MANATEE -- At first glance, there are many similarities between Manatee County Rural Health Services and Florida Community Health Centers.
Both are federally qualified, not-for-profit health centers. Each provides medical services to uninsured and underserved people over a large area in Florida -- Community Health in six counties, Rural Health in three. And both receive millions of dollars in state and federal funding.
But theres at least one key difference between them: Community Healths board meetings are open to the public; Rural Healths are not.
Rural Health has refused to open its meetings, saying board members discuss patient matters that are protected by federal privacy laws. Its not in the communitys best interest to hold open meetings, one of the agencys attorneys said.
But other agencies contacted by the Bradenton Herald say their boards can meet in front of the public because they dont discuss such matters.
They, as well as some non-profit governance experts, say boards shouldnt be discussing those patient matters in the first place. One expert said he found it odd that Rural Health cited patient privacy concerns as a reason for meeting behind closed doors.
Rural Health officials have denied the Heralds request to allow a reporter to attend their board meetings, first made in September after the newspaper reported on conflicts of interest within the agency. The request was made to Rural Healths chief executive officer, Walter Mickey Presha Sr., who also would not disclose the meeting time or location.
The agency since has repeatedly denied the newspapers requests, arguing it is not subject to the states open meetings law because it is a private organization. Instead, Rural Health began releasing information about its board meetings through Tom Nolan, a Bradenton political consultant hired in October to be its media liaison.
Rural Health is not legally obligated to open its board meetings under Florida statutes and recently made a policy decision that its not in the communitys best interest to do so, said Jonathan Fleece, a Bradenton attorney for the agency.
Fleece, a certified health care attorney, said none of the hundreds of health care organizations in Florida he represents have open meetings for that reason. Those that do meet in public sessions, such as Sarasota Memorial Hospital, must because they are part of a governmental entity covered by the open meetings law, he said.
Fleece also said Rural Healths meeting location -- a conference room in its 1312 Manatee Ave. E. facility -- and subject matter also raise patient privacy concerns.
There are patients right outside the conference room where the meeting is, he said. Theres a pharmacy right outside the door. This is not a big corporation with a fancy board room.
The agency keeps minutes of those meetings, but does not release them outside of the organization, Nolan said.
I was told that releasing them would be like opening the meetings, he said.
Individual cases off-limits
Most non-profits close their board meetings, according to Dr. Roy Poses, a Brown University medical professor, medical issues blogger and president of the Foundation for Integrity and Responsibility in Medicine.
But the argument that the entire meeting should be closed because patient issues might be discussed isnt very convincing, he said.
Boards can openly discuss patient matters in a way that does not reveal information that identifies or could be used to identify an individual patient, which is prohibited by federal law, Poses said. That includes holding executive sessions to discuss confidential issues and only talking about large groups of patients during the open-meeting portions.
The burden should be on them why it (the meeting) should be confidential, or if one little piece might be confidential, why should the whole meeting be? he said, noting that his opinions do not necessarily reflect those of Brown University.
Poses also said discussions of individual patient issues should almost never come up at a board meeting anyway. It would be acceptable only under extraordinary circumstances or litigation, he said.
Outi Flynn, director of knowledge dissemination at BoardSource -- a Washington, D.C.-based resource and governance organization for non-profits -- echoed him.
Should the board discuss individual cases? Normally that is not the process, she wrote in an e-mail. You have staff that is bound by HIPAA rules and patient records are confidential. There may be situations where the board needs to be involved but that depends on facts and circumstances. In any case, no patient issues can be discussed in an open meeting.
Agencies split on issue
A Herald survey of federally qualified health centers in Florida found them split on the open-meeting issue.
Of the eight agencies the Herald was able to obtain information from, four said their meetings are open and four said they are not. Another 18 agencies did not return multiple telephone calls last week.
At Community Health, based in West Palm Beach, the public can just show up at board meetings, said Molly Ferguson, its director of program development.
If they want to address the board, we ask that they receive permission first, she said. We do that so we can get through our agenda.
She acknowledged board meetings have drawn scant public interest, partly because theyre held at its administrative office in West Palm Beach -- 45 minutes away from the agencys closest medical facility. Its facilities are in Clewiston, Indiantown, Okeechobee, Fort Pierce, Port St. Lucie and Pahokee.
At the other end of the meeting spectrum, Camillus Health closes its meetings because it is a private organization, said Sam Gil, its vice president of marketing and communications.
No one from the general public has asked in recent years to attend the Miami agencys meetings, he said. But it makes board minutes available afterward like other agencies with closed meetings, Gil said.
An official with a trade group representing Floridas 44 community health centers said the diversity reflects the autonomous and local nature of the agencies.
These are boards made up of the community, said Andrew Behrman, president and chief executive of the Florida Association Of Community Health Centers. They have the right like any other corporation to decide on their own what their operating policies are.