The Governing Board of the Kane County Human Resources Special Service District, D/B/A/ Kane County Hospital monthly meeting was held on Thursday April 30, 2009. The meetings are open to the public. Chairperson Dottie Ratzlaff conducted the meeting.

Kane County Hospital Administrator Sherrie Pandya presented an action item of requiring a Board Resolution for opting out of the Utah State Retirement System.

The resolution pertains to the Kane County Hospital as part of a Special Service District pursuant to Utah State Code 17D Chapter 1. 

Several hospital employees were present and voiced their concern about the possible loss of monies contributed to the Utah State Retirement Plan.

The hospital is a non-profit organization created as Special Service District to provide medical care to the residents of Kane County. It is a “quasi” part of the county government. Operating funds are generated by the Payment in Lieu of Taxes (PLT), Medicaid Disproportionate Share Payments (DSH) and the 1% sales tax.

Employee relations Attorney Wally Lloyd appeared at the request of the Hospital Governing Board. Lloyd explained there are two retirement plans involved in the hospital’s dilemma, the Utah State Retirement System (URS) and the 401(k) operated by the Internal Revenue (IRS). There is a provision in the Internal Revenue code that basically states, if you are a governmental entity such as the hospital, you are not permitted to sponsor a 401(K) plan unless you adopted that plan prior to May 6, 1986.

Lloyd also stated the 401(k) plan cannot be continued in operation because it an inappropriate retirement plan for the hospital employees. He pointed out there is a procedure the IRS created for dealing with this situation. Steps to follow are; officially notifying the IRS, paying a fee and getting the IRS to agree to not charge the hospital back taxes. It will take some time to resolve this situation. If the IRS agrees, the money contributed to the plan could be moved into a valid retirement plan.

Lloyd addressed the second problem: How does the Utah State Retirement System (URS) interact with the hospital? The URS is costly, a bill is sent to the hospital each month for payment for a percentage of payrolls. Lloyd continued that there is a misconception with the URS plan: The employee does not have an individual account, instead there is a record of service.    

Representative Mike Noel attended the meeting and explained the error or misunderstanding was created in 1993, at the time the retirement plan was first presented to the Hospital Board and Administration for approval. They were not aware or told about the IRS code of 1986.   

The employees were upset the error was not found and corrected sooner.

According to Noel, there are more rural hospitals in this same predicament. He has sponsored House Bill 167: County Hospital Retirement Provisions. Noel continued, the URS could have the potential of bankrupting rural hospitals.

Ratzlaff, acknowledged the fact that hospital and employee contributions should have been made to a 403(b) a retirement savings plan for non-profit organizations instead of to the public or state 401(k) plan which is a qualified tax-deferred plan governed by the IRS.

Deferrals to the 401(k) plan are deducted from the employees pay before income taxes are assessed to the wages. The funds contributed and the earnings that accumulate are not taxed until withdrawn.

Ratzlaff said there would be an information meeting held on Friday May 1, for the hospital employees.

Kathleen Salter was selected as chairperson to pursue the challenge of re-establishing the Kane County Hospital Foundation. Human Resource Director Laurali Noteman will assist Salter.

A hospital foundation raises money and community awareness for the hospital. The same way a concrete foundation physically holds up a house, the hospital foundations financially “hold up” thousands of not-for-profit hospitals.

 Salter explained the Kane County Hospital Foundation’s by-laws needed to be up-dated. One of major goals of the foundation is education outreach. Salter would like to encourage a change to the citizens association with the hospital as not just a place to go when a person is sick or visiting someone who is sick but to a positive more learning experience.

 Other objectives were “plan giving” or “estate planning” in regards to contributions to the Kane County Hospital Foundation and how it is done, creating a website, getting the community involved in “fun” things like baseball games and other sports involving the hospital staff. Noteman will set a date for the next foundation meeting.

Dr. David Salter reported on the clinic and how quality care could be improved by participating in the Utah Health Information System, a regional health information exchange. Currently a patient’s information is hand written in the patient’s chart. The history of that documentation or monitoring is not available since the hospital does not have a health information database.

Taking it a step further, Dr. Salter suggested providing some type of community screening process with the information to go directly to the database and be recorded.

Dr. Salter explained medicine has changed and needs to keep up with those changes by moving from a reactive mode of medicine to proactive medicine.

Reactive medical care waits for a disease to begin and then treats the patient by finding and treating the symptoms ex.-hypertension, cholesterol, obesity, and diabetes.

Dr. Salter stated in “chronic illnesses reactive medicine doesn’t work”.

Proactive medical care involves, information management, community-based disease detection, self-management support through patient education.

Dr. Salter stated stimulus money is available for health information technology; it will be given only to instutions that can demonstrate they are in the proactive mode. The cost of state-of-the-art health information technology systems is approximately $60,000 for the first year and $5,000 a year thereafter. That includes hardware, software, training and support.

When asked if this included the hospital, Dr. Salter replied this cost is for the clinic only. To include the hospital would cost approximately $100,000.

Pandya acknowledged the fact that by 2012, all patient medical records will be required to be entered into the electronic record system.

Medical Staff Business: Dr .Ott made reference to the “swine flu” stating there have been 109 reported cases in the United States in 11 states. There have been five probable cases in Utah.

Pandya and Ott had a conference call with Dr. David Blodgett, Southwest’s Director/Health Officer to learn more about what can be done.  When asked if the state will provide pandemic flu supplies to Kane County, Pandya stated only if and when there has been a confirmed case in the hospital. The guidelines are set. Pandya reiterated the ordering of masks, tests etc. is virtually frozen until there is a hospitalized case. Authorizing the closing of schools comes from the Health Department not the doctors at the hospital.

Ott stated if a person does not have a fever of 101 or over, they do not have this disease. Educating the public on the symptoms is necessary. Ott did state there have been several cases of influenza type “B” in the area. When asked if influenza type “B” can turn into influenza type “A” Doctor Ott replied no.

Director of Nursing Rosalie Esplin presented the policies and procedures plan compiled by the nursing staff for the Adverse Drug Event (ADE) in-patient safety program. The program is required to be audited by an outside company every three years at the expense of the hospital.

Esplin explained the program is monitored, in house, quarterly and a report given to the governing board and explained ADE means any adverse drug event involving a medication that has a potential to cause a patient harm.

What the auditors look for is the right drug and dosage prescribed, proper administration, the right patient, and timeliness of drug administration and if the drug is available to give the patient. The hospital passed the audit and the board approved the Nursing Staff’s plan.

Finance Report: Director Steven Howells reported in general, revenue is lower than budgeted and lower than last year, but accounts receivable has improved. 

Human Resources and Public Relations Report: Laurali Noteman thanked the Hospital Auxiliary for the $939,793.00 towards the purchase of equipment for the hospital from 1990 to the present. The auxiliary is currently remodeling the Thrift Store and will be closed from May 11 to May 16 for the installation of new carpeting. Administrator

Pandya asked the board to approve the revised 2009 Auxiliary By-laws. Auxiliary member Mary Craven reported the last revision was done in 2003.

Noteman informed the board the new “question and answer” article from the clinic would appear in the Southern Utah News on May 6, along with a picture of the “clinic girls”.

Pandya presented the Kane County Hospital Laboratory Policy and Procedures. Jeanette Johnson was out of town but has reviewed them. They were taken to Utah Valley and approved by the hospital “Lab” director there as well as the on site medical staff. Pandya requested final approval by the Governing Board. The board approved.