Members in attendance:  Dennis McCutcheon, Billie Hall, Jane Horst, Mike Lewis, Hilda Heady, Elizabeth “Betsy” Degges, Sharon Hanna, Sandra Pope, Tom Hefner (alternate), Jim Welshonce, Sharon Boni, Jim Malone, Bill Shires (alternate)

Others in attendance:  Lamont D. Nottingham, Lynne Sandy, Jodie Jackson, Sheryll Tennant, Anna Reno, Patti Crawford, Elaine Mason, April Vestal, Kathryn Greenlief, Sonnie Strader, Lora Adkins, Michelle L. Kopf, Malinda Turner, Jacquelynn Copenhaver, Melissa Marco, Judy Koehler, Stephen Thomas, Chuck Conner, Pat White, Shannon Bell, Diane Vanhorn, Penny Asbury, Alicia Tyler, Derrick Day, Margaret Novacich, Nancy Dunn, Elaine Price, Steve Fumich, Robert Blake, Howard Stallard

Chair, Dennis McCutcheon called the meeting to order at 2:35 PM.

Introductions:  Lynne Sandy, from the state office of AHEC; Derrick Day, Office of Rural Health; Diane Vanhorn, Winding Roads Consortium, Division of Family Resources and Michelle Kopf of Rivers & Bridges Consortium. An introduction of all in attendance was made.

A motion to approve the consent agenda was made. – Approved - Shires/Welshonce (unanimous)

Comments from the Vice Chancellor
Dr. Mike Lewis presented an update of items from the Legislative Session.
1. A piece of legislation was passed with the work and support of the Recruitment and Retention Committee.  This refers to Senate Bill 709, which relates to the Health Sciences Scholarship Program. This program sets aside funds for awards to health professions students in their final year of training (i.e. Medical students in their fourth year of training would be eligible to receive $10,000, if they would agree to do their residency in state; other health professionals are included). The masters level nursing students is well emphasized. Eligibility, in the past, according to legislation was restricted to masters level nursing and nurse practitioners, practicing in an underserved area for two years or masters level midwives. What this new bill does is open eligibility to masters level nursing graduates that agree to teach for two years.
2. Senate Bill 709 also addresses an increase in awards for fourth year medical students from $10,000 to $20,000 if they do their primary care residency in-state for two years.  The lowest average debt for medical school is $85,000 – WVU, $90,000 – Marshall University and $120, 000 – WVSOM.  Teaching hospitals in other states offer huge signing bonuses.  Specific  language says that one has to do a residency in West Virginia.
3. The RHEP budget will be tight this year.  There probably will not be a cut in the RHEP
funding. Dr. Lewis stated that one thing was made very clear to him, while talking to legislative leadership, including those who are strong supporters of WVRHEP. WVRHEP needs to address more of the issues that were passed in legislation in 1995, and improve the number of community-based residency training experiences (i.e. developing primary care residency programs).  This is in code and suggested very strongly that this will be strengthened in the RHEP funding language this year. This is available on the web. This is not debatable, we must do this very well in order to maintain our funding in the future and hopefully anchor the support of the program.  Maybe, in fact, get an increase if we can show that we are getting more doctors into the residency program.

Hilda stated that one of the things we have not done with the commission and the legislation itself, is require rotations in a primary care residency as part of the training. Just having the structure in the community to train residents is only one part of implementing this requirement. The other part is the willingness of the residency programs to send their residents out into the rural communities and facilities. We need to work with the residency programs in the state to accomplish this. Dr. Lewis state that he felt there would be a push for at least one additional rural primary care residency program in the state.  Changing the Health Sciences Scholarship Program may be one way to enhance medical students’ consideration of the rural residency training programs.   The rules for Senate Bill 709 have not been written.  We are going to be working with important members of nursing education and nursing practice.  We will be inviting some of the members of the Nursing Shortage Study Commission, enacted by Legislature last year, and medical schools involved in the recruitment of students to do rural residency programs in the state. Dr. Lewis said that the bill was passed last night (March 17, 2002) and that he will obtain copies when available

Issue presentation concerning state designated under-served populations as sites for rural rotations
Hilda referred the panel to a letter that was written by Patricia White of the WV Association of Free Clinics and sent to Dr. Lewis. Pat White passed out copies of the letter, a map and a list of clinics and requested that the RHEP State Advisory Panel approve the state funded free clinics as RHEP rotation sites. The concept is that WV Health Right has been in business for 20 years and has established a relationship with health sciences and higher education. Currently, there are ten state funded free clinics throughout the state; most of these clinics are already considered to be eligible for RHEP rotation sites because they are in designated shortage areas. The purpose of Ms. White’s visit is to request that the Advisory Panel consider approving state funded free clinics as RHEP rotation sites.  Ms White stated that WV Health Right is the largest of the State’s free clinics and has been working with the program site at the Cabin Creek Clinic.

Shannon Bell of the Cabin Creek Consortium stated that nursing students going through Health Right receive a phenomenal experience.  She gives RHEP credit for students assigned to the Health Right in Charleston. Melissa Marco at ROVER Consortium stated that students learn a great deal and that she has not received any negative feedback from Health Right students. Steve Thomas stated that he places students with Health Right without issuing RHEP credit. Each clinic operates on an individual basis.

Ms. White put forth the consideration of utilizing Health Right facilities as RHEP training sites.    Hilda answered that the panel cannot make that decision; this consideration must be presented to local boards and must work with the schools to use Health Right locations for extending RHEP rotations.  According to the list, all but three Health Right facilities (Parkersburg, Bluefield and Morgantown) may be utilized for RHEP rotations.

In order to obtain state funds for a free clinic, there must be a mentoring parenting clinic. Patti Crawford asked where do the state funds come from?  Ms. White answered that the state funds come from the division of primary care under public health.

AHEC Development Update
Jane Horst of the Eastern WV Rural Health Education Consortium reported on the progress of the Eastern AHEC.  She stated that a volunteer steering committee was established in early December.  The committee was comprised of approximately 11 individuals representing the WVU Clinical Campus, the Harper’s Ferry Rural Residency, board members of the Eastern WV Rural Health Education Consortium, City Hospital, and the Mountain Health Partners.  Monty Nottingham represented the AHEC program office and Bill Shires of WVSOM participated in the early discussions.

This committee was given a two month goal to establish the foundation for the new AHEC Board and meet four times over the next two months to establish the guidelines for the new AHEC operation.  Jay Bonfili volunteered to serve as the interim Executive Director at the first meeting and his offer was accepted.  City Hospital offered to serve as the lead agency until the 501 C3 incorporation paperwork could be filed.

At the final meeting of the Steering Committee the following had been directed:
1. The Board approved the selection of an attorney to be contracted for the incorporation process and a motion was approved for the incorporation and by-laws process to begin.
2. A job description for the position Executive Director for the Eastern AHEC was approved with the following changes:
a. The job description specified that the AHEC would work with and foster collaboration with RHEP
b. That the qualifications were modified from “masters degree required” to “masters degree preferred”.

The interim director was given approval to begin a national job search, utilizing the current salary. A local search should be undertaken, also.  A time line was not indicated for hiring.

Mountain Health Partners informed Jay Bonfili that they would withdraw their four counties from inclusion in the Eastern AHEC.  They would opt to join the Northern AHEC as that program developed.  The Eastern AHEC would encompass the same nine counties as RHEP.

Jane reported that the steering committee selected the following criteria:
1. Each county participating would have a representative,
2. The board should be made up of about 15 people,
3. The Eastern Division Clinical Campus and the Harper’s Ferry Rural Residency would be represented, and
4. The RHEP Site Coordinators would be considered ex-officio members.

Monty suggested that a representative from a federally funded clinic or grant be included on the board as well as a minority representative.

Jane conveyed that Monty introduced Lynne Sandy as the new AHEC program assistant who will be working with the new AHEC Boards and coordinating the statewide program.  The AHEC trial rotations were proposed for July in the Eastern Panhandle with the theme “Caring for the Community’s Health”.  The rotations would be open to any RHEP student who might be interested in participating and the rotations would kick-off with a possible conference on July 8, in Shepherdstown, featuring well-known speakers.  Dr. K. C. Nau of Harper’s Ferry offered to create a performance review for the trial rotations.

A delegation from WV will be attending the National AHEC Conference in Little Rock, Arkansas, April 21 to April 24.  The delegation will be visiting the Pine Bluff AHEC and meeting with AHEC directors from all over the US. Jane reported that Monty has indicated that the Eastern AHEC could assist with funding in establishing a local HSTA program in Berkeley or Jefferson County. The interim board considered the feasibility that AHEC might contract with the Eastern WV consortium to provide needed services, such as housing or other support areas.
At the end of the February 6th meeting the steering committee was dissolved. The new AHEC board will meet on March 20th at the Eastern WV Rural Health Education Consortium Offices to begin their official duties. Jane passed out an abstract which gives an overview of what the Eastern AHEC is going to be doing in terms of their approach to community health.

Evaluation Committee
Jodie Jackson reported that the server went down and reminders regarding questionnaires did not go out. We would like to get our own server.  There was a two month period when students did not receive e-mail reminders and the response rate electronically went down. Now, the response rate is back up to 66%, but would like to see it go up more. Otherwise everything is going smoothly.

Nancy Dunn at WVUIT is interested in working on a baseline questionnaire for nursing.  She will start working with the evaluation committee and present this questionnaire for the committee to review.  Once the evaluation committee approves the questionnaire, Mike McCarthy stated that he would not have a problem putting it online. Right now the baseline data questionnaire is administered to medical students before they start any RHEP rotations. The student evaluation of rural field experience is administered to all students after each RHEP rotation.

Joint Curriculum/Outreach
April Vestal gave this report for Dr. Kathleen Bors.  She stated that the committee is looking at the Healthy People 2010 Objectives and working with three pilot RHEP consortia.  These pilot sites are to look at  their community service and service learning activities which are currently going on and how those activities relate to the Healthy People 2010 objectives or how they can be changed to do so. The three consortia are Cabin Creek Health Consortium, EWVRHEC – Petersburg and Rivers & Bridges Consortium.  This committee will be working with these sites over the next few months.  Patti Crawford, along with Tom Simms and Jennifer Weiss from the Bureau of Public Health  will be doing training for all site coordinators on the Healthy People 2010 objectives at the site coordinators’ April retreat.  Mike McCarthy will be adding a pull down menu that will be available for students in picking the Healthy People 2010 flagship objectives that relates to their projects.  Then, RHEP can provide legislature with information showing that the Healthy People 2010 objectives are being addressed statewide.  The committee will be developing a timeline on how this will be developed over the next few months.

April reported that the committee has taken the Visions Workgroup information that was developed in November 2000, and is looking at each one of the six areas of development they said they wanted to do. The committee reflected over this information in November 2001, to see where they had been, what has been accomplished and where they want to go.  They felt that it was a good idea to see what committees contributed to the accomplishments and would like to charge those committees to submit reports to the Joint Curriculum/Community Outreach Committee to be submitted to the Advisory Panel at a future meeting date for approval.  This would be great information for Legislators to see.  At the next meeting, the COCC will present a recommendation to the Advisory Panel on the process that will be used to accomplish this task.

Student Advisory Panel
Billie Hall stated that the student panel and the community member met jointly. They are planning a retreat for April 21 and 22.  In working on an agenda last November, students’ concerns were about the quality of IDS sessions, and general RHEP experience.  Jodie Jackson and Sheryll Tennant attended the Student Advisory Panel meeting to do an evaluation presentation on the last six months.  Most students had positive experiences in the community service, IDS sessions and at their rotation sites. Billie thanked Jodie and Sheryll for their presentation.  The committee would like to have a report every six months just to see what the students are saying and how they are doing.

The joint committees discussed the retreat to be held on April 21st and 22nd at Blackwater Falls.
The agenda consists of a discussion on a mentoring program, a movie night and grant writing workshop with the community members and the students. Billie will get word out to students and classmates. Shannon Bell will talk to the Site Coordinators about getting the word out to students also. Invitations will be sent out.

Finance Sub-Committee
Chuck Conner stated that in November 2001, the Finance sub-committee charged a smaller group to look at all of the information they had been dealing with over the past 15 months to come up with a plan of action for next year.  In January 2002, the committee came up with  Policy 2002-01, entitled “Fiscal Year 2002-2003 Allocation Methodology”.  This was presented, discussed, and passed on to the Finance Committee.

Finance
Margaret Novacich reported that the Finance Committee met and items covered on the agenda were as follows:
1. A review of the second quarter reports from consortium, Policy 2001-01 passed last fiscal year, requiring all consortia to submit quarterly financial reports showing their expenditures for that quarter, was made.  All consortia are complying with the policy. All reports from the consortia were reviewed and approved by the Finance Committee.

2. An expenditure report was submitted from WVU Office of Rural Health and the RHEP administration offices.  These reports will be attached to the Finance Committee minutes and be available on the web page (March minutes listing).
3. The final item on the agenda was the review and vote on the proposed Policy 2002-01.  This policy deals with the allocation method for the upcoming fiscal year for all RHEP sites.  Margaret respectfully submitted Policy 2002-01 to the Chairman for consideration and approval by the Advisory Panel.

Dennis McCutcheon pointed out to the panel the changes that were made:  on the first page under “Implementation Responsibility”, add “Local Consortia Board”; second page, after i. add
j.  OSCD (Onsite Clinical Director) – is allocated at $17,000.00 per site coordinator.

The difference in the amounts shown on the policy: $20,000 is the average amount paid to OSCD from 11 consortia.  After contacting the other two consortia (13consortia) the average OSCD pay came out to $17,000.
 
Hilda pointed out that on the second page above the signature line, “Note:  The policy is considered a “beta test” year moving forward “zero based” allocation process for fiscal year 2003-2004”, the guidelines proposed are just guidelines.  The Finance committee is asking every consortium to apply this formula for this coming year.  Hilda assured the consortia that they  will still receive the same amount of money they have always received, but would like to use this test as a formula for the future. She hopes that all consortia will participate in the “beta test” in order to get accurate results. Future guidelines will be based on the test.  By accepting this proposal, the panel is essentially saying to all of the consortia that you have to conduct the beta test this year, knowing that you will get the same amount of dollars you have always gotten.

Dr. Lewis gave a comment stating that the dollar amount is based on Legislative appropriation and directions with that appropriation.

Hilda stated that she and Margaret are willing to attend your board meetings or have special meetings with your agency administrators, your fiscal officers, site coordinators and field faculty to go over the process and even apply the process to your numbers if requested to do so.  These visits have been very helpful in places they have visited.

A motion was made to accept Policy 2002-01. (Betsy Degges/Bill Shires – unanimous)
 

Executive Director’s Report
Hilda Heady introduced Derrick Day as the Director for IT Rural Outreach.  This was his first day on the job.  One of his responsibilities is outreach training.

Hilda gave an update on Southern Counties Transition Process.  RHEP was notified that Boone Memorial Hospital resigned as lead agency of the Southern Counties Consortium on September 18. The resignation was accepted on October 30, 2001.  On October 30th, letters were sent to the Advisory Panel. On November 1, 2001, Dr. Lewis received a letter from Boone Memorial asking what would happen to employees and asking questions about the process.  November 6, Dr. Lewis responded by letting Boone Memorial Hospital know that the Marshall University Research Corporation was asked to become the fiscal agent for the Southern Counties Consortium in the transition period (approximately six months) to designate a new management system. November 29, a further letter of explanation of process was sent. This letter also talked about an appointment of an ad-hoc committee.  Dr. Lewis, Hilda and Dennis McCutcheon had three conference calls where they talked about the process. They decided to utilize the process outlined in the original RHEP Legislation.  They talked about the formation of an ad-hoc committee to review all proposals and make recommendations to the Vice Chancellor, who would make the final decision. She reiterated that in the legislation, the Vice Chancellor is the individual who is given authority to designate the management of the various consortia.  On November 30, 2001, an official notice was sent to Boone Memorial stating that the HEPC was terminating their affiliation agreement, according to the language and requirements in the affiliation agreements.  On January 28, 2002, Dennis McCutcheon sent out letters designating ad-hoc committee members. One conference call has been made with that group of people and the bulk of their work will begin after the proposals have been submitted.  On February 12th, a special informational meeting of the Southern Counties Board was called and met in Logan.  Hilda explained the RFP process to the board and answered questions. An RFP was developed and sent out the first of March.  A town meeting was held on March 7th in Gilbert, WV in Mingo County.  The meeting was publicized on radio, television and in the newspapers.  The notice of the RFP was published in all of the local newspapers and was sent out to a mailing list of agencies that qualified under the legislation. The mailing list was generated by the Bureau for Public Health and reviewed by the Ad Hoc Committee and local site coordinators.   The next process is getting proposals developed and sent in by March 25 and sent on to the Vice Chancellor, Mike Lewis. On April 10th, the Ad Hoc Committee will met to discuss and review the proposals and make a recommendation to the Vice Chancellor. She reported that she is aware of and expects two proposals to be brought forward.  She reported that there are now two people appointed to the Ad Hoc Committee who are directly involved in developing the proposals and that these people will have to be replaced for obvious conflict of interest issues.

Hilda reminded the panel that the CCPH National Conference will be held May 4 through May 7, 2002 in Miami, Florida, and the registration materials are on the web.

Hilda has extra National Rural Health Association (NRHA) annual meeting brochures.  This is the 25th year of the National Rural Health Association.  Our office is doing a group registration for the NRHA through WVU Institutional Membership.  The group rate is $475.  If you wish to receive the group rate, please complete the registration form and payment information and submit to Margaret Novacich no later than April 15, 2002.

On behalf of the RHEP family, flowers were sent to Annie McIntosh in January, when she had her surgery and to Dick Meckstroth after his fall from his roof.  Hilda read a thank you note from Dick Meckstroth.

Other Business
Dennis McCutcheon stated that he was collecting information on the letter he sent out regarding doctors leaving the state due to the pressures from the state’s malpractice climate. He informed the panel that the State Insurance Commissioner called him after receiving a copy of the letter from a legislator.  The State Insurance Commissioner was interested in knowing the names of any doctors or other medical people that have tried to practice in the bordering states and were not allowed to accept WV patients in their office because of their insurance.  If anyone knows of this situation, please give Dennis their name and address to submit to the Commissioner for her to call them.  The Commissioner feels there might be something illegal about this and she would like to try to do something about it.

Dennis found out that the doctor who attended his mother’s broken hip, moved from Beckley to Montgomery County General Hospital in Blacksburg, Virginia.  The physician’s insurance dropped from $94,000 per year to $25,000 per year.

Of the family physicians working at Raleigh General Hospital, three are considering leaving within the next few weeks.

Dr. Malone stated that the number of licensed physicians have gone up over the past eight years, but the number of those actually practicing, have gone down.  Numbers are false;  retirees maintain their license and some physicians have gone out of state to practice while maintaining their WV license. The number of doctors actually practicing in state has gone down tremendously.

Dennis stated that if a physician left the state today, he would pay $18,000 a year tail until his tail ran out and if he stayed in state he would pay $28,000 a year.

Tom Hefner shared Dennis’ letter with his local legislator, who seemed to be very interested. Tom encourages others to share this letter with their legislators. Dennis stated that this letter had been sent to all legislators.  Dennis has received 12 to 15 responses and a few really want to get involved.  Community members (in big numbers) need to approach their legislators regarding this matter.
 
Dr. Lewis stated that at issue is the number of physicians in the state. According to the figures, it looks as though we have as many or more physicians than there were a few years ago (referring to those retired, semi retired or out of state physicians still maintaining their license) and another issue is the distribution of specialties. Physicians in specialty and sub-specialty areas are hard to find or have left the state. The third issue is the high cost of their malpractice insurance.  Talk to your legislators. Dr. Lewis stated that the legislators did pretty well with Senate Bill 601.

Bill Shires stated that residency applications in state are down, also out of state applications are down and that malpractice is the major issue.  CAMC residents are meeting with Governor Wise on March 25, 2002 to bring up some of these issues.  He conveyed that we have seven residency or post type programs with various hospitals around the state. Pertaining to some of our smaller hospitals around the state, if we lose one or two of our physicians, we could lose our program.  These are considered vital preceptors to the program.

A motion to adjourn was made at 3:55 PM (Horst/Degges – unanimous)