Indian River County Hospital District trustees will be giving Treasure Coast Community Health a thorough check-up this spring after a series of big, unexplained changes raised questions about the organization’s finances and leadership.  

Taxpayers are set to give TCCH $4.5 million this year through hospital district property tax assessments, and trustees have a duty to make sure that investment is sound.

With a budget of $35 million and nearly 500 employees, TCCH handled almost 100,000 medical, dental, pediatric and behavioral health visits at its six locations countywide in 2024, serving more than 28,000 unique patients.

Trustee Paul Westcott started the discussion at a hospital district meeting last week, but District Board Treasurer Michael Kint said he also had TCCH on his own list of matters needing attention.

Kint said TCCH has always been seen as a stellar organization that plays an enormous role in serving the community, so it needs to remain financially healthy and well-governed.

Beyond looking at the finances, Westcott wants to make sure TCCH is following its own board bylaws and rules as a Federally Qualified Health Center.

“I think it’s important, because organizations that don't follow their governing documents tend to not be good partners, and they also expose themselves to liability that may interfere with their ability to serve the community,” Westcott said. “They have the right to make hiring and firing decisions. I don’t want to tell them who to hire or fire – that’s not what this is about. This is about governance, and whether or not they are following their governance procedures.”

Three votes were taken outlining the district’s enhanced oversight of TCCH, with no dissenting votes.

Trustees voted to request a copy of the TCCH bylaws, plus copies of board and executive committee minutes related to the sudden and largely unexplained ouster of CEO Vicki Soule in November. Soule abruptly resigned after being told she would be suspended or placed on a leave of absence less than 60 days prior to her employment contract expiration.

Next, trustees voted to get an explanation from TCCH about why plans for Sunshine Physical Therapy to share treatment space in TCCH’s new West Health Center changed. The proposed collaboration between Sunshine and TCCH was an important component of a pitch given by TCCH to trustees that resulted in an extra $1 million capital improvement grant awarded by the hospital district.

“On the Sunshine Physical Therapy decision, I didn’t make the decision [to provide extra funds] based on the commitment to have Sunshine share space with them, but it was definitely a selling point,” Westcott said. “Had they not made it part of the ribbons and bows on the million dollars, I would be less concerned, but it was, for me it was. It was an important part of the package, and I liked it because it was a synergy.”

In the third vote, trustees asked for TCCH’s financial statements from January and February, plus a copy of a recent financial audit performed upon Soule’s exit. This type of audit following a major leadership change is a common practice. Trustees also invited TCCH Board Chair Mary Linterman to answer questions about several recent decisions at an upcoming hospital district chairman’s meeting.

On March 5, TCCH announced the upcoming closure of its Sebastian clinic. Other issues trustees may look at include former CEO Soule deferring her own salary, and the recent departure of a top finance employee at TCCH.

District Executive Director Frank Isele told the trustees that, in his experience working in various healthcare organizations, all the recent decisions made by TCCH stem from mounting financial pressures. “The decisions are money based. When you close a site and you relocate providers to a new location, they're not busy enough,” he said.

“They want to do what's best for patients, but they need to stay in business,” Isele said about clinics like TCCH that serve low-income and the uninsured.

Kint pointed out that actions taken by TCCH over the past year have had an impact on the We Care and Mental Health Court programs. Trustee Karen Deigl said that other nonprofits might come to the district asking for funds to fill in the gaps where TCCH has cut access to services, so trustees need to understand the rationale behind these moves.

While district staff waits to get the requested documents and trustees wait to hear Linterman’s explanations, district legal counsel will review the district’s funding agreements with TCCH to see what remedies the district can exercise – depending on what they find out.

The leadership of TCCH could always refuse the district’s requests, but stonewalling, or giving incomplete answers would come with some peril. The same trustees who want the details and reports are the ones who decide which organizations get funded next year.

District staffer Dawn Carbone, who audits all agencies funded by the hospital district, told trustees that TCCH’s audits and federal reviews have always come back clean, but that all the financials she’s looked at were under Soule’s 17-year leadership. TCCH appointed COO Heather Miranda as its interim head while it searches for a permanent CEO.

Due to a time lag, the 2024-25 audit that might show deteriorating finances won’t be done until next year. Financials for the five months since Soule’s departure would not normally be available until 2028. Hence, the district’s need to ask for recent financial records showing cash flow and bank balances.