County hospice program gets vetted

LEE COUNTY – A discussion that started last week at a Lee County Health Dept. board meeting spilled into the County’s Board of Supervisors' room Monday.
And the discussion got very emotional around whether the county should continue to provide taxpayer support to the LCHD Home Health and Hospice program.
More than 60 people were either in attendance or following along via remote access as the spirited debate unfolded.
The program has been operating in the red for the past two years to the tune of about $300,000, according to Board Chairman Garry Seyb, who called for the workshop discussion that followed the board’s regular meeting.
LCHD’s financial operations manager Tammy Wilson said the department has taken steps to alleviate some of the financial pressures on the program, including moving some of the payroll and benefits for staff into other grant programs.
Supervisor Tom Schulz very pointedly asked how shifting money around within the department was going to help.
“It’s just shifting money from one place to another,” Schulz said.
Wilson said the department was also expecting some reimbursements for hospice patients’ room and board that the county’s program pays up front. That reimbursement comes from Medicare. There are also reimbursements coming from the Veteran’s Administration for service provided to county veterans.
Supervisor Chuck Holmes, who took the message that the county was looking at pulling general levy support for the program from the health department, asked why it’s taken close to three years for the department to correct the deficit spending.
“Why have you waited til now to do something?” Holmes said.
LCHD Director Michele Ross said she takes full responsibility for the lack of attention to the program’s budget, but said expenses for the department as a whole were within budget.
“We did not go beyond our budget, that this board approved, in our total expenses,” Ross said.
She said the pandemic of 2021 and 2022 demanded the health department’s attention saying the department gave more than 20,000 vaccinations sometimes in very inclement weather.
Wilson said the state respects the Lee County Health Department more than the County Board does, a statement that didn’t sit well with Chairman Seyb.
“I have a lot of respect for this health department,” Seyb said. “We’re doing everything we can to get you into a new home, your home.”
Seyb was referring to the county’s efforts to get a new Lee County Health Department built and getting them out of the John Bennett Center at the former ISP facility.
Schulz again pushed the health department on the accounting bookwork and how money is just being moved from one category to another to show a better picture. Wilson said the department has received several grants that allow shifting salaries of staff to those grant programs. Schulz asked if that was detrimental to the home health and hospice program staffing.
Schulz said Wilson wasn’t showing her ability to be a budget director.
Dr. Philip Caropreso, a LCHD board member, demanded Schulz apologize for his comment.
“I don’t speak for the people on this board,” Schulz said. “But I’ll take it under advisement.”
“You’ll take it under advisement…” Caropreso retorted.
Schulz and Wilson argued back and forth repeatedly about the effects moving expenses under other grant program will have on the program’s budget.
Caropreso made an impassioned speech in defense of the health department saying their work guaranteed needed hospice and home health care services to people of Lee County. He said it gives people in end-of-life care a choice of where they want services.
Representatives from Great River Health System’s Southeast Iowa Regional Medical Center Hospice program were on hand and agreed that choice was critical in hospice care. SEIRMC provides hospice care for patients. Schulz said the people that go to that hospital organization would be referred to its hospice program. However, the reps from SEIRMC said they don’t do referrals until the patient has been informed of the choices they have.
Holmes said Schulz didn’t speak for him, but asked again how the department could run two years of deficit spending in the program and do nothing until now to fix it.
Supervisors Ron Fedler and Matt Pflug both showed support for the program and LCHD.
“With what I’ve heard today and the stuff you’ve done to try and fix the problem, I want this board to give you a chance,” Fedler said.
After the meeting, Schulz said he saw some things that looked unusual in the department’s books and has suggested the county do an independent audit of the department’s books.
Lee County Auditor Denise Fraise confirmed she will be speaking with the state auditor on Wednesday as to whether an audit of the books is needed at this point.
Since the discussion took place in a workshop and not as an agenda item on the regular board meeting, no action was allowed. The conversation lasted about 75 minutes before Seyb ended the workshop at about 12:15 with no direction to the board about future discussions or action.