For greater transparency

There is a group of people in Marion County whose mandate is to improve the health of the county’s residents, and they have at their disposal nearly $300 million to do so. They have an operating budget of $12 million each year to spend on a host of programs from playgrounds for children to mental health assistance for first responders.

MCHD started investing approximately $213 million in 2014 when the county, with approval from Marion County voters, decided to lease the county hospital, Munroe Regional Medical Center, to a private healthcare company. The hospital lease has changed hands a few times since then and is now held by AdventhHealth.

The money from the lease came to the MCHD trustees to be used to meet the health needs of Marion County residents.

If you don’t know much, if anything, about them, you’re not alone. The Marion County Hospital District has been operating with scant public attention for many years. It seems the district’s trustees prefer it that way, given the reluctance of the district’s leadership to embrace efforts to become more transparent and make their meetings more accessible.

Since most residents would have a hard time making it to a 5 p.m. Monday board of trustees’ meeting to see how their money is being spent, the “Gazette” has been there for you. After attending MCHD meetings for the better part of 2023, I can state affirmatively that the agendas and minutes of those sessions do not reflect the context of the trustees’ decisions or the serious subjects they consider.

The agendas provide minimal, at best, information about the proposals being considered and often there is little or no documentation about important items up for vote.

Piecemeal initiatives seem to arise out of nowhere, without proposed contracts attached to the agenda item or lacking information to understand how the trustees prioritized one need over another. Some of the initiatives are easily understood: $80,000 for a basketball court at SMA Healthcare, $60,000 for a playground for 36 preschoolers at Belleview Elementary School, an eight-passenger van with really no public reason stated on the agenda for the need, a $70,000 study to improve the resiliency of first responders’ mental health with no contract or agreement with the related departments on who would implement recommendations.

There are other agenda items, however, that would appear to be more complicated but there does not appear to be any formal process for bringing these proposals to the board for approval; it’s almost like you just have to know the right person.

Need an example? The MCHD needed to hire a new lawyer. It’s at least $80,000 annually in attorney’s fees for this position.

I thought to myself, “Great, I know a lot of lawyers read this newspaper. I will report on the opening, and the district will get a lot of choices.”

It took weeks for the district to provide me with even the scope of expertise they wanted for the new lawyer. When I received it, I was told the trustees were not open to receiving unsolicited proposals for legal services; they only wanted proposals from those attorneys from whom they requested proposals.

The law firm chosen was Gooding & Batsel, a prominent firm that has been representing local government entities from the city of Ocala to the College of Central Florida and developers for decades. The firm’s letter acknowledged that there would be conflicts of interest to wade through since they represent so many other institutions in town, but the firm said they would be steadfast about pointing them out.

I’ve reached out to Robert Batsel, Jr. to ask about some of those possible conflicts and am waiting to hear back and do a follow-up report on it in a separate article. At the meeting where that firm was selected, there was no open discussion by the trustees as to why that firm was chosen or about any potential problems with conflicts that could, theoretically, mean the district would have to pay more money for legal services from someone not connected with the firm.

One way to improve the public’s knowledge of what happens at these meetings, considering the paucity of information available before or after the sessions, is to record them for people to view later.

On several occasions, I expressed concerns to the trustees about the lack of any recordings of their meetings. This became relevant as I was reporting on a historical conflict of interest by a trustee over several years involving which investment companies received millions of dollars from the MCHD to invest. I found that the agenda items considered for board decisions had already been destroyed, and there was not enough detail in the meeting minutes to piece together who knew what when.

When I expressed my concern to the trustees’ attorney Joseph Hanratty last year, he replied to my concern that the trustees could start recording their meetings if they’d like to “for political reasons,” but he felt their minutes, as bare bones as they are, complied with state requirements.

As for the legal sufficiency of the minutes, chairperson Teresa Stephens said MCHD Executive Director Curt Brumond told her legal requirements were being met and no further action was needed. She noted that their meetings were open to the public, everyone was welcome, and she expressed happiness I attended them.

Reporting on topics the trustees considered during their meetings related to public health has been difficult. Critical issues such as the lack of comprehensive healthcare for Marion County children are discussed with no obvious strategic planning on how to address the problems. As a result, many Marion families are forced to take their children to hospitals in Gainesville and elsewhere for treatment of their chronic illnesses.

The MCHD’s end-of-year report had a questionable analysis of the cost per resident and the impact of their programs. It would have taken a significant investigation to confirm the accuracy of the stats reported by the staff to the trustees, but at first glance, they seemed to be presenting a misleading narrative.

This past year, I’ve watched the trustees’ Operating Chair, Rusty Branson, try to help the executive director implement the most basic organizational policy measures. Why weren’t these policies implemented years ago?

Faced with continued refusal by the MCHD to recording its meetings, the “Gazette” believed the information being discussed as it relates to public health needs was important enough that we would attend every monthly board meeting, record them ourselves, and publish the video recording for the public.

On Dec. 18, we informed the CEO Brumond more than a month before the next scheduled meeting of our intent to bring recording equipment at the Jan. 29 meeting. We had a conversation agreeing where the video equipment could be set up. He would not agree to allow us to put unintrusive microphones on the conference table to improve the sound quality of the recording.

On Jan. 29, “Gazette” photojournalist Bruce Ackerman and I showed up to record our first meeting only to be directed to the furthest corner of the room where the sound quality, as expected, was horrible. We were told all video and audio recordings had to be done from this point.

Stephens told us to raise our hands if we could not hear what the trustees were saying during the meeting and they would speak up. Deborah Velez, the MCHD chief operating officer, told us our previously arranged position presented a trip hazard to speakers.

Brumond promised he would get help with sound and acoustics so the sound quality should be better in our corner next time. Trustee Harvey Vandeven seemed uncomfortable with how MCHD staff had hamstrung our plans to record the meeting and told us he would work on it before the next meeting.

Trustee Rusty Branson, who watched for our arms during the meeting so he could alert other trustees to speak louder, sent an email following the meeting saying that he hoped that Brumond would be able to address the sound issue.

Trustee David Cope inquired why we didn’t use a boom mike to collect sound. I explained Brumond had turned down our efforts to work out microphone options. Stephens abruptly ended the conversation when Cope made the practical suggestion to remedy the concern.

Trustee Rich Bianculli told me that I could move closer to the trustees but only without my recording device.

At the next MCHD meeting on Feb. 26, the “Gazette” will attempt again to record the meeting so the public can understand the scope of the MCHD’s work. Maybe residents will learn about the type of programing the organization does because one of the goals of MCHD is to reach more people with their services.

Who knows? Maybe “Gazette” readers will pick up some useful tips on how to grow their own investments based on the strategies the trustees employ to navigate those waters.

Don’t lose sight of the important work the MCHD is tasked to perform. For example, the “Gazette” reported about an initiative funded by the district called Beacon Point, a facility that helps meet a high need for substance abuse treatment. Many people called the newspaper asking how to get in touch with the facility following those articles. I recently spoke with a prominent local physician who works in pain management who didn’t even know about the program.

MCHD could use more, not less, public awareness of its mission, challenges and accomplishments.

Most, if not all local government agencies, for some time have recorded their meetings not just for transparency but also to maintain accurate records. They are not legally required to do so; they are choosing to do the right thing.

Stephens sent the “Gazette” a message right before publication that provided some encouragement, “Give us time to see how our new audio equipment can accommodate recording. Then we would need to understand what our state accessibility requirements would be and how we could accommodate those things such as ADA, storage, retrieval, etc.”