Norman Regional Hospital Authority Meeting

NORMAN REGIONAL HOSPITAL AUTHORITY October 24, 2016 5:30 p.m. Norman Regional 901 N. Porter 2nd Floor Board Room AGENDA I. Call to Order ................................................................................................................Mr. Clote II. Introduction and Recognition of Outstanding Employee ............................................Mr. Clote A. November 2016 Employee of the Month, Robert Lytle, Registration Coordinator, Moore Registration – Darvin Hall, Manager Patient Access III. Approval of the September 26, 2016 Board Meeting Minutes ................... Mr. Clote (Pgs.5-16) ACTION NEEDED: Approve or Amend Minutes as Circulated ACTION TAKEN: ___________________________________ IV. Performance Updates ................................................................................ Dr. Smith (Pgs. 17-30) ACTION NEEDED: None, Information Item Only V. Approval of the September 2016, Norman Regional Health System Financial Statements ................................................................................................................. Mr. Hopkins (Pgs.31-80) ACTION NEEDED: Approve or Disapprove September 2016 NRHS Financial Statements ACTION TAKEN: ____________________________________ VI. Medical Staff .......................................................................................................... Dr. Williams A. Report from the October 12, 2016 Medical Executive Committee ACTION NEEDED: None, Information Only B. Recommend Approval of the Revised “Physical and Mental Health Assessment Practitioners Age 70 and Over” Policy ................................................................ (Pg. 81) ACTION NEEDED: Approve or Disapprove the Revised “Physical and Mental Health Assessment Practitioners Age 70 and Over” Policy as Recommended by the Credentials and Medical Executive Committees ACTION TAKEN: ____________________________________ NRHA Agenda 2 October 24, 2016 C. Recommend Approval of the Revised “Endoscopy–Pulmonary Privilege Form (Pg. 82) ACTION NEEDED: Approve or Disapprove the Revised Endoscopy-Pulmonary Privilege Form as Recommended by the Credentials and Medical Executive Committees ACTION TAKEN: ____________________________________ D. Recommend Approval of the Revised Sedation/Analgesia for Non-Anesthesiologist Physicians Privilege Form ............................................................................. (Pgs.83-84) ACTION NEEDED: Approve or Disapprove the Revised Sedation/Analgesia for Non-Anesthesiologist Physicians Privilege Form as Recommended by the Credentials and Medical Executive Committees ACTION TAKEN: ____________________________________ E. Recommend Approval of the New NRHS Request for Cardiothoracic Surgery Robotic Privileges ........................................................................................ (Pgs. 85-87) ACTION NEEDED: Approve or Disapprove the New NRHS Request for Cardiothoracic Surgery Robotic Privileges Form as Recommended by the Credentials and Medical Executive Committees ACTION TAKEN: ____________________________________ VII. Patient Quality & Safety Committee .................................................................... Dr. Anderson A. Report from the October 3, 2016 Patient Quality & Safety Committee ACTION NEEDED: None, Information Item Only VIII. Finance Committee ............................................................................................... Mr. Cubberley A. Report from the September 19, 2016, Finance Committee ACTION NEEDED: None, Information Item Only IX. Old Business .............................................................................................................. Mr. Clote & Mr. Splitt X. New Business ..........................................................................................Mr. Clote & Mr. Splitt Recommend Approval of the Revised FY2017 Utilization Review Plan.............. (Pgs. 88-101) ACTION NEEDED: Approve or Disapprove the Revised FY2017 Utilization Review Plan as Recommended by the Medical Executive Committee NRHA Agenda 3 October 24, 2016 ACTION TAKEN: _____________________________________ XI. Administrative Report ....................................................................... Mr. Splitt ACTION NEEDED: None, Information Item Only XII. Proposed Executive Session. A. Proposed Vote to Convene an Executive Session Pursuant to 25 Okla. Stat. § 307.B.4 to Discuss with Legal Counsel Pending Internal Peer Review/Credentialing Investigation Regarding the Medical Staff Members/Applicants Listed Below and Discussion Regarding the CEO Position Pursuant to 25 Okla. Stat. Section 307.B. and Discussion Regarding the CEO Position Pursuant to 25 Okla. Stat. Section 307.B. ACTION NEEDED: Move to Convene into Executive Session to Discuss with Legal Counsel the Above Referenced Medical Staff Items ACTION TAKEN: ____________________________________ B. Medical Staff Recommendations Regarding the Medical Staff Members/Applicants as Listed in XIII.B 1-4 Below. 1. Recommend New Provisional Medical Staff Appointments: a) Cynthia DiMauro, MD, Active Staff – Medicine Department b) Diana Whiteman, MD, Active Staff – Medicine Department c) Monica Williams, APRN-CNP, Allied Health Staff – Medicine Dept. 2. Recommend Advancement of Medical Staff from Provisional Status: a) Justin Fields, MD, Active Staff – Pediatrics Department b) David Miller, DDS, Active Staff – Surgery Department c) Cynthia West, DO, Active Staff – Pediatrics Department d) Shawn Musgrave, APRN-CNP, Allied Health Staff – Emergency Med. Dept. 3. Recommend Medical Staff Reappointments: a) Mark Camp, MD, Active Staff – Medicine Department b) Muhammad Ishaq, MD, Active Staff – Behavioral Medicine Department c) Roy Mullins, III, MD, Active Staff – Medicine Department d) Leslie Ollar-Shoemake, DO, Active Staff – OB/Gyn Department e) Mehran Shahsavari, MD, Active Staff – Hospital Medicine Department f) Tadgy Stacy, MD, Active Staff – Pediatrics Department g) Kristin Thorp, MD, Active Staff – Medicine Department h) Amanda Wright, MD, Active-Affiliate Staff – Medicine Department i) Storm Eagle, APRN-CNP, Allied Health Staff – Medicine Department j) Laura Velez, APRN-CNS, Allied Health Staff – Cardiovascular Med. Dept. k) Sanober Malik, MD, Consulting Staff – Medicine Department l) Charles Mirabile, MD, Consulting Staff – OB/Gyn Department m) Mohammad Razaq, MD, Consulting Staff – Medicine Department NRHA Agenda 4 October 24, 2016 n) John Stanley, III, MD, Consulting Staff – OB/Gyn Department o) Lorry Krous, MD, Courtesy Staff – Pediatrics Department 4. Recommend Additional Clinical Privileges Steven Carter, MD is requesting analgesia/sedation privileges. He has successfully completed the education requisites and has met the privileging requirements. C. Request to Adjourn Out of Any Such Executive Session and Return to Regular Session ACTION NEEDED: Approve or Disapprove Adjournment of Any Executive Session and Return to Regular Session ACTION TAKEN: ____________________________________ D. Proposed Vote to Approve or Disapprove the Medical Executive Committee Recommendations Regarding Credentialing of the Referenced Medical Staff Members [As Listed in XII B 1-4] ACTION NEEDED: Approve or Disapprove the Medical Executive Committee Recommendations Regarding Credentialing of the Referenced Medical Staff Members [As Listed in XII B 1-4] ACTION TAKEN: _______________________________________ XIII. Board Open Discussion XIV. Closing Comments XV. Adjourn ACTION NEEDED: Motion to Adjourn the Meeting ACTION TAKEN: _______________________________________.