Ketchikan: Healthcare Advisory Committee - July 23, 2026

All right, good morning. Good morning. Good morning. We'll go ahead and call this July 23rd Healthcare Advisory Committee meeting to order. If it's okay, I'm just going to quickly move number 6 up and recognize the new members on the committee.

Mayor Bob Sieberson, thank you, welcome. Abner Hogan, the City Manager. Um, that way we're got everybody recognized before we call the roll.

Yes. Um, Hogue here. Robinson here. Severson here. Mr. Park's not here quite yet.

Um, Miss Cook here. Mr. Smith here.

All right, um, that brings us to persons to be heard, and then, and sticking with the standard city format, Um, we're going to ask folks to keep their comments to 3 minutes, please.

Mark Weaver.

Good morning, Mayor, City Manager, representatives of HAC. Uh, thank you. Uh, we've had some beautiful weather. It's a nice day today. Some folks are probably out enjoying it.

We're here, so Today's an important meeting. There's, uh, a lot of discussion that's been had and continues to be had, uh, regarding the performance of PSLF with the compliance of the lease, which is what this committee is chartered upon. So the, the meeting schedule last meeting was a point of discussion. Uh, it was clear to some of us that it was uncomfortable for PSLF to more of their duty being transparent as they promised during the lease negotiations. And I disagree with that.

I think that you should be more transparent as we requested on the lease. Why? It's about accountability. Who's responsible? Who stands up and takes accountability for their actions?

So I'm going to encourage this committee to continue with the format of last year, which was in the Ted Ferry Building. We filled the conference room. We had an active discussion. Sometimes uncomfortable, but it needed to be had. That room was much larger than this room, and it preceded the Community Health Board.

I would encourage that same format. In fact, I would encourage expansion. To recognize the committee members last time that stood up for the transparency— very important in this community. Now, East Health has got some difficulty with their financials through our Alaska Public Records Request. We've found quite a few discrepancies or nonconformances with the lease, non-disclosure of audited material that's necessary for the city to perform its function, oversight function.

It's been discussed on our Facebook page, Ketchikan Citizens Holding These Cells Accountable, multiple times. I know it's well followed by, um, Miss Cook and all, so it's no surprise to them that this information is missing. Uh, the only fiscal year audited information we got was for fiscal year 2024 and 2025, which was produced in September of 2025. Way past the annual reporting due. Not only that, the quarterly statements are really not statements, they're just numbers that are brought forward.

A financial statement has definitions in generally accepted accounting practices. We need to see that information so we can make certain that Peace Officers are doing exactly what they say they're doing. They're being transparent. They're not. They're withholding information.

They're withholding financials. What they do produce doesn't make sense. They're Net margins, sorry, their losses over the last 4 years under Ms. Stevens and Ms. Cook are negative. That's unique in Alaska. I apologize, forgot to turn off the phone.

I apologize. You have 10 seconds. So we're dealing with a hospital that is, um, financially struggling or needing some help. They did receive a $44 million plus transfusion from down south and another $5 million transfusion from down south. That's your 3 minutes, sir.

Okay, so we're looking for accountability, particularly when they're asking for millions of dollars from the Rural Health Transformation Project. The last transformation of millions of dollars was for primary care. It transformed us to a community without primary care. Thank you, and I apologize for the interruption.

Appreciate your comments. Thank you. Michael Fitzgerald.

I want to thank all you folks for the fine work that you do. I know it's not easy and oftentimes thankless to act as the protectors of the community's interests when it comes to healthcare providers here. It sure sounds like you aren't getting the full picture when it comes to be reassured that the money that goes and comes through the hospital is being used to serve Ketchikan's best interests. And so I think there's some questions that you need to ask, questions that you need to ask of Sarah Cook there. Ask her how many days of cash on hand does KMC currently have.

This is something that they track very closely and regularly because It's the main source of their revenue. Uh, when they report to you folks, they report their operating losses. Uh, that doesn't include the money that they make off of the money that they make. So ask her how many days of cash on hand do they currently have? Ask her what amount of non-operating revenue did they have come in last quarter?

Ask her how much of that non-operating revenue was returned to Ketchikan.

And for my wife, ask her when was the last time that the money from the KGH gift shop benefited patient care units on the hospital— in the hospital. She may tell you, as she has in previous meetings, that that's outside of her scope.

She might laughably tell you that that's not something that they keep track of, and she might tell you nicely that that's none of your business. But if you want to fulfill your duty as guardians of the way that healthcare money is spent here in Ketchikan to benefit the community, you need to be asking these questions, and you need to expect accountability, which I don't believe that you've received up to this point. Thank you. Thank you, Michael.

Do we have anybody online that, uh, would like to be heard today?

Doesn't sound like it. Um, for the record too, is that— is Dr. Park now on? Is that our guest? We have one guest online. Um, I don't believe so.

All right, and is there anybody else, uh, here this morning that would like to be heard? Okay, we'll move on. Um, let's move to item number 4, the approval of the April 23rd, 2026 meeting minutes. Mr. Chair, I move that we approve the minutes as presented.

Second.

We have a motion and a second. Board, call the roll. Hogue? Yes. Robinson?

Yes. Stevenson? Yes. Smith? Yes.

Cook? Yes. Is that Mr. Parks?

Um, I don't believe there are any communications unless there's something I missed. Um, we've already covered the new HAC member appointments. Thank you to the city for quickly stepping in and appointing new members so that we could keep our meeting moving on schedule. Um, that brings us to item number 7, standing business.

Update on the same day, same day clinic, please. Yep, the same day clinic is running as it has been, so nothing to update. They're still open Tuesday through Saturday, helping patients. People can call to get plenty of appointments.

Sarah, do we get any of the food passenger than the Plain Bay Clinic? You know, there's not a way to see if somebody is a cruise ship patient. We can see like demographics, like where they're from. So, but we don't know if they're a cruise ship patient or a family member coming to visit somebody. Yeah, well, my concern is, you know, your emergency department taking a big hit when we have this many passengers in town and I've heard at times it's been overwhelmed.

Because there's a lot of patients waiting for services and you have a limited amount of staff there, right? You have one attending physician sometimes. So I just didn't know if some of that overflow, how you triage that, that may be able to utilize through the clinic. Yeah, anybody that walks in through the ED, we see in the ED, we can't triage them to go to the clinic. For the laws.

All right, thank you. Yep, we might be able to at least ask and see if we can get something by zip code. And yeah, I can get zip code, but it won't let us know if they're on a cruise ship because I've asked. I was curious to how many come there.

I'm not sure precisely what kind of information we can get, not my area, but we also might be able to get some information for you on ED wait times in general. Yeah, well, that, that just came through and you got it, uh, you know, some— I probably work in Skagit, but I had a member call me and they had a family member that had a severe medical issue, was transported by the ambulance, ended up at the ER, and there were no rooms available. There was already 3 or 4 people in the halls or in the room sitting, waiting for attention, and they did get seen by the emergency room physician at the point. I don't think that they were completely pleased with the waiting process and the referrals that they would hope they would get, and then they ended up in the hospital, and then they didn't get seen again by a physician until 3:30 that afternoon. So they stayed overnight.

And so I, I'm just concerned that the impacts of tourism on our mental, on our health system, not just the ER, but our health system in total. Uh, when we get, we had what, 20,000 passenger day the other day. And I don't, and I, I've asked the fire department for their transport logs in regards to moving people from the docks to the, or from the community into the ER. And it's substantial. And there are days and hours that it's, you know, more impactful than others.

But I'm concerned that, um, we are, we're impacting the quality of life for some of the, uh, locals here in regards to that. And I know that you got to provide emergency service to everybody. So when we get to the next item, when we're talking about the remodel, if you're seeing that, I wonder if we're addressing it by how many beds are whatever that situation may be. I just wanted to convey that concern that was sent to me in regards to, you know, future design and ability to staff.

Yeah, I think that's valid concern. Very valid. Yeah. Um, that all we had on that one. All right, the update on the emergency department renovation.

Um, The floor plan that I've presented at the last meeting has now been validated by the architects and the engineers. So they've been on site, taking all the measurements, made sure that shear walls and walls that couldn't be moved were where they thought they were, posts that couldn't be moved, those things. So this floor plan has been validated and will be what we're moving forward with. Amanda, I think you've had this. I don't know if it's been passed on to your successor, but— or Seth, the same.

But trying to slide that over a little bit. So there you go. So the next step here, we have to— a big portion of the equipment has also been placed on this floor plan. The laboratory obviously has just a ton of equipment that has to be placed in order to make their, their new lab as efficient as possible. So then the next step for these, once we can get through that, which we're anticipating will be by next month, mid-month, then this will go to the engineers for construction-ready documents.

Um, one question, one follow-up from last meeting. You had asked if there would be roof penetrations as part of this project, and I did confirm that there most certainly will be. There'll be a new AHU on top, as well as hood vents and some other things. So there will be a need for roof penetrations on that side. Okay.

So, um, Scott, I didn't see that last set of plans for the emergency room. What is the bed count that you're proposing in the redesign unit? Um, I can bring that to the next meeting. I don't have it right. Or you can just report to Abner and then you can—.

Yeah, I can certainly do that. I do know that bed count, as I understand it, is to a large degree dictated by the certificate of need process. So we're, you know, if we decide we need more than what's on there, we would need to go through that process with the state to try to increase that number. So I know certificate of need, I've dealt with this on the Alaska Commission on Aging when they talk about rural healthcare and stuff. So, you know, we're kind of unique in the fact that we have this huge industry that comes to our front door, and the certificate of need should take into consideration, of course, that we have a huge impact in the summer, and of course it rains often in the winter.

But, um, how do you do a certificate of need for the hospital and balance summer load against winter load? Because we got to prepare for the worst, right? It, right?

Yeah, and I, I believe many of those factors were submitted initially, but, um, that, that design is certainly not final yet, and we certainly have time and would love to partner with you if we can to try to, um, get what we need out of it. Yeah, that, that's what I'd like to see. If we're going to invest this much money into an ER, we should try and make it as serviceable to the community as we can, both There's any passengers.

Um, Scott, for the lab remodel and the roof penetrations, do you— are you guys working with a local architect with—. In conjunction with your, um, to my knowledge, not yet. Um, that has been a standard that historically we've Certainly, when we get to the point of project management, they usually bring someone on. Right now, Sabli's been doing most of it. Yeah, but I could certainly ask the project.

I know typically, like, Walsh Whiteley Architects steps in and they did the roof remodel and they have the plans for the roof. And so they could have— they have those details for the penetrations. And so if If you do end up working with them, they would have them, but if not, we can get them, or Public Works can. It would be good to have on hand. Yeah, I think that's, that's a great question.

And then also the contractor who did the roof, um, I would suggest you go with him for that. He's just, he's really good. So, all right, if you can.

So through the chair, Is that a flat roof on top of there? Yeah, it's a tapered insulation with an EPDM membrane. So, flat. So we have some difficulty and there's got to bring people out of town in order to do that. Is there any consideration to add an aluminum or a framed roof with a sloped roof on that rather than—.

So what the tapered insulation does is it does add a slope to to the flat surface. So what was up there before was just a completely flat membrane on just the concrete surface. What we've redone is our standard now is you bring in just different layers of foam insulation. It tapers it down to the roof drains from the parapet, and that drains everything to the roof drains. It also adds a lot of insulation for, you know, heat loss, and it's a much better system.

So, yeah, and we haven't had any problems since. Nope, it's worked very well. Thank you. I know that roof's been problematic for the hospital over the years. Yeah, we've redone almost all of them.

The only one we have left is med surg, and that one actually does have a little bit of slope to it, but it's, it's the last one to go. Good. Thank you. Yep.

Any other questions? Okay, moving to item 7C for service monitoring. Jamie was going to cover that, I think. Yep, I can get it. So yeah, we had a new nurse practitioner start with us a couple weeks ago in primary care.

That's really exciting. And then we have a new physician coming in September for primary care. Huh? Yeah, 1 new nurse practitioner that started a couple weeks ago, Susan Wells, and then we have a new MD starting in September for primary care. So our primary care is growing.

Cardiology, we are still offering visiting cardiologist— cardiology at the time right now. We used to have 3, we only have 1 coming right now because 2 of them retired from Bellingham and Bellingham is recruiting. And we're also looking at Longview to see if any cardiologists from Longview can come up. And then Echo. Oh yeah, just, just to let folks know, again, trying to, trying to lower the bar on what we notify people about.

We've, in imaging, our cardiac sonography service has taken a bit of a hit. Our sonographer is, is on leave right now., and with a narrow bench, uh, left us without that service. It's been close to a month, um, so obviously quick backlog on that service line. We have—. We've moved in parallel with a couple of different options, a couple of different solutions, and we do have sonographers that will be, uh, coming up starting Monday, and we'll work as quickly as we can.

And those, that was sonographers from our other PCEL sites. We had to get them through the Alaska State background check before they could come up and help us. But starting Monday, we'll be offering that service and trying to move as quickly through that backlog or queue as we can.

So I know that the state of Alaska is looking at a nursing compact, trying to figure out a way that we can get away from the sometimes it would be licensing. I know that's improved.

Is there anything like that for physicians across the United States? Not that I'm aware of.

So in cardiology, if a person came in with an issue, are they— and they needed whatever services, if we are lacking the inventories, would they be referred out or medevaced out or according to their need. Specific to the comment I just made regarding echo services? Yeah, it would then have to be a clinical decision by the referring provider. If that was the, you know, absolutely the only imaging modality that could help them get their answer, then they would probably have to ship. I don't think that has happened.

There are some other imaging modalities that allow us to look at the heart. The new CT scanner now has cardiac CTA, which, which helps with that. But it is a pretty— it does— echo does supply some specific information that's important that those other modalities can't give them. So it is, it's a gap. So since we're down to one visiting cardiologist from the previous three, is there— are we creating a larger backlog?

Um, right now, not that I'm aware of. He's been able to keep up on all of, um, the patients by taking care of them on telehealth when he can't be here in person. Thank you. And if anybody needs anything emergently, then they would go south. They'd be referred south.

So I guess when, when we have this large influx, you can have 8 people sitting in the emergency room with a variety of different issues. Um, what is our medevac capacity?

If we had multiple patients that want to get out of here or need to get out of here, what is the turnaround? It all depends on, like, if Guardian has a plane here, you know, because they're the only company that has a plane here on site. Um, otherwise we get them from Airlift Northwest, wherever they're at. And sometimes the plane can be in Anchorage, it can be in Juneau, it can be in Seattle. They can have just delivered.

It also depends on the type of patient because sometimes they'll put 2 patients in a plane. Um, it really just— it all depends on the type of patient. Like, Guardian doesn't take newborns. Airlift Northwest takes newborns. It just—.

There's, there's a lot of dynamics that make it a little bit different depending on I don't know, you might know this, but I don't, I don't know if Bergen has fully switched over their fleet yet, but I know they were in the process of going to turboprops. Yep. Yeah, coming out of jets and going to turboprops. So yeah, because we can have like 4 to 8 a day, you know. Thank you.

And then depending on weather, we can sit on people longer. And you know, like at night when we need to wake up the ferry and wait for fuel and all of those things play a role in the timing of how fast we can get somebody out. So yeah, yeah, because we've had like where the airport was down where you couldn't see what the weather landing was, we couldn't get any planes to land for a bit. That was years ago. Yeah, but like it just all depends on it.

I know there was a delay in callout. Yeah, so if you can't get the fueler. Yeah, so yeah, it just Lots of different variables. Thank you. Heads up, I'm here, guys.

Sorry about the delay. Thank you, Dr. Park. So how many primary physicians or primary care physicians do we have on staff now? On staff right now, we have Dr. Miller. He's a full-time MD.

We have Stephanie Myers, a full-time nurse practitioner. We have Susan Wells. Yep, Susan Wells, full-time nurse practitioner that just started. And we've got Dr. Pankow, he's a 0.5 FTE physician. We have locums right now, we are just finishing up with one locum that's been here for 3 months, MD, and another one is coming in a couple weeks to replace her.

And then we have some relief physicians that come in. Who— and then Dr. Park also sees patients on a 0.1 status. Who am I missing, Dr. Park? Yeah, so of those you just talked about, some relief physicians, so Dr. Rice still sees patients, you know, from time to time. Dr. Brinkerhoff comes in one week a month, and then we will have Dr. Williams coming in the beginning of September.

So what is the targeted staffing level? Are we, are we close to what you did? Yep, that'll be close to target. Okay. And we'll re— we'll reevaluate to see if we need one more after Dr. Williams gets here.

Thank you. Yep. Does that clear the backlog? That's what we're trying to see, because some of the backlog has gone to other, um, community practitioners. So Yeah, what, what will happen is once Dr. Williams is here, we will continue to have an extra locums physician who will be here full time, and so they will overlap for about 2 months, just a little under 2 months.

And so hopefully by the time the locums physician is finished at the end of October, we'll have a good feel for how how much access we still need, and if we still need another person, we'll continue to engage locums to make sure that we have access, but we're also hopeful that Dr. Williams, once she comes on board, will find that we have kind of worked down the backlog, but we've also opened up another position for a primary care physician, so we'll still be recruiting for one more. So right now, if someone comes to town who's new, like an employee from the City, and they want to establish primary care and they call, are they allowed to be placed on a list for care or— because, you know, I have, I know of an employee who was told, "Call back in a few months and maybe we can put you on a list." Yes, they can be put on a list. Okay. Is a few months, uh, right? Because they were told to call back in a few months so we might be able to put you on a list.

Yeah. Yes. No. Okay. They can be, they can be on a list.

Okay. So, excuse me, what would be the targeted best option, I guess, that would you would look at in regards to being able to get on to a, into a primary care physician? With the hospital? Well, if you call right now, you can get in with any of the primary care. They just might not be your full-time provider.

Okay. Yep. But we—. Yeah. So, like, if you're not paneled with somebody, you can still get care for, like, if you have an ear infection or, you know.

Well, even— and I would— yeah, I'll maybe add to that a little bit. So I think one of the things that we're trying to make sure that people understand is just because we're not paneling you with somebody doesn't mean that people still can't have their care. So, for example, As Sarah pointed out, I'm seeing patients half day a week. So I can see patients for their physicals. I can see them for their diabetes.

I can see them for any of that. And I can also arrange follow-up with me, you know, depending on my schedule. But if not with me, we can have that person follow up with someone else. But the plan would not be to empanel somebody with me because since, you know, my schedule is so variable, it doesn't make sense for me to carry a panel. But we're still going to make sure that we have enough people to see patients on a regular basis when needed, but we'll wait for people who are full-time to actually kind of, quote unquote, empanel them as a primary, you know, as their primary care provider.

So I have a question about the target, right? There was a question earlier and you referred to you're getting close to target. Is target that you're referring to for primary care, for example, is that based on how many providers you want to have available? Is that based on wait time to see a provider? Is that based on— what is the target?

Yeah, it's based on—. Yes, all of that. What I would say is, is it's a, um, you know, they're— so basically, from what I understand is, uh, let's say a couple years ago we had kind of from an what we call FTE standpoint, you know, we had around 4.5 FTE of primary care. And so when we get Catherine here or Dr. Williams, I believe that will bring us up to 4.5, which is what we've had in the past. And then we'll see how that goes.

And so if we still feel as though, you know, we've kind of, you know, we, those folks are busy and they're impaled with as many patients as they can handle, then we'll, you know, continue to add, but if that feels like they're— they still have capacity, then we may not have to. So a combination of those two things. And do you have publicly available metrics that you're tracking related to that that you can report on? Like how some—. Like what the current wait time is, or what the, you know, if your target is 4.5 FTEs that you have 3.5 or you have 5, whatever it may be.

Do you have metrics established for all of this? We have metrics for, like, being able to make an appointment within, like, 3 weeks, or, you know, what's the opening, how long. And the reason I ask is because the lease agreement is pretty generic as far as that. It says you'll provide primary care, but it doesn't say to what level you're going to provide primary care. And I think if the community understood what level you're targeting, and we could share that information with them regularly, that could be helpful.

Yeah, and, you know, with Alaska allows nurse practitioners to practice on their own license and have a lot of nurse practitioners in the community that are opening up practices too. Our numbers can change based on that, on who's, you know, we want to make sure that we're respectful and we're not bringing in 10 more physicians and then making it harder for nurse practitioners to have their business. So it's all a balance, but yeah, I can get you— we can get the results for next appointment availability. And I'd be curious for that on any of the things that the contract, that the lease says that you're providing for services. What's the metric that you're using and what does— like a dashboard almost of what that looks like.

I think that would be useful for the community and for me sitting on this group. Some— sorry to interrupt. Some of that is available on the report card, and that report card that we are charged to provide, this committee helps set those. And so, and that's supposed to be reviewed annually, and we're doing that, I believe, at the October meeting. October.

Makes sense. So that'd be a great time. Perfect. Specifics that the committee wanted to include., in that report card as we move into the next calendar year. Yeah.

Okay. Thank you. Yeah, like for ortho, you can get in the very next day. That's the wait time, the same day or next day. Sure.

So, but like ENT, they're visiting, so they come quarterly. So I think that's good information for the public because there's a difference between being paneled and receiving care. Care. Yep. And then with same-day, people can come as well to get care from that nurse practitioner.

Thank you. Yeah, the report card is public. I believe it's the city's website as well. So what we've been working on historically should be publicly available. If we make some adjustments to that.

Okay, good.

Now, okay, anything else on, on core services?

Are all of them being pretty well managed right now? Mm-hmm.

Okay. Yeah, again, with the exception of the diagnostic imaging challenge that I spoke to earlier. Yeah. And we did just add another FTE for physical therapy because we saw that our— we had like a longer waitlist. And so we hired— we added an FTE to that to help break down that.

Um, thank you. Yeah, that's actually kind of a neat story worth mentioning. Uh, we've hired two local, uh, KI graduates recently that were community scholarship recipients from East Southview in our physical therapy department. So, yeah, so that's exciting. Cool kids, very neat.

Yeah.

Okay, um, moving on to 7D. Um, Notification and/or discussion of any changes to our financial assistance policy. This was one that was, when we approved the cadence of the meetings that we would review each of these, it was requested that that one was added to the list to review at every meeting. We don't have any changes to discuss to our financial assistance policy.

That's another one. I think we present that policy in October, if I'm not mistaken.

I don't see it. At any rate, we don't have any, any changes to present.

If there's no comments or concerns or discussion, we'll move on to 7E, which is those items that are identified on our list to discuss at the July— at this meeting. I believe we have some slides related to 1, 2, and 3 under this, under this are really all one and the same in many ways. But I thought I did provide a definition out of the lease of these funding commitments just for folks to— I know personally I had to read through it a couple of times early on just to really try to wrap my head around exactly what it was we needed to have ready to present. So There is a handout in the packet that defines this particular element of the lease that's being shared on the screen as well. Yeah.

Folks want a quick minute to review that, go ahead and take it.

So, Earlier we had comments about financial disclosures and information that is required to be shared under the lease. And so they had a pretty good definition in here, I think, in regards to what total net income and how it's defined.. And then it talked about, you know, any of the direct or indirect expenses associated with the operations and clinical operations that should be in a report. And then the reinvestment into KMC and service area at 100% of total trailing 3-year average of total incomes. And so, uh, in October we'll have you present us what the 3-year trailing income is.

Um, I have that today. Yeah, so we're gonna, we're gonna go through some slides that to address this particular element, and then, um, if there are questions after that, hopefully we'll answer your questions here. Perfect. Thank you.

Do we have the— for your PowerPoint, right? Oh no. Oh, I— she's got your stuff for—. Well, that's down on the agenda a little bit. Do you have the PowerPoint slides now?

Can you switch to that, please? I'm not sure what the title of that particular slide deck was.

We sent two, correct? You remember the—. Which one was titled which? This is it right here. This is it?

Yep. Perfect. Thank you.

Go to the next slide. Thank you.

All right, so here's the 3-year net income for '24, '25, and '26. Up top, we have our patient service revenue. We have our operating revenue, um, our other operating revenue, and a total, and then our expenses, salaries, payroll, medical supplies, purchase services, other operating expenses, and depreciation. Um, gains and losses, we have been not doing great this fiscal year. We did really well, um, comparatively, so we actually had a positive, um, operation this year.

And then, yeah, net income. And then that's our 3-year average. Um, the 3-year average is still a negative because of the negative first 2 years. And then even with the negative, it shows the 3 years of annual capital investment. So $6 million in— a little over $6 million in fiscal year '24, almost $2 million in '25, and $1.7 million in '26.

So the average for that is $3,370,000.

And then next slide, please.

Any questions before we— there's, there's more details in other slides. So do you want me to wait at the end for questions? Sure. Okay. Yeah.

Next slide.

All right, so here is fiscal year '26 approved capital. Um, starts on the 3rd for actual fiscal year. So, Oh, you can see that, um, we have the lab expansion design costs and, um, some of Foundation's funds that also went in here. But that's a whole list of all of the things that were done in fiscal year '26.

So surgical equipment, door replacements, generators, Philips monitors, things like that.

Next slide, please.

And then here's the 3-year running approved capital.

From 23 to 26.

Next slide, please. And then here is what we have for requested capital for the fiscal year '27 and '28.

So are all these achievable?

Yeah, um, good question. So, um, my team right now is looking at all of these items and looking to see what we can ask for in grants and ask from philanthropy and then get system support for because we didn't make enough to support this. So we need system support like we have in the last several years. Yeah. So, yeah, my, my biggest concern with city council is we may be very aggressive in what we want to do, but the reality of it, due to the availability of contractors, escalating costs, all that kind of stuff, is it really an achievable capital budget, or do we need to spread that out over a longer period of time?

Right. So I think that, I mean, like 2028, when you look at that one, it's got the emergency expansion remodel little over $13 million. My guess is it's going to be more than $13 million by the time we get the lab done.

And yeah, so I think that you have a very good point of it might have to be spread out based on the funds that we can get from the system and just— and also looking at to see if there's some equipment that has shorter life than others, then we replace those first. So how do you prioritize this list? Usually it's patient safety and regulatory requirements.

And of course, the lease is very important too. Yeah, I would, I would interject also, even with the size of these numbers, what's not reflected in here is the lab expansion. The ROM on that is currently sitting at about $6.4 million. So Phase 2 of the ED remodel is—. We don't have—.

Once we get the construction documents or bid-ready documents, we'll have a more specific number on that. Also a requirement of the lease that we're obviously committed to fund and get completed, but that's not reflected in here. Part of the design was reflected in the prior year's capital budget. But that's a pretty small chunk of that overall estimate. Thank you.

I think that, well, you know, what's in the lease, I think it's Exhibit G, you know, the numbers that were projected in that spreadsheet for the shared cost between the city and PSALTH and the lease. By most people's— I know Amanda and I have talked about it at length, but those numbers haven't been put in in 2021 or really out of date. And I think—. I can't remember the exact number for the ED expansion and remodel, but I think what's in the lease is like $4 million or something like that, and it's probably going to be $25 million. So it's going to be upgraded by the time we get to the October or January meeting where some of that stuff comes up.

Is what? The update? Some of those numbers that you had in the '21. Well, it's a moving target, right? So some of those things on there, we'll talk about a little bit.

One of the items on our agenda is to have a discussion about those shared costs. But as they come up, you know, we'll have to get some more specific numbers around those, whether or not it's of value to the committee. We could discuss whether or not we want to go through every item on that list and try to come up with some new numbers. But there was inflation built into it that, at least in my opinion, wasn't adequate. But it's a big list.

It is a big list. And so I don't know if there's—. Is there any potential for money coming in the rural transformation? Yes. Yeah, we have, but we put in, um, we put in LOIs and all of our LOIs got approved or moved to next year.

They split them in half and we put 2 forward this year and one is for an integration and OR remodel project. And the second one was for upgrading our fetal monitoring and bringing in a neonatal Teladoc. So, because we use services at a UW, UW. So yeah, those are the 2 things for this year. Thank you.

But we haven't heard back yet. Yeah. Yeah. Okay. Sometime any day.

We, we do have a meeting on the 10th in town, right? We do. Yes. Yep. Have a meeting with them on the 10th, but we should know by the end of the month.

That is what was shared with us before. Thank you. And then we will be working hard in September. To put in, um, some of the other ones that were held for next year.

Good. That our final slide on that? That is our final slide. Any other questions on this element of the lease?

Um, so as we looked at the beginning part of it where we talked about the, uh, 3-year running average being negative, what are probably the top maybe 3 contributors to being in the negative in regards to the average. Yeah, so we found that we had some issues with payers in our long-term care. We've got that corrected. So that has really helped. Have grown in our infusions.

We did over 1,200 more than we expected last year. Yeah, so that's one of the asks for Rural Health Transformation Funds next year is funds to expand our chairs and space so we can keep, you know, as the world changes, different, you know, infusions come out and we can add more services. We need to be ready to grow for those. So that's where we're looking at right now. Um, radiology, that department grew, um, as well.

Um, the physical therapy, that's why we added an FTE to that. And then, um, just better management of our budgets and our expenses and watching things a little bit more closely. Also filling full-time positions. We normally run at 35 travelers and we've kept it under like 12. So, um, which has really helped.

So, um, and just different, you know, um, management of different departments, watching their productivity and overtime and waste reduction and waste. So thank you. Yep, we've done a lot of work this last year. It always seems to be more ahead. Yeah, there's more ahead.

Yeah, okay, not seeing any more questions. Uh, we're going to move on to item 8, which is unfinished business. Um, 8A is a review of the shared capital improvements to the facility from the lease. Um, I shared this particular spreadsheet, although it's It's not formatted well. I apologize again.

This is really hard to see, but if you wouldn't mind, you can just brief overview. Basically what this is, is all of the items that are included in the lease. Shared expenses, some PeaceHealth-directed, some city-directed, but most of these by and large are shared capital expenses identified in the lease, and each one line by line is probably not all that important to the committee. But if you can scroll just to the right a little bit, or slide to the other side of the— what you're projecting, left to right. Yeah, we just took a quick— well, it wasn't all that quick, but we did go through and look at the things on this list that have been completed.

And if you scroll all the way to the bottom, please.

This was in the packet that you would have to look at on your computer in order to really get into the detail. But all the way at the bottom, we've basically just included the— up just a little, one more slide. It's the bottom of the spreadsheet. I'm so sorry about formatting, you guys.

On the far right, there's a total of what PeaceHealth has paid to date from the start of the lease, both in capital expenses.

One more over. It's about $8.1 million in total in capital investment and another $800,000, if I remember correctly, out of operations. So, to date, There you go. Thank you so much. Um, and so just wanted again to just kind of emphasize that there has been continued investment in the facility in terms of those items that were on the lease on PeaceHealth.

Um, and then if there are questions about that in particular, I'm happy to take what I can or bring back answers. But I think the The question I'd like to just have a quick discussion on is of those shared expenses. Again, in the lease, it's really not spelled out very clearly what shared expense means, right? So recognizing that, I'd be interested in hearing from the city what, you know, what you all's take on what that definition looks like. And then we were We were— it was mentioned at an earlier meeting that there potentially could be some, some city money that was identified for this upcoming fiscal year for some of these projects.

So just curious what, what our, what our path forward looks like in terms of these expenses and what opinions might, might be out there on what a shared expense means. I think we do have to have that conversation, and it's going to take a little bit for Abner, of course, to get up to speed on some of this as we go through the process and work with Amanda. And, uh, but I agree with you, it's a little vague, and, uh, we know there are certain things that we, we've talked about in regards to shared expenses. I got to list that thing, um, and, and I'll continue to review that, go over some of that with Aftner, but I don't have any particular idea of how we define the shared expense, especially in regards to if it's a 50/50, 70/30, 60/40. I don't know.

I don't either. So, but I think we can, we could, and it might be project by project, right? Yeah. But I think that's a conversation we should, we should have. Um, in regards to that, that's probably something that, uh, management can, can talk about prior to our meetings so that you can get some kind of a feeling for that.

Okay. I think as a group, we're going to have—. There's a bunch of things that I've seen in the lease that we have to kind of outline ourselves because it's not clear. So, and, Sherrod, I think we need to work together and define what that means from this, from this table, right? I mean, I think that's the purpose of this group.

On that as well as the different levels of service that are provided. For example, like we talked about earlier, where the contract or the lease— I keep calling it a contract, I apologize— where the lease isn't clear, the HAC is going to have to weigh in on what that means. Do you think that prior to October we should maybe have a capital meeting? I would believe so. And see, we've been at this— when the lease was new, we didn't have the background probably that we needed, but now we've gone down the road of ways we can look at our past investments, see what those shared investments were historically, and see if we can somehow manage to, I think, view the future projects through some of those metrics.

I think prior to that meeting, we should get your priorities of this very robust list. Um, I, I do. I have that. Yeah, so we've, we've taken that list, uh, with our facilities team and gone through and extracted like a top 5 list out of that, prioritized them each, um, and made our own priorities. Um, I can't remember if I sent that to you or not, but I do have that and I can get it to whoever is most appropriate.

And then if I might suggest, I think that I think that's a great place to start for two reasons. One, we can take a look at whether or not those cost estimates that are in the lease, which we all probably know are not accurate anymore. And if we identify those priorities between the city and PCEL that we agree we should really tackle next, we could then start to look at what those costs really look like and get some accurate ROMs. Yeah, we need a long-term capital plan because if we see that 15-20% low, it means that we may have to spread the capital projects out even a little bit more because of the ability to fund them. And last year, budgeting-wise, I did place some placeholders for '27 and '28, um, just based off of this list and what— I think you did send me some priorities, and so I did put a few placeholders in there, but we do need to take a hard look because they are just placeholders for now.

I don't know if you have a bigger sheet. Could you supply that to us? Yeah, I tried. My formatting skills are not where they need to be, obviously, but I'll try to get that to you. On your computer, you can blow it up.

Yeah, that's fine. And I would also add just to that, that some of the numbers in that spreadsheet obviously are included in some of the numbers that were presented in the other capital investments. So that's not— my intent was not to, not to, uh, imply that, that those were in addition to the other capital investments. Many of the items on both those lists, some of them cross over.

All right, so we'll, uh, calendar a meeting with the city manager's office and, uh, establish some priorities and start a look some of those pricing. Thank you. Yep. Um, any more discussion on, on that? All right, moving on to 8B.

Um, one of, one of the— reviewing the minutes from the last meeting, one of the things that, that, uh, that, uh, Amanda had brought forward was, um, the parking in, in and around the facility. And just wanted to follow up with you all that after that meeting we did, there's a gate that comes down to that ER and a ramp, you know, that goes up to that parking that was kind of the main area of concern from our neighbors, and we did shut down that parking lot, essentially close that gate off so folks couldn't come and go from that direction and I think that solved it. We didn't hear anything more, um, and asked folks not to park on those— on that street and on in that parking lot any longer. Um, and, and again, just as a reminder, part of that pressure that was, that was kind of pushing people over there was the, the 5th Avenue access, the stairwell that was, that was out of service for a long time. And thank you to the city for taking care of that.

Um, that's done and back open, and I think We still have parking issues on the property, but that makes a huge difference having that back over. And so thank you guys.

Moving on. How many other unfinished business?

At 9A is our updates. We have another— should have another slide deck, correct? No, no, we don't. I thought we did. Yep, nope, and most of it we, we covered with the— really happy to say that we had a positive year financially and just wanted to— last time I shared with you that we had Wendy Dennis as our CNO from Longview and she is still covering Ketchikan as well right now.

And just to share that we had really great growth in long-term care, radiology, infusion, And then one of the comments that was shared before was people feeling safe to speak up. And we put a lot of people, meaning the caregivers, we put a lot of things in place, leadership rounding, daily huddles. We talk about every safety event every morning, Monday through Friday, and the increase in reporting of issues, um, was huge. So people are feeling more safe to speak up and to share. So just wanted to give you that feedback.

Appreciate that because we get some of those comments at the council table in regards to sharing information or reporting, um, the culture. So I appreciate the fact that you update us and let us know what you're working on. And then, just so you guys are aware, we have been struggling, especially with the 5th Avenue stairwell being down. Some, um, we have some homeless encampments happening around the facility, and so we have been working with the police department on that. But sometimes we do get them in our stairwells and stuff and making quite the mess.

So it's been an uptick in in that lately.

And then we will keep you updated with our RHTP when we find out. I'll send an email over to you after, once we hear what we got with more details. Okay. That's all I have.

Thank you.

Very That brings us to item 10 on the agenda, which is the— our future HAC meeting in October. And I will— I'll just open by saying I appreciate the comments from the committee at the last meeting, as well as public comment on this topic. And certainly my opinion changed about the idea that there could be more than one solution to some of the issues that we had at last year's HAC. So I guess I would like to propose that we do continue to keep it and have some discussion about that.

But at the current location, I think moving it into the larger space would be beneficial. I think the— You know, the space still presents some challenges, and I think the timing of the meeting still presents some challenges. So I want to hear from you all about maybe how we solve those. I believe the Community Health Board started last year at 6 or 6:30.

Regardless, I think it's really important that we're able to have, you know, a 30-minute break for folks that need to participate actively in both meetings. So in looking at that, what I heard at the last meeting as one of the key priorities was having this at a time where the public could attend, you know, after work. And so that's the one piece I'd still like to hear from folks about. How do we, you know, stagger that meeting, or where—. How do we—.

How do we time that meeting in a way that we can meet that goal and still run the meeting and get folks out in a reasonable time to get prepared, bio breaks, all that, and be ready for the Community Health Board meeting. So the start time, I think, is maybe the one thing I still kind of would like to hear from folks. I think I'd like to see the start time moved up, but I'd like to see the public meeting on one day and then maybe the this meeting following that. It's too much, I think, for one day, you know, to have both meetings back to back like that. There's a lot of information to process, and plus then you have the overlap.

I was going to ask what the reason is that they're on the same day.

Well, if What I've heard is that it's, it's an opportunity for the public to, to show up one night and be able to address both bodies and not have to take multiple days out of their, out of their schedule to come and see us. But I think you're— I think your, your idea is worth exploring, um, whether or not we have it, you know, on a, on a different day, a little later in the evening, because I do think that, that if that's one of the key concerns from, from the public, I think that is a little bit at risk if we have to start the, the HAC at 4 o'clock in order to get done. Yeah, we really giving them the opportunity to—. I see. So I think that we split them up, and because the, the, the ability to talk in the, uh, town hall meeting format is very important to the public And it's important for all of us to listen to that.

And there's nothing to say that we can't discuss, you know, if they want to bring it up at that meeting and say, we'd like to pass this on to the HAC. I don't have a problem with that. One of the things I'd like to suggest to the community as we do this, if they have a very long explanation in regards to their concerns that they've give us something in writing so we can work with it. It's hard to take all the notes in that and then keep their presentation as a highlight of what they're giving. I think that may cut down on some of the time, and still we're going to get the information we need, because I tried to take notes during that meeting and it was just very difficult, very difficult.

And then I think having that open town hall forum prior to our HAC meeting gives us some probably some items that we may want to discuss and put on future HAC meetings for discussion specifically, you know. So I just think it's a better format. The public has the opportunity, uh, and after work hours to really visit either one of them. Yep, I agree. Yeah, because what was uncomfortable last time was that there was like, we went half an hour over because we want to hear everybody's comments, and it left, you know, those who had gone to work, done that.

Like, it was— I was late to present at the town hall because I needed to eat a snack and use the restroom and grab some water before I did, you know. So, and we didn't even really get to have a PAC meeting. No, we didn't. We didn't even—. It was just, it was just comments.

We didn't even get to discuss anything that was our agendas. So yeah, yeah, yeah. And I don't know if you want to— I don't remember how it went last time, but you may want to have a moderator, you know, so that we can keep the framing and time and concerns directed directly to the issues of the—. Well, I don't mind. I'm open to that too.

I don't mind managing that. Meeting as appropriate. I think one of the things that we didn't have last time was the time limits on public comment, and the city having a standard on that, I think, will help keep that concise. And you can broaden that a bit because of the context that we're looking at. It doesn't have to be 3, it could be 4, it could be 5, or they request extra time, they can ask for it if it's an issue.

But I know that in some of those we just had, repetitive. They kept telling you the same thing over and over in a different, little bit different format. So it drew out the meeting quite long. And it's impassioned, I get that. I understand that completely.

But I think even some notes that we can take back would be nice if they would, you know, think about doing that so we can have a better kind of to digest some of the information that they write, right? It's hard to actively listen and take notes. And then we got to make sure that we stay within the HIPAA regulations when you're talking about stuff. I get that. And so if we're going to have some paperwork at the front door, you should probably have something related so they understand that there are certain things that you can't talk about in patient copies.

There, you know, as, as a group.

Um, this would entertain a motion, uh, for discussion on, on the details regarding that meeting. Then I'd move that we would split them, have the town hall prior to the HAC meeting on one day and then the other one on the other day, and we'll figure the schedule out based on the calendar at that particular point in time and set those meetings up and advertise them. I'll second that.

That's been moved and seconded to have—. And move the time frame for the, uh, town hall meeting up so we have a longer period of time in getting out of there at decent hour. That what you were—. So the town hall right now is set at 6:00 PM. Yeah, do you want to set it earlier?

Is that what you mean? I, I think, um, you know, we, we've run council meetings at 6:00 too. Uh, you need a little break from the time that you're working to the time that you get there. Yeah, a lot of people get off at 5:30 that are, you know, that are on our board, be able to do the town hall. So 6 o'clock works the best for them.

Okay, and if we're splitting it into two different days, that probably is fine then. Yeah. Okay. Can I repeat just so I make sure I understand the motion? What I heard was to have all the October HAC meeting at 6:00 PM at the Ted Ferry in the larger space on a different day.

Following the Community Health Board Town Hall.

So it's been moved and seconded. Any discussion? Further discussion? And that space will be the temporary city center, correct? I think that's what—.

Yeah, just make sure.

We reserve it for the town hall. Will you guys be reserving it? Oh, you got—. Let's just take it from you.

Jackie, do you mind muting? Thanks. Why don't you schedule both? Okay, yeah, we'll just connect and make sure timing—. Yeah, right, but we can make that happen.

So many new people, I want to make sure that we know what we're taking on.

If there's no further discussion, you can call the roll on the motion, please. Cook? Yep. Park?

He's got a thumbs up. Okay, okay. Um, Smith? Yes. Sewardson?

Yes. Robinson? Yes. Hogue? Yes.

All right, motion passes. So our October meeting is set. Um, Brings us to item 11, which is future agenda items.

Again, working from the meeting cadence for the lease terms that we have established in April of this year, we will have some standing items that are split pretty equally throughout the year. Back, back to the comments about getting our normal business covered as well in October. We're sitting at a little over an hour already, so we can expect a similar meeting in October with the, with the standing business. Are there any other future agenda items that folks would like to talk about at this time?

And obviously Amanda and I both, uh, were together to set the agenda. So at any time we've got things that come up, sooner the better, but to one of us, we'll make sure it ends on the agenda. Do you have any kind of a calendar and events where you're attending? I think that you have the community health thing where you take blood and all that kind of stuff, or is there any forum that we're attending in public events around all these or anything like that? If you had a calendar or stuff that, because I think it's very important for the public to know who PeaceHealth is and all the good work we do.

You know, sometimes we dwell on the the negative and not the positive. But I think that for one thing, we got the staff that plays very good. So if you had some staff recognition events where you can send messages or something, I don't know. But I think just the public image, I think that we can work on that.

And send, you know, tell the public what we're doing. And if not, you know, there's some things that are challenging, not just with Peace House but with every medical facility across the United States, right? And the federal government is starting to recognize that. And so it's difficult for young individuals. A lot of the jobs don't have insurance.

And so healthcare is a big issue across the state and across the nation. So I just think some of the positive stuff that we're seeing, newsletters, that kind of stuff, important to show that we're concerned and working on community issues. Thank you.

Okay, uh, committee comments. Nothing.

Oh, good. Glad to be here. Um, we will have elections coming up. There's 3 full-time council seats and, uh, a 1-year seat that will be available at this time. So the matrix didn't change, and, uh, we want to make sure that we have, as we did with this meeting, make sure we fill these positions so we can continue to do the business that we need to do.

Safe to assume that you'll still be the member for the October meeting? Yes. The next meeting, probably. Yes.

Um, I appreciate the effort to staff primary care, concern in the community that I've heard quite a bit. Um, but other than that, um, like I said, just one more time, would Thank you. Thank you both for stepping up. Welcome, welcome. You're both—.

We can help with anything. Please don't hesitate to reach out, um, start to get your feet under you. We got a couple action items, so they're going to get a priority list to Amanda on project. I've got it. Yep.

And then you're going to set up a management meeting in regards to, um, the lease itself, talking about shared services, what that really means. Yeah, yeah, I think, I think I can send them to you, but that's not going to be your role anymore as I understand it, right? So who, who's here until December or until reappointment? Well, I just mean in terms of the work with the, with the specific to the—. So we'll have to work with, with Seth Brackey at Public Works, um, for budgeting because, um, Public Health is under Public Works.

Yeah, but whatever he said you, you're going to share with Seth. Yeah, we'll take care of that internally for now. Yeah, while Amanda continues for continuity until her term expires. Trouble copying Seth either.

Okay, there's no further comments. I move that we adjourn. Thank you, sir. Meeting is adjourned at 10:16. Thank you.

Thanks, guys. Have a great day.