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Bill would place Hospital District under microscope

STORY BY LISA ZAHNER (Week of January 4, 2024)

A Florida House of Representatives subcommittee wants voters to decide – starting in November 2026, and every 10 years after that – whether certain types of local entities like the Indian River County Hospital District and the local mosquito control district should continue to exist for another decade or be dissolved.

Florida over the years has accumulated nearly 2,000 special districts that show up on tax bills, and these entities typically go about their business with little oversight and almost no media coverage.

But about 118 of these districts – which operate independently of counties and cities, including our local hospital and mosquito control districts – could be impacted by the new legislation, which in December was approved 11-to-4 by the House Local Administration, Federal Affairs and Special Districts subcommittee.

State Rep. Robbie Brackett, a former Vero mayor and the Republican vice chair of the subcommittee, voted for the bill which has bipartisan support.  “There are a lot of these districts that have existed for a long time,” said the panel’s ranking Democrat member, Rep. Dan Daley of Coral Springs.  “Some of them do a great job, and some of them don’t.

“Folks don’t know by and large that these districts exist or don’t understand why they exist,” Daley added.  “I think it is past time to have this conversation.”

Some of the special districts – like our hospital and mosquito control districts – have substantial taxing power, and raise millions of dollars of revenue via a millage rate set by elected boards independent of the authority of any city council or county commission.

Among the issues the subcommittee focused on were the desirability of term limits for elected board members, elimination of nepotism and voting conflicts of interest, and fiscal accountability.

“I think this group has always been very sensitive to the fiduciary responsibility that we have to the taxpayers,” said Indian River Hospital District Board of Trustees Chair Marybeth Cunningham.

The mosquito control district’s job is self-explanatory, and even if that special district was shut down by voters, mosquito control tasks would presumably be absorbed by the Indian River Board of County Commissioners.

But just exactly what the Indian River County Hospital District now does is less well understood by many of those who pay the taxes.

Because the Hospital District for decades oversaw the county’s largest hospital, it is sometimes confused with the hospital itself, which is now leased and operated by Cleveland Clinic.  But since the Cleveland Clinic takeover in 2019, the Hospital District’s mission has shifted to funding 26 different agencies and projects which support the overall health and well-being of Indian River County residents from prenatal care to end-of-life care.

The hospital district collects tax dollars and gives that money out in grants to nonprofit groups which, in turn, provide various health services to the public – especially those in need, or those with no or inadequate health insurance.

To raise public awareness of what the Hospital District and its funded agencies are doing with the $13.5 million in budgeted property tax revenues this fiscal year, the district has begun a re-branding effort, which started with the adoption of a new logo at the Dec. 21 Board of Trustees meeting. Executive Director Frank Isele, who started on the job in September, said the hospital district “needs to do a better job of telling our story.”

“It’s very important that the hospital district illustrate, very clearly and objectively, what we do and what our impact looks like, how our impact is measured and the overall impact we are making on the county,” Isele said.

In his first weeks on the job, Isele visited all of the funded agencies to see firsthand who they serve and how they benefit the community with the money granted by the Hospital District. Over the coming months and years, Isele hopes to show Indian River County taxpayers the many success stories made possible through their support of the Hospital District.

Though the agencies that receive grants from the Hospital District also raise funds privately to pay for services and overhead, the fear is that much of what the agencies are able to accomplish with Hospital District funds would need to be abandoned should the district be forced to disband and liquidate its assets.

Board of Trustees member Kerry Bartlett said she wants to see more big-picture data showing that the district is making Indian River County a healthier place to live.

“I look at impact at a higher level. I don’t necessarily look at it from the funding that we give to the organizations and the impacts that they’re having – incredibly important – but it is at that higher level, those metrics that we are working together to improve the healthcare, the health of this community and so the district has got to figure out how to measure that impact, as that’s a unique value proposition that we bring to the table,” Bartlett said.

In between the every-10-year referenda in the proposed bill, every five years the taxing districts now must file comprehensive self-evaluations and financial data, to be scrutinized by Florida’s Office of Program Policy Analysis and Government Accountability (OPPAGA), which can recommend that the district be dissolved, audited further, or put on a correction course to resolve issues.

This reporting requirement was approved by the Florida Legislature in the 2023 session.