Russell County Hospital CEO David Rasmussen told the local hospital board they may need to take a step back from the hospital's proposed building project, saying there has been "no change" within the past month or so in the proposed 40,000 sq. ft expansion and renovation at July's meeting of the hospital's board of directors.

"I think we may need to make it into smaller chunks," Rasmussen said of the proposed expansion at the hospital. "I think the overall project is great but the way it is laid out it is like a five pound hamburger that we have to eat. We need to look at it in smaller chunks and stage it or break it into modules."

Rasmussen said he and the board would need to sit down with The Estopinal Group, the hospital's architects, and talk with them about scaling back on the project, which currently sits at $24 million. Rasmussen said he would like to see that number shrink back to a more manageable figure.

"I don't think we ever had any visions like that," said Jeff Buckley, a vice president with Alliant. "We need to hold the architects to the fire and talk about this and ask what's happened."

Rasmussen presented the board with several financing options and presented examples of how much long term fees, interest rates and debt service would be under Morgan Keegan, Ross Sinclaire and FHA 242.

The hospital has applied to the USDA for a loan of $21 million but funding in the fiscal year's budget is not available for such a project at this time so the board is looking at other ways to fund the project.

The board also has the option to lower the funding request to a level that can be approved under the current and anticipated budget constraints. The USDA application and the feasibility study should be revised and submitted no later than the week of August 1. It is expected board representatives will meet with the architects again before then to hopefully scale back the project's expense before resubmitting anything to the USDA's community facility direct loan and guarantee program.

In other happenings at the meeting:

o Marion Environmental Inc. will begin the extraction of an old underground fuel storage tanks from the hospital grounds on August 15, according to Rasmussen. The tank was formerly used for storage of heating oil or diesel fuel.

o Rasmussen told the board a nurse practitioner had joined the hospital's "Hospitalist" program but did not disclose the name until they actually begin work at the hospital in early September. A hospitalist is a specialist doctor who will see all patients in house as well as the Emergency Department. Rasmussen said Dr. Samuel Bradley had also joined the program over the summer.

o The board heard a presentation on the 340B program, a pharmacy drug purchasing program that limits the cost of covered outpatient drugs to certain federal grantees, federally-qualified health center look-alikes and qualified hospitals. Participation in the program results in significant savings estimated to be 20 percent to 50 percent on the cost of pharmaceuticals for safety-net providers. The purpose of the 340B Program is to enable these entities to stretch scarce federal resources, reaching more eligible patients and providing more comprehensive services.

The board voted to send all local pharmacies letters to see whether or not they would be interested in participating in the program, which could lead to thousands of dollars in savings for the hospital alone and just came to be for critical access hospitals like Russell County. Pharmacies would also receive benefits for participating.

o The board voted to transfer around $1,600 in donations made in honor of the late Kenneth Bernard to the hospital's building fund to the Russell County Hospital Foundation, a non-profit organization, who will keep the funding in a designated account until it is needed for its purpose by the hospital.

o CFO Ken Kimsal gave the financial report, saying the hospital had a rather low month at about 12 percent below budget for the month of June. Kimsal did say the hospital was set to receive about $450,000 back from Medicare, up from $150,000 in November.

"We ended up the year about $864,000 below budget in expense," Kimsal said. He said the hospital, for the year to date, ended up with about $252,000 in operating income with the net income for the month being nearly $234,000.

"Net income for the year was $1,415,170," he said.  Total liabilities and net assets for the year to date is $15,837,071, according to Kimsal, with total current assets being just over $8 million.

o The board voted to purchase a refurbished shelving unit from CBG for $15,000. The shelving unit has 1,127 linear feet on three tracks and will house hospital records in the Rehabilitation Center on US 127.