The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Thursday, December 27, 2018.   Board members present: Curtis Ebeling, Chairman, Joe Doubet-Vice Chairman, Bob Neese-treasurer and Members  Dwight DeRosear and Lori Fulk.  Absent: Judy Wilson, Secretary

Others present:  Dr. Randy Tobler, CEO, Dr. Jeff Davis, CMO, Michael Brandon, Controller, Elizabeth Guffey, RN, CNO, Heather Ayer, RN, Quality/Safety, Lori Nelson, RN, RHC (Rural Health Clinics) Supervisor, Missy Smith, HR Coordinator, Jessica Christen NP and Brenda Prather, Recording Secretary.  Guests: Lee Shultz.

The meeting was called to order at 5:38 pm.  Public comment was offered by Lee Shultz, RN.

Under the consent agenda, a contract for the Mindray Telemetry and Portable Ultrasound Lease/Purchase was discussed.  The board approved, for the 2019 budget, obsolete telemetry equipment for acute care visit and portable ultrasound for use in the Emergency Department, Memphis Medical Services, Operating Room and acute care settings to help with diagnosis and procedural accuracy.  A policy was presented to the board to establish procedures for reserving the public conference rooms/spaces.  The board approved a resolution affirming the retirement plan and deferred compensation employer match enhancements.

In the “Quality Corner” report, facility-wide “dashboards” that track progress in several key areas were presented: Patient Satisfaction, Safety, and Hospital Financial Performance.  Since over 90% of patients answered they “would recommend” our RHC (Memphis Medical Services, Lancaster Medical Services and Wyaconda Medical Services) to a family/friend consistently over time, a new measurement will be identified.

Michael Brandon, Controller, presented the Financial Report for November.  Gross patient revenue for November was $3,515,680; Bad Debt, Charity Care and other Deductions for November was: ($786,886); Net Patient Revenue, November: $1,670,955; Net Patient Revenue Per Day, November: $55,315; Total Operating Expenses for November $1,750,235.  Expenses per day for November was $59,355; Total Operating Profit/Loss November year to date: ($111,090); November Tax Revenue: $42,866; Net profit/loss before depreciation for November was ($12,265); Net loss YTD ($800,895).  Brandon explained this is an improvement to FY’18 at this time, which was ($936,691).

Randy Tobler, MD, Chief Executive Officer, gave an administrative report, starting with OPERATIONS.  340B Contract Retail Pharmacy-the hospital has formed a foundation and separate pharmacy company, necessary because of the hospital’s charter, to acquire and operate Memphis Community Pharmacy (MCP) per approval of the Board’s intent to resume ongoing 340B pharmacy services onsite.

In addition to its activity as investor in the pharmacy, the newly formed foundation will enable SCH to engage in other development activities to benefit the hospital’s mission and area patients it serves.

The current pharmacy owners are leaving the traditional retail pharmacy business to focus on their automated pharmacy dispensing machines business (Medifriend, Inc.).  A Medifriend unit has just been installed and is being tested in the Lancaster Clinic, to be operational soon.  

The new ownership of MCP will go into effect as soon as the formalities necessary to continue uninterrupted operations are completed. During this transition, it is the intent that hospital staff and pharmacy customers will not notice any change in the services offered by MCP. Patients still have the right to fill their prescriptions at the pharmacy of their choice. 

According to Tobler, the on-site 340B pharmacy has yielded enormous benefits to hospital and clinic patients choosing to use it, as well as benefits to the staff by having an in-house pharmacist on duty. 

“Memphis Community Pharmacy is going nowhere, just changing ownership and management to Hospital-affiliated entities,” said Tobler. “Services and staff will remain as they are now. An extension of the pharmacy will be available at LMS through an innovative, and one of the very few, remote dispensing machines in the state. This will enable patients at Lancaster Medical Services to obtain most of their meds, including 340B-eligible prescriptions, by tele-pharmacy, without a trip to Memphis in most cases.

Ambulance District

The Ambulance District affirmed at its December board meeting to separate from the SCH contract no later than the end of June, 2019. Arrangements and accommodations will proceed amicably.

Tiger Cub Care

The space renovation is complete and a Center Director has been hired from within SCH. The final facility inspection as well as administrative requirements, schedules and pricing structure need to be in place before the facility opens.

Virtual Health

The first tele-psychiatry day had seven patients scheduled for January 7th.

Grant Applications

Two grants were submitted in the fourth quarter.  One grant was declined and one grant is pending.


Abigail Manco has accepted the position of Tiger Cub Care Director, transferring from Financial Navigation.


On December 17, SCH hosted a visit by State Senator Cindy O’Laughlin, along with Missouri Hospital Association representatives to discuss  challenges SCH and other rural hospitals face from Managed Medicaid, burdensome regulations, duplicative and/or competitive services in counties with hospital and other health related organization supported with state funds.

Senator O’Laughlin expressed her avid support of access to quality care in rural Missouri, particularly her District. MHA has issued a statement to the DHSS Director advising caution in establishing rules and regulations pertaining to Amendment 2, authorizing the certifying by state licensed physicians for the use of medical marijuana.  Dr. Tobler discussed the real and potential conflicts between state and federal laws regarding the use and authorization of marijuana. Dr. Tobler reported that SCH will need to develop policies and procedures regarding this, after final rules are released by the State.

Jeff Davis, DO, Chief Medical Officer, reported that he has successfully completed all requirements of Family Medicine Board Recertification 2019-2026.

Old Business

The 2018 Board Governance Education has been completed.  Dr. Tobler reminded the board that the BKD (hospital auditors) Readiness Assessment Presentation is scheduled for January 15, 2019, at a special closed meeting. 

The January Meeting for the Annual Joint Medical Staff/Board Meeting is January 21, 2019.  The agenda for the Annual Joint Medical Staff and Board will be 1) SCH clinicians consideration of joining Crossriver Health Partners Network to drive quality and value performance improvement, 2) Hear update on the revenue cycle improvement project, 3) The full Board ratified the Executive Committee’s 12/19/18 approval and execution of documents at establishing the Scotland County Hospital Foundation and Scotland County Community Health Development Services, Inc. d/b/a Memphis Community Pharmacy which enable the hospital’s acquisition of the pharmacy from imgRx-East.  The appropriate resolutions were presented by Dr. Tobler to the full board for consideration and ratification.

New Business

The board approved the Housekeeping Services contract with Lewellen’s GC to commence February 1, 2019. Current SCH Housekeeping staff will be extended employment contracts.

The HVAC contract for replacement of the obsolete control system with the contractor Tycon TMI has been upgraded with major enhancements in the deliverables at no extra charge. 

Executive Session

Those present for closed session were Ebeling, DeRosear, Doubet, Neese, Fulk, Dr. Tobler, Dr. Davis, and Brenda Prather, Recording Secretary.

The following items were discussed:  Legal actions and contracts in negotiation. Personnel.

Meeting adjourned at 8:35 pm.