HomeMy WebLinkAbout20181357.tiffNCMC Board of Trustees
Regular Session Minutes
Monday, March 26, 2018
12:00 Noon
The Board of Trustees of North Colorado Medical Center met in Regular Session on Monday,
March 26, 2018, in the Richard Stenner Boardroom located at North Colorado Medical Center.
Mark Lawley, Chair, declared a quorum and called the meeting to order at 12:00 p.m.
ATTENDANCE REPORT
NCMC Board of Trustees: Catherine Davis (via teleconference), Mark Lawley, Kevin Mullin,
Michael Simone, Brian Underwood, Jason Yeater, and Sean Conway (Commissioner, non-
voting member)
Banner Health: Margo Karsten (NCMC CEO), and Derek Strader (NCMC COO)
Staff: Jeff Carlson (INC. Board Exec. Dir.)
Recording Clerk: Esther Gesick (Weld County Clerk to the Board)
PUBLIC COMMENT - There was no public comment.
APPROVAL OF MINUTES
It was MSC (Underwood/Yeater) to approve the minutes from the February 26, 2018, Regular
Session meeting.
COMMISSIONER'S REPORT
Commissioner Conway stated the Home Rule Charter Review Committee (HRCC) has started
meeting and is tasked with gathering public input and making a recommendation to the Board
of Commissioners for possible cleanup and revisions. Mr. Lawley stated he also serves on the
HRCC and he shared the upcoming public hearing dates. Commissioner Conway stated the
Charter was previously amended, in 2002, to change the Treasurer and Coroner positions
from elected to appointed, and again in 2007, to increase the term limits to three, four-year
terms. He explained the County Attorney has recommended various housekeeping revisions
to ensure consistency and compliance with State law and TABOR (Taxpayer's Bill of Rights),
and the Commissioners are looking forward to any public suggestions. He staled the HRCC
will make its recommendation by July 15th, and then the changes will be voted on by the
Board for referral to the November ballot. In response to Mr. Mullin, Commissioner Conway
explained the offices of Treasurer and Coroner were changed to appointed positions in an
effort to gain more technical expertise through the interview process, versus the general
qualifications listed in the Charter. He stated it is the Commissioners' belief that Weld County
currently has the best Coroner and Treasurer in the state.
He also reported the U.S. Highway 34 PEL (Planning and Environmental Linkages) open houses
are scheduled to be held in Greeley and Loveland during May, 2018, and the North 1-25
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March 26, 2018 NCMC Board of Trustees
2018-1357
groundbreaking is anticipated in early summer for a new managed lane from Highway 402
north to Highway 14 to be completed by the year 2020. He indicated the Commissioners are
monitoring Senate Bill SB18-01 which is under consideration for bonding and sales tax. He
also reported the segment of CR 49 between CR 60.5 and Highway 392 is under construction;
however, some of the bridge work will not be completed until after the irrigation season. He
commented the County is using the same company that completed the previous sections of
CR 49, as well as the southern I-25 project. Lastly, he spoke to Leadership Colorado, along
with Commissioner Cozad and various other leaders from Northern Colorado. Derek Strader
was also in attendance and agreed there was a lot of helpful focus on regionalism.
CEO REPORT or COO REPORT
NCMC COO, Derek Strader, gave the following report:
• The Banner Paramedic Service is looking at a potential relocation of the M Street station
for use by the County Coroner's Office. He stated they are in the first quarter of the new
contract and the roaming ambulances are now stationed. At 90 days, the response times
are well above compliance, but there has been some slippage, so they are reviewing
strategic deployment, considering fatigue, evaluating schedules, and trying to avoid
medic burnout. He reported the West station has tripled its call load and they will be
meeting with Chief, Dave Bressler, to discuss options to handle the growth.
Commissioner Conway noted the two main goals as part of the 2012 transfer were
retention of existing Weld County employees and Tiered licensing of ambulances through
the Board of Commissioners. He stated the agreement automatically renews every five
years, and the terms have worked out very well. He stated all parties involved are
planning for current and future growth for the entire region. Mr. Strader stated Banner
is launching a new brand campaign, including employee forums, public billboards and
social media platforms to introduce the brand.
VISITATION REPORT FROM MARCH 26, 2018
PHARMACY — Richard Einhellig, Sr. Dir. Pharmacy
Following the meeting, Catherine Davis submitted a summary of the departmental
presentation and discussion, and Kevin Mullin also sent a note of thanks to Mr. Einhellig for
his very informative presentation. A written copy of each is attached as a part of these
minutes.
VISITATION REPORT FOR APRIL 30, 2018
Brian Underwood and Jason Yeater
NCMC, INC. REPORT
Jeff Carlson stated he expects to have first quarter reports next month. He mentioned the
volatility of the stock market during the month of February, with $10 million in unrealized
loss, which matters because it affects bonds, credit ratings, and liquid assets. He reminded
the Trustees that the FASB (Financial Accountability Standards Board) and S&P (Standard and
Poer) changed NCMC's outlook rating to an A- based on the entrance of UCH into the market,
Page 2 of 3
March 26, 2018 NCMC Board of Trustees
meaning NCMC was no longer a sole provider in the community. However, as a result of a
very favorable financial market, the covenants and ratios have improved.
NEW BUSINESS
1) Group Visitation Arrangements - The general consensus of the Trustees was in support of
occasional group visits to areas or units that are better suited for visual demonstrations or
tours. Additionally, Chair Lawley recommended written/signed Thank you notes which Anna
can deliver to staff.
ADJOURN
There being no further business to come before the Board, it was MSC [Simone/Yeater] to
adjourn the meeting at 1:09 p.m.
Respectfully submitted,
Esther Gesick
Page 3 of 3
March 26, 2018 NCMC Board of Trustees
Update on NCMC Pharmacy — Top Issues March 26, 2018
Submitted by Catherine C. Davis, Ph.D., MPH
"Critical Drug Shortages Impacting Global and Local Communities"
Richard Eihelling, PharmD, RPh.
History of Contact:
Richard Eihelling graduated from KU — School of Pharmacy and then completed a residency at
The University of Iowa Hospitals and Clinics. He has almost 20 years tenure with NCMC and is
currently serving as Pharmacy Senior Director of the Western Division, which includes NCMC.
Previously, he was Director of NCMC Pharmacy. He has resided in the community for over 25
years.
Overview: Since 1999, FDA has worked with the pharmaceutical industry and stakeholders to
address the critical issue of prescription drug shortages because it impacts health care quality
and delivery in the United States. Currently, production of injectable opioids has nearly
ground to a halt due to manufacturing problems, creating a shortage of staple medications
used to treat a wide array of patients. Concern is mounting at all levels of health care providers,
from academic hospitals to small hospice programs. Several institutions are launching efforts to
conserve injectable opioids and institute safeguards to prevent dosing errors that can result
from rapid changes in medication regimens.
The products in shortage are packaged in vials, patches, and syringes. They are distributed to
hospitals and other medical providers that use them to treat patients undergoing major
surgeries or those who are suffering from intense pain related to trauma or cancer. These
injectable or transdermal delivery systems are distinctly different from the prescription pills at
the root of the U.S. opioid crisis.
The severity of the shortage, which has been brewing since last summer, became clear in early
2018 after Pfizer Inc., the dominant manufacturer of injectable opioids, began notifying
customers that it has halted production of some medicines and will not be able to fully restore
its capacity until the first quarter of 2019. Pfizer has attributed the shortage to a problem with a
third -party manufacturer that produces the pre -filled syringes that contain various formulations
of opioids, including morphine, hydromorphone, and fentanyl.
Each hospital system needs to carefully monitor inventory and use alternative treatments
whenever possible. That might include giving patients oral opioid medicines or using IV Tylenol
when their pain can be managed with a less potent drug. But the price of IV Tylenol has also
tripled since 2014, to $37 per vial compared to $2 per vial for IV morphine. That carries a
significant budget impact, in addition to extra costs for staff members to work overtime to
manage the opioid shortage and receive additional training.
"There is a real cost to drug shortages. "Currently it's injectable opiates. It's going to be
something else next month. This revolving door means something is always going to be short.
With many drugs coming off of patents, there is not a big profit margin for manufacturers to
continue production. Richard noted that much of this information regarding the drug supply
shortage is not new as he reviewed a presentation he gave in 2011, which contained similar
information to today's presentation.
The key to NCMC staying ahead of drug shortages is that they have the leverage of the Banner
Health System where they can buy ahead, safely store the product and distribute it where the
need is greatest. The Banner Arizona Warehouse is registered as an out of state of Colorado.
The most important criterion is to engage early on in interdisciplinary communication with key
patient stakeholders to ensure patient safety — especially when manufacturers/suppliers
change and packaging looks different. NCMC uses restrictive access to opioids with barcoding
at every step from drug leaving the Pharmacy to the patient. This includes the Pyxis dispensing
system.
As of April 14, 2018, the Drug Enforcement Administration (DEA) has raised production quotas
for drug manufacturers Fresenius Kabi and West -Ward Pharmaceuticals to mitigate the
shortage of opioid injectables, but relief is likely months away.2
For up to date information about the FDA's notifications of drug shortages, please see the
following website https://www.fda.gov/Drugs/DrugSafety/DrugShortages/default.htm
Another big impact is the recent hurricane in Puerto Rico which halted production of 50 and
100 ml (small volume) injectable bags by Baxter. Currently, there is a switch within the method
for delivery of small volume injectables using small from IV piggyback to IV push. The key has
been to communicate the need for the change and what are the steps in place for small volume
injectables to all of the patient care stakeholders in the NCMC system.3
Trustee Kevin Mullins wrote the thank you note for Dr. Eihelling taking time to prepare and
present this important information.
References
1. Pfizer : There's a shortage of opioids where they're needed most - in hospitals 2/28/2018
http://www.4-traders.com/PFIZER-23365019/news/Pfizer-There-s-a-shortage-of-opioids-
where-thev-re-needed-most-in-hospitals-26080616/
2. Kacik A. DEA lifts production quotas to ease injectable opioid shortage Modern Healthcare.
April 14, 2018 http://www.modernhealthcare.com/article/20180414/NEWS/180419944
3. https://finance.yahoo.com/news/baxter-import-iv-saline-bags-192608804.html Baxter to
import IV saline bags from Mexico to ease U.S. shortage. January 25, 2018.
Esther Gesick
From:
Sent:
To:
Cc:
Subject:
Richard,
Kevin L. Mullin <KMullin@epmedcenter.com>
Monday, March 26, 2018 3:20 PM
richard.einhellig@bannerhealth.com
Anna.Ashford@bannerhealth.com; catherine.davis1225@gmail.com; Esther Gesick
Thank You
On behalf of the North Colorado Medical Center Board of Trustees, thank you for coming to share important information
about the work of the pharmacy. It was helpful to learn more in-depth the challenges that you face in trying to ensure
that we have the right products at the right time in inventory. There is a lot of talk right now about prescription drug
prices and opioid abuse, I hope that the structural issues that you described will get some focus as well.
Thanks again and keep up the good work.
Sincerely,
KLM
Kevin L. Mullin, MNM, CFRE
Executive Director
kmullinPepmedcenter.com
970-577-4306 — Direct Line
970-387-8252 — Cell
www.GiveToEPMC.org
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