The Lake County Board of County Commissioners met in special session on Friday, February 9, 1990, at 10:30 a.m., in the Board of County Commissioner's Meeting Room, Lake County Courthouse, Tavares, Florida. Commissioners present at the meeting were: Michael J. Bakich, Chairman; Thomas J. Windram; Richard Swartz; C. W. "Chick" Gregg ; and Don Bailey. Others present were: Annette Star Lustgarten, County Attorney; Al Thelen, County Manager; and Toni M. Austin, Deputy Clerk.

AMBULANCES-HOSPITAL DISTRICTS/RESOLUTIONS

Commr. Bakich called the public meeting of the Northeast and Northwest Lake County Hospital Districts to order, for discussion of the possible merger of the two Districts.

Ms. Annette Star Lustgarten, County Attorney, informed the Board that the alternate draft of the proposed resolution, just received by the Board, was prepared by Ms. Jerti Blair, Attorney

representing the Northwest Lake County Hospital District. Included in the resolution is the election of the members of the new Board of Trustees, to be conducted at the general election in November.

Commr. Swartz questioned whether or not there had been sufficient public hearings on the issue of the district merger, and stated that he was concerned with the scheduling of the special meeting today, only three days after a regular scheduled Board meeting, on an issue that will increase taxes, over approximately one-third of the County, by 12 l/2%. At this time, Commr. Swartz stated that he had a question regarding the transfer of reserve funds for indigent care, and that he felt there should be more public hearings in the two hospital districts. Commr. Swartz stated that he was not in favor of, or prepared to, review the presented resolution, with the idea of passing it after discussion today.

Commr. Gregg stated that he disagreed with Commr. Swartz, and that the Board should proceed with the resolution step by step. He stated that he has been involved with the Health Care Committee for a year, and the Northwest Tax District Board, and informed the Board. that the Tax District Board has just voted unanimously for the resolution. Commr. Gregg stated that he felt the merger is in the best interest of the taxpayers of Lake County, and that the millage for the Northwest and Northeast Districts is presently one mill, which will not change. He stated that he would prefer that the Board proceed with the issue, and suggested getting a consensus of the Board. Commr. Gregg stated that the resolution provides for an election in October and November, at which time the voters will have an opportunity to offer their input, with the development of a Board that will concentrate strictly on indigent care.

Commr. Windram stated that he was in agreement with Commr. Gregg , and that he was fully aware of the health care problems that have existed for some time.

Commr. Bailey stated that he did not have any problems with reviewing the resolution today and making the appropriate amendments, but if there is any perception of the need for

additional hearings, he will move in this direction.

Commr. Bakich stated that he felt the resolution needed to be reviewed, and if there are any problems, they can be discussed at that time. If additional time is necessary, the Board will have the opportunity to address this, at the appropriate time. He stated that, with the consensus of the Board, the meeting will proceed. Ms. Lustgarten informed the Board that this is a joint meeting between the Northwest Lake County Board of Trustees and the Board of County Commissioners, who represent the Northeast Lake County Hospital District, with the members and their attorney having the opportunity to speak on the issue.

Discussion began on Page 1 of the proposed resolution, with Ms. Blair informing the Board of the major change regarding the election of officers on Page 4.

Commr. Swartz questioned whether or not the County has the ability to take two dependent special tax districts, under Chapter 189, the act of merger, and to merge these two districts into one independent tax district. He stated that the County is very limited in creating an independent tax district, and discussed three examples of doing so, and questioned the method by which the Board is taking. He discussed Chapter 189, which speaks to the fact of dependent special districts created by the Act prior to the effective date, but which does not address giving the Board additional power. He stated that he has discussed this issue with Ms. Lustgarten in great detail, and that she does not think this restricts the County.

Commr. Swartz discussed the development of the meeting being held right now, and suggested that the County provide broad citizen involvement, in both initiating and developing special districts, as contained in the Act.

Commr . Gregg discussed the public hearings held by the hospital districts, and stated that Ms. Lustgarten established the meeting scheduled today. Commr. Gregg stated that the consensus of the Board was to continue with the discussion of the resolution, and that the Board will follow the guidelines of the legal advisor for the County.

Ms. Blair stated, that even though the Northwest District, under the new Statute, can be deemed as a dependent district, it has been treated as an independent district. It has independent taxing authority, and has been known as an independent district up until this time. With the enactment of the new legislation, there is some question whether it will be deemed independent or dependent. Ms. Blair stated that the Statute does provide that any special districts, and including special districts within a municipality, can merge legally.

Ms. Lustgarten commented on the new legislation stating that, if a Statute sets out a particular procedure that shall be following, that procedure will be followed. There are several

procedures set out in the new legislation, one deals with creation of new dependent districts; one with the creation of new independent districts, which does give limited power to counties; and also a procedure for m erger of districts, and that section does not distinquish between whether you are meeging dependent or independent districts. The procedure for merger of districts is the procedure Lake County is following, and is the reason for her to advise the Board that this is the appropriate procedure, and the Board has the authority to move forward.

Dr. Tully Patrowicz, Eustis, appeared before the Board and commented on the previous public meetings. He stated that there was very poor attendance at the Nosthwest Hospital District meeting, but felt that word has not gotten out about the issue of the merger of the hospital districts. He stated that he did not feel there is a wide spread understanding of the complex issue, which involves taxation. Dr. Patrowicz further stated that the document being presented was read at the Northwest Tax District meeting, with no one receiving a copy. He stated that he is attending this meeting as a designated delegate for the Lake County Medical Society, who discussed this issue at the general meeting Wednesday evening. The majority vote favored that this be placed on the table. At this time, he read to the Board the resolution, from the Lake County Medical Society, requesting that the Board table this issue, for at least three months, to allow the public to be fully informed on this important issue.

Mr. Zeb Osborne, Attorney, appeared before the Board to discuss the attendance at the hospital meetings, and stated that the meetings are not open to the public. Mr. Osborne stated that he disagreed with Dr. Patrowicz, because the issue of menging the hospital districts emerged in 1985. He further stated that copies of the resolution have been available, but with no requests being made for them. Mr. Osborne stated that, if there is a group of community people involved who want to delay action today, Waterman does not want to move forward with something that leaves questions unanswered, yet he did not feel this to be true, because of the press that has been given on this issue. He discussed the meetings that have been previously held by the Board of Trustees, and stated that he was of the impression that most of the people in the community are happy with the steps being taken to resolve the indigent care problem, and the cooperation between the districts.

Commr. Swartz discussed the timing on the issue, and questioned the necessity for the approval of the resolution today. He questioned why the latest draft would not be taken through a public hearing process, in order for the public to become fully aware of the issue.

Mr. Osborne stated that he understood the purpose of this meeting is to review the resolution and answer any questions, and if there are concerns, the Board would postpone action.

Commr. Swartz stated that the purpose of the meeting should be to review all of the factors involved with this proposal, and not to adopt a resolution today. He stated that the Board should provide for public input.

Commr. Bailey questioned the three month period provided in the resolution from the Medical Society, as read to the Board by Dr. Patrowicz, and the date of March 31, 1990, in relation to bonding.

Dr. Patrowicz stated that the Medical Society thought that the three month period would allow for ample wide spread understanding of the issue, and that he felt this issue has been virtually invisible.

Mr. Dan Robuck, Attorney representing Leesburg Regional Medical Center, appeared befote the Board to discuss the time frame involved with the bonds, and stated that the monies have to be in our call first by March 31, 1990, or the bonds will be down rated.

Dr. Patrowicz stated that indigent care is the cross to the issue, but what the County is trying to do is to provide an ordinance that will allow the flow through of money to each hospital for indigent care, but it will be done at a level of complete public understanding. He felt that the Board was wanting to review and to have a complete understanding of the resolution today.

Commr. Bakich stated that he had talked with Dr. Patrowicz the other night, and that he expressed concerns for the entities to provide a financial statement of themselves and all parent companies and holding companies, and the issue of elections. He stated that he did not recall De. Patrowicz mentioning anything in reference to the time frame, wanting more time to review the issue, or anything to that nature. Mr. Robuck and Mr. Osborne discussed financial losses at the hospitals from indigent care, Medicare, Medicaid, and bad debt.

Commr. Swartz stated that he has a problem with turning over a million dollars of taxpayers money that was raised in the Northwest District under a certain charter, to the hospital to improve the balance sheet for a bond eating.

Mr. Howard Hewitt stated that there are antiquated Statutes that the Northwest Hospital District created that does not allow the flow of funds thtough the hospital. He stated that the Board of County Commissioners sits as the Board of Trustess for the Northeast Lake County Hospital District, which allows the flow of funds. Mr. Hewitt stated that the only thing that needs to be accomplished is the disbursement of the millage rate that is presently being taxed.

Dr. Maurice Berger aequested that the Board proceed with the review of the resolution, and take the time to discuss any problems that may revolve from the discussion.

There were no changes to be made to Page 2 and Page 3.

On Page 4, Ms. Blair infonmed the Board that the wording, regarding the term of office, had been stcuctuned in order that the Trustees have staggered terms.

Discussion occurred regarding Page 5, and the general election, with Ms. Lustgarten explaining that the election will provide voting for vacant Trustee seats to take place at the general election in November. At this time, she explained the registration of electors, per the Florida Statutes, and the qualifications for candidates.

After some discussion, Ms. Lustgarten stated that the resolution could be more specific and state non partisan elections.

Discussion occurred regarding Page 6, Elections, voting for vacant trustee seats, with the understanding that when a term expires, it is considered a vacant seat.

Ms. Blair discussed Page 6, and the insection of language that included that the candidates with the highest vote totals shall be deemed elected to the available seats to avoid the possibility of runoffs in this kind of election. At this time, she stated that this should all be stricken from the resolution.

Ms. Lustgarten stated that there should be a method of resolving a tie vote, and stated that the resolution shall provide that, in the event of a tie vote, an election shall be held to break the tie.

Commr. Swartz stated that, with the new language, changes needed to be made to Page 4 regarding the terms expiring on October 31. He stated that the election does not take place until November 8, with Ms. Lustgarten concurring.

No changes were made to Page 7.

Discussion occurred regarding the ad valorem taxation, with Ms. Lustgarten stating that the Board of Trustees of the North Lake County Hospital District will be required to hold the same budgetary adoption process as the County Commissioners. She stated that, in order for them to increase the millage, they will have to go through the trim process.

Dr. Patrowicz stated that the word "shall" levy should be replaced with the word "may" levy one mill, in order for the Board of Trustees to have the option to do what the public wants them to do, as truly elected officials.

Mr. Osborne stated that, when the Committee was formed, its position was, and still is, that it does not care if "shall" levy is deleted, but if you do that, do not put a cap on the millage. At this time, he discussed the Hill-Burton standards, and the increase of millage that will be forthcoming, and stated that the banks rely on the word "shall". He stated that there are provisions on Page 12 that provide for audited financial statements to be filed, not only for the hospitals, but for all affiliated companies, and that proof be made to the tax district board that charity care has been provided, in the amount equal to the tax revenue received.

Discussion occurred regarding the means of changing the one mill cap. Ms. Lustgarten and Mr. Osborne agreed that it would have to be amended by an act of the Legislature. Ms. Lustgarten stated that that is the way it is currently drafted, but you could provide the option of requiring a referendum.

Ms. Lustgarten informed the Board that the word "Care" would be struck from the title of "Lake Sumter Mental Health Center and Hospital".

Mr. Osborne stated that, through compromise, the districts have agreed that they have an obligation to Mental Health indigent care.

Mr. Bert Lacey, Lake Sumter Mental Health Center and Hospital, stated that he is satisfied with the language in the resolution.

Discussion occurred regarding Page 11. Dr. Patrowicz stated that the annual financial report should include every aspect of the hospital's business.

Mr. Robuck stated that, the reason they suggested "and its parent corporation" instead of the names was in case the merger did take place, o r something changes.

Commr. Swartz questioned "indigent" for purposes of this resolution being 200% of the Federal Poverty income guidelines and how this is different than what is contained in the Act for the Northwest Hospital District.

Mr. Robuck stated that the resolution does not exclude Medicaid.

Mr. Osborne stated that the Medicaid program itself operates on 150% of the Fedenal Poverty guidelines.

There were no changes to be made to Pages 13-16.

Discussion occurred aegarding the "Construction of Resolution", "Amendments to the Charter", and "Establishment and Dissolution of the District", with changes being expressed by Ms. Lustgarten and Ms. Blair. Ms. Lustgarten stated that the Board may wish to include under "Establishment and Dissolution of the District" the following: " . . . may be dissolved by action of the Legislature of the State of Florida, on through referendum". She stated that this would be the same language as in Paragraph VII.

Ms. Lustgarten discussed Section X, Comprehensive Planning, and stated that the Statute requires that all special districts comply with the peovisions of Chapter 163. This district does not have the authority to issue bonds, or to do capital improvements. She further stated that, in Section XII, it provides that the current existing districts continue in effect until the new members are appointed by the Boatd, qualify for office, and are inducted.

Ms . Lustgarten explained the language used in Section XIII, Effective Date.

Mr. Joe Stephany appeared before the Board to discuss Page 8, Line 13, "... upon written request by Waterman Medical Center Association, Inc., that the funds are needed for health care", and Page 9, Line 6, "... certifying that the funds are needed for indigent health care." (Page numbers referenced are in the new revision of the resolution). Mr. Stephany urged the Board's consideration for the fire districts. He suggested that the County Attorney present an explanation of anything that the Board can do today that cannot be done by the authority of the Board of County Commissioneas under Florida Statute, Chapter 125.

Ms. Lustgarten stated that there are other statutory provisions regarding the provision of indigent care.

Dr. Patrowicz stated that the following major concerns seem to have been addressed: accountability; opening it up to the public election; and full disclosure of the hospitals' finances.

Dr. Patrowicz discussed the language "The Board of Trustees of the North Lake County Hospital District is hereby authorized, empowered and shall levy an ad valorem tax in said District of one (1) mil on the dollar....". He suggested that "shall levy" be changed to "may levy an ad valorem tax up to one (1) mil...", to allow the public to be involved in making the decision, instead of making it mandated.

Ms. Marilyn Bainter appeared before the Board and stated that she is concerned for the rush to approve the resolution. She further stated that she is concerned about the accountability to the citizens that has been addressed, and the duties of the Board not being pointed out in the resolution. She stated that the citizens will not realize changes are being made until they receive their tax bills. She stated that she did not feel that enough notice has been given to the public on this issue.

Dr. Berger addressed the Board on the issue of the public being notified of the matter being discussed today. He stated that he did not feel that this was the fault of the Boards meeting today, because adequate notice had been given to the press. He further stated that a lot of the fault can be placed on the newspapers.

Commr. Swartz stated that he would have to disagree with this statement, and that the newspapers have tried to accurately report what they were aware of. He stated that the governing body needs to take the responsibility for whether or not the County goes through a public notification process, and not to expect the public to rely on on the goodwill of the press to report it.

Mr. Steve Richey stated that he lives in the Northwest Tax District and that he is concerned about the financial integrity of his hospital, and that he wants to be treated equally with the people across the County. He stated that Leesburg Regional is not getting the money that was approved by referendum from a one mill tax. Mr. Richey stated that, if the Board does not want to vote for it today, it should not delay the issue, because the people in the Northwest Tax District feel that this is a good deal.

Ms. Gail Bass, Legislative Assistant to Representative Everett Kelly, appeared before the Board and stated that she talked with Representative Kelly this morning, who requested that she appeal; to express his views on the issue. Ms. Bass stated that Representative Kelly would like to ask that both of the Boards give him the opportunity to look at what is being done in the hospital districts. She further stated that he does not want to delay anything, or cause any problems for any of the hospitals.

Commr. Gregg stated that Representative Kelly had been asked to serve on the Committee, and he did not attend any of the three meetings. Commr. Gregg stated that, because of the Act, the money cannot get to the hospital. He stated that everyone involved has tried to form a workable agreement with a resolution. He stated that he agrees with the general election, with the Supervisor of Elections qualifying the candidates, and that any action taken today is answerable to the public in November.

Ms. Bass stated that the concern about the elections was also a concern of Representative Kelly's.

Commr . Swartz stated that there seems to be concerns with the March 31st deadline, but that there is nothing to keep the Board from taking this document that has been revised to a public hearing process, in both the Northeast and Northwest Districts, in order to achieve public input. He stated that there is time to take this to a public hearing, to get the btoad base citizen input, and to allow our legislative delegation to be involved with the input.

Commr. Windram stated that, so far, he has not seen anyone from the Northwest Tax District object to the proposal being made. He further stated that he has not heard anyone in the Northeast Tax District suggest that their accountability be altered, or their method of applying their taxes be altered.

Mr. Lonnie Strickland, Director of Health and General Services, stated the issue today would not affect the staff in any way, with the staff being agreeable to whatever is proposed. Mr. Strickland stated that this issue has been discussed fon many years.

Approximately two years ago South Lake had on a ballot a change in their whole Act. The major point of that change took away any reference to indigent care. It diverted all of the money into the hospital. Mr. Strickland stated that, from a staff standpoint, it will not affect the County's operation.

Commr. Bailey stated that he would like to support this issue today, but cannot see why the Board will not schedule this issue for a public hearing. He stated that he felt that most of the key issues have been addressed, but that at least one more hearing should be held.

Commr. Gregg made a motion, which was seconded by Commr. Windram, to adopt the resolution, with the changes discussed requiring the election to be held during the general election, and handled by the Supervisor of Elections, and with the changes referred to in the minutes.

Commr. Swartz questioned the reasons for not having another public hearing.

Commr . Gregg stated that no objections have been heard, and.that notification has been given in the newspaper several times over the past year, and when he served on the Northwest District. He stated that he felt that this is a good working document, and is in the best interest of Leesburg Regional Medical Center, and that Waterman Medical Center will not be hurt by it, and with it benefiting the taxpayers of Lake County.

Commr. Bailey questioned why it would hurt to set another hearing date for the delegation to be able to comment on the issue.

Commr . Windram stated that unanimous endorsement has been made by representation from some of the finest people in Lake County, with them asking for a consensus to help them with a problem.

The Chairman called for the question, with the motion to approve the resolution being carried.

Commr . Bailey and Commr. Swartz voted "no".

On a motion by Mr. Hewitt, seconded by Dr. Berger and carried unanimously, the Northwest Board of Trustees approved the resolution, with the changes made today.

There being no further business to be brought to the attention of the Board, the meeting adjourned at 12:35 p.m.

MICHAEL J. BAKICH, CHAIRMAN

JAMES C. WATKINS, CLERK

TMA/BCC/3-12-90