah, we're in open. MEMBER SLATER: Okay. I will make suchmotion. CHAIRWOMAN SAVAGE: Thank you. May I have a second. MEMBER MURRAY: Second. CHAIRWOMAN SAVAGE: And then we will do anaye vote if -- aye for we approve, nay if not. Shall we vote? (Ayes heard.) CHAIRWOMAN SAVAGE: We have all ayes. Are there any opposed? (No response.) CHAIRWOMAN SAVAGE: Okay. Then they willgo to legal counsel. MS. AVERY: Okay. Thank you. MS. ALIKHAN: Great. MS. AVERY: You also have in your packetthe financial report from IDPH. And what we have is the first quarter,from July to September, and then the fiscal yearfor -- when was the fiscal year? Fiscal year'19 -- sorry -- with the revenue and expenditures. If you would like to review it and send



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any questions you have -- and I say that becauseI wouldn't be able to answer them without double-checking with Ms. Palmer. So if you would like to review them andemail any questions you have, I'll get thoseanswered and back to you. MR. CONSTANTINO: I think Mrs. Demuzio isgone. (An off-the-record discussion was held.) MEMBER DEMUZIO: Hi, George. MR. ROATE: Hey, Ms. Demuzio. Sorry aboutthat. MEMBER DEMUZIO: We were okay, I think.Right? MS. AVERY: Yes. So, Senator Demuzio, I went over -- well,I didn't go over. I made a statement that if you have anyquestions regarding the financial reports toplease let me know and I'll work with Ms. Palmerto get the responses. MEMBER DEMUZIO: Okay. That's good. MS. AVERY: Okay? Thank you. Lunch is still provided. I will ask that



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you-all please stop by and have a bite to eat. Thank you. MEMBER MURRAY: Are we going to adjournbefore lunch, though? MS. AVERY: Yes. CHAIRWOMAN SAVAGE: Shall we have a motionto adjourn? MEMBER MURRAY: So moved. MEMBER MARTELL: Second. CHAIRWOMAN SAVAGE: Meeting adjourned. (Off the record at 12:57 p.m.)



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CERTIFICATE OF SHORTHAND REPORTER

I, Melanie L. Humphrey-Sonntag, CertifiedShorthand Reporter No. 084-004299, CSR, RDR, CRR,CRC, FAPR, and a Notary Public in and for theCounty of Kane, State of Illinois, the officerbefore whom the foregoing proceedings were taken,do certify that the foregoing transcript is a trueand correct record of the proceedings, that saidproceedings were taken by me and thereafterreduced to typewriting under my supervision, andthat I am neither counsel for, related to, noremployed by any of the parties to this case andhave no interest, financial or otherwise, in itsoutcome.

IN WITNESS WHEREOF, I have hereunto set myhand and affixed my notarial seal this 5th day ofJanuary, 2020.My commission expires July 3, 2021. ______________________________ MELANIE L. HUMPHREY-SONNTAG NOTARY PUBLIC IN AND FOR ILLINOIS



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165:13, 184:7,202:11above9:6abreast51:20abso105:6absolutely26:20, 27:1,69:24, 94:18,107:8, 193:12abuse10:22, 11:8,12:19, 19:23,20:5abusers12:21abysmal161:2academic16:1accelerator31:11, 32:15,32:19, 35:22,36:5accept17:9, 17:14,22:21acceptance127:1accepted13:10, 23:1accepting11:24, 101:12,156:8, 161:1,168:3, 170:23access9:6, 11:12,13:3, 14:1,15:10, 21:6,21:13, 21:17,24:7, 25:7,26:16, 26:17,69:7, 69:8,92:5, 94:2,95:6, 95:10,95:16, 96:3,

102:13, 124:13,124:23, 128:11,158:23, 159:10,160:8, 160:21,164:18, 167:6,167:8, 169:12,169:17, 170:2,174:18, 191:11accessibility86:5, 167:21,170:8, 192:10,193:15, 193:17,193:22, 194:2,194:12, 194:23accessing196:23accommodate31:10, 183:10accomplish200:21accordance28:14, 158:21according169:13accordingly141:1account41:13, 169:9accuracy126:20acknowledges192:12acquire120:8acquiring121:1across19:13act28:15, 167:8,200:4action3:11active25:19, 25:21,117:8, 119:12actively157:4

activities161:11actual127:5, 127:22actually60:16, 60:23,80:5, 81:2,92:6, 105:19,127:3, 127:20,128:1, 159:4,163:1, 163:3,171:2, 171:19,172:16, 173:16,185:21acuity171:21acuity-versus-ac-tual171:18acute9:6, 9:22,13:4, 13:6,14:21, 15:13,17:2, 20:10,21:23, 24:24,67:6, 74:11,153:6, 154:2,154:4, 156:3,161:8, 170:4,173:2add32:19, 51:18,73:14, 77:7,96:12, 106:18,131:6, 176:5,187:5, 188:9added91:18, 91:24,195:12adding88:24addition13:23, 24:9,25:4, 25:6,31:6, 35:21,36:5, 51:23,78:3, 90:1,91:12, 92:21,



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162:1, 163:21,172:1, 173:7admitted162:18, 163:23,165:22, 169:1admitting162:4, 168:20adoption92:14, 92:18adult39:4adults21:2advance117:16, 119:16advanced4:6, 4:8,10:17, 83:3,83:6, 84:3,84:7, 114:11,115:3, 115:7,120:12, 127:18advancement88:21, 141:12advances92:2, 92:14,92:15, 92:18,93:21advantage164:13advised63:3, 113:21advocate3:15, 22:4,22:6, 38:2,38:5, 39:22,40:11affairs48:22affect80:1affected159:20affecting162:19affiliated197:20affiliates59:5

affiliation68:19, 70:1affirmative34:2, 37:12,46:23, 55:8,62:6, 64:24,71:11, 76:4,82:14, 130:1,143:10, 147:23,152:4, 175:8,179:23, 185:18,199:17affixed204:18afford191:13, 194:20after10:23, 17:18,20:19, 20:20,22:19, 23:2,49:6, 51:16,113:19, 113:21,124:14, 127:24,137:9, 137:13,138:7, 157:13again17:21, 26:5,26:10, 27:2,44:16, 65:3,80:15, 84:5,105:14, 106:10,106:21, 107:20,132:20, 137:18,164:24, 171:13,172:24, 181:22,183:23, 193:12against121:17, 192:6agencies20:3agency78:23agenda3:5, 5:4, 5:6,6:7, 6:24, 28:6,30:1, 35:2,38:1, 48:1,50:11, 56:1,

66:1, 72:1,77:1, 83:2,84:2, 115:2,131:2, 144:2,149:1, 153:1,176:1, 187:1ages21:3ago117:10, 122:6,126:15, 127:2,127:14, 192:4,192:19, 194:5agree124:15agreed-upon190:3agreement46:14, 70:1,98:7, 98:10agreements4:18ahead32:18, 50:18,52:20, 112:5,170:17, 197:15ahi124:6aim119:16aims119:6al87:22al-khaled84:17, 84:18,88:7, 90:11,91:4, 91:8,94:17, 98:10,101:19, 101:22,109:24alan48:21alcohol10:17, 12:21alden3:16, 48:2,48:7, 48:23,



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52:1, 53:14aligned69:6alikhan2:9, 5:12,113:19, 201:17all6:15, 6:18,7:4, 7:16, 22:3,35:1, 40:23,41:17, 42:2,42:10, 42:21,43:6, 45:4,49:8, 53:13,58:19, 60:2,60:7, 60:19,79:14, 79:18,80:4, 81:9,89:2, 100:21,101:6, 104:9,104:22, 107:9,107:10, 107:15,108:3, 111:21,115:1, 117:6,118:12, 119:9,124:15, 125:1,126:9, 132:9,133:5, 133:7,133:9, 136:14,138:1, 140:12,145:13, 146:2,146:22, 150:6,150:16, 157:21,162:24, 163:9,177:6, 183:15,185:22, 191:8,192:8, 196:3,201:11allison144:12, 145:23allocation80:23allow14:1, 18:6,59:6, 60:4,69:7, 92:15,93:17, 94:2,96:10, 97:12,

98:16allowable108:5allowing23:15, 87:23,92:2almost42:8, 92:17,102:22, 138:10,172:3alone21:1, 93:9,190:19along40:16, 157:23,164:12, 168:2already74:17, 90:23,99:3, 105:4,109:7, 138:15,176:14also2:7, 10:12,10:17, 25:22,26:2, 26:9,26:12, 26:15,40:14, 61:11,79:12, 92:23,96:6, 101:12,118:7, 119:20,126:6, 133:7,138:2, 138:22,150:16, 155:23,160:19, 162:20,172:14, 173:14,182:4, 184:24,191:5, 198:2,198:12, 198:23,201:18alteration3:17, 6:9,35:5, 35:15,36:4, 36:7,37:13alternatively79:16alternatives164:17

although63:1, 63:14,94:20, 134:15,141:24always86:8, 102:23,164:12, 171:7amazing9:19ambitious50:12ambulance40:21, 162:16,170:12ambulances40:23, 41:10ambulate92:16ambulatory88:13, 89:4,89:9, 89:16,90:2, 91:14,91:20, 92:22,93:4, 93:8,94:4, 101:22,102:3, 102:23,103:7, 104:10,105:9, 128:5amend6:6american116:23, 116:24,117:11, 117:19,118:14, 118:18,119:6, 120:1,127:10, 128:8,133:23ami13:8, 13:10,162:10, 167:14,169:22among111:18amount41:22, 81:4,108:18, 140:10,190:3amounts41:19

anatomy120:20anderson3:21, 56:2,56:5, 56:13,56:23, 57:4,57:6, 57:22,58:1, 58:4,58:7, 58:10,58:11, 58:19,58:20, 58:22,58:24, 59:5,60:3, 60:5,60:8, 60:14,60:16, 60:17,60:19, 60:20,60:21angeles137:11angioplasty91:19, 92:7,92:22ann2:11anne168:6, 176:17annual15:14, 43:14,43:21, 44:12,45:12, 51:21,52:10annually44:4, 157:3another22:21, 44:23,63:4, 96:13,166:9, 166:11,192:21answer32:21, 36:9,43:10, 59:11,68:6, 73:15,79:18, 87:12,97:17, 125:8,146:12, 150:20,170:14, 184:1,195:20, 196:19,202:2



DRAFT

answered202:6answering9:4anticipate123:2, 124:2,141:11, 141:23,197:2anticipated51:2, 196:24anticipating124:4anxiety12:24any6:16, 8:10,17:12, 17:17,18:24, 32:21,32:22, 36:10,41:15, 43:9,44:6, 45:16,45:20, 52:3,52:5, 54:5,59:11, 59:13,59:15, 60:11,61:2, 63:9,68:5, 68:6,68:8, 69:12,69:15, 69:16,70:6, 73:15,75:2, 79:19,79:22, 87:12,94:8, 94:23,97:17, 98:4,100:16, 103:5,105:3, 105:10,106:14, 106:15,107:22, 109:3,111:19, 125:8,125:12, 125:17,126:6, 128:18,128:21, 139:11,139:24, 142:6,146:12, 146:15,146:18, 150:19,150:21, 151:1,157:2, 162:2,162:7, 163:9,

166:22, 167:11,170:22, 173:10,174:4, 177:13,177:16, 183:24,184:1, 184:2,184:4, 184:14,189:12, 189:20,194:14, 194:16,194:18, 195:14,195:20, 195:21,197:8, 197:10,198:14, 201:12,202:1, 202:5,202:18, 204:13anymore90:10anyone27:5, 68:8,170:16, 172:4,172:16, 184:4,195:18anything105:7, 107:2anytime8:20anywhere28:6, 126:7,171:7, 195:6apologies114:6apologize185:19, 185:21appear9:12, 23:10,160:18appetite138:9applicable158:21applicant44:5, 77:16,83:11, 85:23,87:6, 105:10,176:17, 191:9,192:12applicant's45:8, 51:24applicants67:4, 73:1,

78:2, 84:16,85:4, 101:16,104:11, 108:19,116:2, 125:6,131:24, 132:9,132:11, 144:24,145:4, 145:13,149:22, 150:6,154:1, 177:6,182:12, 188:9application10:10, 12:9,21:16, 58:14,61:20, 68:1,73:8, 86:18,104:24, 105:4,105:18, 105:23,106:1, 106:11,106:16, 108:11,109:17, 109:19,110:21, 110:23,112:21, 150:15,166:23, 174:22,178:8, 183:12,184:2, 189:15,192:24, 193:1,193:5applications4:3, 178:4applied105:24, 109:14,110:18, 193:2applying104:3appointed60:18appreciate5:5, 96:15,139:6, 145:24,166:15, 166:16,167:5appreciative135:5apprenticeship-s-tyle127:13approach102:19, 156:15,

158:24appropriate58:17, 96:18,97:11, 97:13,106:19, 108:22,158:23, 160:1,165:24, 169:2,170:1appropriately13:24, 105:18,171:21approval3:5, 3:6,25:17, 27:3,51:7, 51:11,53:8, 53:18,104:3, 108:1,108:21, 109:1,109:6, 154:19,193:5approvals54:4approve6:23, 7:8,8:17, 10:9,10:13, 12:8,14:8, 16:11,21:16, 21:22,23:15, 25:9,30:4, 31:1,33:11, 35:4,35:15, 38:4,38:24, 48:6,48:8, 49:11,56:4, 57:2,63:13, 63:18,63:20, 66:4,66:7, 67:5,72:4, 72:9,72:10, 73:2,77:5, 78:3,83:4, 84:6,85:5, 89:3,94:5, 94:7,97:16, 109:2,109:14, 110:18,114:2, 114:15,114:17, 115:5,



DRAFT

116:3, 131:4,131:7, 132:1,144:4, 144:7,145:1, 149:4,149:23, 153:4,154:2, 176:4,176:7, 176:23,181:4, 181:7,182:13, 187:4,201:8approved3:10, 6:22,7:7, 7:20,28:13, 28:18,31:5, 31:6,34:4, 37:14,39:3, 39:12,47:1, 49:13,50:17, 53:23,55:10, 62:9,65:2, 71:13,76:6, 82:16,86:12, 89:14,91:18, 96:20,98:1, 99:6,99:7, 99:11,100:16, 100:20,100:22, 101:23,104:7, 105:7,109:7, 130:3,143:12, 148:1,152:6, 171:12,175:10, 180:3,186:5, 189:1,189:5, 193:4,196:14, 199:19approving15:20, 97:10approximate132:6approximately31:14, 35:17,35:18, 49:19,49:22, 78:5,85:8, 116:6,132:7, 134:8,134:17, 145:7,150:1, 154:6,

177:1, 182:14,182:16, 188:11april85:9architect183:18architectural49:20area11:19, 25:5,42:17, 50:16,79:4, 95:2,95:4, 97:1,118:3, 122:18,122:24, 123:3,123:12, 124:10,124:12, 126:5,126:11, 128:11,157:2, 157:12,158:7, 160:2,160:7, 160:14,160:19, 162:11,162:15, 163:11,168:8, 168:11,169:7, 169:18,169:21, 172:9,173:7, 173:18,174:1, 189:13,189:23, 190:15,194:15, 194:16,194:18, 195:2,195:14, 195:15,196:10, 198:12area's156:20, 189:22areas19:21, 80:16,80:22, 158:14,160:11, 163:5,173:19, 173:22,183:19aren't18:2, 122:8,171:23arlington187:3, 194:3arm26:19

around119:21, 121:5,126:22, 127:19,127:20, 162:14,168:6, 178:5arrest164:17arteries102:24artery92:8, 92:9,92:13arthritis118:24arthroscopic117:3articles119:19asc94:21, 95:24,96:5, 96:10,97:10, 99:7,100:15, 100:16,100:18, 101:4,104:3, 106:19,108:1, 109:3asc-approved99:17ascs95:1, 95:2,95:4, 104:5,104:7, 109:7asked132:11, 171:14,196:13asking30:24, 35:14,38:23, 40:18,44:1, 49:10,57:2, 67:4,73:1, 78:2,85:4, 104:9,105:3, 105:5,116:2, 131:24,144:24, 149:22,154:1, 176:22,182:12, 188:9,191:4, 196:21

aspect184:2aspects53:10assessment12:23, 159:7,159:9, 193:23assistance17:1assisted-living50:14, 50:17,53:3associate122:1, 122:3,122:22associated3:9, 4:16,18:21, 20:17,25:13, 25:18,56:22, 96:3,96:4, 120:23,187:2, 187:5,187:21, 195:11associates118:11, 128:12,187:13, 187:19assure51:23astc83:7, 84:8,85:6, 86:4,87:3, 115:8,116:4, 122:12,123:22, 124:20,188:11, 189:2,189:5, 189:7,189:8, 190:1,190:10, 190:11,190:14, 190:20,190:21, 191:4,191:6, 191:16,191:23, 194:13,194:15, 194:17,194:18, 195:4,195:6astc's189:10, 189:15,189:20, 190:5,



DRAFT

191:2, 192:13,192:17, 192:19astcs122:5, 189:12,189:17, 189:22,189:24, 190:6,190:15, 191:11,195:15athletes117:7, 117:9,121:5athletic118:23attained123:6attempts68:13attendance6:4attention108:16, 195:19attitudes137:7attorney79:11attributed191:22audience5:3, 27:5augment25:7august39:1aurora39:22, 40:11authorized49:14availability24:7, 117:23,124:9available15:5, 15:16,93:15, 139:4,193:21avenue200:15average80:6, 119:3,

160:6avery2:8, 6:14,8:18, 19:1,19:4, 19:7,19:15, 28:1,40:7, 43:21,44:1, 44:19,44:24, 45:3,45:7, 45:15,45:18, 63:1,63:12, 74:2,74:4, 78:22,83:16, 91:5,103:15, 103:18,110:12, 111:10,111:19, 111:21,112:14, 112:22,113:2, 113:5,113:9, 113:11,113:13, 114:20,115:12, 116:20,121:14, 125:24,132:22, 185:19,185:24, 187:15,200:20, 200:23,201:16, 201:18,202:15, 202:23,203:5avoidable156:16aware22:17, 88:16,98:2, 107:22awareness89:1, 164:15,173:15away13:20, 15:24,20:9, 20:12,21:7, 23:4,24:16, 69:3,87:16, 123:22,137:17, 156:10,158:6, 161:5,162:6, 166:4,166:5axel36:3, 37:16,

83:11, 115:17,121:13, 121:15,130:4, 187:12,187:13, 187:18,187:19, 188:22,196:2, 196:18,197:2, 197:6,198:9, 199:21axel's199:10aye6:19, 7:17,201:8ayes6:20, 6:21,7:5, 7:6, 7:18,7:19, 201:10,201:11

Bb-e-t-h12:11b-o-o-k-e-r8:22b-r-o-s-n-a-n149:12b-r-y-a-n84:14back13:14, 17:3,17:21, 30:16,41:18, 53:3,81:4, 81:8,83:13, 100:6,101:15, 109:16,110:3, 110:20,157:13, 166:18,200:19, 200:22,202:6background189:4barrier191:12bartlett3:16, 48:3,48:7, 49:16,51:8, 52:23base86:18, 95:8,

189:8based15:19, 33:7,33:11, 33:15,33:19, 33:23,36:19, 36:23,37:3, 37:6,37:9, 44:2,46:4, 46:9,46:13, 46:17,46:20, 54:13,54:17, 54:21,55:1, 55:5,61:10, 61:15,61:19, 61:23,62:3, 64:5,64:9, 64:13,64:17, 64:21,70:15, 70:19,70:23, 71:3,71:8, 75:10,75:14, 75:18,75:22, 76:1,81:19, 81:23,82:3, 82:7,82:11, 86:6,124:18, 129:6,129:10, 129:13,129:17, 129:21,141:19, 142:15,142:19, 142:23,143:3, 143:7,147:4, 147:8,147:12, 147:16,147:20, 151:9,151:13, 151:17,151:21, 152:1,163:20, 168:12,174:13, 174:17,174:21, 175:1,175:5, 178:17,178:21, 179:2,179:8, 179:13,179:17, 179:20,184:23, 185:3,185:7, 185:11,185:15, 193:19,196:7, 198:22,



DRAFT

199:6, 199:10,199:14basic22:11, 31:23basis88:3, 137:22,138:6, 157:5,169:19, 171:4bea200:14beam42:1beams42:8because9:10, 11:16,13:19, 20:7,21:4, 22:6,41:23, 68:21,69:19, 86:16,86:22, 100:23,102:17, 106:22,117:23, 121:24,123:1, 123:10,126:9, 136:1,137:24, 138:2,140:12, 155:24,160:18, 165:2,171:13, 171:20,172:8, 173:24,177:21, 191:12,191:13, 193:19,202:1become21:11, 57:6,67:8, 68:2,127:9, 138:11,159:1, 161:6becomes124:6, 127:24,137:19bed9:12, 13:10,16:12, 49:15,67:5, 72:6,73:2, 78:4,79:8, 145:1,145:2, 145:5,

146:1, 146:10,153:6, 154:2,154:4, 154:20,160:3, 169:8,173:12beds15:5, 21:13,24:14, 25:5,25:6, 77:7,78:3, 78:5,145:3, 145:5,145:6, 160:4,160:6, 160:15,160:20, 169:10,169:19, 173:10been14:6, 14:12,15:14, 28:18,31:15, 44:9,49:21, 53:7,53:9, 53:22,58:7, 58:23,63:2, 68:19,68:21, 73:24,80:4, 88:18,89:8, 97:3,97:23, 98:1,99:12, 104:11,104:23, 121:17,121:18, 123:13,124:10, 125:7,127:3, 133:22,135:14, 138:16,156:5, 165:20,166:12, 171:5,178:5, 191:4,193:11, 195:17,196:21before18:5, 41:6,50:22, 51:15,52:15, 85:22,94:9, 97:20,100:6, 104:20,105:11, 119:4,189:2, 203:4,204:7beg166:3

began193:10begin18:24, 19:9,51:11, 155:4,191:4behalf18:21, 25:8,57:22behavioral9:16, 9:17,9:24, 10:15,12:18, 13:17,13:23, 14:9,14:19, 15:11,15:13, 17:14,18:6, 20:8,20:12, 20:22,22:9, 22:17,23:21, 24:4,24:8, 24:10,24:15, 25:4,25:10, 154:20,154:21, 156:2,158:24, 160:22,162:1, 164:11,168:1behind20:15, 31:24,40:3, 50:13,50:24being5:5, 5:6,15:22, 18:8,21:6, 50:15,59:18, 60:18,99:22, 122:10,122:18, 122:21,123:24, 159:17,161:1, 161:20,167:5, 189:19,189:23, 190:3believe25:4, 74:23,74:24, 94:1,94:4, 96:6,96:18, 170:8,183:21

believes24:9, 108:23belmont28:23below87:7benefit18:7, 120:14,125:3, 165:7benefits89:9, 89:16,89:22, 120:22,127:2benjamin115:16, 116:21benoit182:3, 186:3best69:20, 88:15,92:3, 93:7,98:21, 108:23,119:8, 135:21,163:18, 172:1,189:9beth8:14, 12:11,155:17better16:2, 23:6,42:21, 93:13,124:6, 138:5,138:21, 140:16,166:12, 166:14,168:23, 169:4,169:14, 169:16between28:7, 41:7,42:8, 93:10,107:24, 109:17,109:18, 110:21,110:22, 118:10,163:22beyond173:10, 193:23big135:15, 138:7bill141:1



DRAFT

billing141:8bit40:3, 40:16,42:20, 110:13,178:6, 189:4bite203:1bjc31:23bleeding92:17blood140:11blue194:1board's5:11, 189:13bodies138:12body140:12bolingbrook1:6booker8:14, 8:21,8:22, 155:17border157:11borne88:14, 127:3both8:12, 14:19,25:3, 32:9,38:15, 57:9,92:1, 95:5,105:7, 107:17,111:4, 124:8,137:3, 146:10bought98:20boundary158:5bourbonnais181:3, 182:15brand-new98:14bratcher31:22, 31:23,

37:15break28:4, 28:6,51:13, 111:11,113:13, 113:16,156:16breese29:4, 200:16brief79:17, 113:19,113:21, 133:10briefly85:20, 85:24,94:16bring31:24, 32:10,42:15, 81:3,101:15bringing120:3brings53:3broad24:1broader123:12, 157:11broken42:19brosnan149:12, 150:12,152:7brought122:4, 126:21bryan84:14, 88:4,94:17bryars2:4, 5:13build50:13, 94:16building3:14, 3:19,4:12, 6:9, 6:11,30:3, 30:6,31:6, 35:3,35:23, 39:10,42:15, 108:21,149:3, 149:6,

149:24, 181:6,182:14, 183:5buildings41:4bump32:18bunch106:11burden44:7, 45:9,156:22burnout97:8business4:21, 48:22,79:13buy98:11

Cc56:2, 63:2,66:2, 72:2calculation107:19, 122:2,122:13, 134:12calendar91:21california122:8call3:3, 3:4, 5:16,8:9, 9:4, 33:2,36:14, 45:23,54:8, 61:5,63:23, 70:9,75:5, 80:10,81:14, 83:12,103:6, 111:22,129:1, 142:10,146:23, 151:4,174:8, 177:19,178:12, 184:18,198:17called17:7, 58:19,73:24, 102:5,119:14, 138:17,

171:5calls16:24, 122:16,190:15came41:18, 157:13campus31:7, 40:22,41:8, 154:3,200:15can't45:1, 90:21,132:13, 161:9,161:10, 166:6,171:6, 178:20,181:21, 187:17,191:13, 194:6,194:19cancer32:1, 32:2,32:11, 170:3cannot22:22, 24:22,51:6, 86:16,103:5, 114:5,120:5, 161:9,162:3, 165:2,192:17capabilities96:13, 122:5capable95:11, 96:24capacity97:6, 195:13capital69:7, 69:23,71:5capture173:23car166:5cardiac87:17, 90:1,91:12, 92:7,92:21, 94:13,95:7, 95:18,95:19, 99:2,99:3, 99:18,



DRAFT

99:22, 100:1,100:3, 100:21,101:1, 101:6,101:9, 101:13,102:16, 103:9,103:11, 103:22,104:6, 106:6,107:16, 107:19,107:24, 112:11cardiocatheteriz-ation90:5, 91:16,92:6, 98:13,109:18, 110:22cardiologists89:7, 93:6cardiology88:9, 94:14cardiovascular85:6, 86:13,86:24, 87:21,88:1, 95:3,100:20, 102:2,102:9, 102:22,109:8carlinville5:8, 50:7carotid92:8, 102:24carriers89:3carries157:3carroll168:16, 172:23,173:17case11:10, 11:21,45:4, 123:13,194:24, 195:1,196:7, 204:13case-manage20:4cases24:18, 26:23,95:22, 97:6,97:11, 97:12,120:23, 122:4,

122:7, 122:8,122:9, 122:13,123:21, 139:20,161:11, 196:5,197:23, 197:24,200:13, 200:14catch-up127:5catchment172:22categorizes190:1category72:7, 73:3,74:15, 99:19,103:22, 154:3,190:5cath87:17, 96:12,96:24, 97:4,99:2, 99:3,99:18, 99:22,100:1, 100:3,100:21, 101:1,101:6, 101:9,101:13, 102:4,102:16, 103:6,103:9, 103:22,105:24, 106:6,107:16, 107:19,107:24, 112:12catheterization90:2, 91:13,92:7, 92:21,95:20, 101:5,104:6, 107:21,108:12cause9:3, 21:3caused40:20caution199:2cdc159:20census74:19, 171:20center3:8, 3:9, 3:15,

4:5, 4:6, 4:13,4:15, 4:16, 8:8,11:3, 12:5,13:7, 15:6,16:1, 16:18,18:21, 22:10,25:3, 25:14,25:18, 26:6,26:14, 32:1,32:11, 32:12,38:3, 38:6,39:4, 39:22,43:5, 59:23,60:1, 67:13,77:3, 77:7,83:3, 83:5,88:13, 89:5,89:10, 89:17,90:3, 91:14,91:20, 92:22,93:5, 93:16,94:1, 94:5,95:7, 95:16,97:15, 101:23,102:23, 103:7,104:10, 105:9,115:3, 115:6,118:9, 118:13,119:24, 120:13,120:23, 121:7,122:19, 123:24,124:6, 126:16,128:5, 128:7,128:10, 140:9,146:5, 146:6,153:2, 153:5,154:4, 160:20,181:3, 181:5,182:1, 187:3,187:5, 187:21,187:23, 191:3,191:9, 193:10,195:10, 197:16,198:1, 198:10,200:17center's10:14, 14:8,16:12, 21:23,

24:3centers23:19, 32:2,67:7, 93:8,95:6, 95:10,102:3, 117:22,118:3, 118:12,120:5, 120:7,126:7, 155:9,155:22, 156:24central145:21ceo21:21, 23:19,60:14, 60:16,66:18, 120:11,155:22, 156:5,157:20certain104:5certainly40:13, 52:12,101:21, 128:10certificate204:1certification191:24certified10:17, 134:13,204:3certify204:8cfo60:16, 60:17cgh3:8, 4:13, 8:7,10:2, 10:3,10:14, 11:3,12:5, 13:7,13:16, 14:8,15:6, 15:15,15:16, 16:11,16:18, 16:24,18:6, 20:7,21:22, 22:10,24:3, 24:6,24:10, 24:13,24:14, 25:3,



DRAFT

153:2, 153:5,154:4, 160:14,162:23, 167:6,167:22, 167:24,173:1chair3:10, 5:17,28:14, 28:18,29:6, 30:23,31:18, 33:3,35:13, 35:24,36:15, 38:22,39:17, 45:24,49:4, 50:1,50:5, 52:11,54:9, 56:21,57:15, 57:19,61:6, 64:1,67:3, 67:19,70:11, 72:24,73:9, 75:6,78:1, 78:16,80:11, 81:15,85:3, 85:15,98:24, 111:24,116:1, 116:14,116:24, 129:2,131:23, 134:7,142:11, 144:23,145:15, 146:20,146:24, 149:21,150:8, 151:5,153:24, 154:14,174:9, 176:21,177:8, 178:13,182:11, 182:22,184:19, 188:8,188:18, 198:18,200:18chairman1:13, 36:3,83:11, 181:19,181:23, 187:12chairperson78:20challenge13:12, 171:17challenged24:13, 165:12

challenges11:6, 13:24,20:18, 40:15,40:16, 68:22,163:12, 163:13champion126:2chance94:8, 97:17,163:18change53:18, 53:21,56:6, 57:11,63:10, 63:19,67:5, 67:24,73:21, 73:24,79:24, 106:23,141:24, 142:3changed74:17changes60:23, 98:15changing53:19, 126:4characteristic190:9characteristics189:7charge171:3, 189:21charitable118:20, 119:10charity189:10, 189:19,189:23, 194:14chart58:13, 59:3,183:21check80:24checking202:3chicago4:6, 17:17,20:21, 20:22,32:9, 32:10,72:3, 73:4,83:2, 83:5,

115:3, 115:6,128:11, 137:10,158:3, 158:13,160:14, 166:4,196:10chicago-area11:23chicagoland11:19, 86:4,162:15chief8:15, 12:13,16:9, 16:15,18:18, 19:12,145:23, 155:16,158:19, 182:3chiefs155:15children's25:23choice94:5choices135:10choose8:11, 133:19,141:4choosing137:2, 139:14,142:2christ3:15, 38:2,38:5chronic14:21circled160:7circulated168:6circumstances163:10cities157:10citizens14:23, 15:3,15:21, 16:23,20:4, 20:8,21:11

city14:20, 16:10,21:10, 21:16,155:14, 157:24civil160:20clarification142:20, 195:23clarifies104:15clarify112:15clarifying129:13clarity104:14clear44:16, 94:5,99:21, 101:1,104:4, 107:10,200:8cleared165:20clearly95:14, 95:21,100:11, 104:24clients11:10, 11:14,11:18, 11:22,12:2, 172:24clinic12:15, 12:16,12:17, 31:6,118:15, 178:8,196:20, 197:20,198:2, 198:4clinical10:16, 196:6,196:11clinics3:13, 3:18,6:8, 6:10, 30:3,30:6, 35:3,35:23, 157:16,173:21clip42:6close21:13, 24:10,



DRAFT

178:8closed128:7, 200:2closeout42:24closer21:18, 40:7,44:19, 74:2,74:4, 116:20,125:24, 132:22closest160:24closing87:18, 124:24,195:8closure69:2, 87:8,92:10, 98:15,177:22, 179:9clustered162:14cms73:21, 73:23,89:23, 90:6,91:10, 91:17,106:17, 106:22,108:2cno158:16, 171:3co-applicants79:5coalition159:6codes100:1, 104:22,106:12, 106:16,106:18, 107:21,109:14, 110:18,123:16coding107:22coe58:13coes57:22collaborate16:18, 155:10,164:5

college146:6columbia32:6combined63:1, 63:14,157:24come18:17, 18:22,46:14, 53:18,100:6, 102:1,104:4, 105:11,109:16, 110:20,121:5, 123:12,127:3, 127:17,162:23, 170:24,172:2, 173:1,193:24, 196:13comes93:3, 109:5,136:8comfort89:20comfortable26:22comfortably92:4comforting93:18coming51:14, 60:2,60:19, 132:15,141:21, 171:10commence50:22comment46:5, 49:8,85:24, 101:19,174:5, 197:11comments8:3, 54:14,57:14, 61:11,68:6, 94:17,121:19, 124:15,125:14, 125:17,128:18, 128:21,139:24, 142:7,146:18, 150:13,

179:3, 184:14commercial89:3, 96:21commission204:20commit108:3commitment14:16, 29:1,51:24, 71:4,82:20, 172:18committed15:21, 19:19,31:16, 39:14,69:23, 183:12commonly87:3communicate190:16communication16:22communities11:17, 16:19,22:4, 24:1,26:1, 159:5,173:5community3:22, 9:2,10:5, 11:10,12:7, 12:15,12:16, 14:1,14:15, 14:16,14:20, 14:24,15:14, 16:1,16:17, 18:7,18:9, 19:13,19:21, 20:3,21:7, 21:12,21:14, 22:5,22:9, 24:6,24:17, 25:11,25:20, 25:21,25:24, 26:13,26:18, 26:20,56:24, 57:23,58:10, 59:1,63:9, 63:18,69:10, 93:1,

94:3, 120:4,121:8, 127:1,135:16, 139:2,154:11, 154:22,155:5, 155:10,156:1, 156:14,156:19, 157:21,158:11, 159:1,159:7, 161:14,161:17, 162:7,163:14, 163:21,164:9, 167:4,170:6, 173:15,195:18, 196:11community's15:10, 22:17community-based155:6, 164:6,164:18comp168:13company3:23, 59:24,66:2, 66:5,66:16, 66:18,67:6, 67:12,68:1, 68:14,68:17, 69:3compared93:11, 169:11,189:16, 189:21comparing99:11comparison137:12complement145:3, 145:5complete49:20, 50:22,51:17completed50:19, 51:6,127:11completing43:3, 43:6,150:15completion49:17, 53:1,



DRAFT

67:9, 78:6,85:9, 116:7,145:8, 150:2,154:7, 177:2,182:17, 188:12complex14:2, 95:22,97:12, 119:23,196:5complexity40:14, 96:5compliance2:11, 4:18,59:8, 78:13,85:14, 87:4,106:24, 109:10,116:13, 121:18,122:15, 124:4,124:24, 195:7complications120:18comply104:16, 109:3component88:5, 162:15components50:21composite123:5comprehensive22:15, 31:24,32:1, 32:11,118:22con48:19, 48:24,68:3, 79:7,79:10, 132:21,132:23, 144:15,182:4concept133:12concern9:3, 13:1,24:9, 103:23,105:17, 108:18,172:9concern's112:19

concerned105:21concerns94:9, 112:10,159:17conclude8:2conclusion57:5condition101:8, 161:18,165:18conduct108:4, 164:9conducting105:8confirmed190:16conformance33:12, 146:2confronted167:2confronting165:4conjunction196:15consider6:7, 91:23,113:22consideration166:16considered23:5, 87:3consistent9:1, 17:6, 36:7consistently162:18, 167:23consolidate178:9consolidation177:22constantino2:10, 28:12,28:17, 30:23,35:13, 38:22,45:17, 49:4,56:21, 59:17,60:13, 67:3,

69:15, 69:22,70:2, 70:5,72:24, 78:1,79:24, 82:19,85:3, 98:24,99:10, 99:15,99:20, 100:2,101:7, 101:14,103:11, 103:21,106:3, 106:5,106:8, 109:20,110:24, 111:20,116:1, 125:18,128:20, 131:23,140:2, 140:17,144:23, 146:19,149:21, 153:24,174:6, 176:21,182:6, 182:11,184:10, 184:12,184:16, 188:8,197:12, 197:17,202:7construction40:6, 40:11,50:22, 51:11,51:12, 51:17,53:2, 149:23,183:4, 183:13,183:17, 183:18,184:11, 195:10consultant48:19, 79:11,84:15consultants88:9, 94:14continually21:9continue9:9, 13:4,44:12, 60:5,60:20, 96:16,162:3continued24:24continuing156:13continuity13:5, 16:21,

24:20, 120:2,161:3, 165:2,170:6continuous15:6contractor98:20control57:4, 57:9,96:11, 155:1,166:23conventional134:6, 135:13conversations53:14convert140:4converting140:2convey93:20cooper176:17, 179:24coordinate9:20coordinated23:24copy168:7core118:21, 167:8corporate56:23, 57:3,57:7, 58:6,58:17, 59:16corporation58:4, 58:5correct43:24, 44:24,105:20, 106:24,107:5, 119:1,119:7, 204:9correctly119:22cost35:6, 35:16,36:7, 49:21,57:10, 67:15,



DRAFT

78:5, 78:14,80:17, 80:22,85:7, 86:20,87:8, 92:24,96:11, 98:23,116:6, 121:2,125:4, 132:6,145:7, 149:24,154:6, 177:1,182:16, 183:17,183:19, 188:11,195:11, 195:15cost-effective88:16, 97:3cost-effectivene-ss89:1costly118:6, 120:6costs89:19, 96:4,170:11, 170:12could13:15, 50:22,52:15, 59:17,68:14, 70:3,83:12, 84:4,91:7, 92:8,92:13, 93:6,95:21, 97:3,103:3, 103:6,109:15, 109:20,110:8, 110:11,110:19, 110:24,126:3, 129:1,131:21, 136:21,141:15, 142:10,144:10, 146:22,150:18, 153:10,169:23, 172:14,172:17, 176:15,181:10, 182:24,184:18, 187:10,198:17couldn't197:17coulterville4:4, 77:2,

77:4, 77:6,79:1, 79:3counsel2:9, 4:20,5:12, 48:19,48:24, 77:16,144:15, 155:2,176:17, 182:1,182:5, 200:13,201:15, 204:12counselor10:18counties168:16country26:24, 32:4,117:5, 117:6,121:6, 126:15,127:19county8:23, 9:2,9:18, 9:20,11:3, 12:14,12:15, 12:16,16:19, 20:24,21:1, 21:22,22:1, 58:8,79:3, 123:19,155:8, 155:17,155:19, 155:21,156:8, 157:4,158:1, 158:2,159:5, 159:6,159:24, 163:16,168:22, 173:17,204:6county's12:22, 12:23,159:11couple127:7, 194:5course15:8, 104:7,104:15, 107:5,109:3court8:13, 18:13,26:4, 27:10,

30:17, 30:20,38:15, 38:18,48:13, 48:16,55:13, 56:14,56:17, 66:20,66:23, 72:18,72:21, 77:19,77:22, 84:20,84:23, 110:4,110:14, 113:3,113:6, 113:8,115:18, 115:21,130:6, 131:16,131:19, 144:16,144:19, 149:15,149:18, 153:17,153:20, 167:16,167:19, 175:13,178:20, 181:12,181:15, 188:1,188:4courtney2:8, 52:14,78:22cover86:10, 126:11,183:1coverage157:16covered88:4, 91:20,105:4, 105:19,105:23, 105:24,193:24, 194:5cpt100:1, 107:22crazy10:2crc1:24, 204:5create16:23, 87:24,156:22created50:20, 117:19,119:13creates15:5, 156:15

creating14:16, 58:18,119:17credentialing193:8creek28:19crime14:22crisis11:20, 11:22,12:6, 14:20,16:20, 20:2,24:11, 25:1,156:3, 156:18,161:24, 164:8,164:18, 165:4criteria32:4, 85:13,100:7, 102:2,116:12, 121:17,121:19, 122:16,124:8, 125:1,133:10, 146:2,183:16, 192:6,192:8, 192:10,193:19criterion78:12, 123:7critical15:18, 18:8,155:12criticism18:1croatian194:9cross194:1crr1:24, 204:4crucial155:7, 159:2csr1:24, 204:4culture142:3current49:17, 86:6,



DRAFT

95:24, 96:23,97:4, 98:15,165:5currently24:11, 59:20,88:7, 88:12,95:1, 101:23,104:7, 120:1,127:21, 139:2,159:12, 159:19,164:1, 193:7,196:17customizing120:19cutting-edge118:17cycle13:14, 17:21,24:24, 137:19,163:7cycling157:7

Dd6:8, 35:2d-a-v-i-d153:16d-e-t-t-m-a-n10:12daily24:13, 80:6,138:6dan2:2, 144:14data165:11, 168:13date49:17, 52:10,53:14, 53:23,78:6, 85:9,116:7, 145:8,150:2, 154:7,177:2, 182:17,188:12daughter26:8david153:15, 165:4

daviess168:15, 172:23davita4:14, 28:19,176:2, 176:5,176:22day17:8, 19:23,28:2, 119:9,137:16, 137:18,162:2, 204:18days9:11, 17:5,17:19, 22:20,117:13, 134:18,136:10, 136:11,138:9dead23:12deal124:8, 165:18deanna1:14death21:3debra1:13, 2:4, 5:12decade15:8, 117:10decades41:3, 58:6,89:6, 93:24december1:7, 6:7, 6:24,31:2, 31:3,49:12, 49:18,78:7, 189:6decide136:10decision68:16, 108:13,136:18decisions109:4declining141:12decrease74:19, 92:17,

92:24decreased89:18, 96:4decreasing120:16, 141:19dedicated15:17, 20:7,96:8, 117:12,118:1, 118:16,162:5deductible194:8deescalate164:7defer100:6, 112:19,113:9deferral113:10deficiencies39:10, 41:21,86:1deficiency86:19deficit170:9define99:24, 101:12,102:16, 103:3defined107:22, 189:13,195:1definition89:24, 91:11,100:24, 102:4,189:18, 195:7delay40:20, 108:19delayed50:20delays50:21deliver40:24, 41:10,69:9, 88:15,92:3demand21:12

demographics165:11demonstrating10:4demuzio1:14, 5:8,5:18, 5:19,19:1, 19:3,19:5, 30:13,30:14, 33:6,33:7, 36:18,36:19, 46:3,46:4, 50:6,50:8, 54:12,54:13, 56:7,61:7, 61:9,61:10, 64:4,64:5, 70:14,70:15, 75:9,75:10, 81:18,81:19, 84:4,90:13, 90:17,90:20, 90:24,103:13, 103:16,112:3, 112:4,114:5, 114:9,114:13, 129:5,129:6, 141:14,141:15, 141:17,142:14, 142:15,147:3, 147:4,149:7, 151:6,151:8, 151:9,174:12, 174:13,176:8, 178:14,178:16, 178:17,178:23, 179:1,184:22, 184:23,187:7, 198:19,198:21, 198:22,202:7, 202:10,202:11, 202:13,202:16, 202:22density162:10dental12:18deny112:10



DRAFT

department1:1, 2:2, 2:4,2:5, 12:14,22:12, 24:24,39:21, 41:1,41:4, 41:11,41:12, 43:5,51:10, 155:8,155:19, 161:23,162:22, 163:16,163:24, 165:3,165:15departments39:5, 163:2dependent140:21depending28:5depicted58:12depicts162:11depression12:24deprives96:2deputies9:8des83:3, 115:4,116:5, 117:20,118:13, 123:19described189:9describing155:12description124:18deserve22:24, 96:19,166:11deserves16:1, 162:8design40:6, 40:10designated31:12, 32:2,58:24, 146:5

designed10:23, 95:7,95:17, 95:19,95:21, 133:18,161:15desires79:15desperate21:17desperately12:2, 12:3despite163:17detail40:3, 45:11,55:6, 86:11,155:3detailed53:5details52:16deteriorate165:1deteriorated42:8determine165:17determined58:16, 165:21,193:17, 196:6dettman8:14, 10:11,10:12, 155:20devastating156:16develop69:9developed159:7, 164:17,190:21developing81:2development48:22, 50:18,51:5, 51:7,53:8, 79:14devices92:10, 92:11

devote117:18diagnose119:22diagnosis119:1, 119:7diagnostic90:4, 91:16diagram162:9, 172:21dialysis4:14, 28:19,95:17, 102:13,133:19, 133:24,134:4, 134:16,135:7, 135:10,135:11, 135:13,135:15, 135:16,135:22, 135:24,136:2, 136:12,136:14, 136:16,136:22, 136:24,137:2, 137:4,137:5, 137:9,137:15, 137:18,138:6, 138:15,138:16, 138:20,138:22, 138:24,139:1, 139:8,139:15, 139:19,140:8, 140:9,140:23, 141:21,176:2, 176:5dialyze140:13dialyzing134:18diana18:19, 21:21,155:20difference41:7, 41:9,137:6, 138:18different5:7, 86:18,102:20, 105:11,108:8, 123:16,135:17, 136:15,

137:22, 161:4,178:3, 190:14difficult20:14, 51:1,100:23difficulties20:16, 90:9difficulty118:24, 196:23dignity22:3dilemma15:6direct162:24directly16:18, 19:13,19:15, 36:4,125:3, 171:5,172:2director10:18, 40:6,40:10, 116:23,133:3, 165:3,187:21directors15:20disadvantages156:22, 163:12discharge20:19, 20:22,92:15, 92:16,92:19discharged9:15, 10:24,161:21discontinuation29:2, 73:2discontinue69:16, 72:6discount190:4discounted194:18discovered41:20discrepancies120:17



DRAFT

discuss101:16, 155:2,165:5discussed111:17discussing135:21discussion6:16, 7:13,19:8, 30:12,35:10, 43:16,48:4, 52:22,59:14, 70:8,73:19, 83:15,90:14, 90:18,100:23, 104:18,110:1, 110:6,111:7, 113:24,114:19, 142:20,154:15, 199:22,202:9discussions53:5disease15:23, 95:18,102:12, 135:18diseases23:6dislocations120:18disorders157:6disparity24:7disrupting162:20distance162:11, 163:8distant12:1, 156:14,158:12distinguish107:24, 170:1distinguished78:21distress164:23district32:6

diverse194:22division145:22dixon11:15, 13:11,168:22doctor90:7, 97:22,111:4, 197:15doctors86:10, 96:19,119:4, 198:5documented122:23, 189:14documents105:1doing68:21, 99:17,106:15, 112:6,118:7, 136:13,140:15, 167:7,168:23, 193:10dollar98:12dollars18:5domb115:16, 116:17,116:21, 122:1,122:3, 122:11,123:2, 123:8,123:14, 123:18,126:8, 128:16,130:5domb's124:14, 124:18dome121:15, 122:22domino50:21done41:20, 42:18,53:7, 59:18,92:8, 93:4,97:3, 102:17,104:20, 117:21,120:5, 122:10,

122:12, 126:16,126:19, 136:22,193:12door23:11, 93:16doors58:5double202:2double-board-cer-tified116:22doubtful124:11, 195:5doubts94:8down53:17, 81:4,81:8drained137:9, 137:23,138:4dramatically170:9drawings49:20, 51:6,51:9drift173:18driftwood4:14, 176:2,176:5drive40:24driving93:22drop83:13drs123:2, 123:8drug10:17ductwork42:6due24:24, 43:22,44:3, 44:4,91:22, 96:23,

97:7, 120:6,167:24, 191:11dulce2:5dupage123:19duplicate25:5duplication86:5, 124:22,192:11, 193:16,193:18, 193:22,194:24duration134:9, 134:17during88:23, 123:14,136:11, 191:19,192:13duty119:12

Ee-29:5, 56:2,56:5, 56:23,56:24, 63:18,66:2, 66:5,72:2, 72:5each5:13, 17:7,122:22earlier109:1, 113:23,155:13, 163:9early42:5, 92:16,118:23easier138:3, 139:4easily24:19, 122:13,162:16east3:13, 3:18,6:8, 6:10, 30:2,30:6, 31:8,35:3, 41:8



DRAFT

eastern25:21, 25:23,190:11, 190:17eat203:1ed13:14, 17:21,156:3, 169:1edge86:15educate73:21education117:12, 117:19,118:20, 134:20,136:15edward29:2effect50:21, 73:22,80:4effective10:6, 96:22effectively9:19, 14:2,20:23, 24:21,25:9, 92:4efficiency59:10efforts150:17egress53:19eight8:10, 42:24,131:6, 132:1eight-station132:2either102:10, 156:11elective97:2electrophysiolog-ist94:13electrophysiology88:10, 90:4,91:15, 94:14

elements166:22elgin160:19, 197:19,198:7eliminating170:11elite121:9else27:5, 105:10,195:18elsewhere157:17, 196:12email202:5emailed49:6emergency22:12, 24:23,39:5, 39:21,41:1, 41:4,41:11, 41:12,43:4, 161:23,162:22, 163:23,165:3, 165:15,172:3employed204:13employees154:10employs190:14ems15:2enable121:7enclosed51:15encounter164:23encountered40:15encourage133:19encouraging135:14end17:20, 41:5,

95:17, 102:12,135:11, 135:18,135:24, 136:17,139:14, 139:18endeavor155:5endoscopic39:6enforcement163:16, 164:3,164:11engagement19:21english194:1enhance22:3enhances93:15enormous140:10, 156:22enough18:2, 42:9ensure158:20, 170:6ensuring8:24enter40:24entire26:3, 26:7,41:23entirely100:24entities58:12, 59:2,60:8entity58:19enumerated107:23enveloped51:15environment16:23, 68:23,93:19episodes25:1, 161:8

equip95:22equipment86:21, 86:23,87:1, 87:2,87:7, 87:9,87:11, 88:23,98:8, 98:12,98:17, 105:22,118:1, 118:4,118:5, 120:6,127:22error97:21errors120:16escort41:10especially163:11esrd132:1, 141:22,176:6essence51:4essential27:1, 155:5,157:18, 162:21essentially126:21establish57:3, 83:6,84:8, 115:7,149:5, 153:5,181:6established99:22, 100:4,101:9establishment49:15, 85:5,116:3, 154:2,182:13estate59:24estates3:16, 48:2,48:7estimate86:24, 87:8,



DRAFT

87:11, 139:13estimated32:13ethnicities190:12european25:21, 25:24,190:11, 190:17evaluation118:22even26:8, 91:22,93:13, 103:9,133:9, 137:6,141:3, 156:14,164:20, 169:4,193:9, 197:22evenings97:6event87:11ever13:10evergreen66:3, 67:7,68:18, 84:3,85:7, 88:12,93:17, 114:12every17:8, 19:23,43:18, 44:3,44:14, 52:9,93:3, 168:4,169:20, 169:21everybody5:5everyday121:7everyone5:2, 18:7,21:13, 26:13everything53:22, 53:23,98:20, 106:19evidenced69:1evolution88:20, 92:5,

92:10evolving88:18ex2:1, 78:23exacerbated156:19, 161:19exact28:9, 89:21exactly93:6, 101:17example92:4, 123:14,138:7exceeded80:24exceeds189:11excellent155:6, 164:15,196:5, 196:11exception183:16exceptional14:12excess86:21, 122:23excited93:22, 133:15,135:3exciting139:1excuse73:5, 90:7,113:3, 122:14,132:5, 169:18,183:7, 192:16executive4:17, 12:13,66:15, 133:23,142:4, 200:10exemption3:20, 29:4,56:5, 62:8,63:18, 65:1,66:5, 71:12,72:5, 76:5exemptions56:22, 63:2

exercise5:9exhibiting164:8exist109:17, 110:21existing39:10, 50:24,77:8, 79:8,95:8, 132:2,138:24, 176:6,176:23, 189:2,195:9, 196:8expand39:3, 39:6expanded58:9, 58:16,134:1expansion39:12, 41:3,42:17, 79:8,144:6, 146:1expansions41:3expect123:11, 142:1,157:22, 163:22,173:6expectation178:5, 189:19expected78:6, 116:7,141:22, 145:8,150:1, 154:7,177:2, 182:17,188:12, 192:14expecting172:24expedient97:4expended31:15expenditures201:23expenses80:17expensive128:2

experience17:23, 20:16,134:23, 138:17,138:18, 164:22,167:23experiences135:4experiencing159:23expert127:9, 127:24expertise93:5, 118:19experts127:17, 138:11,160:4expires204:20explain59:17, 135:5explained44:9explains183:22express171:15expressed112:11, 196:9extend101:14extension28:24, 40:19,43:7, 44:11extensive126:19extent155:1, 166:22extreme141:23, 168:1extremely11:9, 20:14,195:5

Ff-i-o-r-i-n-i12:11faces164:24



DRAFT

facilities1:2, 11:23,28:15, 57:8,57:20, 58:3,74:10, 79:14,80:1, 86:7,87:9, 95:21,97:24, 128:3,161:4, 196:8facility49:15, 50:14,50:17, 51:1,53:3, 77:8,78:4, 79:2,79:9, 80:5,86:9, 86:11,87:19, 95:14,96:7, 96:13,99:23, 100:4,100:14, 101:10,107:14, 117:20,128:15, 132:2,132:13, 133:4,133:18, 135:1,139:12, 172:7,172:11, 176:6,176:24facing14:20fact69:17, 95:12,135:6, 138:4factors191:23failing163:7failure135:11fair160:10fall51:13, 60:8,160:11, 190:5falls19:12, 19:20,155:15, 157:10,157:23familiar26:23, 86:3,

89:15, 93:18,164:23families20:15, 21:8,26:11, 26:12,156:17, 161:10,166:2family2:3, 26:3,26:7, 157:14,161:17, 166:5,166:6fapr1:24, 204:5far9:6, 11:24,13:19, 23:6,53:22, 80:4,104:1, 162:6,166:5, 169:4,189:11fast126:5father26:8fatigue137:17favor6:18, 7:4, 7:16fear21:6february31:4, 43:23,44:21, 67:10,112:24, 113:5,178:7, 188:13federal105:8, 108:5federally12:16feedback45:16, 142:4feel105:14, 137:6,137:13, 137:19,138:20, 139:20,140:16, 169:5,169:11

feeling120:21, 137:9,137:15, 137:23,138:3, 138:4feels108:22fees78:15feet182:14fellows127:19fellowship127:10, 127:13,127:16femoral92:13few15:15, 41:2,44:21, 58:6,122:6, 127:20,135:9, 160:12field117:16, 119:16,126:3, 127:6fifth192:9figure70:3, 74:24filed195:17filing88:5, 91:22,109:2, 193:1filings86:4final4:19, 43:1,51:5, 51:7,53:8, 89:23,90:6, 91:10,91:17finalize51:8finally86:19, 137:17financial4:22, 29:1,

125:1, 201:19,202:19, 204:14financially31:16, 39:14,108:20find139:1, 140:13,165:23finding12:22, 20:18,24:13, 86:20,119:1, 121:21,121:23, 122:14,122:15, 145:24findings12:22, 121:10,121:20, 155:1,167:3, 183:15,189:3, 192:7fine79:16, 103:19finish42:15, 42:21,109:16, 110:20finished41:5fiorini8:15, 12:10,12:11, 155:17fire15:2fireproofed42:2fireproofing42:2, 42:11firmly94:4first8:6, 8:9, 8:19,31:16, 32:5,32:14, 39:15,49:5, 49:23,51:19, 58:4,86:3, 93:3,102:5, 118:15,121:21, 123:10,126:8, 126:14,128:10, 133:5,



DRAFT

173:5, 176:13,189:7, 191:19,191:20, 191:23,192:8, 192:13,201:20firsthand11:6, 20:16,24:15, 165:5fiscal201:21, 201:22five6:4, 8:9, 21:1,111:12, 111:13,116:12, 121:19,122:19, 134:16,136:12, 156:8,159:19, 161:1,168:4, 170:19,171:20, 192:1fix90:9fkc28:20flexibility59:9flight137:10floor134:14, 183:5flourished15:7flow140:11flows140:11fluent194:1fluid138:8, 138:10,140:10fluoroscopy102:15, 102:18,103:2, 103:6fmc28:23focus43:8, 60:5,121:19, 189:2,

192:16focusing43:3folks99:1, 165:16,165:24follow24:21, 161:20follow-up12:2, 107:15,141:10, 172:20following6:9, 28:17follows:200:11foot-long42:14footage35:20forces22:16foregoing204:7, 204:8foremost51:19foresee41:15foreseen40:17form27:7formal150:13formed59:21forward53:16, 107:14found41:24, 69:4,78:12, 80:16,85:13, 86:1,98:18, 116:12,121:18, 140:15,195:6foundation117:1, 117:11founded117:10

four22:20, 119:4,134:8, 134:16,136:12, 137:14,153:19four-county157:1, 157:11fourth192:9frame157:8, 158:1francis71:5freeport173:20, 176:3,176:24, 178:9,179:10frequent54:18, 54:22,134:16, 140:6,140:23frequently140:14, 166:3,166:8fresenius4:9, 131:2,131:5, 132:24,133:2, 133:15friday194:11friedman149:13, 152:8,166:19, 167:18,167:20, 175:11,176:16, 177:12,178:1, 180:1friendly136:21front81:5, 87:13,161:23frustrating9:8, 17:22frustration164:22fulfill119:20, 167:7fulfilling169:6

full5:4, 9:16,43:6, 44:4,44:14, 92:6,164:20, 194:6full-size134:5fully154:24, 163:24,167:4, 172:11function161:10functioning120:21functions20:23, 163:3funding86:21further25:7, 108:3,159:14, 159:24,193:9future71:5, 106:18,139:8

Gg-e-i-l153:14g-o-e-b-e-l144:13gaffner48:21, 50:4,50:9, 52:11,52:17, 53:1,55:12gain89:16gained164:15gap11:11, 24:10gaps109:17, 110:21,156:21gastroenterology89:12gather44:6



DRAFT

geil153:13, 158:17,158:18, 171:1,172:13, 173:11,175:12general2:9, 5:12,9:21, 74:17,89:7, 120:11,138:13, 168:24,173:14, 182:1,197:21, 197:23generally10:1, 134:7,169:1genesis200:17gentle134:15, 136:20,138:2, 140:6gentleman63:6gentlemen109:22, 111:3geographic122:18george2:12, 33:1,36:13, 45:22,54:7, 61:4,63:24, 69:13,70:9, 75:4,79:22, 80:10,81:13, 111:15,111:22, 112:14,114:1, 125:16,128:17, 129:1,139:23, 142:9,146:17, 146:22,150:24, 151:3,174:4, 174:7,177:18, 178:12,184:15, 184:17,197:10, 198:16,202:10getting26:16, 44:7,53:17, 119:4,

159:23, 169:17,169:18gi197:21, 197:23give27:6, 28:2,28:9, 30:21,38:20, 40:2,52:21, 70:3,126:3, 126:13,133:10, 139:13,166:13, 166:18,189:3given95:24, 96:5,107:15, 108:15,142:3, 157:2,162:2, 166:12gives51:16giving163:17go28:9, 32:18,52:20, 74:23,90:15, 102:14,103:19, 108:23,112:4, 113:20,136:8, 136:19,137:1, 137:15,137:17, 138:22,139:13, 165:14,170:17, 193:23,197:15, 200:19,201:15, 202:17goal87:24, 127:16,159:17goebel144:13, 145:19,145:20, 148:2going8:9, 28:3,40:13, 41:19,42:12, 43:2,52:24, 60:13,69:7, 74:22,81:3, 87:18,

87:19, 91:8,99:12, 100:3,101:9, 101:17,101:24, 102:8,102:10, 103:15,104:4, 104:5,105:19, 108:4,109:9, 112:4,112:9, 112:20,113:15, 122:8,122:9, 126:6,133:13, 135:7,136:5, 139:18,142:1, 166:6,171:14, 172:22,200:8, 203:3gollinger72:15, 72:16,73:13, 73:23,74:3, 74:6, 76:7gone17:19, 202:8good5:2, 5:3, 8:21,10:11, 12:10,14:5, 16:8,19:10, 23:17,28:1, 38:12,39:20, 40:5,40:9, 41:14,50:5, 57:19,67:22, 72:15,78:20, 90:21,98:16, 116:17,132:20, 137:11,145:19, 158:18,202:22gotten164:12governance59:7, 60:7government48:22, 105:8,108:6grace43:5graciously109:2

gradual135:19grandparents26:12grant79:6graph160:15, 160:17great26:14, 26:15,45:15, 91:1,118:24, 196:23,201:17greater4:6, 59:9,83:2, 83:5,115:2, 115:6,196:10greatest9:7greg31:22gross35:19, 182:14ground51:13, 51:14group8:6, 21:15,53:14, 58:11,59:24, 79:13,88:9, 88:10,93:22, 117:17,183:7, 183:11group's87:24grow69:18growing50:16, 141:23,192:2, 192:18grown58:15growth9:5, 126:12,183:6, 183:10gsa168:3guarantee105:12



DRAFT

guidance109:4guide157:20guidelines36:8, 74:8guild2:11, 8:4, 8:6,8:20, 18:12,18:15, 19:9,25:12, 27:4,27:9, 52:19gynecological193:10

Hh77:2, 83:2,84:2, 115:2,131:2, 144:2,149:2, 153:2,176:2, 181:2,187:2h-a-n131:15h-a-n-l-o-n66:18half98:17, 139:18han131:15, 133:3,134:22, 135:2,139:16, 140:4,140:19, 143:15hand42:10, 56:15,72:19, 133:13,204:18handful117:4handle9:9, 86:16,165:6, 172:12handling9:5hands30:18, 38:16,48:14, 66:21,

77:20, 84:21,115:19, 131:17,144:17, 149:16,153:18, 181:13,188:2hanlon66:17, 68:17,69:17, 69:24,70:4, 71:14happens165:13happier138:12, 139:8happy5:14, 36:9,43:10, 45:14,52:17, 59:11,68:6, 79:16,87:12, 107:12,125:8, 146:12,150:19, 170:14,183:24, 185:23,195:20hard108:14, 140:12harder126:10hartgrove20:21healthcare2:2, 31:23,57:4, 57:6,58:19, 58:23,59:5, 60:9,60:14, 60:17,60:19, 66:13,66:15, 67:8,67:12, 67:14,68:2, 69:5,69:22, 77:18healthier16:19, 138:13,139:8, 159:5healthy5:14hear19:6, 25:15,40:8, 44:18,

44:20, 74:5,90:13, 90:16,90:19, 90:20,90:22, 90:24,91:7, 103:17,113:20, 114:5,178:20, 181:21,187:17heard6:20, 7:5,7:18, 33:16,46:6, 54:14,61:11, 61:16,80:2, 105:17,107:16, 142:16,147:5, 155:12,163:9, 164:2,165:11, 167:24,195:4, 198:23,201:10hearing57:13, 67:16,73:6, 78:8,85:10, 116:9,132:4, 145:12,150:3, 154:13,177:5, 182:21,188:17hears19:17heat162:9heavily160:12height41:7heightened87:19, 133:22heights187:3, 194:3,198:11held5:6, 19:8,30:12, 35:10,43:16, 48:4,59:14, 70:8,73:19, 83:15,90:14, 90:18,

104:18, 110:1,110:6, 111:7,113:24, 114:19,154:15, 199:22,202:9hello50:8, 135:2,141:17help20:23, 21:11,69:8, 69:18,150:14, 157:20,165:23, 171:13,171:14, 192:17,193:14helpful43:15hemodialysis134:2, 134:6,134:19here5:5, 14:7,16:11, 21:12,22:4, 24:3,25:17, 39:24,52:19, 79:4,86:21, 87:23,88:6, 100:4,101:17, 103:16,107:6, 113:20,132:12, 133:7,135:7, 140:18,154:19, 155:11,155:23, 155:24,157:8, 160:14,162:22, 165:10,167:5, 167:24,168:7, 171:10,194:23, 200:24hereunto204:17heroes119:14hey171:6, 202:11hi31:22, 50:8,149:13, 176:16,



DRAFT

177:12, 202:10hickory28:19high97:7, 140:11,194:7higher87:11, 194:14,194:15, 194:17highest159:22, 168:17highest-cap98:12highlights160:1highly10:1, 14:2,120:6hip116:23, 116:24,117:3, 117:11,117:19, 118:14,118:17, 118:18,118:23, 119:6,119:23, 120:1,120:17, 120:20,120:21, 126:14,127:10, 127:18,128:8hips119:14hispanic190:12, 190:24,196:20, 198:13hispanic-focused192:3historic123:8historical122:20, 123:13,126:13, 163:20historically58:2, 104:12,164:11hit182:24hohulin66:12, 67:22

hold53:9, 74:2,74:4, 90:8holders30:24, 31:5,31:9, 35:14,38:23, 39:2,39:8, 49:10holding54:1holes42:9, 92:12holiday5:14home9:15, 20:19,21:13, 21:18,24:20, 50:13,74:16, 74:21,121:2, 133:19,133:24, 134:1,134:19, 135:15,135:22, 136:12,136:15, 136:19,137:2, 137:5,137:15, 137:21,138:19, 138:21,139:3, 139:14,139:18, 139:22,140:5, 142:2,166:7homeless23:9homelessness14:22, 19:22,20:5homes74:8, 74:10,139:3honor14:12honored155:10hope53:11, 87:6,93:20, 97:14,168:19hoped127:2

hopeful172:14hopefully49:8, 51:15hoping139:7horizon96:2hospital-borne121:1hospitalizations11:14, 11:23hospitals11:16, 13:11,17:7, 17:9,17:13, 18:1,20:21, 24:19,57:5, 57:9,59:23, 97:5,97:9, 97:11,98:16, 118:8,120:10, 156:9,158:13, 161:22,162:19hotlines164:19hour28:7hours9:11, 9:14,13:9, 15:24,20:9, 23:2,24:19, 134:8,137:14, 161:4,162:16however13:3, 15:16,124:4, 124:14,135:13, 135:23,193:23hrsa12:19hsa162:2, 172:8hshs4:10, 29:3,144:2, 144:5,200:15

huge9:24, 26:21human2:5humphrey-sonntag1:23, 204:3,204:23hundred39:23, 67:8,160:5, 160:6hurdle127:23hurdles127:7hurts21:13husband26:7hybrid95:13, 102:5hylak-reinholtz77:15, 79:11,81:6, 82:18hyphen84:18hypothetically109:13, 110:17

Iicu145:3, 146:10idea28:2identified12:23, 24:6,159:9identify20:3, 30:11,38:10, 48:12,56:10, 66:10,72:13, 77:12,84:12, 93:6,115:15, 131:10,144:11, 149:11,153:10, 176:13,176:15, 181:11,181:18, 183:19,187:11



DRAFT

idph2:10, 2:12,49:20, 201:19ignored10:8ii39:7, 159:22ill23:12, 108:15illinois1:1, 1:6,10:19, 13:21,14:7, 16:10,19:12, 19:14,23:22, 28:14,28:22, 29:4,31:8, 32:1,32:8, 32:12,49:16, 51:10,57:7, 58:2,58:3, 58:8,73:4, 79:3,85:7, 95:6,100:17, 100:24,101:23, 116:5,117:7, 120:14,121:9, 122:11,124:12, 124:23,125:4, 128:5,132:3, 133:17,145:22, 146:8,149:24, 154:5,157:9, 159:8,159:15, 160:23,176:24, 182:15,204:6, 204:24illness9:2, 9:6, 9:10,10:21, 11:7,13:8, 14:22,15:23, 16:13,19:22, 21:2,21:5, 21:23,22:7, 23:7,153:6, 154:3,157:1, 161:7,163:11, 163:18,164:5, 164:16,

167:10, 168:9,170:4, 173:2illustration168:5imaging58:12, 59:23,86:24immediately6:9immigrant25:24, 26:11immigrants190:19impact14:21, 135:15,195:14impacts15:2, 21:10,24:20, 163:4implement58:22implementation120:12importance89:1, 157:18,160:1important79:7, 96:7impossible68:24, 172:4impressive92:2improve19:23, 164:4,170:10, 193:17improved59:9, 89:19,94:2improvement88:22, 159:15improving142:5impulse31:23in-center134:3, 134:5,135:22, 136:24,137:4, 137:8,

139:22inability162:17inadequate17:24, 161:19inc57:8, 58:3,176:22incidents9:9include58:9, 101:4,107:19, 108:11,183:5included50:11, 101:1,107:2, 107:21,183:22includes101:13, 119:10,119:11, 155:14,158:22, 160:19including11:3, 20:18,50:6, 51:21,88:11, 89:17,94:3, 104:6,117:7, 122:12,124:20, 162:2,190:4inclusive101:6incorporated23:20, 58:23,122:2increase9:1, 35:5,35:16, 35:19,80:5, 124:1,126:6, 145:2,145:4, 159:17,191:18, 191:19,192:17, 193:8,195:13increased13:3, 36:6,89:19, 192:20increases146:10, 191:22

incrementally197:6indefensible15:12independent25:2, 158:8indiana117:22, 121:24,122:5, 126:17indicate140:22indicated172:21indicating159:21indigent94:3individual120:19, 164:7individualized134:20individuals9:10, 11:13,13:16, 17:2,17:18, 17:20,22:7, 24:23,117:8, 157:1,165:1, 196:21indulgence189:3industry74:17inefficiencies170:11infection89:18infections121:1information44:6, 44:8,52:22, 53:12,108:4, 122:21,183:24informed136:18infrastructure39:11ingress53:19



DRAFT

inherently50:20initial4:3, 53:4,53:18, 113:22initially119:3, 165:17,165:19initiated133:17initiating161:24initiatives60:7injuries117:3, 118:17,118:23, 119:23inmates9:5innovate69:19innovation69:8innovative119:17inpatient9:7, 9:12,10:14, 10:24,11:12, 11:18,11:20, 13:4,13:19, 14:9,15:5, 15:11,20:10, 22:9,22:15, 24:4,24:8, 24:12,24:14, 39:5,74:21, 156:1,157:7, 158:6,159:10, 160:22,161:12, 163:7,163:19, 165:7,165:22inquire17:5inside11:15insight68:15

installation31:11instead32:6, 84:2institute4:8, 28:22,32:3, 69:20,84:3, 84:7,114:12, 116:23,117:1, 117:11,118:15, 118:19,119:6, 127:10,128:8institute's117:19, 120:1instituted69:20institutions73:22insurance17:11, 17:13,89:3insurers96:21intake162:4integral43:4, 58:7integration66:16integrity42:4intend95:23intended95:7, 95:11,95:12intending191:5intense74:12, 74:14,74:20intensive11:5, 17:14,29:3, 145:2,154:21, 161:12intent42:23, 43:5,

69:15, 112:10,132:12, 179:9intention106:14, 172:11interact166:1interest182:23, 183:3,183:23, 196:9,204:14interested135:7international117:14internationally123:17internist125:21, 126:9internist's126:10interplaying108:16interpretation112:20intervening157:4intervention16:20, 20:2,24:12, 88:24,96:13, 154:21,159:18introduce133:11introduction118:14invested52:1involuntary168:1involved60:24iplan159:9issue53:24, 81:9,140:18, 140:21,141:2, 141:6,171:24, 178:2,

193:16, 194:3,194:12, 194:23issues4:18, 41:15,53:17, 125:22,192:8, 193:24item6:10, 30:2,35:2, 38:2,40:20, 48:2,56:2, 72:2,77:2, 84:2,114:9, 144:2,149:2, 153:2,181:2, 187:2items3:10, 3:11,28:13, 28:17,42:16

Jj-o-h-n66:17j-u-l-i-e25:16jack115:17, 121:10,187:12, 187:19jacobi181:19, 181:22,181:24, 183:2,185:22, 186:2jail9:3, 9:5, 9:21,11:4january39:2, 112:23,150:2, 177:3,204:19javon200:14jenkins2:2, 170:18,172:10, 172:19jo168:15, 172:23job1:21, 126:10



DRAFT

joe48:23, 77:15,79:11, 182:5john8:14, 8:22,48:18, 66:17john's4:10, 144:3,144:5, 146:4joined79:12joining5:8joseph200:15joseph's29:3journals119:19julie18:21, 25:16,144:13, 145:20july145:9, 201:21,204:20june159:21justify121:22, 163:24

Kk-a-v-a-n-a-u-g-h153:16k-h-a-l-e-d84:18k-r-i-s-t-i-e153:13kane204:6kara149:13, 166:18,176:16kavanaugh153:15, 165:4,165:9, 173:3keep8:11, 13:15,51:19, 52:9,

171:3, 171:20keeps103:15keith56:12, 57:24kent1:18key159:1, 159:17khaled87:22kidney4:9, 131:2,131:5, 133:23,135:10, 135:18kids26:9, 26:10kilbourn41:6kind42:3, 42:13,118:16, 138:17,174:1knew40:14kniery48:18, 51:18,53:13, 55:11know11:21, 24:15,50:23, 74:18,93:3, 98:19,98:21, 105:10,126:1, 134:3,136:4, 136:6,137:13, 140:19,161:7, 163:9,164:17, 166:15,170:22, 171:9,171:12, 172:8,202:20knowledge98:21, 104:22,119:22, 126:22,128:4, 128:9known67:6, 67:11,124:6, 173:24

knows26:13kristie153:13, 158:17ksb13:18, 25:3,25:6, 170:19,170:23, 171:2,172:15kyle182:3

Ll-a-w-l-e-r144:14l-e-e14:6l-y-o-n-s38:14lab98:13, 99:22,100:1, 100:3,101:6, 101:9,101:13, 102:4,103:6, 103:9,107:24, 109:18,110:22labs87:17, 96:24,97:4, 106:6,108:12lack11:11, 13:4,15:1, 15:4,15:10, 21:6,21:9, 21:12,161:2, 161:20,167:6lall122:1, 122:22,123:2, 123:18lall's123:9landscape88:17language191:3, 191:12languages190:15, 190:17,

194:10, 194:21large117:17, 162:15,189:8, 190:22,192:2, 196:20,198:12larger168:7, 169:7largest11:11last15:8, 18:23,25:13, 32:15,89:6, 110:12,118:10, 122:3,122:7, 123:20,126:18, 135:14,156:5, 168:5,171:2, 171:9,190:1, 191:1,191:21lastly96:15late97:6later49:7law158:21, 163:16,164:3, 164:11lawler144:14lawn38:3, 38:6leaders14:13, 14:15leading21:3learn127:9least23:2, 104:14,117:13, 191:8leave18:13, 27:10,55:13, 130:6,168:11, 175:13leaves17:8



DRAFT

leaving168:18lecturing117:13led89:2, 92:14lee8:15, 14:5,14:6, 16:4,16:6, 155:15,168:22, 172:23left20:15, 48:21,48:23, 79:10,117:17, 182:3,187:22leg120:17legal4:20, 17:11,155:2, 200:13,201:15length89:18, 120:17lenox28:20less140:14, 160:15less-specialized158:11let's96:9, 136:1letter82:20, 82:21,85:11, 99:21,120:11letters67:16, 73:5,73:6, 73:7,78:9, 85:11,116:10, 125:7,132:7, 145:10,150:4, 154:10,154:11, 177:4,182:19, 188:14,188:15level15:23, 25:11,

39:3, 39:21,69:21, 74:21,121:9, 123:5,123:9, 146:5,158:23, 159:22,169:3, 171:22,189:20levels86:7levitin26:2, 187:14,187:20, 197:14,197:16levitt77:17, 79:12,80:20, 81:7,82:17licensed10:16, 12:20,57:5, 74:11,95:1, 95:5,100:14licensee57:11, 67:13licensure51:17lighting42:7like-to-like86:8likely123:3, 123:5,124:1, 163:9likened137:10likewise95:16limit21:4limited11:16, 13:21,185:20, 188:24,195:8limited-specialty83:6, 115:7,116:3linda1:17

line9:22, 51:5,51:12, 52:12,84:5, 122:11linear31:11, 32:14,32:19, 35:21,35:22, 36:5lines161:24link120:2linking20:5list90:3, 91:14,91:20, 92:23,106:16, 107:22,108:1listed100:18, 106:11literally92:12, 122:10literature126:24little3:23, 40:3,40:16, 42:20,44:19, 45:5,49:7, 51:16,52:21, 66:2,66:5, 66:16,66:18, 67:6,67:12, 68:1,68:14, 68:17,69:3, 92:11,92:12, 106:23,110:12, 126:13,136:20, 140:14,178:6, 185:24,189:4live14:17, 23:8lives19:23, 164:4living77:18, 80:21,163:11, 190:19

local13:2, 13:11,15:23, 22:16,23:9, 25:11,120:9, 159:8,160:2locally13:16, 159:12,169:23, 169:24,170:13located31:7, 79:3,86:15, 87:16,88:12, 95:4,128:16, 157:9,160:13, 182:15,196:12locating93:16location50:23, 191:6location's198:6locations5:7, 88:11long44:11, 45:5,99:12, 101:12,103:18, 107:10,162:6, 162:11long-serving158:16long-term49:15, 72:6,73:3, 74:10,77:7, 77:8,78:3, 78:4,78:5, 79:2,79:9, 80:1longer22:20, 161:9,162:7look27:9, 98:22,173:9, 173:15looked19:7, 41:13looking93:9, 108:21,



DRAFT

198:11loop158:3lori131:12, 132:21los137:11lose12:1lost125:21lot26:23, 103:8,126:10, 128:3,137:1, 137:19,137:24, 138:21louder125:23love52:3loved166:2low169:11low-income190:24, 196:20low-stress93:19lower192:14lowering98:22lssi157:3, 163:15ltach74:21lucky32:8lunch28:4, 202:24,203:4lutheran10:19, 120:11,155:8, 155:20luxury135:20lyons38:14, 40:5,

40:9, 40:10,43:24, 45:13

Mm-o-r-g-a-n16:9m-o-r-r-i-s-o-n131:14ma'am111:17, 111:20,139:16, 198:8machine102:11, 134:2,134:6, 134:19,135:13, 136:12,136:19, 136:20,138:20madam5:17, 29:6,30:23, 31:18,33:3, 35:13,35:24, 36:3,36:15, 38:22,39:17, 45:24,49:4, 50:1,50:5, 52:11,54:9, 56:21,57:15, 57:19,61:6, 64:1,67:3, 67:19,70:11, 72:24,73:9, 75:6,78:1, 78:16,80:11, 81:15,83:11, 85:3,85:15, 98:24,111:24, 116:1,116:14, 129:2,131:23, 142:11,144:23, 145:15,146:20, 146:24,149:21, 150:8,151:5, 153:24,154:14, 174:9,176:21, 177:8,178:13, 182:11,182:22, 184:19,187:12, 188:8,

188:18, 198:18,200:18made33:4, 36:16,41:9, 46:1,54:10, 61:7,64:2, 70:12,71:5, 75:7,81:16, 92:20,100:8, 112:1,114:1, 114:3,114:7, 121:23,129:3, 135:15,142:12, 147:1,151:6, 174:10,178:14, 179:3,184:20, 198:19,202:18madison58:8main40:20, 86:20,88:11, 140:4mainstream126:23maintain42:22, 172:1maintains158:20major9:3, 42:1,144:6, 182:24majority15:9, 21:4make19:16, 44:6,44:22, 45:6,53:5, 63:12,83:12, 99:1,99:21, 105:11,105:17, 110:8,114:15, 136:18,139:4, 150:17,171:14, 195:24,201:2makes138:20making162:15

man88:8manage81:8, 156:6managed198:3management11:10, 89:12,116:4, 193:11,196:16manager2:11managers11:21managing88:8, 163:10manipulate138:5manner43:4, 59:6many10:7, 10:22,11:14, 13:9,13:15, 17:4,23:10, 24:18,87:8, 117:21,126:4, 135:6,155:10, 157:6,161:7, 196:1map162:9march116:8marcon197:14, 197:15,197:16, 197:19marginalized21:14, 22:8,167:10mark44:15, 66:12,187:22, 196:2market86:8, 86:13,87:10, 94:22,95:2, 95:4,96:14martell1:16, 5:20,



DRAFT

5:21, 6:13, 7:1,30:7, 33:4,33:10, 33:11,35:7, 36:16,36:22, 36:23,38:9, 46:2,46:8, 46:9,52:21, 54:2,54:16, 54:17,61:14, 61:15,63:22, 64:3,64:8, 64:9,66:9, 70:13,70:18, 70:19,72:12, 75:8,75:13, 75:14,77:11, 80:15,81:17, 81:22,81:23, 82:19,83:8, 84:9,107:15, 112:1,112:8, 112:9,112:17, 114:3,114:7, 114:14,114:16, 129:9,129:10, 131:9,141:10, 142:13,142:18, 142:19,147:7, 147:8,149:9, 151:7,151:12, 151:13,153:7, 172:20,173:9, 174:10,174:16, 174:17,177:20, 178:10,179:7, 179:8,181:9, 184:6,184:11, 184:21,185:2, 185:3,195:22, 196:19,196:24, 197:4,198:6, 199:1,199:2, 200:6,203:9mary3:23, 66:2,66:5, 66:16,66:19, 67:7,

67:12, 68:1,68:14, 68:17,69:3, 72:16maryville56:3, 56:24,58:11masked42:3, 42:10material42:2matters59:8maybe45:5mayo187:22, 196:3,197:7, 197:15,197:19, 198:8,198:10, 199:20mayor8:15, 14:5,14:6, 14:18,15:21, 16:4,16:6, 155:14meal138:8mean102:1, 173:3means102:8, 190:2,191:8mechanical42:6medicaid17:12, 89:2,94:3, 96:21,189:11, 189:16,191:12, 191:23,192:1, 194:5,194:16medical3:8, 3:13,3:15, 3:18,4:11, 4:13,4:15, 6:8, 6:10,8:7, 10:14,11:3, 12:5,12:17, 13:7,

14:8, 15:6,16:1, 16:12,16:18, 21:22,23:6, 24:3,25:3, 26:24,30:3, 30:6,31:6, 35:3,35:23, 38:3,38:6, 43:5,58:11, 59:24,67:12, 68:23,89:10, 116:23,119:19, 128:7,132:24, 133:3,145:5, 146:4,146:11, 149:3,149:6, 149:23,153:2, 153:5,154:4, 157:14,162:21, 165:18,181:2, 181:5,181:6, 182:1,182:13, 183:4,183:6, 183:7,183:11, 187:20,197:13, 197:16,197:19, 200:17medically96:18, 198:3medicare89:2, 90:2,91:9, 91:13,93:9, 96:20,100:1, 100:22,102:1medication22:11medication-assis-ted12:20medications17:19medicine146:8, 157:14meet10:6, 133:9,194:21meeting1:4, 5:6, 6:7,

6:24, 7:9, 7:20,9:13, 104:20,112:23, 113:4,150:18, 203:10meetings117:14, 195:5,200:4meets166:21, 166:24melanie1:23, 110:2,204:3, 204:23members1:12, 2:1, 5:3,14:24, 20:2,21:11, 22:5,32:23, 43:14,49:6, 50:6,57:20, 60:18,63:1, 73:16,78:21, 135:6,181:19, 181:23,188:23memorial3:13, 3:18,6:8, 6:10, 30:2,30:5, 31:8,35:2, 63:10memory50:14, 50:24mental9:2, 9:6, 9:9,9:20, 9:22,10:21, 11:7,11:12, 13:8,13:18, 14:22,15:1, 15:5,15:23, 16:13,17:2, 19:22,20:4, 20:10,21:2, 21:5,21:23, 22:7,23:7, 25:1,153:6, 154:2,156:3, 156:18,157:1, 157:6,158:6, 159:10,159:16, 159:20,



DRAFT

160:19, 161:7,163:10, 163:15,163:18, 164:4,164:8, 164:16,164:19, 167:9,168:9, 170:4,173:2mentally23:12mentioned35:20, 52:14,53:1, 135:12,192:4, 192:19merely162:3merge68:13met132:9, 145:13,150:6, 171:9,172:7, 177:6methodology167:14, 167:20,169:8metro158:13metropolitan160:14, 161:22metrosouth69:2, 87:15,98:7, 98:11,98:19mic19:16, 40:8,44:19, 74:4,125:24, 187:15,187:16michael2:10, 77:17microphone74:2middle23:11might13:20, 43:15,79:18, 105:14,109:17, 110:21,171:11

migration173:23mike18:14, 27:11,30:21, 35:11,38:20, 45:16,49:2, 55:14,56:19, 59:15,60:12, 67:1,69:12, 72:22,77:23, 79:12,79:22, 80:20,81:5, 85:1,111:19, 115:23,125:16, 128:17,130:7, 131:21,139:23, 144:21,146:17, 149:19,150:24, 153:22,174:4, 175:14,176:11, 176:18,182:9, 184:14,188:6, 188:23,197:10mile86:15, 122:24miles13:20, 22:14,23:4, 69:2,87:16, 122:10,122:19, 123:22,156:10, 158:2,158:3, 158:4,158:5, 190:20,191:6, 193:21military119:12million35:17, 49:22,52:1, 70:4,78:6, 80:23,85:8, 86:23,116:7, 145:8,150:1, 154:7,182:17mind24:2mine126:10

minimize183:18minimum169:10, 173:11,173:12minute113:16, 192:4,192:19minutes8:12, 16:3,16:5, 18:11,23:13, 28:7,113:14, 122:6,194:5misdiagnosed119:3miss194:11, 194:20missing120:1mission10:4, 24:2,69:6, 118:18,118:21, 119:16,119:20, 168:14,169:6mississippi158:4mistake100:8mix196:7modalities136:16model73:24, 74:7,74:18, 140:3,140:5modernization39:12, 144:6,145:1, 146:1modernize39:3mokena4:11, 149:2,149:3, 149:5,149:24moment155:3

monday-wednesday--friday134:9money22:2month6:11, 28:18,28:21, 30:4,31:1, 38:4,38:24, 44:10,48:6, 51:12,136:14, 193:4months42:21, 42:24,43:2, 43:18,44:3, 44:9,44:14, 44:21,44:23, 45:5,49:11, 52:9,191:20more18:15, 22:18,23:4, 40:3,40:17, 51:1,52:22, 53:5,53:24, 54:18,54:21, 59:6,59:7, 68:15,80:14, 86:10,87:12, 89:3,96:21, 97:3,97:12, 103:8,108:10, 117:18,122:17, 123:22,132:15, 133:19,133:24, 134:15,135:5, 136:20,138:8, 139:4,140:6, 140:7,140:14, 140:23,142:2, 155:2,156:10, 156:14,170:23, 177:24,196:5morgan8:15, 16:8,16:9, 155:16morning5:2, 5:3, 8:21,



DRAFT

10:11, 12:10,14:5, 16:8,19:10, 23:17,28:1, 28:10,38:12, 39:20,40:5, 40:9,50:5, 57:19,67:22, 68:4,72:15, 78:20,116:17, 116:19,132:20, 145:19,158:18morrison131:13, 133:1,133:13, 133:14,140:20, 141:7,141:13, 141:18,143:14most12:23, 21:14,22:8, 26:9,69:1, 88:15,139:17, 167:10motion6:6, 6:14,6:22, 6:23, 7:7,7:8, 8:16, 30:4,33:4, 35:4,36:16, 38:4,46:1, 48:5,54:10, 56:4,56:7, 61:7,63:5, 63:12,63:17, 64:2,66:4, 70:12,72:4, 72:9,75:7, 77:5,80:12, 81:16,83:4, 84:6,110:8, 112:1,113:23, 114:2,114:3, 114:7,114:15, 114:16,115:5, 129:3,131:4, 142:12,144:4, 147:1,149:4, 149:7,151:6, 153:4,

174:10, 176:4,176:8, 178:14,181:4, 184:20,187:4, 187:7,198:19, 200:2,200:13, 201:3,203:6motions63:15mount4:9, 131:3,131:6, 132:3,133:4, 133:18,135:1, 135:4,136:9move7:1, 30:7,35:7, 41:22,48:8, 63:20,66:7, 72:10,83:8, 84:9,131:7, 144:7,176:7, 181:7moved7:10, 38:7,53:16, 77:9,115:9, 118:8,118:12, 123:18,153:7, 178:5,200:5, 203:8moving107:14, 120:23,126:4, 127:6much16:7, 23:14,28:8, 32:20,45:11, 50:10,51:1, 55:12,57:15, 62:7,70:2, 80:9,82:17, 87:22,89:15, 116:18,121:12, 126:10,130:5, 138:10,138:12, 140:16,152:7, 165:9,170:14, 175:11multiple41:3, 162:1

multispecialty188:10municipal14:11municipally158:8murray1:17, 5:22,5:23, 7:3, 7:10,33:14, 33:15,35:9, 36:17,37:2, 37:3,38:7, 44:16,44:20, 45:1,45:4, 46:1,46:12, 46:13,48:10, 54:11,54:20, 54:21,61:18, 61:19,64:12, 64:13,70:22, 70:23,75:17, 75:18,77:9, 81:16,82:2, 82:3,83:10, 84:11,104:19, 105:2,105:13, 105:16,105:21, 106:4,106:7, 106:9,106:14, 106:21,107:4, 107:6,107:9, 108:7,108:10, 109:11,109:21, 110:7,111:2, 111:8,111:14, 112:2,114:4, 114:8,115:9, 125:20,126:1, 129:3,129:12, 129:13,139:12, 142:22,142:23, 144:9,147:2, 147:11,147:12, 151:16,151:17, 174:20,174:21, 179:12,179:13, 185:6,185:7, 187:9,

198:20, 199:5,199:6, 200:5,201:6, 203:3,203:8murray's110:3, 110:4must9:14, 9:18,9:21mute19:1, 30:16,84:4, 141:15muted19:7myself118:10, 128:12

Nn-e-l-s-o-n19:11n-i-e-h-a-u-s84:15n-o-u-r-i84:18name8:13, 8:21,10:11, 12:10,14:5, 16:8,19:10, 21:20,23:17, 25:16,31:22, 40:9,48:18, 56:18,72:15, 78:24,94:12, 115:22,116:21, 132:20,145:19, 153:21,197:12names38:19, 48:17,66:24, 84:24,131:20, 144:20,181:16, 188:5nation118:16national32:2, 117:13natural156:20



DRAFT

nature123:1, 123:10nay112:16, 201:8nd7:9, 85:9near96:2nearby123:20, 123:23,162:18, 170:18nearly52:1, 86:22,190:10, 190:18necessarily171:22necessary92:23, 94:19,136:15, 161:12,183:10need6:14, 12:5,13:6, 15:18,17:2, 21:17,42:21, 53:23,63:3, 63:15,74:19, 86:9,86:11, 87:19,88:14, 90:23,97:14, 103:23,140:23, 141:19,141:20, 155:12,159:14, 161:15,162:21, 165:17,165:21, 167:14,167:18, 169:2,169:7, 169:8,170:5, 171:15,172:16, 194:6,194:10needed12:3, 17:1,20:6, 20:10,42:22, 44:8,74:14, 118:5,141:24, 146:9needing17:14, 170:2

needs9:7, 9:13,10:4, 10:7,12:23, 15:13,22:9, 22:18,24:5, 24:15,101:8, 140:22,156:1, 157:16,159:7, 159:9,164:16, 167:6,190:13, 191:10,194:21negative80:4, 121:20,167:3, 192:7,192:8negatively15:2, 21:9,163:4negotiated98:18neighborhood96:17, 197:3neither95:10, 136:23,204:12nelson18:18, 19:10,19:11, 19:18,155:16neonatology170:3nephrologist135:3, 135:20net167:9network11:5, 11:8never11:15, 22:23new5:15, 28:20,53:21, 58:18,80:3, 87:11,87:24, 91:24,101:24, 102:2,117:20, 119:17,122:9, 126:2,

133:15, 138:24newest50:13next30:1, 35:1,38:1, 43:22,48:1, 56:1,66:1, 72:1,77:1, 83:1,84:1, 88:12,93:16, 112:23,113:4, 115:1,131:1, 137:16,137:18, 144:1,149:1, 153:1,156:7, 160:24,176:1, 181:1,187:1, 191:7,193:4niehaus84:14, 85:19,97:20, 99:5,99:13, 99:16,99:24, 100:10,101:11, 104:2,104:21, 105:6,105:15, 105:20,106:13, 106:17,107:1, 107:5,107:8, 107:12,107:20, 108:9,108:13, 109:23,111:4, 112:18,113:1, 113:7,113:10, 113:12night23:11nightmare20:17nine60:18, 95:1,159:16, 191:20nine-county168:11nomenclature107:21noncompliance122:14

none17:8, 78:9,95:2, 96:1,190:16, 193:11nonhospital96:20nonprofit116:24, 117:10,127:15nonsurgical198:2normal120:21north158:4northwest23:21, 25:22,26:18, 124:7,157:9, 190:23northwestern25:20, 32:9not-for58:3not-for-profit58:18not-yet-licensed97:24notarial204:18notary204:5, 204:24notation169:16note36:6, 87:14,89:23, 91:9,91:22, 94:23,96:15, 97:21noted5:6, 59:2,82:20, 121:16,122:2, 123:6,124:10, 170:18,188:23, 193:6notes94:21noticeable24:6



DRAFT

noticed42:7, 90:10nouri84:17, 88:7november91:18, 154:8,193:6number9:1, 12:24,24:16, 40:15,74:24, 81:5,88:17, 141:11,141:24, 154:9,159:10, 160:10,196:24numbers141:20, 194:4numerous41:19, 89:14,194:9nursing50:13, 74:8,74:10, 74:11,74:16, 139:3,145:23, 146:6,158:19nxstage134:1, 134:19,136:19

Ooak38:3, 38:6oberlink77:14, 78:20,78:24, 80:3objective173:4obl-asc95:13obligated49:16obligation17:11obtain22:19, 51:17,87:7obtaining87:9, 119:1

obvious18:2obviously126:2occupancy170:21, 172:12occur107:1occurred17:6occurring53:9, 101:17october7:9, 182:18off-hour194:19off-load97:11off-the-record19:8, 30:12,35:10, 43:16,48:4, 59:14,70:8, 73:19,83:15, 90:14,90:18, 104:18,110:1, 110:6,111:7, 113:24,114:19, 154:15,199:22, 202:9offer22:11, 89:21,93:23, 95:2,96:21offered18:8, 78:8,93:23, 129:18offering134:15, 138:17office4:11, 31:12,88:11, 93:17,149:3, 149:6,149:23, 181:6,182:13, 183:4,183:7, 183:9,196:12officer12:13, 145:23,

158:19, 182:4,204:6officers16:24, 17:3,17:17, 17:22,19:18, 20:1,20:16, 164:14,164:22offices198:4, 198:5officio2:1, 78:23often11:24, 13:17,22:21, 97:1,97:5, 118:24,136:3, 137:8,190:4, 190:7oh8:19, 90:11,90:21, 176:12,177:19okay6:18, 6:21,7:13, 7:16,8:19, 16:6,19:5, 33:1,36:13, 45:7,45:18, 45:22,61:4, 63:12,67:20, 74:6,75:4, 80:8,81:13, 83:1,84:1, 91:1,91:3, 99:10,99:15, 103:10,103:20, 105:16,106:4, 106:7,106:21, 107:7,113:2, 113:9,113:11, 113:21,114:13, 114:20,115:14, 116:15,128:24, 131:1,139:23, 142:9,144:1, 144:21,146:21, 149:10,150:24, 151:3,

154:16, 174:7,176:11, 176:18,177:18, 178:11,179:5, 181:1,182:9, 183:2,184:13, 184:17,198:16, 200:7,200:12, 201:2,201:14, 201:16,202:13, 202:22,202:23once11:24, 17:8,43:22, 81:3,161:21, 165:20one9:1, 9:14,12:24, 18:20,21:1, 24:19,32:5, 52:7,56:16, 63:8,68:11, 72:20,78:12, 80:14,80:16, 85:10,86:12, 87:16,90:8, 90:12,95:13, 98:6,103:12, 117:4,117:22, 117:23,123:11, 127:8,127:12, 128:4,135:18, 140:10,156:8, 158:6,159:10, 159:16,159:19, 161:1,168:3, 169:8,170:19, 176:6,177:23, 182:8,183:5, 189:22,195:9, 196:4,196:9one-third169:17, 169:18one-year28:24ones100:19, 160:13,163:11, 166:2



DRAFT

ongoing12:4, 18:4only13:8, 22:10,32:6, 58:10,86:12, 87:18,92:19, 92:20,93:15, 95:13,99:5, 100:12,100:19, 101:3,104:2, 108:18,111:12, 118:15,125:21, 126:9,128:4, 156:8,159:1, 159:22,160:24, 161:1,162:19, 168:3,169:10, 169:17,169:18, 170:19,170:21, 171:21,191:3, 193:14,195:15open1:4, 10:14,14:9, 16:12,18:6, 21:23,24:4, 87:10,101:11, 128:11,154:20, 191:5,200:4, 200:10,200:19, 201:1opened58:5, 97:23,189:6opening9:23, 60:1,94:2, 124:5,168:14, 171:7operate95:12, 99:7,100:16, 109:9,167:13operated123:24operates88:10operating86:12, 87:2,

87:16, 95:13,96:10, 96:24,102:5, 103:7,117:24, 121:23,182:4, 195:12operation192:14operational59:9, 68:21,95:5, 98:1operations58:9, 59:8,60:6, 96:6ophthalmology89:13opioid12:21opportunity9:16, 14:18,50:10, 57:21,101:16, 116:18,125:3, 138:24,139:6, 166:10,166:13opposed201:12opposition73:7, 78:10,85:12, 86:14,87:15, 116:11,125:2, 132:7,145:10, 146:3,150:4, 154:11,177:4, 182:19,188:14, 195:17oppositions67:17option88:1, 92:20,92:23, 96:1,96:19, 128:8,133:20, 142:2,156:12, 166:9,166:11options15:1, 87:20,93:23, 94:22,94:23

order3:3, 8:11,57:3, 111:8,117:18, 133:23,140:24, 142:4orders4:19organization24:5, 25:2,25:23, 58:15,58:18, 59:22,60:24, 157:20,171:18organizational58:13, 59:3,59:8, 59:10organizations14:15, 58:20,155:11originally31:12, 50:12,51:2, 189:5orthopedic26:19, 89:11,116:4, 116:22,117:14, 117:15,124:9, 124:13,124:16, 124:17,126:23, 127:1,127:12, 188:10,188:24, 192:15,192:23, 193:2,193:3, 193:18,193:20, 196:4,196:5, 196:22orthopedics191:5, 193:13orthopod196:15osf66:13, 66:15,67:8, 67:12,67:14, 68:2,69:5, 69:20,69:22other4:21, 14:14,17:13, 17:17,

18:1, 25:24,26:10, 42:23,45:20, 50:21,53:10, 54:5,58:12, 59:2,60:11, 61:2,70:6, 73:13,73:14, 75:2,78:21, 81:11,86:7, 89:10,93:24, 95:8,104:11, 111:19,117:14, 118:4,120:5, 120:7,120:12, 120:18,122:21, 124:10,127:18, 128:4,128:14, 128:21,142:6, 150:13,156:21, 160:17,162:21, 163:1,163:2, 163:4,166:24, 169:12,173:19, 174:2,178:8, 184:2,184:9, 184:14,189:12, 189:17,189:22, 189:23,190:6, 190:15,191:11, 193:23,194:9, 194:14,194:16, 194:18,195:2, 195:4,195:15, 196:9,196:18, 197:8,198:14others89:13, 128:13,161:13otherwise97:2, 204:14ought99:21ourth48:23, 182:5out21:1, 21:4,32:18, 75:1,



DRAFT

78:12, 83:12,85:13, 88:10,88:14, 103:15,104:4, 109:5,109:9, 111:8,116:12, 121:18,123:16, 127:3,127:17, 156:8,156:13, 157:7,163:7, 168:3,191:16out-of-state117:22, 118:11,126:16outcome89:19, 185:23,204:15outcomes119:18, 126:19,126:23, 137:6,138:14, 142:5,162:20outliers160:18outmigration161:5, 168:1,168:7, 168:18,168:21, 168:23,169:9, 170:1,170:9, 172:21outpatient10:20, 11:5,13:3, 13:13,15:7, 17:20,20:24, 23:21,24:21, 74:22,87:20, 88:2,93:12, 99:9,118:7, 123:14,126:14, 157:5outside21:7, 156:7,163:21, 172:3over9:10, 11:17,13:9, 15:8,15:15, 20:9,22:14, 39:23,

40:2, 41:2,52:19, 58:6,70:4, 80:23,81:7, 85:22,89:6, 93:11,97:20, 117:6,117:10, 118:9,119:18, 121:3,122:4, 122:6,124:1, 126:18,133:13, 134:22,135:13, 135:21,138:18, 138:21,141:19, 156:10,157:12, 181:22,191:1, 191:18,191:19, 191:20,202:16, 202:17overall59:10, 60:7,138:12, 142:3,142:4, 170:10oversee57:4, 58:19oversees79:13oversight59:7, 158:15overview132:12overwhelmed136:3own18:8, 86:17,138:11, 146:6,163:13, 173:4,173:5owned158:8owner57:11, 67:9,67:13ownership56:6, 63:10,63:19, 67:5,68:1, 138:4owning96:10

Pp-a-t-r-i-c-k23:18p-a-u-l144:12p-h-e-l-a-n23:18pace88:19pacemaker95:19, 103:1packet201:18pads23:9page3:2, 4:2,56:12, 57:19,57:24, 59:18,59:19, 60:15,62:7, 65:3,189:14pages1:22pain89:12, 116:4,193:11, 196:16palmer202:3, 202:20palos4:11, 149:2,149:5papers19:2paramount26:20paranoid185:24parents26:11park66:3, 67:8,68:19, 84:3,85:7, 88:12,93:17, 114:12part11:4, 39:11,

39:22, 41:12,59:22, 68:2,69:24, 87:3,111:6, 127:10,127:14, 133:15,166:21participates191:24participation3:7, 8:7particular40:18, 40:23,89:8, 117:5,128:6, 141:2particularly21:14, 124:14,163:6parties204:13partner10:6, 68:20,88:8, 94:13,96:16, 171:11partners20:3, 96:17,155:7, 163:14,165:23partnership16:20, 159:5partnerships13:2, 16:21,19:21, 164:3parts42:20past15:15, 58:6,89:6, 123:21,133:17, 135:9,195:5, 196:23pat40:2patchwork161:19patience5:9patient10:23, 17:8,17:9, 22:14,



DRAFT

26:2, 26:6,39:24, 86:17,89:19, 93:2,93:4, 95:8,96:3, 118:21,119:18, 122:20,134:11, 134:17,140:22, 141:1,157:15, 158:16,158:22, 162:13,163:2, 163:10,167:11, 171:6,189:8, 191:10,194:22patient's120:20, 170:6patient-driven74:7patrick18:18, 23:18,38:14, 40:10,155:22pattern196:7paucity96:23paul144:12, 145:23,148:3, 153:12paula181:24pay190:2, 194:6,194:8payable90:3, 91:14payment74:7, 91:10,91:18, 93:21,100:15, 100:18,100:22, 189:20,194:7pays74:9pci95:19, 96:12pd20:1

pdpm73:24, 74:7,80:3pediatric39:4peer-reviewed119:19, 126:24pending178:4, 193:5people18:15, 22:3,22:8, 23:5,24:18, 26:23,137:1, 160:5,164:16, 169:10,169:12peoria158:4, 158:13percent11:18, 23:1,23:3, 31:14,35:6, 35:18,42:9, 49:19,67:9, 81:1,81:6, 81:7,81:8, 81:9,93:11, 97:5,119:2, 120:16,121:3, 122:16,122:23, 123:3,123:5, 123:9,124:2, 168:18,168:19, 169:4,170:21, 183:17,189:15, 189:17,189:20, 189:22,190:4, 190:6,190:7, 190:10,191:17, 191:18,192:20, 192:22,195:16percentage123:23, 139:13,194:14, 194:15,194:17percentages168:10, 168:17percutaneous102:10, 102:11,

102:18, 102:24perfectly185:22perform96:6, 97:12,100:17, 100:19,102:2, 102:9,105:3, 105:6,116:4, 118:2,120:5, 123:11performed88:2, 89:4,118:10, 122:7,123:14, 123:21,194:10performing85:6, 97:6,99:5, 100:12,104:5, 104:23,117:16, 141:9performs107:14, 124:19perhaps108:10, 189:9period29:1, 101:15,135:21, 136:11,136:17, 138:19,191:21peritoneal136:22permit3:12, 28:18,28:19, 28:20,28:21, 28:22,28:23, 28:24,29:1, 30:5,30:24, 31:1,31:2, 31:5,31:7, 31:9,31:10, 31:15,31:16, 34:3,35:14, 35:15,37:13, 38:5,38:23, 38:24,39:2, 39:8,39:9, 39:12,39:14, 39:15,

42:23, 46:24,48:6, 49:7,49:10, 49:11,49:14, 49:23,51:4, 55:9,79:7, 82:15,82:20, 82:21,99:21, 101:8,130:2, 143:11,147:24, 152:5,175:9, 180:2,186:4, 199:18persistently11:22person18:20, 161:8personnel60:24, 69:8perspective14:21, 15:4,123:8, 126:13,172:5perspectives103:4phase39:6, 39:7phelan18:18, 23:17,23:18, 155:22phenomenon159:24philosophy69:6phone19:2, 83:12,141:16physically41:13physician31:12, 121:22,140:24, 157:17,183:9physician's140:21physicians102:7, 103:4,107:17, 122:20,122:21, 142:5,



DRAFT

165:17, 193:7,195:24physiologic140:7pick136:21picked195:3picking19:2piece42:24, 86:23,87:1, 98:17,196:18pillar119:10, 119:15pillars118:18place41:16, 41:18,51:6, 150:17,150:18, 183:14placed24:18placement17:4, 24:12,165:24plaines83:3, 115:4,116:5, 117:20,118:13, 123:19plainly155:24, 165:13plan15:19, 17:20,50:12, 52:23,119:5, 119:8,159:15, 167:13,190:4, 194:7plane137:14planned41:23, 50:15,51:7, 53:8planning28:15, 41:12,50:5, 50:9,158:7, 160:7,

160:11, 160:19,168:8, 168:11,169:7, 195:14plans41:17play193:24pleased182:2plug92:12, 92:13plus32:5pneumonia136:1podiatry89:12point26:21, 40:18,40:23, 45:8,53:24, 60:21,135:18, 162:4,166:1, 173:10points42:6, 182:24police15:2, 16:10,16:15, 19:12,155:15, 164:5polsinelli149:14poor18:4, 189:9,190:8poorest160:21population9:21, 10:7,14:3, 141:22,157:24, 167:11,173:5, 190:24,191:10, 194:22,198:13pose164:9poses13:12, 20:14positive53:15, 53:22,

133:6, 154:24,183:15possible28:8, 73:22,96:12postdischarge17:18posttransaction59:2potentially173:22power42:15practically98:20, 102:6,102:14, 102:20,103:8practice89:8, 94:24,117:17, 120:10,123:1, 123:19,124:19, 157:14,190:22, 192:3,197:13practices26:24, 69:20practicing127:21, 157:17precision88:22, 120:15predicted141:20preference121:2preliminary53:7premier95:6, 95:11,95:12, 97:23,98:1, 99:7premium183:20premiums184:8prep80:18, 80:24preparation78:15

prescription140:22present1:12, 1:15,2:1, 2:7, 5:19,5:21, 5:23, 6:1,6:3, 13:6,35:11, 49:2,56:19, 67:1,72:22, 77:23,85:1, 109:17,110:21, 115:24,131:22, 144:22,149:20, 153:23,165:16, 169:1,171:10, 176:19,182:9, 188:7presentation23:3, 133:11presented124:11presenting24:14, 156:2presently118:2preserving16:16president23:19, 56:12,57:24, 66:13,66:18, 72:16,77:18, 79:12,80:21, 133:2,145:20, 181:24president's133:22prevents18:4previous64:13, 64:17previously35:20, 99:11,108:17price96:22, 98:17,194:6priced98:14



DRAFT

pricing88:24primarily157:9, 168:15,190:12, 190:24primary20:11, 23:20,120:22, 157:19,158:10, 169:22,173:4, 173:16,173:17, 173:18,190:22, 191:2,191:3, 192:3,196:12, 197:22print38:19, 48:17,56:18, 66:24,84:24, 115:22,131:20, 144:20,153:21, 181:16,188:5prior41:15priority9:1, 93:1,159:1, 159:11,159:16private190:2privileges193:3proactive19:20probably98:17, 195:3problem119:9, 160:9problems21:6procedural108:1procedure91:20, 92:23,102:16, 102:17,102:22, 104:22,107:20, 120:19,127:8, 194:10,195:12

procedures32:14, 86:13,87:17, 88:23,89:4, 90:2,90:5, 91:13,91:19, 91:24,93:15, 95:20,96:8, 97:2,99:6, 99:17,100:17, 100:21,101:3, 101:6,102:3, 102:9,103:5, 104:6,105:3, 105:9,105:23, 106:12,106:15, 107:13,107:18, 107:23,108:5, 117:21,118:2, 118:5,118:7, 118:9,119:17, 120:4,120:13, 121:6,121:24, 123:11,124:19, 124:20,126:4, 127:18,193:11, 197:23proceed8:4, 28:3,31:20, 36:1,39:18, 50:2,57:17, 67:20,73:11, 78:18,79:15, 85:17,116:16, 132:18,145:17, 150:10,154:17, 177:10,177:14, 188:20,200:2proceeding178:7proceedings200:10, 204:7,204:9, 204:10process50:18, 81:2,108:12, 108:24,193:8productive14:24, 21:11,

161:17professional117:7, 117:9,121:5profit58:4program10:18, 12:21,14:10, 21:24,119:13, 133:16,138:18, 161:15,163:6, 163:20,164:1, 164:21,165:7, 171:4program's133:21programs10:22, 11:17,12:1, 92:15,92:19, 156:14,157:7, 162:12,163:8, 164:10,192:1progress51:22project's51:21, 195:15projected121:21projections192:23projects89:15, 99:11,124:10, 184:9,195:4promise98:8promising164:10promote167:8promoting16:16propagated41:5proper22:24property53:20

proposal25:9propose145:4proposed78:9, 88:13,95:15, 118:8,118:13, 120:13,120:24, 121:6,121:22, 122:12,122:19, 123:22proposes79:8proposing43:19, 164:1,170:7, 183:3prospect4:9, 131:3,131:6, 132:3,133:4, 133:18,135:1, 135:4,136:9, 198:11prosperous5:15protect17:1, 161:13proven51:1, 119:17,120:15provide11:2, 15:3,22:2, 23:23,25:10, 52:12,68:15, 79:17,85:24, 87:10,87:20, 94:8,97:17, 118:22,121:7, 125:4,132:11, 157:15,157:21, 162:8,162:22, 163:2,163:19, 165:2,169:3, 170:12,172:15, 172:17,173:16, 195:23,196:21provided15:10, 25:5,



DRAFT

58:13, 74:12,169:23, 169:24,170:5, 189:1,189:23, 190:3,192:24, 194:4,202:24provider23:20, 58:8,164:22, 195:17providers11:8, 13:13,92:3, 158:11,164:6, 167:12,183:8, 183:9,195:2provides12:17, 24:11,26:14, 53:11,124:22, 146:9,162:9, 190:23,194:13, 194:15,194:17, 194:19,194:20providing26:21, 120:2,122:20, 157:18,191:4, 196:17,197:21, 198:2provision189:10prudent32:17, 108:11psych22:15psychiatric162:12public1:1, 2:4, 3:7,8:6, 12:12,13:21, 51:10,57:13, 67:16,73:6, 78:8,85:10, 105:1,116:9, 132:4,145:11, 150:3,154:12, 155:18,177:5, 182:20,188:16, 204:5,

204:24published119:18, 126:20,159:20pulled163:1purchase68:14, 68:16purpose26:16, 59:4,60:9purposefully171:19pursuant159:8, 200:2put30:15, 41:17,42:10, 109:15,110:19putting140:10

Qquadruple183:8qualified12:17qualify74:20quality23:23, 26:17,60:6, 93:13,93:15, 96:4,96:22quarter28:5, 201:20querciagrossa66:14, 71:15question43:13, 44:10,52:7, 52:19,80:14, 98:6,105:13, 106:10,108:7, 109:11,110:16, 111:16,125:20, 126:8,141:18, 174:5,177:21, 184:6,

196:19, 197:11questions32:21, 32:23,36:9, 36:11,43:9, 43:11,45:20, 52:3,52:5, 54:5,59:12, 59:13,59:16, 60:11,61:2, 63:7,63:9, 68:6,68:9, 69:12,70:6, 73:15,73:17, 75:2,79:18, 79:20,79:23, 81:11,87:13, 97:17,98:4, 125:8,125:12, 128:22,139:11, 139:24,142:6, 146:12,146:15, 146:18,150:19, 150:22,151:1, 170:15,170:16, 174:2,177:13, 177:16,184:1, 184:5,184:14, 195:20,195:21, 197:8,198:14, 202:1,202:5, 202:19queue53:6quickly97:21quintero2:5

Rr-o-l-l-a38:13radial92:5, 92:9radius86:15raise30:17, 38:15,48:13, 56:14,

66:20, 72:18,77:19, 84:20,115:18, 131:16,144:16, 149:15,153:17, 181:12,188:1raised22:2, 104:21,108:16, 157:13ramp39:10, 40:21,40:24, 41:2,41:9, 41:10,41:13, 41:20,41:23, 41:24,42:13, 42:14,42:18randolph79:3range160:11ranging190:6rapid88:19rapidly192:18rarely13:10rate80:3, 170:21rates97:8, 159:21rather25:6, 112:19,124:22, 161:18ratios163:4ray1:17rdr1:24, 204:4reach135:18reached123:9, 124:3read28:13, 49:8,



DRAFT

49:9, 110:3,110:11, 167:4readily17:13ready177:14real23:7, 59:24reality94:24, 95:24,127:3, 138:14realized68:22, 89:10really40:20, 42:14,42:19, 42:21,42:24, 43:7,53:9, 68:5,68:23, 133:22,135:9, 135:14,139:6, 141:23,150:13, 161:5,169:24, 170:5,171:17, 171:24,173:24reason31:9, 39:8,41:2, 104:19,140:4, 170:22reasonable109:21, 109:23,111:3, 111:5,124:2, 156:15reasonableness78:14, 80:17reasons40:3, 88:6,121:20, 123:10rebounding13:13recall59:21, 132:13receive15:22, 22:24,73:7, 82:21,88:1, 155:7,159:12received53:17, 57:14,

67:17, 67:18,73:7, 78:10,78:11, 85:11,85:12, 116:10,116:11, 125:2,125:7, 132:8,145:11, 150:4,154:9, 154:12,177:5, 182:20,188:14, 188:15,191:23receiving17:24, 134:4,134:20, 136:14,198:1recent12:23, 92:1recently12:12, 15:16,53:2, 69:1,91:17, 117:17,155:18recess113:17, 113:19,113:21recipients189:11, 189:16,191:13, 194:16reclining134:6recognition93:21recognize169:8recommended160:4, 160:12record28:13, 203:11,204:9recover121:2, 137:16recovery10:23, 11:6,11:7, 12:4,39:7, 163:18red160:8reduce170:9

reduced89:17, 89:18,120:24, 204:11reduces120:16reducing170:11reduction121:3refer200:13reference157:8, 158:2referenced122:6referral158:10, 172:4,192:23, 196:7referrals4:20, 80:7,121:22, 156:9,170:20, 170:23,196:1, 197:1,197:5, 199:3referred24:16, 158:12,190:8reflect86:8reflected99:8refurbished87:9refuse13:19regard184:1regarding40:1, 78:8,78:13, 78:14,86:4, 86:19,179:3, 199:3,202:19regards40:12region10:6, 11:2,11:11, 12:19,

13:11, 158:9,158:12, 159:13,162:3, 163:22,168:2, 172:16,173:24regional11:5, 133:2,146:4regions173:1registered18:16registration27:6regular137:21, 161:11,171:4regularly11:13, 16:24,137:4regulated10:1regulatory109:4rehab60:2, 74:20,74:21, 79:1rehabilitation3:24, 4:4,72:2, 72:5,72:17, 73:4,77:3, 77:6reimbursed74:15, 100:14reimbursement73:21, 73:23,80:1, 80:6,101:2, 140:17,140:20, 141:2,141:6reiterate93:2, 94:18relate36:4related9:9, 112:11,204:12relates53:10



DRAFT

relationship190:22, 192:2,196:6, 196:11relative121:3, 167:14,167:16relinquishment28:23relocate39:5reluctant112:5remaining124:8remarkable137:5remarks18:14, 27:11,55:13, 130:6,175:14, 175:15remind49:5reminded8:12renal95:17, 102:12renew45:2renewal3:12, 6:11,28:19, 28:20,28:21, 30:5,31:1, 31:10,31:17, 34:3,38:5, 38:24,39:9, 39:15,40:1, 46:24,48:6, 49:7,49:11, 49:23,51:4, 55:9renovate42:22renovated41:14renovation195:11reorganization15:19, 58:22,

59:4repeat91:4, 178:22,178:23, 183:24repeated90:23replace41:23, 42:13replacement126:14reported1:23, 104:23,106:20reporter8:13, 18:13,26:4, 27:10,30:17, 30:20,38:15, 38:18,48:13, 48:16,55:13, 56:14,56:17, 66:20,66:23, 72:18,72:21, 77:19,77:22, 84:20,84:23, 110:4,110:14, 113:3,113:6, 113:8,115:18, 115:21,130:6, 131:16,131:19, 144:16,144:19, 149:15,149:18, 153:17,153:20, 167:16,167:19, 175:13,178:20, 181:12,181:15, 188:1,188:4, 204:1,204:4reporting43:1, 43:18,54:18, 54:22,60:3reports37:3, 43:21,52:12, 54:3,202:19representatives85:23

represented53:15, 120:10representing79:4, 84:15reps78:23request6:9, 6:11,10:9, 10:14,12:8, 14:8,16:12, 21:23,24:3, 31:17,39:15, 40:1,42:19, 94:6,97:15, 104:13,109:16, 110:20,112:18, 113:10,132:4, 145:11,154:12, 182:20,188:16requested57:13, 67:16,73:6, 78:9,85:10, 87:13,116:9, 150:3,177:5requesting51:3, 154:19requests3:12, 3:17,3:20, 161:2require11:13, 15:24,102:11, 102:13,107:13, 162:24,168:9required22:13, 87:12,104:17, 118:4,120:7, 157:21,161:13requirement173:11, 173:13requirements99:3, 109:4,132:10, 145:14,150:7, 166:21,166:24, 177:7

requires156:4, 162:13requiring11:18, 53:20,103:2, 133:24,135:24research117:1, 117:11,117:12, 117:16,117:18, 118:20,119:15, 126:19,126:21reside122:17, 122:24,123:21resided123:15residence162:10residency127:12residents8:24, 9:14,14:17, 16:17,19:20, 19:24,22:18, 58:8,123:4, 125:4,157:12, 159:11,159:19, 160:16,163:17, 163:21,164:4, 169:20,169:21resolved156:12resource18:8, 119:21resources15:7, 16:22,18:3, 18:4,108:20, 156:7,172:15respectfully10:9, 12:8,27:2, 51:3,79:6, 94:6,97:15, 104:2response6:17, 7:15,



DRAFT

17:6, 27:8,32:24, 36:12,43:12, 45:21,52:6, 54:6,61:3, 63:11,68:10, 70:7,72:8, 73:18,75:3, 79:21,81:12, 98:5,115:11, 125:13,125:15, 128:23,142:8, 146:16,150:23, 166:8,174:3, 177:17,197:9, 198:15,201:13responses202:21responsibility10:5, 12:6,158:20, 159:3responsible16:15responsive23:24restart51:5restate110:7restore120:20restrict104:5restrictions167:22restricts95:14restructure58:17restructuring56:23, 57:3,59:16, 60:10result24:23, 35:21,88:21, 92:1,123:4, 123:20,124:21, 189:10,191:1, 193:18

resulted90:1, 91:12,122:14results13:13resumed200:11retired12:12, 119:12,155:18retreat15:15return161:16, 183:13returning24:23revenue10:2, 201:23review1:2, 4:3, 51:9,52:23, 57:20,67:24, 68:3,85:20, 101:15,133:6, 150:16,201:24, 202:4reviewability195:16reviewed121:17, 192:6revised46:21, 89:24,91:10revision91:11right6:15, 17:10,30:18, 35:1,38:16, 41:6,43:21, 45:4,48:14, 56:15,66:21, 72:19,77:20, 84:21,89:21, 93:1,106:2, 107:9,107:10, 111:21,115:1, 115:19,119:2, 119:4,119:7, 131:17,

133:1, 133:3,144:17, 146:22,149:16, 153:18,178:4, 181:13,182:4, 185:22,186:1, 187:13,187:20, 188:2,202:14rigorous32:3risk92:17, 120:17,120:24, 164:9risks89:17river19:13, 157:24,158:5riverside4:15, 181:2,181:5, 182:1rn133:1roadways53:10robot128:1robotic117:3, 117:24,118:3, 122:5,124:20, 126:2,126:7, 126:14,127:17, 128:1robotics120:12, 120:16,126:5, 126:12,126:20, 128:6,129:23rock19:12, 19:20,155:15, 157:10,157:23, 157:24rockford11:15, 13:11,156:9, 158:3,158:13, 200:15,200:16rockton200:14

role158:9, 158:19,159:3roll3:4, 5:16,33:2, 36:14,45:23, 54:8,61:5, 63:23,70:10, 75:5,80:10, 81:14,111:23, 129:1,142:10, 146:23,151:4, 174:8,177:19, 178:12,184:18, 198:17rolla38:12rollout133:21room86:12, 87:17,95:13, 102:5,103:2, 103:7,172:3, 200:8rooms39:6, 87:2,118:1, 121:23,195:12routinely162:12rukhaya2:9, 5:12rule8:2, 89:24,91:10, 91:18rules44:17, 78:13,85:14, 104:11,104:12, 104:16,106:6, 106:23,107:3, 107:4,112:20, 116:13run17:17running97:5rural13:21, 156:20,



DRAFT

157:16, 163:11,173:15, 174:17rushing185:19russian190:12, 190:19,194:9

Ss-k-i-p10:12, 14:6s-p-e-a-r84:19s-t-e-i-n-k-e153:12s-w-e-i-s38:13safe43:3, 92:20,92:23, 161:16safely92:4safer16:23safety8:24, 16:16,19:19, 93:3,93:16, 158:23,167:9said91:6, 97:23,103:18, 107:17,109:1, 110:24,111:2, 111:4,113:6, 122:11,171:12, 204:9same63:5, 89:22,93:12, 93:23,99:6, 102:6,102:20, 121:9,134:14, 138:17,159:23, 164:23,166:8, 191:20same-day92:15, 92:19sandra1:16

satellite173:21satisfaction89:20, 96:3,96:11satisfies45:13save93:10saving137:24savings125:5saw166:20, 172:7say7:17, 8:12,10:2, 26:4,26:9, 91:8,112:9, 126:9,136:1, 137:8,202:1saying44:18, 44:20,155:4, 171:5scarce174:1scenarios20:17schedule100:15, 100:18,100:22, 134:10scheduled112:23, 112:24,113:4school11:4, 146:8schwab3:24, 72:2,72:5, 72:17,73:3, 74:12science126:22, 127:4scope42:23, 43:6,164:20, 169:2scraped42:5

screening13:7se140:21seal204:18seated145:22, 187:13,187:20second6:12, 6:13,7:2, 7:3, 7:11,7:12, 30:8,30:9, 31:11,32:11, 32:15,32:18, 35:8,35:9, 35:22,36:5, 38:8,38:9, 48:9,48:10, 56:8,56:9, 63:8,63:21, 63:22,66:8, 66:9,72:11, 72:12,77:10, 77:11,83:9, 83:10,84:10, 84:11,90:8, 90:12,103:12, 115:10,115:12, 115:13,122:16, 123:18,127:23, 131:8,131:9, 144:8,144:9, 149:8,149:9, 153:8,153:9, 176:9,176:10, 181:8,181:9, 182:8,187:8, 187:9,190:9, 191:6,192:1, 198:10,200:6, 201:5,201:6, 203:9seconded33:4, 36:16,46:1, 54:10,61:7, 64:2,70:12, 75:7,

81:16, 112:1,114:4, 114:7,129:3, 142:12,147:1, 151:6,174:10, 178:14,184:20, 198:19section42:14, 200:3security16:16see10:3, 11:6,14:14, 14:21,14:24, 15:9,54:2, 90:22,96:9, 110:14,137:3, 137:21,142:1, 160:7,160:8, 160:10,162:14, 164:24,165:14, 165:17,168:5, 168:10,168:17, 168:22,170:5, 173:18,177:19, 191:15seeing184:9seek108:21, 109:1seeking21:4, 68:19seem45:5, 109:21,109:23, 111:2,111:5seems32:17, 106:9,177:21seen11:15, 80:5,89:8, 119:3,132:14, 136:24,138:13, 165:21,169:19sees23:10, 168:8segment24:1



DRAFT

self-admit13:18sell98:8senator1:14, 5:7,5:18, 19:1,19:16, 30:13,33:6, 36:18,46:3, 50:6,54:12, 61:7,61:9, 64:4,70:14, 75:9,81:18, 84:4,90:17, 103:13,112:3, 129:5,141:15, 142:14,147:3, 151:6,151:8, 174:12,178:16, 178:23,184:22, 187:16,187:18, 198:21,202:16send156:13, 166:3,166:4, 201:24sending20:11senior66:12, 77:18,80:21, 181:24,182:3sense45:6, 126:3sent161:3separate63:3, 63:15,80:22, 99:18,121:17sepsis136:1september201:21sequential41:22serve9:7, 10:4,

18:3, 19:24,22:16, 24:2,25:7, 60:20,119:20, 158:9,159:4, 162:3,167:12, 168:15,172:22, 173:4served11:3serves25:23, 26:15,26:16service15:10, 20:11,22:10, 72:7,73:3, 79:4,86:5, 95:8,95:22, 103:22,118:21, 122:18,124:12, 145:2,154:3, 157:11,162:11, 163:14,167:21, 167:23,169:3, 170:5,170:8, 189:13servicepeople119:13services1:2, 2:3, 2:5,9:20, 9:22,10:19, 11:2,11:6, 11:12,11:19, 11:20,12:19, 13:3,13:4, 14:9,15:11, 16:22,17:3, 17:15,20:6, 20:10,20:12, 21:17,22:2, 22:15,23:24, 24:8,24:12, 25:5,25:11, 26:22,29:3, 57:20,69:16, 69:18,74:13, 74:14,74:20, 85:6,86:5, 87:21,

95:3, 109:8,116:5, 124:22,124:23, 129:18,146:11, 155:9,155:20, 157:19,157:21, 158:12,158:16, 158:21,159:12, 160:22,161:19, 162:8,163:19, 164:6,164:19, 164:21,167:7, 167:9,167:15, 167:21,168:2, 168:12,169:22, 170:3,170:4, 170:13,172:17, 173:16,173:17, 178:9,189:11, 190:2,190:23, 193:18,193:20, 196:16,196:22, 198:2servicing86:17, 95:11serving24:5, 25:2,157:9session1:4, 4:17,140:15, 200:2,200:10, 200:19set32:3, 93:1,204:17sets51:16setting10:24, 11:1,20:24, 26:22,89:10, 89:17,96:1, 96:5,96:20, 99:7,101:4, 106:19,120:24, 121:4,161:8settings93:12settlement4:18

seven42:24, 122:20,126:18, 127:2,156:5several9:11, 17:5,17:19, 22:16,68:13shadow23:8shall201:9, 203:6shape41:14share14:16, 135:3shares24:9sheet153:21shell183:5, 183:14shelter23:9sheriff8:14, 8:22,155:17shift142:1shifted45:2shifts134:11shiloh30:3, 30:6,31:8, 35:3shorthand204:1, 204:4should13:18, 81:9,91:4, 109:2,169:23shoulder95:15showing160:15shows170:20



DRAFT

sic6:7, 6:24,169:14sicker97:13side40:22, 41:7,41:8sides14:19signals8:3signature-mig2k204:21significant88:21, 160:9significantly170:10silvis200:17similar73:22, 172:6similarly23:1, 189:18simple106:10, 127:8,193:23, 194:24,195:7simply10:3, 13:15,14:23, 18:2,140:24, 195:1since14:7, 22:18,58:2, 102:1,134:23, 159:22,193:1single59:22, 93:4,119:9single-specialty84:8, 85:5,88:8, 94:1sinnissippi23:19, 23:23,24:8, 24:11,25:8, 155:9,155:22, 156:24,

163:15, 165:23sir63:8sisters145:21sit157:23site53:20, 57:12,67:13, 78:14,80:18, 80:24sits40:21sitters163:1sitting135:20, 137:14situation20:15, 43:15,156:20, 161:5,162:7, 164:14,165:6, 171:19situations164:7six43:18, 44:3,44:14, 52:9,91:18, 91:24,97:2, 126:15,126:18, 127:2,134:11, 171:20,193:3six-month46:10, 46:21six-months55:6size88:22, 157:22,163:24, 183:8sizeable42:9skilled80:6skip8:14, 8:15,10:12, 14:6,155:15, 155:19slater1:18, 5:24,

6:1, 7:12, 30:9,33:5, 33:18,33:19, 37:5,37:6, 46:16,46:17, 48:8,54:10, 54:24,55:1, 56:9,61:8, 61:22,61:23, 63:20,64:2, 64:16,64:17, 66:7,70:12, 71:2,71:3, 72:10,75:7, 75:21,75:22, 82:6,82:7, 115:13,128:14, 129:4,129:16, 129:17,131:7, 142:12,143:2, 143:3,144:7, 147:1,147:15, 147:16,151:20, 151:21,153:8, 174:11,174:24, 175:1,176:7, 176:10,178:15, 179:16,179:17, 181:7,184:20, 185:10,185:11, 199:9,199:10, 200:18,200:21, 201:2slip105:22slowed42:14slowly191:16small74:24, 158:6,170:7, 183:16smaller158:10smaller-size173:10social10:16, 10:19,155:9, 155:20

society23:9, 161:10socioeconomic156:21, 163:12sole57:7, 58:24,192:16solely121:23, 193:19solution18:3some10:2, 22:7,40:14, 42:5,42:6, 42:16,42:17, 53:4,53:7, 53:10,53:11, 68:21,85:24, 105:22,107:20, 139:20,167:10, 173:3,173:8, 173:18,173:19, 173:23,178:4, 199:2somebody115:12, 135:23,137:10someplace74:23something98:18, 101:20,101:24, 106:22,125:3, 166:12,166:14, 197:2sometimes20:19, 22:20,23:11, 101:4,170:1somewhere93:10sophisticated103:8sorry16:4, 19:3,26:4, 48:19,63:16, 74:3,80:13, 83:16,105:15, 111:12,



DRAFT

111:14, 113:8,114:6, 141:17,164:6, 167:16,176:12, 177:19,187:18, 197:17,201:23, 202:11sound32:5source10:1southern32:1, 32:12,146:7southwest158:3southwestern57:7, 58:2space15:17, 15:19,31:12, 31:13,182:15, 183:6,183:9, 183:14spanish191:2, 197:13speak18:16, 18:23,19:15, 23:15,27:6, 40:7,57:21, 80:19,116:18, 165:13,194:9speakers8:1speaking18:20, 99:16,100:13, 160:21speaks190:14, 194:21spear84:19, 94:11,94:12special164:15, 194:7specialist119:2, 119:8,132:21, 132:23specialize10:20

specialized93:14, 96:8,117:24, 118:4,119:24, 120:6,129:18, 129:22specializes196:4specialties89:11, 93:24specialty100:17, 117:2,117:5, 123:10,187:6, 188:10,189:1, 195:9specific103:22, 106:5,106:15, 117:2,120:4specifically10:22, 90:3,91:15, 118:16,119:11, 189:14spell8:13spend117:12spending69:23spine28:22spoke191:2sponsor66:15spreading119:22springfield144:3square35:20, 182:14st4:10, 29:3,49:12, 49:18,71:5, 78:7,116:8, 144:3,144:5, 145:9,146:4, 177:3,182:18, 200:15

stabilization11:20, 22:11,156:4, 164:18staff's145:24staffing163:4, 171:18,171:24stage95:17, 102:12,135:18stand-alone68:18, 68:24standard87:1, 183:20standards33:12, 86:6,86:20, 86:22,87:4, 87:5,100:24, 104:4,158:22standpoint101:2stands22:10start8:20, 94:20,133:12, 181:22started127:13, 191:16starting91:21starts17:21, 137:17state3:11, 22:8,30:22, 31:1,31:4, 31:9,32:5, 33:8,39:8, 43:1,49:13, 63:14,67:2, 67:4,67:18, 67:23,71:9, 72:23,73:1, 77:24,78:11, 78:22,80:24, 85:2,85:4, 85:12,

86:22, 87:5,104:3, 104:12,104:15, 104:17,105:7, 106:22,106:24, 107:3,107:4, 107:7,107:23, 108:2,108:6, 108:14,109:5, 109:8,115:24, 122:11,123:16, 123:17,124:12, 126:7,128:5, 128:10,131:22, 131:24,132:10, 142:16,144:22, 144:24,145:14, 149:20,150:5, 153:23,154:9, 159:15,160:22, 167:12,169:12, 169:16,169:17, 176:19,177:7, 182:7,182:10, 183:20,183:21, 184:24,186:1, 188:7,188:15, 192:5,195:6, 198:23,204:6state's108:12, 109:18,110:22, 189:18state-of-the-art124:23stated39:24, 155:24statement31:20, 36:2,39:19, 50:3,57:17, 67:21,68:12, 73:11,90:6, 116:16,132:19, 150:11,154:17, 172:6,177:10, 188:21,202:18statements78:18, 85:17,



DRAFT

145:18states32:7, 88:18statewide159:18, 160:5,168:12, 169:19,169:20station134:5, 134:7,134:13, 176:6,176:23, 176:24stations131:6, 132:1,134:15, 141:11,141:19, 141:24status51:20staunton3:22, 57:1,57:23, 58:11,59:1, 63:19stay89:18, 136:24,139:22steel41:21, 42:4steinke153:12, 154:18stent92:8stenting91:19stephenson168:16, 173:20stepped83:12steps194:13sterling8:8, 10:19,14:7, 15:3,16:10, 16:17,19:14, 20:1,153:3, 154:5,155:14, 155:15,157:10, 157:13,157:23sticking101:3

stigma21:5still32:17, 44:4,101:7, 103:13,141:7, 141:8,157:15, 202:24stitches92:11stop99:10, 203:1story137:22strange44:17strategy145:20streamlined59:6street41:6strengthen22:3strong163:14structure41:21, 42:4,59:5, 59:7, 60:4structures42:1struggle14:23struggled156:6struggling20:4study159:21stuff126:2submission193:6submit51:9, 179:9submitted49:21, 57:22,160:3subsequent4:3, 42:16,

109:5substance10:21, 11:8,12:18, 19:22,20:5, 112:21substantially168:21suburban25:20suburbs25:22, 26:18,124:7, 190:23succeed68:24successfully14:17, 21:10,25:10suddenly135:23suffer21:2suffering16:13, 157:5sufficient43:20, 94:21suicide21:2, 159:21suitable136:23, 139:21suite102:6suites96:24suits138:6summarize88:6summary79:17, 183:21summer60:1supervised161:11supervision204:11supplied160:13supply160:3, 160:12

support10:23, 13:5,14:14, 16:21,17:23, 24:3,67:17, 67:24,73:8, 78:10,85:11, 87:24,116:10, 120:9,125:7, 134:20,145:10, 150:4,154:10, 155:6,177:4, 182:19,188:15supported42:1, 159:14,167:4supportive161:16sure19:16, 44:6,83:14, 99:1,105:18, 150:12,150:17, 171:1,171:14surgeon116:22, 127:24surgeons117:4, 117:15,119:21, 127:11,192:24, 193:2,193:4, 196:3,196:4surgery4:7, 60:1,83:3, 83:6,87:20, 89:11,89:24, 91:11,93:16, 95:7,115:3, 115:7,117:3, 117:22,118:3, 118:9,118:11, 118:13,119:24, 120:5,120:7, 120:13,120:23, 121:7,122:19, 123:15,123:24, 124:5,124:9, 124:13,



DRAFT

124:16, 124:17,126:7, 126:16,127:12, 128:5,128:6, 187:23,189:1, 191:9,192:15, 193:20,194:19, 195:10,196:22, 197:21,197:23, 198:1surgical3:9, 4:8, 4:16,18:21, 25:14,25:18, 84:3,84:7, 85:6,88:13, 88:17,88:23, 89:5,89:9, 89:17,90:3, 91:14,91:20, 92:22,93:5, 93:8,94:5, 94:22,96:20, 97:15,101:22, 102:3,102:23, 103:7,104:10, 105:9,114:12, 118:19,125:22, 145:5,146:11, 170:3,187:2, 187:5,187:6, 187:21,188:10, 195:9,197:22, 197:24surrounding173:7survey80:17sustainable11:7swedes172:6, 172:15swedishamerican200:16sweis38:12, 39:20switch138:21sworn30:10, 30:19,

38:11, 38:17,48:11, 48:15,56:11, 56:16,66:11, 66:22,72:14, 72:20,77:13, 77:21,84:13, 84:22,115:15, 115:20,131:11, 131:18,144:11, 144:18,149:11, 149:17,153:11, 153:19,176:14, 181:11,181:14, 187:11,188:3system9:5, 23:7,39:23, 66:13,66:15, 67:8,67:14, 68:2,69:5, 69:21,118:4, 128:2,138:3, 140:6,145:21systems11:4, 102:15,164:12

Tt-a-m-m-y19:11t-i-m16:9table18:17, 18:22,79:10take28:4, 53:4,111:11, 113:15,138:4, 138:8,138:10, 150:18,156:11, 172:4,173:6, 183:14taken93:7, 113:17,150:17, 204:7,204:10taking10:2, 10:5,

12:6, 113:13,140:9, 170:19talk125:23, 139:7,177:24talking102:19, 110:13,129:23, 137:23,137:24, 171:11tammy18:18, 19:11target169:14targeted193:4task22:16tax18:5tcu133:16, 133:18,134:13, 134:18,134:24, 135:4,136:8, 136:9,141:5, 141:12,142:20teaching117:15, 119:15,119:20, 146:7team11:10, 14:13,14:15, 16:21,20:2, 24:13technical53:17, 53:24,88:4, 90:9,167:3technically160:20technology5:10, 88:21,92:2, 93:21,103:1, 117:24,127:6, 127:21,128:12telephone1:15tell100:2, 194:2

telling137:22tenet167:8terminology101:5terms126:12, 127:5,127:22tertiary15:24, 158:12,170:2testify8:10testimony14:14, 33:20,33:24, 37:10,44:2, 46:5,46:10, 46:18,55:2, 61:16,61:24, 62:4,63:4, 64:10,64:22, 70:24,71:4, 71:9,81:24, 82:4,82:12, 90:23,107:16, 110:3,110:5, 112:11,129:7, 129:10,129:14, 129:22,142:16, 143:4,143:8, 147:5,164:2, 174:14,175:2, 175:6,179:21, 184:24,198:23, 199:7,199:11, 199:15th154:8, 193:6thankful125:6thanks126:8, 154:23,166:19thanksgiving138:7theoretically109:13, 110:17



DRAFT

therapies140:5therapists12:20therapy74:12, 74:14,140:7, 142:2thereafter204:10therefore57:8, 159:2thing102:21things73:13, 100:12,178:5think32:16, 43:14,43:19, 44:2,44:8, 45:8,69:4, 69:18,81:4, 93:9,99:20, 100:23,101:7, 101:11,103:23, 105:2,112:15, 124:15,126:5, 126:24,132:15, 166:10,166:11, 169:5,169:14, 173:7,178:1, 178:3,196:18, 202:7,202:13thinking185:20third86:19, 119:15,122:7, 191:1,196:15thought137:11thousand39:23, 160:5,160:6three18:15, 39:5,48:15, 66:22,68:20, 77:21,

84:22, 85:13,85:24, 87:17,88:11, 118:17,119:4, 131:18,134:8, 135:12,138:9, 144:18,178:3, 181:14,189:12, 192:8,192:23, 193:1,195:24, 196:3three-hour134:17three-story31:5, 183:4three-times-per--week140:8threshold124:3, 195:16through13:2, 16:19,19:20, 22:11,42:10, 92:8,92:9, 119:13,140:11, 163:23,165:14, 171:11throughout11:2, 28:10,117:6, 121:8,172:8thursday-saturday134:10tied108:20tim8:15, 16:9,149:12time10:10, 17:7,18:24, 32:20,43:8, 51:5,51:12, 51:16,52:12, 59:12,61:1, 85:21,87:23, 89:21,94:15, 97:13,108:18, 117:18,124:1, 133:8,

135:21, 137:24,140:10, 140:15,141:19, 157:2,164:24, 165:8,166:15, 182:24,183:3, 183:14,183:23timely162:18times13:9, 17:4,28:9, 134:8,134:16, 135:12,136:12, 138:2,162:24, 171:5timing91:22, 178:2tina131:15, 133:3,135:2tired137:13today5:5, 45:2,46:6, 50:11,51:3, 61:11,61:16, 62:4,79:6, 85:21,86:13, 87:23,88:6, 94:15,104:11, 126:24,133:7, 145:22,150:18, 154:19,155:11, 155:24,166:13, 167:5,167:24, 182:2,195:4today's5:6together41:20told171:8tolerate162:7took41:13, 74:13,191:17

topic15:14total8:10, 35:19,78:4, 193:7touch171:3traditional134:14, 141:4,141:11traditionally134:3train127:11, 128:13trained93:14, 127:17,127:19, 164:14training157:14transaction57:6, 57:10,67:10, 67:15transcript7:9, 7:20,204:8transcripts3:6transfer13:7, 13:14,17:5, 22:13,22:19, 23:2,161:2, 162:12transferred11:19, 12:1,21:7, 22:22,23:4, 162:6transfers20:18, 162:16transition20:24, 139:5,140:18transitional133:11, 133:16,136:7, 137:1,138:22, 139:14,139:17translates134:10



DRAFT

transparent104:24transport170:12transportation13:22, 21:5,138:1, 156:21transported20:9trauma17:24, 39:4,39:22, 146:5travel9:14treat117:5, 134:7,138:11, 140:24treatable23:8treated23:6, 93:18,104:9, 117:8,189:21, 190:11treating134:24, 156:24,196:20treatment9:16, 9:17,10:20, 12:3,12:21, 15:1,15:22, 17:16,17:20, 22:24,32:13, 118:17,118:22, 119:5,119:8, 134:4,134:14, 159:18,160:1, 161:12,163:8treatments141:8tremendous120:14trend193:14trending193:13triaging161:24

tried51:19true204:8truly160:18, 171:24trustees58:16try17:23, 28:8,84:4, 137:16,138:19, 139:4,141:5, 141:15,164:3, 164:7trying96:12, 99:13,140:13, 171:23tuesday1:7, 6:6, 6:24,7:9, 134:9turn16:23, 40:2,85:22, 97:20,134:22turning192:5turnover97:7tutera77:18, 79:13,80:21tutera-affiliated79:14twin157:10, 157:24two5:7, 8:12,9:14, 16:3,16:5, 18:11,20:9, 23:13,24:19, 30:19,32:8, 38:17,41:14, 42:19,56:22, 57:4,59:23, 63:2,85:22, 86:3,86:10, 89:6,95:3, 95:21,

97:24, 115:20,117:22, 118:11,121:23, 123:4,123:6, 123:9,124:3, 124:8,127:12, 135:17,149:17, 160:17,161:4, 162:16,167:2, 188:3,189:7, 191:22,192:8, 193:19,196:9two-minute8:2two-week138:19type132:14, 136:19types137:3typewriting204:11typically134:18, 190:2

Uuh-huh106:13ultimate57:8umbrella58:21unable22:19, 159:12unacceptable20:13unanticipated39:9unconscionable22:23under17:10, 58:20,60:8, 74:8,74:11, 99:8,100:22, 102:15,104:10, 104:12,105:24, 155:1,158:15, 204:11

underneath41:24, 42:17underprivileged26:18underserved10:7, 14:3,157:19understand9:23, 14:19,42:20, 99:1,99:4, 99:18,100:10, 100:11,103:3, 107:11,113:1, 113:7,157:18, 171:13,171:15, 184:7,197:18understanding74:16, 100:8,108:15, 168:24understands12:5, 97:14understood40:13, 42:12,99:14undertaking9:24, 15:20undue44:7, 45:9unemployment14:23unexpectedly136:2unfortunately24:22uniform59:7uninsured22:22, 119:11,119:12unique14:18, 50:23,118:1, 118:19,120:4, 156:19,189:7, 190:9uniquely164:13unit9:24, 10:15,



DRAFT

13:8, 13:19,13:23, 15:17,16:12, 18:6,20:8, 24:4,24:10, 51:7,53:8, 133:12,133:16, 135:11,136:8, 136:9,137:1, 138:23,139:14, 139:17,153:6, 154:20,156:2, 158:7,162:5, 167:14,168:15, 170:7,173:10, 173:12,177:22united21:21, 22:2,88:18, 155:21units9:7, 39:7university32:10, 146:8unlawful164:8unless63:6, 106:17,177:13unlikely74:18unnecessary124:21, 192:10,193:16, 193:22,194:24unrelated50:14, 50:24untenable161:6until15:15, 23:2,42:18, 51:7,101:15, 189:6updated52:22, 54:3updates28:9, 92:1updating97:21

upgrade43:4upgrades146:9upsetting17:22upward193:13urge25:8urgency133:21urology193:10use18:4, 88:23,134:1, 135:14,136:21using126:5, 136:12,138:19, 189:18,190:17usually20:9, 22:13,49:7utilization86:7, 102:18,134:12, 191:16,192:9, 192:13,192:18, 192:20,192:21, 193:9,193:12utilize41:9, 96:16,138:23utilized134:18utilizing41:16, 134:5,134:24

Vvariance183:16, 184:1various162:12vascular90:4, 91:15,

92:10, 95:6,95:10, 95:16,102:14vast15:9, 21:4vault32:18venture94:18verhulst18:19, 21:20,21:21, 23:14,155:21versus100:1, 102:4via1:15viable94:23vice66:12, 72:16,77:17, 79:12,80:20, 133:2,145:20, 181:24village51:8, 52:23,53:16, 54:4violent17:2virtually118:12visit166:6visits39:24visualization162:24void26:21volume86:16, 91:23,94:21volumes95:12, 95:15,95:23, 199:3vote63:6, 64:14,79:15, 94:9,

104:13, 111:8,111:9, 111:10,112:5, 112:16,112:19, 129:1,177:14, 179:2,201:8, 201:9votes34:1, 37:12,46:23, 55:8,62:6, 63:3,64:18, 64:23,71:11, 76:4,82:14, 130:1,143:10, 147:23,152:4, 175:8,179:23, 185:18,199:17vp158:16, 182:3vulnerable21:15, 22:5,156:13, 156:23,167:11

Wwait9:21, 97:1,112:14, 138:1,162:6waiting9:11, 13:9,17:4, 22:19,138:1want5:13, 15:9,44:12, 96:15,98:24, 100:10,110:9, 110:15,113:9, 117:8,133:5, 133:7,133:10, 136:5,136:10, 136:18,138:21, 167:13,169:24, 171:13,183:1wanted28:1, 85:23,87:10, 97:21,



DRAFT

111:6, 165:12war159:22way20:19, 21:21,22:2, 40:16,88:16, 96:11,97:4, 100:13,108:8, 118:14,135:19, 138:11,140:13, 155:21,190:18ways135:17we'll28:8, 32:16,63:6, 63:12,81:3, 81:8,108:23, 111:10,168:21, 169:5,173:8, 178:7we're19:2, 28:2,32:17, 39:22,39:24, 40:17,43:2, 44:1,87:12, 98:2,99:17, 100:12,100:13, 101:3,101:11, 103:19,104:2, 104:9,107:12, 108:4,109:8, 113:13,113:15, 118:7,138:16, 141:7,141:8, 154:19,167:2, 169:5,170:7, 170:14,173:24, 177:13,185:23, 196:16,198:2, 198:11,201:1we've33:16, 46:14,68:19, 68:21,68:22, 80:5,101:15, 106:20,119:18, 120:15,

127:18, 133:16,136:24, 156:6webbing42:7week134:8, 134:11,134:16, 135:12,136:13, 171:2,171:9weeks97:2welcome5:11well-being19:19, 165:1well-reported89:9went172:6, 173:12,202:16west28:23, 40:22,41:5, 41:7,158:2western158:5westmont128:16whatever104:16, 109:16,110:20, 182:24wheeling198:12whereof204:17whether9:4, 108:1,136:18, 191:11,193:20whiteside8:23, 12:14,12:15, 16:19,20:23, 21:1,21:22, 22:1,155:8, 155:16,155:19, 155:21,157:3, 158:1,159:5, 159:6,

159:24, 163:15,168:16, 172:23whitney77:14, 78:24whole169:16william84:19, 94:12willing120:8, 156:10winter23:12, 51:15wisconsin117:23, 121:24,122:4wish5:13wishes27:6, 101:18withdraw114:15, 114:16withdrawing113:22within86:13, 95:2,95:4, 122:10,122:18, 122:24,123:4, 123:6,124:3, 124:4,158:7, 159:13,162:5, 163:3,166:23, 190:19,191:6, 193:21without9:15, 17:11,17:19, 74:22,87:4, 103:5,108:3, 162:4,163:6, 164:21,165:6, 189:21,202:2witness56:16, 72:20,204:17witnesses30:19, 38:17,48:15, 66:22,77:21, 84:22,

115:20, 131:18,144:18, 149:17,153:19, 181:14,188:3wordings102:20work10:18, 11:8,11:9, 11:13,11:21, 14:12,14:17, 19:23,20:8, 26:10,41:17, 41:19,41:22, 42:22,43:3, 44:5,45:10, 45:17,52:15, 53:7,102:10, 102:11,102:14, 118:20,127:15, 154:23,161:9, 182:7,194:11, 194:20,202:20worked183:18worker10:16working51:5, 51:9,97:8, 107:6,139:2, 189:9,190:8world119:21, 127:20,135:8, 159:22worse9:15, 159:23wouldn't202:2wright131:12, 132:20,132:21, 132:23,143:13wrist92:9writes140:24written175:14



DRAFT

Xx-ray102:11, 102:15

Yy'all139:7y-a-r-o-s-h25:17yarosh18:22, 25:15,25:16, 26:6yea112:16yeah91:9, 107:8,108:9, 109:24,172:8, 177:20,178:1, 201:1year5:15, 32:14,32:15, 32:17,43:22, 44:15,50:19, 51:14,91:21, 117:13,118:10, 122:3,122:7, 123:20,133:17, 135:14,163:23, 168:20,191:1, 191:7,191:19, 191:20,191:21, 193:9,197:3, 201:21,201:22year-old26:8year-to-date192:21yearly43:14years15:15, 22:1,41:14, 68:20,70:4, 88:17,89:7, 117:21,123:4, 123:6,124:3, 124:5,

126:15, 126:18,127:2, 127:12,127:14, 138:16,141:21, 156:5,192:13yelena187:14, 187:20york122:9you-all28:2, 185:20,203:1yourself30:16, 56:11,72:14yourselves30:11, 38:11,48:12, 66:11,77:13, 84:13,115:15, 131:11,144:11, 149:11,153:10, 176:13,176:15, 181:11,181:18, 187:11

Zzero92:17zip123:16

$$152:1, 86:23$100,000169:13$121,000188:12$17.3145:8$19.149:22$280:23$2,446,98035:6$2.478:6

$255,000132:7$27182:17$29.7150:1$38.335:17$40.735:17$6.185:8$631,000177:2$8.1116:7$900,00087:7

..02189:17.8189:17

0048:2, 131:20.3189:220.4190:70028:5, 194:11004299204:400648:2, 48:7,49:14016:8, 6:10,30:2, 35:2, 77:201831:70284:20338:2, 56:2,

63:2, 83:2,115:203077:2, 77:603184:2, 84:7,113:23, 114:2,114:1103283:2, 83:5,115:2, 115:603429:10463:2, 131:2040131:2, 131:5042144:2, 144:504428:2204528:2404856:2, 56:5,56:23, 149:2,149:50498:7, 8:17,10:13, 16:14,18:16, 56:24,63:18, 153:2,153:5051:8, 144:205029:505166:2, 66:5,176:2, 176:505272:2, 72:5,181:2, 181:505425:14, 187:2,187:505738:2, 38:5,



DRAFT

39:1, 39:130648:2, 66:206328:2006528:2106930:2, 30:5,31:2, 35:2,35:5, 35:150772:2, 149:208153:2084204:409176:2

1128:5, 185:211,100157:31.2189:201.6781:6, 81:7101:7, 16:12,70:4, 86:15,93:11, 113:14,113:16, 113:17,122:19, 122:24,123:22, 127:14,153:6, 154:2,154:20, 173:10,173:12, 181:2,190:20, 193:7,193:2110,00032:1610.6190:410022:14, 78:5100,000160:16, 169:10

107191:17, 192:201112:20, 26:8,88:8, 113:18,169:10, 176:24,187:2, 200:31120166:211154:6, 158:2126:11, 28:21,30:4, 31:1,44:23, 90:1,91:12, 185:20,193:6, 200:9,200:11, 203:111314:9135,000157:121438:2, 38:5,39:1, 39:13,51:121444:101494:111513:20, 21:3,28:7, 190:14,194:2115097:51534:131631:7, 48:2,48:7, 49:14,113:181728:20, 28:21,30:2, 30:5,31:2, 35:2,35:5, 35:15174183:9

1764:141828:18, 28:22,28:24, 29:11814:151874:16198:7, 8:17,10:13, 16:14,18:16, 21:24,25:14, 29:5,56:2, 56:5,56:23, 56:24,63:18, 66:2,66:5, 72:2,72:5, 77:2,77:6, 83:2,83:5, 84:2,84:7, 113:23,114:2, 114:11,115:2, 115:6,131:2, 131:5,144:2, 144:5,149:2, 149:5,153:2, 153:5,176:2, 176:5,181:2, 181:5,187:2, 187:5,201:23197758:5

2228:5, 83:2,115:22(c)(200:32(c)(1200:32(c)(5200:32,500157:42.1190:6

2.7183:172089:7, 160:1520,000190:192004:17, 4:20,42:14, 145:52014:22201114:72012189:6201539:2201649:13, 189:6201722:18, 191:18201831:4, 123:14,191:17, 191:18,191:24, 192:20,193:1220191:7, 31:2,49:18, 89:23,91:10, 192:21202031:3, 67:10,78:7, 90:6,91:17, 91:21,91:24, 154:8,188:13, 204:19202149:12, 85:9,116:8, 177:3,182:18, 204:202022150:2202339:1, 145:92034:232041:22



DRAFT

2172:6, 73:2,127:19, 169:4,200:321522:18227:9, 85:9,121:17, 192:62237521:21232145:6249:11, 13:9,23:2, 42:21,43:2, 48:6,49:11253:9, 77:7,78:3, 79:825,000158:1250119:19, 197:3276123:16283:1029867:5

33,000169:203.3154:73.4195:16303:13, 23:1,28:5, 134:18,136:10, 136:11,154:830013:20, 70:4,118:9, 122:4,197:3

3139:1, 49:12,49:18, 78:7,116:8, 145:9,177:3, 182:183238:4, 38:24,44:9, 44:10,45:534160:6, 161:4353:18, 17:7,121:33632:7383:1539170:21

44,500156:244.2189:1640117:13, 160:4,169:1341200:94321:3, 183:84531:14, 185:20,185:21483:164921:24

55168:20, 194:115.335:185.3435:6

5.8189:155011:18, 23:4,42:9, 93:11,122:16, 122:23,123:3, 123:5,123:9, 124:2,156:10500163:225132:453113:1754168:19, 200:1155158:3, 158:5563:21, 145:1,145:35723:3, 203:1159191:18, 192:225th204:18

66,000157:26-month45:660119:2, 160:4,169:13, 189:14600163:22, 168:20604901:6622123:15633:22, 168:1964145:3663:23

6849:156th6:24

77,000169:2170158:4723:247422:17578:4, 79:8,158:4, 160:2075,000182:1476168:18774:4

88,00032:138-foot41:680168:18834:6844:88th6:7

991:89,00019:2090190:10900,00086:24, 98:149119:4



DRAFT

920032:1594120:1698154:4990032:16



DRAFT

Documents

Transcript of Open Session Meeting - Illinois.gov · 2020-02-26 · Transcript of Open Session Meeting Date: December 10, 2019 Case: State of Illinois Health Facilities and Services