March 29, 2022 Tuesday 9:00 am
The Bourbon County Commission met in open session with all three Commissioners and the County Clerk present.
Also present for all or some of the meeting were Clint Walker, Anne Dare, Don Coffman, Matt Crystal, Drew Solomon, Tom Booser, Merrill Atwater, Dr. Randy Nichols, and Mark McCoy.
Eric Bailey presented permits for Joe Kerr at Indian Rd and 195th for an entrance culvert. The second permit is for Craw-Kan to install fiber lines in the southwest part of the county. Clifton made a motion to approve the permits at Indian Rd & 195th and also for Craw-Kan in the southwest area of the county. Lynne seconded. All approved.
Eric said that he received a phone call this morning regarding a utility company cutting Maple Rd. at approximately 190th or 195th he has not seen it yet. He was not aware of this and is going to work with them to get the appropriate permits. Eric said that he does not think that cutting the road was the best option but he was not aware of the project prior to them cutting the road. Eric asked that if a utility company contacts a commissioner, then please refer them to his department so they can look at all options and get appropriate permits. Jim said that he had a conversation several months ago with a utility company but he said that he told them to contact Eric.
Eric said that due to the road safety plan grant received last year, TranSystems Company is in town gathering data. Eric said that if you see vehicles with lights driving around gathering data but those vehicles should be clearly marked.
Eric discussed the placement of a stop sign in Bronson in the area of 25th & Bay St at the far west part of the curve. He provided maps and of the location and it was discussed as to what the best placement would be. Jim made a motion to place a stop sign at the intersection of Bay and the curve between 25th & Bay. This would stop the westbound traffic on Bay Street and the sign would be placed on northwest corner of the intersection. Clifton seconded. All approved.
Eric said that Dustin had worked diligently to find a dump truck and it paid off because they were able to find a 2008 Sterling in Tulsa for $60,000.00 and it has the plow attachments that they will be able to put the county plow on it. Eric said that they finished at 267th and Arrowhead with the 36” culvert replacement so that isn’t so narrow now. He said that they are scheduled to burn at Elm Creek Lake on Friday, weather permitting. Eric gave an update on the windmills saying that they are still working on the punch list that he submitted and everything is going good on finishing up. Jim Harris asked if Eric had received information on federal funding for the year yet. Eric said yes, but that it had been postponed. Lynne asked about the ditching on Wagon Rd that he had received a call on. Eric said that it is on the list and they are working as fast as they can but they also need to look at fixing cross tubes if the ditching is going to really help anything.
Millie Lipscomb, with the Elk’s Lodge, said that with costs rising on everything, that she was requesting a donation from the county of $750 instead of $500 that has been donated by the county the last few years. Clifton made a motion to donate $750 to the Elk’s Lodge for their fireworks display this year. Lynne seconded. All approved.
Ashley presented the contract with Hamlin Energy to help secure the best price for a gas supplier since Pro Solutions is going out of business. She said that they will look and price as well as monitor bills and recommend locking in a price or changing suppliers. She also said that the contact is not for a specific time frame that it can be revoked at anytime with a written letter from the county. Clifton made a motion to allow Chairman Harris to sign the contract with Hamlin Energy. Lynne seconded. All approved.
Clifton made a motion to amend the agenda to add mowing at 401 Woodland Hills Blvd. Lynne seconded. All approved.
Clifton made a motion to move county counselor comments to the end of the agenda. Lynne seconded. All approved.
Clifton said he had been asked if the bids received were apples to apple and he said that they are not. Justin Meeks recommended rejecting all bids and rebidding it. He said that he thinks that we should rebid with better specs. Jim agreed. Clifton made a motion to reject the bids for mowing and rebid it with more detailed specs and to be due back by next Tuesday’s meeting. Lynne seconded. All approved.
Clifton made a motion to go into executive session under KSA 75-4319(b)(4) to discuss data relating to financial affairs or trade secrets of corporations, partnerships, trusts, and individual proprietorships. The session will last for 30 minutes returning to the commission room at 9:57 am and will include the 3 commissioners, Noble Health representatives (Drew Solomon, Tom Boozer, and Marrill Atwater), Josh Jones, Shane Walker, Susan Bancroft, and Justin Meeks. Lynne seconded. All approved.
Clifton made a motion to resume normal session at 9:57 am with no action. Lynne seconded. All approved.
Clifton made a motion to move the executive session for personnel matters to next week’s meeting. Lynne seconded. All approved.
Susan reminded everyone that the meeting next week on March 5th will be held at the Mapleton Community Center at 6 pm and asked what the commission wanted to do about future meetings in outside areas of the community. Jim said that he would like to see one held at Garland and Hiatville. Lynne said he would like to see a night meeting held here at the courthouse as well and Jim agreed. Lynne also said that if you are going to have meetings at those locations you should probably have one at Fulton, Hammond and even Devon. Jim said he would be in favor of trying that and proceed based on attendance. Jim recommended that once we have been to several remote locations for meetings, that they continue with a remote location meeting once per quarter and an evening meeting at the courthouse every 4-6 weeks possibly. Susan said that she would work on a schedule. Susan handed out a capital improvements document to help department heads to understand what needs to be taken into consideration when looking at capital projects. This also includes personnel. If a department needed to add personnel they would have to justify the reason for requesting.
Noble Health Presentation – Drew Solomon gave an update on the feasibility study. It is substantially complete. There are a few items that need to be done. A lot of good findings. Tom Booser will provide additional information. Tom is the coordinator of the research. All of rural Kansas has a demographic trend happening. Every year 25 families leave this county. Right now 19% of the population of Bourbon County is 65+. In 20 years 40% of the population will be 65+. This region is the least healthy in the entire state. Kansas used to rank 9th in terms of health and has declined to 29th out of the 50 states. Through community meetings and surveys the consensus is that we need more healthcare. Data shows there is a very significant trend in this county. There was substantial migration for healthcare from this area prior to the hospital closing. Eleven million dollars per year for healthcare leaves Bourbon County for care outside of this county. If this is going to be a sustainable hospital it must control the out migration. It must find a way to build trust in the community and attract people back. In this community, in this region, these hospitals carry twice the uncompensated care burden as most rural hospitals. As the population ages, you can see from a financial standpoint, your coverage may exceed, in terms of income from a hospital, 40% of revenue. Medicare pays less than private insurers. Medicare typically pays less than the cost to deliver the care. The current model of this hospital the cost to deliver the care is higher than what the reimbursement is. Every time you see a patient you lose money. The only way a hospital can fix that is from a high percentage of private insured patients. If you have a large Medicare/Medicaid population and you can control payments you have a very stable model. This is why so many hospitals get some level of tax subsidy because there is a structural mismatch between costs and revenue. The only way to surmount this, going forward, is to do something different than you’re doing right now or what has been done in the past. This is a structural problem and you have to change the approach. Part of that is collaboration. Rural hospitals should collaborate more. This is going to require transformation. A completely different way of behaving in regard to healthcare. There has to be some sort of community leadership to get people to understand that using healthcare in the region keeps it sustainable. In this region, workforce could be the main component of whether a hospital is viable or not. There is a nursing school in Pittsburg that graduates about 120 students per year. On average, those students owe $25,000 which could be about 15 to 20% of your pay every month to pay off that loan. What if there were help for these candidate nurses so they wouldn’t have that debt. This requires community activism and some original thoughts. The former hospital operated in a certain model allowing surgery and other things like that. There is a merging model called a rural emergency hospital that could be an option for this hospital. It is emerging legislation that is not done. There is no assurance that this hospital would qualify for it but is at least an option to look at. It provides some sustainability for rural hospitals and may provide an option for this community. It is set to go into law in January 2023 so we will know how this plays out as this hospital comes. On the building itself, we believe could be supported by the operations. It can be a platform for other services for the community. You have a very large hospital, maybe not all of it is used for healthcare. Recommendations for viability – we believe moving the hospital into a non-profit 501(c)(3) status, given the appraisal on the hospital, is the appropriate way to go forward. We’ll need a tax exempt bond to support the building. Collaboration with other hospitals is needed. You have to reduce migration out on healthcare services. This is critical. We think given the space in the hospital, there is the potential for behavioral health unit. This behavioral health unit would house patients outside of Bourbon County and provide revenue for the hospital and provide the services needed. There is a high need for this. The structure and the size of the facility enables this and should happen. In the basement of the hospital, the idea to serve families with a daycare and headstart program. There is space to do it. That enables people who consider having careers and working in the hospital to have a way to care for their children while they work. The rest of the community can use it as well. The disconnect between people using services outside the region and staying put is based on the trust that people have in a hospital. You have to rebuild the trust of the community to use the hospital and to believe they get the best care there. If the $11,000,000.00, that leaves the county for healthcare, if just 30 to 40% were to remain in the community that is the difference between a viable and not viable hospital. The large burden of uncompensated care there has to be a way to mitigate that. Get people enrolled in Medicaid that can be and things such as that. Coordinate services with other hospitals in the region. Every hospital in the region loses money. Work with the business community to contract directly with them to provide healthcare in this town for the people who work here. If we can do that then you have a sustainable basis for a hospital going forward. It doesn’t fall on just hospital management it is a community project. Drew Solomon stated that the market rate value of the building is $19.6 million. The appraisal brings to light that there is a significant asset there. Clifton asked when the study would be complete and receive the report. Drew stated 4 to 6 weeks should see it completely finished. Rob Harrington thanked Noble Health for their work on this project.
Public Comment – Donald Coffman asked if a new stop sign was being put out in Bronson that hadn’t been there before. Jim stated that they would be. Donald asked if a “stop ahead” sign should be placed before the stop sign to let people know it’s there. Jim confirmed Eric would be putting one out as well as the stop sign. Clint Walker talked about the loss of over $1,000,000 by not expanding Medicare. Clint also stated they Allen County subsidizes their hospital at $2,000,000 per year and their ambulance service $1,000,000 per year.
Elected Official Comment – Bill Martin brought to the commission’s attention a Kansas Supreme Court case that affects the sheriff’s office. Bill suggested that the commissioner’s get with the county counselor to go over the case. Justin stated there were comments in a previous meeting about the commissioners controlling elected officials employees. Some statutes say that commissioners are responsible for policy except elected officials. You guys have no control over the hiring and firing of elected official’s employees. If there is a policy in the handbook and the elected official doesn’t want to follow it they don’t have to.
Commission Comments – Lynne wants to see commission meeting at Devon, and one at Lake Fort Scott. Jim stated he wants to go off-site once per quarter and have a night meeting every 5th or 6th meeting depending on participation. Jim stated that he is not in favor of raising the mill levy. Lynne stated that department heads with a surplus should use that money for raises for their departments.
Clifton made a motion for an executive session 75-4319(b)(2) for consultation with an attorney for the public body or agency which would be deemed privileged in the attorney-client relationship for possible litigation for 5 minutes, including 3 commissioners, Justin Meeks, and Shane Walker returning at 10:58am. Lynne seconded. All approved. Clifton made a motion to return to normal session at 10:58am with action. Lynne seconded. All approved. Lynne made a motion to allow Justin to handle litigation situation that has arisen. Clifton seconded. All approved.
Clifton made a motion for an executive session 75-4319(b)(2) for consultation with an attorney for the public body or agency which would be deemed privileged in the attorney-client relationship for possible litigation for 7 minutes including Justin, Susan Bancroft and 3 commissioners returning at 11:06am. Lynne seconded. All approved. Clifton made a motion to return to normal session at 11:06am with no action. Lynne seconded. All approved.
At 11:07 Clifton made a motion to adjourn. Lynne seconded. All approved.
THE BOARD OF COMMISSIONERS
OF BOURBON COUNTY, KANSAS
(ss) Jim Harris, Chairman
(ss) Lynne Oharah, Commissioner
Ashley Shelton, Bourbon County Clerk
April 5, 2022, Approved Date