Medical Staff Report

Chief of Staff Paul Gaulin, MD, reported that COVID-19 care at Humboldt General Hospital meets or exceeds any standards. Elective surgeries are temporarily suspended due to COVID. Under Humboldt County Health Officer Charles Stringham's informed guidance, Dr. Gaulin said access to positive testing and follow-up is moving in the right direction.

Administration Department Report: CEO

COVID-19 Update

HGH Chief Nursing Officer LeeAnn Cushway provided an update on the hospital's COVID-19 status. Things have been flowing very nicely with the hospital's COVID plan. In March, the hospital designated an area for COVID-positive patients. Following are the COVID-19 highlights presented by CNO Cushway:

• 4/1 - Activated partial Emergency Operations Centers for FEMA documentation and tracking of activities.
• 4/3 - Developed cost center for COVID-19 staffing hours/supplies.
• 4/3 - Set up field hospital at Winnemucca Event Center for potential surge with 150% hospital capacity per state requirement.
• 4/8 - Implemented new process of admitting mental health patients to Acute Care.
• 4/1-4/27 - Received confirmation of 37 COVID-19 positive persons.
• 4/1-4/27 - Admitted 11 total COVID-19 patients to HGH; seven patients required intubation and were transferred to tertiary facilities and four were discharged to home from HGH.
• 4/1-4/18 - Notified of two mortalities from COVID-19 in Humboldt County.
• 4/16 - Participated in LTC state survey with focus on infection control process; there were zero findings and the state commended staff and administration for its processes.

CNO Cushway also noted the many community donations and outreach efforts that have buoyed staff morale and provided important protection, like face shields and intubation boxes. Trustee Bill Hammargren praised the nursing home staff for helping to protect residents.

EMS Update

HGH Interim EMS Director Jordan Kohler discussed the Community Paramedicine program and manager Gricelda Soto, who helped oversee more than 700 phone calls to COVID-19 patients. The field hospital is set up and ready for use. Director Kohler said the five-hour process was seamless; he thanked his predecessors for the equipment and supplies that made the mobile unit possible.

Telehealth Medicine

Practice Administrator Robert Johnson reported on the telehealth system and efforts to invite patients to utilize the system. Administrator Johnson briefly explained how the system works and noted telehealth is now available to Medicare patients.

COO Report

Chief Operating Officer Tiffany Love reported that:

• Security has restrict access to the hospital; security team members participate in daily briefings.
• Cerner's focus is capturing revenue and improving the financial reports.
• The switch to Medhost will take place by December 31, 2020.
• Wi-Fi services are now available for the field hospital.
• Improvements have been made to the patient portal.
• A GoToMeeting system is being used for pain management services.

HR Report

HR Director Didi Almendares reported that:

• High risk employees have been able to work from home.
• In all, 43 employees have been tested for COVID-19; six were high risk.
• Nine employees have taken advantage of the FFCRA emergency paid sick leave.
• An emergency telecommuting agreement allows employees to work offsite.
• There has been a high turnover in environmental services and ads have been placed on social media and the radio soliciting employees.
• The employee assistance program is helping staff.

CEO Update

Interim CEO Karen Cole shared that:

• Dr. Subha Rajan, MD, an FP/OB, started on April 27, 2020.
• Brittani Smith, MD, an FP/OB, will start in fall 2020.
• David Massuck, MD, a FP, will also start in fall 2020.
• The search continues for psychiatric services and an OB/GYN.
• The pharmacy hoods have been certified as balanced, and the remainder of the project has been completed and is awaiting final inspection by the state.
• The cafeteria project will include a flooring change and kitchen hood replacement.
• The hospital has goals for protecting and caring for patients and employees, including treatments for infectious disease and implementation of preventive care measures. Guidance will be sought from the CDC, state agencies and professional associations to assist staff in dealing with the COVID-19 pandemic.
• It is anticipated elective surgeries will be reinstated soon.
• The EZ Lab is available as an alternative for lab work.
• Screening protocols for both the clinics and telemedicine are in place.
• Medical and other staff have been exemplary in their efforts during these trying times.

Trustee Hammargren asked about staff whose hours have been reduced and if there have been cutbacks. CEO Cole advised that staff has been requested to take PTO if they desire. Some staff were allowed to take time off without using PTO. Trustee Hammargren asked if any staff were being forced to take leave. CEO Cole advised staff were given a choice. The numbers of staff taking leave has decreased. Trustee Hammargren asked if there are things that can be offered to the staff. Board Secretary Michelle Miller suggested a special board meeting may be needed to discuss some of these items. CEO Cole noted that there has been some shifting of staff, so it is not necessary to send staff home.

Consent Agenda

Board trustees approved the minutes for the March 31, 2020, meeting. Additionally, board members approved medical staff applications for appointments, reappointments and privileges for 18 medical providers.

Interim CFO Tim Powers presented the financial report for February and March 2020 to the HGH Board of Trustees.

Interim CFO Tim Powers presented and explained the February and March 2020 financials. CFO Powers believes good strides are being made with the Cerner system implementation. He reviewed patient days, admits, daily average census and AR aging. Board Secretary Miller suggested a board meeting be scheduled as soon as possible to go over the financial numbers. Board Chairman JoAnn Casalez suggested a meeting at 5:30 p.m. Tuesday May 5, 2020, and every two weeks thereafter. Trustee Ken Tipton asked about additional expenses due to the COVID-19 pandemic and if some of those expenses will be reimbursed with the stimulus payments. CFO Powers explained how the COVID expenses are being accounted for. To date, $900,000 has been received from CARES Act funding. Administration will begin working on the interim cost report tomorrow. Chairman Casalez asked board members to send her an email with any questions they may have for the budget meeting. CEO Cole advised the state is expecting final budgets to be sent in at the normal time.

Business Items-Other Reports

1. Hospital Administration-IT/ proposal to purchase Panasonic recorder-controller and software for security video recording in the amount of $19,517.91/ IT-Administration - CEO Cole requested this item be tabled. No action was taken.

2. Hospital Administration-IT/ proposal to enter into an agreement with Triyam healthcare data management solutions to extract, convert and archive existing EHR systems medical records data into the new Fovea medical records archival system for a project fee in the amount of $56,945 and license and maintenance fees in the amount of $2,283 per month/ IT-Administration - COO Love advised it will cost approximately $300,000 to continue with Medhost, which is not feasible. The prices for the proposed new archival system are more economical. Trustee Tipton asked if Medhost can be terminated right away. COO Love responded Medhost will be in use until December 31, 2020. Trustees unanimously approved the purchase of healthcare data management solutions to extract, convert and archive existing EHR systems medical records data into the new Fovea medical records archival system for a project fee in the amount of $56,945 and license and maintenance fees in the amount of $2,283 per month from Triyam as presented.

3. Hospital Administration / proposal to enter into an agreement with Nevada News Group for promotional and advertising services in print media in the sum of $450 per week and in broadcast media in the sum of $3,000 per month / Administration - This item was tabled. No action was taken.

4. Hospital Administration / proposal to enter into an agreement with Care Adopt for telepsychiatric evaluation, medication management and collaborative care management services / Administration - Practice Administrator Johnson said various options for psychiatric services have been considered and all are expensive. Johnson said there is a significant need for the services and the proposed care adopt services are low compared to others. The community will be well served even though it is not a money maker. Trustee Gene Hunt asked how quickly the services can be obtained. Administrator Johnson advised they can be in place by the end of May. Trustees unanimously agreed to enter into an agreement with Care Adopt for telepsychiatric evaluation, medication management and collaborative care management services as presented.

5. Hospital Administration / proposal to enter into an agreement with Danny J.Sayegh, MD, to provide family practice, nursery call and other medical services / Administration - CEO Cole provided a background on Dr. Sayegh and noted CNO Cushway previously worked with Sayegh in Las Vegas. One provider was out when the COVID-19 restrictions were put in place and it was unknown if other physicians would be affected. CEO Cole asked Sayegh if he would be interested in working on a temporary basis for six months to provide needed services and to see if he fits with the organization. If Sayegh works out, it may be an opportunity to stop using other locums. Trustees unanimously agreed to enter into an agreement with Danny J. Sayegh, MD, to provide family practice, nursery call and other medical services as presented.

6. Hospital Administration-Finance / proposal to authorize certifications of the validity of accelerated payment requests from the Medicare remittance program / CFO-Administration - Controller Kim Plummer advised that due to the COVID emergency legislation, the district is able to request an advancement on Medicare payments, but the advance funds will have to be paid back. The certifications authenticate the validity of the accelerated payment requests. Trustees unanimously agreed to authorize certifications of the validity of accelerated payment requests from the Medicare remittance program as presented.

Trustee Comments

All board members thanked and expressed appreciation for the efforts of the staff in dealing with the challenges created by the COVID-19 pandemic.

Trustee Hammargren said he welcomes the return of elective surgeries and he encourages people to come back to the hospital.

Chairman Casalez thanked interim CFO Powers for his department's efforts to implement the Cerner system.

The Humboldt County Hospital District Board of Trustees will meet next at 5:30 p.m. Tuesday, May 26, in the Sarah Winnemucca Conference Room.

Meeting agendas, board minutes and more will be/are available at: