Members in Attendance:  Patti Crawford (for Bill Shires), Jim Welshonce, Gaye Mitchell, Sharon Boni, Steve Smith, Richard Meckstroth, Imogene Foster (for E. Jane Martin), Norman Ferrari, Jill Cochran, Elizabeth “Betsy” Degges, Sharon Hanna, Allison Witte, Jane Horst, Hilda Heady, Dennis McCutcheon, Mike Lewis

Others in Attendance: Lynne Sandy, Judy Koehler, Gail McClung, Alicia Tyler, Robin Cotrill, Anna Reno, Brenda Michael, Julie A. Peasak, Carla Campbell, Penny Asbury, Ralph Utzman, Malinda Turner, Lora Adkins, Jacquelynn Copenhaver, Erin Condo, Sonnie Strader, Shannon Bell, Chuck Conner, April Vestal and Sandra Baker

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

Introductions on new people attending were made: Gail McClung, Secretary, Rural Mountain Consortium and Robin Cottrill, Part Time Outreach Assistant at Little Kanawha Area Consortium.

A motion to accept the consent agenda as posted was made and approved (Ferrari/Mitchell – unanimous)

Comments from Vice Chancellor
Dr. Mike Lewis gave an update on the Graduate Medical Education Council.  He conveyed that the legislative leadership made it clear during their session that they wanted to increase the emphasis residency training in rural communities and Dr. Lewis, as a first step, is forming this council.  An RHEP Graduate Medical Education Advisory Council needs to have broad-based input. The council will be made up of the following: Representatives from CAMC and WVU (major teaching hospitals); Rural Hospital Representative, Bob Harman, Administrator, Grant Memorial Hospital in Petersburg; RHEP Site Coordinator, Chuck Conner from Winding Roads Consortium; a couple of primary care residency directors (to be named);  a medical school representative, Bill Shires from WVSOM; and a DHHR representative (will be reporting directly to Secretary Nusbaum).  We are considering requesting permission from the legislature to have a legislative staff member who will report directly to a legislative chair, such as the chair of Senate Education or Senate Finance or possibly House Education because this will be a direct link with legislature.  Dr. Bob Walker from Marshall University has agreed to be the Chair of the Advisory Council; Hilda Heady has agreed to be a member as well as Dr. Nottingham. Alicia Tyler and Jennifer Plymale agreed to help staff the Council. One or two people have not responded yet

Healthy People 2010 Objectives and RHEP
Patti Crawford reported that the Healthy People 2010 (HP 2010) ties in with the Visions Work Group document completed in November 2001, under the recommendation for partnership building. It was the intention of the Visions Workgroup for RHEP to discover opportunities to collaborate around health outcome strategies with other state agencies and the HP 2010.  Patti did a presentation for the Site Coordinators at their retreat and at the Support Staff’s regular meeting.  Jennifer Weiss from the Bureau of Public Health was the coordinator for HP 2010 and helped prepare the document. Jennifer attended the Site Coordinator’s Retreat and did an overview of HP 2010 and Patti did a Power Point presentation on how it linked into some of the community service activities that RHEP was doing.  Patti reviewed community service reports since January 2002 and discovered that there were quite a few sites linking their service learning activities to HP 2010.  In the Curriculum/Outreach committee Shannon Bell and Patti looked at how HP 2010 could be incorporated with service learning.  There are four volunteer pilot sites which will take on the task of incorporating HP 2010 and service learning into their monthly RHEP reports.  These sites include: EWVRHEC-Petersburg, Rivers & Bridges Consortium, Rural Mountain Consortium and Cabin Creek Health Consortium.  These site coordinators have been asked to interface with agencies in their community (i.e. local health departments, hospitals, primary care centers, regional health promotion specialists, etc.) to assess the priority health needs in their areas.  They should focus on three to six of these needs and work with their local consortium boards to agree upon health outcomes for the residents in their consortium site and begin to match the community service projects with these needs. Mike McCarthy has already put 29 focus areas of HP 2010 on TRACKER.  Any consortium can click on any of these focus areas.  The difficulty is narrowing these focus areas down and refining them to see the outcome.  We want to show that we are meeting the mission of RHEP (recruitment and retention and improving the health of our rural residents).  The outcomes are measurable and beneficial reports for legislators.  One will also be able to track a project and its impact on the community.  The pilot sites will meet today after this meeting.

Service Learning – Patti reported that Shannon put together a template containing the following:  2010 objectives, example projects meeting HP 2010 and projects tying into community and service learning projects. Each consortium may modify the template to fit their needs and put a copy into the orientation packet for their students or put it on their consortium web page. The students may pick the objective they wish to do or bring their own project.

AHEC
Jane Horst reported that a group of nine from WV attended the AHEC National Conference in Little Rock, Arkansas. They attended a lot of workshops and learned how AHEC functions (similar to RHEP).  She visited an AHEC center in Pine Bluff.  The Eastern AHEC has formed an official board of 18 members, with representatives from each of the nine counties and WVU.  Both site coordinators will serve as ex-officio members.  Sample by-laws have been drawn up and will be brought forth for approval at the next official AHEC board meeting to be held on May 28th.   Eastern AHEC is in the process of advertising for an executive director.  Jay Bonfili is still the interim director.  July 8th is the kickoff date for the first trial rotation period. They would like to have seven or eight students.  There will be a kick off festival and conference in Shepherdstown to get everything started. Trial rotations will last four weeks and the regular rotations will be seven to eight weeks. Students must address a research project, which will be built on by incoming students.  Each area AHEC will address a research project. Malinda and Jane have been sharing much information with other site coordinators as other sites are getting ready to come on board.  The matching fund situation for the Eastern AHEC is being held up until the matching funds are identified. The research corp. will not release any funds for the AHEC operation.  One of the things that came out of the conference is looking at ways other national AHECs are funded.  Hilda asked about the cash match in other states and Jane reported that in 80% of the AHECs, the state matches the federal funding, others matches are from grants (private and foundation funding) and shadow accounting.

Policy 2002-02: Conflict of Interest
Hilda explained that most boards should have a conflict of interest policy. Conflict of Interest policies are used to protect individual board members when and if their board takes action that might directly impact the board member. Hilda stated that since this was a policy with pretty standard language, it did not need any further committee review.  The attorney at HEPC has seen and approved this policy.  The policy was put out for your review and questions.  All consortium boards and panel members will sign and submit this form to WVRHEP.  Dr. Lewis will check to see if this form has to be notarized.  A motion to accept this policy was made and approved (I. Foster/Welshonce – unanimous).

Finance/Sub-Committee
Chuck Conner stated that the Finance Committee met and reviewed the budget proposals for 2002-2003.  These budgets were reviewed consortium by consortium and approved. Some Lead Agencies/Boards will receive a letter with comments or questions to be answered regarding the last reporting quarter for this year.  Southern Counties Consortium was granted an extension regarding their report due to the transition going on.  All 13 consortia are in audit compliance and up-to date.

Recruitment and Retention
Alicia Tyler reported that there were three excellent reports given at today’s meeting.  Jodie Jackson and Ken Shannon gave their final report on the financial incentive study. The Robert Wood Johnson and Benedum Foundations funded this study under the Southern Rural Health Access Project.  This was beneficial to Dr. Lewis when working with the Legislature in order to increase the amount of awards given to medical students from $10,000 to $20,000.   She stated that Ken Shannon gave a report on the Recruitable Community Project, which is also funded by the Robert Wood Johnson Foundation Initiative.  This project will continue for another two years.  He demonstrated a retention game that may be accessed on the web.  Communities or doctors can look at the important factors in retaining a provider that has been recruited. Alicia reported that Bob Whitler gave a report on the 2002 residency match at CAMC with some data obtained from WVU and Marshall residencies.  He pointed out that we really need to look at specialists and sub-specialty supply.  A report from their sub-committee was given. They have been looking at ways to help improve the Health Sciences Scholarship Program, particularly in terms of recruiting medical students and to make recommendations to Dr. Lewis regarding rules.  With our new Legislation, we have to revisit the rule making process and these are official rules that are on file at the Secretary of State’s office.  The subcommittee did not recommend any substance of changes in the rules, but they recommended some things that we can do administratively to improve the program.  They are looking at a way to improve our selection process of giving awards to medical students, how to work with them and nurture relationships while they are in their residency training, making them aware of rural practice opportunities and keeping them informed of financial incentive programs.  The following are the recommendations:
1. Schools form a screening committee to interview applicants as an evaluation tool and make sure that the students understand the program requirements.
2. Placement coordinators at the three schools serve as a point of contact for information of opportunities.
3. The division of recruitment will provide a map of eligible rural underserved areas by July to be included in the application packet.
4. A two tiered process be put in place.  The subcommittee has agreed to serve as a review committee to review all applications and take into consideration what the schools have learned when they interview candidates.  The subcommittee will send their application recommendations to the Recruitment and Retention Committee at the November meeting and the Recruitment and Retention Committee will then make recommendations to the Vice Chancellor.

As a result of increasing the schools role and time needed to process applications, the application deadline will be moved from October 31st to October 15th.

Alicia has a copy of Bob Whitler’s report, a copy of Jodie’s report, and recruitable community overheads.  Hilda suggested that the financial incentive report be sent to April to be posted on the RHEP website.

Dr. Lewis stated that there has been a significant change in the law, referring to rules respective to master’s level of nursing graduates. Eligibility is open to MSN graduates that agree to teach for two years.

School Committee
Ralph Utzman reminded the panel of a discussion held last fall regarding the inclusion of an Allied Health representative (PT, OT, Med. Tech, Social worker, PA, Dental Hygienist, MPH, Community and Health Promotion Specialist) to serve on the Advisory Panel.  The School Committee was charged with making recommendations on how to accomplish this task. The School Committee recommended that there be a subcommittee of the School Committee representing all allied health, which will elect or recommend one representative to serve on the Advisory Panel.  Hilda suggested that clinical psychology be represented on the subcommittee even though it is not included in Allied Health.  Marshall is looking at developing a rural tract in clinical psychology for their masters nursing students.

Executive/Associate Directors’ Report
Ad Hoc Committee Findings
Hilda reported on the Ad Hoc committee findings for Southern Counties Consortium management system.  There were only two proposals submitted.  The Ad Hoc committee met on April 10th and reviewed the proposals.  One proposal was from a group that wanted to form their own “Not for Profit” corporation and the other proposal came in from Boone Memorial Hospital.  The Committee recommended to the Vice Chancellor that he accept the proposal from the group that was going to form their own “Not for Profit” corporation and work with Marshall Research Corp. to serve as their fiscal agent.  The process and development has taken place.  A board has been formed.  Penny stated that they are having their first transitional board meeting on Friday.  A small group of individuals will help them make the transition to the new board.  They hope to have everything in place and operational by July 1st.  Carla reported that they have exciting things going on with AHEC and working on the possibility of working as one board.  The board will consist of approximately 15 members; eight or ten of those were on the original board or worked with Southern Counties on their community service projects.  Ten of the members are actually community members (two members from each county), and the remaining membership is made up of field faculty and clinic representatives.

One of the things in the RFP specifically was applicants were to address ways to increase the number of rotations and training sites primarily in Mingo County.  To cultivate involvement in Mingo County, the hospital in Ranson and ARH were contacted and are very enthusiastic about the program and accepting students.  Through this proposal Carla and Penny were offered an in-kind office space.  Their central office will be located in Oceana.  Most of the time they will travel to Mingo and McDowell Counties.  They will not be tied down to one clinic.  Hilda stated that we now have our second consortia that is headed by its own non-profit corporation. This proposal addresses all five counties and the other proposal only addressed two counties (Logan, Boone and half of Mingo Counties).  Dr. Lewis asked if both proposal met all stipulations of the RFP?  Hilda stated that they did not. One of the stipulations was to contract with the Marshall University Research Corporation to as the fiscal agent and the other proposal stated they would not do that as they wanted to act as their own fiscal agent.

Do we need a policy review session in July?
Hilda asked if anyone is aware of any current policies that are in need of review, revision or policies needing to be developed and asked if we needed to have a policy review meeting this coming July?  No response to the question was made.

Student/Community Member Retreat
April reported the Student Advisory Panel and the Community Member Committee has been working together. They had a retreat in January 2001, with approximately 30 people in attendance. Several recommendations were brought forth from that joint retreat and they have been talking about these for some time.  Another retreat was planned for April of this year at Blackwater Falls. There were only seven responses and it wasn’t feasible at this time so the retreat was cancelled. Parr Thacker has been Interim Chair of the Community Member Committee for almost a year and they have been soliciting for a community member to take over as Chair.  Recently, Lisa Hileman, EWVRHEC-Petersburg, said that she will co-chair the committee and Michael Tierney (has not officially accepted) from Cabwaylingo Consortium would serve as the other co-chair.  As a result of low attendance of past community member meetings, the committee will be looking at having a meeting once or twice a year and meeting for a longer period of time.  The structure of this committee may look different in the future.  Lisa will try to do communication through our list serve and talk with Michael Tierney on getting an agenda and possibly having a mini retreat.  April stated that the Student Panel consisted of really good students this year. They took on a leadership role, especially Billy Hall.  The student advisory committee may be scheduled to meet less frequently as well, to improve attendance.  If the meetings are moved to once or twice a year in Flatwoods, she would appreciate the schools emphasizing the importance of student attendance.

Role of Research Corp as Fiscal Agents for Local Consortia
Hilda talked about the role of the university research corporations as fiscal agents for local consortia to see if there is enough interest for us to pursue this as a possible management model for other RHEP consortia.  Using Marshal’s Research Corp has been a plus for the development in the Southern Counties Consortium. Penny and Carla were transitioned as full time employees to the Research Corp so there would gap in their pay and their benefits were paid. The Research Corp has agreed to provide fiscal management for this consortium for only 5%.  Dr. Lewis and Hilda feel that this is a very good mechanism to look at especially if there are consortia that want to become their own independent not for profit organization or even those with lead agencies finding themselves in a marginal position possibly due to budget cuts, being unable to support RHEP. Hilda would like feedback regarding this matter.  Dr. Lewis stated that Southern Counties is a good model and you cannot beat 5% overhead.  The universities certainly know how to meet the stipulations of the grant monies.  He feels the role of the research corp acting as fiscal agents is something worth looking into.

The floor was open for questions.
1. Chuck Conner asked that having Marshal Research Corp acting as the fiscal agent for Southern Counties, “Would that money remain at Marshall?”  Hilda stated that even though Marshall is acting as fiscal agent for Southern Counties, the budget would be approved and managed by the local board.
2. Jane Horst asked if WVU and WVSOM are willing to act as fiscal agents.  Hilda replied that we haven’t approached them yet because there was not a need at this time. She also stated that once a precedent has been set, it is much easier for people to follow suit. Patti Crawford stated that WVSOM does not have a Research Corp.

If anyone has more questions or would like for the panel to pursue this matter, please let Hilda know.

Other Business

CCPH Conference
Chuck Conner gave a report on the CCPH Conference held in Miami.  There were nine RHEP members to attend this conference.  The title of the conference was “Partnership as a Leverage Point for Change”.  He stated this was a wonderful conference with people from around the nation talking about partnerships.  Chuck took two of his community members so they could see the level of play RHEP has at the national level.  There is not another state in the nation that has a statewide package as we do; people even ask about the TRACKER system and how they can obtain access to it.  Winding Roads Consortium is in the process of evaluating a partnership survey tool for the New York Academy of Medicine.  People across the nation look to RHEP to assist in partnership matters.

Joint Outreach/Curriculum Committee
April stated that the committee has looked at each of the recommendations from the Visions Workgroup report and assigned or referred these recommendations to particular RHEP committees. The JCOC committee has assigned or referred at least one recommendation to each RHEP committee. The Joint Curriculum/Outreach Committee would like approval to send individual recommendations to the appropriate committee and in turn, these committees will report back to the JCOC two weeks prior to the September meetings.  A cover letter will accompany the recommendations.  The document will be posted on the website.  The feedback should consist of what they have done regarding their objective or what they plan to do. The committee felt that this is a great way for the legislature to see, in one document, all the way we have been working as a partnership. This committee is asking the Advisory Panel to set this as an official referral. If the Advisory Panel agrees, the JCOC will send a memorandum to each of the committee chairs and ask them to discuss their assigned/referred recommendation(s) and report back to the JCOC. The main purpose is to have one place where everything done in RHEP is posted to the website.  A motion was made and approved to send out the referral letters to various committees (Degges/Ferrari –unanimous).

NRHA
Hilda reported that the NRHA meeting was held last week in Kansas City with 16 people attending from West Virginia.  Twelve of these people were from RHEP.  She stated that one of the groups that have been organized at the national level conducts a pre-conference to the NRHA conference.  This group is called the Rural Medical Educators Group.  This group is made up of people from all over the country involved in doing rural health training, mostly in medicine.

There were three West Virginians on the program that gave workshops.  There were actual comments about the RHEP program made at one of the keynote sessions. Hilda won a drawing for free airfare and free registration for next year’s conference in Salt Lake City, Utah.  Since Hilda’s expenses are paid, she would like to give this to a community member to attend next year’s conference.  If anyone has a suggestion on making the decision of who will get to go to Salt Lake City, please let Hilda know.  Part of the criteria in making this decision should be that this person in interested in becoming a member NRHA and representing the RHEP program at that level.

Jane Horst asked about information on the NRHA special meeting being held for the WV group on May 30th.  Hilda stated that there are 43 or 45 state with associations for rural health.  WV has one of the strongest rural conferences at the state level but does not have a state association. The Federal Office of Rural Health Policy has begun to support state associations. State associations are informed of grant activities and opportunities. We feel that we are at a disadvantage because we do not have the communication link with the federal government through a state rural health association.   The Federal Office of Rural Health Policy has seed grants of about $8000, which are given to any state that wants to form a new association.  They will do a follow-up the next year with a $10,000 grant.  The Bureau submitted a grant, received the grant and is holding an interest meeting at Jackson’s Mill on May 30th.  The Executive Director of NRHA, Steve Wilhide, will be there to give an address regarding the advantages of the state association and some of the advocacy work that the association does to benefit the state.  A luncheon will follow and an open meeting will be held to see if there is enough interest to pursue forming an association in the state.  If there is enough interest to form this association, we hope that we can annually develop a legislative and regulatory agenda for our state legislature that would include all of the items that represents a wide group of people who are rural health advocates.

Thank You
Dr. Meckstroth thanked everyone for the cards, flowers, emails and prayers.

Dennis McCutcheon thanked everyone for cards he received.

Medical Equipment
Dennis reported that on the collection of medical equipment.  Equipment is readily available and still coming in.  We need a mechanism to raise money to pay someone to head this project.  We also need to start getting this equipment distributed to those in need.  Hilda stated that we already have a grant written if anybody can identify a funding source.

A motion to adjourn was made and approved at 3:05 PM (Horst/Boni – unanimous)