COC-Minutes-6-15-2007.doc by chrstphr


									Citizens Health Care Oversight                                            June 15, 2007
Committee Meeting Minutes

                                  Summary Minutes

                                     June 15, 2007

 The Citizens Health Care Oversight Committee meeting was held in the County
Commissioner’s Chambers, Neil Combee Administration Building, Bartow.

The members present were as follows: Brian Hinton, Nancy Thompson, John McArthur,
Dr. Nobo, Connie Kinnick and Misilene Fulse.

COC Members Absent: Steve Henderson, Stacy Campbell-Domineck and Ann Leroy

Other County Staff in attendance were as follows: Ed Smith, Jr., Steve Yaskal, Wilma
Daniels, JoAnn Fioravanti, Debi Curry, Joy Johnson, Larry Skidmore, and Michael

Other County Staff not in attendance: Dr. Haight.

The meeting was called to order by Nancy Thompson, Chairperson; and asked all
members to do a formal introduction.

Brian Hinton led the Pray and the Pledge of Allegiance.

Nancy Thompson: advised the committee that they had received a copy of the May 18,
2007 COC minutes to review; she asked for any additions or corrections to the minutes.
She asked for a motion to approve the minutes as written.

B Hinton: Made a motion

Connie Kinnick: Second the motion

The minutes were approved as written.

Dr. Nobo: Asked Debi Curry to go back to highlighting the questions that have been
asked by the COC members. He stated that he had missed that because he knew that he
had asked a couple of questions of the CHSS staff. He stated that he found this to be
very helpful.

Nancy Thompson: Asked Debi Curry if that would be a problem?

Debi Curry: Not a problem

Nancy Thompson: stated that the highlighting helps the committee to save time in pulling
out the questions from the previous meeting.

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Committee Meeting Minutes
N. Thompson: Old Business: Wilma Daniels and Gwen Hall are going to talk to us
about the Plan Benefit Design.

Gwen Hall: Introduced herself

Wilma Daniels: Introduced herself

Gwen Hall: She went over the slides regarding the exclusion and all of the other slides.

Wilma Daniels: Did the formal presentation of the exclusions list.

N. Thompson: Asked how do we define advanced oncology verses oncology which is
the expected duration of treatment?

W. Daniels: In the past advance was used to mean chemo and radiation therapy;
something other than one set.

N. Thompson: the type of treatment

W. Daniels: Yes; the ongoing the six weeks of treatment would be considered the
advanced oncology.

Dr. Nobo: Gyn-oncolgy surgical procedure or other surgical procedures; you do pay for

W. Daniels: we do pay for the surgical procedure; part yes.

Dr. Nobo: Advanced; meaning most chemo is given no more than 6 months or even less.
It is not really an advanced treatment; it is more the cost of each treatment; have you
contacted some of the pharmacies; sometimes they can give discounted prices

W. Daniels: Normally it is patient specific; their cancer center or at the same time we
could assist in possibility getting that through some of the indigent drug programs offered
through the pharmaceutical companies. This is on a case by case basis; we can’t call
them up we need this drug or that drug.

Dr. Nobo: He stated; so that it is not a complete exclusion; could we say it is a case by
case; for example: breast cancer radiation. Perhaps it is between 8 to 10 treatments; if
you have a discounted price or do you flatly say no.

W. Daniels:    We currently say no on anything that is more than 1 or 2 radiation

N. Thompson: We say no but we try to find other ways to help them pay for it.

W. Daniels: Said she would let Gwen Hall address this; we had arrangements with the
Cancer Center and they were helping out a lot of our patients.

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Committee Meeting Minutes
G. Hall: This is one of the topics; which it happens to be alphabetically in order in the
very beginning. This is most likely going to be the largest discussion. Don’t mind
discussing it now. If we are expected to cover upwards of 18 thousand covered lives; we
want to provide as much help as possible to the most people possible. Cancer treatments
are very expansive; we are looking to partner with others in the field so that we can
provide this service.

W. Daniels: Continued on the explanations of the exclusion list.

G. Hall: Discussed Dialysis and explained that is subject should to be discussed at the
end in more depth.

B. Hinton: Asked if the numbers could be run in the terms of what type of exposure
based on the existing population; that it would cost per year.

W. Daniels: Explained that is some of the statistics that we have staff working on; such as
how many in the past; how many now that may be needing and the cost of that dialysis
for the first three month; we are working on some of those numbers and bring back in the

Dr. Nobo: What is the cost for one dialysis treatment is it more than we pay for one day
hospital stay?

W. Daniels: We don’t have that information at this time; that is what staff is putting
together for us to bring back at a later date.

N. Thompson; Said that there must be some cost benefit analysis; we don’t yet have the
data to do that. If we could come away today with a short list of things we want them to
go back and do some more research that will help them to focus what they are doing and
next time maybe we could actually take some action about changes we want to make in
the plan.

W. Daniels: continue to explain the rest of the exclusion slides.

Dr. Nobo: Asked about what services can be considered plan sponsorship?

W. Daniels: We need to look at the IV Therapy; that is one that comes up quite
frequently. That if we can get the patient out of the hospital; maybe a saving to us if the
cost is actually less expensive through home health care? As well as maybe some other
minor things that we can not get done; that should be done by a home healthcare nurse
that would be limited in time services.

Dr. Nobo: We are looking into that?

W. Daniels: Yes; returned to discussing the exclusions list.

B. Hinton: Told the committee that Hospice now covers COPD patients. 58% of the
people that have died in Polk County; died while in Hospice care.

Citizens Health Care Oversight                                              June 15, 2007
Committee Meeting Minutes

W. Daniels: Continued on…

Dr. Nobo: Do we pay for Behavioral Health drugs?

W. Daniels: We do

Dr. Nobo: When I read exclusions; I believe that we don’t do any thing for that service.
I think that perhaps the Inpatient Behavioral Health Services to another category.

W. Daniels: We do not give them medicine while they are in patient. When they get
discharged they will get discharged with the medication.

Dr. Nobo: Is the Joint Replacement one that needs to be moved because it is not totally
excluded? This should be a case by case.

W. Daniels: I think if you look we do have an asterisk which claims a case by case bases.

Dr. Nobo: That asterisk can be very confusing. We should move them to a case by case

W. Daniels: Make 2 categories on the exclusion list; these are no and these are
exclusions by a case by case.

A discussion ensued on getting patient to enroll in Medicaid and where and who they can
do this process. Through Polk Works on dedicated computers that have trained staff
available to help.

Dr. Nobo: Stated that it would be nice to have some where recorded that if you are in the
Plan or if you could qualify in the Plan and you are expecting that Social Services staff
will help them be able to follow through and get Medicaid. That would be nice to have
that written somewhere so that this would help the patient get quicker care. A lot of the
time they will show up in the middle of the pregnancy or even in the third trimester. This
would also help elevate these ladies making trips to the Emergency Room.

W. Daniels: Explained that in Social Services; and this is written that Social Services
help individuals apply for other programs that they may be eligible for and help them
complete the applications as necessary; which does include Medicaid. Social Services
tells everyone that they come into contact with; if you are pregnant apply for Medicaid;
we will help them if they don’t know who; we give them the Web-Sites. Some staff will
go into the system with them and try and help them to do it. It is very time consuming
for staff to do this; but if we have several people waiting we may not be able to do the
whole thing with and share with them other places they can go to get help to complete the
forms. This would include the Public Libraries have computer that are available too.

Dr. Nobo: Has requested that some words be put in the Plan that are very clear that “If
you are pregnant or your daughter becomes pregnant you can still come to the Plan and

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Committee Meeting Minutes
they will help you get the other care; since the Plan may drop you as soon as you become
pregnant”. Is that a possibility?

Ed Smith: We are going to come back later with a list of recommendations based on this
discussion today. Than what we will do is we will include your comments as part of that
discussion and the whole group will vote.

Dr. Nobo: Perfect

W. Daniels: State that even when they have cancer and it will be a 12 month or longer
we will help them to do what they have to do for Social Security including even if it
means contacting the Social Security Office and making sure they did receive their
application; did they get the lab/pathology reports from the physician who is providing
the care. We do try to help and we want them to get that care.

Dr. Nobo: My concern is that they show up late; that they don’t go to the ER; no you’ve
got that wrong.

W. Daniels: Ok; part of the concern for us is that they won’t go and get any care. If we
don’t help them!

Dr. Nobo: Correct; that is our concern.

W. Daniels: We are very proactive; whether they are applying for Medicaid or applying
for Social Security. We are very active in that. Continued on the slide presentation.

G. Hall: She explained how United Health works regarding post operative visits for
physical rehab visits. Polk HealthCare gives 12 visits; there is continuity of care of an
industry standard. She continued to explain how the plan has change and offering the
care as it is needed to get the patient back to a productive life.

G. Hall: Stated that we will disregard that word Exclusions: we used that word because it
was a flag to let our Providers that we do not cover everything. Looking as the Plan
grows; the Plan Benefit design; what are things covered, limitations. Limitations would
be a better word; so we will fix that.

N. Thompson: Yes; The Plan Limitations

G. Hall: Continued on discussing the exclusion list (limitation list).

Dr. Nobo: When will we go back to the advanced Oncology? For the list that we are
planning on making in the very near future; we need: what options we have to deal with
the drug companies. But I sense that the really prohibited cost is more the chemo than
the radiation?

G. Hall: the radiation verse the chemo; chemo seems to be available for this population.

Dr. Nobo: So than it is more the radiation?

Citizens Health Care Oversight                                               June 15, 2007
Committee Meeting Minutes

G. Hall: Yes sir

Dr. Nobo: So we need to define that to see how well can help. Because when Mr.
Powers is here; it seems that he was talking about; my mistake perhaps; the chemo and
radiation not just one.

G. Hall: He is; because it is labor intensive to do that. I will say that other facilities
provide the services as well. No just LRMC; Winter Haven has done their share, Bond
Clinic will get a clinic; everybody has taken their share. She explained how Mr. Powers
brought a team from his hospital over to meet with CHSS staff from a contracting stand
point; from a benefit stand point; a service delivery stand point. This is one item that we
will be bringing back to you; we are working on it and it has come up at other facilities as

Dr. Nobo: He has concern about telling a woman who has breast cancer that we will do
the surgery; but you are on your own for radiation. When she knows that the radiation
could save your life. This is something we must look at extensively to make sure that we
work with some institutions in this area that are willing to give us X number of free
radiation treatments so that patient; now that she knows she has cancer of the breast; with
a lumpectomy or mastectomy that she will have a continuum of care; to see her children
graduate from High School; college and etc.

N. Thompson; Explained how the Welfare Reform Legislation that parents are not
automatically eligible for Medicaid; the children are; but if the parents aren’t working or
participating in a work program they are not Medicaid eligible. They have to comply
with the program rules. A lot of them what they are doing is they are doing child only
cases or they are transferring guardianship to grand parents so that the children can get
the Medicaid and they are flying without anything; or maybe they are coming in for the
Plan. There are a lot of gaps there.

G. Hall: We will bring information back; this is not unique to Polk County. We are on
the fore front of addressing it when other communities are not.

Dr. Nobo: they have even voted it down.

G. Hall: Yes sir you are correct. She continued on the presentation from the slides.

B. Hinton: Stated that another part of that; he keeps hearing the same thing that I have
heard for a while in terms of waiting on pre- authorization payments and processing and
that kind of thing and that is more Administrative than program orientated. We need to
devote more energy there before we look at expending our services; if we can’t fulfill all
of our services right know.

G. Hall: This is something that I have to talk to Providers about everyday; we all do; we
are all advocates; myself, Wilma, Steve whoever may get the call. The hospitals are
calling; the doctors are calling; we are behind; this is not a news flash. We were behind
last year; we mentioned that we needed infrastructure; we needed IT; we needed staff; we

Citizens Health Care Oversight                                              June 15, 2007
Committee Meeting Minutes
are getting there. We have made great strides if you want to look at volume verses where
we are today; we have made tremendous strides and we are looking for efficiencies. The
software is coming; I believe we will be reviewing the bids for the software next week.
That is the hub of all of this; regardless; that is how we are going to pay; how we are
going to do authorizations. In the future you will not see as much data from me as far as
what we have been doing; you are going to be seeing outcomes. Because we are flipping
our entire department around; it doesn’t matter to look at a snapshot of how many
orthopedics referrals we did. What we want to share with you is success; how many of
the surgeries do we do and they get back to work. We are fiscally responsible; we will
share the fiscal information; but it is all going to change; and part of that is the
preauthorization; we are working with Lakeland Regional, Heart of Florida, Bartow is
coming up and Lake Wales facility which we have already met with these facilities
talking about the ER authorization. We have made strides; there are some authorizations
that will never go away and if they did then you might as well not have any
Administration oversight of the Plan. The clients need to be managed not the physicians.
Does that answer your questions?

B. Hinton: Explained that he knows that there have been improvements; there is still a
lot of concern out there by the providers for the delays. But before we expand and we
can’t handle what we have got now we need to focus on what we can handle now and
getting that ramped up; and working better than adding additional work to the mix.

G. Hall: That is the pleasure of this board. We are working at 2 platform levels right
now gearing up and there is a lot going on. We are an extremely busy division to try and
deliver the service. We will bring the recommendations back and if you decide to table
those until such a time that the infrastructure is in place with an IT system; this is a
decision of the group and our administration.

Dr. Nobo: We have told the commissioners that we are capable of doing the job; I do
hear what Brian is saying no I don’t want to delay anything because I don’t want to have
to come back an answer questions by the commissioners like I had.

G. Hall: We are the best at what we do; we are efficient, we are effective and can do the
job and the issue of the TPA is off the board.

N. Thompson: Had we made changes in the Plan and did have a TPA we still be
negotiating with them to make that expansion and would be in less of control of the Plan.

G. Hall: did a recap of what the goal is of the Plan. Servicing a population of between 18
and 20 thousand people active enrollment every single day just like an insurance
company we are not an insurance company but managing that population and at some
point we will plateau. She continued to explain the coverage; explained about the ID
cards; using of network providers; no limitation or cap on the number of visits this is to
promote the access and early intervention with their primary care home. She explained
that we do want to get away from referrals and we are moving in that direction.

Citizens Health Care Oversight                                                  June 15, 2007
Committee Meeting Minutes
Dr. Nobo: Asked Wilma if you have a family whether the children are moving into the
house; because not being able to afford their own home and they would rather do that
than live in a car or on the street. We are almost penalizing them or are we not.

W. Daniels: Explained that the case manager should be looking at dependency; are they
being claimed as a dependent by their parents; is the person working than their
economically independent of their parents as long as they are not claimed on their tax
returns. Those are the things we are looking at; you can have a house whole within a
house whole.

Dr. Nobo: The key if the parents are claiming her on their taxes; as a dependent. I can’t
claim my 24 year old; so that doesn’t make sense what you just said.

W. Daniels: They can still be claimed as long as the parent is providing the majority of
the support. There are restrictions and I am not a tax attorney or a tax person at all. If that
person is not working at all and completely dependent on the parent; if the person is
working and can be separate from that house whole; because the can claim economic
independence; we would count them separately. Discussion ensued what economic
independence means and discussed a case that Dr. Nobo had been told about. She told
the committee that there is a policy in place and she will be sure to refresh staff on what
the policy is and that will be done at the next staff meeting.

G. Hall: continued on the slide presentation.

N. Thompson: stated that as the Plan has increase it was expected that ER visits would
increase but it has done it has gone down instead. I would like to see this every month
“Active Enrollment verses ER Utilization”

G. Hall: said that was possible but it may come in a different format.

Dr. Nobo: Requested to see in a full year; in the summer people don’t go to the ER as
often; during football games; after the game they will show up in the ER we do need to
see the whole year; which will show all of the statistics.

G. Hall: Continued with the presentation.

S. Yaskal: Told the committee that the enrollment next year will start to level off
between 18 to 20 thousand clients; just because of the dollars that we are bringing.
Unless we can do something that will reduce the cost per person we will be leveling off.

E. Smith: Stated that the more serves that we add; and the more of the expensive services
that we add that number will go down; that is a trade off.

N. Thompson: Well we also hope that people get in the Plan and stay in the Plan when
they are eligible. Stopping the dropping out until they get sick again; than they come

Citizens Health Care Oversight                                              June 15, 2007
Committee Meeting Minutes
G. Hall: Stated it costs a lot of money to get people healthy; once they are healthy it is
not as expensive.

Dr. Nobo: asked how many physicians are enrolled as providers?

G. Hall: We are over 515; something like that.

Dr. Nobo: Do you have a lot of patients that are not being seen by physicians because
they are too booked or more than a 6 week delay to see a doctor?

G. Hall: I don’t have an answer I don’t collect that data; maybe Wilma could.

Dr. Nobo: Some doctors you have to wait 2 to 3 months before you can get in to see

W. Daniels: Not for primary care; we can normally get them in within a week to 2
weeks. We have some offices that are really quicker.

Dr. Nobo: That is great.

W. Daniels: If a client comes in and they are sick in the case managers office; we have
been able to call some primary care and have gotten them in to see the doctor on the same

Dr. Nobo: That is just great.

M. Fulse: In terms of reenrollment once a patient is in the Plan and they have to come
back and be reenrolled is it true that they have to come all the way to Bartow?

W. Daniels: No that is not true they can be seen at anyone of the out posted locations
included on the Mobile Outreach Vehicle. They can enroll at the hospitals too. We are
trying to have evening and weekend hours at the hospital so there is some alternative to
the M-F; 8-5 hours. Saturdays are very busy.

C. Kinnick: I want to reinforce the preventive services; if we can stress the primary care;
the access to care and the people receiving some of these services; in years from now the
dialysis need; the oncology need; maybe those needs might be reduced in the long run.

N. Thompson: Asked about if there was any new business to come before the committee.

Dr. Nobo: I noticed that Connie is not on the Agenda to give her report?

N. Thompson: She will be.

Dr. Nobo: I had asked some questions acting as the chair when Nancy was not present. I
asked for a legal opinion in writing to say exactly what was voted on. I did receive a
letter and I also did speak with the County Attorney. I got a letter from him and it said
that my question should have been directed to someone else in writing. But I have not

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Committee Meeting Minutes
had a chance to do that; I want to know why my question has to be in writing; while other
questions that have been asked from this committee have not had to be in writing. In fact
from the first day that we had met we had always asked questions and we had asked for
legal opinions; they were always given. In fact; Mr. Hinton question which was a great
question; he got the honor of getting a slide done. My question which I felt was
extremely important which is asked on page 12; 4th paragraph; 6th line has not been
answered. Will someone speak?

M. Duclos: I stand by the letter that I signed and I sent you; I am asking you to put it in
writing so that I can get you an accurate answer.

Dr. Nobo: My question sir; no one on this committee has ever been asked to do that. If
we are asked to do that; that is fine; I will do that. But my question was simple: I will
ask for a legal opinion in writing later to say exactly what was voted. So it was a simple
question; I would like a legal opinion.

M. Duclos: I don’t understand that question; I would like to see that in writing to be sure
that I know what you are asking; in fact once you put that in writing; than I may still be
unable to (inaudible……..)

Dr. Nobo: I am not going to put in writing; I am going to ask you here in front of this
committee and than ask: I would like to know (which I thought I said that) exactly what
the tax payers voted for. That is all that I am asking. “What exact”

C. Kinnick: The Statute

Dr. Nobo: Yes the Statute; I got whole pages of it; I just want a line saying it was voted
to pay for whatever!! That is what I am asking.

M. Duclos: The Statute list what it can be used for.

Dr. Nobo: Yes; but that is many, many pages; and I would just like to know exactly in
English terms; not in lawyer a synopsis; exactly what the tax payers voted for. Voted for
supporting all care in Polk County or was it to support only those who could meet a
certain rules or criteria. Than what I may ask in writing is why am I asked to put that in
writing; while questions like for example Mr. Hinton as I said; in fact I looked for his
answer received a slide and I am being told now that I have to write my questions.

M. Duclos: No Dr. Nobo you are not being told that you have to write every question!

Dr. Nobo: Just some questions.

M. Duclos: I am asking that you have to write that question so that I will understand
what you are asking

C. Kinnick: he was seeking clarification

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Committee Meeting Minutes
Dr. Nobo: Ok well; than here is my clarification; my clarification sir; I would just like an
opinion a synopsis is that the correct word I should use. Exactly what was the purpose of
the tax? To pay for whose care that is all.

N. Thompson: Isn’t that just outlined in the ordinance; that was passed by the voters
which is just a couple of pages long.

Dr. Nobo: Fine

N. Thompson: We all have copies of that

Dr. Nobo: Well than I would like it explained well; I would like it explained in laymen’s
term; and now it is coming to that point if it is that simple Miss Thompson; than why
couldn’t I have someone come up here and say look here are the 2 pages let me go over it
with you since you are a lay person you have know no idea about laws and maybe you
are confused Dr. Nobo but that is why we are here for to explain things to you. Let me
explain it to you and than I would say thank you so much for you explanation; thank you
so much for telling me exactly were it is at and I am so glad that it is only 2 pages.

M. Duclos: Yes sir you will receive (inaudible)

Dr. Nobo: Thank you; I don’t want it personal this is not personal I just want some
answers here to be given for everyone to hear. There is a discussion whether we are
having a meeting next month. It can be the following month; it doesn’t make any
difference I would just like.

Mr. Smith: If I could just make a comment; I don’t know if this will resolve the issue;
possibility not. But each member is given a book when they come on board; and in that
book is a copy of the statute, a copy of the ordinance and I am not sure if there is a copy
of the ballot. Is there a copy of the ballot?

B. Hinton: There was originally

N. Thompson: There was when we got our original notebook; yes

Mr. Smith: Ok so it is all right in there and fairly straight forward.

N. Thompson: But; Dr. Nobo is seeking clarification

Dr. Nobo: But that is a different issue

N. Thompson: So if we could have that for the next meeting whenever that meeting
happens; therefore putting it to rest.

Dr. Nobo: Thank you

B. Hinton: It appears that it has been directly towards was the tax specifically to authorize
funding FQHC’s? That is really the issue I guess.

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Committee Meeting Minutes

N. Thompson: That is maybe a yes or no answer.

M. Duclos: Maybe

Dr. Nobo: Well I would expect a little more that a yes or no answer. But I guess
whatever answer you want to give me that will be the one I will have to take at this time.

N. Thompson: Thank you; any old business to come before the committee; any new
business. Mr. Skidmore; Mr. Smith.

Mr. Smith: No

N. Thompson: No new business; Connie

C. Kinnick: Gave her report on the Polk HealthCare Alliance.

N. Thompson: We have 3 members here today of a short shift who have said they can’t
attend the July meeting on the date that it is scheduled. Is there any business such that it
would prohibit us from canceling the July meeting?

Mr. Smith: None that I know of.

N. Thompson: Ok hearing that could I have a motion from the committee.

Dr. Nobo: So move

C. Kinnick: I’ll make a second.

N. Thompson: Second; you can’t be here right Connie; all of those in favor say AYE;
(All stated AYE). We get a little vacation in July. We can all go to the cabin in Georgia.

C. Kinnick: Come to the cabin in Georgia and we can have a little meeting there.

N. Thompson:      Any public comment to come before the committee today.              Good
Morning sir.

PUBLIC COMMENT: Clifton Dollison, Pastor at First Missionary Baptist Church,
Winter Haven: Certainly I have enjoyed what I have heard thus far this morning; I know
that there was certainly discussion whether or not what is this for. It sounds almost a
little late in the game to figure that out. I hope that we are here to help those who are
uninsured and underinsured and that is the goal to be a blessing to those who need it the
most. We do appreciate and I am here representing the P.E.A.C.E. organization which I
have been a part of for a number of years and certainly I am glad to do so. All over Polk
County I have an opportunity to share with other Pastors and other congregations about
the need for healthcare in Polk County. We recognize the hard work that has been done
by many of the staff and some of which are present here today and certainly we
appreciate the progress however; much more is needed in this area. For the past five

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Committee Meeting Minutes
years we have followed the issue of healthcare and of course we have heard the cries of
the people and there is a need and you all know this very well; need for increase access to
healthcare to our congregations and to many throughout our community. We were told
years ago that the sales tax needed to be passed to address the problem and we trusted our
officials and we worked hard in getting the sales tax passed. The research that we have
done in this area we had looked at several models to find the most effective model to
deliver the most treatment for the least amount. Than you hired a consultant to bring
recommendation and the recommendation was we need clinics and we need the clinics
now. We are here today to say enough is enough people who could have been diagnosed
with cancer 8 months ago have not been and are suffering and dying in Polk County.
Sales taxes have been collected for almost 2 plus years now still our emergency rooms
are still over crowded; it is good to hear that the numbers are going down; but I am in the
emergency rooms often and I still see the over crowding. So today we are here to
reaffirm our stance we agree with the experts that you hired to asses the problem; we
have heard and continue to hear the cries of the community for help and assistance. We
need the clinics and we need them now; just as we had trusted our officials when we
passed the tax on our own sales; again we had trusted them to make the right decision and
not delay in bringing health and wholeness to our community who greatly needs it.
Thank you so very much for all of your efforts and we look forward to hearing even more
on this very vital issue in Polk County. Thank you very much.

N. Thompson: Thank you

Dr. Nobo: Gwen at the last meeting you said that there were some clinics from Winter
Haven that there is a possibility that we maybe able to do some type of talking; you and I
had a date to meet with the Director and to do what this gentleman is asking to
immediately since these clinics are open already to increase the number. What happen to
that; I know we had canceled that for something; but I am still available.

G. Hall: Yes we did talk about the 6 clinics that are owned by Winter Haven Hospital;
but we also talked about the other clinics in Polk County as well.

Dr. Nobo: My question is

G. Hall: If I can answer; the date; there is not date yet; because the Medical Director
hasn’t been available to me. My negotiations and my discussions are basically are
centered around access to healthcare for HealthCare Plan enrollees and it really; and I
will just be honest in my opinion and I don’t want to over step my bounds; it has nothing
to do with the initiative on the clinic operation.

Dr. Nobo: I am sorry; say that again. I am sorry I just didn’t hear you.

G. Hall: Let’s see; I will be meeting personally with Winter Haven Hospital just like I do
with Watson Clinic; Bond Clinic and Gessler Clinic and everybody else for quality of
health care and access to health care for the Polk HealthCare Plan enrollees. We do not
have a contract with them now today; it is; I have had no discussion with their
Administration that they could assume any volume. They express an interest in being a
provider similar to other provider which means take a small number of clients and not

Citizens Health Care Oversight                                                June 15, 2007
Committee Meeting Minutes
replace any services and programs or clinic operations. The meeting has not been held
because Dr. Vega who is the Medical Director has not been there.

Dr. Nobo: Ok the Polk County Medical Association wants to work very aggressively
with you to increase any facilities that could be available to our members and to the
citizens of Polk County. Therefore; again I will offer my services to call the physician
personally; in fact I will anyway and I will try to set up an appointment so that we can
come and speak with him. Sometimes and you have said many times from a doctor to a
doctor it is easier. Because what this gentleman said is true and if we have clinics that
are already available and we can get them going while the other is being fixed in
Lakeland than why not do that. I will call that physician myself and if I have to I will call
the Administrator of Winter Haven Hospital who has always been great in helping us
with We Care to help you.

G. Hall: I am trying to get every provider in Polk County involved.

N. Thompson: Right

G. Hall: It is not just about those 6 clinics it is all clinics

Dr. Nobo: Exactly

G. Hall: It just happens to be that we had talked about that last month.

N. Thompson: Good; Brian

B. Hinton: I had related question that I had forgot to ask earlier. Ed where are we in
terms of the Central Florida HealthCare has the BoCC approved that contract and has that
moved forward.

E. Smith: Absolutely that contract is executed and we have a binding contract with them
and we are going forward; there is a timeline that has been developed for renovation of
the Lakeland facility and we will report on that at the August Meeting.

N. Thompson: Good I can’t want until we get to hold a meeting in the Lakeland Clinic.

E. Smith: That would be nice

N. Thompson: Gaye can buy us coffee and cookies. Other questions or comments; John

J. McArthur: Ed has anything been done on the next clinic; the one to be located in
Winter Have?

E. Smith: Well of course Central Florida Health Care was awarded the RFP both clinics
because that is what we had advertised for. We have not; we have not executed a
contract on Winter Haven yet because we wanted to emphasize Lakeland first and than
Winter Haven. But we fully anticipate that we will be doing that in the fall.

Citizens Health Care Oversight                                    June 15, 2007
Committee Meeting Minutes
J. McArthur: Ok; thank you

N. Thompson: Other questions or comments? Hearing none we will stand adjourned.
NOTE: no motion was called for the adjournment.

Meeting Adjourned at10:09:43 AM
Transcribed by: Debi Curry; Office Manager, IV
                Community Health & Social Services Division


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