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Stew Lilker’s

Columbia County Observer

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LSHA

It's Tax Time & the Lake Shore Hosp Auth Wants Your Money & is Looking for Ways to Spend It

Columbia County, FL – Thursday's last minute Lake Shore Hospital Authority Budget Workshop was a learning experience for most of the Governor appointed board and for the first time in over a decade a presentation was given which gave the Board members an idea of the budget; the Board's responsibilities; and an idea of what was on the road ahead. As for the taxpayers, the one's that keep the Authority afloat, they appear to be looking at a Governor appointed board that does not represent the population of the people it serves and higher taxes, a trend in all political subdivisions of Columbia County.

The Auditor – Financial Advisor – Accountant

Powel and Jones (Richard Powell or Powell) is the Lake Shore Hospital Authority accountant – inside/outside auditor – financial advisor (all one person). Richard Powell is the only auditor that the Authority has had in decades.


Richard Powell of Powell & Jones

Powell's lifetime multi-tasked engagement is problematic.

His 2002 extended contract expired in 2005. Its expiration was ignored by the Governor's Board.

In 2008, Powell's contract was approved by the Authority, based on a problematic clause in the expired 2002 contract. That was the last time a public record exists for the engagement of Powell.

Richard Powell also prepared the budgets up to this year, when former County Manager Dale Williams, on the retirement of the unqualified political operative and Authority Manager Jack Berry, took over the day to day management of the Authority. Dale Williams does budgets.

Mr. Williams pointed out during the Thursday meeting that almost no meaningful records of Authority expenditures were maintained and that actual expenditures for prior years are not available for the Board. This results in a Governor's Board which has almost no reliable way to judge if the projected FY 2019 budget is legitimate, honest, and reasonable.

Financial Assistance Program
Backroom Thoughts - Researching Options

Manager Williams told the Board, "I spoke to some of you. You want to make sure the financial assistance program is doing everything it can do and needs to do in the community. There's a ton of ideas."

The Attorney General has found in opinions going back over 40 years that the Sunshine Law applies to meetings between a board member and an individual who is not a board member when that individual is being used as a liaison between, or to conduct a de facto meeting of board members. "Staff should refrain from polling board members on specific issues which will come before the board for consideration."

Additionally, the courts have found, "Every thought, as well as every affirmation act, of a public official as it relates to and is within the scope of his official duties, is a matter of public concern; and it is the entire decision-making process that the legislature intended to affect by the enactment of the statute before us [Sunshine Law]... Every step in the decision-making process, including the decision itself, is a necessary preliminary to formal action. It follows that each such step constitutes an 'official act,' an indispensable requisite to 'formal action.' within the meaning of the act."

"It is also how and why the officials decided to so act which interests the public.... the legislature could only have meant to include the acts of deliberation, discussion and deciding occurring prior and leading up to the affirmative 'formal action' which renders official the final decisions of the governing bodies."

The public had a clear right to know the thoughts and ideas of those speaking with Manager Williams in the shadows of the back room. The "ton of ideas" from the Governor's Board members which led Manager Williams to say, "What I'm trying to do now is look across the county at similar programs and I'm trying to find what they do. I don't think we need to reinvent the wheel. I think we need to look outside the box."

Indigent Care Assistance


The Board listens to Dale Williams. Much of the Berry Board has been replaced by Columbia County's young white Turks, the up and comers of the Republican Party.

Years ago the Authority had over a thousand individuals receiving indigent care assistance.

In May 2015, with Authority clients plummeting to 176, client visits to the behemoth Authority headquarters dropped to an average of 1.4 visits a day.

Things were so dismal that Authority Manager Berry refused to provide the number of clients and client visits during board meetings, thus keeping them out of the minutes and the public eye.

The 2009 Affordable Care Act, or Obama Care, forced many in the indigent population to obtain health insurance or qualify for Medicaid, taking the load off the backs of the taxpayers of Columbia County. The Authority client load declined to a reported 138 in December 2016.

Board members were beside themselves as the Authority was morphing into a vestigial organ. Things were so slow that the full time Manager Berry could barely be found at the Authority.

The pie in the sky plans in some of the Board member's heads to turn the downtown location of Shands at Lake Shore into a regional medical metropolis was going nowhere and sinking fast.

All Manager Berry and the Board could muster was a name change to Shands Regional Medical Center and three monstrous sign-scapes on Lake City's main drag which look like entrances to a seedy motel, or worse. Only the pink flamingos and the girls are missing.

Dr. Mark Thompson
He wants to raise taxes; spend more

Dr. Mark Thompson was recently appointed to the Authority Board after his associate, Dr. Waseem Khan, was forced to resign because he didn't meet the residency requirements to be a board member.

Dr. Thompson wants to increase the indigent care load on Columbia County taxpayers and at the same time subsidize Community Health Systems (CHS), the private NY stock exchange listed hospital conglomerate that leases the hospital.

On Thursday evening he told the Board, "I don't want any of us to be under the illusion that we are meeting our obligation to take care of the indigent of this county. I'm actually in favor of increasing the millage -- I think we should be at, at least 1.5 (mils), if not more."

1.5 mils equal approximately $3.5 million. Presently, Shands (CHS) is spending about half of that on indigent care on Columbia County residents.

"We are basically taking care of those patients who happen to come here voluntarily to fill out a card and be part of the Authority health care system. That is like 12-15% of the patients that are being taken care of at the hospital that are indigent. We're going to have to discuss that at future meetings."

Board member Thompson continued, "I talked to some people. We did talk about renegotiating the lease. I think within that conversation you look at a block grant to take care of indigent care. It's not necessarily per piece (sic) of anybody who signs up. But they have I'm sure historical data of how much indigent care they take care of, of Columbia County residents every year. Then there is a lease to negotiate. I think we negotiate a block grant to take care of those patients, rather than just any individual. How do we make all these people sign up? The point is you can't make people sign up."

Veteran Manager Dale Williams told Dr. Thompson, "The Auditor General's Opinion might be an obstacle to that."

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