In the Matter of PMC PANEL MEETING

July 26, 2007

Commissioners Ghan and Whitworth participated in a meeting of the PMC Citizens Panel.  Commissioner Ghan opened the meeting at 4:05 p.m.  Panel members present were Lela Liggins, Bob Chandler, Dorsey Hill, Mayor England, Sephen Weeg, Tom Dial, Nancy Renn, Dr. Evans and Angela Mendez as well as interested parties and   Cindy Hepworth taking minutes.  Ghan gave opening remarks and introduced Joe Lupica President of Stroudwater Capital.  John Peel Senior Vice President of Stroudwater Capital joined the meeting in progress. 

            Lupica said the panel was formed as an outreach move.   It’s first phase of gathering information has been occurring which now gets used in some practical process fact based.  Lupica said the Commissioners have duties imposed upon them to make decisions by vote.  He suggested you must think before you vote and said the Commissioners could just vote, or they could analyze, get facts, see what community members of all walks of life have to say about this county property and then make a decision.  This is a very public process.   Lupica said most things the county does with Stroudwater is done under the clock of attorney client privilege but the community is involved.   Lupica said Strouwater will depend on the panel to help refine information.

            Peel said after a few community interviews they have been having you start seeing a thread of concerns as to what those folks interviewed want to see.  There may be a different perspective but you get a pretty good composite of what the community wants, needs or desires to see in their hospital.   He said they have done a lot of listening and now begin the process of put that information into some organized fashion for the Commissioners would like to see working together with the panel to see what the process is. 

Lupica gave a presentation of this process considering:

COMMUNITY AGENDA

            The Community’s Treasure

                        What do you want to accomplish?       

            Respect the small-city atmosphere and quality of life.

                        Clinical excellence

                        Delivered on an attractive campus

                        Support ISU’s medical education objectives

                        Provide accessible and affordable quality health care to all

Hospital of choice for professionals and their patients throughout the region

STATED VISION OF VALUES

Vision for single campus regional referral center with well-defined centers of excellence

Compassion

Dignity

Excellence

Education

Accountability

Collaboration

COMMUNITY AGENDA

1. What does a community need?
2. What do the physicians need to serve their patients?
3. Consideration (in no particular order)
   1. Keep patient in their hometown
   2. Provide best tools for your caregivers
   3. Commitment to employees
   4. Professional satisfaction of physicians
   5. Future capital sustainability and quality
   6. Care for the indigent and working poor
   7. Impact on economic development

CONTENTS

Community

Two duties 

Guiding principles

Process

Community

VALUES COME FIRST

Community values

            Become objectives

                        And objectives drive the outcome

COMMISSIONERS DUTIES

            State’s constitution and statutory framework

            Imposes Decision-Making duties on Commissioners and potentially on the voters

Duty to Vote includes duty to deliberate

            Listen

            Investigate and analyze options

            Ask pointed questions

            Debate

            Then vote

Weeg asked how we tie this all into timing?  Do we stop construction?  Lupica said we do have to consider those impacts.  Everyone is very cognizant for the need for speed.  We are making a hundred year decision.  How long will it take to get the right answer.  The request for information issue must be addressed.  

Listen to your hopes, wants and needs

Articulate the values and objectives of the citizens of Bannock County

Independently verify the feasibility of capital plans

Ask citizen based questions to those who seek privilege of serving the people of Bannock County

Deliberate and vote with real options on the table

Advocate for the people of Bannock County period.

EVOLVING ROLE OF CITIZENS PANEL

Initial role; gather information

            The panel has gathered valuable public testimony

            On community objectives and potential models

CONTINUING ROLE;  Report and review

            Refine results of testimony and listening sessions

            Create community based guidelines

            Help Commissioners and Prosecutor draft pointed questions for interested parties

Dorsey said she felt like they did not have all the answers, especially the financials.  

GUIDING PRINCIPLES

            Options are . . . optional!

            Process is important

            Sequencing:  Ideas first, then conclusions

            Honest thoughtful people can disagree so assume all are acting in good faith

            If good will could build a new hospital we’d have one by now.

            Its about what we all want

ANALYTICAL PROCESS

            Fair

            Fact based

            Research driven

            Focus on long term results

PUBLIC DECISION PROCESS

            Why the Commissioners have established this process:

                        They have accepted their duty

                                    To deliberate

                                    Foster public debate

                                    To make a decision

                                    They demand a fact based analysis

                        They want to listen to citizens   

They need to examine options and ask questions

            Process supports framework of constitutional duty and law

PUBLIC DECISION PROCESS

            Trust the process

            Deliberate

Participate

Independently assessed

 Honest and principled

PROCESS CHART

                                    Clarity of leadership

                                    Stakeholder values

Physician/citizen input                            research                                  

Community questions                                        verify capital plan

                                        Assess option

  Bond market financing                                    capital partner financing/resources

  Transfer of ownership                         Transfer of ownership

  Debt capacity                                     local or national partner

  Timing                                                            other affiliation structures

And After all

It is the community’s treasure

And what do we want to accomplish

A healthy future

Evans asked about the request for financial information from the hospital.  The Commissioners said they have been working with the hospital for the past few weeks to get the information.   Evans asked if the information could be given to the Commissioners but not the public.  Ghan said they are trying to stay within the laws of public records disclosure and get the information necessary and use it honestly and properly to make the decision.   Lupica said he is in the business to know what is proprietary and what should not be public knowledge and there are state laws regarding this issue.  The county is requesting financial information, statistical information to make a public presentation for their findings and analysis.  Ghan said a list of information has been developed with the Commissioners, Stroudwater and the county attorney and some information has been received but we are working to get the rest of the information.   Dial asked if the option to govern is chosen that the hospital will be run by a broad base board of community citizens would they run into the same problem with the hospital giving only the information they deem to give.  Who would help that board of community people get information when the County Commissioners and citizens cannot currently get the information they request now of a county owned hospital.  There was a discussion as to the request for information and how the information would be used and protecting what information should be restricted.  Dial again expressed concerns as to the county owning the hospital and not being able to get information.  Bonding information was in question.  The media expressed concerns over not receiving information from the hospital.  Dr. Stevens said he had been present in hospital board meetings and asked questions but had not received answers.  He feels the hospital and board already act as if they are private.  Lela Liggens asked if it is a county hospital the county should receive information yearly.  Ghan said the Commissioners do receive the annual audit reports and the Commissioners are able to sit in the board meetings.  Ghan said we are working through the process to get the information from the hospital.  Weeg agreed this is a hundred year decision and it was his opinion that the panel must have due diligence to see if any option is viable and there is currently a road block that has to be overcome.  The big question is can the plan work financially and said if the panel does not get the information it needs to make the decision the panel may wonder if something is wrong.  Weeg said we need to get through this roadblock.  It was mentioned that a community board would not have the clout the Commissioners have to make a decision in the future.  Lupica said the information asked for was very standard stuff that Stroudwater asks for all the time.  Krista Madsen with PMC said the hospital has monthly board meetings open to the public.  Financials are discussed as well as strategic planning etc.   Lupica said the hospital administration has prepared the information but are restricting the use of some of this information which Lupica says might inhibit their reporting capabilities.   Stroudwater wants to verify and validate the information to help make conclusions for the Commissioners in their decision making process.   Renn said the panel and county has been gathering information, and asked how much more they can ask.  How will we come to the questions and who will they be directed to.  Lupica said those specific questions would be directed to the hospital, Capella, etc.  Weeg asked about a need for future work sessions and asked if that would mean working with Stroudwater with all the information they have both gathered to develop a plan.  Peel said Stroudwater will sift through their data looking for common things, guidelines, questions, taking the objective financial analysis which will all be formed with the help of the panel.   Dorsey said things are happening with the community and the hospital that suggests we need to hurry this process along.  Lupica reminded the listening sessions take longer than the analysis.  Whitworth asked the people to be patient and to look at the things that must be considered so the Commissioners can make the right decision.   The panel agreed that they also want to make the right decision for the community.  Lupica said we need to continue with the public debate. 

Meeting adjourned at 6:10 p.m.