MINUTES OF THE MEETING OF THE BOARD OF COUNTY COMMISSIONERS

BREVARD COUNTY, FLORIDA

 

 

November 5, 2008

 

 

The Board of County Commissioners of Brevard County, Florida met in special session on November 5, 2008, at 9:15 a.m. in the Government Center Florida Room, 2725 Judge Fran Jamieson Way, Viera, Florida.  Present were:  Chairman Truman Scarborough, Commissioners Chuck Nelson, Helen Voltz, and Mary Bolin, County Manager Peggy Busacca, Assistant County Manager Heidi Denis, County Attorney Scott Knox.  Absent was:  Commissioner Jackie Colon.

 

 

The invocation was given by Father Gray Echols, Prince of Peace Anglican Church, Viera.

 

 

Commissioner Voltz read aloud a Resolution recognizing Dr. Joseph Gurri as the recipient of the 2008 Surgical Volunteerism Award of the American College of Surgeons.

 

Motion by Commissioner Voltz, seconded by Commissioner Nelson to adopt Resolution recognizing Dr. Joseph Gurri as the American College of Surgeons 2008 Domestic Volunteer Award Recipient.  Motion carried and ordered unanimously.  (See page                                                                                    

                                  for Resolution No. 08-295)

Dr. Joseph Gurri expressed appreciation for the Resolution.  He stated Brevard County is a great place to live and he has always been happy he came here; Brevard has always had a strong ethic of volunteerism; and he is very grateful for the recognition.

Commissioner Voltz mentioned that Dr. Gurri is one of the local surgeons who works at Holmes Regional Medical Center and the Board recognizes him today for what he has given back to society; those sacrifices do not come cheap, they come very, very expensive; and she thanked him for all of his hard work.   She also mentioned Dr. Greer is with the Board today and he wrote the book “Waking Up In America”; and from what she understands it is a phenomenal book and she will get a copy to read.

 

Commissioner Scarborough mentioned he apologized to the good Dr. Greer this morning, as he is here because he insisted for him to be here.  He has heard many speakers over the years but what everyone is in store for today is going to be fantastic; this gentleman can inspire beyond belief; and the Board is privileged to have Dr. Greer here today, thank you.

 

Commissioner Voltz introduced Dr. Pedro Jose Greer, Jr. as the Chief of Gastroenterology at Mercy Hospital, Miami, Assistant Dean at Florida International University College of Medicine, and Author; and stated the book “Waking Up In America” is available in the back of the room.

OPENING REMARKS (CONTINUED)

 

Dr. Greer explained the book “Waking Up In America”; stated he was actually born in Miami when his parents were visiting; and then they went back to Cuba.  He stated he comes from Miami, played football at University of Florida (UF); and it was the second year they had desegregated the Southeastern Conference; the dorms were segregated; and because of his last name they assumed he was black, and they put him in the black half of the dorms.  He stated the point is to look at what they have in common not the differences; and the beauty of this Country is they are all Americans and all have one common dream to make this Country great, families happy, and to live a good moral life; and that is what they try to do.  He stated he went into the area of healthcare and followed his cousin Dr. Gurri, because he is somebody that he has always looked up to, and was always the brilliant one and a brilliant surgeon.  He mentioned that their fathers are and were physicians too.  He stated he would like to congratulate Brevard County for actually getting together on Healthcare issues; and wants to give some experience of what he has been doing.  He inquired what is the state of healthcare in United States; stated it depends on how a person looks at it; it is a broken system because there has never been a system; stated it is such because there are 50 different countries living within one flag; and every single state has its own rules and regulations, counties, etc.  He advised 85 percent of healthcare dollars come out of the taxpayers pockets, whether it is federal, a millage tax or State; what the Country has been doing is the wrong thing, every time there is a problem in healthcare they try to reform the healthcare system; and it is a public health analogy such as a body floats down a river and they resuscitate that body, ten bodies float by them and call your buddies, 1,000 float by a person builds a clinic, and 10,000 float by and a person builds a hospital; somewhere along the line somebody has to ask why is the bridge broken.  He inquired what is the actual cause of all the disease that has been a progression that right now the World Health Organization has just came out with its first report known as Social Determinate, the social and public policy issues and lifestyle issues and all those types of issues that influence disease treatment and outcomes.  He stated he is also seeing, which is quite alarming to him, that because of social determinates they have changes in genetic structures.  He mentioned that he is a Liver Specialist and Digestive Disease Specialist; stated Hepatitis C is the number one cause of liver transplants in the Country.  He stated across America, 54 percent of treatments have a sustained virus response; in other words, they get rid of the virus; unless someone is African-American, Hispanic or poor, then it is only 17 percent; and what it turns out to be is that the metabolic syndrome is the obesity issue, insulin resistance of the liver.  He stated as a Liver Specialist, it is now estimated that the number one cause of Cirrhosis in the Country by the year 2015 will be non-alcoholic fatty liver infiltration of the liver because of metabolic issues within the body.  He stated it is not just the other issues they are looking at, it is obesity and risk factors for colon, ovarian, esophageal, and breast cancers; and those are social determinates that if not addressed aggressively will bankrupt the system.  He stated one of the concerns he has is with the Veterans; Veterans do not have the highest level of education and will be the first ones dropped from their health insurance rolls; either that, or loose their jobs; stated the VA system is bursting at the seams with only 30 percent of Veterans; and most of them are World War II and Korean Veterans utilizing the VA system that will be over run with this problem.  He stated they need to be prepared in this Country to be able to deal with all these different issues that impact healthcare and the economy; only 51 percent of businesses in the State of Florida insure their employees, and in South Florida it is less than 35 percent; and most of those that is over 85 percent of the uninsured in the State are employed full-time.  He mentioned as Dr. Gurri points out, insurance is not the answer, it is a financial method such as  access,  and  the  ability  to  see  a  doctor,  it is showing up to get there, to have blood pressure checked, cholesterol checked, appropriate diet; and  it  is  doing  what  is  needed  to do to be able to take care of that individual.  Dr. Greer

OPENING REMARKS (CONTINUED)

 

explained there are two things that need to be done; one is the political aspect, which Brevard County has, and the second is agreeing on a solution with everybody sitting together and working on the plan such as the doctors, nurses, CEO’s of businesses, hospitals, and clinics working together about human life.  He stated another amazing thing is how much the nurses have taught the doctors about being the advocates for patients they see on a daily basis and the interactions they have with the individuals.  He stated it is the stories that they take home, the sadness they find in their hearts, and the happiness that sometimes they can bring to them.  He stated one of the things he mentions that has been done recently is the building of a new Florida Medical School at Florida International University; and it will be the first Medical School in the Country in 25 years.  He stated the difference is they decided what the competencies are expected from doctors and threw out all of the curriculum that has ever been used and started a whole new curriculum; and most of it is based on Organ System Teaching, which is what has been used at the University of Pennsylvania College of Medicine since the 1970’s.  He noted one other thing done is called strands, which is one of the things he is in charge of; a strand called Medicine Society or Health and Society begins the first six weeks of medical education giving them the ethical foundations and the moral justifications of medicine; they need to understand that it is part of ethics and morals within the profession;   that is followed by what is called cultural competency, social determinate after giving them social epidemiology, biostatistics; and then they are taught the foundations of nursing, public health, and social work.  He stated that by month eight a medical student, nursing student or a public health student is assigned to several houses that have been selected in the 200 percent below poverty level; and they are responsible for those households until they graduate from medical school.  He stated the students have to look at a medical problem, and they have to see what causes that problem and come up with a solution and a team to have interdisciplinary teamwork working with that because the idea is not to produce more primary care doctors, the idea is to produce doctors that are socially aware and responsive when they see a problem and respond to it.  He inquired if there is a new drug on the street, how is it stopped.  He mentioned he remembers a few years ago a little girl her father was Cuban and mother was Mexican they were living in a car and she was six years old, her knee hurt and he remembers her saying she wanted to be a doctor because that was her dream; and all he could think about was his children get to go to private schools and this young lady lives in a car and her dreams will be so difficult if not impossible.  He stated he wants to live in a country where everybody fulfills their dreams; and in his profession they are the ones that can sit there and say they have the right to pursue happiness, but it is hard to be happy when you are sick, so it is incumbent upon those in healthcare to come and do this; stated he feels it is because when he and Dr. Gurri went to medical school nobody told them they had to take just insured patients; and one of the things  they do as volunteers is follow their oaths, and all the other volunteers are trying to do what the profession tells them to do.  He thanked the Board for inviting him to be here, and applauded what the Board does in the community, and he wishes more communities around the Country were like Brevard; and he would be more than happy to answer any questions.  Chairman Scarborough  stated  it  is  wonderful  where  the  Board  is  with this because last Thursday Commissioner Nelson chaired a Workshop on Homelessness, and while the Board heard a lot about the homeless issues, he does not think it really has the health issue as a part of it, but it certainly is because there is an increasing number of homeless; and the Board heard about the homeless people that fought over in Vietnam that just psychologically find it more comfortable to live out in the woods. Chairman Scarborough stated then it is found that the subprime loans are going to cause more, and more layoffs, plus Brevard County will exceed the rest of the Country in unemployment  not only because of certain  things happening in Florida,  but also with what is happening  at  the  Space  Center with layoffs.  He stated looking at the homeless issue he feels

OPENING REMARKS (CONTINUED)

 

Dr. Greer has given the Board a new challenge with the homeless of how the Board can also look at their particular health needs, and how the Board can reach out.

 

Dr. Greer noted not only that, but as the Board looks at the homeless needs in an appropriate setting when they are housed, disease can be prevented when done right by working closely with public health; and when looking back at the mistakes that have been made, it is amazing to see what could have been prevented. 

 

Commissioner Voltz inquired how many other doctors in the community are doing similar things Dr. Gurri is doing.  Dr. Gurri replied it is actually an enormous number of course, and he is referring to the community that he works with; and the rate of the volunteer treatment among physicians is extremely high.  He stated simply working in a formal fashion with the Brevard Health Alliance, it is close to 120 physicians that have worked with the Brevard Health Alliance donating their services, not to mention the large number of people that just do it in the course of their practice; and anybody that works in a hospital is dealing with patients that come in through the emergency room and many times those patients find a home with those doctors on a long-term basis, and they are treated in the mix. 

 

Dr. Greer added what is done in the Emergency Room Diversion Program is they will take patients that are uninsured and discharged from clinics; and that prevents the extremely high cost of the emergency room.  He stated now there is primary care, which is a very unique program, but there are very few places in the country that are doing that; it is a forward thinking innovative program because now the hospital can afford it instead of spending the money or wasting it on unnecessary care in the ER; and when an uninsured patient comes in that needs surgery and needs it acutely, that is how the money can be used.  He stated the innovation that they are doing here is extremely impressive.

 

Commissioner Voltz replied that is very nice to hear and the Board has always known that the volunteerism in Brevard County is far beyond what anybody could expect; many of the County departments could not even function without the volunteers; and she appreciate all that is done and much of the community does not know what is done and the depth it takes to perform by volunteering physicians.

 

Dr. Gurri explained the State gives protection from malpractice litigation and also sovereign immunity which is administered through the Brevard Health Alliance; and Florida has the most effective law in the Country, which really should be a model. 

 

Commissioner Voltz thanked Dr. Gurri for being present today; and stated the next issue on the Agenda is Community Health Assessment Data.

 

 

Dr. Kristi Sands Van Sickle, Executive Director of Brevard Healthcare Forum, stated for those people that are not familiar with the Forum it is sponsored by Florida Technical College of Psychology and Liberal Arts, which is a Countywide coalition of healthcare providers, including the three hospital systems, Circles of Care, Devereux of Florida, County Health Department, Healthy Start,  and the  Brevard  Health  Alliance.  She  stated the  goal  is  to  help  improve the

 

 

health of the County’s residents and they aim to do this by facilitating dialog between the group, collaborating on joint initiatives’, and promoting and providing Countywide health education.

 

Dr. Karen Van Caulil, Executive Director of Health Council of East Central Florida, Inc. stated her organization is non-profit but they are written in Florida Statue as local health councils and they facilitate the regional health planning process.  She advised the four Counties she represents are Brevard, Orange, Osceola, and Seminole; and Commissioners appoint three of her Board members to two year terms; stated there are a few Board members here today such as Lisa Gurri who is one of the representatives on the Health Council Board, Shauna Kelser who just finished a term, and Joann Mezera, Chair of the Health Council Board, is also present; and they use the Brevard Health Alliance as their go to group.  She stated their primary functions are data collection analyses, research, evaluation of initiatives, planning, and early implementations plus utilize different task forces, committees, and work groups to make connections to help move things along.  She stated she is looking forward to sharing some of the data they have been using in Brevard to identify needs initiatives.

 

Dr. Sands Van Sickle stated she would like to give some background information on the County health assessment; the assessment was conducted in the four counties that are under the Health Council of East Central Florida; she stated the surveys had very large data sets with thousands of families that were surveyed; and the results of the surveys can be generalized to the entire County.  She stated the County health assessment was previously done in the three other counties in 1999; Brevard was added in 2004; in 2006, a child in adolescence assessment was done for the first time in all four counties; the County health assessment will be updated in 2009 with interviews that are going to begin this month; and the data should be available early in 2010.  She advised data from both surveys has been used very widely in Brevard County by organizations, agencies, and the healthcare forum, to identify three major areas of focus, which are increasing access to healthcare for the uninsured, childhood obesity, and behavioral health.  She noted 1,600 families were surveyed in 2004; the individual that answered on behalf of the family was asked to rate their health status; over 14 percent rated their health as fair or poor; Brevard reported fewer people in fair of poor health in the region as a whole, the State or the Nation; and it is interesting to note that three other counties who had this data in 1999 saw an increase in fair or poor health over the five year period.  She stated women, uninsured, poor, and non-white populations were more apt to report fair or poor health; respondents were also asked if they had ever been diagnosed by a health professional with depression; and in Brevard 12.3 percent of adults reported they had been diagnosed with depression, which was significant as compared to the United States which was 8.5 percent.  She stated chronic depression is a serious issue in the East Central Florida region; chronic depression is defined as depression which lasts more than two years; one in five adults in Brevard  reported  chronic  depression  in  the  survey;  and women, uninsured, poor, and non-white populations are more  apt  to  report chronic depression.  Dr. Sands Van Sickle stated data came from the Child and Adolescence Survey; parents were asked to respond for one child in the family on what medical conditions the child suffered from; in Brevard 38.8 percent of the children had some sort of Allergy; Attention Deficit Hyperactivity Disorder (ADHD) was reported at 16.6 percent; Asthma reported at 15.9 percent; and Developmental and Learning Disabilities were reported at 9.4 percent.  She stated cardiovascular disease shows that Brevard was behind the United States with having blood pressure checked in the last two years, and had a higher rate of high blood pressure diagnosed; Brevard was better at cholesterol levels checked, but there was a much higher rate of  high  cholesterol  than  U.S.  rates;  95  percent  of  individuals who have high blood pressure

 

              

should be doing something to take action to control it; and in Brevard the number of people who have high blood pressure who are taking action is 80.8 percent, which is way below the target. 

 

Dr. Van Caulil stated Brevard’s percentage of skin cancer in 2004 was 14.6 percent; that is a much greater percentage than the other three counties involved in the survey; but that is to be expected in a beach community.  Commissioner Voltz inquired if the Brevard County was compared to other beach counties.  Dr. Van Caulil responded yes, it is very comparable to others.  She stated cancer screenings are very important; compared with the rest of the Country, Brevard County is doing better with sigmoidoscopy, colonoscopy, blood stool tests, mammograms, and digital rectal examines, but not on pap smears.  She stated people were asked if they have had a medical professional diagnosis them with diabetes, not counting gestational diabetes, which happens frequently during pregnancy; 9.3 percent of the Brevard’s residents revealed that they had diabetes, which is higher than the region, and United States; the growth was tremendous between 1990 and 2004; and the evidence to date shows that rate is going to be even higher as it has certainly become a very common disease.  She stated when that question is broken down the self reported diabetes is from age 18 to 65; and it has been found that there are a lot of diabetic kids in the United States also.  She stated looking back at the data in the adult population, women are at a higher rate than men, for diabetes, as well as older adults, poor, blacks more so than whites or Hispanics.

 

Chairman Scarborough inquired if there will be a presentation on seniors seeing multiple doctors.  Dr. Van Caulil replied no, but it is really important to support the efforts for a regional health information organization for just that reason; and what that means is having communication with other doctors on what another doctor may have prescribed a patient.  Commissioner Voltz added that if pharmacies communicated with doctors better they would also know that the patient is being seen by another doctor.  Dr. Van Caulil stated it is important for people to know their own numbers, such as blood pressure, cholesterol level, and blood sugar level; and the County compares well on blood pressure and cholesterol but lower on knowing sugar levels.  She stated a survey question asked whether folks have been limited in some way due to a physical, mental, or emotional condition, and Brevard reported the highest rate of limitations of all the counties responding at 19.3 percent; and so it may be one-fifth of the adult population who are saying they have some restricted ability due to a medical or social issue.  She stated the obesity issue is high; the CDC says 60 percent of the population should be at a healthy weight; Brevard reports in at 37.8 percent of people who gave a healthy weight; overall, Florida reports less of an overweight problem than the rest of the United States; but Brevard fell between the rate that Florida  has  and  the  United  States;  and  there  is  definitley  an  issue  at  58.7  percent  being overweight.  Dr. Van Caulil stated another survey question indicated that only 35 percent of the overweight adults that participated in the survey said he or she was trying to diet and exercise to change their situation.  She stated 75 percent of folks should be consuming five or more servings of fruits and vegetables a day, and Brevard scored high with 39.1 percent.  She stated people were asked about leisure time physical activity in the last month, which would include walking, gardening, and biking; in activity levels are really significant and on the rise; one quarter of the Brevard adult population reported zero leisure time physical activity in the last month; 57.8 percent of the folks said that they have jobs that entail mostly standing or sitting; and a lot of folks have multiple jobs, so by the time a person gets home they plop in a chair, watch television, and do not eat fruits and vegetables.  She stated while looking at the data from the child and adolescent health assessment, Brevard kids are pretty heavy at 20.2 percent overall of the kids were overweight as reported, by their parents with boys being heavier than girls;  North and Central  County were fairly identical as far as what

 

was reported; and South County had a lower percentage of kids reporting as overweight.  Commissioner Voltz inquired has the research gone back to follow up on those obese children to see if they have become obese adults, and also to find out if the parents of those children are also obese.  Dr. Van Caulil responded there has been a lot of research on that; the primary predictor of weight in a child is the weight of the parents; and actually this region has a really neat opportunity with a national children’s study that is starting right now and will follow from pregnancy through 20 years of age of children in this region to look at things like that.  She stated again looking at prevalence it is the younger kids aged six to eleven, the poorer children, and non-white children that are being seen when breaking the data down; and this was in 2006, which is pretty recent.  She advised right now there is a regional consortium being established to prevent childhood obesity; and there has been a lot of momentum around this because of the data working with schools, and pediatricians around the area because it is a very serious issue that could become a life long health problems. She stated while looking at the physical activity it is interesting to compare the percentages between north, central and south communities; South County kids are not participating in vigorous activity at the same rate as the rest of the area in the County; vigorous activity is not that vigorous; it is three times a week of 20 minutes of more; and there was a great initiative several months ago you to get Brevard up and moving and get families engaged.  She noted as far as the number of fast food meals eaten in the past week, the south part of the County had more fast food meals, with one to two meals per week; and the recommendation is to not even eat one fast food meal in a week.  She stated in Brevard County, the average serving of vegetables served per day was two for kids and 1.8 servings of fruit per day; but recent research indicates to prevent cancer and chronic disease, one should consume five to 13 servings of fruits and vegetables per day.

 

Dr. Sands Van Sickle stated she will be talking about tobacco and alcohol risk behaviors; chronic drinkers, based on self-reported data, which is usually under-reported, 9.1 percent of adults in Brevard reported drinking at least two drinks per day compared to the rest of the counties in the region and the United States figures, Brevard County is significantly different than the region and the national figures.  She stated later in the day the Board will hear from Keith Lundquist, who is the Chair of the Brevard Healthcare Forum, about one of the initiatives the Forum has been working on related to chronic drinking.  Chairman Scarborough inquired about the definition of chronic drinking, and if it is two drinks a day.  Dr. Sands Van Sickle replied the definition of chronic drinking is two drinks a day every day; the national standard for men is less than 14 drinks per week; for women, it is seven or less drinks per week; and there are sizes that relate to standard drinks depending on whether the drink is wine, beer, et cetera; but chronic drinkers tend to be white men who are middle-aged with higher incomes.  She stated binge drinkers are defined as people who have five drinks or more in one sitting in the past month; Brevard’s rate of binge drinking at 13.4 percent, is lower than other counties in the region; the demographics of binge drinkers are somewhat different than the demographics of chronic drinkers because they tend to be younger adults and the income levels are more equivalent, and the race ethnicity more equivalent as well.  Dr. Sands Van Sickle stated in the region there has been a decline in drinking and driving over time, and that is very good news; in fact, Brevard’s figures are comparable to Florida’s figures, which are two percent of people reporting driven and had too much to drink in the past month; however, 13.3 percent of adults in the age group of 18 to 39 acknowledged drinking and driving in the past month, which gives more information of how to target initiative.  Dr. Sands Van Sickle stated on the survey of children and adolescents who have had one drink of alcohol excluding for religious reasons, Brevard  had  the largest number in the region at 46.5 percent; the figures were broken down by

 

 

North, Central and South County; and the Central part of the County had the highest number of adolescents who reported underage drinking.   Commissioner Voltz inquired if that data is collected from the school system.

 

Dr. Van Caulil stated with this particular data the parent was initially interviewed and then they gave consent for their adolescent to be interviewed separately by a telephone survey done at home; but there is data from the schools as well.  Dr. Sands Van Sickle stated of the same 46.5 percent who said yes, they have had at least one drink of alcohol in their life; 22 percent said they had a drink at least one or two days; and 2.8 percent said they had a drink ten days out of the month.  Dr. Van Caulil stated smoking in the region has been reduced but Brevard still had, in 2004, over one in five people smoking; Prevent of Brevard Inc. is the single community provider for the Brevard County, State of Florida Tobacco Prevention and Control Program, which is know as the Brevard Tobacco Initiative; and the program’s goals are to reduce exposure to second hand smoke, promote cessation, prevent initiation of tobacco use, and build a partnership in support of these efforts.  She noted the Brevard Tobacco Initiative currently has 30 partners, healthcare providers, education, social service agencies, and law enforcement; and in a parallel effort, all the campus’ of the major hospitals in Brevard are going smoke-free in conjunction with the Great American Smoke-out on November 20, 2008, which is very exciting news.  She stated the demographic information on current smokers disproportionally affects the uninsured and the poor, which is very serious considering they are less likely to be able to receive needed healthcare services; Prevent is working closely with the Brevard Health Alliance on cessation efforts; and that is important because Brevard Health Alliance services all patients regardless of their ability to pay.  She stated the adolescent portion of the survey found that Brevard had the highest rate of teen smoking in the region; teens are also a special focus of the Brevard Tobacco Initiative; and a strong component of the project is establishing clubs called Students Working Against Tobacco (SWAT).  She stated Brevard girls are more likely to smoke than boys, at 18.9 percent, compared to boys at 18.1 percent.  She stated adolescents in Brevard are also more likely to use smokeless tobacco products than adolescents in other counties in the region.  She stated teens were asked whether he or she had been in a car in the last month with someone who was drinking alcohol; the highest numbers in the region were 9.6 percent of teens in Brevard reported that they had; and the Brevard Youth Substance Abuse Prevention Coalition is currently working on various aspects of a comprehensive plan to reduce motor vehicle related crashes.  She stated in referring back to school data there is a confidential survey called Behavioral Risk Factor Surveillance Survey (BERFUS); the State feels it is accurate data, but they did some focus groups with teens and he or she replied they do not answer it truthfully; and they are thinking of some ways to get the data in a different way to look at rates.  She stated the Brevard Healthcare Forum asked the adolescents to picture in their heads their four best friends and asked the risk behaviors of their four best friends; kids tend to do what their friends are doing; the kids reported that their friends tried alcohol without their parents knowing at a rate of 38.8 percent, 38.5 have been sexually active, 27.3 percent smoked cigarettes, 21.7 percent used marijuana, 8.1 percent had friends how have been pregnant or who had gotten a girl pregnant, 6.5 percent had friends who have sold illegal drugs, 6.1 percent said they had friends who have used cocaine, LSD, and amphetamines, and 3.6 percent said they had friends who owned or carried a hand gun; and there were very different responses from asking the same sorts of questions in the schools.  Dr. Van Caulil stated for access to healthcare services, insurance is not the only solution but it certainly helps; unfortunately, Brevard has a very high rate of adults that are uninsured; and this was very important data in helping the Brevard Health Alliance to be able to attract Federal funding because the data was broken down for them.  Chairman Scarborough stated Florida is the worst in the Nation with fully

 

employed people without healthcare.  She stated that is a recent trend because when looking at the insurance and uninsurance data, if someone was employed he or she had health insurance; but there are so many people with part-time jobs, or work for  small  employers  that  cannot afford  insurance; and there are going to be some really different numbers for the next year survey.  She advised the data is from 2004, when men were more likely to be uninsured than women, younger adults, the poor, and the non-white population; at the time, there was a different dynamic than there is currently; there were a lot of young adults and men who were opting out of healthcare coverage because their employers gave them a menu of benefits in which they could pick and choose what they would take and put the cash in their pocket; and that is not seen as much now.  She stated the uninsured are much less likely to have preventative healthcare; insured are more likely to have a specific source of ongoing care, a doctor with a check-up every year, blood pressure, cholesterol, mammogram, prostate examines, and dental care. 

 

Dr. Sands Van Sickle stated of people who have experienced difficulties or delays receiving needed healthcare, Brevard fared better than the other counties; but it was still far worse than the Healthy 2010 objective, which was seven percent or lower; Brevard was at 37 percent, which is a little worse than the national rate of 36 percent; and it will be interesting to see the 2009 findings from the updated community health assessment.  She advised compassionate drug programs have been put in place in Brevard since 2004, which allow uninsured populations to obtain free medications directly from drug manufacturers; and also, the Board approved the Prescription Discount Card Program, which was put in place in August of 2008, which will help with the cost of prescriptions as well.

 

Dr. Greer noted that CVS Pharmacy has just announced that they have 400 generics and will provide a three-month supply of medications for $9.99.  Dr. Sands Van Sickle stated there are a lot of great changes being made in the prescription industry, plus they have home delivery services available.

 

Dr. Van Sickle stated everyone knows the importance of prenatal care on birth outcomes; the poor and non-white were less likely to be accessing prenatal care; also, breast feeding has a tremendous impact on the health of kids; with the younger kids more likely to have been breast fed than older kids; unfortunately, the poor are less likely to breast feed, and the black population, which has the higher rate of infant deaths; and so it is definitely for targeting healthy start initiatives.  She stated the folks who participated in the survey were asked if they had a regular doctor, and they responded he or she does have a specific source of on-going medical care; and it was asked that it not be the emergency room but their own regular doctors.  She stated in looking whether Brevard residents are getting those routine check-ups, medical, and dental, and the County is doing good in the routine medical area but behind in the dental area because there are a lot of folks going to the emergency room for dental issues that have really manifested themselves.  She stated the data is continuously updating, and they are interviewing 1,600 people in the four-county area, so an updated list can be put together to put a Health Summit together in the winter to share the findings and to use that data to measure what has been going on and to see if new things have surfaced so that everyone can all work together to target new initiatives.

 

An audience member stated she wanted to mention that the group at the Sunflower House and the Senior at Lunch Program has a Brown Bag Event; if all seniors put their medications in a brown  bag  and  take them to the Sunflower House and/or if they are going to a Senior at Lunch

 

sites, CVS pharmacists will be there and will go through their medication and make sure there are not any drug interaction.

 

Commissioner Voltz stated she contacted the four people on the panel so that everyone can talk about individual issues at individual hospitals because they are not all the same.

 

Dr. George Mikitarian, CEO, Parrish Medical Center, thanked the Board for the opportunity to speak today and to be with his colleagues’ as they maneuver through the healthcare environment.  He stated Dr. Greer made a comment that the current health insurance system is an employer-based system; in this economy, what he is finding is that as employers of small businesses continue to struggle they are passing the healthcare burden onto their employees; in some cases removing healthcare coverage in total; the fact that there is an employer-based system even less than half now of the employers in the State provide health insurance coverage in some way, shape, or form is certainly impacting North Brevard with the impending layoffs, job reductions related to the Space Center, as well as the economic fall-out in the next year or two will greatly impact the number of insured people that will continue to be a provided service to. He stated Dr. Greer was right that insurance is not the issue; stated what he would like to address is the distinct difference between people who have insurance and people that are accountable for their healthcare; sometimes those two do not correlate, even people with health insurance are not necessarily the healthiest people, or the people who utilize healthcare services in the smartest way; and he would encourage a discussion on individual accountability.  He stated healthcare in the end is provided locally by healthcare providers, Circles of Care, and Brevard Healthcare Alliance; it is discussed too often at the National level and not often enough addressed at the local level; while everyone may be waiting in anticipation of some kind of healthcare reform Nationally, whether it is universal healthcare or some variation of that, but in the end everyone goes back to work this afternoon continuing to provide care locally; and it needs to be addressed by people who are accountable for themselves on their own healthcare and by the professionals who are accountable for the people that are served and represent.  He stated in the recent elections people were polled, and asked the most significant issues that impacted their decisions to elect a person or not; with the economy, over 60 percent of the people said that was the number one issue; he stated he would offer when it came to healthcare they are one in the same; and the Board often has forums and summits on healthcare and in fact what healthcare is, is life.  He stated the slides seen earlier today and the surveys of teens are things that occur in life; they are not healthcare specific, but they impact what is called healthcare; and as the Board looks at the lay of the land in where the County is going as a society, he thinks that where the County is headed is the merging of healthcare in the economy, society, community, and in life.  He stated as the Board at times struggles with decisions that are made day in and day out, whether is it jobs, business, public service, safety, and parks and recreation, he encourages the Board to think of healthcare, because everyone is either impacted by healthcare, or they all impact healthcare.  He stated in North Brevard he is finding the society issues impacting healthcare are alcoholism and depression; stated when there are no jobs, the pressure is on the family, and there is an increase in domestic violence, alcoholism, and violent crimes; those things end up as part of the healthcare system; and they clearly are intertwined, but society is becoming better educated about that fact.  He stated there is a tremendous waste in the healthcare system and he thinks they will be talking about that as a Nation   more,  and  will  continue  to  do  that  at  Parrish  Medical  Center;  there  are  so  many

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inefficiencies still in the healthcare system; he feels if it really is investigated Nationally at a National level between the laws, bureaucracies, regulations, inefficiencies, the lack of information systems, communication between  physician to physician, and hospital to pharmacy continues to compound the struggles that continue with providing great healthcare to the community; and with the Board’s involvement with some of those things mentioned,   it   can   certainly   encourage   collaboration,  and  cooperation  among  healthcare providers to get better at working together, and communicating better.  Dr. Mikitarian stated in North Brevard they are trying to do that by bringing people around the table to talk about how information can be transferred better for the better of patient care, the reduction of duplication of effort, reduction of expending resources where they do not need to be expended, and the re-use of those resources in places where they need to be used.  He stated four years ago Parrish Medical Center was serving 3,000 people annually in the underinsured, and uninsured clinic; this year 15,000 people are budgeted for service in the community clinic; three more full- time physicians could be added to the current three full-time physicians; and probably would still not meet the needs of North Brevard.  He stated he would like to congratulate Dr. Greer for presenting what he presented today, and also Dr. Gurri, for receiving the volunteerism award; volunteers are the heart and core of the healthcare system; without them he could not imagine what healthcare would be like; there are hundreds of volunteers that commit their time and resources every single day at Parrish Medical Center; and virtually every physician in the County provides volunteer healthcare to the patients that they care for.  He stated he will leave Board with what it can do to help healthcare; stated the Board can continue to support volunteers with the volunteer concept and system by encouraging people to volunteer, whether it is an hour a month, or a year, they can commit to looking in on a neighbor to see how they are doing, if they are taking their prescribed medication, making sure people are eating, and having access to the great social systems that the Board has in this County; and then recognizing people who are doing great works in the community.  He noted one thing the Board could do, because it has the television cameras and the attention of over half a million people in the County, is to help educate people to be accountable for their own healthcare decisions, for businesses to be accountable for their employees, neighbors to be accountable to neighbors, and educate people where they can go to access healthcare, and educate healthcare providers on what they can do to help each other become more successful, and continue to connect with people; stated Chairman Scarborough has done a great job in North Brevard by helping organizations like Parrish Medical Center to sit down, and talk to make sure he or she are filling the gaps of where people are accessing healthcare; and summits, forums, cooperation, and collaboration are important for the Board to span the gaps from one part of the County to another and asking healthcare professionals to do the same.  He stated Parrish Medical Center is the public hospital in the County; it was stated briefly about the advantages of sovereign immunity; Parrish Medical Center’s employed physicians do enjoy sovereign immunity, which is provided in the community clinic and for some physicians that provide services in the emergency department; and stated he does not know if there is something the County can do to help the physicians at Wuesthoff or Health First access some of those advantages in the State of Florida.  He stated it relieves a great amount of anxiety on the part of physicians who for the most part are seeing a patient for the very first time, with very little information, being asked to do extra ordinary things, and the least they can do is to provide the support they can as a community.

 

Chairman Scarborough stated thanks to Dr. Mikitarian, because he has been an inspiration to everyone in North Brevard and there will be a health village come into being; this is a remarkable idea where seniors can come in and rather than moving around the different areas they  will  all  be  located  together; Dr. Mikitarian has Dr. Pamela Trinity on his staff and she has

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the ability to talk to seniors in this holistic sense; with hosting seminars and the idea is reaching out rather than having a fragmented  medical system, but through the hospital having people able to reach out and come in to a community where a multi-faceted issue. 

 

Commissioner Voltz inquired what are some specific issues that Parrish Medical Center has that maybe other hospitals are not aware of.  Dr. Mikitarian responded the universal healthcare Nationally current estimates are that 45 to 50 million people in the Country are uninsured; and it is understood many are accessing some portions of the healthcare system through clinics or emergency departments.  He stated to imagine another 40 million people with formal access to healthcare providers in the Country and how will they be served; many hospitals are at capacity and physicians are working as hard as possible; with new medical schools being built they are the first ones in 25 years to be built; there is not enough education and training available to healthcare providers; and there is not enough providers, facilities and funding to help formally access the healthcare system.  He stated there is continued struggling with manpower projections and inquired what should be done in the next five to ten years to educate and recruit the next generation of healthcare providers in areas known such as genetic counseling and all of the new mallgaleties that will certainly exist five to ten years from now; and handling the volume today is a huge challenge; and for him at Parrish Medical Center taking care of patients with mental health diseases continues to be the number one priority in challenges, it permeates all aspects of the community, infiltrates every person in the County; mental health treatment and insurance is not respected enough; and the County has to get better as a community in handling mental health disease.  He stated as the economy struggles and people living longer, more mental disease will be seen, especially at the Alzheimer’s Foundation and Circles of Care; and they are doing an incredible job and there could not be enough capacity built for them to handle all the future challenges.  He stated the challenges at Parrish Medial Center are enough providers in the right areas and times and the issues of dealing with mental health.

 

Commissioner Voltz stated the number of small businesses that do not offer insurance and the larger employers not offering very good insurance in the Northern area of Brevard is a big issue impacting Parrish also more than Central and South County.  Dr. Mikitarian responded that is correct with other places where there are larger employers that are offering health insurance.      

 

Chris Kennedy, CEO, Viera Hospital of Health First Systems, stated there will be three entities that will sit on Viera Health Park property and will be neighbors with the County offices; there will be a new Pro-Health and Fitness Facility, a medical office building, which will have an urgent-care center along with diagnostic area; and in 2011 the hospital will open.  He stated to step back from that specific role to talk a bit about more from the Health First perspective and then back to Viera Health Park; Brevard is a wonderful place to live and citizens are well served by the healthcare institutions and he is looking forward to seeing the challenges that are placed before them in ways that can be worked together so they can be resolved, because it is something that has to be done together; and it is realized some of the uniqueness’ of his organization in which there are three hospitals, and soon will be four, a health plan that is a mechanism for trying to solve some of the healthcare issues relative to small business health insurance; and a medical group that allows to compliment their physicians within Brevard gaps in coverage.  Mr. Kennedy stated it is critically important, not just for the success of his organization, but really a success of the infrastructure of healthcare in Brevard County.  He stated he has had the privilege of being at the Cape for 28 years serving as a Clinician, repertory therapist, working surgery through serving as that president for eight years and five years  of  being CEO at Holmes Regional Medical Center, prior to his appointment one year ago

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at Viera Health Park; and he has an interesting diverse perspective and viewpoint of the healthcare system in Brevard.  He noted Dr. Mikitarian would be happy to know that for nine months he worked as a therapist at Parrish Medical Center; and those were fun and interesting days.  He stated  there  are a couple of  things  that he  feels  are  very important to the Viera area; he has looked for things that can be put in place from the start that will help to address many of the problems the Board heard communicated today; when talking about access to care, he is speaking about issues of providers, whether that is a patient at a hospital as an inpatient, diagnostic, testing, and education; and his organization felt it was as important to try to keep a community healthy as it was to go ahead and take care of them when they were sick.  Mr. Kennedy stated one of the things that have distinguished Viera Hospital and some of the colleauges today is the issue of wellness and how to provide a venue to go ahead and have folks and keep them healthy.  He stated the healthcare system is broken to the point where what gets reimbursed is for treatment of care, not for keeping the community healthy, and yet it is important enough that he believes, like, pro-health and fitness, a number of programs brought in the beginning that deal with childhood issues of obesity, of creating a venue where the kids with family are being provided with daycare where a parent can work out knowing their child is cared for so he or she can get the education needed and they can exercise to help with the obesity issues, and really create a focal point of rehabilitation; and he thinks that is going to be a key component going forward, and not just caring for folks when they are having debilitating illnesses, but keeping a community healthy, and how that is done in conjunction with other folks that have like types of vision  He stated it has been recognized that there is access to a wonderful medical community from the Viera Hospital site; the County is very fortunate to have the level of clinical professional expertise of its medical staff; other than some small issues there is no reason to leave Brevard County to receive medical care; stated Brevard does not have a burn center or a heart transplantation center, but short of those two characteristics, day in and day out, the level of care being provided by the medical community is really second to none; and that is one of the crown jewels of Brevard County.  He stated Viera Hospital of Health First System has a level two trauma center for Brevard County and Indian River County; the trauma center requires a tremendous commitment of specialists that have to be available 24 hours a day, seven days a week; a First Flight helicopter is a $3.5 million aircraft that is committed to giving patients the best chance of survival; and a number of years ago, that was not something the County enjoyed, as it is an expensive program to run, but vital to the long-term growth of the community.  He stated fragmentation is a huge issue for the County, which is applaudable to the Board; one of the things the Board could assist with is regional health information; the fragmentation of not knowing the elderly patients  of  which  are taking which  medicines,  of  combining a sub-specialist that has a tremendous amount of patients to see, make sure electronically the infrastructures are in place to get accurate  communication and medical information that will be vital to a long-term success of any future healthcare for Brevard.  Mr. Kennedy stated colleagues have recognized in larger groups many years ago so they could operate as a large integrated group, and have spent a lot of time, initiative, and dollars so that as a group they could go ahead and communicate; the larger groups, because of the size had the wherewithal where that could be a possibility; and that will be critically important, not just for the medical staffs, but for the employers, caregivers, pharmacists, hospice care, and home care to find a way of starting to link and tie together so that right decisions can be made in the right setting, that is what will allow Viera Hospital to be as cost effective as possible.  He stated the Board has the ability and influence to allow its citizens to continue to have a wonderful place to live; facilities are being created within the area that will allow physicians to choose where they want to go when they get out of their programs; Brevard is a beautiful place to live, but the question  is  if  it  has  the  type  of  infrastructure  that  is required or the type of schools that are

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needed when physicians consider where they want to raise a family; and those are things the Board influences, in compliment to the hospitals which provide a venue to be able to attract medical staff, nurses, and other caregivers.  He stated basically there are two types of folks that are hired that care for patients, and all the rest of the people are caring for the people that are caring for the patients; plus, he wants to create a needed environment were there is affordable housing so that there are folks that can work close, and live close to were they work as those are critically important elements; and as a population ages and needs more healthcare resources, the ability to have transportation for close proximity to those services are going to be critical.  Mr. Kennedy stated the Board should keep in the back of its mind that the environment that it is working on day-to-day to create this thing called Brevard County goes hand in hand with the health professionals ability to go ahead and care for the health of the community; lastly, it is a very challenging business entity this thing called healthcare, and having a very large amount of folks who do not have the ability to either pay or have a mechanism were their employer cannot even provide for insurance, leaves healthcare organizations in a position where those people are taken care of them, and a way must be found to collaborate together so there is not duplication; and those resources can be taken advantage of and done in the most cost effective way possible.  He stated the mental health issue is a real issue; he knows that in the Legislative update the Board supports the addition of a facility for Baker Act-type patients; because if the hospital does not have a bed, they are in a bed that is occupied by another patient being able to come in to the emergency room to be assessed and an intervention to occurs when your emergency room can no longer function as an emergency room, the community is at risk and then the issues will start of emotional disorders having to go on divert. He stated there is a there is a real issue that surrounds the capacity and ability to care for mental health patients, and an issue of capacity for emergency room patients for their physical health; but there is a solution for that in the Central part of the County; there is also a solution for hospital beds; and that is one that is going to have to be watched very closely, or the primary mission of taking care of folks that have physical ailments will become one that will become secondary.

 

Commissioner Bolin stated she would like to welcome Mr. Kennedy because she represents the Viera area; and any facility that can assist in keeping the people well is most appreciated.

 

Emil Miller, CEO, Wuesthoff Health Systems, stated he appreciates the invitation to speak before the Board today.  He stated clearly a variety of items have been touched on today on a Countywide perspective; he believes from a psychiatric service perspective, Wuesthoff Medical Center in Rockledge has been challenged with its psychiatric service program, which includes  Baker  Act;  over  the  last  two  years it has been discussed trying to assess the best direction for not having a reduction in capacity for Baker Act or Mental Healthcare Acute Services;  and to date, the level of service at Wuesthoff has not changed, and it is a continued attempt to try and come up with a solution that keeps the bed capacity whole in the County.  Mr. Miller stated another thing that has been a real bonus for Wuesthoff has been the Brevard Health Alliance (BHA) initiative; one of the nice things that has been seen is the BHA working with the emergency departments in an effort to help off-load and redirect patients to the Health Alliance facilities; stated it has been a tremendous benefit plus providing home base or a primary care physician to hopefully render some degree of consistent medical care to that patient as apposed to them jumping in and out of an emergency room setting only when they are in a very acute state, which means he or she are going to have that addressed, but from a follow-up perspective, and a patient compliance point of view are always the unknowns that as he or she walk  out  of  that  emergency  room door will they be seen again in three or five months again in

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crisis, or is he or she truly going to follow-up from medication perspective, and primary care or specialty coverage.  Mr. Miller stated across-the-board in this County a significant commitment by the medical community steps up, and become actively engaged formally, and informally, which has been going on for decades.   He stated Brevard Health Alliance (BHA) offers a venue for a much more comprehensive arena for the physicians to render those services; but BHA has been a huge advantage for South County and certainly from Wuesthoffs’ perspective in Central and in South County is seeing the impact of that as well; and he is thankful to have that asset in the community.  Mr. Miller stated physicatiric services, uninsured component, the positive impact upon the uninsured population with BHA, the looking forward aspect with economics, the mental health issue from an out-patient perspective is growing, and a solution is not really being seen to help the County improve with the budgetary shortfalls; there are certainly not a lot of answers to those issues, but the problems and concerns need to be shared as the Wuesthoff looks forward as being the safety net for the community; and the healthcare panel are all non-profit providers.  He advised the safety net is the emergency department, and it is that two in the morning phone call to the Specialist saying there is a such and such case in the emergency room, and now there is the liability insurance issue; and inquired if there is some way the Board could help address this for the physicians as it would certainly help take one burden off the doctors; but stated there are countless patients seen on a daily basis in all of the emergency departments across the County that are truly unreimbursed, but have all the liability in the world that goes with that care; and from a physicians perspective, the medical community has really stepped up.

 

Commissioner Voltz stated that is an interesting issue that physicians do not have that same protection; and inquired if that is not available to everybody.  Mr. Miller responded it is a public hospital and there is still liability.     

 

Chairman Scarborough stated the Board is going to discuss Legislative issues in the afternoon; if there is anything out there indicating 501(c)(3) hospitals have obtained sovereign immunity through acts of the Legislature, the Board can put it in the Legislative package and run with it; and this is a wonderful time to raise that issue if the Board can get some information.

 

Commissioner Voltz added that would be great, because the doctors in the emergency room have to see patients, and would feel much more comfortable because they do not know anything about them, and would be more willing to treat them.  Mr. Miller advised it is not just the emergency room doctors, it is the specialists who are called in at all hours of the day or night, and usually walk into an acute situation.  He stated another thing that is being seen with the folks that are insured with the rising cost of healthcare is higher co-pays, deductibles are a bigger number, and again there is a higher amount of out-of-pocket costs, which again people are having to make very difficult decisions between addressing healthcare versus basic needs; healthcare tends to be secondary or not a real priority; and patients may feel great, but that could change at any given time.

 

Dr. Joseph McClure, CEO, Melbourne Internal Medicine Association (MIMA), stated he is pleased to be invited to join the group today; stated he has a different perspective and thought, without any particular direction, he would like to talk about success.  He stated briefly, MIMA is the largest medical group in the County, and one of the top 20 employers in the County; it is one of the top two or three medical groups in the State that is not affiliated with a university or an institution; and it is about 40 years old and has multi-specialty coverage with about a dozen offices in South County with Diagnostic facilities in multiple locations.  He stated MIMA has done

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some things that answer some of the issues that have came up today that could make a big difference in the way medicine is practiced; and he wants the Board to understand it may help with some thoughts as to what quality medical care is going to look like a decade from now.  He stated  MIMA  was  established  as  a  consulting  internal  medicine  group  in the 1960’s by some physicians who were practicing cardiology, endocrinology, and oncology; it grew as a sub-specialty group until the 1980’s when primary care doctors were added such as family practice physicians, primary care-interns and so forth; and it continued to grow in that sort of way until 1995 when almost abruptly the surgeons were added.  Mr. McClure mentioned Dr. Gurri was the first surgeon added to the group.  He stated MIMA entered a period of rapid expansion; in the last decade it has seen a specific focus on technology with the expansion of diagnostics, and increasing attention to quality issues; and those two things are the same thing.  He stated there has been a tremendous investment in automation; if the County wants to have a Cardiac 64-Slice CT Ribeye Cardiologist, MIMA does it like no one else does; if the County wants to have Cardiac PET it is MIMA also; and if a person goes to a primary care doctor and he or she wants to make sure that every one of the specialists notes is in the chart that is being seen right then that is MIMA as well.  He stated when a person goes to a physician at MIMA they have all of his or her records, and it is with that doctor, wherever he or she is in the world, if a person is a member of their group; the plan is to continue to grow in South County and are in the midst of a major building project which will put MIMA mid-way between three hospitals in the County; and increasingly, because of the investment and technology, leadership is provided in that area and MIMA is hoping to provide services to physicians in smaller groups who cannot afford the technology, but who have to have the types of programs MIMA has.  He stated MIMA’s doctors are foremost in the area of volunteerism; MIMA’s and the future is also involving an association with the University of Central Florida (UCF) which is very close to MIMA and will provide access in both directions to quality medical education, and teaching; and one of the challenges faced by MIMA is in recruitment.  He stated people stay alive because of what the Board does in reference to the public policy decisions such as clean water, planning to make waste management proper, control of insect factors, social programs, and pre-natal care issues, etc. etc.  He asked everyone to go back in time and think about what their parents were worried about in the summers of this Country 50 years ago; there was terror because the mothers were afraid the children were going to get Polio; they do not do that anymore because of vaccinations; what is killing people now is tobacco, obesity, and lack of medical care; some of the things that can be done to make a difference is to support programs to get people to stop smoking; and the Brevard Tobacco Initiative is a group of people who are really trying to make a difference and are supportive for those that want to take advantage of the program.  He stated the Board already knows that people get to be a fat adult because he or she were a fat kid; it is a big problem, but there is no controversy about it; and he is not sure that the focus is being done to help try to fix it.  Dr. McClure stated a pilot study was done with a MIMA physician going into the schools teaching children how to eat differently, and what effect it would have on their lipid levels; it was easy; stated the Doctor measured their lipids with permission, taught the students how to eat right for one month, the levels went down; the push back he received was from the parents; obesity was not an epidemic 15 to 20 years ago; and people should approach obesity differently now. 

 

Commissioner Voltz expressed appreciation to Dr. McClure for a lot of very good information; and stated some indigents do not have very good insurance, has an issue, needs an MRI, and the doctors themselves say a PET Scan would be good, but it is not covered; and inquired are those services volunteered, or is it just the physical services from MIMA.  Dr. McClure replied everything  has  a system, and in this area the assistance would be the Brevard Health Alliance,

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as it has grown into a very high quality organization; and stated what happens is that an institution is not asked to do everything, they ask one person to do one thing so when a PET Scan is needed the Brevard Health Alliance will find a place that will do the Scan.
 

Commissioner Voltz also espressed appreciation Dr. Mikitarian because Parrish Medical Center provided the finances for Dr. Greer to be here today.

 

Commissioner Nelson also expressed appreciation to Dr. Mikitarian and he would like to get together with him soon because Chairman Scarborough has done a great project called the Chain of Lakes; and he would like to invite him to Merritt Island to have a medical project formed in the same possible way.

 

Chairman Scarborough stated great things can happen with the help of Dr. Mikitarian.

 

Commissioner Bolin stated in regards to document management, she has a household that likes to go to a doctor and not a group; stated she knows there are a lot of different doctor groups in Brevard County; and inquired if it is possible in Brevard County to put together the intermingling of medical records on an individual, no matter which doctor they go to in the County.  Dr. Militarian stated the Federal Government has an intense interest in doing that; it is impossible to create one big database; but it is likely there will be ways for different electronic medical record data bases to talk to each; but there has to be the electronic medical record to begin with; and a decision has to be made to invest the money to put the information into something that is retrievable in that kind of fashion.  He noted there are big employers in the community, such as government contractors, that are working on ways to get systems to talk to each other; but Parrish is looking at something smaller that would offer the ability for a smaller office group to work with Parrish to provide the electronic medical records and the back-up database so they can have that kind of access; and the answer to Commissioner Bolin’s question is yes, but it costs money.

 

Commissioner Voltz stated the morning has been very eye opening, enlightening, informative, and she thoroughly enjoyed it.  She noted lunch is provided on the second floor, and invited everyone to join. 

 

The meeting recessed at 12:00 p.m. and reconvened at 1:00 p.m.

 

 

RESOLUTION, RE:  RECOGNIZING JOHN THRASHER               

 

Commissioner Voltz read aloud a resolution recognizing John Thrasher.

 

Motion by Commission Nelson, seconded by Commissioner Bolin, to adopt Resolution recognizing John Thrasher for his years of public service as an advocate for the Space Industry in Brevard County and the State of Florida.  Motion carried and ordered unanimously.

(See page                                             for Resolution No. 08-296.)

 

 

John Thrasher stated lobbyists are not used to being recognized; it is a true privilege and honor to work with the Board; the Board’s support of his efforts with staff and plus what has been done in  Tallahassee  has  just been incredible; he believes in Brevard County the Board has some of

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the most complex issues given the industry and the reliance on the Space Program; the efforts made in the last two years to bring that to the forefront is because of the Board and its support for him; and thanks the Board for the very kind honor.

 

 

John Thrasher, Southern Strategy Group, stated the Presidential candidates both spent millions of dollars in the State of Florida for voter turn-out and trying to convey their message; in addition to that there was a number of congressional races that were very prominent throughout the State of Florida; several in South Florida, and of course the Board knows about the ones held in Brevard; to spite of the tens of millions of dollars spent on campaigns in the State of Florida, at the end of day last night the Florida Legislature will almost be identical in term of its makeup of the Florida Legislature, republican versus democratic; and unfortunately, Tony Sasso’s race was the only incumbent legislative race to lose in Florida.  He stated in spite of all that went on with the election, the State of Florida will basically stay the same as it begins the new year; stated it is an interesting phenomenon for the State and gives the chance to begin now with new leadership when speaker Ray Sansom will be sworn in, in two weeks and Senate President Jeff Atwater will also be sworn in, all of who are known entities to the Board; Senator Thad Altman will be an enormous asset to the County, and of course Senator Mike Haridopolos, and in the senior member of your delegation, Ralph Poppell, in the House, will be a great leader for the Board’s efforts in Tallahassee.  He stated he is looking forward to working with the new members of the Board’s delegation; and he would like to come back and meet some of the new members on their home turf.  He stated in two weeks the Organizational Session will be held and the Space Forum that has set the table for the program in the space legislation that will be done; when starting the program the one concern all along had been that out of the entities that are interested in that they had to all be on the same page, but that is how to get things done in the Florida Legislature; and believes that will be able to be accomplished again some significant things in the Florida Legislature for Space, and that will be the number one priority of things to accomplish.  He stated there have been a lot of things done; certainly last year there was some great successes in terms of the launch infrastructure, the $14.5 million, and the Workforce Development and it will continue to build off of what was done last year; he explained it is incremental to builds on every single year, a foundation, to continue those efforts; and part of that foundation has been the Boards help in getting things done in Tallahassee.  He stated it is also about saving an industry for the area that creates an enormous economic benefit through good jobs, and that is what Florida should be about; stated he is not trying to give a political speech, but the County can do something that enhances the ability to keep those jobs and talk about space more in Tallahassee, and the importance of that with the new administration; all of those things are on the table; and he looks forward to continued efforts with Governor  Christ  who  is  committed  and  is  trying  to  find  the  right solutions to ensuring the liability and continuance of the Space Program.  He added he appreciates Leigh Holt’s great efforts being done on the Board’s behalf; she helps keep him focused on the things needed to be focused on; and he also would like to thank Peggy Busacca for her support, and all the Board members for all being done to make the missions successful.

Dr. Heidar Heshmati, Director, Brevard County Health Department, thanked the Board for inviting him to the Workshop; he feels it is a good starting point; and he would like to start with some positives, and then go through the problems.  He advised Brevard County has the lowest rate of T.B.; homeless people may have T.B.; his staff goes out once a week and finds homeless people and gives them medication to take for one year; the compliance by the homeless is 100 percent; and that is why Brevard County has the lowest T.B. cases.  He stated
the State of Florida has the highest rate of immunization; healthcare professionals are
everywhere to protect people in Brevard County; people may not see them, but they are there; and if there is a case of meningitis in the middle of the night, his staff goes out and takes care of the contact to help stop the outbreak.  Dr. Heshmati stated there are many physicians in the County that have not seen a case of the measles; the last case of rabies in Brevard County was in 1929; every week, someone is exposed to rabies; and if they are not taken care of, they will die because there is no treatment for rabies.  He stated the Health Department works with every organization closely with teamwork; no pregnant woman should be without prenatal care, unless it is by personal choice; and if they are legal, or illegal, it does not matter, as the Health Department will take care of them.  He stated the Health Department started, with Holmes Regional Medical Center and Health First, the Cervical Cancer Program; and after a few years, the number of advanced cervical cancer went down 10 times as a result of the Program.  He stated there are many excellent groups and organizations in the County, along with excellent physicians that volunteer their time; and they never refuse to see a patient if there is a need.  He noted volunteer physicians are going to come to the new Health Department facility; stated anyone who wants to volunteer can be given sovereign immunity with some paper work to be filled out by the volunteer; and there is not a problem with that.  He stated there are many people who do not have basic healthcare because of money; so many people need help; there are several organizations will take care of some of those people; but that does not cover everybody who needs basic healthcare.  He noted the United States is the only advanced country in the world that does not have basic healthcare for its citizens; the United States has the best hospitals, and best physicians; there are 80 to 90 dentists who come to the Health Department to volunteer their time; but there is not enough; and there are 900 patients on the waiting list.  He stated there is no system for basic healthcare to take care of the basic needs of people; the money is there; and the United States has spent three times more than France for healthcare per person, two times more than Germany, and two times more than England.  He stated 30 years ago he moved to the United States; it was the best decision for him to bring his family to this great country with its great people; he has watched eight Presidential elections; each time, a candidate talked about healthcare; but he has not seen anything happen; and hopefully, this time something will happen, but he does not know.  He stated his point is that there needs to be basic healthcare for everyone; it could come from the Federal Government, the State, or each county or city; and hopefully something can be done.

 

Commissioner Voltz stated that Dr. Heshmati is being very humble, as he has put Brevard County on the map with initiatives that he continues to do; Brevard County is a model for many other areas; and inquired if he would touch on some of that.  Dr. Heshmati responded what has been done here is teamwork; he communicated with the Surgeon General and finally received a call from the Surgeon General for ideas with modern medicine that can be applied; and what he believes should be done is any money coming into the County for healthcare should go into one pool, and then spent first for basic healthcare.  He stated he applied for a grant of taxpayers money, but it is not an organized system; the question is why other countries can do it and the U.S. cannot; three years ago one of the major problems was medication, it was so expensive, now  Wal-mart  came  up  with  200  medications filled for $4; and inquired how can Wal-mart do

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that and other organizations or pharmacies cannot.  He stated hopefully something will happen Nationwide from the new government being put into place now and he is thankful for the time given to him to speak today.

 

Lisa Gurri, CEO, Brevard Health Alliance (BHA) stated she would like to thank Commissioner Voltz for allowing everyone to come together; all the professionals present today could not do the work without working with each other; and this is a great forum to have today for communication to come together for healthcare.  She stated Brevard Health Alliance really is a community asset; it does not belong to anyone, as it is a 501(c)(3) and governed by a community board that is encompassed by several community leaders from different sectors; by Federal regulation, 51 percent of the board must be consumers of BHA services, in other words, the majority of the decision making at Brevard Health Alliance is done by the people that receive care there.  She stated Brevard Health Alliance started from a steering committee that generated between public health, Health First, and the County Commission sitting over a nine-month period process inquiring how is it going to put these resources together and what more money can be brought into the County to take care of some of these tough healthcare issues; Brevard Health Alliance was formed as a separate 501(c)(3) because of a couple of guiding principles; one is that every citizen in this County has the right to basic healthcare; and it has been permeated in this session regardless of race, ethnicity, cultural, and economic status.   She stated furthermore, and preventative care is not only the right thing to do, it is the most economical thing to do, because if a disease is treated in an early stage it will prevent the taxing of the healthcare system downstream.  Ms. Gurri inquired who is responsible; stated it is everyone’s responsibility, because these are not someone else, they are neighbors, co-workers, and friends; she inquired if anyone ever sat on a bench next to a homeless individual and worried maybe if he or she had active Tuberculosis; inquired if anyone would want their pre-school student in a school that has active, communicable diseases, or a food industry concern about folks being up to date with their immunizations; and it takes every one with public health, non-profit, hospital systems, and County Government to ensure the safety and the access to healthcare.  She stated Brevard Health Alliance is a private non-profit and is what is called a Federally Qualified Health Center (FQHC); the solution of the steering committee was that it figured out a way to find a vehicle that gave a different emphasis on how the resources would be pooled together; in March 2005 there was success in a grant process to pull Federal dollars into Brevard County; and they are the only entity in this community with Federal and State dollars that allow access to basic primary healthcare services without ability to pay.  She stated the Brevard Health Alliance believes in access; the meaning of access is an entity that can provide the right care at the right time in the right place where there are not any barriers; an FQHC identifies that as reducing barriers in terms of socioeconomic, transportation, and cultural language issues; there are three clinics across the County located in Palm Bay, Melbourne, and Rockledge, with the whole notion of FQHC comes with some resources; and those are the Federal Torts Claim Act (FTCA), which is an extension of sovereign immunity that allows everyone in their clinics and any physician that participates in the clinics to be covered by the Federal government, so the substitute defendant is the United States Department of Justice; and the BHA does not carry malpractice.  She stated another assest that comes with an FQHC is the ability to purchase pharmaceuticals at 32 percent of wholesale, so pharmaceuticals on behalf of the patients served at almost veterans prices; by pooling these resources money can be saved in the service delivery process that allows the BHA to provide care to those that have no insurance; and the other resource it allows is to bill at cost for Medicaid patients.  She stated there have been 19,500 patients registered since March 2005 and that is with three and one half years of  operation  with  four  case  managers  across  the  system,  13  providers,  either board

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certified family practice or certified nurse practitioners, BHA enables $4 million a year in free pharmaceuticals through large manufactures of pharmaceutical companies; and it is done in an organized way across each of the systems.  Ms. Gurri stated the Board has heard a bit about the system  of  sovereign  immunity  that  allows  physicians  to  volunteer  their  services;  it is done through a very organized system of case management that allows the doctor to do their piece; and the BHA provides the x-ray, diagnostic, and lab so the doctor only has to come in and do the piece they do which allows for a very efficient system to provide that care.  Ms. Gurri stated BHA’s total budget this year is about $4.6 million; $1.7 million came in local funding through Health First and Wuesthoff, which was leveraged three and a half years ago with the Federal Government to bring another $1.3 million in, in Federal funds; and without the generous nature of this community and the hospitals, BHA could not have pulled in the Federal dollars.  Ms Gurri stated the County provides $112,000 into funding which brings another $235,000 from the State level, and that was done recently to open the pediatric clinic; the Health Department provides $170,000 into services; stated BHA believes in a system of care that moves those access barriers and severely reduces them; and the biggest challenge in the future is going to be another 200,000 individuals living at the Federal poverty guideline or below that needs access to care and how thoughtful decisions are going to be made to move those resources systematically forward to care for a larger panel of individuals.

 

Commissioner Voltz stated Wuesthoff and Health First has been mentioned; and inquired if Parrish is involved.  Ms. Gurri responded Health First started by throwing their assets in and cashing in, in the early stages; it took a year and one-half for Wuesthoff to say this model works, and folks are sitting back and watching because it is such a critical decision in the community and it affect access at their hospitals; and with Health First and Wuesthoff, it was a prudent business decision that this is the model in the systems that will be used to care for the uninsured.

 

Keith Lundquist, Chair, Brevard Healthcare Forum and Vice President of Health First stated since 1996 the Brevard Healthcare Forum (BHF) has been sponsored by the Florida Institute of Technology and has served as Countywide coalition of healthcare providers and other organizations; the membership includes representatives from Parrish, Health First, Wuesthoff, Circles of Care, Devereux, Brevard County Health Department; Brevard County Medical Society, Health, Start Coalition, and many, many others; and the forum has representation to and from the Health Council of East Central Florida, which is one of 11 local health planning councils created by Statutes in Florida in 1982.  He stated it really is a three-fold mission; first is to identify and build consensus around the healthcare priority and directions within the County; second is to facilitate dialog in joint healthcare initiatives among those stake holders to act as a forum a location where the healthcare providers and other interested parties can come to the table and look at things that can happen jointly for the good of health in the County; and third is to provide and support communitywide healthcare education.  He stated there is a vision to make healthcare in the County safer, accessible, and affordable; and that is where the County needs to be in the future.  He stated the three priorities that have been identified based upon the data seen earlier are childhood obesity, access to primary healthcare services, and behavioral healthcare, because those are seemingly the three gaps within the County and the three that the BHF identified as ones it wants to work on specifically.  He stated more than 20 percent of the County’s childhood adolescent population ages two, to 19 were classified as overweight and having a Body Mass Index (BMI) of the 95^th percentile or greater for their age and sex; some of the actions the BHF has taken have been assembling a task force starting in 2007 to begin sharing  ideas  to  look  at the data, best practices, and identifying some no-blame solutions and

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approaches for children and families; one of the efforts BHF has been involved with earlier in April 2008 was an event that was Countywide called Get Active Brevard and it was a lot of different   activities   for   children   such  as  climbing  walls,  a  skate  park,  jump  rope,  soccer demonstrations, and a jump house, that was held at the Brevard Regional Park along with educational sessions for the children and parents to help address adolescent obesity.  Mr. Lundquist advised the event will be repeated again in 2009 because it was such a success; and the response back from individuals that attended were that they were going to choose healthier lifestyles.  He stated the second area of focus is access to primary healthcare services; as seen Nationally and in the County, anywhere from one out of five Brevard adults lack healthcare insurance; in 2008 Florida Kid Care reported 53,000 uninsured children within Brevard, and BHF has tried to align actives like Brevard Kid Care Coalition to help inform residents that there are State funded programs that are available to many of the locals.  Mr. Lundquist stated BHF is also looking into the best way to provide, through the Federally Qualified Health Center (FQHC) additional access to the uninsured and under insured, and certainly to support and endorse initiatives aimed at reducing, despairing, and increasing access to healthcare for all Brevard residents.  Mr. Lundquist stated the third area is behavioral healthcare; it poses a serious threat in the County with the economic conditions present that the needs will only grow; the capacity of the healthcare providers is not what it needs to be, and one of the closely related and associated factors is chronic and binge drinking, which is an area that the forum is addressing through public service announcements and messages; and looking at what can be done to alert healthcare providers to proved education for physicians, nurses, and other healthcare workers to do effective screens and brief interventions on patients.  He stated one final activity he would like to mention is patient safety, there was a patient safety task force that was formed in the late 1990’s; and it has had quite a few successes already throughout the County.  He stated one success was to develop a pandemic flu plan, which ended up in a brochure that all three healthcare systems put together so that if that issue hit Florida everyone would be prepared for it; have been trained hospital staffs on infant abduction with standardized emergency codes used by all area hospitals so the consistency is there along with wrist band colors; and another success was to review best practices for all patient falls to help reduce avoidable problems, and
training programs such as prevention of surgical fines.  He stated one activity coming up very soon is all hospitals in Brevard will become smoke and tobacco free campuses’ not only in the facility but on the entire campus itself to provide a safe and healthy environment for patients, employees, physicians, nurses, and visitors.  He stated the BHF is attempting to deal with those issues of highest concern and try to bring together the resources that are available to address those issues. 

 

Chairman Scarborough stated one thing that has not came up is that people are becoming concerned about secondary infections in hospitals and maybe deferring visits or surgery because he or she are scared to obtain the healthcare they need; and inquired if anyone would be addressing that issue today.  Mr. Lundquist responded certainly each of the hospitals and health providers, whether it is in physician offices, health centers, are doing things individually; stated the forum’s supporting that patient safety workforce, whether it be looking at education of all providers on issues such as fire safety issues to help reduce the anxiety as well as the reality of that; and the Department of Health is certainly working on a lot of initiatives as well, so yes, it is a concern.

 

Commissioner Voltz commented on the childhood obesity issue with physical education being taken out of schools because it was unaffordable; and stated she wants to add something back into  the  Legislative  package  to  be looked at, and put that back into place because it is a huge

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and long-term problem.  Ms. Busacca responded that is going back into the package to make physical education available for certain ages.

 

Mr. Lundquist added he would certainly support that, whether it is nutritional or educational it is going to be a positive impact.

 

Jennifer Floyd, Executive Director, Healthy Start Coalition of Brevard, stated she wanted give some background information on Healthy Start; it is a Florida initiative that was started in Legislation in 1991; the goals of the initiative is to reduce infant mortality, low birth-weight,  health,  and  developmental  outcomes;  since  this  initiation  15  years  ago most people can not believe it has been in existence for so long because they have never heard of it; and it is a coalition to use local community input for planning, implementation, and evaluation of comprehensive plans a system of care.  She stated Healthy Start works with Brevard Health Alliance, hospitals, health department, and mental health institutions, plus they look at pregnant women on the inter-connectional side, post-partum, and children up to age three that may be at risk for infant mortality and low birth weight issues with a pregnancy; the entire system is looked at in regards to caring and planning for healthy births; and legislatively they are mandated and tasked to be the gate keeper for all of maternal and child health.  She stated Health Start works with every obstetrics office; currently there are 23 offices, both in the private side and the three County Health Departments; and they also work with the five birthing hospitals to work with the entire system of care issues.  She mentioned the Healthy Start Coalition also does the screening and looks at risk factors for low birth weight; the screen is done on every women that gives birth in the five hospitals; once that is done, she is accepted into a program that offers a plethora of services ranging from care coordination, meeting with the client in the home or at the workplace, smoking education and cessation, breast feeding education, parenting education, psychosocial counseling, inter-conceptional care, and a lot of community referrals; the largest misconceptions is that the service is for the poor, but that is not true as this service is free to any woman and it crosses all socioeconomic barriers; and this service is here to serve the community.  She stated during fiscal year 2006 through 2007 Healthy Start provided over 41,000 services to over 23,000 pregnant women and over 17,000 services to over 1,700 infants; and that is an increase of 15 percent of services to pregnant women and an increase of 24 percent of services to infants.  She stated the County is facing two tremendous challenges that need to be shared today, and those are that low birth weight and pre-term deliveries are on the rise; low birth weight is classified as less than five pounds and five ounces; and the contributing factors are very young women, women over age 35, smoking, less than 18 months between pregnancies, and recently the economic factors.  She stated pre-term delivery contributing factors are less than 37 weeks, smoking, inductions, and again the economic factors as of present; and it has been heard that access to healthcare is another factor, however, if there is a high-risk pregnant woman that does not have access to a full-time periontologist there are two practices that come from Orlando on a part-time basis.  She stated a huge issue in the community is that there are no full-time specialists available if a person does not have access to insurance.  She also noted she wants to applaud the Board for starting this process and to please continue the process because she would like to see small and large businesses come together with social services and the healthcare system to continue to help the citizens of the community.

 

Commissioner Voltz inquired with the babies, has Ms. Floyd seen a difference between North, South, and Central County.  Ms Floyd responded yes, obstetric offices are closing more in the North  than  they  are  in  the  South  and  Central  with  there being a much greater difference in

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where they can access the care; but as far as low birth weight and pre-term delivery based on a number of births no there is no difference.

 

Jim Whitaker, President, CEO, Circles of Care, stated Circles of Care has finally been discovered; he is pleased with these types of discussions; and it is beginning to be noticed more.  He stated he believes items tend to be funded by slots; early in his career what bothered him was that there were Federal Grants for substance abuse, alcohol, and mental health; and there was a pile of money being monitored very closely and the monies could not be moved from one category to another.  He advised one day it was decided to combine it all together and give the money to the States; one check would be given, but still receive audits for substance abuse, alcohol, and mental health; in working together like this maybe there can be some economies scale; and he applauds the Board for hosting the Workshop.  He stated another good thing is there has been discussions over the last two years; stated Jim Kennedy  from  Health  First  started getting involved with security officers who were called into all the emergency rooms to try and handle all the brouhaha that was going on with the alcoholics, drug abusers, mentally ill, and staff that were getting into arguments with patients, and it was creating a mess; Mr. Kennedy put together some meetings to meet monthly for two years with the emergency room staff, and visited each others program; and it was found that there were not a lot of beds in rooms just sitting there.  He stated the more that was learned about each other, it was decided something had to be done to make it as palatable as possible; alternate ways have been found through utilizing other agencies that were never known about before.  Mr. Whitaker stated all the problems have not been solved and the funding issue pointed out a lot of holes present in the current system.  He stated once the entire system is in law it can always be amended; stated he hopes it is a good path that nationally sets the tone that mental illness and substance abuse is an illness and a disease; and if treated properly, is less expensive to than misdiagnosing.  He stated emergency room physicians will tell that 30 to 50 percent of everybody that comes into the emergency room, regardless of why they are there, has an alcohol, drug abuse or mental health problems somewhere in that system; if he or she goes to a private practice physician those are the first items ruled out as one of the causes of why he or she came to the doctor; and feels in the next couple of years this subject is going to have to be looked at for some creative ways to get some help without necessarily being funded as he feels it is not going to be available from the State.  He stated something that was tried and almost approved was limited sovereign immunity; not full sovereign immunity because that is really hard to get because the government likes to have that for their own; limited sovereign immunity has been argued in the mental health field, because of Baker Act and Marchman Act, which is a State mandated system that mandates Circles of Care and the County to put money in it with the State writing all the rules, and they have to be admitted; but yet the State would not give limited sovereign immunity.  He stated through the adult and children Baker Act Crisis Unit, and Substance Abuse Program last year there were over 6,500 admissions; add that to the out-patient population that has seen, that is an additional 12,000 people; they are dealing with 18,000 to 19,000 people a year in the substance abuse and mental health field, and yet that process is operated overall with 85 percent inpatient occupancy; but in the Baker Act Crisis Unit it was 100 plus for the last two years running, which is the peak at what can be done; and that is why he is trying to work with everybody to see what can be done.  He stated he has been working with Lisa Gurri on a Federal level for some funding; and he does not know what Circles of Care would do without the Brevard Health Alliance and their van to come by and see many of the patients or the ability to have a person seen by a dentist.  He stated Circles of  Care is the third largest mental health center in Florida and the most comprehensive center for children, along with a residential, supported apartment, life management, and job skills programs which is

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all for the severe mentally ill which means they are not back in the hospital, jail or in and out of the emergency room; unfortunately, the population has grown a lot during that time, and now there are new people coming in to the system that have not been prepared for; and Florida has not sponsored any new adult mental health beds in ten years, but the population of Florida has grown a lot in ten years.  Mr. Whitaker stated hopefully there will be help from Mr. Thrasher and Ms. Holt; there is an exercise in Tallahassee of a ten percent cut; money is tight, the budget will more than likely not be met this year or next; and the ten percent across-the-board is an exercise that has a lot of traction in social services because of a lot of the people do not seem to have the same sort of clout.  He stated a ten percent cut in Baker Act and Marchman Act across-the-board is devastating; and he is also concerned about the seven to ten percent cut to Medicaid and Medicaid services particularly for children at age 17 and 18 that fall through the cracks.  He stated maybe the cuts can be mitigated under the community safety and see what else maybe government in Tallahassee could let go of before the County lets go of some of the services in the community, because he feels there is not going to be a big check for the new Baker Act beds.  He stated if mitigation on the cuts can be held them off as long as possible, there will be about 700,000 cuts for the first exercise already this year with most of that in substance abuse; and some ways are being figured out to handle that; but another cut on top of that is very serious and it will fall to the hospitals, which is unfair. 

 

Chairman Scarborough stated that Commissioner Voltz Chaired earlier in the month a Mental Health Workshop; it seems to be folding over again and again, and just like the Homeless Issues Workshop these trends keeps repeating themselves.  Mr. Whitaker stated that this is the first time he has heard all three hospital administrators say this is a major problem for all of them; and plus, the legislatures both on State and the Federal level hear that it is coming from the government, hospitals, and the police, it will help to realize this is a problem and it is costing people a lot of money to not treat it appropriately.

 

Joe Steckler, CEO, Alzheimer Foundation, stated he is no longer the CEO, it is now Chris Stagman, but he prefers to speak as an elder advocate and the fact he has been associated with healthcare for 17 years; not as a professional provider, but as a person that gets involved in seeing that a person gets help; and he has listened to two doctors talk about statistics today, three hospital CEO’s, and a major clinic CEO talk about awareness, access to the healthcare, and future needs.  He stated there still is not a plan on how things will be done on the eldercare side; and what concerns him are that a year ago there were 47,000 people with a frailty level of five on a waiting list in the State of Florida for healthcare services, homecare, daycare, cleaning, and cooking services.  He stated he has gone into the home of an 85 year old woman and asked her if he could use the restroom so it could be checked out and noticed it was filled with cockroaches, dog and cat feces, and urine all over the place; stated the woman took her shower outside with the hose; this is the part of the healthcare system that is generally not spoken about; and he informed her son, but he said nothing was wrong, so he reported them and she is now in a nursing home where she should be.   He stated so many people do not understand what needs to be done to make things happen; in the past year, when there were 47,000 on that waiting list for services the State of Florida shut the program down with no funding and that program is still closed down; and there are now over 60,000 people on that waiting list.  He noted there are recent cuts of more items he would like to make public about what is going to happen to services in the State of Florida for the part of the healthcare system that is not covered by the hospitals or other State and Federal funded programs; stated it is a known fact that Brevard County is the sixth oldest in the State of Florida in terms of the number of people that  are  over  the  age  of  65, and 24^th in the United States; and there is a problem that it is not

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getting any better it is only getting worse.  He stated if people could be kept out of nursing homes and kept in the element of care which they will function better in, it will reduce the cost of the overall care;  in the  legislative package  there is a  program called  Community Care  for the

Elderly and it is going to be cut by the Governor, but under the program a certain amount of dollars could serve 1,200 people and help people; and that program has been available since July 1, 2008, but because of the fact that Department of Children and Families would not process people for over a year, and the doctors themselves do not refer many of their patients to the type of services that Community Care for the Elder or the Brevard Alzheimer’s Foundation provides.  Mr. Steckler stated an HMO provider of Medicaid waiver services BAF is eligible to put $6 million into Brevard  County  this year, so far there are 21 received clients; that is all they can process through so far; and that is not even approaching $6 million.  He stated if there is no attention paid to what is happening across-the-board, more of the care dollars that the County has will be lost and by losing these care dollars the County then becomes more of a catch-22 situation because it then evolves upon the non-profit organizations to try to raise money to cover the cost of programs that do not get funded; and some non-profits are dependent only on what is given to them from Federal or State sources.  He inquired what is going to happen if the County does not have a better appreciation for what it could lose.  He stated closing homecare for the elderly with a savings of $1.2 million will reduce the number of people served from 3,500 to 2,500; the State is talking about doing away with the Alzheimer’s Disease Initiative money, which now gives $22 a year to each Alzheimer’s patient; land that is in a State that the Governor has three programs that is designed to bring people into the State, and now it is telling the second largest income producers, the elderly, that their services are going to be cut.  He stated the Diversion Program that Mr. Stagman and Mr. Johnson will speak about later is the lowest reimbursed program in 37 counties in the Sate of Florida, and there will be reductions on the way; the way the program is supposed to work is if a person needs services beyond what are provided to keep them at home, that organization is legally responsible for providing that care; the County government is proposing to increase the cost four times from $55 a month to over $200 a month for each client that is in a nursing home; and he inquired where the County is going to get that money.  He stated some people feel the delegation is doing a good job, but that is a matter of opinion because he has be writing to them for ten years telling them about the Diversion Program and other Programs, but there have been no results.  He stated he and Mr. Stagman had a conversation with Medicare/Medicaid in Washington D.C. roughly five months ago about a program called Follow the Money; it is designed to take people in nursing homes out of nursing homes and put them in daycare and keep them at home; 29 States have qualified for that Program and they have been given $1.44 billion, but Florida is not one of a battle between the Agency for Healthcare Administration (AHC) and Department of Elder Affairs (DOEA). 

 

He stated the Brevard Alzheimers Foundation has worked with the County Government since 1993 with the County Government support mostly with land; private support and some State support have built and paid for three Dimentia Centers in Titusville, Micco, and Melbourne; and the services provided to those programs are excellent services that can now care for 176 people a day in adult day healthcare and are running about 65 to 70 percent full.  He noted part of the problem is awareness of people understanding that these programs are available; and the awareness of these programs needs to be there in parts of this healthcare system so that by dedicating and devoting “X” number of dollars to a type of care that is least costly in a long run it will cost less for the overall care program. 

 

 

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Chairman Scarborough stated after the last speaker the Board is going to come back and take these local and State initiatives and everybody interested the healthcare issues; this will end up being more than just discussion today; and what scares him the most is that most people do not understand when  talking  about  Medicaid  it  is  both  the  State and a Federal program, unlike Medicare; and a portion of that State Program is paid by the County.  He inquired if Interim County Manager, Mr. Whitten could tell the Board what has historically been given over the last few years, or what has been paid to the  State,  so  the  Board  can  understand  because  it  is  going  to  take  from other programs because the State is going to tell the County it is going to have to be contributing more to the program. 

 

Dr. Willie Humphrey, Director, Dental Program, Brevard County Health Department, stated there are quite a few issues, of but he is mainly concerned about urgent dental care services, the availability of them, and the accessibility of the services to the uninsured residents of Brevard.  He stated most people do not understand the pain a person goes through; when he receives uninsured dental patients at the Health Department, most of the time their teeth are decayed and there is nerve exposure; when there is nerve exposure the bacteria that causes the decay gets into the nerve and it starts to multiply; the nerve is a soft tissue but it is surrounded by a hard rigid tooth, therefore, when the bacteria starts to multiply it produces gas and the gas is being produced so fast until it cannot escape as fast as it is being produced so the patient begins to describe the pain as a heartbeat-type of throbbing, or a pulsating type of pain; and when this type of pain is present a person cannot eat, sleep or work.  He stated most of the patients try home remedies such putting an aspirin on the teeth which ends up burning the tissue and it does not help, or he or she floods the tooth with Orajel and that does not help either; the next step is to call the dentist to inquire how much is the charge to remove a tooth; and the next question is if payments are accepted, and after the answer is no, he or she ends up at the emergency room.  He stated at the emergency room the patient is going to receive pain medication and most importantly antibiotics; the antibiotics are going to do work on the bacteria that is producing the gas so the tooth will calm down so the patient can eat again, sleep, and go back to work; and the patient will feel good for a few days or a few weeks, then all of the sudden the throbbing pain will return and now their face is swollen; and the only resource they have is to return back to the emergency room because they are going to get pain medications and most importantly antibiotics.  He stated he received a call from a 71 year old gentleman who is taking chemotherapy; the gentleman stated he needed to have all of his teeth extracted because his physician said that he had to have a bone marrow transplant; but before that can be done all of his teeth had to be removed; he had 19 teeth, and a few were loose; there is no program available to handle the situation for the gentleman, but he told the gentleman that he would get this done for him because he spoke with the Adult Dental Coordinator Volunteer at the Brevard County Dental Society; and fortunately, there is an oral surgeon that partners with the Brevard County Health Department to help with the needed procedure.  He noted the gentleman was not in pain but was offered hope because he had worried too much about what is going on in his life to have to have the stress of thinking about how he is going to get his teeth removed; and these are some of the problems and the description of the type of pain that the uninsured dental patients are facing, but all of those things require urgent dental care.  He stated there are issues of availability of urgent dental services as opposed to accessibility to those services; Health Department has partners it is working with, such as the Brevard County Dental Society, Brevard Health Alliance; the Brevard County Dental Society has a Volunteer Adult Dental Program; and that Program has a full-time dental coordinator, which is present with him today, and she attends different Dental Society Meetings  and  private  dental   offices  to  try  and  persuade  the  dentist to come to their facility

HEALTH COMMUNITY REPRESENTATIVES (CONTINUED)

 

and perform the urgent dental care on the patients.  He advised there are now approximately 50 dentists that come to the Health Department to help partner with the Health Department; in Melbourne he is working with the Brevard Health Alliance to perform the same services two nights a week at the Brevard County Health Department that were referred by the Brevard Health Alliance; and as far as the accessibility to those services, the Volunteer Adult Dental Program has about 800 patients on a waiting list that needs urgent dental care.  Dr. Humphrey stated the Brevard Health Alliance is scheduling four to six months ahead, so if an individual calls now and says he or she has a dental problem their appointment will be scheduled four months later; and the problem is the availability, and then the need for those services.  He stated the Brevard County Health Department will be moving to a new and larger facility in Viera that will allow more public health services to the community; the dental program will be moving from a two-chair facility in Rockledge to a four-chair facility in Viera; and a Grant was received to get two new chairs and the Health Department is going to transfer the two existing chairs to complete the four chair facility.  He stated recently he had a meeting with Dr. Heshmati about the uninsured residents of Brevard not being able to receive the urgent dental care they need in a timely manner; the suggestions made to him by Dr. Heshmati were to keep the two existing chairs in Rockledge, and if the funding comes in, have a full-time dentist, an assistant, and make some adjustments in the building, upgrading some of the equipment, and have the project be exclusively for providing urgent dental care in a timely manner for the uninsured residents of Brevard.  Dr. Humphrey feels this is a great idea and thinks the Board should consider that in one day the facility could see 14 to 20 patients; in a good week they could see 70 to 100 patients; stated it is going to be beneficial because those patients that are going to the emergency room for the same procedure and using the emergency room for a revolving door can be eliminated; and the Brevard County Health Department can also be a ready source of referrals for the hospitals so he or she can get the emergency treatment done within a reasonable amount of time and will not need to go back for that same treatment because once the Health Department gets it done it is done.  He stated as far as the Brevard Health Alliance, the number of scheduled patients can be reduced to a significant degree until patients can be seen within an reasonable amount of time; the 800 people that are waiting in the Volunteer Adult Dental Program can be immediately started to cut into those numbers, he feels that is a win, win situation; for those who work directly with the patients when personal statements are heard such as hurting so badly he or she cannot sleep or they cannot afford the treatment; after treatments, they can sleep, and enjoy eating again; and those statements are the most important and rewarding.  He expressed appreciation to the partners here today, and he hopes the partnership will continue so the urgent care needs can be met; and also stated for any other healthcare providers present today, if they feel they can join, they can join in and maybe this worthwhile project can become a reality and that will increase the availability of these emergency dental services to met the needs of the community for these services.

 

Commissioner Voltz inquired if transportation is an issue for patients to get to where the Health Department is located.  Dr. Humphrey responded no, because of the Volunteer Adult Dental Program; there are some dentists that live in the South end of the County and in the North; and where they live is where they volunteer.  He stated there are quite a few dentists volunteering in the Northern part of the County so therefore, the waiting list there is not as bad as in the other two sections of the County; and then again when a person is in pain they will find a ride and even ride a bicycle, and he believes dental pain will make a person do something to alleviate the pain. 

 

 

HEALTH COMMUNITY REPRESENTATIVES (CONTINUED)

 

Chairman Scarborough stated again the Board will be coming back to the Legislative issues and there are a lot of things that has came up such as Seniors, Homelessness, and assisting with sovereign immunity issues to limit the liability, and all of the issues will be addressed.                 

 

 

Don Lusk, Parks and Recreation Director, stated he has an Agenda Item that has to do with Model “Best Practices” Program that has really been proposed as a joint program between the Board, Parks and Recreation Department, Housing and Human Services Department, Department of Elder Affairs, and the Community Services Council.  He stated at the Senior Issues Workshop a few weeks ago there was a presentation on Prime Timers.  He stated he had not heard of Prime Timers until Chairman Scarborough asked him to visit; and while visiting Prime Timers it was the same day as Department of Elder Affairs was there visiting.  He stated in the Agenda Report there is a color continuum that talks about the aging continuum; the important part about a program such as Prime Timers is getting at the front end of the continuum on the self-care and positive aging part.  Chairman Scarborough stated Dr. Doug Beach, Secretary of Department of Elder Affairs (DOEA), would like to participate with Mr. Lusk; stated Prime Timers can happen elsewhere in the County; and if it goes elsewhere in the County it will be without the religious connotation.

 

Commissioner Bolin stated she has had the pleasure of attending Prime Timers; within two hours there was a group of 100 seniors doing everything possible in talking about the complete circle; they participated together in activities, singing, and clever physical exercises with a song that every time a person heard a word that start with “B” like My Bonnie Lies Over the Ocean they had to raise their hands over their head and then it kept adding on to it to the point where their arms, legs, and head were moving all around.  She stated the second thing the Prime Timers did to get everyone involved was a Turkey Bowl, with frozen turkeys; a person would throw the turkeys down the aisle into bowling pins that were lined up; it was an exercise for community spirit, clapping, and just having fun, and she walked away with a wonderful feeling.

 

Chairman Scarborough stated Prime Timers is a wonderful opportunity with the help of matching State funds to take this program as part of a Parks and Recreation program and move it to other districts; and each district could have the Prime Timers at different times.  He advised Mr. Lusk has identified the source of funds because there was $40,000 left over from the SCAT program; the Board budgeted $3.5 million in general revenue coming back from the Tax Collector and received a little over $5.9 million; and Mr. Whitten has advised at the mid-year Budget the Board recognized a $4.6 million, which still leaves another $600 unrecognized.  He stated he hopes the funds are not an issue but whether Prime Timers is something that the Board wants to encourage people with.

 

Motion by Commissioner Voltz, seconded by Commissioner Bolin, to approve and authorize the Chairman to execute a “Letter of Understanding” with the State of Florida, Department of Elder Affairs (DOEA), Communities for a Lifetime, for the purpose of developing a model “best practices” positive aging program based on the successful “Prime Timers” senior adult program operated  by  Temple  Baptist  Church  in  North  Brevard; approve as requested by DOEA, a 50

percent cash match not to exceed $40,000; authorized the County Manager to execute the documents as required to implement the program contingent upon the County Attorney and Risk Management approval; and directed the Parks and Recreation Director to work with DOEA, the Housing & Human Services Department and other community agencies to develop the Program at multiple locations elsewhere in the County.  The Board further approved funding for the Program from the SCAT New Route funding that was approved by the Board earlier in the year, in which $40,000 is available to be transferred to the program on a one-time basis, as SCAT will require several months to implement the new route.  Motion carried and ordered unanimously.

 

 

BREVARD COUNTY ACTIONS

Chris Stagman, Executive Director, Brevard Alzheimer’s Foundation (BAF), stated these Workshops are outstanding; as he sits in the room today with his elder issue hat on and hears everyone talk, a person can begin to see the pattern and connect the dots; and hopes the Board continues to hold the Workshop because he thinks they are very useful.  He stated what he has heard today from the CEO’s of hospitals was a need for awareness and a lot of talk about bringing small businesses into the fold to help spread the awareness; stated as reported to the Board at the last Workshop, seniors need a single point of contact in the community to get help; and 2-1-1 does that to an extent, but it is information and referral only.  He stated One Senior Place has given the Alzheimer’s Foundation an in kind donation of some office space and phone lines for a whole year so it can launch a “We Help” concept as a senior information network; and seniors in the community in Brevard would have one point of contact to go to.  He stated the next thing that is going to happen is a Case Management component; seniors need to talk to somebody and somebody needs to be on the phone that is listening to them and then bring them in for a free consultation; stated it is very much like trying to put a puzzle together; each home situation is dynamic, whether dealing with a mom in Brevard and a daughter that is in Ohio, or husband and wife are here in Brevard and wife does not understand what is going on with the husband which could be Dimentia; and there could be a number of different things going on with health issues.  He stated what the Alzheimer’s Foundation, One Senior Place, and William A Johnson’s, P.A. Elder Law firm is doing as far as giving free legal advice to folks if he or she has an issue with guardianship; stated there needs to be some awareness of the services that are in the community for seniors to begin to connect the dots to get the folks together; and BAF provides a very strong service network under “We Help” so that when seniors know they have one point of contact he or she can get the proper Case Management care.  He stated “We Help” has a strong provider network to refer seniors out to, and he knows somebody is going to answer their questions, make appointments, and go with them to the referred help; but then it was taken a step further and wondered how businesses could get involved; and this is where the request really comes to the Board.  He stated a huge gap is seen in small businesses, and even in large businesses in the community that have access to seniors every day, that are not trained and do not know what to look for that a senior may potentially need help; a good example is within County government; if Code Enforcement gets a phone call say that someone has six feet tall grass and it has not been mowed in awhile and they go to the door and an 85 year old woman answers it, obviously that senior needs some type of assistance with the grass being mowed.  He stated the proposal to the Board is to, under the “We Help” tent; and provide this elder friendly program to where “We Help” will train County staff and local banks.

 

BREVARD COUNTY ACTIONS (CONTINUED)

 

William A Johnson, P.A. Elder Law Attorney, stated the decision tree would be low cost as simply a piece of paper with information on who a person would call when something occurs; for the most part, senior issues rarely are a one issue item; usually things are compounded into legal, financial, and healthcare issues, which would simply be what the decision tree would be; and if adult exploitation was seen, a call to Adult Protective Services can be made to determine if there is an immediate threat in place, or is it a neglect situation then they would need to call We Help so someone can go to them to see what is happening with the person and that way people are not calling Adult Protective Services to do things that could be done though We Help.

 

Commissioner Voltz inquired if an 85-year old woman goes into her bank with her 50-year old son and withdraws money, how it is recognized that it is odd, or whether it is legal for them to do that.  Mr. Johnson replied there are tellers that have called him if something did not look right; usually the teller can tell; and there is no real explanation as to how they know, but the just know something is not right.

 

Chairman Scarborough mentioned an estate he handled in which a gentleman had died and had no relatives around; stated he moved into an apartment two months before he passed; the people who owned the apartment had withdrawn $100,000 or more, as so-called gifts; the gentleman’s intentions are not known because he is dead; if somebody goes into a department store and steals something all the bells and whistles go off, but if somebody steals money from an elderly person who is suffering from depression who needs a friend, they get away with the theft because they cannot prosecute; and he feels there is something wrong with the world in that way.  Mr. Johnson replied the brokerage world has had more input, such as the caregiver trying to withdraw money; and the account was frozen by the brokers so the sudden change can be identified.  Commissioner Voltz inquired what kind of position does it put the son in that somebody is all of the sudden coming in and inquiring why is he taking his mothers money.  Mr. Johnson replied people usually very thankful that somebody was paying attention.

 

Commissioner Bolin inquired with the “We Help” program is there an age limit of who would be involved or financial qualifications that have to match.  Mr. Stagman responded there is no age limit; stated many times the caregiver is out-of-state and do not know where to begin; the idea is to have a centralized point-of-contact for a senior helpline that goes a step further; and it does intense care management and training the community on what to look for. 

 

Commissioner Bolin mentioned that in the State of Iowa there are professionals, who are senior advisors, and these people are hired to determine the best place for an individual, and it is presented to the family as a package deal; and inquired if that service is available in the State of Florida.  Mr. Johnson responded Brevard has ten people providing those professional services and they are called Geriatric Care Mangers.  Commissioner Bolin inquired if the Geriatric Care Managers are listed in the phone book.  Mr. Johnson replied there is a National Association of Geriatric Care Managers.  Mr. Stagman stated it is another example of how to connect the dots so folks will know those services available.

 

Commissioner Voltz inquired how much will it cost the Board to provide the “We Help” services.  Mr. Stagman responded a strong proposal for $66,800 will provide 20 training sessions in the community, decision tree brochure awareness, and a person in charge to make sure the coordination happens with the Commission on Aging and County services; it is one time request

BREVARD COUNTY ACTIONS (CONTINUED)

 

of the Board to help start the program; and the Alzheimer’s Foundation will be looking at grants and other ways to continue to sustain the program through its entirety. 

 

Commissioner Bolin inquired where will the money come from.  Chairman Scarborough responded the Board started at $3.5 million and then moved it to $4.6 million and it basically was moved into reserve, but there is still another $600,000, which was given from the Tax Collector that has not even been allocated anywhere; he also stated he could not think of a better way to spend a little extra money than to help the seniors; the $5.9 million went to the General Fund,  and  that  is  why  the  $6.2  million  does  not   all  come  to the Board; and what

Mr. Whitten sent to him was that the Board originally had moved it from $3.5 million to $4.6 million when the adjustment was done one week ago, and the Board actually got an additional $600,000 from which the Board has even touched.  He stated there is money there that is not even reflected in the budget; and the reserves would not even be reducing reserves because this has not even gone into the reserves.

 

Commissioner Nelson inquired if the item could be brought back to the Board as an actual Agenda Item so everyone will have all the details on December 17, 2008, that way it will all be out in front if anyone has questions.

 

Chairman Scarborough replied that can be done.

 

Commission Bolin state she would like to have the paperwork on it.

 

Keith Lundquist stated the service sounds like a great opportunity for seniors; and inquired if there are parameters as far as who would be referred to as agency X, Y, or Z.  Mr. Stagman responded that he wants to provide a network of people in the community that provide quality services.  He stated all of the sub-contractors will have his cell phone number so they can call on Saturday or Sunday if there is a problem that needs to be talked about; those are the kind of connections, or the kind of provider network that needs to be provided so there is some reciprocity amongst everyone to refer to each other; and the seniors will be getting a good quality service.  Mr. Lundquist stated his point would be if there are County dollars involved, to make sure there is equity among the various providers; stated One Senior Place for instance, has certain regulations, probably appropriately so, but only one type of agency; and he did not know if that will be the case.  Chairman Scarborough responded no, the Board just wants to make sure the people with direct contact with seniors are able to see more than just their particular area.

 

Commissioner Voltz added if there is any additional input; please give it to the Board before the November 17, 2008 meeting and please contact all Board members.

 

Chairman Scarborough stated please move on to the next issue.

 

William A Johnson, P.A. Elder Law Attorney, stated one of the Legislative proposed actions for the State that is in the packet is community care for the elderly and the nursing home diversion waiver cuts; it should be proposed to the Legislators that they fight not to have those programs cut; his experience in elder law is that every time there is a budget crisis the first item to go is social services; the easiest thing of the social services to pick on typically is long-term care; and there seems to be a myth, or a general attitude, that the people on Medicaid should have planned  better  or  bought  long-term care insurance.  He stated the handout he provided was a

BREVARD COUNTY ACTIONS (CONTINUED)

 

study done by the Kiser Family Foundation; it shows over half of seniors aged 65 plus have less than $25,000 a year in income and they simply cannot afford long-term care insurance; seniors aged 65 to 69 of those who do apply for long-term care insurance, 28 percent get rejected; and those from 70 to 75 that jumps up to 38 percent and now it is starting to get up to half of the people who tried to get this cannot.  He stated a majority  of  people  think  the seniors did not plan well and subsequently, that is why they are going on the State dole; stated that is not the case, as he has many people that have came into his office who cannot afford long-term care insurance  or  cannot  get  qualified  and/or  he or she cannot find a provider; and long-term care

insurance, with it has its time and place, is not the panacea it has been made out to be.  He stated that will leave with the Diversion Waiver program which is a service that provides services at home or in certain assisted living facilities that have contracts with the providers in that program; in the last fiscal year there was a waiting list; and before the Diversion Waiver even came into affect there was a program used that is called the ALF Waiver that is still around but it is very low funded because the Diversion Waiver took its funding.  He stated in the resent legislative materials it mentions the costs of what the State pays is $1,300 for somebody in the Diversion Waiver to help them stay at home or get services at an assisted living facility; and that is not 24/7 care and the family needs to be involved.  He explained what happens when the programs and budgets are cut, waiting lists are created and families are left with somebody in need who needs help now, without a way to get it; and what usually happens is they end up being put in a nursing home which usually costs the State $5,000 a month instead of $1,100 a month.  He explained he knows that information because he has personally told hundreds of families to put their loved ones in a nursing home because they simply could not wait because of a waiting list; he or she needed help; and their loved one was in danger at home, and it was not a safe environment.  He stated other times when there is no care in the home and the level of care does not meet where the senior is on the continuum of care, that difference is where bad things happen such as missed medications, falls, and a whole serious of events; with preventative medicine and keeping them at home safely would save the State a lot of money; if the program is cut again he will be telling families the same thing again; and if a family needs immediate help they will have to put their loved one in a nursing home. 

 

Chairman Scarborough inquired how much in this fiscal year is sent to the State for Medicaid contribution.  Assistant County Manager Heidi Dennis responded Medicaid nursing costs in 2008 is estimated at $422,360.53; budgeted was $514,948 for 2009; the State’s proposed cost to increase that will be from $55 a month per person to $202 per month per person; and the additional will be $2,548,080.

 

Chris Stagman, Executive Director, Brevard Alzheimer’s Foundation stated with these forums help people to begin to see how to connect the dots; the “We Help” Program, because it is awareness and prevention, if seniors know where to go early and do not wait too late and get dumped to Medicaid, it is a cost saving measure; also, the Nursing Home Diversion Program is one of the few things in Tallahassee that he feels is right; it is not being run really well, but it is right as far as putting the money where it needs to go; and again, the idea is to divert people from going to nursing homes by providing community based services in the community.  He stated he has seen that in the Alzheimer’s Foundation, and people laugh at him because there are two things that he knows how to do very well; one is eat and the second is how Tallahassee works; and as he started working with Mr. Steckler and figuring out what was going on in Tallahassee he realized this is a big cash cow for the HMO’s throughout the State.  He stated with the help of Senator Posey the Brevard Alzheimer’s Foundation is now a certified managed care  organization  under  the  program;  and  they  are  now  playing  with the Humanas, Amera

BREVARD COUNTY ACTIONS (CONTINUED)

 

Groups, and others folk throughout the state specifically in Brevard to help residents get the capitated rate of about $1,100 a month per client to provide services to keep them out of the nursing home, and it will help keep that $2.5 million amount down.  

 

 

 

Chairman Scarborough inquired with the legislative initiatives that are coming on now, Leigh Holt will integrate them into the package and view it again on December 17, 2008 as a whole and see if any Commissioner wants to add anything additional.  Mr. Stagman responded as far as the legislative package, he feels the discussion they just had about the $2.5 million contribution needs to be added to the legislative agenda so that Mr. Thrasher can go to Tallahassee with that included.

 

Mr. Stagman stated page 19 in the legislative package this is part of what the Governor and the Secretary of Elder Affairs are proposing to do, which is to eliminate all of the senior programs that are funded under the General Revenue and move them over to Medicaid; and that is why, the Board’s increase is what it is.  He stated the community care for the elderly program is a very effected and cost effective program for the State, however, part of the grand plan is to eliminate the General Revenue Programs and take that money and put it over to the Medicaid matching programs, and them some of that cost shift down to the County; the County gets funding from Alzheimers’ Disease Initiative Dollars (ADI) that is about $220,000 that they get straight from General Revenue that comes to the foundation through the Area Agencies on Aging (AAA) that is helped to subsidize adult daycare slots predominantly; and that would be eliminated if they had their way.  He stated the Community Care for the Elderly (CCE) is probably most important because the County gets the most chunk of money through the Community Services Council (CSC); and he feels the CCE issue has to be on the top of Mr. Thrasher’s and Ms. Holt’s list of trying to help in Tallahassee this next session. 

 

 

 

 

Ian Golden, Housing and Human Services, stated the items he will mention are from the Homeless Issues Workshop held last week to be brought back as legislative issues; and what was looked at is the need for more housing.  He stated after getting comments from some of the speakers at last week’s Homeless Issues Workshop and also solicited comments from the Brevard Continuum of Care Coalition, and what came about was one local, three state, and one federal issues for the Board to have some discussion about.  He stated the local issue revolves around barriers that municipalities around the State, and not just in Brevard County, put in place in regards to zoning issues for group homes; Florida has a Statute that allows for group homes of up to six individuals, but many times local municipalities put Zoning Codes and Ordinances into place that reduce that amount; what happens is that the local not-for-profits are then not able to provide that type of housing in the community; and it is very important for the ones at the low end of the socioeconomics spectrum, either homeless or on the cusp of homelessness, because they cannot afford one on their own, or with one or two roommates, pay market rent.  He stated the recommendation to the Board would be to host a meeting or a forum with the municipalities in Brevard to take a look at what the current zoning is throughout the County to see  if  there  are  any  ways  to  discuss  what  other options there are for housing, review those

SPECIAL HOMELESS ISSUES (CONTINUED)

 

ordinances and identify some productive ways for County and municipalities to work together to not only look at their autonomy in the municipalities, but in their needs as municipalities.

 

Chairman Scarborough inquired if Mr. Golden is asking there be a Workshop on the issue.  He stated he has sat in zoning meetings and there are multiple sides in an early conversation before there is a zoning discussion; and it is the best way to do it so all the wrinkles are out before getting to that particular crunch time.  Commissioner Nelson stated he has seen circumstances where a home was in a neighborhood and they added additional pavement in the front yard; it really turned into a commercial facility in a residential setting; and he thinks what the State envisioned was it would like just like everything else, but there would be up to six people in it; the reality is it becomes a nursing home-lite; and that is not what it ends up being all the time.  Chairman Scarborough stated there needs to be a good conversation where different parties are brought in to see multiple perspectives; and that would be a good way to start.  Commissioner Nelson responded that it may even be as simple as the location within that community.

 

Mr. Golden stated at the State level the three items were identification of homeless, food stamp applications, and healthcare issues.  He stated a lot of the homeless face issues with losing their identify; part of that has to do with being able to replace lost or stolen identification; without a social security card a person cannot get a driver’s license, and with a drivers license a person cannot get a social security card; and that is heard a lot from the homeless that are trying to access services and cannot because they do not have one of those forms of identification.  He stated the individual gets trapped into the cycle where they want help and to change their situation and are not able to because they cannot access those services.  He stated the issue and a possible solution is to take a look at the State level about taking a look at some identification cards that are already out their such as disabled veterans, and a person coming out of the corrections system, and just being able to allow the Division of Motor Vehicles to utilize those two identification systems where they do not now, would be a way and an avenue for homeless and others to be able to get identification cards.  He stated the second issue at the State level is food stamp usage; it is being looked at to have more access points to help people to get into the food stamp system; the issue heard from the not-for-profits is not that they do not want to provide the service, it is that the not-for-profits are either faith based or there is no physical ability to put the computer system into place for the internet access and a fax machine to get the information back and forth to the State; and a solution with food stamps is to make a change in the way the State hands out old equipment.  He stated the County is able to do that; when there is excess equipment it can be transferred to a not-for-profit; there is a stream lined system, in which a memo is sent to the County Manger and Property Control; but the state currently does not have a system like the Brevard’s in place, and it would be a way to enable some of those not-for-profit partners to become those access points.  He stated the third issue is healthcare and dental is the hardest specialty services to access for any population; when looking at what services a person is able to get to and regular physicians have a requirement for licensesure for pro-bono work to maintain licensesure; there is not a requirement currently in place for dentists; and changing licensesure and requiring pro-bono work of dentist could alleviate, hopefully, some of the backlog.

 

Commissioner Bolin inquired if a heart doctor is required to give free work to keep their license, but a dentist is not.  Mr. Golden responded with that is correct, and neither is an optometrist required to give free work.

 

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Dr. Heshmati stated it is not a requirement for any physician to do any volunteer work for licensesure; when applying for the license there is a box to mark that he or she volunteers to work if there is a disaster of some sort; and for a dentist the Dental Society is pushing that if any dentist wants to be a member of the Dental Society, they need to participate in volunteer dentistry.   He stated to get the  privilege of the hospital for physician; one of the requirements before was that there had to be volunteer work done; but now that is no longer a requirement.  He stated there is close to 70 or 80 dentists helping, but that is not enough; and there is more opportunity available if hospitals would put some partnership funding into the dentistry field. 

 

Mr. Golden stated there was a suggestion requiring pro-bono work; the impression was that right now the materials used cannot be written off on their taxes; and inquired if that is true.  Dr. Heshmati explained he has discussed it with the Financial Medical Association (FMA) and it does not work for doctors because how can they be tax free if a doctor is not getting anything how can it be a tax brake.  Mr. Golden responded he feels the concern was with materials used in the course of providing the pro-bono work not exactly for the time of the doctors themselves.

 

Mr. Golden stated one item heard at last week’s Workshop is on a Federal level had to do with veterans benefits and how those benefits originate and go to the State where the Veteran was discharged from the military; it can take up to two years for those benefits to follow that person if they move to a different state; and the significant impact for Florida is that because Florida is a retirement destination there are a lot of people that only come for a part of the year such as a snow birds with their benefits continuing in their home State and do not follow them here to Florida.  He stated there has not been an idea put together as what the Federal level is looking for with a change in Florida, but just the idea of starting the Federal representatives looking at and trying to make it a fairer process and have those dollars follow the person even when a service is utilized; and the hospital is able to bill for those services as needed. 

 

Chairman Scarborough inquired if there is anything Dr. Heshmati thinks that should be added to the legislative packet with health.  Dr. Heshmati responded the sovereign immunity issue does not have any problems because if a person looks very carefully at the rules and regulations of sovereign immunity it is very clear any practitioner or organization that provides healthcare to anybody without asking for money can have sovereign immunity with no problem; stated it all comes through him; there is an application stating that they do not discriminate; and he will sign it and the doctor will have sovereign immunity.  He stated in reference to what Mr. Whitaker was talking about he feels was a cap or limitation on malpractice, and it is something that the Medical Society is working on every year, but so far has not been successful in doing so; and maybe since he is the Medical Society President he could get some help from the Board and the Medical Society.  He stated the Obstetrics and Gynecology (OBGYN) residents in other states do not want to come to Florida because it is impossible not to have malpractice; when a doctor has malpractice they cannot get insurance anymore; even if a person wanted to start it, it is $150,000; if and when there is one law suit the insurance cost can go to $200,000 to $250,000; and feels there should be a cap on it.

 

County Manager Peggy Busacca inquired if Dr. Heshmati could help on the sovereign immunity issue at the public hospitals versus the non-public hospitals, because some of the doctors at the public hospital, Jess Parrish, were getting a different kind of sovereign immunity than at the non-public hospitals.  Dr. Heshmati explained Jess Parrish is a public hospital; it is just like Brevard Health   Alliance,  they  are   covered;  any   employee  at   the  hospital  is  just  like  the  Health

 

SPECIAL HOMELESS ISSUES (CONTINUED)

 

Department, they can be sued; but not individually; and it is not sovereign immunity, it is just coverage because it is a community hospital and it do not need Brevard Health Alliance. 

 

Ms. Busacca inquired if the Board needs to consider in the legislative package that emergency room doctors and specialists treating uninsured people would also have sovereign immunity even if they were not a community hospital.  Dr. Heshmati responded they can if they signed with him with some requirements; if a patient is seen on the street and a doctor helps them they have some immunity again, but still there are other requirements that if there is no other help available, and if there is help and a doctor does some thing wrong they are not covered.

 

Commissioner Voltz stated Bill Ellis stated that there was a bill over the last several years and this year it looks as if it may get a bit more traction than the rest and it was on the sovereign immunity issues; and maybe the Board could ask of Mr. Ellis to support what is being done.  Chairman Scarborough inquired if there are any other health issues to discuss.  Ron Morgan stated he had asked Keith Lundquist if he had any access to the Florida Bright Project dollars, which is the State program for substance abuse by older adults over age 55; the State targets a percentage for different drugs and medications, but alcohol is 70 percent; and that is the biggest problem most people have.  He advised Florida Bright Project was up for 16 sites in Florida; Brevard County is not one of them; and he would appreciate it if Brevard County could be designated as a site for Florida Bright Project.

 

 

 

Chairman Scarborough inquired if there are any questions referring to the legislative package.  Commissioner Voltz responded the next Board needs to relook at the package because there will be three new Commissioners and the priorities may change; and it should be put back on the Agenda to talk about.   Government Relation’s Manager Leigh Holt stated it is very important for this Board, as quickly as possible, bless the package, and if that is on the December 17, 2008 that is fine so the new pieces may be added.  Chairman Scarborough stated Commissioner Nelson wants to bring back more of Mr. Stagman’s suggestions to be added.  Ms. Holt stated this is being seen as the marching orders and she is ready to go Tallahassee to work with the Governor’s staff on the budget right now; there may be new issues that need to be added on, but at least there is something to work from for the time being.  County Manager Busacca inquired about the working factor of budget that Ms. Holt brought up; state one of the issues the Board has is the Community Care for the elderly which could be $2.5 million; and inquired would the Board like to move that up to one of its priority issues.  Chairman Scarborough responded that it is a priority because it would be devastating to the Commission to have another $2.5 million; stated things coming under the radar and the Board does not even know they are happening; and a new Board coming in they may not be as sensitive.  Chairman Bolin stated she feels comfortable with what is presented to be a very good program; and as far as the marching orders the Board will be adding a few more things to it and the foundation is there to move forward.

 

Commissioner Nelson stated he knows there were some generators given last year and now one is being asked for, for Sunrise; and inquired if the other ones have been installed, and the cost involved.  Mr. Lay responded there was not a cost to the Board but there was a cost to the State; for installation at each school there was a cost of $1.2 million; there is one in place at Quest  and  Ralph  Williams  Elementary  Schools.  He stated in the pool of generators the State

 

found one generator that was not wanted by another school board; it was agreeing that the Brevard County School Board would take it for $500,000; and it is critically needed and that is why thy money is being asked.  Commissioner Nelson responded he thinks it is great.  Ms. Holt commented that this item was put in last year’s package and the delegation was outraged that the department in Tallahassee had budgeted to buy all of these generators and not install them.

 

Upon motion and vote, the meeting adjourned at 4:55 p.m.

 

 

 

 

 

ATTEST:

 

                                                                        ­­­­­­­­­­­­_________________________________

                                                                        TRUMAN SCARBOROUGH, CHAIRMAN

                                                                        BOARD OF COUNTY COMMISSIONERS

                                                                        BREVARD COUNTY, FLORIDA

SCOTT ELLIS, CLERK