Tavares, FL - May 29, 2011 -
You might call it Vance and Stan and Marilyn's "Excellent Adventure" driving up to Tallahassee on Thursday for the first meeting on Friday, May 27th of the Florida State Commission to Review Taxpayer Funded Hospital Districts (FSCRTFHD ?). We will refer to it as the Commission or HDC (Hospital District Commission). The Commission was established by Gov. Scott in an Executive Order.
(Updated below on May 31 to add clarifying text and indicate audio recordings have been posted to the official website)
Most website links we found are listed below in the text, or a links section at the bottom.
Note: Due to the holiday weekend, only one news article has been published on this meeting as of Sunday. I will add updates to this page after more appear. They will be in the LINKS section at the bottom of this page.
Summary:
You can read a news article HERE about the Commission meeting, with quotes both from Lake County's Marilyn Bainter, a member of the North Lake Hospital District, and Vance Jochim, writer of this blog. Bainter and Jochim were the ONLY parties providing public input at the end of the meeting.
This Commission was created by Governor Scott to investigate Hospital Tax Districts in Florida and make recommendations. We first wrote about it HERE in an earlier post. Members of the Commission seem to be
Our interest is that our local North Lake County Hospital District (NLCHD) provides about $5-million to EACH of two local hospitals, Waterman and Leesburg, and we wanted to understand the objectives of the Commission and provide public input supporting improvements in Hospital District practices. We have written numerous articles on NLCHD, which are HERE.
No decisions were made at this first of many meetings, which was mostly focused on establishing guidelines, learning about Sunshine rules and providing a list of information they want from staff for the next meeting, to be held on June 20 (Monday).
The Commission is using staff and facilities from the Florida AHCA ( Agency for Health Care Administration). Two absent Commission members called in via phone. One was a Florida Representative who only listened for half the meeting, however, the official list of Commission members does NOT list the Representative, so that must be new. Another Commission vacancy will not be filled so as not to delay the Commission. The Commission members asked the AHCA staff to initiate some basic research, including more statistics on all the Hospital Districts so they can decide specifically which ones would be part of the review. Apparently, there are some Hospital Districts that exist, but are dormant, and may be excluded (or should be closed if recommended).
About 60 people were there, including lobbyists, press members (inlcuding the NY Times), MANY staff from AHCA, representatives of various affected hospitals including both Florida Hospital (parent of Lake County's Waterman Hospital) and a rep for Leesburg Regional Health Center.
Transparency of Commission Activities: At the request of FiscalRangers.com several weeks ago (and probably others), the Commission has already established a website HERE where agendas, supporting attachments, minutes, and audio recordings of meetings will be posted, as well as other documents. We also asked for a streaming video and online audio broadcast, which are being considered. A Commissioner pointed out the need for streaming video and had to tell them about the free service Ustream, which is used by our own Lake County Board for meetings. They also intend to provide a phone line for callers to listen to the discussion, but not provide feedback (again, technical issues), but may allow call in questions later. As of today, two days after the Friday meeting, the website has downloadable copies of the Agenda and all supporting documents provided to the Commission members. UPDATE: As of May 31, the audio recordings have been posted to the website. We expect the minutes to be posted fairly soon on that website, so we will not post those links here.
Details of the meeting
Basically, the members of the Commission were given a set of seven objectives listed in Governor Scott's Executive Order, with five of them focused on "government operated" hospital districts. There are only 10 of 67 Florida Counties that have Hospital Tax Districts. A number of them actually own one or more hospitals, which are considered "government operated".
This blog has never focused on the South Lake Hospital District, which DOES own half of South Lake Hospital, but it will certainly fall under the purview of this Commission. Our articles on this blog will only focus on how the Commission affects the North Lake County Hospital District.
Clarification: We have talked about the lack of specific spending rules, performance audits and low accountability for funds provided to the two local Hospitals by the North Lake County Hospital District. However, we should clarify for those that do not understand our definition of accountability or audit methods. The District DOES have financial audits by a CPA firm to warrant that they spent funds like described in their financial statements, which basically list a few large payments indirectly to the Hospitals. In addition, each Hospital has audited financial statements and also forwards data to AHCA for required reports. But, when we talk about accountability and auditing, we are talking about the complete lack of guidelines for how our own North lake County Hospital District Tax revenues are to be spent by the Hospitals (i.e. not for renovations or bonuses), a complete lack of audits to ensure compliance with those desired guidelines (which are non-existent at this point) and a lack of any performance audits to ensure that the funds received by the hospitals from NLCHD are efficiently spent. For instance, are they being used to pay for non-paying patients just because the Hospital doesn't have an aggressive or fair collections process?
I will write a future article on this issue to further clarify it. The hospitals or AHCA will say they have financial audits, and they do, but not the type to verify exact, efficient uses of Lake County tax funds. Additionally, they will say they spend the full $5-million on indigent care, but that is not what the law says - it uses a vague term "for continued hospital care" which can be defined in many ways. The indigent care question is up in the air, because the hospitals are both non-profits, they escape paying most all taxes, and when creating a non-profit, to get that status, they had to agree to absorb costs for all health care patients who could not pay, so why should they get another subsidy when they are already getting huge tax breaks, AND reporting profits in prior years. Finally, if the hospitals really needed subsidies from Lake County taxpayers, why didn't the Tax District Board establish pay caps on staff until the subsidies were no longer needed. Remember, the Federal government did that for the General Motors bailout, so why isn't that done for local hospitals receiving taxpayer bailout subsidies? In contrast, the regulations establishing the North Orange County Hospital District have NO cost reduction or cost control tradeoffs from the hospitals for receiving about $5-million in subsidies.
Conclusion:
Marilyn and I gave public input to focus on ensuring that the Commission also reviewed operations of Hospital Districts that were Tax Districts only, and did not run government owned hospitals. Thus, they will be sure to also review those Tax Districts, their need for sunset provisions, need for better accountability, need for spending guidelines, need for pay caps as long as subsidies are needed, etc.
We expect that there will be very good transparency on meeting proceedings and opportunities for public input. This committee, unlike the North Lake County Hospital District, is objective and is NOT controlled by Hospital representatives. I have corresponded with staff several times to ensure there was adequate transparency, and their website indicates a very good understanding of the need for transparency.
I will post updates on future issues and meetings of the Commission.
The Excellent Adventure:
I rode up to Tallahassee with Marilyn Bainter and her husband, Stan Bainter, former Florida State representative. A number of people came up to Stan at the meeting who knew him when he was in the Florida House. He and Marilyn even knew the chair of the Commission, Dominic Calabro, as well as some GOOD looking lobbyists and staff members of elected officials.
We got to the Commission meeting early, and met with some attendees. Later after the meeting and our public input, we were joined by several "like minded" people from other Counties that had similar problems with Hospital Districts or the Hospitals their District owned and ran.
Riding with Stan and Marilyn is one of those "you can't make this up" experiences. Marilyn has a new car and Stan was driving. It was raining after we stopped for food, and Stan went out to get the car. Then the rain came down in buckets. He pulled up to the door and Marilyn and I ran to the passenger doors, and were getting drenched as buckets of water came down. Stan didn't know how to work the door locks to unlock the passenger doors, and we got thoroughly soaked.
It was certainly a memorable adventure. It's the kind of stuff you would see in an I Love Lucy episode.
Lake County taxpayers are lucky to have the Bainter duo on their side.
Links:
FiscalRangers.com articles on this Committee will be posted under the category "North Lake County Hospital District" on this blog and all those articles can be seen HERE.
The official AHCA provided website for the Commission is HERE, which also has a link to Governor Scott's Executive Order number 11-63, which specifies the 7 major objectives of the Commission, and there is also a link for the Commission Members:
http://www.fdhc.state.fl.us/mchq/FCTFH/fctfh.shtml
Other articles on the Commission - before and after this May 27 meeting:
http://www.wctv.tv/news/headlines/Panel_Begins_Health_Safety_Review_122821444.html
This one, by Lloyd Dunkelberger, is apparently syndicated – I have found it in three different newspapers. This one is the Sarasota Herald-Tribune. They may have been edited or shortened from the original.
Sarasota Herald Tribune:
http://www.ocala.com/article/20110527/ARTICLES/110529733/1454?p=all&tc=pgall&tc=ar
http://fltrib.com/scotts-review-taxpayer-funded-hospitals-ready-gear
http://capitalsoup.com/2011/03/23/governor-scott-orders-review-of-government-run-hospitals/
This blog by John Degroot covers the North Broward County Hospital District (Florida)
http://john-degroot.com/2011/05/27/stay-tuned.aspx
This link is to an article about a controversy in a Seattle Hospital District because the head of the publicly funded and government owned hospital is paid over $1-million and is the highest paid govenment employee in Washington State.
http://www.king5.com/home/valley-medical-center-122473009.html
Vance Jochim
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