RIVERSIDE MEDICAL CENTER BOARD OF COMMISSIONERS REGULAR MEETING APRIL 24, 2014

Transcription

1 RIVERSIDE MEDICAL CENTER BOARD OF COMMISSIONERS REGULAR MEETING The regular monthly meeting of the Riverside Medical Center Board of Commissioners was held on Thursday, April 24, 2014, at 4:00 p.m. in the Hospital Cafeteria. Members present: Lionel Jones; Lavern Jenkins; James Knight; Gerald King; Violet Tate: Barry Kennedy; Mark James, M.D.; and Pamela Breland. Members absent: James Thomas; and Rachel Gill Guests present: Kyle Magee, M.D., CEO; John Allen, Hospital Attorney; Ben Lott, Assistant Administrator/VP Clinical Services; Lesia McQueen; Michael Magee, John Seal; Claire McGuire; Sharon Breland; Carol LeBlanc; Shad Jenkins; Melissa Gilmore; Crystal Lyons; Annie Ball; Myra Gunnell; Lynn Mayeux; Frank Voelker, M.D.; Any Seal; Brandon Bean, M.D.; Mark Watson; David Powers, M.D., Lucy Parker; Kenny Seal; Sharon Beckett; Edna Kennedy; Jerry Thomas, M.D., Libeau Berthelot, M.D.; Kay Robbins ; Denise Fitzgerald; and Sherae Killingsworth. The meeting was called to order by Lionel Jones, Chairman at 4:00 p.m. INVOCATION Board Member Reverend King gave the Invocation. PLEDGE OF ALLEGIANCE Board Chairman Mr. Lionel Jones called for the Pledge of Allegiance. APPROVAL OF MINUTES The minutes of the regular meeting held on March 27, 2014 were reviewed and approved by Mr. Jenkins seconded Mr. Knight as presented. ANNUAL BOARD PERFORMACE APPRAISAL FOR 2013 Mr. Jones reviewed the summary of the Board of Commissioners Annual Performance Appraisal for the year 2013, a complete copy of the report is on file with these minutes. He stressed the importance of each Board Member completing the appraisal that is required every year. Mr. Jones stated the main emphasis on improving revenue without impacting patient care. Mr. Jones stated that continued efforts on financial stability and the overall participation of Board Members to be emphasized. He said we will continue recruiting doctors and be aggressive with inpatient services provided. DIAYLSIS Dr. David Powers introduced himself to the Board of Commissioners as the Medical Director for Fresenius. He told the Board of Commissioners he was concerned that he, as the Medical Director, was not notified about the lease not being renewed and that he learned about the situation in January from a nurse. Dr. Powers said that he went to Fresenius management that day to ask what was going on but was given no information. Dr. Powers stated that he purchased the dialysis equipment and assets from Riverside in 2003 and later sold it to Fresenius before becoming the local unit s Medical Director. Dr. Powers said his intention at the meeting was to find out what the Board s plans are. He was concerned about the plans for the dialysis center and the impending displacement of patients as well as the issues that could arise due to the disruption to patient s dialysis schedules. The dialysis center is currently serving 24 patients. Michael Magee said the hospital s auditor said the hospital was losing money by leasing he space for dialysis use and had recommended a few times that something else be done with the building. Since

2 PAGE 2 OF 9 DIAYLSIS (Continue) the hospital is a critical access hospital, space that is used for direct care of its patients is cost reportable with Medicare, but by leasing the space to a third party, the hospital does not get any reimbursement from Medicare. Mr. Magee provided the timeline from December to present for Dr. Powers with all the attempts that was made to contact Fresenius. Mr. Magee said the contract with Fresenius states that if the lease is not being renewed, a 90 days notice must be given but because we care about these patients as members of the community we chose to give 180 days notice instead. Mr. Magee said we gave Fresenius adequate notification to let them know we won t be renewing their lease, so they would notify the Medical Director, Dr. Powers as well as the patients. Mr. Magee said it was always the hospital s intention that the patients would know in enough time, and the company had six months to arrange for adequate displacement. Dr. Powers did not dispute the information or timeline, saying he believes Fresenius has not handled this well at all. Dr. Powers asked the Board to provide at least 60 days to determine if another dialysis vendor could be found and to make a plan for where patients can go in the meantime. He said if we had 60 days, that s 60 days to do a better job than we ve done, I m here to plea for any delay. Dr. Brandon Bean expressed his concern for the patients as well as and also requested additional time to place the patients. The Board of Commissioners deferred the issue for further discussion in Executive Session. FINANCE AND CAPITAL PLANNING COMMITTEE REPORT Mr. Jenkins reviewed the minutes of the Finance and Capital Planning Committee meeting held on April 22, 2014, a complete copy of which is on file with these minutes. REVISED TUITION REIMBURSEMENT Mr. Jenkins presented to the Committee the Revised Tuition Reimbursement policy, a copy of which is on file with these minutes. He stated that the changes to the policy were from 6 to 12 hours per semester and also to include reimbursement for books and supplies needed for each course. Mr. Jenkins said team members participating in the previous tuition assistance program have the following two options: a) Keep the same terms and conditions under the old policy or b) Elect to accept the new policy terms and conditions, which would include but not limited to any reimbursement differential for previous courses taken that were reimbursed at a lower rate than the new policy. There were no changes to the tuition assistance form. Upon review, a motion was made by Mr. Jenkins seconded by Ms. Breland to approve policy as presented. Motion carried. MRI MOBILE CONTRACT Mr. Jenkins presented to the Committee the MRI Mobile Contract, a copy of which is on file with these minutes. He said that the current contract is with Alliance Imaging at $365 per MRI scan which includes staff, and the contract expires on May 31 st. Mr. Jenkins obtained a quote from COL Imaging Solutions, LLC for $350 per MRI scan which includes staff and this month for a month to month with a 90 day out. Mr. Jenkins said the monthly minimum guarantee of 50 MRI scans, monthly cap not to exceed 80 MRI scans and $25 per Pre Employment Screening scans. He also stated that RMC has the option to convert to unstaffed rate of $285 per scan by giving COL 30 day notice. Mr. Jenkins also stated that the amount of MRI scans being preformed has decreased. He further stated that Alliance did provide a new quote in the amount of $355 per scan. Dr. James asked what size and age of the MRI unit COL Imaging would provide. At the request of the Committee, Mr. Magee said as per his conversation with Patrick Howard the company will put RMC logo on the trailer, the manufactured date of the MRI unit was 2004, the refurbishment date of the MRI equipment was February 2014 (work consisted of new Gradient Amps and RF amps) and the software platform was upgraded to 9.11X. The mobile coach was also refurbished on February This work consisted of Repainting of the entire exterior of the coach, new flooring inside

3 PAGE 3 OF 9 FINANCE AND CAPITAL PLANNING COMMITTEE REPORT (Continue) coach, generator overhaul, HVAC overhaul, lift gate overhaul. This coach looks fantastic and is practically brand new. Mr. Magee said there will be no down time for hook up of the unit. Upon review, a motion was made by Mr. Jenkins seconded by Ms. Breland to approve the contract as presented. Motion carried. VERBAL ANNOUNCEMENT OF TAX MILLAGE Mr. Jenkins said that a verbal announcement of the tax millage must be announced at this Board Meeting and placed in the newspaper prior to being approved at the June Board meeting in accordance with guideline as set by the Louisiana Legislative Auditors office. CHIEF FINANCIAL OFFICER S REPORT Mr. Magee said the cash balance as of today is $2,063,000. We currently have 30 days cash on hand which was enhanced by receiving the UPL funds for the 3 rd & 4 th quarters. The account payable is at $870, 000. Mr. Magee stated there were 41 admissions for the month which was 14 patients less than last year and a 25% reduction for the year compared to a budget of 65 and prior year of 55. He reported that there were 35 observation stays compared to 13 last year. There were 119 acute, 28 swing bed and 32 observations patients days with a total decrease of 117 or 39% compared to last year. The average daily census of all admissions including swing bed, acute and observation for the month is Mr. Magee reported that during March the acute average daily census was 3.84 compared to 6.74 for the prior year and 7.48 budgeted. The swing bed census average was 0.90 for the month of March. The average length of stay for acute during the month of March for the hospital was 3.22 and for swing bed is The average length of stay for acute Medicare for March is 3.33 days which was a decrease from last month at Total equivalent patient days for the month were 1,134 compared to a budget of 1,498 and prior year of 1,256. Total emergency department visits were 1,351 for the month, compared to 1,295 for prior year and 1,275 budgeted. There were 53 surgical procedures performed during the month compared to budget of 65 and prior year of 61. There was a 6.67% increase or 11 additional surgery cases year to-date. There were 1,777 outpatient registrations during the month with 5,022 year-to-date which is an increase of 3.61% or 175 registrations from prior year. There were 196 FTE s for March compared to 178 for the prior year and 186 budgeted. Mr. Magee said noted the increase is due to PTO cash which accounts for four additional FTE s and three employees out on FLMA with seven additional staffing needed to fill those positions. Accounts payable days were at 55 for March and 29 for the prior year. Mr. Magee said less than 60 days on an average to pay our vendors is right within our range. Total Patient Revenue for the month of March was $3,578,348 which was under budget. There continues to be a drop in inpatient revenue by 42% year-to-date. Total Other Revenue for March was $175,525. Total Gross Revenue for March was $3,753,874. Total Deductions from Revenue for March were $2,254,565. He presented the contractual allowances for Medicare and Medicaid broken down by inpatient and outpatient by payer for Medicare, Medicaid, Bayou Health Plans, Champus, Franklinton Rural Health Clinic, and Pediatric Internal Clinic. Mr. Magee stated a breakdown by Medicaid and Medicare contractual allowances with the total contractual allowance for March is $1,333,527. The year to date contractual allowances is $3,904,902. The breakdown by Medicare allowance for the Franklinton Rural Health Clinic is ($14,696) and the year to date is ($34,581). He reported that the Pediatric Internal Clinic

4 PAGE 4 OF 9 CHIEF FINANCIAL OFFICER S REPORT (Continue) Medicare allowance is $4,197 for March and the year to date is $14,379. Total breakdown by commercial other allowance is $633,806 for the month and $1,846,905 year to date for the hospital. Net revenue for March was $1,499,309 which was below budget and 11% decrease compared to last year. Personnel expenses totaled $1,076,102 for the month which was under budget by ($32,212). Other operating expenses were $757,904 during March which was over budget by $18,498 due to repairs and maintenance. Total Operating expenses for March were $1,834,006 which was less than budget by ($13,714). The net operating loss for the month of March was ($334,697) compared to a budgeted loss of ($79,031). Non-operating profit for the month was $124,098. The hospital experienced a net loss for the month of ($210,600). He reported a 47% decrease in inpatient revenue compared to what was budgeted is leading to the net loss. The itemized list of the income statement was ed to the Committee in detail prior to the meeting. The current assets were $3,853,524 with current liabilities at $2,801,352 providing a current ratio of 1.37 for March and the prior month was Mr. Magee stated that we would like to see that number greater than 2. Mr. Magee stated that the current ratio measures the ability of the hospital to rely solely on its liquid assets to pay current liabilities. Mr. Magee presented a Cash Flow Statement for March 2014 which identified the activities of the hospital that are generating or consuming the cash. The hospital has generated $464,038 this year providing a cash balance as of March 31, 2014 of $766,506. The total days Operating Cash on Hand was 13 days which is a decrease from 14 for March. He said expenses per day average are $57,910 for March and the prior month was $58,044. The daily operating revenue is $48,978 which is a difference of $8, The Sinking Bond Fund has been paid off and all remaining funds have been dispersed in the Emergency Department and Rehab areas as required by the bond. He presented a graph of cash on hand on a day by day basis for the month of March. He reported that the average cash on hand was 15 for the month of March. Mr. Magee said we are currently at 30 days cash on hand, where compared to last year at this time, the hospital had an average of 3 days cash on hand. Mr. Magee presented a cash projection statement and graph from March Mr. Magee stated the projection was created based off historical data from collections and expenditures. He further stated that our cash position has improved since we received all the UPL and ad valorem funds. Mr. Magee reported that there were no capital expenditures during the month of March Total capital expenditures for the year were $146,885. Mr. Magee reviewed the Accounts Receivable Analysis totals and graph. Gross Accounts Receivable as of March 31, 2014 was $6,514,019 which reflected an increase of $232,287 from February. Total days of gross revenue uncollected were compared to for the prior month. There was an increase of 2.91 for the March and the prior month was at Net days uncollected were days compared to December 31, 2013 of days. He reported the State average benchmark is Mr. Magee presented a graph with gross accounts receivable days from March 2012 through March 2014 which reflects a downward trend slope currently, a copy of which is on file with these minutes. There was no

5 PAGE 5 OF 9 CHIEF FINANCIAL OFFICER S REPORT (Continue) recipient that qualified for the Charity Program during the month of March. The year-to-date written off balance for the Charity program is $11, The monthly listing of the amounts written off as bad debts for the month of March were presented and reviewed at the meeting, which was approved by Ms. Breland and seconded by Mr. Jones as presented. Motion carried. Accounts written off as bad debts during March 2014 totaled $290,726. The year-to-date bad debt is $872,332. A summary of the bad debt accounts was presented showing the percentage of the accounts that were payor type versus stay type. He reported that the accounts written off as uncollectible in March for the Franklinton Rural Health Clinic were $ He reported that the accounts written off as uncollectible in March for the Pediatric and Internal Medicine Clinic were $ The year-to-date write off for both clinics is $ Mr. Magee said the Profit and Loss Statement was ed to the Committee in detail prior to the meeting. BUILDING & GROUNDS REPORT Mr. Knight presented the Building & Grounds Report which was held on April 2, 2014, a complete copy of which is on file with these minutes. Mr. Knight stated that we received a quote from Stewart Signs to replace the current sign in the front of the hospital and the Committee placed the sign on hold in order to use the funds for patient care areas with hopes of the possibility that the RMC Foundation, be able at some point to assist with the purchase of a new sign. Mr. Knight said eventually we are going to have armed security for the facility before an incident happens. Dr. Magee explains several incidents that occurred within the last three months. Dr. Magee also said that he feels the hospital should be on lock down like other facilities after 5 p.m. in the evening. His plans are to have all side entrances locked at 5 p.m. and front entrance locked after visiting hours around 8:30 p.m. so that all traffic has to be entered through the Emergency Department with hopes to have ED card swipes for all employees to help secure the hospital. A memo will be forwarded to all employees prior to the lock down process being implemented in the near future. SURPLUS LIST Mr. Knight presented for review by the Committee a surplus equipment list, a copy of which is on file with these minutes. The Committee agreed to allow the equipment to be declared surplus and taken to the State of Louisiana Agency. Motion carried. MEDICAL STAFF REPORT The last meeting of the Riverside Medical Center Medical Staff was held on April 17, 2014, a copy of which is on file with these minutes. A presentation on Wound Care was presented by Dylan Sanders and Tim Foret from Wound Care Specialists. Dylan Sanders stated that at Louisiana Wound Care Specialist our team is designed to treat the patient in an outpatient setting with a comprehensive wound care management plan. Dr. Foret notified the Medical Staff that we are still awaiting the final revisions for Bylaws from Ms. Griffith but there was a house bill that passed that does away with the requirements for the collaborative agreement so by saying that even though Ms. Griffith is working on the Bylaws changes if this bill passes as is, then we need additional changes to the Bylaws in the future.

6 PAGE 6 OF 9 MEDICAL STAFF REPORT (Continue) The MEC Metformin Form for the Radiology Department was presented but after discussion it was decided that the form and policy would remain the same. He also stated that St. Tammany, Lakeview, North Oaks, and the American College of Radiology policies were checked and our policy is current with those. The Medical Staff agreed with the current contrast policy and form and staff will be reeducated. The MEC approved the Acknowledgement & Understanding of the Notice of Privacy Practices Consent as presented by the Quality Council. Upon review, the MEC approved the Revised Annual Review of the Abbreviations Policy & Symbol List with changes as discussion with the Medical Staff. There was a discussion regarding the Fresenius contract with the Medical Staff and Dr. James requested that Dr. Powers be placed on the Board Agenda for the meeting scheduled for Thursday, April 24, The Medical Staff reviewed the new criteria for patients to received cardiac rehab. Upon review, a motion was made by Dr. James seconded by Mr. Jenkins to approve the consents and the abbreviation policy and symbol list as presented. Motion carried. PATIENT CARE REPORT Mr. Lott presented the Patient Care Report for April 24, 2014, a complete copy of which is on file with these minutes. The clinical report is as follows: We continue to be agency free in all clinical departments. The in-patient census is below normal and the supervisors are making adjustments as necessary. I am working with Michael to evaluate acute admissions versus observations. We will provide each physician with their year-to-date admit rate with a comparison to last year. The Supervisors continue to review all transfers in real time and will make recommendations for review in ED Quality. We continue to review complaints and quality indicators to report to ED Quality. C&M is also reviewing physician statistics for improvement and incentives. On April 7, we activated our hospital disaster plan due to an influx of patients in the Emergency Department from an accident. The process went smoothly with no major occurrences. The ED saw a record 76 patients that day. The Cardiac Rehab service continues to grow. We recently did an inservice for the medical staff on the CMS Final Decision Memo, which includes coverage for cardiac rehab services to certain Medicare beneficiaries with heart failure. The Employee 340B Pharmacy Program started on April 1 with great success. To date, the pharmacy has filled day prescriptions. This is a huge benefit to the employees. We will perform a study after the 90 day mark to evaluate the savings to the hospital. We continue to work with Sentry and Forshags Pharmacy on an indigent contract to offer on the retail side of the program. We will keep the Board updated as the program progresses. PAGE 7 OF 9

7 PATIENT CARE REPORT Pharmacy, Nursing, and IT services are implementing the ED pharmacy cabinet interface. The electronic prescriptions interface is implemented and working. We had an on-site evaluation from Geaux Tech, LLC, a third party consultant recommended by LHA. They are looking at our IT infrastructure and will make recommendations for improvement. We had an on-site visit from CPSI to evaluate us for best practices. They made some recommendations on their visit and they will provide us with a written report in the coming weeks. We also had an on-site visit from Cerner EMR vendor who did demonstrations for all departments. We are in the process of looking at pricing and will update the board as the project progresses. Mr. Lott stated that Bryan Tate is coordinating with Toshiba for the installation of the new Radiology equipment in the coming months. The fluoroscopy room is tentatively scheduled for install in June, Mammography is scheduled to start July 7, x-ray is scheduled to start July 28 and CT December 1. We received a signed transfer agreement from Lakeview. I did get an update from STPH s staff attorney on the agreement we presented them with. Mr. Lott said he forwarded to John Allen for follow-up. Also, he said we are working with our EMS provider to update our existing transfer agreement with language specific to the cath lab. We received our statement of deficiencies from the CLIA survey in December. Jeffrey Vince, Rachel Sones, Lesia McQueen, and Ben Lott completed the plan of correction and sent back to CMS. We will have a more detailed report in the future. The Performance Improvement and Risk Management are as follows: Post ED Visit Follow Up Phone Calls: The March phone calls yielded a 96% satisfaction rate. 100% of patients stated they were kept informed during their stay and understood their discharge instructions.j.l. Morgan and Associates: Overall March satisfaction was at 91%, for the ED 88%, Inpatient was at 92%, and Outpatient was at 92%. Our med verify rate was 99% for March This is above the hospital set threshold of 90% We had a teleconference with Tulane, HCA, and In Touch Solutions about the telemedicine program. They are working with us on protocols and plan for RMC nurse and physician education on May 18 & 20, Crystal Lyons is working on policies, regulations, and planning. The framing process has begun on the Cath lab building. Marty Rogers, Supervisor, will begin on April 28. We have made contact with the Louisiana Department of Health and Hospitals to notify them of our occupancy intent and our intent to open a Cath Lab. The tentative timeline we will be providing them is: March 24-groundbreaking, June 9- equipment installation, and July 1-opening. We will keep you all informed as the process progresses or the timeline changes. We participated in the American Association s Heart Walk on March 29 at Fountainbleau State Park. Several participants from RMC helped at our table and walked the 5K walk. Our fundraising efforts were successful. Mr. Lott expressed his appreciation to those who participated. Dr. Yasheka Nicholson will be in Franklinton May 6-8 working with staff in preparation for her start date PAGE 8 OF 9

8 PATIENT CARE REPORT (Continue) June 1. We are planning a welcome dinner on May 7 at 6pm at Mike s. Board members and medical staff are invited to attend. Dr. Deavens will begin his practice once he completes his Residency this summer. RMC will participate in the American Cancer Society s Relay for Life at Cassidy Park in Bogalusa on May 2. Several fundraisers have taken place and have been successful. Anyone interested in joining our Relay team can contact John Seal or Cathy Martin. Mr. Jenkins asked if we have obtained the CPSI data. Mr. Lott stated that all interface expectation agreements have been signed and in place as required prior to March 31 st deadline which gives them 90 days to place all modules to collect the data. He said that our collections of data will begin on July 1 st and all issues resolve with system. ATTORNEY REPORT Mr. Allen stated that he has reviewed modified multiple contracts for the hospital. He said that Ms. Griffith is making the final revisions to the Bylaws. There was a house bill that passed that does away with the requirements for the collaborative agreement. Ms. Griffith is working on the Bylaws changes if this bill passes as is, then we need additional changes to the Bylaws in the future. Mr. Allen stated that the majority of his time has been working on the current Fresenius contract with RMC and making sure all obligations has been met in the contract. Mr. Allen stated that he investigated the process of the Fresenius contract and Administration not only complied with all of the provisions of the lease but went above and beyond by notifiying Fresenius a 180 day out as proposed to the 90 days that was subscribed in the lease. Further, they offered another facility as well as to help meet Fresenius with any needs they may have had should Fresenius choose to use that location. MANAGEMENT REPORT Dr. Magee announced that there will be some advertising that will be done on radio station the Triple U which is There are about 420,000 listeners. RMC will be the very first commercial played for the first 48 hours. No commercials have been played what so ever and now in the process of starting to play them. He stated there is a contest that will start and whoever the first contestant is will win $ There is a series of commercials that will be on going for at least a two month period. He suggested that everyone tune in to 98.9 it is coming soon. The go live will be soon. He said everyone has a chance to win, no exclusions. He further stated that we do have a new website rmchospital.com. If you haven t seen it please do so. He said Five Start Media is still doing some revisions but it looks totally different. Application can now be completed online as other facility currently does. PUBLIC PARTICIPATION Denise Fitzgerald commended the Board by saying, it is so nice to hear all the positive things happening with the cath lab, new physicians coming to be able to obtain more admissions. She stated that she works the night shift and how horrible it is to having only three patients in this hospital, it breaks her heart. We re still busy and continue to move forward. She told the Board that the employee s believe in them and appreciate all that being doing. She continued by saying we have a great Administrative team now and she feel really sad about the issue with the dialysis but knows and trust the Board will do the right thing for those patients. We care about our patient at RMC. Myra Gunnell thanked the Board for all the hard work that has been achieved. We appreciate the Board so much and it s very encouraging to see things moving forward. She asked the Board if there was any way the employees would get a raise this year and if it was budgeted. We appreciate the incentive bonus received. Michael Magee stated that a raise is in place if the revenue continues to come in like the PAGE 9 OF 9 PUBLIC PARTICIPATION (Continue)

9 present. We know the employee s have earned a raise since one hasn t been given in seven years but considering we still have a loss when we turn things around with the new services and investing in new physicians it takes time to actually see the results. He said when we have more revenue with a positive income, absolutely we will give raises. She said we know it takes time to get on our feet and everyone is understands. Dr. Magee reiterated that the Administrative team meets and discusses everything with raises included and when would it be feasible, all aspects of the hospital. Mr. Jones said on his behalf as well as the Board, we do appreciate and understand what the employee s have been through and not having a raise in a long time which is our priority to do as soon as we possibly can. He continued by saying, the VALIC is being paid back to employee as well. Annie Ball told the Board we really appreciate the incentive bonus more than you will ever know. We also know that every company has to spend money to make money to be able to give raises. She has one issue to be address concerning the short term disability. She realizes that short term insurance is on a voluntary basis but employees need a policy that explains the process and how you received 60% from disability insurance but the hospital can make up the difference. We have several problems with employee s having issues and a policy needs to be implemented. Mr. Seal stated that previously the short term disability insurance had informed the hospital that an employee could not received any payments from the hospital while receiving short term disability. Recently, it was brought to our attention that the short term disability insurance carrier had a different interpretation of how employee would receive funds during their disability period. Mr. Seal stated that a policy is being revised based on the new information and will be presented at the next Board meeting. Claire McGuire reported that the Bylaws & the Articles are almost ready to be mailed out tomorrow. She reported that Richard Watts had started the process and will complete as pro bono ad hoc only for the Foundation. The next Foundation meeting is scheduled for May 8 th at 3:30 p.m. in the Physicians Resource Room. EXECUTIVE SESSION A motion was made to adjourn to Executive Session for Quality Matters by Mr. Knight, seconded by Ms. Breland. The public was excused at 5:25 p.m. A motion was made to adjourn Executive Session and reconvene the meeting by Mr. Jenkins, seconded by Dr. James. The meeting was reconvened at 6:20 p.m. Upon reconvening the meeting, a motion was made by Dr. James, seconded by Mr. Knight to accept the Quality Report as presented. Motion carried. After, further discussion of the Fresenius lease that expires on May 31, 2014, a motion was made by Dr. James seconded by Mr. King to extend the lease for an additional 30 days which will expire June 30, Motion carried. ADJOURNMENT There being no further business to be brought before the Board, the meeting was adjourned at 6:20 p.m. E. Kyle Magee, M.D., Secretary