Lee Memorial Health System Quality/Safety Board & Full Board of Directors’ Meetings
Lee Memorial Health System Quality/Safety Board & Full Board of Directors’ Meetings Thursday, November 6, 2014 1:00 p.m. AGENDA QUALITY/SAFETY BOARD & FULL BOARD OF DIRECTORS MEETINGS November 6, 2014 1:00 p.m. BOARD OF DIRECTORS OFFICE Gulf Coast Medical Center – Boardroom (Medical Office Building) 13685 Doctors Way, Ft. Myers, FL 33912 239-343-1500 FAX: 239-343-1599 13685 DOCTORS WAY #190 FT MYERS, FLORIDA 33912 1. CALL TO ORDER (Sanford Cohen, M.D., Board Chairman) Lee Memorial Health System Board of Directors, sitting as the Lee Memorial Health System (LMHS) Board of Directors for Gulf Coast Medical Center & Lee Memorial Hospital/HealthPark Medical Center and the Board of Directors of its subsidiary corporations, including but not limited to Cape Memorial Hospital, Inc. doing business as Cape Coral Hospital; Lee Memorial Home Health, Inc.; and HealthPark Care Center, Inc. CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER 2. INVOCATION & PLEDGE OF ALLEGIANCE (Rev. Mason Jackson, MDiv) HEALTHPARK MEDICAL CENTER 3. PUBLIC INPUT – Agenda Items: Any Public Input is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Staff prior to meeting. LEE MEMORIAL HOSPITAL GOLISANO’S CHILDRENS HOSPITAL OF SOUTHWEST FLORIDA THE REHABILITATION HOSPITAL 4. (William Hearn, D.O., PLC Chairman) 5. Lee Memorial Health System at Coconut Point Update and Recommendations (Approve) (Kevin Newingham, VP Strategic Services) LEE PHYSICIAN GROUP LEE CONVENIENT CARE PHYSICIAN’S LEADERSHIP COUNCIL (PLC) REPORT(Accept) 6. PRESIDENT’S REPORT (Jim Nathan, CEO/President) BOARD OF DIRECTORS 7. Lease- 7331 College Parkway, Fort Myers (Approve) (David Cato, VP Outpatient Operations) DISTRICT ONE Stephen R. Brown, M.D. 8. QUALITY/SAFETY PORTION: STEVE BROWN, M.D., QUALITY/SAFETY LIAISON DISTRICT TWO Richard B. Akin Nancy M. McGovern, RN, MSM 9. DISTRICT THREE QUALITY/SAFETY AND FULL BOARD OF DIRECTORS MEETING MINUTES OF 9/18/14 (Approve) (Diane Champion, Board Secretary) Sanford N. Cohen, M.D. David Collins Access Infusion Lease (Approve) (Marjory May, VP Continuum of Care) Marilyn Stout 10. Diversity as Part of the Cure 11. Seasonal Surge 12. OTHER ITEMS DISTRICT FOUR (Yemisi Oloruntola-Coates, Manager, Diversity & Language Services) Diane Champion Chris Hansen DISTRICT FIVE Jessica Carter Stephanie Meyer, BSN, RN (Donna Giannuzzi, RN, Chief Patient Care Officer) Date of the next QUALITY/SAFETY BOARD MEETING February 19, 2015, 1:00 p.m. Gulf Coast Medical Center –Boardroom (Medical Office Building) 13685 Doctors Way, Fort Myers, FL 33912 110614 QUALITY/SAFETY & FULL BOARD\AGENDA(FINAL).doc Page 1 of 2 AGENDA (Page 2 of 2) BOARD OF DIRECTORS OFFICE QUALITY/SAFETY BOARD & FULL BOARD OF DIRECTORS MEETINGS November 6, 2014 1:00 p.m. 239-343-1500 FAX: 239-343-1599 13685 DOCTORS WAY #190 FT MYERS, FLORIDA 33912 CAPE CORAL HOSPITAL LMHS SYSTEM BUSINESS – SANFORD COHEN, M.D., BOARD CHAIRMAN 13. OLD BUSINESS 14. NEW BUSINESS 15. BOARD MEETING CRITIQUE 16. BOARD OF DIRECTORS REPORTS 17. Date of the next Meeting: GULF COAST MEDICAL CENTER HEALTHPARK MEDICAL CENTER LEE MEMORIAL HOSPITAL GOLISANO’S CHILDRENS HOSPITAL OF SOUTHWEST FLORIDA THE REHABILITATION HOSPITAL Thursday, November 20, 2014: 1:00pm – Finance Board & Full Board of Directors & TRAUMA District meeting Gulf Coast Medical Center – Boardroom 13685 Doctors Way, Ft. Myers, FL 33912 LEE PHYSICIAN GROUP LEE CONVENIENT CARE 18. ADJOURN (Sanford Cohen, M.D., Board Chairman) BOARD OF DIRECTORS DISTRICT ONE Stephen R. Brown, M.D. Marilyn Stout DISTRICT TWO Richard B. Akin Nancy M. McGovern, RN, MSM DISTRICT THREE Sanford N. Cohen, M.D. David Collins DISTRICT FOUR Diane Champion Chris Hansen DISTRICT FIVE Jessica Carter Stephanie Meyer, BSN, RN 110614 QUALITY/SAFETY & FULL BOARD\AGENDA(FINAL).doc Page 2 of 2 BOARD OF DIRECTORS Invocation Prayer & Pledge of Allegiance ___________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS PUBLIC INPUT – AGENDA ITEMS: Any public input pertaining to items on the Agenda is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Staff prior to meeting. Refer to Board Policy: 10:15F: Public Addressing the Board Non-Agenda Item: Individuals wishing to address the Board on an item NOT on the Agenda, the Board office must be notified of subject matter at least three (3) days prior to the meeting to allow staff time to prepare and to insure the matter is within the jurisdiction of the Board. PLC REPORT 11/6/14 1. MS Obligations and Independence forms accepted by all MEC’s. 2. Financial disclosure forms adopted to be proactive in meeting regulatory requirements. 3. Email and phone agreements accepted by MEC’s to allow IT to institute an Enterprise wide solution to physician communication. 4. LMH MS Quality noted some slow response times of physicians for some critical results. Currently using Nursing elevation process. 5. MS has identified that mail order pharmacy may be the default in EPIC. May result in delay in obtaining discharge medications. Change in EPIC is being instituted. 6. The MS president of CCH, Dr. Keys has tendered his resignation as President, effective 11/30/14. Dr. Claunch will assume the role of MS President of CCH. 7. Transfusion safety initiative has been a huge success. Health Park has realized significant monetary savings while decreasing inpatient days. 8. Census: Rapidly increasing. Seasonal surge plans have been initiated at all campuses. 9. One serious safety event has occurred at GCMC breaking a 23 month streak. This is currently being investigated and is under quality review. 10. GI call issue is being addressed at each campus and should be resolved shortly. 11. Employee engagement score at GCMC was 95%! 12. At GCMC 2013 Star data was made available to the MEC. 13. GCMC again received the AHA Stroke Care Alert Award. 14. Mass Casualty Drills have taken place at our campuses. 15. EBOLA Initiative: Spearheaded by Mr. Nathan. 16. Dr. Saunders and Steve Streed have addressed each MEC. 17. Phone conference by Administration and Physician leaders took place to address the need to disseminate the Ebola updates to the entire active MS. 18. Progress of Nursing and Doctor rounding changes. ___________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS LEE MEMORIAL HEALTH SYSTEM AT COCONUT POINT UPDATE AND RECOMMENDATIONS (Kevin Newingham,V.P. Strategic Services) B BO OA AR RD DO OF FD DIIR RE EC CT TO OR RS S RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc) Keep form to one page, SUBMIT (thru SLC Member) ELECTRONICALLY to L Drive – Miscellaneous - BOD Presentations by Noon the Friday before you’re scheduled on agenda. DATE: 11/6/14 LEGAL SERVICE REVIEW? YES_X_ NO__ SUBJECT: Lee Memorial Health System at Coconut Point Update and Recommendations REQUESTOR & TITLE: Kevin Newingham, Vice President Strategic Services; David Cato, Vice President Outpatient Operations PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) On June 26, 2014 the LMHS Board of Directors voted to support a planning initiative to finalize a vision for the Coconut Point Medical Village SPECIFIC PROPOSED MOTION: Motion to: Approve Concept Plan for the Lee Memorial Health System at Coconut Point Authorize proceeding with Next Phase of Planning, including but not limited to: » Detailed Business Planning: › LMHS Service profile › Physician complement and affiliation model › Volume Projections › Space Needs Program › Financial Projections › Plan of Finance » Team Formation – Development / Project Management, Architect / Engineer » Sports Medicine and Performance Center Feasibility Study This request supports the following Strategic Initiative(s): Financial Viability/Clinical Integration » » PROS TO RECOMMENDATION Enhance ability to meet LMHS Mission in South Lee County Community Support and Demand for Services Enhance OP Revenue Growth Service Lines help support public mission CONS TO RECOMMENDATION Cost of Capital LIST AND EXPLAIN ALTERNATIVES CONSIDERED LMHS’ request for certificate of need to develop an inpatient facility by transferring 80 beds from Lee Memorial Hospital was denied. FINANCIAL IMPLICATIONS Budgeted _X___ (including cash flow statement, projected cash flow, balance sheet and income statement) Non-Budgeted ____ Business Planning, Development, Project Management, and Architect/Engineer funding is already including in both the FY 2014 and FY 2015 project budgets. Capital funding for future construction activities will be requested in FY 2016 and beyond once the detailed business planning is completed. OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) All activities will be related to planning and design as described in the motion and under financial implications. SUMMARY LMHS is exploring the potential development of an innovative healthcare campus, Lee Memorial Health System at Coconut Point (LMHSCP), to meet community needs and address service gaps in Southern Lee County. Navigant has been engaged to assist in the development of the Lee Memorial Health System at Coconut Point concept through the planning phase. Significant growth in this community is projected over the next ten years and the opportunity exists to provide a broad array of services that support health, wellness and interventional treatment will be included at the site including an ASC, Freestanding ED, Imaging, Lab, Disease management, Medical Fitness Center and Physician Offices. BOD/Forms/Reporting Forms/Board (Action) Reporting Form – revised 4/4/13 cs Lee Memorial Health System at Coconut Point Board Update November 6, 2014 ©2014 Navigant Consulting, Inc. All rights reserved. Navigant Consulting is not a certified public accounting firm and does not provide audit, attest, or public accounting services. See www.navigantconsulting.com/licensing for a complete listing of private investigator licenses. Investment banking, private placement, merger, acquisition and divestiture services offered through Navigant Capital Advisors, LLC., Member FINRA/SIPC. Project Overview / Executive Summary ©2014 ©2014 Navigant Navigant Consulting, Consulting, Inc. Inc. Lee Memorial Health System at Coconut Point Page 22 Page Project Overview and Recap of Work-to-Date Project Overview » The recent denial of Lee Memorial Health System (LMHS) Certificate of Need (CON) to develop an inpatient facility by transferring 80-beds from Lee Memorial Hospital in need of replacement to its property in southern Lee County has led LMHS to reassess its strategy for how best to use its approx. 31-acre site in Estero to address community needs in Southern Lee County. » LMHS is exploring the potential development of an innovative healthcare campus, Lee Memorial Health System at Coconut Point (LMHSCP), to meet community needs and address service gaps in Southern Lee County. » Navigant has been engaged to assist in the development of the LMHSCP concept through the planning phase. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 3 Executive Summary » Significant community need identified for a differentiated health and wellness ambulatory care offering. › Significant growth in the senior population is accelerating demand for multi-specialty care in the area, including chronic care management and focusing on healthy lifestyles. » The LMHSCP will be designed to become a destination with distinction by offering patientcentric, integrated and coordinated care delivery that is enabled by technology. › May include a broad array of services that support health, wellness and interventional treatment will be included at the site including an ASC, Freestanding ED, Imaging, Lab, Disease management, Sports Medicine and Performance Center and Physician Offices. » Multiple options identified for physician affiliation to drive clinical integration goals. › Significant number of employed LPG doctors along with strategically aligned independent physicians at the site will an have impact on how LMHS will clinically integrate. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 4 Executive Summary » Phase I of the LMHSCP is estimated at 172,000 square feet at a cost of $140 million or ~ $800/sq. ft. including land costs. Cost reduction opportunities will be diligently pursued during the design phase of the project. » LMHS ownership results in the lowest cost of capital and lowest occupancy costs. › Identifying the best ways to take advantage of lower costs of capital while finding appropriate economic partnerships with physicians and other key participants in the overall program will be important. › While the cost of capital may be higher through other forms of financing and ownership, other options should be explored as well, including retail and business opportunities. » LMHS has the opportunity to achieve a projected opening in 1Q2017 if move into implementation phase in 4Q2014. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 5 Vision for the Lee Memorial Health System at Coconut Point ©2014 ©2014 Navigant Navigant Consulting, Consulting, Inc. Inc. Lee Memorial Health System at Coconut Point Page 66 Page The Vision for Lee Memorial Health System at Coconut Point Proposed Draft Vision Statement PROPOSED DRAFT: Lee Memorial Health System at Coconut Point (LMHSCP) will be a health and wellness destination for residents of Southwest Florida with a special focus on the senior population, offering convenient, easily accessible, and integrated medical and preventative wellness services across the continuum of care in a pleasing campus environment / retail setting. SPECIALTY CARE IMAGING SURGERY CENTER LMHSCP can be designed with the Wellness Center as the “anchor” (i.e., high-touch, high-volume), offering health assessments for designing individual regimes, early detection of healthcare issues, patient education, and chronic disease management, among other offerings. PRIMARY CARE REHAB THERAPY WELLNESS CENTER LABORATORY FREE-STANDING EMERGENCY INTEGRATED WITH RETAIL AND COMPLEMENTARY SERVICES ©2014 Navigant Consulting, Inc. LMHSCP will have medical office space for a mix of employed and independent primary care physicians and specialists. LMHSCP will operate urgent care / free-standing emergency (FED) and an ambulatory surgery center (ASC) with imaging, lab, and rehab primarily supporting FED & ASC. LMHSCP will also have available space for a retail district and health-related complementary services, such as adult day care, among other services. Lee Memorial Health System at Coconut Point Page 7 Illustrative “Destination with Distinction” Ideal Patient Flow and Key “Touch Points” Ideal patient flow Selecting LMHSCP / Physicians Pre-Services Arriving / Check-In / Wayfinding Service Post-Service Follow-Up Potential follow-up services One Registration One Point of Scheduling Patient recognized at all LMHS POS Patient is recognized upon arrival Patient schedules with one call One Combined Schedule of Care Prioritized D&T Scheduling Itinerary provided to patient One Clinical Record (EMR) One Patient Portal No repetition, accurate data capture All clinical info available Patient can review MOB services Online Services (sched., forms, etc.) Patient can request results Patient receives consolidated statement Collectively the five “ones” improve the entire patient experience. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 8 Conceptual Site Plan ©2014 ©2014 Navigant Navigant Consulting, Consulting, Inc. Inc. Lee Memorial Health System at Coconut Point Page 99 Page Groupings and Adjacencies METHODOLOGY Areas are grouped into development zones and adjacencies are defined for use in design. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 10 Concept Plan – Phase 1 Phase 1 includes 3 development zones – Integrative Medicine / Wellness / ASC / Emergency, Physician Office Suites and Sports Medicine and Performance Center with retail components augmenting clinical areas. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 11 Concept Plan – Phase 1 ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 12 Community Design Guidelines ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 13 Preliminary Project Costs ©2014 ©2014 Navigant Navigant Consulting, Consulting, Inc. Inc. Lee Memorial Health System at Coconut Point Page 14 14 Page Preliminary Master Corporate Budget Summary Medical Services Buildings Physician Office Building Sports Medicine and Performance Center Administrative and Building Support Total Square Feet 72,000 42,000 55,000 3,000 Total Project Costs $ 69,924,000 $ 28,814,000 $ 38,973,000 $ 2,089,000 172,000 139,800,000 Totals » Medical Services Buildings include ASC, Freestanding ED, Clinical Decision Unit, Imaging, Lab, Integrative Medicine / Wellness Center, Registration and Retail. » Total Project Costs include: › › › › › › › › Land cost allocation (note: land previously acquired by LMHS); On and off site improvements; Building construction costs; Soft Costs (professional fees, testing, permits, financing costs, insurance, taxes, etc.); Furniture, Fixtures & Equipment; Medical Equipment; Information Technology (hardware and software); and, Contingency. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 15 Preliminary Master Project Schedule ©2014 ©2014 Navigant Navigant Consulting, Consulting, Inc. Inc. Lee Memorial Health System at Coconut Point Page 16 16 Page Master Project Schedule – Phase I Phase I scope includes ASC, Freestanding ED, Clinical Decision Unit, Imaging, lab, Wellness, Retail, and Integrative Medicine / Wellness and Physician Offices. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 17 Request for Board Motion ©2014 ©2014 Navigant Navigant Consulting, Consulting, Inc. Inc. Lee Memorial Health System at Coconut Point Page 18 18 Page Request for Board Motion » Approve Concept Plan for the Lee Memorial Health System at Coconut Point. » Authorize proceeding with Next Phase of Planning, including but not limited to: » Detailed Business Planning: › LMHS Service profile › Physician Complement and Affiliation Model › Volume Projections › Space Needs Program › Financial Projections › Plan of Finance » Team Formation – Development / Project Management, Architect / Engineer. » Sports Medicine and Performance Center Feasibility Study. ©2014 Navigant Consulting, Inc. Lee Memorial Health System at Coconut Point Page 19 Open Discussion / Q&A ©2014 ©2014 Navigant Navigant Consulting, Consulting, Inc. Inc. Lee Memorial Health System at Coconut Point Page 20 20 Page ___________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS PRESIDENT’S REPORT Jim Nathan CEO/President LMHS Board of Directors President’s Report November 6, 2014 Bellevue Employees Face Ebola at Work and Stigma of It Everywhere NYT, Oct. 29! Related to Dr. Craig Spencer, NY’s first Ebola patient who worked for Doctors Without Borders in West Africa Beautician to new Bellevue employee (6 year client): “Find someone else to do your hair” Bellevue nurses who moonlight elsewhere “not needed” Bellevue hiding their name badges when outside of hospital Staff treating Dr. Spencer shunned by their own peers Staff seeking shelter in hospital to avoid risk to family and friends Teenage son to mother: “You work at Bellevue; stay away from me!” Anxiety continues and partly by media and political reactions; not clinical Medical Director re employees caring for Dr. Spencer - Free to go home after shifts, take mass transit, hug & kiss loved ones - “Zero risk” but “for caution” 117 EMS and treating employees are being monitored twice daily by health department with regular temperature checks and monitoring early signs of fever - Following Emory University Hospital and Nebraska Medical Center protocols Scientists Predict Few US Ebola Cases Simulation models call for a range of as few as two and as many as 130 in the US by the end of this calendar year Ebola disease traits: a fairly predictable virus are now well known; extremely infectious/contagious only through direct contact with body fluids, requiring no more than 21 days for symptoms to emerge Ebola projections complicated: human behavior less predictable due to ease of travel, direct personal contact, misdiagnosis, not telling the truth of exposure As of last week, nine Ebola cases treated in the US with one death; seven infected in West Africa Much bigger concern to scientists is not spread to US but what if to India >>> Mumbai or Delhi, for example 1 How the 2014 Governors’ Races Could Influence Medicaid Expansion Speculation prior to Tuesday’s elections where there might be a chance for a “softening” against Medicaid expansion or insurance coverage expansion depending on the choice for governor State Alaska Florida Georgia Kansas Maine Wisconsin Winner Independent (most likely) Republican Republican Republican Republican Republican Supreme Court Won’t Hear Obamacare Subsidy Case for Now Issue: Whether language in ACA allows individuals accessing health exchange coverage to receive tax credits in states that have not established their own exchange but utilize the federal HealthCare.gov Language: One section of ACA states tax credits available to Americans who enrolled “through an Exchange established by the State” ACA assertion: Clear intent of the law was to offer subsidies and expand coverage in every state Supreme Court: Case not listed; could choose to do so at a future date Ending Obamacare Subsidies: Risks vs. Rewards Debated About 85% of 5 million HealthCare.gov customers receive subsidies Magnitude causes political issues against repealing or losing subsidies if the Supreme Court were to ever rule that the language (above) results in no subsidies in states with federally provided exchanges Would be even more exasperated in states where Medicaid expansion has also not occurred versus states that expanded Medicare and also provided their own exchanges By the way, “employer sponsored health insurance” IS subsidized through tax exemptions! Solution might be to loosen requirements of state run exchanges thereby encouraging states to offer the tax subsidies through state exchanges rather than the federal exchanges 2 In Florida, another 200K Obamacare Enrollees are Projected for 2015 Over 980,000 Floridians signed up last year but has declined to 762,000 due to non payment or loss of eligibility or other reasons 91% received some subsidy (above national numbers) with average net premium of $68 per month Enrollment through the health exchanges begins effective Nov. 15; 90% of Americans aren’t aware (Kaiser Foundation) Insurers targeting healthy, younger enrollees, especially those who have been on parents coverage to age 26 Last year 26.9% of Florida exchange enrollees between age of 18 and 34; projections had been for 40% Florida v Feds still debating whether 2015 rates going up or not - Florida: predicts 13.2% and attributes it to few young people signing up; hence higher first year costs - Fed formula: predicts 4% drop - Reality: Florida prevents the state health insurance commissioner from regulating health insurance rates until 2016 Insurers Have Big Plans for 2015 Obamacare Enrollment Health plans anticipating at least 20% growth over 2014 Exchanges are now big business for Aetna, WellPoint, many Blues plans; United hardly active last year plans focus in two dozen states up from 4 CBO: Projecting 13 million in exchanges in 2015 and 24 million in 2016 Health Overhaul Doubts Ease for Insurers Share prices for the nation’s biggest health plans (Aetna, United, WellPoint) at all time highs WellPoint: Added 751,000 through public exchanges and another 700,000 through Medicaid; considering raising quarterly dividends Florida Business Coalition Backs Medicaid Expansion Statewide business coalition: “A Healthy Florida Works” (www.ahealthyfloridaworks.com) Supports extension of health coverage in Florida Providing education regarding the “business case” or economic benefits for covering nearly one million more uninsured Floridians Reduce burden on Florida businesses to carry the burden of uninsured through higher premiums due to the “hidden tax” (cost shift) Make insurance more affordable so that businesses can offer health insurance for employees thereby also reducing number of uninsured State of Florida to save more than $2.5 billion in general revenue while returning over $50 billion in Florida funds being collected for expansion 3 B BO OA AR RD DO OF FD DIIR RE EC CT TO OR RS S RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc) Keep form to one page, SUBMIT (thru SLC Member) ELECTRONICALLY to L Drive – Miscellaneous - BOD Presentations by Noon the Friday before you’re scheduled on agenda. DATE: 11/6/14 LEGAL SERVICE REVIEW? YES_X_ NO__ SUBJECT: Request for Lease approval for space located at 7331 College Parkway, Fort Myers REQUESTOR & TITLE: David Cato, Vice President Outpatient Operations PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) Capital funding for this project was approved by the LMHS Board of Directors on 9/18/14 under the category of Program Development: Outpatient Projects SPECIFIC PROPOSED MOTION: Motion to 1) Authorize LMHS to enter into a lease with OH10, LLC to lease approximately 1,148 sq. ft. located at 7331 College Parkway, Suite 110, Fort Myers, based upon the terms as set forth in the attached Letter of Intent subject to LMHS legal counsel review for consistency with the terms provided and for legal sufficiency of the lease agreement and 2) Authorize the execution of the lease by the President or the Chief Operating Officer after legal review and approval of the lease. This request supports the following Strategic Initiative(s): Financial Viability PROS TO RECOMMENDATION CONS TO RECOMMENDATION Cost of Capital (equipment) Enhance OP Revenue Growth Central Location Profitable Service Line LIST AND EXPLAIN ALTERNATIVES CONSIDERED Not leasing space. This alternative would limit LMHS ability to enhance OP Revenue growth under the strategic initiative Financial Viability FINANCIAL IMPLICATIONS Budgeted _X___ (including cash flow statement, projected cash flow, balance sheet and income statement) Non-Budgeted ____ This project is funded in the FY 2015 Capital budget under program development of OP projects. OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) All costs including FTE’s are accounted for in financial analysis for this project. SUMMARY Project enables LMHS to meet demand for providing access to patients seeking MRI’s. The location is central and will be located in a medical office building that houses physician offices that will create synergies for patients seeking multiple health care services in this location. The financial feasibility performed for this project shows strong growth and return on investment that will contribute to enhancing the health system’s revenue growth and operating margin. BOD/Forms/Reporting Forms/Board (Action) Reporting Form – revised 4/4/13 cs Lease Approval 7331 College Pkwy Outpatient MRI Suite November 6, 2014 1 Background Information • Planned fiscal year 2015 project creating opportunity for LMHS to meet patient access needs to MRI services in busy Medical Office location – Central Location – Patients will have access to multiple health care services – Synergistic Opportunities with Physicians in building 2 Background Information • Capital funding for this project was approved by the LMHS Board of Directors on 9/18/14 as part of the overall fiscal year 2015 budget under the category of Program Development: Outpatient Projects • Supports Financial Viability Strategic Initiative – Enhances Outpatient Revenue Growth – Profitable Service Line – Project positive ROI to enhance LMHS operating margin 3 Space concept/Basic lease terms • Location of space – 7331 College Parkway, Fort Myers • First floor location encompassing approximately 1,148 sq. ft. of rentable space. Co‐located in office building with other health care providers and physician offices. • Initial lease rate ‐ $16 psf plus CAM (estimated at $6.91 psf) • Total Annual Lease Cost = $26,300 • Term – 5 years with three 5 year renewal options 4 Specific Proposed Board Motion Motion to 1) Authorize LMHS to enter into a lease with OH10, LLC to lease approximately 1,148 sq. ft. located at 7331 College Parkway, Suite 110, Fort Myers, based upon the terms as set forth in the attached Letter of Intent subject to LMHS legal counsel review for consistency with the terms provided and for legal sufficiency of the lease agreement and 2) Authorize the execution of the lease by the President or the Chief Operating Officer after legal review and approval of the lease. 5 B BO OA AR RD DO OF FD DIIR RE EC CT TO OR RS S RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc) Keep form to one page, EMAIL to: [email protected] by Noon eight (8) days PRIOR to presenting. DATE: 11-06-14 LEGAL SERVICE REVIEW? YES_X_ NO__ SUBJECT: Current Lease Extension and Additional Office Space for Home Infusion REQUESTOR & TITLE: Michael Koleff, Director – Home Infusion and Marjory May, Vice President – Continuum of Care PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) The Board approved a transaction in June 2010 which resulted in Access Infusion Partners, L.L.P. becoming wholly owned by the health system. A lease was assigned to Lee Memorial Health System as a part of that transaction. SPECIFIC PROPOSED MOTION: Motion to (1) authorize Lee Memorial Health System to enter into the Metro Commerce Lease as presented, for 8,000 square feet of leased space and a five year term, and (2) authorize the execution of the Metro Commerce Lease by the health system President or Chief Operating Officer. PROS TO RECOMMENDATION Will provide the appropriate work space for current and future growth – space will be doubled. Will provide for needed additional warehouse space. Will reduce the cost per sq. ft. from $12.00 to $10.18. Landlord performing and funding build out (except IS needs) Additional five-years to lease agreement – current end date April 30, 2015 CONS TO RECOMMENDATION Additional $2,785/month in office lease expense. LIST AND EXPLAIN ALTERNATIVES CONSIDERED Relocation was considered and determined to be more costly due to the pharmacy needing a regulated clean-room. The existing clean-room was brought up to USP 797 standards in August of 2010 at an approximate expense of $75,000. To construct a clean-room from the ground up would be significantly more expensive. FINANCIAL IMPLICATIONS Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement) Non-Budgeted __x__ An additional $2,785 per month along with a one-time expense of approximately $10,000 for IS networking needs. OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) Network lines and a new data switch will be needed. SUMMARY The Lease will increase Home Infusion’s office space from 4,000 sq. ft. to 8,000 sq. ft. Current rent is $4,000. per month. The additional space will provide infrastructure that is necessary to sustain growth and improve the work environment. We have experienced over an 80% growth in doses, 69% in net revenues, and over 200% in net income over the last ten years. Given that the landlord is absorbing the expense of the leasehold improvements, such as wall and flooring changes requested by the health system, a five-year lease is required. The five-year lease term will be mitigated by the fact that the lease rate per square foot is being reduced from $12.00/sq. ft to $10.18/sq. ft. The total lease payment will be an additional $2,785 per month. BOD/Forms/Reporting Forms/Board (Action) Reporting Form – revised 5/14/13 cs METRO COMMERCE CENTER BUSINESS LEASE This agreement, entered into this ____ day of ____________, ______, between, METRO COMMERCE CENTER, LLC, of 11220 Metro Parkway, Suite 27, Fort Myers, Florida, 33966, herein called the Landlord, and LEE MEMORIAL HEALTH SYSTEM, of 12801 Westlinks Dr. Suite 102, Fort Myers, Florida 33913, herein called the Tenant. 1. DESCRIPTION OF PREMISES Landlord leases to Tenant, and Tenant hires from Landlord, as herein provided, the premises known as Suite 29, 30, 31 & 32, Metro Commerce Center, located at 11220 Metro Parkway, Fort Myers, Florida, 33966 (the “Premises”). 2. TERM The term of this lease is 60 months. The 5 year term of this lease will commence on the first day of the month following the completion of the improvements, after the build out has been approved by Tenant as being in conformance with Exhibits A and B (the “Occupancy Date”). Exhibits A and B are hereby incorporated by reference as if fully set forth herein. For clarity purposes, the start and end dates of this lease will be adjusted by means of a separate amendment to this lease at that time. 3. RENT AND OCCUPANCY The total rent under this lease is Four Hundred Seven Thousand One Hundred and 00/100 ($407,100.00), plus applicable sales tax. Tenant agrees to pay Landlord such amount in monthly installments plus applicable sales tax, payable at 11220-27 Metro Parkway, Fort Myers, Florida, 33966, according to the following schedule: Monthly Rent Years 1 – 5 $6,785.00 If the Occupancy Date is not on the first day of the month, the first month’s installment shall be prorated and shall be due and payable at the start of this lease. The remaining installments shall be payable in advance on the 1st day of each month thereafter during the term of the lease. ADDITIONAL RENT Should Tenant fail to pay, within five (5) days of the due date, any payment provided for herein, then Tenant further promises to pay to Landlord a late payment charge of Five Dollars ($5.00) per day per payment for each payment that is late. This provision for late charges shall not be deemed to extend the time for payment, or be a “grace period” or “cure period” that gives Tenant a right to cure a default or default condition. Imposition of late charges is not contingent upon the giving of any notice or lapse of any cure. For any checks of Tenant that are returned to Landlord unpaid by Bank, Tenant shall pay a fee of $40.00, which fee may be increased from time to time due to increasing Page 1 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenant administrative costs; period provided for herein, and shall not be deemed a waiver of any right or remedy of Landlord; OCCUPANCY Tenant shall have occupancy as set forth in Section 2. of this lease. Tenant is responsible for the purchase of applicable fire extinguishers for the units. The monthly rent shall not become due and owing until Tenant the Occupancy Date, in accordance with section 2 above. However, Tenant has access to the Premises for the purpose of upgrading the communication and information systems of the Premises upon execution of this Lease. SECURITY DEPOSIT A Security deposit of $0.00 shall be made at the time of executing this agreement. 4. Current Lease. There is a Lease Agreement between Landlord and Tenant, dated January 5, 2012, for Suites 31 and 32 of the Premises, which shall remain in full force and effect until the commencement date of this Lease, as evidenced by the amendment referenced in section 2 above. On the commencement date of this Lease, the January 5, 2012 Lease shall terminate, and will be superseded by this Lease. 5. USE OF THE PREMISES, GENERALLY The leased premises are to be used for Pharmacy Services. Tenant agrees to restrict their use to such purposes, and not to use, or permit the use of, the premises for any other purpose without first obtaining the consent in writing of Landlord, or of Landlord’s authorized agent, which consent shall not be unreasonable withheld. No person may occupy the unit, or any portion thereof, as living quarters. 6. NO USE THAT INCREASES INSURANCE RISK Tenant shall not use the premises in any manner, even in his use for the purposes for which the premises are leased, that will increase risks covered by insurance on the building where the premises are located, so as to increase the rate of insurance on the premises, or to cause cancellation of any insurance policy covering the building. Tenant further agrees no to keep on the premises, or permit to be kept, used, or sold thereon, anything prohibited by the policy of fire insurance covering the premises. Tenant shall comply, at his own expense, with all requirements of insurers necessary to keep in force the fire and public liability insurance covering the premises and building. 7.. NO WASTE, NUISANCE, OR UNLAWFUL USE Tenant shall not commit, or allow to be committed, any waste on the premises, or use or allow the premises to be used for any unlawful purpose. 8. DELAY IN DELIVERING POSSESSION This lease shall not be rendered void or voidable by Landlord’s inability to deliver possession to Tenant at the beginning of the lease term; nor shall such inability to deliver render Landlord liable to Tenant for loss or damage suffered thereby. If Landlord cannot deliver the premises at such time, the rent for the period Page 2 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants between the beginning of the term and the time when Landlord can deliver possession will not be charged to Tenant and the term will begin following possession by the Tenant as amended by separate addendum. With the exception of permitting and construction delays not the responsibility of Landlord, Tenant shall have the right to cancel the lease if possession is not delivered within thirty (30) days of the beginning of the lease term. 9. PAYMENT OF UTILITIES Landlord will provide for all tenants’ use one dumpster to be used exclusively for office generated trash only (i.e. wastebasket items). Tenant agrees that any trash generated from operations, (i.e.. manufacturing, production, assembly, testing, distribution, etc.) will not be placed in the dumpster provided by the Landlord but that Tenant shall at his own expense provide a container and trash pickup service with the same Lee County approved vendor which Landlord has contracted with. Landlord shall make space available to Tenant on the premises for such container. TRASH AND OTHER ITEMS LEFT TO ACCUMULATE OUTSIDE A TENANT’S UNIT WILL BE REMOVED BY THE LANDLORD AT TENANT’S EXPENSE. Each Tenant will be assessed their prorata share of the monthly water and sewer charges based upon Tenant’s square footage rented in relation to the total rented space. Tenant shall obtain electricity, telephone service, janitorial, pest control, and any other desired services to his unit at his own expense. Any Tenant who disproportionately uses water/sewer or generates large amount of garbage, trash, and refuse shall bear the increased costs of such disproportionate use. Landlord retains the right, in his good faith discretion, to determine disproportionate use or excessive trash. Landlord reserves the right to assess as additional rent the cost of such disproportionate use of water/sewer or excessive trash by Tenant and Tenant agrees to pay such additional rent by reason of such use. Water to irrigate the grounds is charged to the building through a separate water meter and is paid for by the Landlord. 10. REPAIRS AND MAINTENANCE Tenant, at his expense, shall maintain and keep the premises, including without limitation, storefront windows and doors (including appropriate framing), all other windows and doors including the overhead door, and interior walls and ceilings in good repair. Landlord shall maintain the parking lot, loading zone in rear, building roof, and exterior wall, except the doors and windows, in good condition. Landlord agrees be responsible for the cost of maintenance and repair of all air conditioning unit(s). This includes a yearly preventive maintenance check and cleaning of the unit(s) by a licensed air conditioning contractor chosen and scheduled by the Landlord. Tenant must notify the Landlord when problems develop with the air conditioning system so that Landlord can schedule the appropriate repairs with Landlord’s air conditioning contractor. If it becomes necessary to replace rather than repair the complete inside air handler unit, the complete outside condenser unit, or both, then Landlord in his sole discretion shall make that decision and Landlord will be responsible to pay 100% of the costs for such replacement. Tenant is responsible for the maintenance and repair of Tenant’s plumbing systems with the exception that Landlord will repair, at Landlord’s expense, any mechanical component of the toilet(s) internal tank Page 3 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants that may cause excessive water usage (leakage) if not repaired. Tenant’s responsibility is to notify Landlord that the toilet(s) is not functioning properly. 11. DELIVERY, ACCEPTANCE, AND SURRENDER OF PREMISES Landlord represents that the premises are in fit condition for use for Pharmacy Services. Tenant agrees to accept the premises on possession as being in a good state of repair and in sanitary condition. He shall surrender the premises to Landlord at the end of the lease term, if the lease is not renewed, in the same condition as when he took possession, allowing for reasonable use and wear, and damage by Acts of God, including fire and storms. Any additional improvements made to premises either by Landlord or Tenant during the term of this lease are also to be maintained in a good state of repair and shall remain with the premises at the conclusion of the lease. Tenant shall remove all business signs or symbols placed on the premises by him before redelivery of the premises to Landlord, and to restore the portion of the premises on which they were placed in the same condition as before their placement. 12. PARTIAL DESTRUCTION OF PREMISES Partial destruction of the leased premises shall not render this lease void or voidable, or terminate it except as herein provided. If the premises are partially destroyed during the term of this lease, Landlord shall repair them, when such repairs can be made in conformity with local, state, and federal laws and regulation, within 120 days of the partial destruction. If the repairs cannot be so made within the time limit, Landlord has the option to make them within a reasonable time and continue this lease in effect. If the repairs cannot be so made in 120 days and if Landlord does not elect to make them within a reasonable time, either party hereto has the option to terminate this lease. Landlord shall notify Tenant within ten (10) days of the partial destruction whether Landlord intends to make repairs. Landlord shall not be responsible for the repair of any damage to improvements made by Tenant not resulting from the fault of Landlord. Where Tenant is not at fault for the damage, the rent shall be prorated based upon the proportion of the space available for Tenant’s use to the total area of the leased premises, otherwise the rent shall not be reduce because of the damage or inability to utilize the premises. 13. LANDLORD’S ENTRY RIGHT OF ENTRY Landlord, or any of Landlord’s agents, reserves the right to enter on the premises at reasonable times to inspect them, to perform required maintenance and repair, or to make additions or alterations to any part of the building in which the premises leased are located, and Tenant agrees to permit Landlord to do so. Landlord may, in connection with such alteration, additions, or repairs, erect scaffolding, benches, and similar structures, post relevant notices, and place movable equipment without any obligation to reduce Tenant’s rent for the premises during such period, and without incurring liability to Tenant for disturbance of quiet enjoyment of the premises, or loss of occupation thereof. In the absence of an emergency or other compelling reason, Landlord shall exercise this right to entry only during reasonable hours and with reasonable advanced notice to Tenant, subject to the other provisions of the Lease. Page 4 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants Landlord may post a notice "For Rent" at anytime within one hundred twenty (120) days prior to the expiration of the Lease. The right of entry shall likewise exist for the purpose of removing placards, signs, fixtures, alterations or additions which do not conform to this Lease Agreement. If Tenant shall have removed all or substantially all of its property from the Premises, Landlord may immediately enter the Premises and alter, renovate or redecorate the Premise without abatement of Rent and without incurring any liability to Tenant and such act shall have no effect upon this Lease Agreement. 14. NOTICES All notices required or permitted under this Lease Agreement shall be in writing, unless a contrary intention is clearly indicated. A notice shall be deemed to have been given to the address last designated in writing by the recipient for the delivery of notices on the third (3rd) day following the day posted in the United States Mails, properly addressed to the recipient at such address. Until either party shall have received written notice from the other specifying a different address, the addresses set forth on the first page of this Agreement shall be used. 15. SIGNS, AWNINGS, MARQUEES, ETC. Tenant will not construct or place, or permit to be constructed or placed, signs, awnings, marquees, or other structures projecting from the exterior of the premises without Landlord’s written consent thereto. Tenant shall not cause any sign, advertisement notice, or other lettering to be exhibited, inscribed, painted or affixed to the building or affixed to any portion of Metro Commerce Center except Tenant SHALL BE REQUIRED to install at Tenant’s expense one (1) business identification sign above his unit(s) of the following size: 2.5 ft. wide by 12 ft. long, constructed to match the sign above the Leasing Office (Suite 27) OR at Tenant’s expense, to have his business name on the door in white lettering and/or logo placed on his unit’s front glass of a size approved by Landlord. Units 9, 10, 11, 12, 21, 22, 23, & 24 may not install a sign above their unit, but are required at Tenant’s expense, to have their business name and/or logo placed on their unit’s front glass door in white lettering of a size approved by Landlord. In addition, these specific unit numbers just referenced may place an identification sign on the sign posts provided by Landlord in the atrium area in front of the units, at Tenant’s expense. In the case of all signs and lettering, Landlord must approve designs prior to ordering and installation. Landlord shall, however, have the right to place such identification, directional, or other signs on the premises as he deems desirable and necessary to the orderly operation of Metro Commerce Center and for the convenience of unit Tenants, their tenants, guests, and invitees. Tenant further agrees to remove signs, displays, advertisements, decorations, or window coverings he has placed, or permitted to be placed, on the premises which were placed on the property without the written permission of Landlord. If Tenant fails to remove such signs, displays, advertisements, decorations, or window coverings within seven (7) days after receiving written notice from Landlord to remove the same, Landlord reserves the right to enter the premises and remove them, at Tenant’s expense. 16. “QUITTING BUSINESS”, “BANKRUPTCY”, OR “LOST OUR LEASE” SALES Tenant agrees not to conduct “Quitting Business”, “Lost Our Lease”, “Bankruptcy”, or other such types of sales on the premises without Landlord’s written consent. Page 5 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants 17. OUTSIDE STORAGE Tenant shall keep all his personal property and stock within his unit. No outside sales or storage on Metro Commerce Center property is permitted whatsoever. The 10-foot loading zone to the rear and adjacent to each building is for loading and unloading purposes only. No vehicle shall be parked any longer than that time necessary to load or unload. 18. TENANT'S LIABILITY INSURANCE Prior to occupancy and all times during the Term of this Lease, Tenant shall purchase at its own expense and keep in continuous force a policy or policies of comprehensive liability insurance, including public liability and property damage, in an amount not less than Two Million Dollars ($2,000,000) combined single coverage for bodily injuries or deaths of persons or damage to property occurring in or about the premises, Fire Legal Liability of not less than $50,000, and burglary, vandalism, and glass breakage. Said insurance shall be issued by a company or companies having, at all times, at least an A.M. Best rating of VII and shall be admitted in the State of Florida. Said insurance shall not be canceled unless at least thirty (30) days prior written notice shall be given to Landlord, along with a certificate from the insurance company providing the new policy or policies. An original Certificate (s) of Insurance shall be delivered to Landlord upon the commencement of the Term of this Lease and upon each renewal of said insurance policy or policies during the Term, hereof. Such Certificate(s) shall specifically show Landlord as ADDITIONAL INSURED, thereunder. To the extent that a loss is covered by insurance in force and recovery is made for such loss, the Landlord and Tenant hereby mutually release each other from liability and waive all rights of recovery against each other for any loss from perils insured against under their respective fire and other hazard insurance policies, including extended coverage, provide that this waiver shall not be applicable if it has the effect of invalidating any insurance coverage of Landlord or Tenant. 19. USE OF PREMISES. NON-HAZARDOUS USE In a manner consistent with the requirements of insurance carriers insuring the property; 20. TENANT’S ASSIGNMENT, SUBLEASE, OR LICENSE FOR OCCUPATION BY OTHER PERSONS Tenant agrees not to assign or sublease the leased premise, any part thereof, or any right or privilege connected therewith, or to allow any other person, except Tenant’s agents and employees, to occupy the premises or any part thereof, without first obtaining Landlord’s written consent. Landlord expressly covenants that such consent shall not be unreasonable or arbitrarily refused. One consent by Landlord shall not be consent to a subsequent assignment, sublease, or occupation by other persons. Tenant’s unauthorized assignment, sublease, or license to occupy shall be void, and shall terminate the lease at Landlord’s option. Tenant’s interest in this lease is not assignable by operation of law, nor is any assignment of his interest herein, without Landlord’s written consent. 21. SURRENDER OF PREMISES Tenant, upon the end of the Lease Period or other soon termination of this Lease Agreement, shall quietly and peacefully surrender the possession of the Premises, without notice, in the same condition as Page 6 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants Tenant is required to maintain the Premises, ordinary wear and tear expected, and, if required by Landlord, shall remove any and all alterations, additions, improvements and fixtures installed by Tenant, and repair any and all damages occasioned by such removal. The cost of complete cleaning, shampooing carpets, patching nail holes and other damage to walls, painting walls to hide patching, trash removal, charging fire extinguishers (if Landlord’s fire extinguishers) and restoration of Premises shall be at Tenant's expense. All work to be performed shall comply with applicable building codes, governmental or other agency regulations carried out in a good, workmanlike manner and finished to industry standards. Landlord's exercise of any of its remedies, its receipt of keys or its possession of the Premises shall not be considered a “Surrender of the Premises” by Tenant. 22. Liens Tenant shall neither cause nor permit any mechanics’ or other liens, claims or encumbrances to attach to the Premises. Tenant shall notify the contractor(s) making any such improvements that Landlord's liability for the improvements is expressly prohibited by this Lease. Notwithstanding the provisions of this Paragraph, should any such liens be filed, Tenant shall promptly take such action as necessary to discharge such liens and failing to do so, Landlord may, without waiving its rights and remedies based on such breach by Tenant and without releasing Tenant from any obligations, cause such liens to be discharged by any means Landlord shall deem proper, including the payment and satisfaction of the claim giving rise to such lien or by action to declare the lien invalid pursuant to Florida Statues. Tenant shall pay to Landlord, within five (5) business days after written demand, any sum paid by Landlord to remove such liens, including Landlord's attorneys' fees and all incidental costs. Failure by Tenant to do so shall be a monetary default, hereunder. If requested by Landlord, Tenant shall join with Landlord in executing a short form notice of this Lease, or other notice authorized by Florida Statutes or other law, which carries out the intent that Landlord's interest not be subject to lien improvements made by Tenant. Said notice may, at Landlord's option, be recorded in the Public Records of Lee County, Florida for the purpose of giving constructive notice of this Lease provision. Tenant, however, may not record this Lease or the short form notice of this Lease without the prior, written consent of Landlord. 23. ALTERATIONS, ADDITIONS, ETC. BECOMING LANDLORD'S PROPERTY All additions, fixtures, alterations and other improvements to the Premises made by Tenant shall become the sole and exclusive property of Landlord, unless either otherwise agreed in writing by Landlord and Tenant, or removed by Tenant at the request of Landlord as herein more particularly provided. 24. WAIVER OF SUBROGATION Tenant hereby waives any and all rights of recovery, claim, action or cause of action, against Landlord, its agents, officers and employees, for any loss or damage that may occur to the person or property of Tenant, Tenant's employees, agents, patrons, contractors, licensees and invitees, express or implied, that may occur upon or within the Property by reason of fire, the elements, or any other casualty or cause which may or could have been insured against by Tenant with commercially acceptable public liability and/or fire and extended coverage insurance policies, regardless of cause or origin, including the negligence of Landlord, Landlord’s agents, officers and employees. 25. SUBORDINATION AND ATTORNMENT This Lease Agreement and Tenant's rights hereunder are and shall be subject to and subordinate to any and all bona fide mortgage liens now or hereafter encumbering the Premises given to secure any present Page 7 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants or future indebtedness of Landlord or any prior or subsequent owner of the Premises. Tenant shall, if possession is taken under, or any proceedings are brought for the foreclosure of, or in the event of the exercise of the power of sale under any mortgage, charge, lease or sale and leaseback transaction, deed of trust or the lien resulting form any other method of financing, refinancing or collateral financing made by Landlord or otherwise existing against the Premises, attorn to the mortgagee, chargee, lessee, trustee, other encumbrances or the purchase upon any such foreclosure of sale and recognize such mortgagee, chargee, lessee, trustee, other encumbrances or the purchaser as Landlord under the Lease. 26. LEASE BREACHED BY TENANT’S RECEIVERSHIP ASSIGNMENT FOR BENEFIT OF CREDITORS, INSOLVENCY, OR BANKRUPTCY Appointment of a receiver to take possession of Tenant’s assets, Tenant’s general assignment of benefit of creditors, or Tenant’s insolvency of taking or suffering action under the Bankruptcy Act is breach of this lease. 27. LANDLORD’S REMEDIES ON TENANT’S BREACH If Tenant breaches this lease, Landlord shall have the following remedies in addition to his rights and remedies at law in such event: (a) RENTRY Landlord has the right to obtain possession of the premises as provided by law. (b) TERMINATION After reentry, Landlord may terminate the lease on filing thirty (30) days written notice of such termination to Tenant. Reentry only, without notice of termination, will not terminate the lease. (c) RELETTING PREMISES After re-entering, Landlord may relet the premises or any part thereof, for any term, without terminating the lease at such rent and on such terms as he may choose. Landlord may make alteration and repairs to the premises. 1. LIABILITY OF TENANT ON RELETTING Tenant shall be liable to Landlord in addition to his other liability for breach of the lease for all expenses of the reletting, and of the alteration and repairs made, which Landlord may incur. In addition, Tenant shall be liable to Landlord for the difference between the rent receive by Landlord under the reletting and the rent installments that are due for the same period under this lease. 2. APPLICATION OF RENT ON RELETTING Landlord at his option may apply the rent received on reletting the premises as follows: a. To reduce Tenant’s indebtedness to Landlord under the lease not including indebtedness for rent. b. To expenses of the reletting and alterations and repairs made. c. To rent due under this lease. Page 8 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants If the new Tenant does not pay a rent installment promptly to Landlord, and the rent installment has been credited in advance of payment to Tenant’s indebtedness other than rent, or if rentals from the new Tenant have been otherwise applied by Landlord as provided herein, and during any rent installment period the installments are less than the rent payable for the corresponding installment period under this lease, Tenant agrees to pay Landlord the deficiency separately for each rent installment deficiency period, and before the end of that period. Landlord may at any time after such reletting terminate the lease for the breach because of which he reentered and relet. Landlord may recover from Tenant on terminating the lease for Tenant’s breach all damages proximately resulting from the breach, including the cost of recovering the premises, and the worth of the balance of this lease over the reasonable rental value of the premises for the remainder of the lease term, which sum shall be immediately due Landlord from Tenant. 28. ATTORNEY FEES AND COSTS In any litigation arising out of the breach, enforcement, or interpretation of this Lease, the prevailing party in such litigation shall be entitled to recover reasonable attorney’s fees, costs and expenses. 29. EFFECT OF EMINENT DOMAIN PROCEEDINGS Eminent domain proceedings resulting in the condemnation of a part of the premises leased herein that leave the rest usable by Tenant for purposes of the business for which the premises are leased will not terminate this lease, unless Landlord at his option terminates it by giving written notice of termination to Tenant. The effect of such condemnation, should such option not be exercised, will be to terminate the lease as to the portion of the premises condemned, and leave it in effect as to the remainder of the premises. Tenant’s rental for the remainder of the lease term shall in such case be reduced by the amount that the usefulness of the premises to him for such business purposes is reduced. All compensation awarded in the eminent domain proceedings as a result of such condemnation shall be Landlord’s. Tenant hereby assigns and transfers to Landlord any claim he may have to compensation for damages as a result of such condemnation. Should the condemnation exceed thirty percent (30%) of the premises, Landlord my, at his option, terminate the lease provided that sixty (60) days written notice is given to Tenant and that such notice is given within thirty (30) days of Tenant being given notice of such reduction in his premises. 30. HOLDING OVER If Tenant shall retain possession of the Premises, or any part thereof, following the expiration or sooner termination of this Lease for any reasons, whatsoever, as exhibited by occupancy of furniture and/or equipment and/or not restoring the space per Paragraph 20 herein (“holding over”), the following shall apply: 30.1 For any holding over with the consent of the Landlord, which shall be deemed a tenancy from month to month, the terms, covenants and conditions of such tenancy shall be the same as provided herein and as provided in any subsequent, executed Amendments or Addendums to the Page 9 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants Lease, except that the monthly Base Rent and Common Area Maintenance Fees shall be One Hundred Twenty (120%) of the Base Rent and the Common Area Maintenance fees in effect on the date of such expiration, plus applicable rental taxes. 30.2. For any holding over without Landlord’s advance written consent, Tenant shall pay to Landlord for each day of such retention two times the amount of the daily rent and common area maintenance fees in effect on the date of such expiration or termination, plus applicable rental taxes. Tenant shall also indemnify and hold Landlord harmless from any actual loss or liability resulting from the delay by Tenant in surrendering the Premises. 30.3. Acceptance by Landlord of rent after such expiration shall not result in any other tenancy or any renewal of the term of this Lease, and the provisions of this Paragraph 34 are in addition to and do not affect Landlord's right of re-entry or other rights provided under this Lease or by applicable law. 31. NOTATIONS ON CHECKS Tenant checks deposited for payment of sums due under this Lease will not be controlled by notations on the checks or accompanying letters, such as “Paid in Full”, “Final Payment”, etc. 32. COVENANT OF QUIET ENJOYMENT; PARKING; OTHER RULES Tenant covenants and agrees to keep his premises and the adjacent sidewalk neat and clean; not to disturb the quiet enjoyment of other tenants; not to cause, maintain, or permit a nuisance in or about the premises; not to allow his employees, guests, invitees, or customers to disturb other tenants and their employees, guests, invitees, and customers; to require his employees not to park in the spaces adjacent to the sidewalk in front of the buildings, to prohibit employees from using parking spaces immediately in front of other units, as long as there is available parking in the center portion of the parking lot away from the buildings , and otherwise to be a harmonious occupant of Metro Commerce Center. Landlord reserves the right to institute, in writing, additional rules and regulations (including parking rules and regulations) as Landlord deems necessary for the proper operation of Metro Commerce Center. Landlord also reserves the right, in its good faith discretion, to determine that a tenant is disruptive to the quiet enjoyment of other tenants and to the harmony of Metro Commerce Center and after giving three (3) days written notice to cease specific acts or activities, to terminate the lease. Tenant shall have the non-exclusive right to use parking spaces which have been created on the Premises. Tenant shall not have the right to use more than it’s pro rata share of the total spaces available. Landlord reserves the right to assign designated spaces to Tenant and to other tenants in the building so that each tenant has the right to the exclusive use of the designated spaces. Tenant shall not permit any vehicle to remain parked unattended in any part of the driveway or parking area in a manner that blocks other tenants' access to streets, parking or other tenants' doors and truck docks. No parking is permitted in any areas other than designated parking spaces. The parking areas are to be used only for those vehicles which are directly related to the operation of Tenant's business, such as service cars and trucks and employee's vehicles. In no event are the parking areas to be used for the parking of semi- tractor/trailer rigs (except for loading and unloading), heavy equipment (such as cranes, bulldozers, large flatbed trucks and trailers), storage trailers, recreational vehicles (such as campers, boats, trailers, etc), disabled vehicles (unless company vehicles, and then only until repaired, but not for more than a period of ten (10) days), or vehicles with expired license plates. Landlord has the right to Page 10 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants tow or have removed any vehicle on the Land that is in violation of this Paragraph 31. All costs for such towing, removal and redemption of vehicle(s) shall be borne by the tenant responsible for the violation. Storage of materials, equipment, garbage, etc. in the parking area or anywhere on the Site outside the Premises is strictly prohibited. 33. GUARANTY [] Check here if there is a guaranty of lease. The guaranty is attached as Exhibit “A”. 34. EFFECT OF LANDLORD’S WAIVER Landlord’s waiver or breach of one covenant or condition of this lease is not a waiver or breach of others, or of subsequent breach of the one waived. 35. LEASE APPLICABLE TO SUCCESSORS This lease and the covenants and conditions hereof apply to and are binding on the heirs, successors, legal representatives, and assigns of the parties. 36. TIME OF ESSENCE Time is of the essence of this lease. THE REMAINDER OF THIS PAGE IS LEFT INTENTIONALLY BLANK. Page 11 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants 37. ADDITIONAL PROVISIONS FACSIMILE SIGNATURES ON THIS LEASE SHALL BE SUFFICIENT TO BIND THE PARTIES. a. RADON GAS Radon Gas is an odorless, colorless, naturally occurring radioactive gas that, when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over time. Levels of Radon that exceed Federal and State guidelines have been found in buildings in Florida. Radon is found throughout the soil and is prevalent in areas with large amounts of phosphate. Radon gas enters buildings through exposures in foundations (porous block, cracks in slabs, loose fitting pipes). The push to make all structures tightly sealed and energy efficient has, unfortunately, resulted in an increase in the potential for radon gas to be trapped inside buildings. Prolonged exposure to concentrations of radon gas increases the risk of lung cancer. For more information regarding radon and radon testing: 1.) Obtain U.S. Government Publication #OPA-96-004 or later related federal, state and local publications; 2.) Call the Environmental Protection Agency's toll free hotline at 900-SOS-RADON; or 3.) Call Florida Department of Health and Rehabilitative Services (HRS) at 900-543-9279. Pursuant to 404.056(9), Florida Statutes. BY SIGNING THIS RENTAL AGREEMENT, THE TENANT AGREES THAT UPON SURRENDER, ABANDONMENT, OR RECOVERY OF POSSESSION OF THE UNIT AS PROVIDED BY CHAPTER 83, FLORIDA STATUTES, THE LANDLORD SHALL NOT BE LIABLE OR RESPONSIBLE FOR STORAGE OF THE TENANT’S PERSONAL PROPERTY ABANDONED IN THE UNIT AND LANDLORD MAY RETAIN OR DISPOSE OF SUCH PERSONAL PROPERTY AT LANDLORD’S DISCRETION. 38. IMPROVEMENTS Landlord with construct at Landlord’s sole cost, improvement to the premises as set forth in the attached Exhibits A and B. Page 12 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants IN WITNESS WHEREOF, the LANDLORD and TENANT have caused this Lease Agreement to be executed by their respective and duly authorized officers the day and year written above. METRO COMMERCE CENTER, LLC ________________________________ Witness ________________________________ Witness ________________________________ Witness ________________________________ Witness (Landlord) ___________________________________ By: W. Michael Kerver, Agent LEE MEMORIAL HEALTH SYSTEM (Tenant) By: _________________________________ (Signature) __________________________________ (Print Name and Title) Page 13 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants EXHIBIT “A” 1) At the present time, the warehouse portion of Unit 29 and the “New Room” in Unit 30 are connected without a wall dividing the spaces. A new wall will be built to between the two spaces (approx. 20’ 8” as highlighted) to create the “New Room”. 2) In the “New Room” Landlord will construct a closet to house the existing and new air conditioning equipment. The interior walls will be finished and painted drywall. There will be constructed an 8’ acoustical drop ceiling with appropriate light fixtures. Electrical outlets on the walls will be provided. The existing overhead loading door and entrance door next to it will remain as is. The concrete floor will be painted in lieu of carpeting per tenant request as this space will be used as a warehouse. A new central AC unit will be installed to cool the space and an opening between Units 29 & 30 will be built to access Unit 30’s warehouse. 3) A second opening will be created between the existing office portions of Units 31 & 32 and Units 29 & 30. To accommodate the opening, an existing toilet room will be eliminated and replaced by a storage closet and a wall in office “D” will also be modified. These improvements will be properly finished and painted. 4) The existing paint in the offices and open areas is accepted by Tenant in “as is” condition. 5) The existing carpeted floor coverings in Areas D, F, G, & H will be cleaned at Landlord’s expense. 6) Landlord will install new floor coverings at Landlord’s expense as follows: - Area “B” will receive new vinyl tile. - Areas “A” and “E” will receive new 20 oz. commercial grade glue down carpet. Landlord will attempt to match the new carpet with the existing carpet but cannot guarantee an exact match. - New linoleum flooring will be installed in bathroom “C”. Page 14 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants EXHIBIT “B” Page 15 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenants Page 1 of Error! Reference source not found. __________ __________ Initials Landlord Initials Tenant QUALITY/SAFETY BOARD OF DIRECTORS MEETING Thursday, November 6, 2014 LEE MEMORIAL HEALTH SYSTEM QUALITY/SAFETY & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, September 18, 2014 LOCATION: Gulf Coast Medical Center, Board of Directors Boardroom, Medical Office Building, 13685 Doctors Way, Fort Myers, FL 33912 MEMBERS PRESENT: Sanford N. Cohen, M.D, Board Chairman; Chris Hansen, Board Vice Chairman; David Collins, Board Treasurer; Diane Champion, Board Secretary; Richard Akin, Director; Steve Brown,M.D., Director; Nancy McGovern, RN, MSM, Director; Marilyn Stout, Director; Jessica Carter, Director; Stephanie Meyer, BSN, RN, Director NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and on the Board of Directors website at www.leememorial.org/boardofdirectors, for public inspection. SUBJECT DISCUSSION MEETING CALLED TO ORDER INVOCATION AND PLEDGE OF ALLEGIANCE PUBLIC INPUT PURCHASE OF LAND FROM LEE MEMORIAL HOSPITAL, INC., A FLORIDA NON-PROFIT CORPORATION d/b/a LEE HEALTHCARE RESOURCES EMPLOYEE ENGAGEMENT UPDATE FY 2015 BUDGET ACTION The LEE MEMORIAL HEALTH SYSTEM QUALITY/SAFETY BOARD & FULL BOARD OF DIRECTORS MEETINGS were CALLED TO ORDER at 1:02 p.m. by Sanford N. Cohen, M.D., Board Chairman. Rev. Cynthia Brasher gave the Invocation, followed by the Pledge of Allegiance. None at this time Dr. Cohen asked for approval of the Purchase of Land from Lee Memorial Hospital, Inc., a Florida Non-Profit Corporation d/b/a Lee Healthcare Resources. A motion was made by Nancy McGovern to approve the Contract of Sale for the purchase of land described as, Tract F-1, Colonial Commons Replat recorded in Clerk’s instrument #2013000261055 from Lee Memorial Hospital, Inc. a Florida Non-Profit Corporation d/b/a Lee Healthcare Resources to Lee Memorial Health System for the purchase price of $1,443,108.98 plus closing costs. Further, to authorize the President to execute the Contract of Sale and all other documents necessary to close the transaction. The motion was seconded by Diane Champion and it carried with no opposition. Kristy Rigot presented the Employee Engagement update for 2014. Dr. Cohen asked for approval of the FY 2015 Operating Budget Dr. Cohen asked for approval of the FY 2015 Capital Budget Dr. Cohen asked for approval of the FY 2015 Room Rate A motion was made by David Collins to approve the FY 2015 operating budget that provides a 3.2% Gain from Operations. The approval of the FY 2015 operating budget will provide the funding for the FY 2015 Capital Budget of $80 million. The motion was seconded by Marilyn Stout and it carried with no opposition. A motion was made by David Collins to approve the FY’2015 Capital Budget of $80 million which is approximately 60% of Budget FY2015 operating cash flow. The motion was seconded by Marilyn Stout and it carried with no opposition. A motion was made by Marilyn Stout to approve the FY 2015 Acute Care Hospital room rates which provide for a 5% increase over current rates. The motion was seconded by David Collins. The motion carried with one opposition. FOLLOWUP LEE MEMORIAL HEALTH SYSTEM QUALITY SAFETY & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, September 18, 2014 Page 2 of 3 SUBJECT DISCUSSION FINANCIAL& STATISTICAL REPORTS OF AUGUST 2014 Dr. Cohen asked for approval of the Financial & Statistical reports of August 2014. A motion was made by Nancy McGovern to approve the Financial & Statistical Reports of August 2014. The motion was seconded by Diane Champion and it carried with no opposition. REFUND AND REFINANCE 2009 SERIES C BONDS Dr. Cohen asked for approval of the Refund and Refinance 2009 Series C Bonds presented by Ben Spence. A motion was made by Nancy McGovern to approve to adopt the resolution authorizing and approving the refunding and refinancing of the outstanding Lee Memorial Health System Hospital Revenue Bonds 2009 Series C; approving a direct loan in the principal amount of not to exceed $18,445,000 for the purpose of refunding and refinancing the 2009 Series C Bonds approving a form of loan agreement; authorizing the execution and delivery of documents and the taking of all other necessary actions in connection with the loan; providing for severability; and providing an effective date. The motion was seconded by Diane Champion and it carried with no opposition. Dr. Cohen asked for approval of the Consent Agenda consisting of: A. Risk Management Quarterly Report A motion was made by Marilyn Stout to approve the Consent Agenda consisting of: A. Risk Management Quarterly Report. The motion was seconded by Nancy McGovern and it carried with no opposition. CONSENT AGENDA CHAIRMAN TO QUALITY/SAFETY LIAISON The QUALITY/SAFETY portion of the meeting was CONVENED at 1:46 p.m. QUALITY/SAFETY MINUTES OF 6/12/14 Diane Champion asked for approval of the Quality/Safety minutes of 6/12/14. SYSTEM BOARD PERFORMANCE RD INDICATORS, 3 QTR. FY 2014 Dr. Krivenko presented the System Board Performance Indicators, 3 Qtr. FY 2014. rd LMHS ISOLATION PROCEDURES FOR MERS AND EBOLA Stephen Streed presented Lee Memorial Health System’s Isolation Procedures for MERS and Ebola. CLINICAL TRANSFORMATION INITIATIVE INTRODUCTIONS Dr. Krivenko introduced Dr. Marilyn Kole as the new VP of Clinical Transformation and Mary Beth Saunders, MD. TRANSFUSION SAFETY UPDATE OTHER ITEMS FOLLOWUP ACTION Dr. Krivenko presented the Transfusion Safety update. None at this time. A motion was made by Jessica Carter to approve the Quality/Safety & Full Board of meeting minutes of 6/12/14. The motion was seconded by Chris Hansen and it carried with no opposition. A motion was made by Diane Champion to accept the Quality rd Performance Indicators, 3 QTR FY 2014. The motion was seconded by Jessica Carter and it carried with no opposition. . LEE MEMORIAL HEALTH SYSTEM QUALITY SAFETY & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, September 18, 2014 Page 3 of 3 FOLLOWUP SUBJECT DISCUSSION ACTION NEXT QUALITY/SAFETY MEETING The next Lee Memorial Health System Quality/Safety Board Meeting is: Thursday, November 6, 2014, 1:00 p.m. Gulf Coast Medical Center, Medical Office, Boardroom 13685 Doctors Way, Fort Myers, FL 33912 The Lee Memorial Health System Quality/Safety portion of the Meeting was ADJOURNED at 3:10p.m. The gavel was turned back to Sanford N. Cohen, M.D., Board Chairman, At 3:18 p.m. to RECONVENE the LMHS Full Board portion of the meeting. OLD BUSINESS Jim Nathan updated the Board on the South Lee County plans stating they should th be ready to present at the November 6 meeting. NEW BUSINESS None at this time. BOARD MEETING CRITIQUE BOARD OF DIRECTORS REPORTS All Board members felt the meeting went well and was very informative. Nancy announced an upcoming program titled “Update on Genomics in the Management of Early Stage Breast Cancer & DCIS” which will be held on October th 30 at CRU. Diane thanked all those who were present at the Doc Coggins Top Finalist brunch today and reminded Board members of next Tuesday’s Auxiliary Installation luncheon. Chris Hansen and David Collins spoke about the recent EPIC conference they attended this week. NEXT REGULAR MEETING The next LEE MEMORIAL HEALTH SYSTEM PLANNING BOARD & FULL BOARD MEETING will be held on October 2, 2014, 1:00 p.m. in the Gulf Coast Medical Center, Medical Office Building, Boardroom 13685 Doctors Way, Fort Myers, FL 33912 ADJOURNMENT The LEE MEMORIAL HEALTH SYSTEM PLANNING BOARD & FULL BOARD OF DIRECTORS MEETINGS ADJOURNED at 3:24 p.m. by Sanford N. Cohen, M.D., Board Chairman Minutes were recorded by Katie Fournier, Board Assistant/Board of Directors Office ________________________________________ Diane Champion Board Secretary Date approved Diversity as Part of the Cure: Lee Memorial Health System Presented by: Yemisi Oloruntola-Coates Manager of Diversity & Language Services DIVERSITY ʺI learned this, at least, by my experiment; that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours.ʺ ~ David Thoreau Life in Color Diversity Means Multiple Identities •Gender Roles •Age/ Generation •Race •Ethnicity •Language •Social Class •Education •Family Origin •Spiritual •Regional •Literacy •Career •Role in Organization •Physical Ability •Sexual Orientation •And the list goes on…. What is Cultural Competence? • Cultural and linguistic competence is a set of congruent behaviors, knowledge, attitudes and policies that come together in a system, organization or among professionals that enables effective work in cross-cultural situations. • “Culture” refers to integrated patterns of human behavior that include the language, thoughts, actions, customs, beliefs and institutions of racial, ethnic, social or religious groups. • “Competence” implies having the capacity to function effectively as an individual or an organization within the context of the cultural beliefs, practices and needs presented by patients and their communities. A Case of Implicit Bias • • • • Implicit Bias is a negative evaluation of one group and its members relative to another, however, it is not overt but shown in hidden messages and or actions. It is also known as Hidden Bias or Unconscious Bias We all perceive the world through our own “filters” of past knowledge Exposure to a stimulus activates related concepts – More accessible in memory – More likely to be applied in information processing, behavior We may not be aware we hold particular associations – Can develop early in life Thin- Slicing The Importance of Diversity at Lee Memorial Health System Diversity is a strategic business imperative and not a social or legal program because: – It supports an inclusive work environment where individuals feel welcomed valued and respected – Provides education to staff at all levels and disciplines to provide to ensure that culturally and linguistically appropriate service delivery is rendered through cultural competency trainings, language services, community outreach and more – Focuses us on initiatives that strengthen openness and inclusion to enrich and enhance the interactions with our patients, employees, and the community we serve Three Main Components Education Community Language Svcs LMHS Diversity: An Integrated Service Delivery Model Community Relations & Affairs IS HR Division Legal Services Registration DIVERSITY CAO & Leadership Teams Marketing/ PR Quality Clinical Education In the NEWS! “Medical interpreters help patients, doctors communicate”. December 9,2012 “Hospitals often ignore policies on using qualified medical interpreters” April 30, 2014 “When the patient gets lost in translation” April 23, 2009 “Why does it matter to have credentialed medical interpreters? January 31, 2014 Source: US Census Bureau Poor Communication Impacts Patient Safety •Serious medical events (Cohen et al., 2005, Bartlett et al. 2008) •Sentinel events (The Joint Commission, 2007) •Poor medication compliance/ adherence (Audrulis et al., 2002; Flores et al., 2003) Resource: Bartlett, G. et al. CMAJ 2008: 178: 1555‐1562 Laws Governing Language Services: Spoken Language • Title VI Civil Rights Act of 1964: “No person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance”. • • • Language is considered a proxy for national origin. We must provide the same quality care regardless of language spoken Enforced by the Office of Civil Rights (OCR) 23 Sign Language Services for Deaf & Hard of Hearing • Title II of the American with Disabilities Act (ADA): “Prohibits discrimination on the basis of disability in all services, programs, and activities provided to the public by State and local governments”. • • • ADA ensures equal access to services for persons who are deaf and hard of hearing ADA requires effective communication and the provision of appropriate auxiliary aids and services Enforced by the Department of Justice (DOJ) How WE Care for our Communication Vulnerable Patients LMHS Communication Strategy Onsite Medical Interpreter 1 2 5 6 Video Remote Interpreter (all languages) 3 Trained Dual Role Interpreter 4 Contracted Vendor (Sign Language Only) Cyracom Blue Phone Patient Communication Board Deaf and Hard of Hearing Patients Communicates interpretation needs Identify patient’s communication needs and record patient’s demographics, i.e., language , ethnicity, cultural needs,etc. Have patient complete Form #2973, Intake Selection for Interpretive Services, and include in their medical record To reach an interpreter: The VRI Unit can be used 24/7 for sign language interpretation. On-site Interpreter: Deaf and Hard of Hearing Center Call: 239-4610334 Assess patient’s communication needs and include in Plan of Care Translation by ASLI Call: 478-2275669 Communication Assistive Devices/ Equipment The VRI Unit and the ADA Kit can be obtained by contacting the Administrative Supervisor at your campus. Patient Communication Boards can be obtained from the Administrative Supervisor or ordered using Purchase Request Form 0011. Please go to the Diversity Website for more detailed instructions. States their Cyracom VRI ID # or name if on-site RESOURCES Diversity website on IntraLee Interpretation /Translation Policy (S0906428) Main Office:424-3806 Interprets and provides cultural information as needed VIDEO REMOTE INTERPRETING (VRI) The VRI Unit can be requested from the Administrative Supervisor at each hospital. Patient must sign waiver Form 2794 and it must be documented and recorded on patient’s chart Patient denies qualified LMHS interpretation services preferring to use family or friends. Yes No Document on patient’s chart interpretation services provided (Cyracom VRI ID # or name of on-site interpreter) Your Medical Interpreters Arelis Estevez, CHI Norma Schuler, CHI Frankie Bailey Zori Martinez Helena Arteta Pedro Contreras Martha Mayorga‐Beck Liz Vargas, CHI Michel Lanoix “Great companies respect their customers and employees – people at all levels and from all backgrounds. By showing respect for others, an organization or team itself becomes respected. It rises in stature and makes a positive impact on the world” James Collins THANK YOU Q& A Diversity & Language Services FY 14 Accomplishment FY 14 INNOVATION • • • • Held and hosted the first Healthcare Diversity Summit in SWFL through the National Diversity Council. Jim Nathan was the Keynote Speaker. Over 120 people in attendance. Implemented Video Remote Interpreting (VRI) in acute care and trained 615 LMHS employees. Received $15,000 in grant money though the foundation to purchase 8 VRI’s. Held the first LPG ONLY Medical Interpretation Training program and trained 30 LMHS employees. To date 400 LMHS Employees have been trained to become Dual Role Interpreters. Revised and created the Diversity Diver Report that provides Diversity metrics on our patients and satisfies population served. All Nursing Leadership will be able to identify population trends on their units in regards to language/ Interpreter utilized, race/ethnicity, generation, and religion. FY 14 TEAMWORK • • • • Language Services team has translated 52 documents, saving the system $5283.30 which is a 58% increase in translations from FY 13. Patient Encounters for FY 14 totaled 16,298 . Partnered with Clinical Documentation on EPIC Nurse Assessment Screens to ensure that information and questions are in compliance with cultural competence metrics/needs (Ongoing). Recognized by the following institutions for our work on Diversity, Cultural Competency, & Community Outreach: Florida Hospital Association (Case Study) Cyracom (Case Study) Institute for Diversity, IFD & American Hospital Association, AHA NAACP (focusing on our community outreach) FY 14 EDUCATION • • • • • Conducted the first mandatory education for the Rehab Hospital on Cultural Competency for their accredito the Commission on Accreditation of Rehabilitation Facilities (CARF). Partnered with Employee Relations, Legal, and Business Partners for targeted interventions – 10 interventions. This is a 400% increase from FY 13. One patient intervention saved the health system $35,000. Nursing Matters Magazine Editorial Board; the following articles published: Creating a Connection Culture The Culture of Poverty Just Breathe! Caring People Caring for my Child Conducted 42 trainings throughout the system & community focusing on Diversity and Cultural Competenc (number excludes Nursing Orientation). Which is a 56% increase from FY 13. Held the following major educational events: Religion & Culture and How it Impacts our Health Diversity as Part of the Cure @ HP, GCMC, Lee and CCH ACHE Diversity and Inclusion in Healthcare FY 14 COMMUNITY 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Annual Family Health Forum SWFL Diversity Council Quality Life Center: Fundraiser/ Magic Johnson, Staff Training & Development MLK Community Event NAHSE SWFL Black History Society ACHE 21st Century Collaboration; Economic Development, Health Committee Dunbar Community School Activities; Career Day Community TV CCH & HPMC Auxiliary FACE Awards Living with Diabetes Accion Hispana Viva Cape Coral Diversity Council FGCU 17. 18. Hispanic Chamber of Commerce SWFL Chamber of Commerce 19. NAACP Youth Council Presentation & Women Inspiring the Next Generation 20. Military Veterans Job Fair; Military Support program Hodges University Nations Association Lee County School District Events 21. 22. 23. This is a 283% increase from FY 13 to FY 14. Diversity & Language Services has been active participants; hands on in all of these activities resulting in influencing 5,000+ members in the community. Headline Goes Here LMHS SURGE Body copy goes here RESPONSE Donna Giannuzzi CNO/CAO Lisa Sgarlata CAO LMH Josh DeTillio CAO GCMC Scott Kashman CAO CCH Kathy Bridge‐Liles CAO GCHSWF ©Copyright Lee Memorial Health System • All rights reserved Headline Goes Here Goal of Capacity Surge Body copy goes here The Provision of Patient Care in the safest and most efficient manner possible. Key Points to Remember Headline Goes Here Body copy goes here Volume growth Increased ED Volumes Increased admissions (acuity driven) Replication of response from previous years CAO/VP Communication Twice daily bed meetings Temporary placement strategies Resource Management Resource Management Headline Goes Here Body copy goes here Surge Staffing Plan: CNO, VPs of Patient Care Services and HR Adjusted staffing plans to accommodate growth Financial Investment Increased traveler cost Increased PRN salary Increased RN and CNA Recruitment Focus Multi‐prong Response Capacity Investments Headline Goes Here LMH Overflow unit CCH: Opening 39 additional beds Body copy goes here HPMC: Opening of overflow beds GCHSWF: Opening Pediatric hold beds GCMC: Opening of overflow areas New System Programs to Increase Capacity Newly established Chest Pain Centers Opening hospital based outpatient CHF services LEAN: Process Flow opportunities: Direct Admit process PDCA in conjunction with IPALC (Independent Physicians Association of Lee County) and LMHS Transfer Center ED VSM (System sustainability) Pediatric and Adult pull‐through strategy “ED to Bed” at HPMC Multi‐prong Response (cont’d) Headline Goes Here Policy Review Body copy goes here Review and revision “Census Management Policy” Collaboration with ED physicians, Administration, ED Directors, ED staff and EMS Continuum of Care (Outpatient) House Calls program EMS: EMS Communication Protocol Collaboration with EMS and Information Systems Transparency of data Headline Goes Here Body copy goes here Patient Safety is our #1 Goal! Headline Goes Here Body copy goes here Questions? ___________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS OTHER ITEMS ADJOURNMENT __________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS DATE OF THE NEXT REGULARLY SCHEDULED MEETING QUALITY/SAFETY FULL BOARD MEETING Thursday, February 15, 2015 at 1:00p.m. Gulf Coast Medical Center- Boardroom Medical Office Building 13685 Doctors Way Ft. Myers, FL 33912 LIAISON TO CHAIRMAN: Lee Memorial Health System FULL BOARD OF DIRECTORS MEETING Thursday, November 6, 2014 BOARD CHAIRMAN: Sanford Cohen, M.D. ___________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS OLD BUSINESS ___________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS NEW BUSINESS ___________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS BOARD MEETING CRITIQUE ___________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS BOARD OF DIRECTORS’ REPORTS __________________________________ L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS DATE OF THE NEXT REGULARLY SCHEDULED MEETING: FINANCE BOARD & FULL BOARD OF DIRECTORS MEETINGS Thursday, November 20, 2014 1:00pm Gulf Coast Medical Center Boardroom 13685 Doctors Way, Ft. Myers, FL 33912
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