Ms. Karen B. Rose Deigl

1. Have you ever spent any time at the health care providers funded by the Indian River County Hospital District (IRCHD) to observe how their facilities work (e.g. spent a day in the Indian River Medical Center [IRMC] emergency room) and have you ever met with any indigent members of the community to understand their life situations?  If so, generally speaking, what have you learned?

“For 15 years I have been involved in some capacity with each of the providers that the IRCHD funds. As a former employee of the IRCHD I had the opportunity to review each of the grants that were submitted by the providers annually and be part of their program funding annual audit process. In 2005 I developed the indigent care qualification manual that is still in effect today, although it has been amended. I was the project manager for the 2006 Indian River County Comprehensive Needs Assessment and participated on the advisory committee of the most recent Indian River County Health Needs Assessment. I, along with Lenora Ritchey and Ellie McCabe initiated the IRC Mental Health Collaborative that has made great strides in the effort to enhance the overall awareness of mental health needs in this community. I have spent many hours in meetings with all the Executive Directors and staff of IRCHD providers over the last 15 years. As the CEO of the Senior Resource Association (SRA), I am still in constant contact with all IRCHD providers as well as additional, multiple social and health care agencies in our community.

In my current position as CEO of SRA we provide services to seniors and their families as well as manage the overall public transportation system in IRC. Most of my clients are indigent. I use Federal, state and local public funding as well as philanthropic funding to provide services to those individuals who have no other means. So I am VERY aware of the clients’ life situations.”

2. Are you concerned about the adverse impact of Sebastian River Medical Center’s (SRMC) $64 million expansion may have on any of the health care providers supported by IRCHD? Would you be in favor any opportunities for the IRCHD to partner with SRMC to better serve the county’s underserved populations?

“While SRMC had their official ground breaking ceremony it will be sometime before construction is completed. Capacity and demand are the basic fundamentals of the business equation. IRC continues to grow and all businesses, including health care providers of IRCHD, must prepare for a shared market place. I am always in favor of looking at options to serve the county’s underserved population; however, I would want to do a great deal of research to determine if using taxpayer dollars to fund another business that the community does not own would be the best use of public funds.” 


3. Are you familiar with the District’s Vision, Mission and Strategic Plan recently developed and approved by the Trustees? Do you support the IRCHD transitioning from a “Hospital” to a “Health” District? Additionally, if IRCHD is to become a “Health” District what other organizations, would you like to support?

“I am very familiar with the strategic plan and support those efforts. I’m not completely convinced on the idea of changing from a Hospital District to a Health Care District. Although it is in the strategic plan I believe there are plans to have further discussions, including town hall meetings to receive public input. Through Legislation and the Special Act of 1959 the Hospital District was formed to allow the ability to raise bonds to build a hospital. The language of the Trustees authority is very broad, allowing them to make decisions about the hospital land and facilities and ensuring health care for all residents of our County. I would consider additional funding to other organizations only if the program funded was proven to be a best practice and was determined that it filled a gap within our healthcare system while also staying within the mission of the IRCHD.” 


4. In the strategic plan it says that: “By November 1, 2016, staff will recommend method for utilizing the Health Needs Assessment data in all District communications.” Is there a need for a new Health Needs Assessment to collect data from for-profit health care providers such as private practitioners and even SRMC itself, rather than only the not-for-profit organizations that were included in the current assessment?

“The Health Needs Assessment recently completed included for-profit healthcare representation at those meetings. In fact, the CEO of the Sebastian River Medical Center was part of the advisory committee for that assessment and attended some of those meetings. I welcome insight from all healthcare providers whether for-profit or not-for-profit.”

5. On August 18, 2016 IRMC CFO Greg Gardner spoke before the IRCHD Trustees and projected a breakeven operation for the fiscal year ending 09/30/16. When asked why the Sebastian River Medical Center, with the same demographics, makes money and we don’t, Mr. Gardner said it was due to the “egregious” disparity in private payer rates between what IRMC, LRMC and SRMC are paid for the same services. With Blue Cross, for example, SRMC is paid twice what IRMC is paid and Lawnwood Regional Medical Center (LRMC) is paid three times as much for the same services. This speaks to different contracts between the hospitals and the private payers. SRMC is owned by Community Health Systems (CMS), who owns 200 hospitals. Mr. Gardner said if IRMC was paid the same rates by Blue Cross as SRMC, it would bring $50 million to IRMC’s bottom line. Obviously an organization like CMS has more leverage. Do you support the IRCHD taking the necessary steps to sell IRMC to organizations like CMS to gain leverage to bring more to the bottom line?

“I would not support the IRCHD selling the hospital land and facilities to organizations like CMS for the sole reason to simply gain leverage to bring more to the bottom line. There is a much broader and complex business plan to look at if considering that option.”

6. Hospitals that are not part of a university, a health system or a chain of private hospitals are often called “community hospitals.” A regional hospital is a hospital that serves a larger area than a local hospital. On its website, IRMC indicates that “in late 2006, to reflect the transition from a good community hospital to a top-quality medical center, the hospital changed its name from Indian River Memorial Hospital to Indian River Medical Center. Indian River Medical Center is focused on providing quality healthcare to Indian River, St. Lucie, Martin, Okeechobee, Orange, Osceola, Polk, Brevard and Seminole counties in Florida. Counties.” So is IRMC a community hospital and what would be the difference if IRMC became part of a chain of private hospitals?

“Yes, IRMC is a community hospital as only a small portion of business comes from outside of our county. The difference would depend on what chain of private hospital; as each has a different mission. But for the most part for-profit hospital chains do not cater to the needs of the community. They tend to pick and choose the more profitable services, so service centers such as the Scully-Welsh Cancer Center, Behavioral Health Center and IRMC obstetrics program would likely diminish. Community Hospitals owned by the taxpayers are more driven by the needs and wants of the residents.”

7. There has been a lot of community discussion that IRMC is not transparent to the IRCHD with its financial data surrounding personnel issues, other subjects including financial details on IRMC’s Heart and Cancer Center, affiliations with Duke University’s programs and why, for cancer, IRMC chose Duke rather than the Moffitt Cancer Center; as well as, whether or not the private practices acquired by IRMC are making or losing money. In accordance with the IRCHD lease with IRMC, Section 9.f.i. b, “with reasonable promptness such other financial data requested by Lessor (IRCHD) as may be demonstrated to be necessary to protect the interests of the Lessor” shall be furnished to IRCHD.  Additionally, two IRCHD trustees sit on the IRMC Finance Committee.  With this background, why can’t these transparency issues be resolved as a duty to the Indian River County taxpayers who support the IRMC?

“Through the Special Act, the Master Lease and the Indigent Care Agreement there are specific protocols set up for IRMC to report both fiscal and specific operational information to the Hospital District on a regular basis. It is imperative that the Trustees continue to inquire and collect the necessary information needed to allow the Trustee’s to make prudent decisions representing the best interest of the taxpayers.”

8. Do you feel that the IRCHD is over-reaching its duties by trying to run the IRMC rather than just fund it? Do you feel the IRCHD is trying to run it?  If not, should they pay more attention to doing so?

“I do not feel that IRCHD is trying to run IRMC. IRCHD has an obligation to the taxpayers to have oversight of the health and welfare of the organization. There are processes put in place for that oversight.

The Hospital District requires IRMC to provide financial presentations at each IRCHD meeting along with any other operational information requested. There are three appointed District Trustees that sit on the Board of Directors of IRMC. Two District Trustees sits on each of the IRMC Finance Committee, Audit Committee and one Trustee sits on the Governance Committee. Lastly, of the four members of the IRMC Board of Directors nominating committee, two are District Trustees.

A candidate for IRMC Board Membership must be recommended and approved unanimously by all four nominating committee members. IRCHD Trustees should not try to run the operations but they certainly must have a great deal of oversight, thus providing influence over IRMC strategies and outcomes.”

9. Have you had any communications of any type with IRMC administration, any members of the IRMC Board of Directors, or any of the IRCHD funded organizations related to running for or serving on the IRCHD?  Do you have any personal relationship with any member of IRMC administration, members of the IRMC board of directors, or members in the same capacity of any IRCHD funded organizations? If yes to either, what was the content of those conversations about the IRCHD or nature of the personal relationship and how do you plan to avoid any perceived or real conflicts of interest?

“I do not have any personal relationship with any administrative staff or board members of IRMC. Through my work in the community I have professional relationships with all of the Executive Directors of IRCHD providers and meet with them regularly on a number of community healthcare issues. After making the decision and submitting my application to run for Trustee to the Supervisor of Elections office, I scheduled a meeting with Jeff Susi and Greg Gardner at separate times. I was able to ask a number of questions about the facilities, new programs, and the fiscal status specifically funding from the IRCHD. Jeff toured me through the new Scully Cancer Center and discussed how important the philanthropic community is to the well-being of healthcare in our community. My meeting with Greg involved the current year fiscal budget request presented to the District. I also asked him to include in our meeting the staff person who assesses the eligibility qualification of patients so I could gain more insight on the current qualification process.”

10. Please share your thoughts on how the Affordable Care Act (Obamacare) has affected our indigent population, IRMC, the health care providers IRCHD supports and the private practitioner community.

“The numbers of individuals deemed IRCHD Indigent have reduced due to the requirement to participate in the Affordable Care Act (ACA). Previously they would have qualified for the IRCHD Indigent Program, however since they now have insurance they no longer qualify. Unfortunately, those same individuals who now have insurance presenting to hospitals, IRCHD providers, and/or private practitioners, most likely will not be able to afford the insurance copay required. Either the copays will go unfunded, causing bad debt to the provider or they will just not present to any healthcare facility because they know they can’t afford the copay, causing poorer health issues among those individuals.”

My Commentary:

“With a Masters Degree in Health Administration and more than 15 years’ professional experience advocating for and supporting families in Indian River County, my passion and knowledge about the IRCHD Trustee’s role is obvious. IRMC should be held accountable for the proper management of its land and facilities and how to use and monitor taxpayer dollars to provide healthcare for those who need it most in our community.”